Sample records for transitional case management
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NASA Astrophysics Data System (ADS)
Treuer, Galen; Koebele, Elizabeth; Deslatte, Aaron; Ernst, Kathleen; Garcia, Margaret; Manago, Kim
2017-01-01
Although the water management sector is often characterized as resistant to risk and change, urban areas across the United States are increasingly interested in creating opportunities to transition toward more sustainable water management practices. These transitions are complex and difficult to predict - the product of water managers acting in response to numerous biophysical, regulatory, political, and financial factors within institutional constraints. Gaining a better understanding of how these transitions occur is crucial for continuing to improve water management. This paper presents a replicable methodology for analyzing how urban water utilities transition toward sustainability. The method combines standardized quantitative measures of variables that influence transitions with contextual qualitative information about a utility's unique decision making context to produce structured, data-driven narratives. Data-narratives document the broader context, the utility's pretransition history, key events during an accelerated period of change, and the consequences of transition. Eventually, these narratives should be compared across cases to develop empirically-testable hypotheses about the drivers of and barriers to utility-level urban water management transition. The methodology is illustrated through the case of the Miami-Dade Water and Sewer Department (WASD) in Miami-Dade County, Florida, and its transition toward more sustainable water management in the 2000s, during which per capita water use declined, conservation measures were enacted, water rates increased, and climate adaptive planning became the new norm.
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Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative.
Bennett, Sara; Rodriguez, Daniela; Ozawa, Sachiko; Singh, Kriti; Bohren, Meghan; Chhabra, Vibha; Singh, Suneeta
2015-06-13
During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition. We conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later. Considerable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of "transition manager" at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition. In the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of transition by both donor and government; detailed transition planning and close attention to program alignment, capacity development and communication; engagement of staff in the transition process; engagement of multiple stakeholders post transition to promote program accountability and provide financial support; signaling by actors in charge of transition that they were committed to specified time frames.
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Role transition from caregiver to case manager--Part II.
Schmitt, Nancy
2006-01-01
This two-part article explores the process of role transition as it pertains to nurses moving from roles of caregivers to roles of case managers. Part 1 of the article presented a theoretical model that demonstrated the interplay of significant factors in the process of role transition and discussed how this model could be used to examine nurses' experience of this transition. Part 2 presents findings from a qualitative study involving interview and focus group data contributed by nurses who have made the transition from caregiver to case manager. Data point to specific tensions experienced by these nurses, which are associated with time-task orientation, interactions and relationships, business culture and objectives, and self-image and professional identity. Recommendations for preparing and supporting nurses through this role are also offered.
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O'Donnell, Lolita T
2007-01-01
To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.
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Case management redesign in an urban facility.
Almaden, Stefany; Freshman, Brenda; Quaye, Beverly
2011-01-01
To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.
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Understanding Transitions Toward Sustainable Urban Water Management: Miami, Las Vegas, Los Angeles
NASA Astrophysics Data System (ADS)
Garcia, M. E.; Manago, K. F.; Treuer, G.; Deslatte, A.; Koebele, E.; Ernst, K.
2016-12-01
Cities in the United States face numerous threats to their long-term water supplies including preserving ecosystems, competing uses, and climate change. Yet, it is unclear why only some cities have transitioned toward more sustainable water management. These transitions include strategies such as water conservation, water supply portfolio diversification, long-term planning, and integrated resource management. While the circumstances that motivate or moderate transition may vary greatly across cities' physical and institutional contexts, identifying common factors associated with transition can help resource managers capitalize on windows of opportunity for change. To begin the process of identifying such factors, we ask two questions: 1) what combinations of conditions are associated with water management transitions?, and 2) what are the outcomes of these transitions? We examine three cases of utility-level water management in Miami, Las Vegas, and Los Angeles to create data-driven narratives detailing each city's transition. These narratives systematically synthesize multiple data sources to enable cross-case comparison and provide insights into how and why cities transition. Using the foundational concepts from the exposure-based theory of urban change, we focus our analysis on three broad categories of variables that influence urban water management transition: biophysical, political, and regulatory exposures. First, we compare these factors across time and across cities using metrics that standardize diverse data sources. Next, we incorporate qualitative factors that capture a city's unique conditions by integrating these metrics with salient contextual information. Then, through cross-city comparison, we identify factors associated with transition.
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Transition from Clinical Manager to University Lecturer: A Self-Reflective Case Study
ERIC Educational Resources Information Center
Oldland, Elizabeth
2011-01-01
This paper is a case study exploring the author's use of reflective practice to facilitate the transition in role from a clinical manager with teaching responsibilities in a critical care unit to university lecturer. The similarities and differences in the roles with respect to learner characteristics, teaching contexts and effective teaching…
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O'Donnell, Lolita T
2007-01-01
The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.
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Using the "Seven A's" assessment tool for developing competency in case management.
Gallagher, Louise P; Truglio-Londrigan, Marie
2004-01-01
In the latter part of the 20th century, healthcare reform sparked a transition in the nursing curriculum from acute care to primary and secondary care. Faculty responded to this challenge by redesigning curricula in creative ways. The transitional curriculum introduced community clinical experiences designed to challenge students to practice in diverse, nontraditional sites and in more independent ways. Such practice requires the nurse to function as designer, coordinator, and manager of patient care in addition to the traditional provider role. Additionally, the transitional curricula emphasized the roles of communicator, educator, facilitator, listener, and advocate to a greater degree. For students to achieve competence in the above roles, the curriculum must include learning activities that allow them to practice as case managers in the community. This paper presents the "Seven A's" as a framework for students to gain an understanding of and engage in the role and process of case management in the community.
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Hughes, Anne K; Woodward, Amanda T; Fritz, Michele C; Reeves, Mathew J
2018-02-01
Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.
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Bankston White, Cheri; Birmingham, Jackie
2015-01-01
Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. This is Part 2 of a two-part article written for case management directors, particularly new ones. Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes. This article attempts to answer the following questions: Are case management directors prepared for an expanded role that affects departments and organizations outside of their own?How does a case management director manage the transition of care of patients while managing required relationships outside the department?How does the director manage program outcomes in such a complex department? Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Findings/Conclusions: Part 1 found that case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. Implications for Case Management: A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the directors who are drawn from clinical case management or other leadership positions and thrust into this role are prepared to navigate within the organization, much less across the whole spectrum of payer, provider, and monitoring organizations. Yet the external focus of the director's role continues to grow in importance as the health care industry evolves and more focus is placed on population management and relationships with payers and community providers. PMID:25700135
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Case management directors: how to manage in a transition-focused world: part 1.
Bankston-White, Cheri; Birmingham, Jackie
2015-01-01
Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role.We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time.To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay current as the regulatory environment continues to change. Providing a list of functions for which they are responsible, practical strategies for carrying them out, and places to go for help and information can help hospital case management directors operate with the confidence and knowledge they need to influence the quality and safety of patient care for the entire care team and to provide the best possible interactions with patients and family members.
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Bell, Stephen W; Parry, B; Neill, M
2003-08-01
This article reports the seventh known case of adenocarcinoma arising in or adjacent to an ileal pouch after proctocolectomy for ulcerative colitis. It is the second reported case of adenocarcinoma in the anal transitional zone in this setting. A literature review is presented of the six previous cases published, and on the wider subject of how to best manage the anal transitional zone. It is concluded that this is a rare, but catastrophic, event with a potentially poor prognosis and can occur late (more than a decade) after the original surgery. All ileal pouches performed for ulcerative colitis should be followed for extended periods. The development of dysplasia necessitates close follow-up, including regular biopsies, and local excision and pouch advancement can manage persistent dysplasia. When operating for dysplasia or cancer, biopsies of the anal transitional zone should be performed or consideration given to mandatory mucosectomy.
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Case management directors: how to manage in a transition-focused world: part 2.
Bankston White, Cheri; Birmingham, Jackie
2015-01-01
Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the directors who are drawn from clinical case management or other leadership positions and thrust into this role are prepared to navigate within the organization, much less across the whole spectrum of payer, provider, and monitoring organizations. Yet the external focus of the director's role continues to grow in importance as the health care industry evolves and more focus is placed on population management and relationships with payers and community providers.
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Integrated corridor management transit vehicle real-time data demonstration: Dallas case study
DOT National Transportation Integrated Search
2014-12-01
As part of the U.S. Department of Transportations Integrated Corridor Management (ICM) Initiative, Dallas Area Rapid Transit (DART) purchased new automatic passenger counter (APC) technology for its Red and Orange line light rail vehicles to provi...
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Granata, Randy L; Hamilton, Karen
2015-01-01
Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.
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Baldwin, Kathleen M; Black, Denice; Hammond, Sheri
2014-01-01
This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.
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Bowker, Matthew A.; Miller, Mark E.; Garman, Steven L.; Belote, Travis; Guntenspergen, Glenn R.
2014-01-01
Ecosystems may occupy functionally distinct alternative states, some of which are more or less desirable from a management standpoint. Transitions from state to state are usually associated with a particular trigger or sequence of triggers, such as the addition or subtraction of a disturbance. Transitions are often not linear, rather it is common to see an abrupt transition come about even though the trigger increases only incrementally; these are examples of threshold behaviors. An ideal monitoring program, such as the National Park Service’s Inventory and Monitoring Program, would quantify triggers, and be able to inform managers when measurements of a trigger are approaching a threshold so that management action can avoid an unwanted state transition. Unfortunately, both triggers and the threshold points at which state transitions occur are generally only partially known. Using case studies, we advance a general procedure to help identify triggers and estimate where threshold dynamics may occur. Our procedure is as follows: (1) Operationally define the ecosystem type being considered; we suggest that the ecological site concept of the Natural Resource Conservation Service is a useful system, (2) Using all available a priori knowledge to develop a state-and-transition model (STM), which defines possible ecosystem states, plausible transitions among them and likely triggers, (3) Validate the STM by verifying the existence of its states to the greatest degree possible, (4) Use the STM model to identify transitions and triggers likely to be detectable by a monitoring program, and estimate to the greatest degree possible the value of a measurable indicator of a trigger at the point that a state transition is imminent (tipping point), and values that may indicate when management intervention should be considered (assessment points). We illustrate two different methods for attaining these goals using a data-rich case study in Canyonlands National Park, and a data-poor case study in Wupatki National Monument. In the data-rich case, STMs are validated and revised, and tipping and assessment points are estimated using statistical analysis of data. In the data-poor case, we develop an iterative expert opinion survey approach to validate the degree of confidence in an STM, revise the model, identify lack of confidence in specific model components, and create reasonable first approximations of tipping and assessment points, which can later be refined when more data are available. Our goal should be to develop the best set of models possible given the level of information available to support decisions, which is often not much. The approach presented here offers a flexible means of achieving this goal, and determining specific research areas in need of study.
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Transition Management and Social Innovation in Rural Areas: Lessons from Social Farming
ERIC Educational Resources Information Center
Di Iacovo, Francesco; Moruzzo, Roberta; Rossignoli, Cristiano; Scarpellini, Paola
2014-01-01
Purpose: The article reflects on transition management in rural areas and the possible implications for extension services able to support social innovation and rural change, starting from experiences on social farming in different areas of Italy. Design/methodology/approach: By presenting three case studies we investigate the role of social…
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Collaboration of hospital case managers and home care liaisons when transitioning patients.
Kelly, Margaret M; Penney, Erika D
2011-01-01
Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices, and different levels of experience and training. Consensus regarding the implementation of the hospital's guidelines was achieved through a series of discussions within the workgroup in developing practice guidelines. Multiple revisions and secondary reviews by colleagues and directors took place before the guidelines were accepted and implemented. Recommendations for improving collaboration with liaisons included (1) taking time to become familiar with one another's practices and backgrounds; (2) ensuring clear discussions of roles, responsibilities, and expectations with liaisons related to individual cases and organizational requirements and limitations; (3) providing time and forums for ongoing communication and follow-up; and (4) recognizing that responsibility for certain aspects of the discharge planning process may be shared but that the case manager, in partnership with the multidisciplinary team, is ultimately accountable for the effectiveness and outcomes of the discharge plan.
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Bankston-White, Cheri; Birmingham, Jackie
2015-01-01
Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role. We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Findings/Conclusions: Case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. Implications for Case Management: As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time. To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay current as the regulatory environment continues to change. Providing a list of functions for which they are responsible, practical strategies for carrying them out, and places to go for help and information can help hospital case management directors operate with the confidence and knowledge they need to influence the quality and safety of patient care for the entire care team and to provide the best possible interactions with patients and family members. PMID:25629731
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Jacobs, Bart; Thomé, Jean-Marc; Overtoom, Rob; Sam, Sam Oeun; Indermühle, Lorenz; Price, Neil
2010-05-01
Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study period-notably the development of performance indicators and targets and the performance monitoring.
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ERIC Educational Resources Information Center
Sanga, Mapopa William
2016-01-01
This case study investigated the process 119 faculty members underwent as they transitioned from using Desire to Learn (D2L) learning management system (LMS), to using Canvas LMS. Other than analyzing technological issues faculty members encountered while navigating various aspects of the Canvas interface, the study also analyzed technological…
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Assessment of DoD Wounded Warrior Matters -- Fort Riley
2013-08-06
staffing levels, including squad leaders and Nurse Case Managers, are appropriate to meet the mission for effective management and support of Soldiers...military staff; physicians; nurses ; behavioral health specialists, such as psychologists and social workers; occupational therapists, including...primary mission – to heal and transition. The “Triad of Care” consists of a squad leader, a nurse case manager (NCM), and a primary care manager
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CM experts: hospitals need ED case managers now more than ever.
2012-10-01
It's no longer a luxury for hospitals to have case managers in their emergency departments, according to some case management experts--it's a necessity to make sure patients are admitted in the proper status and to ensure that those being discharged from the emergency department have what they need to manage their conditions. Hospitals need to ensure that patients meet medical necessity criteria to avoid losing reimbursement. Case managers can help provide a smooth transition from the emergency department back to the community and connect patients with post-discharge services. Case managers can work with patients who frequently utilize the emergency department and educate them about more appropriate venues of care.
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The development of an acute care case manager orientation.
Strzelecki, S; Brobst, R
1997-01-01
The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.
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Deployment of lean six sigma in care coordination: an improved discharge process.
Breslin, Susan Ellen; Hamilton, Karen Marie; Paynter, Jacquelyn
2014-01-01
This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..
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A national study of transitional hospital services in mental health.
Dorwart, R A; Hoover, C W
1994-01-01
OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. PMID:8059877
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Transitioning from Marketing-Oriented Design to User-Oriented Design: A Case Study
ERIC Educational Resources Information Center
Laster, Shari; Stitz, Tammy; Bove, Frank J.; Wise, Casey
2011-01-01
The transition to a new architecture and design for an academic library Web site does not always proceed smoothly. In this case study, a library at a large research university hired an outside Web development contractor to create a new architecture and design for the university's Web site using dotCMS, an open-source content management system. The…
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Land management in the American southwest: a state-and-transition approach to ecosystem complexity.
Bestelmeyer, Brandon T; Herrick, Jeffrey E; Brown, Joel R; Trujillo, David A; Havstad, Kris M
2004-07-01
State-and-transition models are increasingly being used to guide rangeland management. These models provide a relatively simple, management-oriented way to classify land condition (state) and to describe the factors that might cause a shift to another state (a transition). There are many formulations of state-and-transition models in the literature. The version we endorse does not adhere to any particular generalities about ecosystem dynamics, but it includes consideration of several kinds of dynamics and management response to them. In contrast to previous uses of state-and-transition models, we propose that models can, at present, be most effectively used to specify and qualitatively compare the relative benefits and potential risks of different management actions (e.g., fire and grazing) and other factors (e.g., invasive species and climate change) on specified areas of land. High spatial and temporal variability and complex interactions preclude the meaningful use of general quantitative models. Forecasts can be made on a case-by-case basis by interpreting qualitative and quantitative indicators, historical data, and spatially structured monitoring data based on conceptual models. We illustrate how science- based conceptual models are created using several rangeland examples that vary in complexity. In doing so, we illustrate the implications of designating plant communities and states in models, accounting for varying scales of pattern in vegetation and soils, interpreting the presence of plant communities on different soils and dealing with our uncertainty about how those communities were assembled and how they will change in the future. We conclude with observations about how models have helped to improve management decision-making.
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From waste to sustainable materials management: Three case studies of the transition journey.
Silva, Angie; Rosano, Michele; Stocker, Laura; Gorissen, Leen
2017-03-01
Waste policy is increasingly moving on from the 'prevention of waste' to a 'sustainable materials policy' focused agenda recognising individual wastes as a resource. In order to comparatively analyse policy developments in enhanced waste management, three case studies were selected; San Francisco's Zero Waste Program, Flanders's Sustainable Materials Management Initiative and Japan's Sound Material-Cycle Society Plan. These case studies were chosen as an opportunity to investigate the variety of leading approaches, governance structures, and enhanced waste policy outcomes, emerging globally. This paper concludes that the current transitional state of waste management across the world, is only in the first leg of the journey towards Circular Economy closed loop production models of waste as a resource material. It is suggested that further development in government policy, planning and behaviour change is required. A focus on material policy and incorporating multiple front runners across industry and knowledge institutions are offered as potential directions in the movement away from end-pipe land-fill solutions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Nurse case management: negotiating care together within a developing relationship.
Yamashita, Mineko; Forchuk, Cheryl; Mound, Bronwyn
2005-01-01
TOPIC/PROBLEM: The purpose of this study was to explicate the process of nurse case management involving clients afflicted with chronic mental illness. Grounded theory was the method of choice. Interviews were conducted with nurses in inpatient, transitional, and community settings in four cities in southern Ontario, Canada. Negotiating care together within a developing relationship emerged as the basic social process. "Building a trusting relationship" was identified as the foundation of case management. Salient differences were found between the three settings, yet the basic social process was consistent across settings. This underscores the therapeutic relationship as the basis for nurse psychiatric case management.
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NASA Astrophysics Data System (ADS)
Sholihah, Mar'atus; Anityasari, Maria; Maftuhah, Diesta Iva
2017-06-01
The rapidly growing urban population, the increasing impact of climate change, and the constantly decreasing availability of the good quality water become the major triggers that force urban water professionals to continuously focus on sustainable urban water management (SUWM). The city as a focal point of population growth in the world has become a critical object for its resiliency, not only in terms of the environmental deterioration but also of the water supplies security. As a response to the current condition, the framework of urban water management transition has been introduced as a sort of transformation for a city to achieve SUWM. Water Sensitive City (WSC) is the ultimate goal of this framework which integrates water access and supply security, public health protection, flood prevention, environmental protection and livability, and economic sustainability. Recently, the urban water management transition and WSC concept are going to be implemented in some cities in Indonesia, including Surabaya. However, in addition to provide a wide range of benefits, the implementation of WSC also brings challenges. In terms of geographical and social aspect, public policy, and the citizen behavior, the cities in Indonesia are undoubtedly different with those in Australian where the concept was developed. Hence, assessing the suitability of urban water management transition in the Indonesian context can be perceived as the most important phase in this whole plan. A case study of Surabaya would be identified as a baseline to measure whether the proposed sequence of urban water management transition is suitable for Indonesian local context. The research aimed to assess the suitability of the framework to be implemented in Indonesia and to propose the modified framework which is more suitable for local context in Indonesia.
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DOT National Transportation Integrated Search
2010-02-01
Transit Operations Decision Support Systems (TODSS) are systems designed to support dispatchers and others in real-time operations : management in response to incidents, special events, and other changing conditions. As part of a joint Federal Transi...
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Case Management of Young Children with Behaviour and Mental Health Disorders in School
ERIC Educational Resources Information Center
Browne, Graeme; Cashin, Andrew; Graham, Iain
2012-01-01
When young children with behaviour and mental health disorders do not receive appropriate specialised support their problems can escalate over time. Their parents find the transition to and early years of schooling stressful and difficult. This paper argues that case management can be an effective strategy for this group of children. Although…
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The "wins" of change: evaluating the impact of predicted changes on case management practice.
Stanton, Marietta P; Barnett Lammon, Carol Ann
2008-01-01
A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.
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DOT National Transportation Integrated Search
2011-03-01
In late 2008, New Orleans Regional Transit Authority (RTA) began to execute a delegated management contract with a multinational private firm, in order to not only increase efficiency and effectiveness in operation and maintenance of public tra...
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LMS Transitioning to "Moodle": A Surprising Case of Successful, Emergent Change Management
ERIC Educational Resources Information Center
Lawler, Alan
2011-01-01
During 2009-10 the University of Ballarat implemented the open-source learning management system (LMS) "Moodle" alongside its existing legacy LMS, "Blackboard". While previous IT implementations have been troublesome at the university, notably the student information and finance management systems in 2008-09, the…
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Management of Hypothalamic Obesity during Transition from Childhood to Adulthood.
Bretault, Marion; Carette, Claire; Barsamian, Charles; Czernichow, Sébastien
2018-01-01
Hypothalamic obesity (HO) is a rare and serious disease of various origins: tumor, traumatism, radiotherapy, vascular, genetic, or even psychotropic drug use. HO usually begins in childhood with eating disorders and progresses with an aggregate of severe comorbidities. Transition from pediatric to adult health care is a critical period to assure weight stability and a good management of comorbidities. In case of loss to follow-up, there is an increased risk of major weight gain and long-term complications with severe obesity. To minimize this risk, pediatric and adult specialists must work together to prepare, supervise, and monitor transition. Transition ideally involves the patient, parents, and care providers with a good communication between pediatric and adult teams from expert centers. Maintaining a diet and physical activity management plan, acquisition of autonomy for hormone replacement therapy and management of psychosocial consequences of obesity are fundamental issues in patients with HO. Patient associations and specialized diet center weight loss programs can help as well as group approaches. © 2018 S. Karger AG, Basel.
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Cross-continuum Care Continuity: Achieving Seamless Care and Managing Comorbidities.
Boston-Fleischhauer, Carol; Rose, Robert; Hartwig, Laurie
As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.
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The role of rural nurse managers in supporting new graduate nurses in rural practice.
Lea, Jackie; Cruickshank, Mary
2017-04-01
To investigate the nature and timing of support available to new graduate nurses within a rural transition to practice programme. For new graduates in rural practice successful transition is complicated by the unique role of the rural nurse, staff ratios and resources within rural environments. Little is known about the support needs of graduates working in rural health services, or who is best placed to provide support during their transition. This was a qualitative case study, using individual interviews with new graduate nurses at 3, 6 and 9 months milestones during a 12-month rural transition to practice programme plus interviews with experienced rural nurses who were employed in rural health agencies where the new graduate nurses were employed. Graduates in rural health services rely on nurse unit managers and nurse managers for feedback, support and debriefing, provision of emotional support, advocacy, openness, encouragement and protection from organisational requests and demands during the transition to rural nursing practice. Nurse managers play an important role in rural health services in the provision of support for new graduate nurses. As clinical leaders rural nurse managers and nurse unit managers, have an important role in facilitating the successful entry and retention of new graduate nurses into the rural nursing workforce. © 2016 John Wiley & Sons Ltd.
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Post-Soviet transition: improving health services delivery and management.
Antoun, Joseph; Phillips, Frank; Johnson, Tricia
2011-01-01
During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new public management principles. © 2011 Mount Sinai School of Medicine.
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ERIC Educational Resources Information Center
Ellis, Gary D.
2014-01-01
This paper is a case study. It tells the story of the process that the Council on Accreditation for Parks, Recreation, Tourism and Related Professions beta test site created its learning outcomes assessment program. A planning process was used that has evolved from quality management philosophy and practice: DMADV. Use of DMADV required precise…
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Improving publicly funded substance abuse treatment: the value of case management.
Shwartz, M; Baker, G; Mulvey, K P; Plough, A
1997-01-01
OBJECTIVES: This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system. METHODS: A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long-term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics. RESULTS: The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients. CONCLUSIONS: Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs. PMID:9357349
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-09-28
.... SUPPLEMENTARY INFORMATION: The Task Force is a non-discretionary Federal advisory committee established to (a... for wounded, ill, and injured members of the Armed Forces; ii. Medical case management; iii. Non... Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Member of...
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Case management needs of older and elderly cancer survivors.
Stanton, Marietta; Franco, Gina; Scoggins, Reggie
2012-01-01
The purpose of this study was to examine the case management needs of older and elderly adults. The specific aim was to describe the results of a survey distributed to cancer survivors, asking them to respond to questions about their specific needs. The survey targeted the physical, psychosocial, social, and spiritual needs. Outpatient setting, outreach program. Fatigue, fear of reoccurrence, and sleep disturbances were of the greatest concern to the older and elderly cancer survivor. Case managers dealing with elderly cancer survivors can target these needs in terms of transitions from inpatient to outpatient care and beyond into the survivorship period.
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On-boarding the Middle Manager.
OʼConnor, Mary
The trend of promoting clinical experts into management roles continues. New middle managers need a transitional plan that includes support, mentoring, and direction from senior leaders, including the chief nursing officer (CNO). This case study demonstrates how the CNO of one organization collaborated with a faculty member colleague to develop and implement a yearlong personalized on-boarding program for a group of new nurse middle managers.
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ERIC Educational Resources Information Center
Ashburner, Jill K.; Bobir, Natasha I.; van Dooren, Kate
2018-01-01
After leaving school, young people with autism spectrum disorder often struggle with social, educational and employment participation. A post-school transition programme underpinned by individualised case management, where mentees are guided to complete self-selected projects by mentors with multimedia skills, was evaluated using a qualitative…
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Improving the Transition Outcomes of Low-Income Minority Youth with Disabilities
ERIC Educational Resources Information Center
Balcazar, Fabricio E.; Taylor-Ritzler, Tina; Dimpfl, Shawn; Portillo-Pena, Nelson; Guzman, Alberto; Schiff, Rachel; Murvay, Michele
2012-01-01
This study describes the results of a program developed to improve the transition outcomes of low-income minority youth with disabilities. The program relies on case management support to facilitate interagency collaboration. The participants included 164 graduates from special education and 26 youth from an equivalent comparison group. Two case…
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77 FR 187 - Federal Acquisition Regulation; Transition to the System for Award Management (SAM)
Federal Register 2010, 2011, 2012, 2013, 2014
2012-01-03
... architecture. Deletes reference to ``business partner network'' at 4.1100, Scope, which is no longer necessary...) architecture has begun. This effort will transition the Central Contractor Registration (CCR) database, the...) to the new architecture. This case provides the first step in updating the FAR for these changes, and...
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Choi, Jin-Ho; Yoo, Han-Wook
2017-02-01
Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.
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Prendergast, Michael; Cartier, Jerome J
2008-01-01
In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.
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Boyd, Andrew D; Li, Jianrong ‘John’; Burton, Mike D; Jonen, Michael; Gardeux, Vincent; Achour, Ikbel; Luo, Roger Q; Zenku, Ilir; Bahroos, Neil; Brown, Stephen B; Vanden Hoek, Terry; Lussier, Yves A
2013-01-01
Objective Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties. Materials and Methods Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty. Results We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with ‘abdominal pain’ and ‘gastroenteritis’ accounting for approximately 3.5%. Discussion Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables. Conclusions Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition. PMID:23645552
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Career Management in Transition: HRD Themes from the Estonian Civil Service
ERIC Educational Resources Information Center
Rees, Christopher J.; Jarvalt, Jane; Metcalfe, Beverley
2005-01-01
Purpose: To explore, through a case study, some of the key career-related HRD issues that senior managers are currently facing in the Estonian civil service. Design/methodology/approach: Presents primary empirical research into career management in the Estonian civil service since 1991, that is, in the post-Soviet era. The research involved…
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Office development, parking management, and travel behavior : the case of midtown Atlanta
DOT National Transportation Integrated Search
1999-05-01
The effects of special parking provision in zoning ordinances are assessed based on a case study of midtown Atlanta. The study results indicate that it is somewhat easier to promote increased office development around rail transit stations than it is...
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Short- and Long-Term Management of an Acute Pustular Psoriasis Flare: A Case Report.
Georgakopoulos, Jorge R; Ighani, Arvin; Yeung, Jensen
Generalised pustular psoriasis (GPP) and acrodermatitis continua of Hallopeau (ACH) are chronic, relapsing variants of pustular psoriasis proven to be remarkably challenging to treat. Due to their uncommon presentation, there are few described cases in literature and scarce evidence for management. Further information is needed to help dermatologists formulate treatment plans for patients presenting with such diseases. We report the case of a 68-year-old man with a 3-year history of psoriasis presenting to our clinic with a severe breakout of GPP and associated ACH. The patient underwent treatment with cyclosporine A (200 mg PO twice daily) for a period of 2 weeks. This provided dramatic improvement in disease symptoms, with clearance of pustules, remarkable reduction of ACH lesions, and absence of pain. The patient was transitioned to infliximab (5 mg/kg intravenous) and apremilast (30 mg PO twice daily), displaying minimal GPP relapse and well-controlled onychodystrophy for several months. This case supports the use of cyclosporine as a first-line agent in providing immediate symptomatic relief for pustular psoriasis flares. Transitioning to infliximab and apremilast combination therapy offers a unique treatment regime for long-term GPP and ACH management.
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Public transportation in the 1980's: responding to pressures of fiscal austerity. Final report
DOE Office of Scientific and Technical Information (OSTI.GOV)
Meyer, M.D.; Hemily, P.B.
A telephone survey of 30 transit general managers was used to determine the general response of transit agencies to fiscal pressures. A more detailed case study of the Greater Bridgeport Transit District provided greater detail on the response process in one agency, especially focussing on the identification and implementation of feasible options. The concept of a transit agency's operational environment was used to identify the key analysis variables that guided the survey and case study. In general, these variables could be classified into two major categories: (1) those relating to the degree of decisionmaking independence of the agency, and (2)more » those relating to the degree to which an agency is capable of responding to financial pressures.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Miller, P E
Tips and case histories on computer use for idea and outline processing: Productivity software to solve problems of idea hierarchy, transitions, and developments is matched to solutions for communicators. One case is text that ranges from methods and procedures to histories and legal definitions of classification for the US Department of Energy. Applications of value to writers, editors, and managers are for research; calendars; creativity; prioritization; idea discovery and manipulation; file and time management; and contents, indexes, and glossaries. 6 refs., 7 figs.
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Leibowitz, Arleen A.; Lester, Robbie; Curtis, Philip G.; Farrell, Kevin; Fox, Aaron; Klipp, Luke H.; Wise, Jason
2014-01-01
Background Many uninsured people living with HIV/AIDS (PLWHA) will obtain managed health insurance coverage when the Affordable Care Act (ACA) is implemented in January 2014. Since 2011, California has transitioned PLWHA to Medicaid managed care (MMC) and to the Low Income Health Program (LIHP). Objectives To draw lessons for the ACA implementation from the transitions into MMC and the LIHP. Methods Surveys about clients and services provided before and after the transition to MMC and the LIHP were sent to 43 HIV service providers. Usable responses were obtained from 18 (42%). Results Although total client loads were similar in the pre- (January 2011) and post- transition periods (June 2012), many clients transitioned from fee-for-service (FFS) Medicaid to MMC. Over this period, responding agencies served 43.5% fewer PLWHA in FFS Medicaid while the share of PLWHA covered by MMC rose from 16.9% to 55.5%. Managed care covered a smaller number of services than either FFS Medicaid or Ryan White sites. Ryan White providers reported that 53% of the clients they served in January 2011 had transitioned to the LIHPs. Nonetheless, they continued to provide services to many of these clients and Ryan White cases loads did not decline. Conclusions PLWHA enrolled in Medicaid managed care continue to depend on Ryan White sites to supply the full range of services that will allow them to take full advantage of increased access to care under ACA. PMID:24126449
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Alvarez, Renae; Ginsburg, Jacob; Grabowski, Jessica; Post, Sharon; Rosenberg, Walter
2016-04-01
The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components-care coordination, case management, and patient engagement-which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment's emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.
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Saleh, Shadi S; Freire, Chris; Morris-Dickinson, Gwendolyn; Shannon, Trip
2012-06-01
To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis. Randomized controlled trial. A general hospital in upstate New York State. Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months. The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow. Cost-benefit ratio of the PDCT program; self-management skills and abilities. The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities. Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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Role for a Labor-Management Partnership in Nursing Home Person-Centered Care
ERIC Educational Resources Information Center
Leutz, Walter; Bishop, Christine E.; Dodson, Lisa
2010-01-01
Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…
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ERIC Educational Resources Information Center
Davlatov, Ismail D.; Mulloev, Sharif M.
This book provides an indepth description and analysis of financial management and budgetary procedures for education in Tajikistan. This country's case is exceptional even for the group of newly independent post-Soviet countries. In addition to the difficulties of the transition period similar for all former centrally planned economies…
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Schools and Leadership in Transition: The Case of Scandinavia
ERIC Educational Resources Information Center
Moos, Lejf; Moller, Jorunn
2003-01-01
This article will set the context of democratic leadership in Scandinavian countries. This concept will be discussed in a dual perspective. On the one hand there are pressures to transform the governing of the schools towards a more "rigorous" form of New Public Management (NPM) with models of leadership/management from the world of…
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ERIC Educational Resources Information Center
Rysalieva, Symbat Dj.; Ibraeva, Gulmira A.
This book provides an indepth description and analysis of financial management and budgetary procedures for education in Kyrgyzstan. The case of this country is interesting for practitioners and researchers due to its policy of accelerated transition to a market economy, with associated hardships for educational finance and budgeting. Kyrgyzstan…
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ERIC Educational Resources Information Center
Carter, Sharon D.
2013-01-01
This qualitative case study investigated the process of teaching the self-management strategies, self-determination, and self-monitoring to chronically misbehaved students from the perspective of a secondary special education teacher. The investigation used a purposeful sample to select an urban high school setting and a tenured special education…
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Jagannadha Matta; Janaki Alavalapati; John Kerr; Evan Mercer
2005-01-01
Indiaâs Joint Forest Management (JFM) policy, in which government forest agencies and local communities jointly manage forests, has been touted as a successful strategy in helping both forests and people. Its efficacy in the field, however, is uneven. Although government forest departments are charged with implementing JFM, very little is known about their perspectives...
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From conventional drainage to sustainable stormwater management: Beyond the technical challenges.
Goulden, Shula; Portman, Michelle E; Carmon, Naomi; Alon-Mozes, Tal
2018-08-01
Countries and cities are increasingly recognizing the value of adopting Sustainable Stormwater Management (SSWM) goals and measures. SSWM serves multiple hydrological, ecological, social and economic goals and can replace substantial parts of conventional drainage infrastructure. Following international experience in the socio-technical nature of transitions in stormwater management, this research investigates how socio-institutional factors enable the transition from conventional to sustainable stormwater management over time. The research is based on analysing available relevant documents, semi-structured interviews and focus groups, all in a single country case study (Israel). We found significant changes in professional awareness and discourse, some advances in professional standards of work and changes to the regulative system, supporting infiltration practices in particular. We concluded that the three-pillared socio-institutional framework, composed of cultural-cognitive, normative and regulative changes, was insightful for mapping factors supporting transition from conventional drainage to SSWM. Elements within the three pillars can work simultaneously and synergistically to achieve widespread change. At the same time, while SSWM always strives to achieve multiple goals, the order of priority of the various goals may differ from place to place and may change over time. Thus the transition process across the socio-institutional pillars should be renewed if and when the priority of goals changes. The urban and regional planning system can play a crucial role in enhancing the transition process from conventional to sustainable stormwater management. These conclusions may be relevant to other localities and countries that are struggling with such transitions to sustainability. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Multifractal analysis of managed and independent float exchange rates
NASA Astrophysics Data System (ADS)
Stošić, Darko; Stošić, Dusan; Stošić, Tatijana; Stanley, H. Eugene
2015-06-01
We investigate multifractal properties of daily price changes in currency rates using the multifractal detrended fluctuation analysis (MF-DFA). We analyze managed and independent floating currency rates in eight countries, and determine the changes in multifractal spectrum when transitioning between the two regimes. We find that after the transition from managed to independent float regime the changes in multifractal spectrum (position of maximum and width) indicate an increase in market efficiency. The observed changes are more pronounced for developed countries that have a well established trading market. After shuffling the series, we find that the multifractality is due to both probability density function and long term correlations for managed float regime, while for independent float regime multifractality is in most cases caused by broad probability density function.
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Kuehn, Chuck; Tidwell, George; Vhugen, Jann; Sharma, Anjali
2015-01-01
In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.
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ERIC Educational Resources Information Center
Doren, Bonnie; Flannery, K. Brigid; Lombardi, Allison
2012-01-01
The purpose of the study was to examine the potential efficacy of a professional development training model targeting IEP case managers of transition-age students. A training model was developed and a pilot study conducted to understand the promise of the model to improve the development of critical components within the IEP document that support…
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Provencher, Louis; Frid, Leonardo; Czembor, Christina; Morisette, Jeffrey T.
2016-01-01
State-and-Transition Simulation Modeling (STSM) is a quantitative analysis method that can consolidate a wide array of resource management issues under a “what-if” scenario exercise. STSM can be seen as an ensemble of models, such as climate models, ecological models, and economic models that incorporate human dimensions and management options. This chapter presents STSM as a tool to help synthesize information on social–ecological systems and to investigate some of the management issues associated with exotic annual Bromus species, which have been described elsewhere in this book. Definitions, terminology, and perspectives on conceptual and computer-simulated stochastic state-and-transition models are given first, followed by a brief review of past STSM studies relevant to the management of Bromus species. A detailed case study illustrates the usefulness of STSM for land management. As a whole, this chapter is intended to demonstrate how STSM can help both managers and scientists: (a) determine efficient resource allocation for monitoring nonnative grasses; (b) evaluate sources of uncertainty in model simulation results involving expert opinion, and their consequences for management decisions; and (c) provide insight into the consequences of predicted local climate change effects on ecological systems invaded by exotic annual Bromus species.
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Khan, Ahmed; Chuenpagdee, Ratana
2014-09-01
Rebuilding collapsed fisheries is a multifaceted problem, requiring a holistic governance approach rather than technical management fixes. Using the Northern Gulf cod case study in eastern Canada, we illustrate how a "fish chain" framework, drawn from the interactive governance perspective, is particularly helpful in analyzing rebuilding challenges. The analysis demonstrates that factors limiting rebuilding exist along the entire fish chain, i.e., the pre-harvest, harvest, and post-harvest stages. These challenges are embedded in both the ecological and social systems associated with the Northern Gulf cod fisheries, as well as in the governing systems. A comparative analysis of the pre- and post-collapse of the cod fisheries also reveals governance opportunities in rebuilding, which lie in policy interventions such as integrated and ecosystem-based management, livelihood transitional programs, and cross-scale institutional arrangements. Lessons from the Northern Gulf cod case study, especially the missed opportunities to explore alternative governing options during the transition, are valuable for rebuilding other collapsed fisheries.
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"From me to HIV": a case study of the community experience of donor transition of health programs.
Rodríguez, Daniela C; Tripathi, Vandana; Bohren, Meghan; Paul, Amy; Singh, Kriti; Chhabra, Vibha; Singh, Suneeta; Bennett, Sara
2015-08-19
Avahan, a large-scale HIV prevention program in India, transitioned over 130 intervention sites from donor funding and management to government ownership in three rounds. This paper examines the transition experience from the perspective of the communities targeted by these interventions. Fifteen qualitative longitudinal case studies were conducted across all three rounds of transition, including 83 in-depth interviews and 45 focus group discussions. Data collection took place between 2010 and 2013 in four states: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries' view of transition. While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.
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Managing the Near Term Functions of Change in Medical Units.
1986-06-06
BIBLIOGRAPHY Books Ackoff, Russell L. and Jamshid Gharajedaghi and Elsa Vergara Finnell. A Guide to Controlling Your Corporation’s Future. New York...Management In Transition. San Francisco : Jossey-Bass Publishers, 1985. 156 -. Havelock, Ronald G. and Mary C. Havelock. Training for Change Agents A...Jones-Irwin, 1984. Kirkpatrick, Donald L. How To Manage Change Effectively Approaches, Methods, and Case Examples. San Francisco : Jossey-Bass Inc
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Haynie, J Michael; Shepherd, Dean
2011-05-01
Career researchers have focused on the mechanisms related to career progression. Although less studied, situations in which traumatic life events necessitate a discontinuous career transition are becoming increasingly prevalent. Employing a multiple case study method, we offer a deeper understanding of such transitions by studying an extreme case: soldiers and Marines disabled by wartime combat. Our study highlights obstacles to future employment that are counterintuitive and stem from the discontinuous and traumatic nature of job loss. Effective management of this type of transitioning appears to stem from efforts positioned to formulate a coherent narrative of the traumatic experience and thus to reconstruct foundational assumptions about the world, humanity, and self. These foundational assumptions form the basis for enacting future-orientated career strategies, such that progress toward establishing a new career path is greatest for those who can orientate themselves away from the past (trauma), away from the present (obstacles to a new career), and toward an envisioned future career positioned to confer meaning and purpose through work.
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ERIC Educational Resources Information Center
Fudge, Daniel L.; Skinner, Christopher H.; Williams, Jacqueline L.; Cowden, Dan; Clark, Janice; Bliss, Stacy L.
2008-01-01
A single-case (B-C-B-C) experimental design was used to evaluate the effects of the Color Wheel classroom management system (CWS) on on-task (OT) behavior in an intact, general-education, 2nd-grade classroom during transitions. The CWS included three sets of rules, posted cues to indicate the rules students are expected to be following at that…
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Lovelace, Derenda; Hancock, Diane; Hughes, Sabrina S; Wyche, Phyllis R; Jenkins, Claire; Logan, Cindy
In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%. To examine the impact of the McGuire VAMC TCP on Veteran ED and hospital utilization and costs. Veterans being discharged to home following an inpatient admission, ED visit, and/or short rehab stay. The primary means of identifying patients for the program is through daily screening of the previous 24-hour admission and ED report, which the inpatient nurse practitioner performs. She completes an extensive review of each Veteran's electronic medical record to determine the number of ED visits and inpatient admissions at the VAMC and in the community. Initial criteria for consideration in the program included the following: more than two hospital admissions and/or ED visits in the past 90 days or at high risk for readmission based on a Care Assessment Need score of greater than 95. Two hundred Veterans participated in the program in fiscal year (FY) 2013, with 146 participating in FY 2014. A retrospective chart review of Veterans participating in the TCP in FYs 2013 and 2014 was conducted, with a focus on number of admissions and ED visits 90 days prior to admission to the TCP and 90 days following TCP admission. Average admission and ED costs for this VA were calculated to determine cost savings from pre- to post-90 days of admission and ED visits. Veterans who obtained TCP services in FYs 2013 and 2014 experienced a 67% decrease in hospital admissions and a 61% decrease in ED visits in the 90 days following participation in this program compared with the 90 days prior to participation. This produced an estimated net savings of $3,823,673 in medical center costs. In addition, registered nurse case managers (RN CMs) noted improved patient compliance and satisfaction with care and the licensed clinical social worker noted reduced caregiver burden. The results of this program demonstrate how using an interdisciplinary approach to develop patient-centered transition plans of care through intensive case management interventions improves resource utilization with substantial financial savings. This program represents a feasible option for other VAMCs as well as civilian hospitals seeking to provide cost-effective transitional care to patients upon discharge and prevent untimely readmissions. With an RN CM at the hub of patient care, this program successfully demonstrates the value of smooth care transitions.
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Extraboard performance : TriMet case study.
DOT National Transportation Integrated Search
2012-02-01
This paper examines extraboard operations and management at TriMet, the transit provider for the Portland Oregon metropolitan area. The : extraboard consists of a pool of operators who fill open work resulting from absences and other causes. The pape...
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Transit Pricing Demonstration in Bridgeport, Connecticut : A Case Study
DOT National Transportation Integrated Search
1986-03-01
Sponsored by the Urban Mass Transportation Administration, Office of Service and Management Demonstrations, the Bridgeport Pricing Demonstration began in September 1979 and ended in June 1985. It was one element of a broader brokerage demonstration a...
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Managing for resilience: an information theory-based ...
Ecosystems are complex and multivariate; hence, methods to assess the dynamics of ecosystems should have the capacity to evaluate multiple indicators simultaneously. Most research on identifying leading indicators of regime shifts has focused on univariate methods and simple models which have limited utility when evaluating real ecosystems, particularly because drivers are often unknown. We discuss some common univariate and multivariate approaches for detecting critical transitions in ecosystems and demonstrate their capabilities via case studies. Synthesis and applications. We illustrate the utility of an information theory-based index for assessing ecosystem dynamics. Trends in this index also provide a sentinel of both abrupt and gradual transitions in ecosystems. In response to the need to identify leading indicators of regime shifts in ecosystems, our research compares traditional indicators and Fisher information, an information theory based method, by examining four case study systems. Results demonstrate the utility of methods and offers great promise for quantifying and managing for resilience.
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Singh, Riddhi; Quinn, Julianne D; Reed, Patrick M; Keller, Klaus
2018-01-01
Many coupled human-natural systems have the potential to exhibit a highly nonlinear threshold response to external forcings resulting in fast transitions to undesirable states (such as eutrophication in a lake). Often, there are considerable uncertainties that make identifying the threshold challenging. Thus, rapid learning is critical for guiding management actions to avoid abrupt transitions. Here, we adopt the shallow lake problem as a test case to compare the performance of four common data assimilation schemes to predict an approaching transition. In order to demonstrate the complex interactions between management strategies and the ability of the data assimilation schemes to predict eutrophication, we also analyze our results across two different management strategies governing phosphorus emissions into the shallow lake. The compared data assimilation schemes are: ensemble Kalman filtering (EnKF), particle filtering (PF), pre-calibration (PC), and Markov Chain Monte Carlo (MCMC) estimation. While differing in their core assumptions, each data assimilation scheme is based on Bayes' theorem and updates prior beliefs about a system based on new information. For large computational investments, EnKF, PF and MCMC show similar skill in capturing the observed phosphorus in the lake (measured as expected root mean squared prediction error). EnKF, followed by PF, displays the highest learning rates at low computational cost, thus providing a more reliable signal of an impending transition. MCMC approaches the true probability of eutrophication only after a strong signal of an impending transition emerges from the observations. Overall, we find that learning rates are greatest near regions of abrupt transitions, posing a challenge to early learning and preemptive management of systems with such abrupt transitions.
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Quinn, Julianne D.; Reed, Patrick M.; Keller, Klaus
2018-01-01
Many coupled human-natural systems have the potential to exhibit a highly nonlinear threshold response to external forcings resulting in fast transitions to undesirable states (such as eutrophication in a lake). Often, there are considerable uncertainties that make identifying the threshold challenging. Thus, rapid learning is critical for guiding management actions to avoid abrupt transitions. Here, we adopt the shallow lake problem as a test case to compare the performance of four common data assimilation schemes to predict an approaching transition. In order to demonstrate the complex interactions between management strategies and the ability of the data assimilation schemes to predict eutrophication, we also analyze our results across two different management strategies governing phosphorus emissions into the shallow lake. The compared data assimilation schemes are: ensemble Kalman filtering (EnKF), particle filtering (PF), pre-calibration (PC), and Markov Chain Monte Carlo (MCMC) estimation. While differing in their core assumptions, each data assimilation scheme is based on Bayes’ theorem and updates prior beliefs about a system based on new information. For large computational investments, EnKF, PF and MCMC show similar skill in capturing the observed phosphorus in the lake (measured as expected root mean squared prediction error). EnKF, followed by PF, displays the highest learning rates at low computational cost, thus providing a more reliable signal of an impending transition. MCMC approaches the true probability of eutrophication only after a strong signal of an impending transition emerges from the observations. Overall, we find that learning rates are greatest near regions of abrupt transitions, posing a challenge to early learning and preemptive management of systems with such abrupt transitions. PMID:29389938
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-04-20
... CONTACT: Mail Delivery service through Recovering Warrior Task Force, Hoffman Building II, 200 Stovall St... Review of Non- Medical Case Management. 9:30-9:45 a.m. Break. 9:45-10:45 a.m. Task Force Recommendation... Task Force through the contact information in FOR FURTHER INFORMATION CONTACT, and this individual will...
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Nursing perception of patient transitions from hospitals to home with home health.
Smith, Shannon Bright; Alexander, Judith W
2012-01-01
The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.
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Supporting veterans' transitions from permanent supportive housing.
Montgomery, Ann Elizabeth; Cusack, Meagan C; Gabrielian, Sonya
2017-12-01
Little research has assessed the nature of veterans' departures from permanent supportive housing (PSH), which may be of positive valence (e.g., moving into more independent housing). This study aimed to identify participants appropriate for "graduation" from PSH and how to support their transitions. This mixed methods study used qualitative data from PSH program staff, 445 PSH participants' responses to a survey assessing their experiences and administrative records, and qualitative data from a subsample of 10 participants who graduated from the program. Participants were classified as "stayers" (retained in PSH for at least 600 days); "graduates" (exited with improvement in community integration); or "involuntary leavers" (exited for reasons of negative valence). Template analysis of qualitative data from PSH staff described graduation processes; qualitative data from participants were analyzed using a thematic analysis approach. The study compared veterans' characteristics using chi-square and analysis of variance (ANOVA) tests; a multinomial logistic regression assessed correlates of graduates' and involuntary leavers' exits from PSH. Approximately one half of participants who exited the program were graduates. Processes used by program staff to identify potential graduates varied. Participants' self-report of substance use and mental health problems was associated with involuntary leaver status. Frequency of case management, a trusting relationship between participant and case manager, and participants' receipt of compensation related to disability incurred during military service were associated with graduation. To support successful transitions from PSH, programs should focus on providing high-quality case management that may respond flexibly to participants' varying recovery needs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Yolasığmaz, Hacı Ahmet; Keleş, Sedat
2009-01-01
In Turkey, the understanding of planning focused on timber production has given its place on Multiple Use Management (MUM). Because the whole infrastructure of forestry with inventory system leading the way depends on timber production, some cases of bottle neck are expected during the transition period. Database design, probably the most important stage during the transition to MUM, together with the digital basic maps making up the basis of this infrastructure constitute the main point of this article. Firstly, the forest management philosophy of Turkey in the past was shortly touched upon in the article. Ecosystem Based Multiple Use Forest Management (EBMUFM) approaches was briefly introduced. The second stage of the process of EBMUFM, database design was described by examining the classical planning infrastructure and the coverage to be produced and consumed were suggested in the form of lists. At the application stage, two different geographical databases were established with GIS in Balcı Planning Unit of the years 1984 and 2006. Following that the related basic maps are produced. Timely diversity of the planning unit of 20 years is put forward comparatively with regard to the stand parameters such as tree types, age class, development stage, canopy closure, mixture, volume and increment.
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The political economy of a public health case management program's transition into medical homes.
Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele
2015-11-01
Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. Published by Elsevier Ltd.
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Assessing air quality impacts of managed lanes.
DOT National Transportation Integrated Search
2010-12-01
Impacts on transit bus performance and air quality were investigated for a case study high-occupancy / toll (HOT) lane project on a corridor of I-95 near Miami. Trends in air pollutant concentration monitoring data in the study area first were analyz...
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Assessing air quality impacts of managed lanes
DOT National Transportation Integrated Search
2010-12-01
Impacts on transit bus performance and air quality were investigated for a case study high-occupancy / : toll (HOT) lane project on a corridor of I-95 near Miami. Trends in air pollutant concentration : monitoring data in the study area first were an...
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Toward a process-level view of distributed healthcare tasks: Medication management as a case study.
Werner, Nicole E; Malkana, Seema; Gurses, Ayse P; Leff, Bruce; Arbaje, Alicia I
2017-11-01
We aim to highlight the importance of using a process-level view in analyzing distributed healthcare tasks through a case study analysis of medication management (MM). MM during older adults' hospital-to-skilled-home-healthcare (SHHC) transitions is a healthcare process with tasks distributed across people, organizations, and time. MM has typically been studied at the task level, but a process-level is needed to fully understand and improve MM during transitions. A process-level view allows for a broader investigation of how tasks are distributed throughout the work system through an investigation of interactions and the resultant emergent properties. We studied MM during older adults' hospital-to-SHHC transitions through interviews and observations with 60 older adults, their 33 caregivers, and 79 SHHC providers at 5 sites associated with 3 SHHC agencies. Study findings identified key cross-system characteristics not observable at the task-level: (1) identification of emergent properties (e.g., role ambiguity, loosely-coupled teams performing MM) and associated barriers; and (2) examination of barrier propagation across system boundaries. Findings highlight the importance of a process-level view of healthcare delivery occurring across system boundaries. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Navigating the transition to ecosystem-based management of the Great Barrier Reef, Australia
Olsson, Per; Folke, Carl; Hughes, Terry P.
2008-01-01
We analyze the strategies and actions that enable transitions toward ecosystem-based management using the recent governance changes of the Great Barrier Reef Marine Park as a case study. The interplay among individual actors, organizations, and institutions at multiple levels is central in such transitions. A flexible organization, the Great Barrier Reef Marine Park Authority, was crucial in initiating the transition to ecosystem-based management. This agency was also instrumental in the subsequent transformation of the governance regime and provided leadership throughout the process. Strategies involved internal reorganization and management innovation, leading to an ability to coordinate the scientific community, to increase public awareness of environmental issues and problems, to involve a broader set of stakeholders, and to maneuver the political system for support at critical times. The transformation process was induced by increased pressure on the Great Barrier Reef (from terrestrial runoff, overharvesting, and global warming) that triggered a new sense of urgency to address these challenges. The focus of governance shifted from protection of selected individual reefs to stewardship of the larger-scale seascape. The study emphasizes the significance of stewardship that can change patterns of interactions among key actors and allow for new forms of management and governance to emerge in response to environmental change. This example illustrates that enabling legislations or other social bounds are essential, but not sufficient for shifting governance toward adaptive comanagement of complex marine ecosystems. PMID:18621698
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Automation is key to managing a population's health.
Matthews, Michael B; Hodach, Richard
2012-04-01
Online tools for automating population health management can help healthcare organizations meet their patients' needs both during and between encounters with the healthcare system. These tools can facilitate: The use of registries to track patients' health status and care gaps. Outbound messaging to notify patients when they need care. Care team management of more patients at different levels of risk. Automation of workflows related to case management and transitions of care. Online educational and mobile health interventions to engage patients in their care. Analytics programs to identify opportunities for improvement.
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Heflinger, C A; Northrup, D A
2000-11-01
Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.
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Transitioning home: comprehensive case management for America's heroes.
Perla, Lisa Y; Jackson, Patricia D; Hopkins, Sherry L; Daggett, Margaret C; Van Horn, Linda J
2013-01-01
The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the "signature injury" of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article. © 2013 Association of Rehabilitation Nurses.
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Orange, V J; Robinson, D E
1999-02-01
The use of buyer/planners may becoming more popular. If they are, the reason is probably that many companies are integrating materiel management skill sets as a way of increasing the effectiveness of their supply chains. Harley-Davidson recently created a supply management function composed of buyer/planners. This article describes the method it used to achieve the transition, the training plan it implemented to support the process, and the role management played in achieving success.
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ERIC Educational Resources Information Center
Roberts, Ken; Teshmatullo, Akhamadov; Firdavsiy, Kurbanov; Sarateppo, Boltaev; Tholen, Jochen
2007-01-01
This article arises from case studies in 2006 of 20 businesses in Samarkand (Uzbekistan), surveys of their up to 30-year-old employees (r = 419), follow-up interviews with eight of these employees, and matched samples in Almaty (Kazakhstan) and Bishkek (Kyrgyzstan). The main difference between education in Samarkand (and Uzbekistan in general) and…
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Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus
2017-01-01
Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. © The Authors, published by EDP Sciences, 2017.
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Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus
2017-01-01
Bertolotti’s syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I–V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient’s symptoms, especially patients diagnosed with “far out syndrome” treated with laminectomy. Clinical outcomes were more heterogenetic for patient’s treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient’s clinical outcome over time, whereas steroid injection only improves the patient’s symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. PMID:29243586
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Integrated Transitions of Care for Patients With Rare Pulmonary Diseases.
Moreo, Kathleen; Lattimer, Cheri; Lett, James E; Heggen-Peay, Cherilyn L; Simone, Laura
Many continuing education (CE) resources are available to support case management professionals in developing competencies in transitions of care (TOC) that apply generally across disease areas. However, CE programs and tools are lacking for advanced TOC competencies in specific disease areas. This article describes 2 projects in which leading TOC, case management, and CE organizations collaborated to develop CE-accredited interdisciplinary pathways for promoting safe and effective TOC for patients with rare pulmonary diseases, including pulmonary arterial hypertension (PAH) and idiopathic pulmonary fibrosis (IPF). The interdisciplinary pathways apply to PAH and IPF case management practice and TOC across settings that include community-based primary care and specialty care, PAH or IPF centers of expertise, acute care and post-acute settings, long-term care, rehabilitation and skilled nursing facilities, and patients' homes. Both PAH and IPF are chronic, progressive respiratory diseases that are associated with severe morbidity and mortality, along with high health care costs. Because they are relatively rare diseases with nonspecific symptoms and many comorbidities, PAH and IPF are difficult to diagnose. Early diagnosis, referral to centers of expertise, and aggressive treatment initiation are essential for slowing disease progression and maintaining quality of life and function. Both the rarity and complexity of PAH and IPF pose unique challenges to ensuring effective and safe TOC. Expert consensus and evidence-based approaches to meeting these challenges, and thereby improving PAH and IPF patient outcomes, are presented in the 2 interdisciplinary TOC pathways that are described in this article. In coordinating care for patients with complex pulmonary diseases such as PAH and IPF, case managers across practice settings can play key roles in improving workflow processes and communication, transition planning, coordinating TOC with centers of expertise, coordinating care and TOC for patients with comorbidities, providing patient and caregiver education, promoting engagement between patients and the team, advancing the care plan, and improving ongoing adherence to treatment in order to maximize the patient's pulmonary function. Details regarding these interprofessional roles and responsibilities are provided in the full interdisciplinary TOC pathways for PAH and IPF.
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Measuring the Success of Warrior Transition Units
2009-04-30
overworked case managers.”1 They described patients and family members who were frustrated with the “messy bureaucratic battlefield”2 of Walter Reed...on every Warrior that includes an analysis of suicide risk, violence towards others, medication use, falls, driving, alcohol, non-prescribed drug use
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McAiney, Carrie A; Hillier, Loretta M; Paul, Janice; McKinnon Wilson, Jane; Tersigni Phelan, Anna; Wagner, Fred; O'Connor, Sheli
2017-01-01
Limited continuity of care, poor communication between healthcare providers, and ineffective self-management are barriers to recovery as seniors transition back to the community following an Emergency Department (ED) visit or hospitalization. The intensive geriatric service worker (IGSW) role is a new service developed in southern Ontario, Canada to address gaps for seniors transitioning home from acute care to prevent rehospitalization and premature institutionalization through the provision of intensive support and follow-up to ensure adherence to care plans, facilitate communication with care providers, and promote self-management. This study describes the IGSW role and provides preliminary evidence of its impact on clients, caregivers and the broader health system. This mixed methods evaluation included a chart audit of all clients served, tracking of the achievement of goals for IGSW involvement, and interviews with clients and caregivers and other key informants. During the study period, 632 clients were served. Rates of goal achievement ranged from 25%-87% and in cases where achieved, the extent of IGSW involvement mostly exceeded recommendations. IGSWs were credited with improving adherence with treatment recommendations, increasing awareness and use of community services, and improving self-management, which potentially reduced ED visits and hospitalizations and delayed institutionalization. The IGSW role has the potential to improve supports for seniors and facilitate more appropriate use of health system resources, and represents a promising mechanism for improving the integration and coordination of care across health sectors.
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Risk management of hazardous substances in a circular economy.
Bodar, Charles; Spijker, Job; Lijzen, Johannes; Waaijers-van der Loop, Susanne; Luit, Richard; Heugens, Evelyn; Janssen, Martien; Wassenaar, Pim; Traas, Theo
2018-04-15
The ambitions for a circular economy are high and unambiguous, but day-to-day experience shows that the transition still has many difficulties to overcome. One of the current hurdles is the presence of hazardous substances in waste streams that enter or re-enter into the environment or the technosphere. The key question is: do we have the appropriate risk management tools to control any risks that might arise from the re-using and recycling of materials? We present some recent cases that illustrate current practice and complexity in the risk management of newly-formed circular economy chains. We also highlight how separate legal frameworks are still disconnected from each other in these cases, and how circular economy initiatives interlink with the European REACH regulation. Furthermore, we introduce a novel scheme describing how to decide whether a(n)(additional) risk assessment is necessary with regard to the re-use of materials containing hazardous substances. Finally, we present our initial views on new concepts for the fundamental integration of sustainability and safety aspects. These concepts should be the building blocks for the near future shifts in both policy frameworks and voluntary initiatives that support a sound circular economy transition. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Patient population management: taking the leap from variance analysis to outcomes measurement.
Allen, K M
1998-01-01
Case managers today at BCHS have a somewhat different role than at the onset of the Collaborative Practice Model. They are seen throughout the organization as: Leaders/participants on cross-functional teams. Systems change agents. Integrating/merging with quality services and utilization management. Outcomes managers. One of the major cross-functional teams is in the process of designing a Care Coordinator role. These individuals will, as one of their functions, assume responsibility for daily patient care management activities. A variance tracking program has come into the Utilization Management (UM) department as part of a software package purchased to automate UM work activities. This variance program could potentially be used by the new care coordinators as the role develops. The case managers are beginning to use a Decision Support software, (Transition Systems Inc.) in the collection of data that is based on a cost accounting system and linked to clinical events. Other clinical outcomes data bases are now being used by the case manager to help with the collection and measurement of outcomes information. Hoshin planning will continue to be a framework for defining and setting the targets for clinical and financial improvements throughout the organization. Case managers will continue to be involved in many of these system-wide initiatives. In the words of Galileo, 1579, "You need to count what's countable, measure what's measurable, and what's not measurable, make measurable."
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Colbert, Alison M; Durand, Vanessa
2016-01-01
The time after incarceration is widely regarded as tenuous and stressful, and for women living with chronic illness, self-management is yet another stressor. Intervening before the individual is overwhelmed is critical to ensuring success. In this article the Women in Transition to Health, a nurse-led intervention based on Lazarus and Folkman's Transactional Model of Stress and Coping, designed to improve health outcomes in women recently released from jail or prison is described. Motivational interviewing and case management are used to strengthen coping skills and encourage engagement in care. Using the stress model to address the unique needs of this population holds promise for improving health and quality of life.
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A Case for a Collaborative Classroom
ERIC Educational Resources Information Center
Osterholt, Dorothy A.; Barratt, Katherine
2011-01-01
Students making the transition into college typically come face to face with increased independence and decreased external structure. This may be especially problematic for students with learning disabilities who may be less capable of managing in times of change than others. The outcome is often chronic procrastination, absenteeism, and…
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Policy evaluation for a bus-based transit system: the case study of Busan, Korea
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lew, K.S.
This study considers a quite specific set of dimensions of transit evaluation as a comprehensive management-strategy approach for addressing the ongoing problems of urban public transit systems and apply them in a case study. With increasing difficulties in providing effective public transportation, attention in this study was placed on providing for the movement of people in an efficient and equitable manner. This study was therefore concerned with just identifying and evaluating policy options that are feasible within the socio-economic and political context of the Busan metropolitan area and, in particular, how the criteria of efficiency and equity can best bemore » achieved by implementing transit policy alternatives. In the absence of long-run major public investment in urban transportation, the criteria of both efficiency and equity can only be furthered through managerial strategies applied within a systematic evaluative framework. By emphasizing the planning, operational, and managerial considerations of fixed-route bus transit in Busan, it has been acknowledged that efficient and equitable public transportation can be provided through a variety of social, economic, political, and institutional arrangements that are possible to apply from a policy viewpoint in the immediate future.« less
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ERIC Educational Resources Information Center
Stoten, David William
2015-01-01
The growth in opportunities to enter higher education in the past two decades has led to a remarkable increase in the proportion of the British population who are now educated to graduate level. This transformation of the landscape of higher education has also been associated with an increase in student dropout, increasing dependence on lecturers,…
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CMS keeps raising the stakes on quality improvement.
2014-10-01
A significant portion of the Centers for Medicare & Medicaid Services (CMS) 2015 Inpatient Prospective Payment System final rule focuses on quality and raises the percentage of the Medicare base payment hospitals can lose if they perform poorly. Case managers must be involved with patients from the minute they come in the door, through the hospital stay, and after discharge, experts say. Reimbursement is affected by risk-adjustment, which means case managers must make sure the documentation is as complete and specific as possible to show the full picture of the patient's severity of illness as well as any conditions that were present on admission. As the readmission reduction program expands to add new diagnoses and the penalties for poor performance increase, case managers must change their focus from discharge planning to transition planning that takes into account what resources patients need after discharge, experts say.
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Daire, Judith; Gilson, Lucy
2014-01-01
In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. PMID:25274644
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Pappas, Anthony J; Knight, Stephen W; McLean, Katherine Zanyk; Bork, Susan; Kurz, Michael C; Sawyer, Kelly N
2016-09-01
Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death. In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen. We present a case of a 49-year-old man diagnosed with an acute saddle PE who was incidentally found to have a thrombus-in-transit and patent foramen ovale and required open thrombectomy. Identification of these additional potentially life-threatening features was possible only due to our availability of risk-stratification resources, specifically bedside echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit rare, with a reported incidence estimated at 4%, the presence of thrombus-in-transit may change emergent clinical management. A multidisciplinary team of resources should be considered emergently as part of a hospital-based PE system of care. Copyright © 2016 Elsevier Inc. All rights reserved.
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Fundraising and Values: When Do You Say "No" to Money
ERIC Educational Resources Information Center
Hunsaker, Johanna S.
2010-01-01
Larimor University entered a relationship with a donor during a time of continuous leadership changes. The case study had many issues: questionable ethics in fundraising and donor relations, leadership failing to uphold the values by which the institution was founded, leadership transition and succession planning, ineffective management policies,…
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Continuous Quality Improvement: Making the Transition to Education.
ERIC Educational Resources Information Center
Hubbard, Dean L., Ed.
This book is a collection of case studies by 27 educational and industrial leaders describing the implementation of specific Total Quality Management techniques which have demonstrated their value. Essays and their authors are as follows: "Process Improvements Using Team Environments" (Scot M. Faulkner); "Team Effectiveness" (Robert S. Winter);…
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Wiemann, Constance M.; Hergenroeder, Albert C.; Bartley, Krystle A.; Sanchez-Fournier, Blanca; Hilliard, Marisa E.; Warren, Laura J.; Graham, Sarah C.
2016-01-01
An electronic medical record (EMR)-based transition planning tool (TPT) designed to facilitate transition from pediatric to adult-based health care for youth (16–25 years) with special health care needs was introduced at a large children's hospital. Activities to increase provider use were implemented in five plan–do–study–act cycles. Overall, 22 of 25 (88%) consenting providers in four pediatric subspecialty services used the TPT during 303 patient encounters, with nurses and case-managers the top users and physicians the least likely users. Use was highest with intensive technical assistance and following the introduction of an upgraded tool. Provider satisfaction with the TPT and self-reported transition planning activities notably increased across the PDSA cycles. PMID:26209173
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Towards adaptive and integrated management paradigms to meet the challenges of water governance.
Halbe, J; Pahl-Wostl, C; Sendzimir, J; Adamowski, J
2013-01-01
Integrated Water Resource Management (IWRM) aims at finding practical and sustainable solutions to water resource issues. Research and practice have shown that innovative methods and tools are not sufficient to implement IWRM - the concept needs to also be integrated in prevailing management paradigms and institutions. Water governance science addresses this human dimension by focusing on the analysis of regulatory processes that influence the behavior of actors in water management systems. This paper proposes a new methodology for the integrated analysis of water resources management and governance systems in order to elicit and analyze case-specific management paradigms. It builds on the Management and Transition Framework (MTF) that allows for the examination of structures and processes underlying water management and governance. The new methodology presented in this paper combines participatory modeling and analysis of the governance system by using the MTF to investigate case-specific management paradigms. The linking of participatory modeling and research on complex management and governance systems allows for the transfer of knowledge between scientific, policy, engineering and local communities. In this way, the proposed methodology facilitates assessment and implementation of transformation processes towards IWRM that require also the adoption of adaptive management principles. A case study on flood management in the Tisza River Basin in Hungary is provided to illustrate the application of the proposed methodology.
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2010-01-01
Background Managing change has not only been recognized as an important topic in medical informatics, but it has become increasingly important in translational informatics. The move to share data, together with the increasing complexity and volume of the data, has precipitated a transition from locally stored worksheet and flat files to relational data bases with object oriented interfaces for data storage and retrieval. While the transition from simple to complex data structures, mirroring the transition from simple to complex experimental technologies, seems natural, the human factor often fails to be adequately addressed leading to failures in managing change. Methods We describe here a case study in change management applied to an application in translational informatics that touches upon changes in hardware, software, data models, procedures, and terminology standards. We use the classic paper by Riley and Lorenzi to dissect the problems that arose, the solutions that were implemented, and the lessons learned. Results The entire project from requirements gathering through completion of migration of the system took three years. Double data entry into the old and new systems persisted for six months. Contributing factors hindering progress and solutions to facilitate managing the change were identified in seven of the areas identified by Riley and Lorenzi: communications, cultural changes in work practice, scope creep, leadership and organizational issues, and training. Conclusions Detailed documentation of the agreed upon requirements for the new system along with ongoing review of the sources of resistance to change as defined by Riley and Lorenzi were the most important steps taken that contributed to the success of the project. Cultural changes in tissue collection mandated by standards requirements introduced by the Cancer Bioinformatics Grid (CaBIG®) and excessive reliance on the outgoing system during a lengthy period of dual data entry were the primary sources of resistance to change. PMID:20525187
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Edgerton, Mary E; Grizzle, William E; Washington, M Kay
2010-06-02
Managing change has not only been recognized as an important topic in medical informatics, but it has become increasingly important in translational informatics. The move to share data, together with the increasing complexity and volume of the data, has precipitated a transition from locally stored worksheet and flat files to relational data bases with object oriented interfaces for data storage and retrieval. While the transition from simple to complex data structures, mirroring the transition from simple to complex experimental technologies, seems natural, the human factor often fails to be adequately addressed leading to failures in managing change. We describe here a case study in change management applied to an application in translational informatics that touches upon changes in hardware, software, data models, procedures, and terminology standards. We use the classic paper by Riley and Lorenzi to dissect the problems that arose, the solutions that were implemented, and the lessons learned. The entire project from requirements gathering through completion of migration of the system took three years. Double data entry into the old and new systems persisted for six months. Contributing factors hindering progress and solutions to facilitate managing the change were identified in seven of the areas identified by Riley and Lorenzi: communications, cultural changes in work practice, scope creep, leadership and organizational issues, and training. Detailed documentation of the agreed upon requirements for the new system along with ongoing review of the sources of resistance to change as defined by Riley and Lorenzi were the most important steps taken that contributed to the success of the project. Cultural changes in tissue collection mandated by standards requirements introduced by the Cancer Bioinformatics Grid (CaBIG) and excessive reliance on the outgoing system during a lengthy period of dual data entry were the primary sources of resistance to change.
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Institutional change to support regime transformation: Lessons from Australia's water sector
NASA Astrophysics Data System (ADS)
Werbeloff, Lara; Brown, Rebekah; Cocklin, Chris
2017-07-01
Institutional change is fundamental to regime transformation, and a necessary part of moving toward integrated water management. However, insight into the role of institutional change processes in such transitions is currently limited. A more nuanced understanding of institutional frameworks is necessary, both to advance understanding of institutional change in the context of transitions toward improved water management and to inform strategies for guiding such processes. To this end, we examine two contemporary cases of transformative change in Australia's urban water sector, exploring the evolution of institutional change in each city. This paper offers insights into regime transformation, providing guidance on types of institutional structures and the ways structure-change initiatives can be sequenced to support a transition. The results reveal the importance of regulation in embedding regime change and suggest that engagement with structural frameworks should begin early in transition processes to ensure the timely introduction of supporting regulation. Our findings also highlight the inextricable link between culture-based and structure-based change initiatives, and the importance of using a diverse range of institutional change mechanisms in a mutually reinforcing way to provide a strong foundation for change. These findings provide a foundation for further scholarly examination of institutional change mechanisms, while also serving to inform the strategic activities of transition-oriented organizations and actors.
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Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.; Streja, Elani; Rhee, Connie M.; Soohoo, Melissa; Chen, Joline L.T.; Molnar, Miklos Z.; Obi, Yoshitsugu; Gillen, Daniel; Nguyen, Danh V.; Norris, Keith C.; Sim, John J.; Jacobsen, Steve S.
2017-01-01
Abstract In patients with advanced (estimated glomerular filtration rate <25 mL/min/1.73 m2) non-dialysis-dependent chronic kidney disease (CKD) the optimal transition of care to renal replacement therapy (RRT), i.e. dialysis or transplantation, is not known. Mortality and hospitalization risk are extremely high upon transition and in the first months following the transition to dialysis. Major knowledge gaps persist pertaining to differential or individualized transitions across different demographics and clinical measures during the ‘prelude’ period prior to the transition, particularly in several key areas: (i) the best timing for RRT transition; (ii) the optimal RRT type (dialysis versus transplant), and in the case of dialysis, the best modality (hemodialysis versus peritoneal dialysis), format (in-center versus home), frequency (infrequent versus thrice-weekly versus more frequent) and vascular access preparation; (iii) the post-RRT impact of pre-RRT prelude conditions and events such as blood pressure and glycemic control, acute kidney injury episodes, and management of CKD-specific conditions such as anemia and mineral disorders; and (iv) the impact of the above prelude conditions on end-of-life care and RRT decision-making versus conservative management of CKD. Given the enormous changes occurring in the global CKD healthcare landscape, as well as the high costs of transitioning to dialysis therapy with persistently poor outcomes, there is an urgent need to answer these important questions. This review describes the key concepts and questions related to the emerging field of ‘Transition of Care in CKD’, systematically defines six main categories of CKD transition, and reviews approaches to data linkage and novel prelude analyses along with clinical applications of these studies. PMID:28201698
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[Relationships between settlement morphology transition and residents commuting energy consumption].
Zhou, Jian; Xiao, Rong-Bo; Sun, Xiang
2013-07-01
Settlement morphology transition is triggered by rapid urbanization and urban expansion, but its relationships with residents commuting energy consumption remains ambiguous. It is of significance to understand the controlling mechanisms of sustainable public management policies on the energy consumption and greenhouse gases emission during the process of urban settlement morphology transition. Taking the Xiamen City of East China as a case, and by using the integrated land use and transportation modeling system TRANUS, a scenario analysis was made to study the effects of urban settlement morphology transition on the urban spatial distribution of population, jobs, and land use, and on the residents commuting energy consumption and greenhouse gasses emission under different scenarios. The results showed that under the Business As Usual (BAU) scenario, the energy consumption of the residents at the morning peak travel time was 54.35 tce, and the CO2 emission was 119.12 t. As compared with those under BAU scenario, both the energy consumption and the CO2 emission under the Transition of Settlement Morphology (TSM) scenario increased by 12%, and, with the implementation of the appropriate policies such as land use, transportation, and economy, the energy consumption and CO2 emission under the Transition of Settlement Morphology with Policies (TSMP) scenario reduced by 7%, indicating that urban public management policies could effectively control the growth of residents commuting energy consumption and greenhouse gases emission during the period of urban settlement morphology transition.
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Enrollment Planning Using Computer Decision Model: A Case Study at Grambling State University.
ERIC Educational Resources Information Center
Ghosh, Kalyan; Lundy, Harold W.
Achieving enrollment goals continues to be a major administrative concern in higher education. Enrollment management can be assisted through the use of computerized planning and forecast models. Although commercially available Markov transition type curve fitting models have been developed and used, a microcomputer-based decision planning model…
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Organizational Development in Transition: The Schooling Perspective.
ERIC Educational Resources Information Center
Snyder, Karolyn J.; And Others
This paper presents the initial findings of a comprehensive 28-school multi-site case study, which sought to identify patterns in schools that are changing bureaucratic work patterns to those found in quality-management systems. The schools are located in Florida, Virginia, Minnesota, and Louisiana; all are led by principals who are trainers in…
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Case Study of a Successful Learner's Epistemological Framings of Quantum Mechanics
ERIC Educational Resources Information Center
Dini, Vesal; Hammer, David
2017-01-01
Research on student epistemologies in introductory courses has highlighted the importance of understanding physics as "a refinement of everyday thinking" [A. Einstein, J. Franklin Inst. 221, 349 (1936)]. That view is difficult to sustain in quantum mechanics, for students as for physicists. How might students manage the transition? In…
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The effects of housing systems for laying hens on egg safety and quality
USDA-ARS?s Scientific Manuscript database
Transitions in laying hen management and housing systems have constantly occurred throughout the history of commercial egg production. Around the world, there has been a rapid shift in hen housing requirements since the turn of the current century. In most cases, the changes in hen housing require...
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Bennett, Sara; Ozawa, Sachiko; Rodriguez, Daniela; Paul, Amy; Singh, Kriti; Singh, Suneeta
2015-10-01
In low and middle-income countries, programs funded and implemented by international donors frequently transition to local funding and management, yet such processes are rarely evaluated. We reflect upon experience evaluating the transition of a large scale HIV/AIDS prevention program in India, known as Avahan, in order to draw lessons about transition evaluation approaches and implementation challenges. In terms of conceptualizing the transition theory, the evaluation team identified tensions between the idea of institutionalizing key features of the Avahan program, and ensuring program flexibility to promote sustainability. The transition was planned in three rounds allowing for adaptations to transition intervention and program design during the transition period. The assessment team found it important to track these changes in order to understand which strategies and contextual features supported transition. A mixed methods evaluation was employed, combining semi-structured surveys of transitioning entities (conducted pre and post transition), with longitudinal case studies. Qualitative data helped explain quantitative findings. Measures of transition readiness appeared robust, but we were uncertain of the robustness of institutionalization measures. Finally, challenges to the implementation of such an evaluation are discussed. Given the scarceness of transition evaluations, the lessons from this evaluation may have widespread relevance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Asset management guide : focusing on the management of our transit investments.
DOT National Transportation Integrated Search
2012-10-01
To advance transit asset management, this guide provides a transit-specific asset management framework for managing assets indi-vidually and as a portfolio of assets that comprise an integrated system. The guide provides flexible, yet targeted guidan...
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Curry, Jonathan L; Tetzlaff, Michael T; Wang, Sa A; Landon, Gene; Alouch, Nail; Patel, Sapna P; Nagarajan, Priyadharsini; Gupta, Shiva; Aung, Phyu P; Devine, Catherine E; Khoury, Joseph D; Loghavi, Sanam; Prieto, Victor G; DiNardo, Courtney D; Gershenwald, Jeffrey E
2018-06-01
Myeloid sarcoma is a rare extramedullary hematologic malignancy. Accurate and timely diagnosis may be challenging because myeloid sarcoma is known to mimic solid tumors, including hepatobiliary, nasopharyngeal, and breast carcinomas. We report a case of myeloid sarcoma that developed in the primary tumor lymphatic drainage field of a previously treated intermediate-thickness cutaneous melanoma, clinically and radiographically mimicking an in-transit metastasis, in a patient with myelodysplastic syndrome. The diagnosis of myeloid sarcoma was achieved after surgical excision of the mass and pathological examination that included extensive immunohistochemical studies. Awareness of such an unusual clinical presentation can help reduce diagnostic delay and ensure that adequate tissue is obtained for pathological examination and ancillary studies that are critical for accurate diagnosis and appropriate patient management.
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Nic Lochlainn, Laura; Mandal, Sema; de Sousa, Rita; Paranthaman, Karthik; van Binnendijk, Rob; Ramsay, Mary; Hahné, Susan; Brown, Kevin E
2016-01-01
This report describes a joint measles outbreak investigation between public health officials in the United Kingdom (UK) and the Netherlands following detection of a measles cluster with a unique measles virus strain. From 1 February to 30 April 2014, 33 measles cases with a unique measles virus strain of genotype B3 were detected in the UK and the Netherlands, of which nine secondary cases were epidemiologically linked to an infectious measles case travelling from the Philippines. Through a combination of epidemiological investigation and sequence analysis, we found that measles transmission occurred in flight, airport and household settings. The secondary measles cases included airport workers, passengers in transit at the same airport or travelling on the same flight as the infectious case and also household contacts. This investigation highlighted the particular importance of measles genotyping in identifying transmission networks and the need to improve vaccination, public health follow-up and management of travellers and airport staff exposed to measles.
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Optimization-Based Management of Energy Systems
2011-05-11
Power [kW] F u e l co n su m p tio n [g a l/h ] 50 kW ~45 kWh 10 Energy Management Framework: Dealing with Uncertainties Test Cases used to exploit...collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE MAY 2011 2. REPORT TYPE 3. DATES COVERED 00-00...served under all operating conditions. ‘Customizable’ power quality and reliability Seamless transition between islanding and off-grid operation
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DOT National Transportation Integrated Search
2016-11-01
To advance transit asset management, this guide provides a transit-specific asset management framework for managing assets individually and as a portfolio of assets that comprise an integrated system. The guide provides flexible, yet targeted guidanc...
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75 FR 43197 - Public Housing Assessment System (PHAS): Asset Management Transition Year 2 Extension
Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-23
...): Asset Management Transition Year 2 Information (75 FR 1632), dated January 12, 2010, for PHAs with... only. B. PHAS Scoring During Transition Year 2 The Transition Year 2 notice (75 FR 1632, January 12... System (PHAS): Asset Management Transition Year 2 Extension AGENCY: Office of the Assistant Secretary for...
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Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica
2016-01-01
Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity.
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Daire, Judith; Gilson, Lucy
2014-09-01
In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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ERIC Educational Resources Information Center
Alfred, Mary V.
2005-01-01
This study explored the experiences of African American women as they transitioned from welfare to work and develop economic self-sufficiency. The barriers to self-sufficiency included the "work-first" philosophy and case management practices, labor market conditions and employment practices, and personal history. HRD can help minimize…
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ERIC Educational Resources Information Center
Fiszbein, Ariel, Ed.
This book is about education system reform in Central and Eastern Europe, with emphasis on decentralization and management. In the past, local authorities served as implementation arms of the central ministry, while finance and decision-making were controlled by the central government, leaving local communities with little influence. New education…
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Esthetic management of anterior dental anomalies: A clinical case.
Chafaie, Amir
2016-09-01
Many types of dental abnormality can be observed in the anterior sectors, where they can cause genuine esthetic problems for our patients. While conventional prosthetic treatments offer the best solutions in terms of esthetic result and durability, they involve the sacrifice of significant quantities of mineralized dental material and cannot be undertaken before the periodontal tissues are mature. Other less invasive alternatives should be envisaged as transitional, or sometimes even permanent, solutions for the management of these anomalies in children and adolescents. This article discusses these options and presents a clinical case where composite resin veneers and microabrasion of the enamel were used to treat dental agenesis and enamel dysplasia. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.
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Al Awaisi, Huda; Cooke, Hannah; Pryjmachuk, Steven
2015-11-01
Studies have demonstrated that the transition experience of new graduate nurses is complex and frequently negative, leading to dissatisfaction with nursing and increased attrition. Existing studies of new graduate nurses' transition experiences tend to be concerned with the experiences of new graduate nurses in the West. To date, no study has been conducted examining the transition experience in any Middle Eastern country where the cultural context surrounding nursing education and practice is different. To explore the experiences of new graduate nurses during their transition period in the Sultanate of Oman. A qualitative case study utilising an embedded single case design was conducted to investigate the transition experience of new nursing graduates from one university in the Sultanate of Oman. Data were collected from the perspective of new graduate nurses and also from the perspective of other key informants who are key organisational actors such as clinical instructors, managers and preceptors. As is characteristic of case study design, this study employed triangulated methods including individual and focus group interviews, observation and documentary analysis. Data collected were thematically analysed using Microsoft Access. This study showed that nursing is not an attractive choice for Omani students to study and pursue as a future career. During the transition period, new graduate nurses experienced reality shock resulting mainly from a theory-practice gap. They found themselves with limited practical experience but a high level of theoretical knowledge that was difficult to utilise in practice. They experienced many competing priorities in their working environment which resulted in task-orientation and compromised patient care. Many new graduate nurses resented their involvement in basic nursing care, which they believed should not be part of their role as degree nurses. Omani new graduate nurses' transition experiences are complex and highly affected by the working conditions and the status of nursing in Oman. Basic nursing care was believed by new graduate nurses to negatively affect the status of nursing. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Self-management and transitions in women with advanced breast cancer.
Schulman-Green, Dena; Bradley, Elizabeth H; Knobf, M Tish; Prigerson, Holly; DiGiovanna, Michael P; McCorkle, Ruth
2011-10-01
Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions-shifts from one life phase or status to another, for example, from cure- to noncure-oriented care-because they can be disruptive and stressful. Little is known about individuals' experiences with self-management, especially during transitions. Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Participants' mean age was 52 years (range 37-91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens' health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Self-management preferences can vary. Providers should explore and revisit patients' preferences and ability to self-manage over time, particularly during transitions. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
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49 CFR 659.31 - Hazard management process.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., operational changes, or other changes within the rail transit environment. (b) The hazard management process must, at a minimum: (1) Define the rail transit agency's approach to hazard management and the... Agency § 659.31 Hazard management process. (a) The oversight agency must require the rail transit agency...
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49 CFR 659.31 - Hazard management process.
Code of Federal Regulations, 2011 CFR
2011-10-01
..., operational changes, or other changes within the rail transit environment. (b) The hazard management process must, at a minimum: (1) Define the rail transit agency's approach to hazard management and the... Agency § 659.31 Hazard management process. (a) The oversight agency must require the rail transit agency...
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Kneale, Laura; Choi, Yong; Demiris, George
2016-01-01
Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.
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Adapting California’s ecosystems to a changing climate
Elizabeth Chornesky,; David Ackerly,; Paul Beier,; Frank Davis,; Flint, Lorraine E.; Lawler, Joshua J.; Moyle, Peter B.; Moritz, Max A.; Scoonover, Mary; Byrd, Kristin B.; Alvarez, Pelayo; Heller, Nicole E.; Micheli, Elisabeth; Weiss, Stuart
2017-01-01
Significant efforts are underway to translate improved understanding of how climate change is altering ecosystems into practical actions for sustaining ecosystem functions and benefits. We explore this transition in California, where adaptation and mitigation are advancing relatively rapidly, through four case studies that span large spatial domains and encompass diverse ecological systems, institutions, ownerships, and policies. The case studies demonstrate the context specificity of societal efforts to adapt ecosystems to climate change and involve applications of diverse scientific tools (e.g., scenario analyses, downscaled climate projections, ecological and connectivity models) tailored to specific planning and management situations (alternative energy siting, wetland management, rangeland management, open space planning). They illustrate how existing institutional and policy frameworks provide numerous opportunities to advance adaptation related to ecosystems and suggest that progress is likely to be greatest when scientific knowledge is integrated into collective planning and when supportive policies and financing enable action.
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Hydrogeologic controls on groundwater discharge and nitrogen loads in a coastal watershed
Russoniello, Chrtopher J.; Konikow, Leonard F.; Kroeger, Kevin D.; Fernandez, Cristina; Andres, A. Scott; Michael, Holly A.
2016-01-01
Submarine groundwater discharge (SGD) is a small portion of the global water budget, but a potentially large contributor to coastal nutrient budgets due to high concentrations relative to stream discharge. A numerical groundwater flow model of the Inland Bays Watershed, Delaware, USA, was developed to identify the primary hydrogeologic factors that affect groundwater discharge rates and transit times to streams and bays. The distribution of groundwater discharge between streams and bays is sensitive to the depth of the water table below land surface. Higher recharge and reduced hydraulic conductivity raised the water table and increased discharge to streams relative to bays compared to the Reference case (in which 66% of recharge is discharged to streams). Increases to either factor decreased transit times for discharge to both streams and bays compared to the Reference case (in which mean transit times are 56.5 and 94.3 years, respectively), though sensitivity to recharge is greater. Groundwater-borne nitrogen loads were calculated from nitrogen concentrations measured in discharging fresh groundwater and modeled SGD rates. These loads combined with long SGD transit times suggest groundwater-borne nitrogen reductions and estuarine water quality improvements will lag decades behind implementation of efforts to manage nutrient sources. This work enhances understanding of the hydrogeologic controls on and uncertainties in absolute and relative rates and transit times of groundwater discharge to streams and bays in coastal watersheds.
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75 FR 1632 - Public Housing Assessment System (PHAS): Asset Management Transition Year 2 Information
Federal Register 2010, 2011, 2012, 2013, 2014
2010-01-12
... accounting under asset management, also known as ``Transition Year 2.'' FOR FURTHER INFORMATION CONTACT: The... System (PHAS): Asset Management Transition Year 2 Information AGENCY: Office of the Assistant Secretary... by HUD under the Public Housing Management Assessment Program (PHMAP), the regulations for which are...
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Transitioning to an Intramedullary Lengthening and Compression Nail
2017-01-01
Summary: The magnetic intramedullary lengthening nail is an innovative technology that allows for creative ways to treat difficult problems. The lengthening option has revolutionized femur fracture management with bone loss and malunion therapy. The compression version of this nail has provided a gradual method to compress nonunions and difficult fractures that may obviate the need for many current uses of external fixation. Three cases are presented in this manuscript demonstrating a new paradigm in the management of bone loss/shortening of the tibia and femur, and recalcitrant nonunions. PMID:28486284
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Guidelines for Implementing Change: A Case Study
NASA Astrophysics Data System (ADS)
Masekela, Belinda; Nienaber, Rita
To attain and sustain a competitive advantage organizations are continually faced with the need to change their structures, processes and technologies. Converting to new technology and implementing a new information management system in an organization results in inevitable changes in organizational procedures impacting on the people involved. A major problem encountered during this process is resistance to change, which may contribute to total failure of this system. Change management is the process that can be used to negate this impact and assist employees in transitioning to a new way of doing things.
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Safety Management Information Statistics (SAMIS) - 1995 Annual Report
DOT National Transportation Integrated Search
1997-04-01
The Safety Management Information Statistics 1995 Annual Report is a compilation and analysis of transit accident, casualty and crime statistics reported under the Federal Transit Administration's National Transit Database Reporting by transit system...
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Bennett, Sara; Singh, Suneeta; Rodriguez, Daniela; Ozawa, Sachiko; Singh, Kriti; Chhabra, Vibha; Dhingra, Neeraj
2015-01-01
Background Between 2009–2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition. Methods The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs. Findings Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition. Interpretation The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified. PMID:26327591
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DOT National Transportation Integrated Search
2008-06-23
This document presents the notes taken at the USDOT Integrated Corridor Management (ICM) Transit Data Gaps for Rail Transit Systems Initial Planning Workshop. Different scenarios for handling increased demand on rail and bus transit systems are discu...
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Guidebook : managing operating costs for rural and small urban public transit systems.
DOT National Transportation Integrated Search
2013-05-01
This guidebook is a resource for rural and small urban transit agency managers to use in better understanding, predicting, and managing operational costs. Doing so can improve the efficiency, effectiveness, and sustainability of public transit in the...
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Dallas integrated corridor management (ICM) transit vehicle real-time data demonstration.
DOT National Transportation Integrated Search
2015-01-01
This project demonstrated and evaluated the ability to collect and transmit transit location and passenger loading data to a transit management center(s) and/or Integrated Corridor Management (ICM) system in real time. It also demonstrated and evalua...
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Pilling, Samantha; Slattery, Justine
2004-01-01
Speech pathology managers frequently move into careers beyond their clinical discipline. As practicing speech pathology managers and students of business leadership, we were curious about the nature of career transitions out of speech pathology management. We conducted an exploratory descriptive study investigating the perceived competencies that facilitate such career transitions and when further education is required to effectively equip one for such transition. The perceived skills related to a speech pathology background are identified along with the gaps in competence for moving into general management positions. Career management practices that facilitate this type of career transition are provided as recommendations for career planning.
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Barriers, Challenges, and Decision-Making in the Letter Writing Process for Gender Transition.
Budge, Stephanie L; Dickey, Lore M
2017-03-01
This article addresses the challenges that clinicians face in writing letters of support for transgender and gender-diverse clients. It addresses common but challenging clinical representations to help the reader understand the nuances associated with writing letters. Three cases are presented. The first addresses systemic challenges, the second addresses management of care, and the third addresses co-occurring mental health concerns. Recommendations for practice are provided based on the experiences included within the 3 case examples. Copyright © 2016 Elsevier Inc. All rights reserved.
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Almeida, Daniel Benzecry de; Mattei, Tobias Alécio; Sória, Marília Grando; Prandini, Mirto Nelso; Leal, André Giacomelli; Milano, Jerônimo Buzzeti; Ramina, Ricardo
2009-06-01
Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.
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When can a green entrepreneur manage the local environment?
Brandt, Urs Steiner; Svendsen, Gert Tinggaard
2016-12-01
How do we deal with environmental management issues at the local level? Traditionally, the approach proposed from an environmental management perspective has involved various kinds of "top-down" regulatory measures, such as defining a standard that must be satisfied or a tax on pollution. Conversely, there has been less focus on the analysis of local, bottom-up approaches, as for example the effectiveness of various ways of organizing a local environmental transition process. Our focus is on analyzing of under what conditions it is possible for a "green entrepreneur" (GE) to manage a transition from brown to green energy? Theoretically, we consider four entrepreneurial skills, at least two of which must be present for the GE to succeed. In the case of the Danish island of Samsø and its rapid introduction of renewable energy, three of these skills are found to be present: profits, communication, and trustworthiness. The GE, however, failed to activate the fourth skill concerning the ability to persuade local non-green actors regarding the value of the green component. Thus, a main result is that it is crucial to convince non-green locals about the profitability of local environmental management rather than its potentially green components. Copyright © 2016 Elsevier Ltd. All rights reserved.
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ERIC Educational Resources Information Center
Misiunas, Mindaugas; Stravinskiene, Inga
2010-01-01
The article reasons the aspect of change and transition in higher education institutions implementing quality management systems. Psychological and behavioural responses of high school staff towards quality management system being implemented are discussed; transition phases of the employees are introduced; specific features of staff management in…
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DOT National Transportation Integrated Search
2011-09-01
This handbook provides an overview of public transit in Iowa and how to do business with the Iowa Department of Transportation (Iowa DOT) Office of Public Transit (OPT). It is intended to be a tool to assist transit managers navigate through the many...
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Transitions: Managing the Transfer of Security Responsibility
2010-02-05
Index 1.2_Transitions-ConceptNote_v2.0_draft Index Transitions: Managing the Transfer of Security Responsibility A Concept Paper...reporting burden for the collection of information is estimated to average 1 hour per response , including the time for reviewing instructions...TITLE AND SUBTITLE Transitions: Managing the Transfer of Security Responsibility 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6
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Elli, Luca; Maieron, Roberto; Martelossi, Stefano; Guariso, Graziella; Buscarini, Elisabetta; Conte, Dario; di Giulio, Emilio; Staiano, Annamaria; Barp, Jacopo; Bassotti, Gabrio; Bianco, Maria Antonia; Buri, Luigi; Carrara, Maurizio; Ghidini, Benedetta; Giannini, Olivia; Knafelz, Daniela; Miele, Erasmo; Peralta, Sergio; Riccio, Elisabetta; Tomba, Carolina; Zilli, Maurizio; Guadagnini, Tiziana
2015-09-01
In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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Department of Defense Recovering Warrior Task Force
2014-09-02
used by RWs, which DoD must first identify, such as private sector job training, employment skills training, apprenticeships, and internships (JTEST- AI ...employment, other transition support, referrals and warm handoffs within and across sectors , and case management. Communities that are geographically remote...of Medicine76; recognition of the need for private sector participation is coalescing. We see evidence of the private sector’s readiness to embrace
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ERIC Educational Resources Information Center
Knowlton, Steven R., Ed.; Barefoot, Betsy O., Ed.
Thirty-eight brief articles first make the case for using newspapers in the college classroom and then offer examples of how newspapers should be used in the following subject areas: business (advertising, business writing, management); English (composition, research writing, women's studies); first-year seminar (honors seminar, reading, study…
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Ryan L. Maroney
2006-01-01
The number of protected areas in Mongolia has increased fourfold since the countryâs transition to a market-based economy over a decade ago; however, many of these protected areas have yet to realize their intended role as protectorates of biodiversity. Given the prevalence of (semi-) nomadic pastoralists in rural areas, effective conservation initiatives in Mongolia...
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-16
... above the contracting officer. FAR 7.105(b)(5)(iv) was added to discuss the strategy to transition from... ADMINISTRATION 48 CFR Parts 1, 2, 7, 16, 32, 42, and 50 [FAC 2005-50; FAR Case 2008-030; Item I; Docket 2011-0082... to the Regulatory Secretariat on or before May 16, 2011 to be considered in the formulation of a...
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Sitzenfrei, Robert; Möderl, Michael; Rauch, Wolfgang
2013-01-01
Traditional urban water management relies on central organised infrastructure, the most important being the drainage network and the water distribution network. To meet upcoming challenges such as climate change, the rapid growth and shrinking of cities and water scarcity, water infrastructure needs to be more flexible, adaptable and sustainable (e.g., sustainable urban drainage systems, SUDS; water sensitive urban design, WSUD; low impact development, LID; best management practice, BMP). The common feature of all solutions is the push from a central solution to a decentralised solution in urban water management. This approach opens up a variety of technical and socio-economic issues, but until now, a comprehensive assessment of the impact has not been made. This absence is most likely attributable to the lack of case studies, and the availability of adequate models is usually limited because of the time- and cost-intensive preparation phase. Thus, the results of the analysis are based on a few cases and can hardly be transferred to other boundary conditions. VIBe (Virtual Infrastructure Benchmarking) is a tool for the stochastic generation of urban water systems at the city scale for case study research. With the generated data sets, an integrated city-scale analysis can be performed. With this approach, we are able to draw conclusions regarding the technical effect of the transition from existing central to decentralised urban water systems. In addition, it is shown how virtual data sets can assist with the model building process. A simple model to predict the shear stress performance due to changes in dry weather flow production is developed and tested. PMID:24210508
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Transitions of Care Model Inclusive of Unplanned Care Improves the Patient Experience
Cox, Jon; Teague, Stephanie; Beck, Eric
2016-01-01
A major emphasis in health care is creating an experience whereby patients receive the right care at the right time from the right provider in the right setting at the right cost. Over the past several decades, there has been considerable effort in the area of medical management, with prior authorization, gatekeeper utilization management regimens, and other techniques designed to guide patients and caregivers into desired treatment pathways. Alternatively, the concept of demand management may be employed to achieve these desired outcomes by giving patients meaningful, expanded choices beyond traditional acute-care settings. The implementation of a novel, patient-centered, unplanned care delivery model is described along with illustrative case studies. PMID:28725828
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A Manual on risk management for the public transit industry
DOT National Transportation Integrated Search
1986-09-01
APTA is pleased to offer this manual on Risk Management for the Public Transit Industry to its members. This manual was funded by the American Public Transit Association (APTA), and was written to assist the non-insurance transit professional in crea...
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Institutions in transitioning peri-urban communities: spatial differences in groundwater access
NASA Astrophysics Data System (ADS)
Gomes, Sharlene L.; Hermans, Leon M.
2016-05-01
Urbanization creates challenges for water management in an evolving socio-economic context. This is particularly relevant in transitioning peri-urban areas like Khulna, Bangladesh where competing demands have put pressure on local groundwater resources. Users are unable to sufficiently meet their needs through existing institutions. These institutions provide the rules for service provision and act as guidelines for actors to resolve their water related issues. However, the evolving peri-urban context can produce fragmented institutional arrangements. For example in Khulna, water supply is based on urban and rural boundaries that has created water access issues for peri-urban communities. This has motivated local actors to manage their groundwater needs in various ways. General institutional theories are well developed in literature, yet little is known about institutions in transitioning peri-urban areas. Institutions that fail to adapt to changing dynamics run the risk of becoming obsolete or counter-productive, hence the need for investigating institutional change mechanisms in this context. This paper examines peri-urban case studies from Khulna using the Institutional Analysis and Development framework to demonstrate how institutions have contributed to spatial differences in groundwater access with local actors investing in formal and informal institutional change as a means of accessing groundwater.
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Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions.
Javalkar, Karina; Johnson, Meredith; Kshirsagar, Abhijit V; Ocegueda, Sofia; Detwiler, Randal K; Ferris, Maria
2016-01-01
Health care transition readiness or self-management among adolescents and young adults (AYA) with chronic conditions may be influenced by factors related to their surrounding environment. Study participants were AYA diagnosed with a chronic condition and evaluated at pediatric- and adult-focused subspecialty clinics at the University of North Carolina Hospital Systems. All participants were administered a provider-administered self-management/transition-readiness tool, the UNC TRxANSITION Scale. Geographic area and associated characteristics (ecological factors) were identified for each participant's ZIP code using the published U.S. Census data. The Level 1 model of the hierarchical linear regression used individual-level predictors of transition readiness/self-management. The Level 2 model incorporated the ecological factors. We enrolled 511 AYA with different chronic conditions aged 12-31 years with the following characteristics: mean age of 20± 4 years, 45% white, 42% black, and 54% female. Participants represented 214 ZIP codes in or around North Carolina, USA. The Level 1 model showed that age, gender, and race were significant predictors of transition readiness/self-management. On adding the ecological factors in the Level 2 model, race was no longer significant. Participants from a geographic area with a greater percentage of females (β = .114, p = .005) and a higher median income (β = .126, p = .002) had greater overall transition readiness. Ecological factors also predicted subdomains of transition readiness/self-management. In this cohort of adolescents and young adults with different chronic conditions, ecological disparities such as sex composition, median income, and language predict self-management/transition readiness. It is important to take ecological risk factors into consideration when preparing patients for health self-management or transition. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Dimensions of the transition service coordinator role.
Betz, Cecily L; Redcay, Gay
2005-01-01
This article describes the development and implementation of an innovative advanced practice role, as a transition service coordinator for nurses who work with adolescents with special healthcare needs. Transition services for adolescents with special healthcare needs is an area of growing clinical need requiring that all healthcare professionals, including advanced practice nurses develop new clinical knowledge and skills to practice effectively. This emerging specialty area will require advanced practice nurses to provide direct services blending both pediatric and adult healthcare needs and to function in advanced practice roles such as case managers who can ensure the coordination of services between these two very different systems of care while promoting the youth's acquisition of goals for adulthood. This nursing role was first created to provide and coordinate transition services to youth seen in a piloted clinic titled Creating Healthy Futures. This article describes the various components of this nursing role that incorporated the advanced practice dimensions of clinical expert, consultant, change agent, leader, researcher, and educator that can be replicated in other clinical settings.
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The costs of transit fare prepayment programs : a parametric cost analysis.
DOT National Transportation Integrated Search
Despite the renewed interest in transit fare prepayment plans over the past : 10 years, few transit managers have a clear idea of how much it costs to operate : and maintain a fare prepayment program. This report provides transit managers : with the ...
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Atlanta NAVIGATOR case study. Final report, May 1996--Jun 1997
DOE Office of Scientific and Technical Information (OSTI.GOV)
Amodei, R.; Bard, E.; Brong, B.
1998-11-01
The Atlanta metropolitan region was the location of one of the most ambitious Intelligent Transportation Systems (ITS) deployments in the United States. This deployment included several individual projects--a Central Transportation Management Center (TMC), six Traffic Control Centers (TCC), one Transit Information Center (TIC), the Travel Information Showcase (TIS), and the extension of the Metropolitan Atlanta Rapid Transit Authority (MARTA) rail network and the new high-occupancy vehicle (HOV) lanes on I-85 and I-75. The Atlanta Centennial Olympic Games and Paralympic Games created a focus for these projects. All of these systems were to be brought on line in time for themore » Olympic Games. This report presents the findings of the NAVIGATOR Case Study and documents the lessons learned from the Atlanta ITS deployment experience in order to improve other ITS deployments in the future. The Case Study focuses on the institutional, programmatic, and technical issues and opportunities from planning and implementing the ITS deployment in Atlanta. The Case Study collected data and information from interviews, observations, focus groups, and documentation reviews. It presents a series of lessons learned and recommendations for enabling successful ITS deployments nationwide.« less
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Thomson, Brenda; Gorospe, Gerry; Cooke, Liz; Giesie, Pam; Johnson, Shirley
2015-08-01
Hematopoietic stem cell transplantation (HCT) is a complicated treatment modality used to address hematologic malignancies and other disorders. The complex care of patients undergoing HCT places them at high risk for poor outcomes during times of transition. Education is a critical component of preparing patients and caregivers to move through the many phases of the HCT treatment trajectory (i.e., preadmission, preparative regimens, inpatient admission, discharge, outpatient management, survivorship). The purpose of this article is to provide a useful systematic approach to the standardization of patient teaching methods across various professional nursing roles in the HCT trajectory (i.e., nurse coordinator, midlevel staff, case manager, inpatient nurse, day hospital nurse) in an effort to improve outcomes related to patient transitions. A performance improvement project based on physician and health services researcher Avedis Donabedian's conceptual framework was implemented at a National Cancer Institute-designated comprehensive cancer center in the western United States, with the intention of enhancing nurses' knowledge and standardizing the education of patients undergoing HCT and their caregivers from pretransplantation to survivorship. Donabedian's framework was a helpful model in enacting changes focused on transitions in care for the population of patients undergoing transplantation. For this population, implementing and sustaining coordinated care across multiple nursing roles in a treatment trajectory is complex. However, early possible indicators of success (e.g., decreased length of stay, lower readmission rates) were promising outcomes.
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Yalcin, Samet; Yalcin, Bulent; Gecim, Ethem I
2009-01-01
Management of patients with chronic constipation (CC), irresponsive to medical treatment, is very difficult. There are some surgical approaches reported for the treatment. In this study we aimed to assess the results of different surgical procedures in patients with severe CC who were refractory to intensive medical treatments. Fifteen patients with refractory chronic constipation underwent surgical management between 1998 and 2003 in Ankara University School of Medicine Department of General Surgery. Median age of the patients was 40 years (range, 24-77), female/male ratio was 11/4, median duration of symptoms was 13 years (range, 4-35 years) and median interval of two subsequent bowel movements was 15 (range, 5-30) days. Preoperative evaluation including barium enema, colonoscopy, colonic transit time, and cinedefecography and balloon expulsion test were done in all patients. Clinical analysis of constipation with these tests indicated a simple slow transit colon in three patients but more complicated variations of combined anatomical functional disorders in the rest of the cases. Surgical procedures consisted of total colectomy, Frykman-Goldberg procedure, Wells procedure and appendisostomy, laparoscopically in 8 of them. Deep vein thrombosis developed in the postoperative period after rectopexy and pelvic floor repair in one case. The median follow-up time was 5.5 years. Fourteen (93.3%) patients had an excellent bowel movement and were highly satisfied with the surgical management. Surgical interventions may be beneficial in selected patients with refractory chronic constipation (Tab. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.
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Joly, Elizabeth
2016-06-01
To present a discussion of a theoretical perspective developed through integrating Meleis' Transition Theory and Bronfenbrenner's Bioecological Theory of Human Development to inform nursing and advanced nursing practice supporting the transition to adulthood for young people with medical complexity. Theoretical perspectives to inform nursing practice in supporting successful transition are limited, yet nurses frequently encounter young people with medical complexity during the transition to adulthood. Discussion paper. A literature search of CINAHL and Medline was conducted in 2014 and included articles from 2003-2014; informal discussions with families; the author's experiences in a transition program. The integrated theoretical perspective described in this paper can inform nurses and advanced practice nurses on contextual influences, program and intervention development across spheres of influence and outcomes for the transition to adulthood for young people with medical complexity. Young people and their families require effective reciprocal interactions with individuals and services across sectors to successfully transition to adulthood and become situated in the adult world. Intervention must also extend beyond the young person to include providers, services and health and social policy. Nurses can take a leadership role in supporting the transition to adulthood for young people with medical complexity through direct care, case management, education and research. It is integral that nurses holistically consider developmental processes, complexity and contextual conditions that promote positive outcomes during and beyond the transition to adulthood. © 2016 John Wiley & Sons Ltd.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-11-16
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Federal... Committee meeting of the Department of Defense Task Force on the Care, Management, and Transition of...
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Unlocking Hospitality Managers Career Transitions through Applying Schein's Career Anchors Theory
ERIC Educational Resources Information Center
McGuire, David; Polla, Giovana; Heidl, Britta
2017-01-01
Purpose: This paper seeks to unlock the career transitions of hospitality managers through applying Schein's career anchors theory. It seeks to understand how Schein's Career Anchors help explain the career transitions of managers in the Scottish hospitality industry. Design/methodology/approach: The paper adopts a non-sequential multi-method…
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DOT National Transportation Integrated Search
2013-09-01
This report surveys the state-of-practice of transit railcar maintenance management and fleet management practices. It emphasizes a lifecycle management approach to fleet management. It also emphasizes the role of performance improvement programs and...
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Pak, Raymond W; Moskowitz, Eric J; Bagley, Demetrius H
2009-03-01
For many years, the gold standard in upper urinary tract transitional-cell carcinoma (UT-TCC) management has been nephroureterectomy with excision of the bladder cuff. Advances in endourologic instrumentation have allowed urologists to manage this malignancy. The feasibility and success of conservative measures for UT-TCC have been widely published, but there has not been an objective cost analysis performed to date. Our goal was to examine the direct costs of renal-sparing conservative measures v nephroureterectomy and subsequent chronic kidney disease (CKD) or end-stage renal disease (ESRD). Secondary analysis includes a discussion of survival and quality-of-life issues for both treatment cohorts. Retrospective review of a cohort of patients treated at our institution with renal-sparing ureteroscopic management of UT-TCC who were followed for a minimum of 2 years. The costs per case were based on equipment, anesthesia, surgeon fees, pathologic evaluation fees, and hospital stay. ESRD and CKD costs were estimated based on published reports. From 1996 to 2006, 254 patients were evaluated and treated for UT-TCC at our institution. A cohort of 57 patients was examined who had a minimum follow-up period of 2 years. Renal preservation in our series approached 81%, with cancer-specific survival of 94.7%. Assuming a worst-case scenario of a solitary kidney with recurrences at each follow-up for 5 years v nephroureterectomy and dialysis for the same period, an estimated $252,272 U.S. dollars would be saved. This savings would cover the expenses of five cadaveric renal transplantations. Conservative endoscopic management of UT-TCC in our experience should be the gold standard management for low-grade and superficial-stage disease. From a cost perspective, renal-sparing UT-TCC management is effective in reducing ESRD health care expenses.
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ERIC Educational Resources Information Center
Association for Education in Journalism and Mass Communication.
The Business of Mass Media section of the proceedings contains the following 13 papers: "Management in Transition at the Rocky Mountain News" (Jim Redmond); "The Rise and Fall of the Distress Sale: A Strange Case of Comparative Broadcast Policy-Making" (Alan G. Stavitsky); "Journalists' Assessment of Group Ownership and…
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NASA Astrophysics Data System (ADS)
Larsen, S. G.; Willardson, T.
2017-12-01
Some exciting new science and tools are under development for water management decision-making in the Western U.S. This session will highlight a number of examples where remotely-sensed observation data has been directly beneficial to water resource stakeholders, and discuss the steps needed between receipt of the data and their delivery as a finished data product or tool. We will explore case studies of how NASA scientists and researchers have worked with together with western state water agencies and other stakeholders as a team, to develop and interpret remotely-sensed data observations, implement easy-to-use software and tools, train team-members on their operation, and transition those tools into the insititution's workflows. The benefits of integrating these tools into stakeholder, agency, and end-user operations can be seen on-the-ground, when water is optimally managed for the decision-maker's objectives. These cases also point to the importance of building relationships and conduits for communication between researchers and their institutional counterparts.
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NASA Astrophysics Data System (ADS)
Larsen, S. G.; Willardson, T.
2016-12-01
Some exciting new science and tools are under development for water management decision-making in the Western U.S. This session will highlight a number of examples where remotely-sensed observation data has been directly beneficial to water resource stakeholders, and discuss the steps needed between receipt of the data and their delivery as a finished data product or tool. We will explore case studies of how NASA scientists and researchers have worked with together with western state water agencies and other stakeholders as a team, to develop and interpret remotely-sensed data observations, implement easy-to-use software and tools, train team-members on their operation, and transition those tools into the insititution's workflows. The benefits of integrating these tools into stakeholder, agency, and end-user operations can be seen on-the-ground, when water is optimally managed for the decision-maker's objectives. These cases also point to the importance of building relationships and conduits for communication between researchers and their institutional counterparts.
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Norbash, Alexander
2017-06-01
To suggest a methodical approach for refining transitional management abilities, including empowerment of a growing leader, leading in an unfamiliar organization or leading in an organization that is changing. Management approaches based on the body of work dealing with leadership studies and transitions and dealing with leadership during times of transition and change management were consolidated and categorized. Transitional leaders can benefit from effective leadership training including defining and prospectively accruing necessary experiences and skills; strengthening information gathering skills; effectively self-assessing; valuing and implementing mentoring; formulating strategy; and communicating. A categorical approach to transitional leadership may be implemented through a systems-based and methodical approach to gaining the definable, and distinct sets of skills and abilities necessary for transitional leadership success. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-01
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Committee meeting of the Department of Defense Task Force on the Care, Management, and Transition of...
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-05-25
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and...
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-06-25
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... of the Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-01-31
..., Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Amended... of the Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded... edition of the Federal Register (77 FR 3454) is amended to reflect changes in the meeting times and agenda...
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Review on Malaysian Rail Transit Operation and Management System: Issues and Solution in Integration
NASA Astrophysics Data System (ADS)
Masirin, Mohd Idrus Mohd; Salin, Aminah Mohd; Zainorabidin, Adnan; Martin, David; Samsuddin, Norshakina
2017-08-01
In any context, operation and management of transportation systems are key issues which may affect both life quality and economic development. In large urban agglomerations, an efficient public transportation system may help abate the negative externalities of private car use such as congestion, air and noise pollution, accident and fuel consumption, without excessively penalizing user travel times or zone accessibility. Thus, this study is conducted to appraise the Malaysian rural rail transit operation and management system, which are considered important as there are many issues and solution in integration of the services that need to be tackled more conscientiously. The purpose of this paper is to describe some of the most important issues on integration of services and rail transit system in Malaysian and how to solve or reduce these problems and conflicts. In this paper, it consists of the historical development of rail transit construction in Malaysia. This paper also attempts to identify the important issues related to rail transit services and integration in Malaysian rural rail operation and management system. Comparison is also conducted with other countries such as UK, France, and Japan. Finally, a critical analysis is presented in this paper by looking at the possible application for future Malaysian rail transit operation system and management, especially focusing on enhancing the quality of Malaysian rural rail transit. In conclusion, this paper is expected to successfully review and appraise the existing Malaysian rural rail transit operation and management system pertaining to issues & solution in integration. It is also hoped that reformation or transformation of present service delivery quality of the rail transit operation and management will enable Malaysia to succeed in transforming Malaysian transportation system to greater heights.
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Thompson, Alarna M N; Henwood, Suzanne M
2016-06-01
This study seeks to add to current literature a descriptive account of the lived experience of radiographers' transition to, and experiences of, management roles and identifies additional resources and support that are perceived as being beneficial for this transition. This study employed a descriptive phenomenological stance. Using purposive sampling, six South-East Queensland based private practice radiology managers, who had held their position for longer than 3 months, participated in audiotape recorded in-depth interviews exploring their transition to, and experiences of management in radiology. Thematic analysis was used to describe and make meaning of the data. Overall, five central themes emerged through thematic analysis of the data. The results indicate that all participants' had an underlying drive to succeed during their role transition and highlight the importance of a comprehensive orientation by a mentor; the training and support to enable preparation for the role, especially in the area of people management skills and communication; the importance of access to networking opportunities and the importance of concise expectations from higher management. Role transition can be marred with uncertainty, however; key suggestions indicate the importance of having support mechanisms in place before, during and after transitioning to a managerial role.
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Siek, Katie A; Khan, Danish U; Ross, Stephen E; Haverhals, Leah M; Meyers, Jane; Cali, Steven R
2011-10-01
Older adults with multiple chronic conditions often go through care transitions where they move between care facilities or providers during their treatment. These transitions are often uncoordinated and can imperil patients by omitted, duplicative, or contradictory care plans. Older adults sometimes feel overwhelmed with the new responsibility of coordinating the care plan with providers and changing their medication regimes. In response, we developed a Lesser General Public License (LGPL) open source, web-based Personal Health Application (PHA) using an iterative participatory design process that provided older adults and their caregivers the ability to manage their personal health information. In this paper, we document the PHA design process from low-fidelity prototypes to high-fidelity prototypes over the course of six user studies. Our findings establish the imperative need for interdisciplinary research and collaboration among all stakeholders to create effective PHAs. We conclude with design guidelines that encourage researchers to gradually increase functionality as users become more proficient.
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Keeley, F X; Tolley, D A
1998-04-01
Endoscopic treatment of upper-tract transitional-cell carcinoma (TCC) is well established. Nevertheless, many patients still required major ablative surgery. We have applied our experience with laparoscopic nephrectomy to the performance of laparoscopic nephroureterectomy in order to make the management of upper-tract TCC entirely minimally invasive. Since 1993, we have performed 22 laparoscopic nephroureterectomies for upper-tract TCC. Initially, we excluded patients with tumors below the pelvic brim, but we now offer a trial of laparoscopy to all patients. We describe the evolution of our technique, which involves resecting the ureteral orifice prior to laparoscopic dissection of the kidney and ureter. We have had to convert three cases to open surgery, one each for bleeding, failure to progress, and unappreciated tumor extent. Operative times averaged 156 minutes, which compares well with contemporary times for open nephroureterectomy. Complication rates, transfusion requirements, and length of stay, although higher than those of laparoscopic nephrectomy, were all reduced in comparison with open nephroureterectomy.
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McManus, Margaret; White, Patience; Pirtle, Robin; Hancock, Catina; Ablan, Michael; Corona-Parra, Raquel
2015-01-01
This pediatric-to-adult health care transition pilot project describes the process and results of incorporating the "Six Core Elements of Health Care Transition (2.0)" into a Medicaid managed care plan with a group of 35 18-23 year olds who have chronic mental health, developmental, and complex medical conditions. The pilot project demonstrated an effective approach for customizing and delivering recommended transition services. At the start of the 18-month project, the Medicaid plan was at the basic level (1) of transition implementation of the Six Core Elements with no transition policy, member transition readiness assessment results, health care transition plans of care, updated medical summaries, transfer package for the adult-focused provider, and assurance of transfer completion and consumer feedback. At the conclusion of the pilot project, the plan scored at level 3 on each core element. The primary reason for not scoring at the highest level (4) was because the transition elements have not been incorporated into services for all enrollees within the plan. Future efforts in managed care will benefit from starting the transition process much earlier (ages 12-14), expanding the role of nurse care managers and participating pediatric and adult-focused clinicians in transition, and offering payment incentives to clinicians to implement the Six Core Elements of Health Care Transition. Copyright © 2015 Elsevier Inc. All rights reserved.
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Safety Management Information Statistics (SAMIS) - 1994 Annual Report
DOT National Transportation Integrated Search
1996-07-01
The Safety Management Information Statistics 1994 Annual Report is a compilation and analysis of mass transit accident and casualty statistics reported by transit systems in the United States during 1994, reported under the Federal Transit Administra...
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Enhancing success in transition service coordinators: use of transformational leadership.
Rearick, Ellen
2007-01-01
The lifespan of children with special healthcare needs has been extended because of improved technology and medical advances. Successful transition to the adult arena of healthcare, social services, and education by adolescents with special healthcare needs (ASHCN) is lacking. The transition service coordinator (TSC) is a multifaceted role of advanced practice nursing that provides highly specialized transition services to adolescents with special healthcare needs. The use of key concepts from the transformational leadership theory may improve healthcare outcomes. This article applies to pediatric and adult primary care and case management services that serve adolescents with special healthcare needs. Employing key concepts of transformational leadership theory will enhance the success of the TSC to improve both collaboration among stakeholders in the transitional team and young adults' transition to the world of adult services. Enhanced communication resulting in improved sharing of information, understanding of the stakeholder roles, and provision of formal linkages between pediatric and adult medical providers is a significant outcome affecting the ASHCN. Improved collaboration will produce a smooth transition for the ASHCN to the world of adult social services education, and employment. Incorporating the transformational leadership dimensions of idealized influence, inspirational motivation intellectual stimulation, and individualized consideration will enhance the ability of the TSC to improve collaboration among stakeholders in the transitional team and the quality of services for the ASHCN.
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A systems approach to energy management and policy in commuter rail transportation
NASA Astrophysics Data System (ADS)
Owan, Ransome Egimine
1998-12-01
This research is motivated by a recognition of energy as a significant part of the transportation problem. Energy is a long-term variable cost that is controllable. The problem is comprised of: the limited supply of energy, chronic energy deficits and oil imports, energy cost, poor fuel substitution, and the undesirable environmental effects of transportation fuels (Green House Gases and global warming). Mass transit systems are energy intensive networks and energy is a direct constraint to the supply of affordable transportation. Commuter railroads are also relatively unresponsive to energy price changes due to travel demand patterns, firm power needs and slow adoption of efficient train technologies. However, the long term energy demand is lacking in existing transportation planning philosophy. In spite of the apparent oversight, energy is as important as urban land use, funding and congestion, all of which merit explicit treatment. This research was conducted in the form of a case study of New Jersey Transit in an attempt to broaden the understanding of the long-term effects of energy in a transportation environment. The systems approach method that is driven by heuristic models was utilized to investigate energy usage, transit peer group efficiency, energy management regimes, and the tradeoffs between energy and transportation, a seldom discussed topic in the field. Implicit in systems thinking is the methodological hunt for solutions. The energy problem was divided into thinking is the methodological hunt for solutions. The energy problem was divided into smaller parts that in turn were simpler to solve. The research presented five heuristic models: Transit Energy Aggregation Model, Structural Energy Consumption Model, Traction Power Consumption Model, Conjunctive Demand Model, and a Managerial Action Module. A putative relationship was established between traction energy, car-miles, seasonal and ambient factors, without inference of direct causality. The co-mingling of traction power with energy for rail yard and switch heating skewed certain energy intensities. It was concluded that managerial actions such as: demand-side energy conservation strategies, utility rebates, rate case intervention and open market purchases of deregulated power can lower transit operating cost.
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Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin
2016-01-01
Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and its dynamics (e.g., order transitions). Effects on self-related information processing, on identity development, and toward a more pronounced autonomy in life (instead of feeling helpless against the chaoticity of state dynamics) were evident in the presented case and documented by the monitoring system.
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What's in a Number: How we Measure Community Engagement
NASA Astrophysics Data System (ADS)
Budden, A. E.; Aicher, R.; Butland, S.; Varga, M.
2017-12-01
The importance of community management is increasingly recognized and the role of the community manager is becoming professionalized. Yet, activities involved in community management - or community engagement - are widespread, and have typically been taken on by a variety of actors. These activities will look different depending on the type of community an individual is working with, and the maturity of the community. Regardless of the myriad of tools and practices used in community management, most community managers are seeking growth and a transition to a mature and self-sustaining community. Measuring this growth and degree of engagement can be challenging. Harder still is inferring the impact of community growth. In this paper we discuss some of the most commonly used metrics for community engagement, their advantages and limitations, and their context dependency, drawing from case studies of communities at different stages of the community life-cycle.
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76 FR 47296 - Transit Asset Management (TAM) Pilot Program Funds
Federal Register 2010, 2011, 2012, 2013, 2014
2011-08-04
... makes funds available for public transportation providers, State Departments of Transportation (DOT... transportation asset management at the nation's rail and bus public transportation agencies. FOR FURTHER... asset management at the rail and bus public transportation agencies. Transit Asset Management Selections...
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Primary immunodeficiency disease: a model for case management of chronic diseases.
Burton, Janet; Murphy, Elyse; Riley, Patty
2010-01-01
Patient-centered chronic care management is a new model for the management of rare chronic diseases such as primary immunodeficiency disease (PIDD). This approach emphasizes helping patients become experts on the management of their disease as informed, involved, and interactive partners in healthcare decisions with providers. Because only a few patients are affected by rare illnesses, these patients are forced to become knowledgeable about their disease and therapies and to seek treatment from a healthcare team, which includes physicians and nurse specialists who are equipped to manage the complexity of the disease and its comorbidities. Importantly, therapy for PIDD can be self-administered at home, which has encouraged the transition toward a proactive stance that is at the heart of patient-centered chronic care management. We discuss the evolution of therapy, the issues with the disease, and challenges with its management within the framework of other chronic disease management programs. Suggestions and rationale to move case management of PIDD forward are presented with the intent that sharing our experiences will improve process and better manage outcomes in this patient population. The patient-centered model for the management of PIDD is applicable to the primary care settings, where nurse case managers assist patients through education, support them and their families, and facilitate access to community resources in an approach, which has been described as "guided care." The model also applies specifically to immunology centers where patients receive treatment or instruction on its self-administration at home. Patient-centered management of PIDD, with its emphasis on full involvement of patients in their treatment, has the potential to improve compliance with treatment, and thus patient outcomes, as well as patients' quality of life. The patient-centered model expands the traditional model of chronic disease management, which relies on evidence-based medicine, provider expertise, clinical information systems, and patient education. This approach supports patient self-management with strategies that empower and prepare them for their role as expert patients.
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NASA Astrophysics Data System (ADS)
Srinivasan, M. A.; Rao, C. Dhananjaya; Krishnaiah, M.
2016-05-01
The present study describes Mie lidar observations of the cirrus cloud passage showing transition between double thin layers into single thick and single thick layer into double thin layers of cirrus over Gadanki region. During Case1: 17 January 2007, Case4: 12 June 2007, Case5: 14 July 2007 and Case6: 24 July 2007 the transition is found to from two thin cirrus layers into single geometrically thick layer. Case2: 14 May 2007 and Case3: 15 May 2007, the transition is found to from single geometrically thick layer into two thin cirrus layers. Linear Depolarization Ratio (LDR) and Back Scatter Ration (BSR) are found to show similar variation with strong peaks during transition; both LDR and Cloud Optical Depth (COD) is found to show similar variation except during transition with strong peaks in COD which is not clearly found from LDR for the all cases. There is a significant weakening of zonal and meridional winds during Case1 which might be due to the transition from multiple to single thick cirrus indicating potential capability of thick cirrus in modulating the wind fields. There exists strong upward wind dominance contributed to significant ascent in cloud-base altitude thereby causing transition of multiple thin layers into single thick cirrus.
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Performance measures for public transit mobility management.
DOT National Transportation Integrated Search
2011-12-01
"Mobility management is an innovative approach for managing and delivering coordinated public : transportation services that embraces the full family of public transit options. At a national level, there are : currently no industry recognized perform...
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Best practices in bus dispatch.
DOT National Transportation Integrated Search
2012-06-01
In 2007, the National Center for Transit Research (NCTR) sponsored a study to examine best practices in : extraboard operator management. In most transit agencies, extraboard manpower is managed by the : dispatch function, but extraboard management i...
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DOE Office of Scientific and Technical Information (OSTI.GOV)
None
The Office of Legacy Management (LM) is an integral part of the U.S. Department of Energy’s (DOE’s) strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. LM will work with each site using an integrated team approach to ensure a successful transition. Part of this process will include transition of Government records and information. The Office of Legacy Management Information and Records Management Transition Guidance focuses on LM’s goal to preserve and protect legacy records and information. This guidance document establishes a framework for the transfer ofmore » records management responsibilities for sites transferring to LM. It describes the requirements, responsibilities, and procedures for the efficient and cost-effective transfer of custody, ownership, and management of records and other information products from the transfer site to LM. Records management practices are critical to the functions of Federal agencies because records provide information about, or evidence of, the organization, functions, policies, decisions, procedures, operations, or other activities. Therefore, the information generated by an agency is created, maintained, and dispositioned through records management processes that ensure the appropriate preservation and retrieval of essential information. Because of their intrinsic value, best practices to preserve information and records should be utilized when records are transferred from one organization to another. As the transfer program completes cleanup activities at closure sites, a transitional process will facilitate the transparent shift in the management of site records activities to LM. The roles and responsibilities of the transfer site and/or program and LM described in this document are a necessary foundation for cooperation and coordination and are essential to the successful transition of records and information responsibilities. The DOE Office of the Chief Information Officer (OCIO) has a central role in DOE records management by providing guidance, expertise, and coordination to all DOE offices and organizations and coordination with the National Archives and Records Administration (NARA). LM and the transfer site will complete an integrated transition plan which will integrate all transition elements including information and records. As part of the overall transition plan, an Information and Records Transition Plan will be developed consistent with the integrated transition plan for the site transfer and included as an attachment. The Information and Records Management Transition Plan will be developed to assist both organizations in organizing the tasks; establishing a timetable and milestones for their completion; and identifying manpower, funding and other resources that will be needed to complete the ownership transfer. In addition, the plan will provide a valuable exchange of institutional knowledge that will assist LM in meeting the obligations of responsibly managing legacy records. Guidance for the development of the plan is included in this document. Records management concerns that may arise during site closure, such as management support, contract language and agreements, interactions with the OCIO and NARA, resource and budget considerations, and procedures to safeguard records are addressed. Guidelines and criteria for records management transition activities are also provided. These include LM expectations for the inventory, scheduling, and disposition of records; the management and transfer of electronic files, including databases and software; records finding aids, indices, and recordkeeping systems; and the process for the transfer of hard copy and electronic records to LM.« less
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Multiple Case Comparison of the In-Transit Visibility Business Process
2003-03-01
therefore we give it the highest levels of development , testing, training, continuous improvement (lessons learned ) with all of the staff. b. How do you... the Air Force. Results from this study indicate that a lack of emphasis on policy development and management practices, rather than poor system...frequently require information on what they will receive, not just when they will receive it (Gilmore, 2002). This shift in strategy makes the study
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Security and emergency management technical assistance for the top 50 transit agencies
DOT National Transportation Integrated Search
2007-04-01
Between May 2002 and July 2006, the Federal Transit Administration (FTA) provided technical assistance to the top 50 transit agencies through the Security and Emergency Management Technical Assistance Program (SEMTAP). The scope and purpose of the pr...
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New Forms of Managerial Education in Knowledge Society
NASA Astrophysics Data System (ADS)
Maly, Milan
Paper illustrates the ways of knowledge sharing in transition companies in two main topics: the methods of knowledge management of local managers in joint ventures with foreign partners from free market countries and the development of leadership behavior and decision making styles in privatized companies in the Czech Republic. Lack of previous experience is the main reason for the adoption of different ways of managerial education. Several systems like the tandem, distant learning, mixed, foreign and hired managerial systems are analyzed, and the role of both partners, local and foreign managers, is specified. The analysis of leadership behavior and decision-making styles specifying five levels of participation. Czech managers consider it to be appropriate to use a more autocratic style than a participative one. Only in a few cases, mostly in joint ventures, can we see some elements of the partnership style.
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Quetiapine-induced hypertriglyceridaemia causing acute pancreatitis
Franco, John Mark; Vallabhajosyula, Saraschandra; Griffin, Timothy John
2015-01-01
Second-generation antipsychotics have well-known metabolic side effects such as hyperlipidaemia and hyperglycaemia. A middle-aged man presented with epigastric and flank pain associated with nausea, and was noted to have elevated triglycerides (3590 mg/dL or 40.53 mmol/L), lipase and glucose. Haematological parameters revealed neutropenia with pancytopaenia. The patient was started on conservative management for acute pancreatitis, and on intravenous insulin and oral gemfibrozil for lowering of his triglycerides. He gradually improved and was transitioned to oral atorvastatin and fenofibrate. His triglycerides, glucose and leucocyte counts normalised at discharge and he was transitioned to ziprasidone. The combination of hypertriglyceridaemia, worsening hyperglycaemia and neutropenia made us suspect quetiapine as the causative agent. Medications cause only 0.1–7% of acute pancreatitis cases, with quetiapine implicated in only five-reported cases. Hypertriglyceridaemia (>600 mg/dL or 6.77 mmol/L) is frequently reported with quetiapine use, but severe hypertriglyceridaemia (>1000 mg/dL or 11.29 mmol/L) has been reported in <10 patients. PMID:25976202
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41 CFR 101-4.230 - Transition plans.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Transition plans. 101-4.230 Section 101-4.230 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 4-NONDISCRIMINATION ON THE BASIS OF SEX IN...
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Harvey, Desley; Foster, Michele; Strivens, Edward; Quigley, Rachel
2017-05-01
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Delivering team training to medical home staff to impact perceptions of collaboration.
Treadwell, Janet; Binder, Brenda; Symes, Lene; Krepper, Rebecca
2015-01-01
The purpose of this study was to explore whether an evidence-based educational and experiential intervention to develop team skills in medical homes would positively affect team members' perceptions of interprofessional collaboration. The study population consisted of primary care medical home practices associated with the health plan sponsor of this research. All practices were located within the greater Houston region of Texas and had more than 500 patients. A cluster design experimental study was conducted between August 2013 and June 2014. Fifty medical home practices, 25 intervention and 25 attention control, were recruited as study sites. Results indicate that individual team members in the medical homes receiving the intervention were significantly more likely than the individual team members in the attention control groups to report higher levels of positive perception of team collaboration after the 12-week intervention. This research indicates that educating teams about interprofessional collaboration tools and supporting technique use may be an effective strategy to assist medical homes in developing collaborative environments. Case management experience in collaboration supports the role facilitating team training. Transforming culture from hierarchical to team-based care supports the case management approach of collaborative practice. In addition, role satisfaction attained through the respect and communication of team-based care delivery may influence retention within the case management profession. As case managers in primary care settings assume roles of embedded care coordinators, program leaders, and transition facilitators, an understanding of collaboration techniques is needed to support the entire care team to achieve desired outcomes.
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NASA Technical Reports Server (NTRS)
Baumann, Paul R.
1990-01-01
Before county and local governments will utilize satellite data extensively for landcover inventories, digital image processing techniques must be developed to identify transitional land-use conditions and create large-scale, readable land-cover maps. This study examines a satellite-based land-cover inventory done for Schoharie County, New York and reviews the problems encountered in identifying and mapping brushland - a significant transitional land use - within the county and region. Brushland throughout the Northeast represents a barometer for measuring the shift away from agricultural land use to second-home property. Detecting and locating brushland on a regular basis can greatly assist county and local government officials in planning and managing a county's future.
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Transitioning to the Learning Management System Moodle from Blackboard: Impacts to Faculty
ERIC Educational Resources Information Center
Varnell, Page
2016-01-01
What are the workload impacts to faculty during a Learning Management System (LMS) transition? What type of support is needed by faculty during an LMS transition? Transitioning to a new LMS may result in faculty problems with learning a new technology platform in addition to teaching. The purpose of this phenomenological study was to explore the…
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Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report.
Damous, Sergio Henrique Bastos; Darce, George Felipe Bezerra; Leal, Renato Silveira; Costa, Adilson Rodrigues; Ferreira, Pedro Henrique Alves; de Oliveira Bernini, Celso; Utiyama, Edivaldo Massazo
2018-01-01
Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Zlotnick, Cheryl; Tam, Tammy; Zerger, Suzanne
2012-09-01
Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition. © 2012 Blackwell Publishing Ltd.
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49 CFR 659.31 - Hazard management process.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 49 Transportation 7 2014-10-01 2014-10-01 false Hazard management process. 659.31 Section 659.31... Agency § 659.31 Hazard management process. (a) The oversight agency must require the rail transit agency..., operational changes, or other changes within the rail transit environment. (b) The hazard management process...
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49 CFR 659.31 - Hazard management process.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 49 Transportation 7 2013-10-01 2013-10-01 false Hazard management process. 659.31 Section 659.31... Agency § 659.31 Hazard management process. (a) The oversight agency must require the rail transit agency..., operational changes, or other changes within the rail transit environment. (b) The hazard management process...
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49 CFR 659.31 - Hazard management process.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 49 Transportation 7 2012-10-01 2012-10-01 false Hazard management process. 659.31 Section 659.31... Agency § 659.31 Hazard management process. (a) The oversight agency must require the rail transit agency..., operational changes, or other changes within the rail transit environment. (b) The hazard management process...
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41 CFR 101-4.225 - Educational institutions eligible to submit transition plans.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Educational institutions eligible to submit transition plans. 101-4.225 Section 101-4.225 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 4...
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41 CFR 101-4.225 - Educational institutions eligible to submit transition plans.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Educational institutions eligible to submit transition plans. 101-4.225 Section 101-4.225 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 4...
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Ersig, Anne L; Tsalikian, Eva; Coffey, Julie; Williams, Janet K
2016-01-01
Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood. Copyright © 2016 Elsevier Inc. All rights reserved.
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77 FR 42354 - Designation of Transportation Management Areas
Federal Register 2010, 2011, 2012, 2013, 2014
2012-07-18
... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Federal Highway Administration Designation of Transportation Management Areas AGENCIES: Federal Transit Administration (FTA), Federal Highway... Management Areas (TMAs). The FTA and FHWA are taking this action in compliance with the agencies' authorizing...
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Transformation of scientists and engineers into managers
NASA Technical Reports Server (NTRS)
Bayton, J. A.; Chapman, R. L.
1972-01-01
The purposes of this research were to determine the principal problems and obstacles faced by specialists during the transition period when they are becoming managers, and to discover ways by which their difficulties might be avoided or overcome. It was found that senior management officials are unaware--or tend to ignore the importance--of the transition process and its problems, that little attention has been given to developing management training to overcome transition problems, and that much of the training which is offered is largely irrelevant to these problems.
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NASA Technical Reports Server (NTRS)
Witkin, S. A.
1976-01-01
A viable quality program for the urban mass transit industry, and a management approach to ensure compliance with the program are outlined. Included are: (1) a set of guidelines for quality assurance to be imposed on transit authorities, and a management approach to ensure compliance with them; (2) a management approach to be used by the transit authorities (properties) for assuring compliance with the QA guidelines; and (3) quality assurance guidelines to be imposed by properties and umta for procurement of hardware and systems.
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NASA Astrophysics Data System (ADS)
Niedbalski, Zbigniew; Nguyen, Phu Minh Vuong; Widzyk-Capehart, Eleonora
2018-03-01
Nowadays, for a number of reasons, many open pit mines are considering a transition from Open Pit (OP) to Underground (UG) to remain competitive. In OP-UG transition, UG operation is operated simultaneously with the OP operation for a certain period of time. Guidelines for the simultaneous operation of OP and UG are very difficult to establish, as there are very few case studies available. Yet, because of the OP-UG interactions; the operation has a higher safety, technical and management requirements than the OP or UG methods when considered separately. In Vietnam, Cao Son is one of many OP mines, which decided to change the operational system from OP to UG. Simultaneous operation started in 2015 and will be conducted until 2030 when the OP mine Cao Son ends its mining activities. In this paper, selected geomechanical considerations of the simultaneous operation are presented. A number of numerical modelling calculations using finitedifference software with code FLAC were carried out for calibration process, slope stability analysis and the OP-UG interaction analysis for the Cao Son - Khe Cham II-IV mine. Based on the results obtained from numerical modelling, the geomechanical assessments of simultaneous operation Cao Son - Khe Cham II-IV are discussed in this paper.
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Applications for improved inventory management for public transit systems
DOT National Transportation Integrated Search
2001-01-01
This report documents and presents the results of a Testing and Demonstration (T&D) Project on applications for improved inventory management for public transit systems. This project is a follow-up to an earlier study on inventory management for bus ...
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Financial Management for Transit: A Handbook.
ERIC Educational Resources Information Center
Heaselden, Mark; And Others
This handbook is primarily intended to serve as a primer for transit system managers who have not had any formal financial education through college classes, professional development programs, or extensive on-the-job programs. The following topics are covered: financial planning techniques for transit (beginning the financial planning process,…
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Pinto, Bruno; Partidário, Maria
2012-04-01
The history of the establishment and management philosophies of the mainland Portuguese Protected Areas was reconstructed through the use of written records and oral history interviews. The objectives were to review the main philosophies in the creation and management of these areas, to assess the influence of international PA models, to compare the Portuguese case with other European and international literature concerning PAs and to discuss the value of the oral history in this research. As main results, it was found that the initial management model of "Wilderness (or Yellowstone)" was replaced by the "new paradigm" of PAs when the democracy was re-established. Changes in the management philosophies within this "new paradigm" were also identified, which resulted in the transition of a "Landscape" to a "Nature conservation" model. After the establishment of the Natura 2000 network, the "Biodiversity conservation" model prevailed. It was also found that the initiative for the establishment of most PAs came from the government, although there were few cases of creation due to the action of NGOs and municipalities. Finally, oral history interviews enabled the addition of information to the literature review, but also provided more insight and detail to this history.
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5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions § 9701.232...
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5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions...
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Effective management of low back pain: it’s time to accept the evidence
Manga, Pran; Angus, Douglas E; Swan, William R
1993-01-01
Low back pain is a ubiquitous and economically costly problem. Unfortunately, the clinical management of low back pain is not yet well understood. Chiropractic management of back pain, long the black sheep of back care, has undergone a transition and is now a more respected and understood alternative to conservative medical care, itself under increased scrutiny due to unsatisfactory outcomes and unacceptable iatrogenic side effects. The substantial amount of clinical and related research on the effectiveness of manipulation for low back pain is summarized here from a larger study, divided into randomized control trials, case-control trials, meta-analyses and descriptive studies. The chiropractic management of low back pain is found to be a more effective way of dealing with this medical, social and economic problem. It is suggested that greater utilization of chiropractors be encouraged such that the “right people are doing the right things at the right time”.
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Management of organisational changes in a case of de-institutionalisation.
Parlalis, Stavros K
2011-01-01
This paper seeks to explore the development of a discharge programme in one learning disability hospital in Scotland. The study aims to concentrate on organisational developmental changes in that institution. The model of the management during the discharge programme was investigated. The aim of the study is to explore how the discharge programme developed, as seen under the lens of organisational change, in order to find out what kind of model of management is more suitable in similar programmes. A case study was employed. Data were collected by means of interviews. The interviews followed a structured format. The sample of the study had to be a purposive sample and the method of snowball sampling was used; finally, 28 interviews were conducted. A grounded approach was adopted for the data analysis. The software program QSR "NUD*IST" (version "N6") was used as a technical tool, in order to facilitate the data analysis. The findings of this study show that various management models were adopted in the four phases of the discharge programme. These different models represent a "quest" by the institution's management regarding the most appropriate model for managing the discharge programme. This study shows that this goes on continuously in organisations under transition until they settle down to a more permanent state. It was concluded that management models, which are composed of characteristics from the organic theory of organisational management, could apply in discharge programmes. The data gathered enabled the researcher to arrive at a model of management which is suitable for managing organisational changes in discharge programmes, the named "stakeholder management model".
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Nguyen, T; Henderson, D; Stewart, D; Hlyva, O; Punthakee, Z; Gorter, J W
2016-07-01
Recent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self-management of their health is key in successful transition to adult healthcare. To date, there is limited research on self-management promotion for youth. The purpose of this study is to explore self-management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare. Part of a larger longitudinal transition (TRACE-2009-2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers. The emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent. Results support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self-management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self-management skills in transitioning youth and parents. © 2016 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.
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Martin, Julien; McIntyre, Carol L.; Hines, James E.; Nichols, James D.; Schmutz, Joel A.; MacCluskie, Margaret C.
2009-01-01
The recent development of multistate site occupancy models offers great opportunities to frame and solve decision problems for conservation that can be viewed in terms of site occupancy. These models have several characteristics (e.g., they account for detectability) that make them particularly well suited for addressing management and conservation problems. We applied multistate site occupancy models to evaluate hypotheses related to the conservation and management of Golden Eagles (Aquila chrysaetos) in Denali National Park, Alaska, and provided estimates of transition probabilities among three occupancy states for nesting areas (occupied with successful reproduction, occupied with unsuccessful reproduction, and unoccupied). Our estimation models included the effect of potential recreational activities (hikers) and environmental covariates such as a snowshoe hare (Lepus americanus) index on transition probabilities among the three occupancy states. Based on the most parsimonious model, support for the hypothesis of an effect of potential human disturbance on site occupancy dynamics was equivocal. There was some evidence that potential human disturbance negatively affected local colonization of territories, but there was no evidence of an effect on reproductive performance parameters. In addition, models that assume a positive relationship between the hare index and successful reproduction were well supported by the data. The statistical approach that we used is particularly useful to parameterize management models that can then be used to make optimal decisions related to the management of Golden Eagles in Denali. Although in our case we were particularly interested in managing recreational activities, we believe that such models should be useful to for a broad class of management and conservation problems.
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Efficacy of a Transition Theory-Based Discharge Planning Program for Childhood Asthma Management.
Ekim, Ayfer; Ocakci, Ayse Ferda
2016-02-01
This study tested the efficacy of a nurse-led discharge planning program for childhood asthma management, based on transition theory. A quasi-experimental design was used. The sample comprised 120 children with asthma and their parents (intervention group n = 60, control group n = 60). The asthma management self-efficacy perception level of parents in the intervention group increased significantly and the number of triggers their children were exposed to at home was reduced by 60.8%. The rates of admission to emergency departments and unscheduled outpatient visits were significantly lower in the intervention group compared with the control group. Transition theory-based nursing interventions can provide successful outcomes on childhood asthma management. Transition theory-based discharge planning program can guide nursing interventions to standardize care of the child with asthma. Combining care at home with hospital care strengthens ongoing qualified asthma management. © 2015 NANDA International, Inc.
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Instructor guide : managing operating cost for rural and small urban transit systems.
DOT National Transportation Integrated Search
2013-01-01
The purpose of the workshop is to provide rural and small urban transit managers and staff with tools to analyze, track, predict, and manage operational costs. The workshop will have a beginning and ending general session, and will provide six sessio...
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2012-04-14
CAPE CANAVERAL, Fla. – At the Shuttle Landing Facility at NASA’s Kennedy Space Center in Florida, media representatives interview space shuttle managers following the arrival of space shuttle Discovery. Behind the rope with their backs to the camera are, from left, Bart Pannullo, NASA Transition and Retirement vehicle manager at Kennedy Dorothy Rasco, manager for Space Shuttle Program Transition and Retirement at NASA’s Johnson Space Center Stephanie Stilson, NASA flow director for Orbiter Transition and Retirement at Kennedy and Kevin Templin, transition manager for the Space Shuttle Program at Johnson. Discovery will be hoisted onto a Shuttle Carrier Aircraft, or SCA, with the aid of the mate-demate device at the landing facility. The SCA, a modified Boeing 747 jet airliner, is scheduled to ferry Discovery to the Washington Dulles International Airport in Virginia on April 17, after which the shuttle will be placed on permanent public display in the Smithsonian's National Air and Space Museum Steven F. Udvar-Hazy Center. For more information on shuttle transition and retirement activities, visit http://www.nasa.gov/transition. Photo credit: NASA/Kim Shiflett
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Kang-Yi, Christina D; Adams, Danielle R
2017-01-01
This systematic review aimed to (1) identify and summarize empirical studies on youth with behavioral health disorders aging out of foster care and (2) address implications for behavioral health policy, research, and practice. We identified previous studies by searching PubMed, PsycINFO, EBSCO, and ISI Citation Indexes and obtaining references from key experts in the child welfare field. A total of 28 full articles published between 1991 and 2014 were reviewed and summarized into the key areas including systems of care, disability type, transition practice area, study methods, study sample, transition outcome measures, study analysis, and study findings. Considering how fast youth who have behavioral health disorders fall through the crack as they exit foster care, one cannot understate the importance of incorporating timely and appropriate transition planning and care coordination for youth who have behavioral health disorders aging out of foster care into the usual case management performed by behavioral health systems and service providers.
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The number comb for a soil physical properties dynamic measurement
NASA Astrophysics Data System (ADS)
Olechko, K.; Patiño, P.; Tarquis, A. M.
2012-04-01
We propose the prime numbers distribution extracted from the soil digital multiscale images and some physical properties time series as the precise indicator of the spatial and temporal dynamics under soil management changes. With this new indicator the soil dynamics can be studied as a critical phenomenon where each phase transition is estimated and modeled by the graph partitioning induced phase transition. The critical point of prime numbers distribution was correlated with the beginning of Andosols, Vertisols and saline soils physical degradation under the unsustainable soil management in Michoacan, Guanajuato and Veracruz States of Mexico. The data banks corresponding to the long time periods (between 10 and 28 years) were statistically compared by RISK 5.0 software and our own algorithms. Our approach makes us able to distill free-form natural laws of soils physical properties dynamics directly from the experimental data. The Richter (1987) and Schmidt and Lipson (2009) original approaches were very useful to design the algorithms to identify Hamiltonians, Lagrangians and other laws of geometric and momentum conservation especially for erosion case.
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First order phase transitions resulted from collective Jahn-Teller effect
NASA Astrophysics Data System (ADS)
Rosenfeld, E. V.
2018-01-01
Generally, in case of the collective Jahn-Teller effect, a high-symmetry structure of a matrix in which quantum systems with degenerate ground state are inserted becomes distorted. This usually smooth transition can become abrupt only if the matrix by itself is a trigger and JTE merely activates its switching. It is shown in this paper that proper insertion into matrix of quantum systems with the singlet ground state and degenerate excited state leads to the formation of a new metastable state of the whole system and a stepwise appearance of JTE. Using nanotechnology, a matrix of any nature can be transformed into trigger in this way if one manages to synthesize and insert into it proper quantity of quantum JT-active centers with appropriate energy spectrum.
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Vergara, Franz H; Sheridan, Daniel J; Sullivan, Nancy J; Budhathoki, Chakra
The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Acute care adult medicine inpatient units. A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Implementing brief (<10 min) face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p < .001). Increasing reach rates by a telephonic case manager facilitates communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.
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Transition and closeout of the Fernald Closure Project
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bilson, H.E.; Terry, T.; Reising, J.
The U.S. Department of Energy (DOE) and Fluor Fernald have completed the majority of the cleanup of the Fernald Site. The over 1,000 acre complex for processing uranium has been demolished and soil contamination has been remediated. With acres of wetlands and prairies replacing the buildings and waste pits. At the end of the project the focus shifted to developing demonstrating the completion of the project and the contract, as well as ensuring a smooth transition of the facility from the DOE's Environmental Management (EM) Program to the DOE's Legacy Management (LM) Program. Working with the DOE, each portion ofmore » the closure contract was examined for specific closure definition. From this negotiation effort the Comprehensive Exit and Transition Plan (CE/T Plan) was written. The CE/T Plan is intended to assist DOE in the analysis that the site is ready for transfer into long-term stewardship (LTS) (also referred to as legacy management) and that Fluor Fernald, Inc. has satisfactorily completed the closure contract statement of work elements. Following the Lessons Learned from the closure of the Rocky Flats Site, the DOE's Legacy Management Program created a matrix of Transition Elements required to ensure adequate information was in place to allow the new prime contractor to perform the Legacy Management scope of work. The transition plan included over 1,000 elements broken down into functional areas and relied on specific Fernald Responsibility Transition Packages (RTPs) for detailed transition actions. The template for Closure and Transition Planning used at the Fernald Site was developed using the best Lessons Learned from across the DOE Complex. The template could be used for other sites, and lessons learned from this closure and transition will be appropriate for all closure projects. (authors)« less
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Managing high-risk patients: the Mass General care management programme
Kodner, Dennis L.
2015-01-01
The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure, standards of practice, collaborative approach to care transitions and information technology tools that were used in the original demonstration project. PMID:26417211
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Medical management and leadership: a time of transition?
Dickinson, Helen; Phelps, Grant; Loh, Erwin; Bismark, Marie
2017-07-01
Perspectives on medical management and leadership are in a time of transition, but there is much we still need to understand better. This paper explores some of the tensions and dilemmas inherent in understandings of medical management and leadership. © 2017 Royal Australasian College of Physicians.
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Development of a decision support tool to better manage Alabama's rural public transit vehicles
DOT National Transportation Integrated Search
2000-01-01
In an ongoing effort to improve mobility and quality of life for Alabama's citizens, researchers at the University of Alabama in Huntsville are working to improve the state's ability to manage its rural transit fleet. This fleet management consists o...
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Nicolo, Giuseppe; Dimaggio, Giancarlo; Procacci, Michele; Semerari, Antonio; Carcione, Antonino; Pedone, Roberto
2008-11-01
This study uses the Grid of Problematic States (GPS) to examine Lisa's case, one of the most successful in the York Psychotherapy Depression Project. This study tried to assess whether the contents of mental experience form stable clusters consistent with a diagnosis of depression. It was possible with the GPS to pinpoint problematic states typical of depression and trace the transitional states occurring in Lisa between two different mental states: depressive and well-being. The GPS analysis suggested that the treatment successfully managed to deal with symptoms and to change the patient's thought themes and emotions. At the end of treatment, Lisa was less sad and displayed some anger, and a state of being nurtured emerged.
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Wright, J; Elwell, L; McDonagh, J E; Kelly, D A; Wray, J
2017-02-01
Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: "emotional impact of transplantation," "protection vs. independence," and "ending relationships and changing roles." Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a "managerial" to a "supervisory" role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Zig-zag tape influence in NREL Phase VI wind turbine
NASA Astrophysics Data System (ADS)
Gomez-Iradi, Sugoi; Munduate, Xabier
2014-06-01
Two bladed 10 metre diameter wind turbine was tested in the 24.4m × 36.6m NASA-Ames wind tunnel (Phase VI). These experiments have been extensively used for validation purposes for CFD and other engineering tools. The free transition case (S), has been, and is, the most employed one for validation purposes, and consist in a 3° pitch case with a rotational speed of 72rpm upwind configuration with and without yaw misalignment. However, there is another less visited case (M) where identical configuration was tested but with the inclusion of a zig-zag tape. This was called transition fixed sequence. This paper shows the differences between the free and the fix transition cases, that should be more appropriate for comparison with fully turbulent simulations. Steady k-ω SST fully turbulent computations performed with WMB CFD method are compared with the experiments showing, better predictions in the attached flow region when it is compared with the transition fixed experiments. This work wants to prove the utility of M case (transition fixed) and show its differences respect the S case (free transition) for validation purposes.
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Transition of Care from Childhood to Adulthood: Congenital Adrenal Hyperplasia.
Bachelot, Anne
2018-01-01
Deficiency of the 21-hydroxylase enzyme is the most common form of congenital adrenal hyperplasia (CAH), accounting for more than 95% of the cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, impaired bone mineral density, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and practitioners. In adulthood, the aims of the medical treatment are to substitute cortisol and, when necessary, aldosterone deficiency, to ensure normal fertility, and to avoid the long-term consequences of glucocorticoid use on bone, metabolism, and cardiovascular risk. Recent data suggest that poor health status is likely to begin in adolescence and persist into adulthood, highlighting the importance of this time period in a patient's endocrine care. During transition from pediatric to adult specific care, a shift in treatment goals is thus needed. Successful transition from pediatric to adult health care requires a regular follow-up of patients by a multidisciplinary team including pediatric endocrinologists, urologists, gynecologists, psychiatrists, and adult endocrinologists. All of this could be included in a specific therapeutic education program regarding transition and/or CAH. © 2018 S. Karger AG, Basel.
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Naeem, Farooq; Johal, Rupinder K; Mckenna, Claire; Calancie, Olivia; Munshi, Tariq; Hassan, Tariq; Nasar, Amina; Ayub, Muhammad
2017-01-01
Cognitive behavioral therapy (CBT) is found to be effective for common mental disorders and has been delivered in self-help and guided self-help formats. Crisis and transitional case management (TCM) services play a vital role in managing clients in acute mental health crises. It is, therefore, an appropriate setting to try CBT in guided self-help format. This was a preliminary evaluation of a formulation-driven cognitive behavioral guided self-help. Thirty-six (36) consenting participants with a diagnosis of nonpsychotic illness, attending crisis and the TCM services in Kingston, Canada, were recruited in this study. They were randomly assigned to the guided self-help plus treatment as usual (TAU) (treatment group) or to TAU alone (control group). The intervention was delivered over 8-12 weeks. Assessments were completed at baseline and 3 months after baseline. The primary outcome was a reduction in general psychopathology, and this was done using Clinical Outcomes in Routine Evaluation - Outcome Measure. The secondary outcomes included a reduction in depression, measured using the Hospital Anxiety and Depression Scale, and reduction in disability, measured using the World Health Organization Disability Assessment Schedule 2.0. Participants in the treatment group showed statistically significant improvement in overall psychopathology ( P <0.005), anxiety and depression ( P <0.005), and disability ( P <0.005) at the end of the trial compared with TAU group. A formulation-driven cognitive behavioral guided self-help was feasible for the crisis and TCM clients and can be effective in improving mental health, when compared with TAU. This is the first report of a trial of guided self-help for clients attending crisis and TCM services.
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ERIC Educational Resources Information Center
European Training Foundation, Turin (Italy).
This document presents a management tool kit on training needs assessment and program design for countries in transition to a market economy. Chapter 1 describes the tool's development within the framework of the project called Strengthening of Partnership between Management Training Institutions and Companies, Ukraine-Kazakhstan-Kyrgyzstan.…
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Manager’s Guide to Technology Transition in an Evolutionary Acquisition Environment
2005-06-01
program managers, product managers, staffs, and organizations that manage the development , procurement, production, and fielding of systems...rapidly advancing technologies. Technology transitions can occur during the development of systems, or even after a system has been in the field ...Documentation Evolutionary acquisition is an acquisition strategy that defines, develops , produces or acquires, and fields an initial hardware or software
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Model of urban water management towards water sensitive city: a literature review
NASA Astrophysics Data System (ADS)
Maftuhah, D. I.; Anityasari, M.; Sholihah, M.
2018-04-01
Nowadays, many cities are facing with complex issues such as climate change, social, economic, culture, and environmental problems, especially urban water. In other words, the city has to struggle with the challenge to make sure its sustainability in all aspects. This research focuses on how to ensure the city sustainability and resilience on urban water management. Many research were not only conducted in urban water management, but also in sustainability itself. Moreover, water sustainability shifts from urban water management into water sensitive city. This transition needs comprehensive aspects such as social, institutional dynamics, technical innovation, and local contents. Some literatures about model of urban water management and the transition towards water sensitivity had been reviewed in this study. This study proposed discussion about model of urban water management and the transition towards water sensitive city. Research findings suggest that there are many different models developed in urban water management, but they are not comprehensive yet and only few studies discuss about the transition towards water sensitive and resilience city. The drawbacks of previous research can identify and fulfill the gap of this study. Therefore, the paper contributes a general framework for the urban water management modelling studies.
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Business and Management Education in Transitioning and Developing Countries: A Handbook
ERIC Educational Resources Information Center
McIntyre, John R., Ed.; Alon, Ilan, Ed.
2005-01-01
Business education is a critical ingredient in establishing a viable middle class of managers in transitioning and developing economies. Compiled in association with the Center for International Business Education and Research, this comprehensive examination of business and management education, pedagogical models, and curricula innovations in…
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Malaria investigation and treatment of children admitted to county hospitals in western Kenya.
Amboko, Beatrice I; Ayieko, Philip; Ogero, Morris; Julius, Thomas; Irimu, Grace; English, Mike
2016-10-18
Up to 90 % of the global burden of malaria morbidity and mortality occurs in sub-Saharan Africa and children under-five bear a disproportionately high malaria burden. Effective inpatient case management can reduce severe malaria mortality and morbidity, but there are few reports of how successfully international and national recommendations are adopted in management of inpatient childhood malaria. A descriptive cross-sectional study of inpatient malaria case management practices was conducted using data collected over 24 months in five hospitals from high malaria risk areas participating in the Clinical Information Network (CIN) in Kenya. This study describes documented clinical features, laboratory investigations and treatment of malaria in children (2-59 months) and adherence to national guidelines. A total of 13,014 children had a malaria diagnosis on admission to the five hospitals between March, 2014 and February, 2016. Their median age was 24 months (IQR 12-36 months). The proportion with a diagnostic test for malaria requested was 11,981 (92.1 %). Of 10,388 patients with malaria test results documented, 8050 (77.5 %) were positive and anti-malarials were prescribed in 6745 (83.8 %). Malaria treatment was prescribed in 1613/2338 (69.0 %) children with a negative malaria result out of which only 52 (3.2 %) had a repeat malaria test done as recommended in national guidelines. Documentation of clinical features was good across all hospitals, but quinine remained the most prescribed malaria drug (47.2 % of positive cases) although a transition to artesunate (46.1 %) was observed. Although documented clinical features suggested approximately half of positive malaria patients were not severe cases artemether-lumefantrine was prescribed on admission in only 3.7 % cases. Despite improvements in inpatient malaria care, high rates of presumptive treatment for test negative children and likely over-use of injectable anti-malarial drugs were observed. Three years after national policy change, there is a gradual transition to artesunate. Continued efforts to support improved routine inpatient malaria care through dissemination and implementation of guidelines, and access to recommended drugs are needed together with improved capacity of hospitals to investigate other causes of severe illness in children. Efforts to improve clinical information could help track progress.
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Clinician roles and responsibilities during care transitions of older adults.
Schoenborn, Nancy L; Arbaje, Alicia I; Eubank, Kathryn J; Maynor, Kenric; Carrese, Joseph A
2013-02-01
To identify the perceived roles and responsibilities of clinicians during care transitions of older adults. Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated. An acute care hospital, a skilled nursing facility, two community-based outpatient practices, and one home healthcare agency. Forty healthcare professionals directly involved in care transitions of older adults (18 physicians, 11 home healthcare administrative and field staff, four social workers, three nurse practitioners, three physician assistants, and one hospital case manager). Perspectives of healthcare professionals regarding clinicians' roles and responsibilities during care transitions were examined and described. Content analysis revealed several themes: components of clinicians' roles during care transitions; congruence between self- and others' perceived ideal roles but incongruence between ideal and routine roles; ambiguity in accountability in the postdischarge period; factors prompting clinicians to act closer to ideal roles; and barriers to performing ideal roles. A conceptual framework was created to summarize clinicians' roles during care transitions. This study reports differences between what healthcare professionals perceive as ideal roles of clinicians during care transitions and what clinicians actually do routinely. Certain patient and clinician factors prompt clinicians to act closer to the ideal roles. Multiple barriers interfere with consistent practice of ideal roles. Future investigations could evaluate interventions targeting various components of the conceptual framework and relevant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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A Guide to Transitions in Education and Training Systems.
1980-06-01
possessing high power and force and somewhat approachable in his position. If A2 is critical to the success of the change, the best approach may be to have...transition model. In this section we will highlight the problems unique to the transition state and outline a coordinated approach for its management. As...Essential to the effective management of the transition period is: - Psychological acceptance of uncertainty on the part of key leaders; - Clear and
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Alternative Fuels Data Center: Mass Transit
traveled and fuel used by private vehicles. Vehicle fleet managers, corporate decision makers, and public effective incentives for fleet managers and corporate decision makers to build mass transit ridership
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Transit management certificate program.
DOT National Transportation Integrated Search
2012-07-01
TTI worked closely with the Landscape Architecture and Urban Planning Department : (LAUP) of Texas A&M University (TAMU) to develop a transit management certificate : focus for the current Graduate Certificate in Transportation Planning (CTP) housed ...
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Bowers, Len; James, Karen; Quirk, Alan; Wright, Steve; Williams, Hilary; Stewart, Duncan
2013-07-01
Although individual conflict and containment events among acute psychiatric inpatients have been studied in some detail, the relationship of these events to each other has not. In particular, little is known about the temporal order of events for individual patients. This study aimed to identify the most common pathways from event to event. A sample of 522 patients was recruited from 84 acute psychiatric wards in 31 hospital locations in London and the surrounding areas during 2009-2010. Data on the order of conflict and containment events were collected for the first two weeks of admission from patients' case notes. Event-to-event transitions were tabulated and depicted diagrammatically. Event types were tested for their most common temporal placing in sequences of events. Most conflict and containment occurs within and between events of the minimal triangle (verbal aggression, de-escalation, and PRN medication), and the majority of these event sequences conclude in no further events; a minority transition to other, more severe, events. Verbal abuse and medication refusal were more likely to start sequences of disturbed behaviour. Training in the prevention and management of violence needs to acknowledge that a gradual escalation of patient behaviour does not always occur. Verbal aggression is a critical initiator of conflict events, and requires more detailed and sustained research on optimal management and prevention strategies. Similar research is required into medication refusal by inpatients.
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Khan, Mohammad Iqbal; Tariq, Mohammad; Rashid, Danyal
2008-01-01
Carotid endarterectomy is the most commonly performed vascular surgical procedure. One of the complications of carotid endarterectomy is Pseudoaneurysm of the carotid artery frequently managed by endo-vascular technique. Pseudoaneurysm caused by other aetiological factors is rare entity. Penetrating trauma and neck surgery are known but very rare causes of pseudo aneurysm of the carotid artery. We have successfully managed a case of carotid artery pseudoaneurysm caused by incision and drainage of parapharyngeal abscess. This surgery also leads to the palsy of right vagus nerve causing complete hoarseness of voice. The patient presented with Transit Ischaemic Attacks (TIA) and amurosis fugos. Resection of aneurysm and reconstruction of right carotid artery lead to complete recovery. Vocal cord palsy was managed by Vox implant injection leading to full recovery.
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Recentralization within decentralization: County hospital autonomy under devolution in Kenya
Manyara, Anthony M.; Molyneux, Sassy; Tsofa, Benjamin
2017-01-01
Background In 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning. Methods We used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning. Findings Devolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care. Conclusion Increasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions. PMID:28771558
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Quetiapine-induced hypertriglyceridaemia causing acute pancreatitis.
Franco, John Mark; Vallabhajosyula, Saraschandra; Griffin, Timothy John
2015-05-14
Second-generation antipsychotics have well-known metabolic side effects such as hyperlipidaemia and hyperglycaemia. A middle-aged man presented with epigastric and flank pain associated with nausea, and was noted to have elevated triglycerides (3590 mg/dL or 40.53 mmol/L), lipase and glucose. Haematological parameters revealed neutropenia with pancytopaenia. The patient was started on conservative management for acute pancreatitis, and on intravenous insulin and oral gemfibrozil for lowering of his triglycerides. He gradually improved and was transitioned to oral atorvastatin and fenofibrate. His triglycerides, glucose and leucocyte counts normalised at discharge and he was transitioned to ziprasidone. The combination of hypertriglyceridaemia, worsening hyperglycaemia and neutropenia made us suspect quetiapine as the causative agent. Medications cause only 0.1-7% of acute pancreatitis cases, with quetiapine implicated in only five-reported cases. Hypertriglyceridaemia (>600 mg/dL or 6.77 mmol/L) is frequently reported with quetiapine use, but severe hypertriglyceridaemia (>1000 mg/dL or 11.29 mmol/L) has been reported in <10 patients. 2015 BMJ Publishing Group Ltd.
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Microscopic origin of black hole reentrant phase transitions
NASA Astrophysics Data System (ADS)
Zangeneh, M. Kord; Dehyadegari, A.; Sheykhi, A.; Mann, R. B.
2018-04-01
Understanding the microscopic behavior of the black hole ingredients has been one of the important challenges in black hole physics during the past decades. In order to shed some light on the microscopic structure of black holes, in this paper, we explore a recently observed phenomenon for black holes namely reentrant phase transition, by employing the Ruppeiner geometry. Interestingly enough, we observe two properties for the phase behavior of small black holes that leads to reentrant phase transition. They are correlated and they are of the interaction type. For the range of pressure in which the system underlies reentrant phase transition, it transits from the large black holes phase to the small one which possesses higher correlation than the other ranges of pressures. On the other hand, the type of interaction between small black holes near the large/small transition line differs for usual and reentrant phase transitions. Indeed, for the usual case, the dominant interaction is repulsive whereas for the reentrant case we encounter an attractive interaction. We show that in the reentrant phase transition case, the small black holes behave like a bosonic gas whereas in the usual phase transition case, they behave like a quantum anyon gas.
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Kind, Amy J H; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth
2016-02-01
The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
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Survival tactics for managing the hospital marketing effort.
Schaupp, D L; Ponzurick, T G; Schaupp, F W
1994-01-01
Hospital marketing is an intricate and complex process. Especially difficult is the transition the hospital marketer must make from designing marketing strategies to implementing those strategies. This transition usually causes the marketer to call upon a different set of skills. These skills involve managing the personnel needed to implement the designed marketing strategy. Unfortunately, little in the way of formal training is provided the marketer for developing these management skills. Therefore, the authors have comprised a series of tactical procedures designed to assist the hospital marketer to survive this transition. Using these tactics for decision-making guidelines may help to improve the management of the hospital's marketing effort.
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Schmidt, Silke; Markwart, Henriette; Bomba, Franziska; Muehlan, Holger; Findeisen, Annette; Kohl, Martina; Menrath, Ingo; Thyen, Ute
2018-04-01
Patient education programs (PEPs) to improve disease management are part of standard and regular treatment in adolescents with diabetes. In Germany, youth with inflammatory bowel disease (IBD) receive individual counseling but not PEPs in group settings. Generic PEPs have been developed in order to improve transition from child-centered to adolescent health services. The aim of the study was to investigate the effects of a transition-oriented PEP on quality of life (QoL) and self-management in young patients with IBD (PEP naive), compared to patients with diabetes (familiar with PEPs). A 2-day transition workshop was oriented at improving psychosocial skills and addressed both generic as well as specific aspects of the condition. A controlled trial on the outcomes of a generic transition-oriented PEP was conducted in 14- to 20-year-old patients with IBD (n = 99) and diabetes (n = 153). Transition competence and QoL were assessed at baseline and 6-month follow-up. Results show that the intervention lead to a significant increase in QoL only in patients with IBD. The PEP significantly improved transition competence in both groups, however to a higher extent in subjects with IBD. Transition-oriented PEPs can have differential effects in different patient groups. However, this needs further longitudinal investigations. What is Known: • To date, evidence has accumulated concerning the effectiveness of patient education programs (PEPs) in pediatric health care for chronic conditions such as type 1 diabetes, asthma, atopic dermatitis, or obesity but is less documented in inflammatory bowel disease (IBD). In particular, PEPs in the transition period have not been investigated in youth with IBD. • The current study focuses on evaluating a PEP for transition preparation and management designed to be generically used across different chronic conditions since many aspects of managing chronic conditions share commonalities across conditions. The 2-day workshop included condition-specific modules adapted to the specific medical needs but was otherwise similar in quality and organization among different conditions. What is New: • The transition-oriented PEP was effective in enhancing self-management and transition management skills in both patients with IBD and diabetes; however, effects were higher in youth with IBD. A significant impact of the intervention on patients' QoL compared to the control group was only identified in youth with IBD. • We recommend that patients with IBD have access to PEP as a standard treatment as well as to a transition program during the course of illness.
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2013-01-01
Background Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. Method We report the findings of a survey of 96 healthcare professionals working in children’s (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Results Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. Conclusions We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management. PMID:23842080
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Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Swift, Katie D; Hollis, Chris
2013-07-10
Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.
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The Last 100 Days of a Presidency: What Boards Need to Know and Do
ERIC Educational Resources Information Center
Johnson, Sandra S.; Eckel, Peter
2013-01-01
Many boards will find themselves hiring a new president in the near future, as higher education faces unprecedented turnover in its top leaders. Not only must they manage the transition of a new president into the institution, but they must also manage the transition of the current president out. Best practices for the transition are discussed in…
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Impact Of Radio Frequency Refarming On Transit Communications, Tcrp Report 11
DOT National Transportation Integrated Search
1996-01-01
THIS REPORT WILL BE OF INTEREST TO GENERAL MANAGERS, OPERATIONS MANAGERS, AND COMMUNICATIONS SPECIALISTS RESPONSIBLE FOR COMMUNICATIONS SYSTEMS WITHIN TRANSIT AND PARATRANSIT ORGANIZATIONS. THE REPORT PROVIDES INFORMATION CONCERNING THE FEDERAL COMMU...
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Safety Management Information Statistics (SAMIS) - 1993 Annual Report
DOT National Transportation Integrated Search
1995-05-01
The 1993 Safety Management Information Statistics (SAMIS) report, now in its fourth year of publication, is a compilation and analysis of transit accident and casualty statistics uniformly collected from approximately 400 transit agencies throughout ...
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Integrating transit with road pricing projects.
DOT National Transportation Integrated Search
2013-06-01
This study examined various levels of the treatment of public transportation in conjunction with the implementation of : managed lane highway projects. It details the ranges of transit investments identified in and associated with managed : lanes tha...
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Best practices in bus dispatch [summary].
DOT National Transportation Integrated Search
2012-01-01
In 2007, the National Center for Transit Research : sponsored a study of best practices in extraboard : operator management, finding that in most transit : agencies, extraboard manpower is managed by : dispatchers as one of their many functions. This...
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Chernomas, Wanda M; Care, W Dean; McKenzie, Jo-Ann Lapointe; Guse, Lorna; Currie, Jan
2010-01-01
The workplace for new graduates must be a constructive learning environment to facilitate their development. Nurse managers need new graduates who can "hit the ground running." Conflict between the needs of new nurses and the realities of the workplace often creates role confusion and tension in new graduates and threatens employers' ability to retain them. As part of a larger study that examined the effectiveness of a new strategy on new nurse retention and workplace integration, we conducted focus groups with new nurses and nurse managers. This paper discusses the perspectives of new nurses on their role transition from graduates to practising professionals and the perspectives of nurse managers on the workplace integration of new nurses. The thematic findings integrate new nurses' perspectives on their needs during role transition with the perspectives of nurse managers in meeting those needs. The discussion includes strategies to facilitate successful transition and integration of new nurses into the workplace within the context of recruitment and retention.
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ERIC Educational Resources Information Center
Haynie, J. Michael; Shepherd, Dean
2011-01-01
Career researchers have focused on the mechanisms related to career progression. Although less studied, situations in which traumatic life events necessitate a discontinuous career transition are becoming increasingly prevalent. Employing a multiple case study method, we offer a deeper understanding of such transitions by studying an extreme case:…
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iSAW: Integrating Structure, Actors, and Water to study socio-hydro-ecological systems
NASA Astrophysics Data System (ADS)
Hale, Rebecca L.; Armstrong, Andrea; Baker, Michelle A.; Bedingfield, Sean; Betts, David; Buahin, Caleb; Buchert, Martin; Crowl, Todd; Dupont, R. Ryan; Ehleringer, James R.; Endter-Wada, Joanna; Flint, Courtney; Grant, Jacqualine; Hinners, Sarah; Horsburgh, Jeffery S.; Jackson-Smith, Douglas; Jones, Amber S.; Licon, Carlos; Null, Sarah E.; Odame, Augustina; Pataki, Diane E.; Rosenberg, David; Runburg, Madlyn; Stoker, Philip; Strong, Courtenay
2015-03-01
Urbanization, climate, and ecosystem change represent major challenges for managing water resources. Although water systems are complex, a need exists for a generalized representation of these systems to identify important components and linkages to guide scientific inquiry and aid water management. We developed an integrated Structure-Actor-Water framework (iSAW) to facilitate the understanding of and transitions to sustainable water systems. Our goal was to produce an interdisciplinary framework for water resources research that could address management challenges across scales (e.g., plot to region) and domains (e.g., water supply and quality, transitioning, and urban landscapes). The framework was designed to be generalizable across all human-environment systems, yet with sufficient detail and flexibility to be customized to specific cases. iSAW includes three major components: structure (natural, built, and social), actors (individual and organizational), and water (quality and quantity). Key linkages among these components include: (1) ecological/hydrologic processes, (2) ecosystem/geomorphic feedbacks, (3) planning, design, and policy, (4) perceptions, information, and experience, (5) resource access and risk, and (6) operational water use and management. We illustrate the flexibility and utility of the iSAW framework by applying it to two research and management problems: understanding urban water supply and demand in a changing climate and expanding use of green storm water infrastructure in a semi-arid environment. The applications demonstrate that a generalized conceptual model can identify important components and linkages in complex and diverse water systems and facilitate communication about those systems among researchers from diverse disciplines.
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Brandt, Silke; Lieven, Elena; Tomasello, Michael
2016-01-01
ABSTRACT Children and adults follow cues such as case marking and word order in their assignment of semantic roles in simple transitives (e.g., the dog chased the cat). It has been suggested that the same cues are used for the interpretation of complex sentences, such as transitive relative clauses (RCs) (e.g., that’s the dog that chased the cat) (Bates, Devescovi, & D’Amico, 1999). We used a pointing paradigm to test German-speaking 3-, 4-, and 6-year-old children’s sensitivity to case marking and word order in their interpretation of simple transitives and transitive RCs. In Experiment 1, case marking was ambiguous. The only cue available was word order. In Experiment 2, case was marked on lexical NPs or demonstrative pronouns. In Experiment 3, case was marked on lexical NPs or personal pronouns. Whereas the younger children mainly followed word order, the older children were more likely to base their interpretations on the more reliable case-marking cue. In most cases, children from both age groups were more likely to use these cues in their interpretation of simple transitives than in their interpretation of transitive RCs. Finally, children paid more attention to nominative case when it was marked on first-person personal pronouns than when it was marked on third-person lexical NPs or demonstrative pronouns, such as der Löwe ‘the-NOM lion’ or der ‘he-NOM.’ They were able to successfully integrate this case-marking cue in their sentence processing even when it appeared late in the sentence. We discuss four potential reasons for these differences across development, constructions, and lexical items. (1) Older children are relatively more sensitive to cue reliability. (2) Word order is more reliable in simple transitives than in transitive RCs. (3) The processing of case marking might initially be item-specific. (4) The processing of case marking might depend on its saliency and position in the sentence. PMID:27019652
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Transfers and transitions between child and adult mental health services.
Paul, Moli; Ford, Tamsin; Kramer, Tami; Islam, Zoebia; Harley, Kath; Singh, Swaran P
2013-01-01
Transfer of care from one healthcare provider to another is often understood as a suboptimal version of the process of transition. To separate and evaluate concepts of transfer and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). In a retrospective case-note survey of young people reaching the upper age boundary at six English CAMHS, optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer. Of 154 cases, 76 transferred to AMHS. Failure to transfer resulted mainly from non-referral by CAMHS (n = 12) and refusal by service users (n = 12) rather than refusal by AMHS (n = 7). Four cases met all criteria for optimal transition, 13 met none; continuity of care (n = 63) was met most often. Transfer was common but good transition rare. Reasons for failure to transfer differ from barriers to transition. Transfer should be investigated alongside transition in research and service development.
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Garvey, Katharine; Laffel, Lori
2018-01-01
Adolescence and young adulthood are times of multiple developmental changes, including physiological, social, emotional, cognitive, and behavioral transformations. The adolescent or young adult living with type 1 or type 2 diabetes must navigate the vicissitudes of these developmental stages while managing the rigors and self-care demands of these conditions. Diabetes in children is managed by adults, mainly by parents. As the child matures, diabetes management tasks transition from parents to the developing teen. This transition in care is a process that generally begins in early adolescence and culminates when the older teen successfully accepts and manages diabetes self-care tasks. Along with the transitions in diabetes management tasks, older teens and young adults must be prepared for transfer from the pediatric diabetes care team to an adult-focused health care team. Numerous publications have described the challenges associated with both the process of transition and the act of transfer. Lack of preparation during transition followed by unsuccessful transfer often results in gaps in diabetes care exceeding 6 months, deterioration in glycemic control, increase in emergency room use and hospitalization, and emergence of diabetes complications among older teens and young adults. There is need for ongoing research internationally to address these deficiencies in order to improve the short- and long-term health of young persons with diabetes. © 2018 S. Karger AG, Basel.
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Qiao, Jianmin; Yu, Deyong; Wu, Jianguo
2018-02-01
Agricultural ecosystem management needs to ensure food production and minimize soil erosion and nitrogen (N) leaching under climate change and increasingly intensive human activity. Thus, the mechanisms through which climatic and management factors affect crop production, soil erosion, and N leaching must be understood in order to ensure food security and sustainable agricultural development. In this study, we adopted the GIS-based Environmental Policy Integrated Climate (EPIC) model to simulate crop production, soil erosion, and N leaching, and used a partial least squares regression model to evaluate the contributions of climate variables (solar radiation, precipitation, wind speed, relative humidity, and maximum and minimum temperature) and management factors (irrigation, fertilization, and crop cultivation area) on agricultural ecosystem services (AES) in the agro-pastoral transitional zone (APTZ) of northern China. The results indicated that crop production and N leaching markedly increased, whereas soil erosion declined from 1980 to 2010 in the APTZ. Management factors had larger effects on the AES than climate change. Among the climatic variables, daily minimum temperature was the most important contributor to the variations in ecosystem services of wheat, maize, and rice. Spatial changes in the cultivated area most affected crop production, soil erosion, and N leaching for majority of the cultivated areas of the three crops, except for the wheat-cultivated area, where the dominant factor for N leaching was fertilization. Although a tradeoff existed between crop production and negative environmental effects, compromises were possible. These findings provide new insights into the effects of climatic and management factors on AES, and have practical implications for improving crop production while minimizing negative environmental impacts. Copyright © 2017 Elsevier B.V. All rights reserved.
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Everitt, Ian K; Gerardin, Jennifer F; Rodriguez, Fred H; Book, Wendy M
2017-05-01
The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients. © 2017 Wiley Periodicals, Inc.
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Geology and evolution of lakes in north-central Florida
Kindinger, J.L.; Davis, J.B.; Flocks, J.G.
1999-01-01
Fluid exchange between surficial waters and groundwater in karst environments, and the processes that control exchange, are of critical concern to water management districts and planners. High-resolution seismic data were collected from 30 lakes of north-central Florida. In each case study, lake structure and geomorphology were controlled by solution and/or mechanical processes. Processes that control lake development are twofold: (1) karstification or dissolution of the underlying limestone, and (2) the collapse, subsidence, or slumping of overburden to form sinkholes. Initial lake formation is directly related to the karst topography of the underlying host limestone. Case studies have shown that lakes can be divided by geomorphic types into progressive developmental phases: (1) active subsidence or collapse phase (young); (2) transitional phase (middle age); (3) baselevel phase (mature); and (4) polje (drowned prairie) - broad flat-bottom that have one or all phases of sinkhole. Using these criteria, Florida lakes can be classified by size, fill, subsurface features, and geomorphology.Fluid exchange between surficial waters and groundwater in karst environments, and the processes that control exchange, are of critical concern to water management districts and planners. High-resolution seismic data were collected from 30 lakes of north-central Florida. In each case study, lake structure and geomorphology were controlled by solution and/or mechanical processes. Processes that control lake development are twofold: (1) karstification or dissolution of the underlying limestone, and (2) the collapse, subsidence, or slumping of overburden to form sinkholes. Initial lake formation is directly related to the karst topography of the underlying host limestone. Case studies have shown that lakes can be divided by geomorphic types into progressive developmental phased: (1) active subsidence or collapse phase (young); (2) transitional phase (middle age); (3) baselevel phase (mature); and (4) polje (drowned prairie) - broad flat-bottom that have one or all phases of sinkhole. Using these criteria, Florida lakes can be classified by size, fill, subsurface features, and geomorphology.
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Safety Management Information Statistics (SAMIS) - 1991 Annual Report
DOT National Transportation Integrated Search
1993-02-01
The Safety Management Information Statistics 1991 Annual Report is a compilation and analysis of mass transit accident and casualty statistics reported by transit systems in the United States during 1991, under FTA's Section 15 reporting system.
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Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization
Pollack, Ari H; Backonja, Uba; Miller, Andrew D.; Mishra, Sonali R.; Khelifi, Maher; Kendall, Logan; Pratt, Wanda
2016-01-01
Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs. PMID:27500285
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Seeing about soil — management lessons from a simple model for renewable resources
NASA Astrophysics Data System (ADS)
Lichtenegger, Klaus; Schappacher, Wilhelm
2014-02-01
Employing an effective cellular automata model, we investigate and analyze the build-up and erosion of soil. Depending on the strategy employed for handling agricultural production, in many cases we find a critical dependence on the prescribed production target, with a sharp transition between stable production and complete breakdown of the system. Strategies which are particularly well-suited for mimicking real-world management approaches can produce almost cyclic behavior, which can also either lead to sustainable production or to breakdown. While designed to describe the dynamics of soil evolution, this model is quite general and may also be useful as a model for other renewable resources and may even be employed in other disciplines like psychology.
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Gibson-Scipio, Wanda; Gourdin, Dustin; Krouse, Helene J
2015-01-01
Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition. Copyright © 2015 Elsevier Inc. All rights reserved.
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Zalewski, Kathryn
2007-03-01
Physical therapy intervention for those with chronic disabling conditions typically follows an episode of care approach: therapists provide services when a decrement in functional performance occurs such that individuals require intervention to return to baseline performance. Attention to the psychosocial supports required for successful transition can be unintentionally minimized when the focus of an episode of care follows a change in physical function. The purpose of this case report is to present and discuss the challenges to successful community reintegration following physical therapy intervention with an emphasis on developing independent exercise habits in management of a person with multiple sclerosis. RW, presented in this case study, is a 52-year-old man diagnosed with progressive multiple sclerosis five years before self-referral to a pro bono physical therapy clinic.
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Crosby, Lori E; Quinn, Charles T; Kalinyak, Karen A
2015-04-01
The lifespan of patients with sickle-cell disease (SCD) continues to increase, and most affected individuals in high-resource countries now live into adulthood. This necessitates a successful transition from pediatric to adult health care. Care for transitioning patients with SCD often falls to primary care providers who may not be fully aware of the many challenges and issues faced by patients and the current management strategies for SCD. In this review, we aim to close the knowledge gap between primary care providers and specialists who treat transitioning patients with SCD. We describe the challenges and issues encountered by these patients, and we propose a biopsychosocial multidisciplinary approach to the management of the identified issues. Examples of this approach, such as transition-focused integrated care models and quality improvement collaboratives, with the potential to improve health outcomes in adulthood are also described.
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The EBM-DPSER Conceptual Model: Integrating Ecosystem Services into the DPSIR Framework
Kelble, Christopher R.; Loomis, Dave K.; Lovelace, Susan; Nuttle, William K.; Ortner, Peter B.; Fletcher, Pamela; Cook, Geoffrey S.; Lorenz, Jerry J.; Boyer, Joseph N.
2013-01-01
There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within a framework already familiar to resource managers. PMID:23951002
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A first-line nurse manager's goal-profile.
Johansson, Gunilla; Pörn, Ingmar; Theorell, Töres; Gustafsson, Barbro
2007-01-01
The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfillment. The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice.
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The EBM-DPSER conceptual model: integrating ecosystem services into the DPSIR framework.
Kelble, Christopher R; Loomis, Dave K; Lovelace, Susan; Nuttle, William K; Ortner, Peter B; Fletcher, Pamela; Cook, Geoffrey S; Lorenz, Jerry J; Boyer, Joseph N
2013-01-01
There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within a framework already familiar to resource managers.
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Teaching for Democracy in the Absence of Transitional Justice: The Case of Northern Ireland
ERIC Educational Resources Information Center
Worden, Elizabeth Anderson; Smith, Alan
2017-01-01
In many cases, political circumstances do not allow formal for transitional justice processes to occur in countries undergoing a transition from a violent past. In this paper, we ask if education can become a default front line of transitional justice work in the absence of explicit action by the state to address past injustices. Drawing from…
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-11-07
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Federal Advisory Committee meeting of the Department of Defense Task Force on the Care, Management, and...
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Forecasting timber, biomass, and tree carbon pools with the output of state and transition models
Xiaoping Zhou; Miles A. Hemstrom
2012-01-01
The Integrated Landscape Assessment Project (ILAP) uses spatial vegetation data and state and transition models (STM) to forecast future vegetation conditions and the interacting effects of natural disturbances and management activities. Results from ILAP will help land managers, planners, and policymakers evaluate management strategies that reduce fire risk, improve...
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The role and significance of nurses in managing transitions to palliative care: a qualitative study
Kirby, Emma; Broom, Alex; Good, Phillip
2014-01-01
Objectives Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses’ accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions. Design Qualitative study using semistructured interviews. Setting Two health services with public as well as private clinical environments in a major metropolitan area of Australia. Participants Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care. Results Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses’ informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time. Conclusions The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health professionals, patients and families is required to provide a broader interdisciplinary understanding of futility and contributions to the negotiation of palliative care. PMID:25270859
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Influence of governance structure on green stormwater infrastructure investment
Hopkins, Kristina G.; Grimm, Nancy B.; York, Abigail M.
2018-01-01
Communities are faced with the challenge of meeting regulatory requirements mandating reductions in water pollution from stormwater and combined sewer overflows (CSO). Green stormwater infrastructure and gray stormwater infrastructure are two types of water management strategies communities can use to address water pollution. In this study, we used long-term control plans from 25 U.S. cities to synthesize: the types of gray and green infrastructure being used by communities to address combined sewer overflows; the types of goals set; biophysical characteristics of each city; and factors associated with the governance of stormwater management. These city characteristics were then used to identify common characteristics of “green leader” cities—those that dedicated >20% of the control plan budget in green infrastructure. Five “green leader” cities were identified: Milwaukee, WI, Philadelphia, PA, Syracuse, NY, New York City, NY, and Buffalo, NY. These five cities had explicit green infrastructure goals targeting the volume of stormwater or percentage of impervious cover managed by green infrastructure. Results suggested that the management scale and complexity of the management system are less important factors than the ability to harness a “policy window” to integrate green infrastructure into control plans. Two case studies—Philadelphia, PA, and Milwaukee, WI—indicated that green leader cities have a long history of building momentum for green infrastructure through a series of phases from experimentation, demonstration, and finally—in the case of Philadelphia—a full transition in the approach used to manage CSOs.
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Transformational change in healthcare: an examination of four case studies.
Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D
2016-04-01
Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.
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French policy for managing the post-accident phase of a nuclear accident.
Gallay, F; Godet, J L; Niel, J C
2015-06-01
In 2005, at the request of the French Government, the Nuclear Safety Authority (ASN) established a Steering Committee for the Management of the Post-Accident Phase of a Nuclear Accident or a Radiological Emergency, with the objective of establishing a policy framework. Under the supervision of ASN, this Committee, involving several tens of experts from different backgrounds (e.g. relevant ministerial offices, expert agencies, local information commissions around nuclear installations, non-governmental organisations, elected officials, licensees, and international experts), developed a number of recommendations over a 7-year period. First published in November 2012, these recommendations cover the immediate post-emergency situation, and the transition and longer-term periods of the post-accident phase in the case of medium-scale nuclear accidents causing short-term radioactive release (less than 24 h) that might occur at French nuclear facilities. They also apply to actions to be undertaken in the event of accidents during the transportation of radioactive materials. These recommendations are an important first step in preparation for the management of a post-accident situation in France in the case of a nuclear accident. © The Chartered Institution of Building Services Engineers 2014.
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Preparing your Offshore Organization for Agility: Experiences in India
NASA Astrophysics Data System (ADS)
Srinivasan, Jayakanth
Two strategies that have significantly changed the way we conventionally think about managing software development and sustainment are the family of development approaches collectively referred to as agile methods, and the distribution of development efforts on a global scale. When you combine the two strategies, organizations have to address not only the technical challenges that arise from introducing new ways of working, but more importantly have to manage the 'soft' factors that if ignored lead to hard challenges. Using two case studies of distributed agile software development in India we illustrate the areas that organizations need to be aware of when transitioning work to India. The key issues that we emphasize are the need to recruit and retain personnel; the importance of teaching, mentoring and coaching; the need to manage customer expectations; the criticality of well-articulated senior leadership vision and commitment; and the reality of operating in a heterogeneous process environment.
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The road weather bulletin #2 : road weather management publications and training materials.
DOT National Transportation Integrated Search
2003-03-01
In March of 2001, the Federal Transit Administration (FTA) and the Federal Highway Administration (FHWA) engaged Gannett Fleming, Inc., to develop the first ever Tunnel Management System to benefit both highway and rail transit tunnel owners througho...
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Managing Inventory At A Transitional Facility
NASA Technical Reports Server (NTRS)
Hutchins, Henry A.
1993-01-01
Kennedy Inventory Management System, KIMS, geared to needs of facility in transition from research and development to manufacturing. Operated jointly by several contractors at Kennedy Space Center, KIMS designed to reduce cost and increase efficiency of fabrication and maintenance of spaceflight hardware.
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Applebaum, Mark A; Lawson, Erica F; von Scheven, Emily
2013-01-01
Efforts to facilitate transition of care to adult providers for adolescents with chronic disease are not uniformly successful and many patients encounter challenges. The goal of this study was to assess transition readiness and preferences for tools to aid in the transition process with an emphasis on technology and social media. We surveyed and performed focus groups on patients aged 13-21 years from a pediatric university-based rheumatology and general pediatric practice. Demographics and transition readiness were assessed using a questionnaire. Transition readiness was assessed by examining patient knowledge and independence with care. Focus groups were conducted to elicit perspectives about desirable features of a transition program and useful tools. Thirty-five patients completed surveys; and 20 patients and 13 of their parents participated in a focus group. The median patient age was 17 years and 74.3% were female. A Likert scale (0-10, 10=most) was used to evaluate concern over changing to an adult medical provider, (mean=6.4, SD=2.6), preparedness for disease self-management (mean=6.0, SD=2.8), and perceived importance of self-managing their condition (mean=7.1, SD=3.1). Themes that emerged from focus groups included a desire for support groups with other teens, a preference for using text messaging for communication and a desire for an online health management program. Teens with chronic disease are able to identify health maintenance tasks and strategies that will aid in developing independence with healthcare management. These findings support the idea that developing engaging applications and support groups will assist teens in the transitioning.
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Mass transit : many management successes at WMATA, but capital planning could be enhanced
DOT National Transportation Integrated Search
2001-07-01
In recent years, the Washington Metropolitan Area Transit Authority's (WMATA) public transit system has experienced problems related to the safety and reliability of its transit services, including equipment breakdowns, delays in scheduled service, u...
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Caltrans : transit funding manual : managing the delivery of transit projects
DOT National Transportation Integrated Search
2001-05-01
This manual attempts to provide a step by step transit funding process. Included in this manual : is an overview of Caltrans Division of Mass Transportation, roles and responsibilities in : assisting local agencies to deliver transit projects. Transi...
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NASA Astrophysics Data System (ADS)
Wang, Zhihuan; Nabet, Bahram
2015-12-01
Semiconductor nanowires have been used in a variety of passive and active optoelectronic devices including waveguides, photodetectors, solar cells, light-emitting diodes (LEDs), lasers, sensors, and optical antennas. We review the optical properties of these nanowires in terms of absorption, guiding, and radiation of light, which may be termed light management. Analysis of the interaction of light with long cylindrical/hexagonal structures with subwavelength diameters identifies radial resonant modes, such as Leaky Mode Resonances, or Whispering Gallery modes. The two-dimensional treatment should incorporate axial variations in "volumetric modes,"which have so far been presented in terms of Fabry-Perot (FP), and helical resonance modes. We report on finite-difference timedomain (FDTD) simulations with the aim of identifying the dependence of these modes on geometry (length, width), tapering, shape (cylindrical, hexagonal), core-shell versus core-only, and dielectric cores with semiconductor shells. This demonstrates how nanowires (NWs) form excellent optical cavities without the need for top and bottommirrors. However, optically equivalent structures such as hexagonal and cylindrical wires can have very different optoelectronic properties meaning that light management alone does not sufficiently describe the observed enhancement in upward (absorption) and downward transitions (emission) of light inNWs; rather, the electronic transition rates should be considered. We discuss this "rate management" scheme showing its strong dimensional dependence, making a case for photonic integrated circuits (PICs) that can take advantage of the confluence of the desirable optical and electronic properties of these nanostructures.
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Hoekstra, Anna V; Jairam-Thodla, Arati; Rademaker, Alfred; Singh, Diljeet K; Buttin, Barbara M; Lurain, John R; Schink, Julian C; Lowe, M Patrick
2009-12-01
Evaluation of the impact of a new robotic surgery programme on perioperative outcomes for endometrial cancer A prospective database of all patients undergoing staging for endometrial cancer during July 2007-July 2008 was collected and analysed. Demographic data and perioperative outcomes were compared between cases performed via laparotomy, laparoscopy and robotics. Sixty-five patients underwent staging during the time of data collection (LAP-26, LSC-7, ROB-32). No difference in surgical volume in the year before vs. after robotics was identified. Median operative time for robotics and laparotomy was significantly less than for laparoscopy (p = 0.023). There was no significant difference in lymph node yields between the three groups (p = 0.92). Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05). Median hospital stay was 1 day for the minimally invasive groups. Total number of perioperative inpatient days decreased from 331 to 150 in one year. Practice management of endometrial cancer transitioned from a predominantly open approach (5.6% LSC) to robotics (11% LSC, 49% ROB) within 12 months. Robotic surgery dramatically altered our management of endometrial cancer and was associated with a significant improvement in several perioperative outcomes when compared to laparotomy and laparoscopy. Copyright (c) 2009 John Wiley & Sons, Ltd.
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Stokes, Jonathan; Kristensen, Søren Rud; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter
2017-08-03
Health systems must transition from catering primarily to acute conditions, to meet the increasing burden of chronic disease and multimorbidity. Case management is a popular method of integrating care, seeking to accomplish this goal. However, the intervention has shown limited effectiveness. We explore whether the effects of case management vary in patients with different types of multimorbidity. We extended a previously published quasi-experiment (difference-in-differences analysis) with 2049 propensity matched case management intervention patients, adding an additional interaction term to determine subgroup effects (difference-in-difference-in-differences) by different conceptualisations of multimorbidity: 1) Mental-physical comorbidity versus others; 2) 3+ chronic conditions versus <3; 3) Discordant versus concordant conditions; 4) Cardiovascular/metabolic cluster conditions only versus others; 5) Mental health-associated cluster conditions only versus others; 6) Musculoskeletal disorder cluster conditions only versus others 7) Charlson index >5 versus others. Outcome measures included a variety of secondary care utilisation and cost measures. The majority of conceptualisations suggested little to no difference in effect between subgroups. Where results were significant, the vast majority of effect sizes identified in either direction were very small. The trend across the majority of the results appeared to show very slight increases of admissions with treatment for the most complex patients (highest risk). The exceptions to this, patients with a Charlson index >5 may benefit slightly more from case management with decreased ACSC admissions (effect size (ES): −0.06) and inpatient re-admissions (30 days, ES: −0.05), and patients with only cardiovascular/metabolic cluster conditions may benefit slightly more with decreased inpatient non-elective admissions (ES: −0.12). Only the three significant estimates for the musculoskeletal disorder cluster met the minimum requirement for at least a ‘small’ effect. Two of these estimates in particular were very large. This cluster represented only 0.5% of the total patients analysed, however, so is hugely vulnerable to the effects of outliers, and makes us very cautious of interpreting these as ‘real’ effects. Our results indicate no appropriate multimorbidity subgroup at which to target the case management intervention in terms of secondary care utilisation/cost outcomes. The most complex, highest risk patients may legitimately require hospitalisation, and the intensified management may better identify these unmet needs. End of life patients (e.g. Charlson index >5)/those with only conditions particularly amenable to primary care management (e.g. cardiovascular/metabolic cluster conditions) may benefit very slightly more than others.
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Transitioning youth to adult healthcare: new tools from the Illinois Transition Care Project.
Sanabria, K E; Ruch-Ross, H S; Bargeron, J L; Contri, D A; Kalichman, M A
2015-01-01
To improve youths' transition to adult healthcare, especially for youth with disabilities, The Illinois Transition Care Project created separate, yet complementary, curricula for pediatric and adult-oriented providers. Content from the curricula was tested by practicing physicians. The project created a library of skill worksheets with functional goals for patients. All methods included opportunities to teach life skills to patients to independently manage their conditions. The curricula used Maintenance of Certification (MOC) Part 4 credit as an incentive for physician participation. Pediatric pilot data indicate improvement across all sites and activities. Adult medicine results indicate increased perceived importance and feasibility of accepting young adult patients with childhood conditions. Patient/parent reviewers indicate the tools are understandable, interesting, and effective. Findings suggest the curricula, with MOC Part 4 credit for physicians, are effective in improving transition care. Project results provided new information on population management for transitioning youth and on the use of MOC Part 4 credit as an incentive. Findings have implications for primary care and specialty physicians, team-based care, teaching self-management skills to patients and methods for engaging adult-oriented physicians in the transition process.
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Physicians’ Outlook on ICD-10-CM/PCS and Its Effect on Their Practice
Watzlaf, Valerie; Alkarwi, Zahraa; Meyers, Sandy; Sheridan, Patty
2015-01-01
Background The United States is one of the last countries to change from ICD-9-CM to ICD-10-CM/PCS. The compliance date for implementation of ICD-10-CM/PCS is expected to fall on October 1, 2015. Objectives Evaluate physicians’ perceptions on the change from ICD-9-CM to ICD-10-CM/PCS and its effect on their practice, determine how HIM professionals can assist in this transition, and assess what resources are needed to aid in the transition. Results Twenty physicians were asked to participate in one of three focus groups. Twelve physicians (60 percent) agreed to participate. Top concerns included electronic health record software readiness, increase in documentation specificity and time, ability of healthcare professionals to learn a new language, and inadequacy of current training methods and content. Conclusion Physicians expressed that advantages of ICD-10-CM/PCS were effective data analytics and complexity of patient cases with more specific codes. Health information management professionals were touted as needed during the transition to create simple, clear specialty guides and crosswalks as well as education and training tools specific for physicians. PMID:26807074
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Treatment of severe acute pancreatitis and its complications
Zerem, Enver
2014-01-01
Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder. PMID:25320523
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Tajima, Shogo; Koda, Kenji
2015-01-01
A limited number of pulmonary adenocarcinoma cases with morule-like components have been described to date, and the most frequent histological subtype is papillary-predominant adenocarcinoma. Occasionally, this type of adenocarcinoma is associated with solid-predominant adenocarcinoma. EGFR mutations are predominant in adenocarcinoma with morule-like components, followed by ALK rearrangements. Herein, we present 2 cases of solid-predominant adenocarcinoma with morule-like components harboring either an EGFR or KRAS mutation. This KRAS-mutant case is the first to be associated with morule-like components, to the best of our knowledge. Both cases showed transition between micropapillary and morule-like components. Transition between morule-like and solid components was also observed in both cases. Although a few cases of solid-predominant adenocarcinoma have been shown to harbor morule-like components, this type of transition has not been previously well described. We surmised that the solid components of some EGFR-mutant adenocarcinomas might be derived from morule-like components.
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19 CFR 123.22 - In-transit manifest.
Code of Federal Regulations, 2011 CFR
2011-04-01
... separate in-transit manifest is not required. (b) Additional copies. In the following cases additional... train sheet shall also be presented. (4) In all other cases where no in-transit manifest form is... enter and reenter Canada in a continuing movement en route to a final destination in the United States...
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19 CFR 123.22 - In-transit manifest.
Code of Federal Regulations, 2014 CFR
2014-04-01
... separate in-transit manifest is not required. (b) Additional copies. In the following cases additional... train sheet shall also be presented. (4) In all other cases where no in-transit manifest form is... enter and reenter Canada in a continuing movement en route to a final destination in the United States...
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19 CFR 123.22 - In-transit manifest.
Code of Federal Regulations, 2013 CFR
2013-04-01
... separate in-transit manifest is not required. (b) Additional copies. In the following cases additional... train sheet shall also be presented. (4) In all other cases where no in-transit manifest form is... enter and reenter Canada in a continuing movement en route to a final destination in the United States...
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When Educational Transitions Are Supported by Students
ERIC Educational Resources Information Center
Parrilla, Ángeles; Gallego, Carmen; Sierra, Silvia
2016-01-01
This paper shows how inclusive and participative research is developed into two case studies of students facing educational transitions. The studies were developed in two different places in Spain describing different approaches to support transitions by students. The first case focuses on activities organised and developed together by students…
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Managing critical materials with a technology-specific stocks and flows model.
Busch, Jonathan; Steinberger, Julia K; Dawson, David A; Purnell, Phil; Roelich, Katy
2014-01-21
The transition to low carbon infrastructure systems required to meet climate change mitigation targets will involve an unprecedented roll-out of technologies reliant upon materials not previously widespread in infrastructure. Many of these materials (including lithium and rare earth metals) are at risk of supply disruption. To ensure the future sustainability and resilience of infrastructure, circular economy policies must be crafted to manage these critical materials effectively. These policies can only be effective if supported by an understanding of the material demands of infrastructure transition and what reuse and recycling options are possible given the future availability of end-of-life stocks. This Article presents a novel, enhanced stocks and flows model for the dynamic assessment of material demands resulting from infrastructure transitions. By including a hierarchical, nested description of infrastructure technologies, their components, and the materials they contain, this model can be used to quantify the effectiveness of recovery at both a technology remanufacturing and reuse level and a material recycling level. The model's potential is demonstrated on a case study on the roll-out of electric vehicles in the UK forecast by UK Department of Energy and Climate Change scenarios. The results suggest policy action should be taken to ensure Li-ion battery recycling infrastructure is in place by 2025 and NdFeB motor magnets should be designed for reuse. This could result in a reduction in primary demand for lithium of 40% and neodymium of 70%.
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Managing Critical Materials with a Technology-Specific Stocks and Flows Model
2013-01-01
The transition to low carbon infrastructure systems required to meet climate change mitigation targets will involve an unprecedented roll-out of technologies reliant upon materials not previously widespread in infrastructure. Many of these materials (including lithium and rare earth metals) are at risk of supply disruption. To ensure the future sustainability and resilience of infrastructure, circular economy policies must be crafted to manage these critical materials effectively. These policies can only be effective if supported by an understanding of the material demands of infrastructure transition and what reuse and recycling options are possible given the future availability of end-of-life stocks. This Article presents a novel, enhanced stocks and flows model for the dynamic assessment of material demands resulting from infrastructure transitions. By including a hierarchical, nested description of infrastructure technologies, their components, and the materials they contain, this model can be used to quantify the effectiveness of recovery at both a technology remanufacturing and reuse level and a material recycling level. The model’s potential is demonstrated on a case study on the roll-out of electric vehicles in the UK forecast by UK Department of Energy and Climate Change scenarios. The results suggest policy action should be taken to ensure Li-ion battery recycling infrastructure is in place by 2025 and NdFeB motor magnets should be designed for reuse. This could result in a reduction in primary demand for lithium of 40% and neodymium of 70%. PMID:24328245
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Study of the Careers of Participants in UMTA's Transit Management Programs (Section 10)
DOT National Transportation Integrated Search
1983-11-01
This paper contains the results of a study of two Transit Management Training Programs for which UMTA provides fellowships. From 1969 to 1982, 428 fellowships were granted for attending a program at Carnegie-Mellon University, and 769 for attending N...
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75 FR 23843 - Discretionary Bus and Bus Facilities Program
Federal Register 2010, 2011, 2012, 2013, 2014
2010-05-04
... transit facilities and equipment. d. For facilities, evidence of proposed project compliance with ``Green Building'' certification. 3. For transit asset management system projects: If asset management system...-New York, Administrator, Region 7-Kansas One Bowling Green, Room 429, New City, MO, 901 Locust Street...
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DOT National Transportation Integrated Search
2003-03-01
In March of 2001, the Federal Highway Administration (FHWA), in conjunction with the Federal Transit Administration (FTA), engaged Gannett Fleming, Inc., to develop the first ever Tunnel Management System to benefit both highway and rail transit tunn...
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DOT National Transportation Integrated Search
2012-09-01
This report summarizes the results of a 13-month effort by CodeRed Business Solutions (CRBS) to consider how urban rail transit agencies can leverage data within their maintenance management systems to build asset inventories for higher-level analysi...
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Jessica E. Halofsky; Stephanie K. Hart; Miles A. Hemstrom; Joshua S. Halofsky; Morris C. Johnson
2014-01-01
Information on the effects of management activities such as fuel reduction treatments and of processes such as vegetation growth and disturbance on fire hazard can help land managers prioritize treatments across a landscape to best meet management goals. State-and-transition models (STMs) allow landscape-scale simulations that incorporate effects of succession,...
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An investigation of transitional management problems for the NSTS
NASA Technical Reports Server (NTRS)
Hunsucker, John L.; Law, Japhet S.
1987-01-01
Analysis and recommendations were provided to the National Space Transportation System (NSTS) on managing the transition from a research and development (R/D) structure to an operational structure. Summaries of published literature on the theory and applications of transition, or change management, and the results of interviews with additional industry personnel whose organizations either have gone through or are now going through change are contained. The issues of flight rates and the flight decision are addressed. The use of a computer simulation model to analyze the effect of varying different parameters on the flight rate was also discussed. The issue of NASA's changing demographics was examined and why this may be a cause for concern. The impact of the whole shuttle system structure on the Challenger accident was presented along with the highlights of the Rogers Commission Report. The proposed reorganization of the NSTS management structure is discussed and how this transition from R/D to operations can be performed.
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Computer program for determining rotational line intensity factors for diatomic molecules
NASA Technical Reports Server (NTRS)
Whiting, E. E.
1973-01-01
A FORTRAN IV computer program, that provides a new research tool for determining reliable rotational line intensity factors (also known as Honl-London factors), for most electric and magnetic dipole allowed diatomic transitions, is described in detail. This users manual includes instructions for preparing the input data, a program listing, detailed flow charts, and three sample cases. The program is applicable to spin-allowed dipole transitions with either or both states intermediate between Hund's case (a) and Hund's case (b) coupling and to spin-forbidden dipole transitions with either or both states intermediate between Hund's case (c) and Hund's case (b) coupling.
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Mishra, Manisha; Sawhney, Ravindra; Kumar, Anil; Bapna, Kumar Ramesh; Kohli, Vijay; Wasir, Harpreet; Trehan, Naresh
2014-01-01
The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.
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Mele, Valentina; Compagni, Amelia
2010-01-01
The approval (2003) and enforcement (2005) of a smoking ban in Italy have been viewed by many as an unexpectedly successful example of policy change. The present paper, by applying a processualist approach, concentrates on two policy cycles between 2000 and 2005. These had opposing outcomes: an incomplete decisional stage and an authoritative decision, enforced two years later. Through the analysis of the different phases of agenda setting, alternative specification and decision making, we have compared the quality of participation of policy entrepreneurs in the two cycles, their political strategies and, in these, the relevance of issue image. The case allows us to direct the attention of scholars and practitioners to an early phase of the policy implementation process – which we have named "transition to practice". This, managed with political strategy, might have strongly contributed to the final successful policy outcome.
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Computed tomography findings of acute gastric volvulus.
Millet, Ingrid; Orliac, Celine; Alili, Chakib; Guillon, Françoise; Taourel, Patrice
2014-12-01
To assess the diagnostic performance of CT signs of gastric volvulus in both confirmed cases and control subjects. We retrospectively reviewed CT findings in 10 patients with surgically confirmed acute gastric volvulus and 20 control subjects with gastric distension. Two radiologists independently evaluated CT images for risk factors of gastric volvulus, direct findings of gastric volvulus by assessing gastric dilatation, the presence of an antropyloric transition point, the respective position of the different stomach segments and of the greater and lesser curvatures, stenosis of the gastric segments through the oesophageal hiatus and for findings of gastric ischemia. The sensitivity and specificity of each finding were calculated. The most sensitive direct signs of gastric volvulus were an antropyloric transition point without any abnormality at the transition zone and the antrum at the same level or higher than the fundus. The presence of both these two findings as diagnostic criteria of gastric volvulus had 100% sensitivity and specificity for the diagnosis of gastric volvulus. There was no association between CT signs of ischemia and final bowel ischemia at pathology. CT is both highly sensitive and specific for diagnosing acute gastric volvulus. CT is highly reliable for diagnosing acute gastric volvulus with two findings. The two signs are gastropyloric transition zone and abnormal location of the antrum. This allows fast surgical management of this emergency.
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Cochi, Stephen L; Hegg, Lea; Kaur, Anjali; Pandak, Carol; Jafari, Hamid
2016-02-01
The world is closer than ever to achieving global polio eradication, with record-low polio cases in 2015 and the impending prospect of a polio-free Africa. Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. As the initiative nears completion after more than twenty-five years, it becomes critical to document and transition the knowledge, lessons learned, assets, and infrastructure accumulated by the initiative to address other health goals and priorities. The primary goals of this process, known as polio legacy transition planning, are both to protect a polio-free world and to ensure that investments in polio eradication will contribute to other health goals after polio is completely eradicated. The initiative is engaged in an extensive transition process of consultations and planning at the global, regional, and country levels. A successful completion of this process will result in a well-planned and -managed conclusion of the initiative that will secure the global public good gained by ending one of the world's most devastating diseases and ensure that these investments provide public health benefits for years to come. Project HOPE—The People-to-People Health Foundation, Inc.
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Jangland, Eva; Yngman Uhlin, Pia; Arakelian, Erebouni
2016-11-01
The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Tuomainen, H; Schulze, U; Warwick, J; Paul, M; Dieleman, G C; Franić, T; Madan, J; Maras, A; McNicholas, F; Purper-Ouakil, D; Santosh, P; Signorini, G; Street, C; Tremmery, S; Verhulst, F C; Wolke, D; Singh, S P
2018-06-04
Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
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The US Army in Transition: Implications of the IDF Experience in the Second Lebanon War
Israel Hezbollah War as a historical case in which a contemporary army had to transition from sustained irregular operations to large-scale...conventional war . The case study shows that the Israeli Defense Force did not make this transition effectively, and it examines factors that contributed to
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ERIC Educational Resources Information Center
Young, Dallin George
2016-01-01
This paper advocates an integrated approach to transition programmes at South Africa's higher education institutions through drawing on the US literature on the first-year student experience and specific reference to behavioural interaction theory. The case for developing intentional and vertically integrated transition programmes is tied to: the…
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Metal-Insulator Transition Revisited for Cold Atoms in Non-Abelian Gauge Potentials
DOE Office of Scientific and Technical Information (OSTI.GOV)
Satija, Indubala I.; National Institute of Standards and Technology, Gaithersburg, Maryland 20899; Dakin, Daniel C.
2006-11-24
We discuss the possibility of realizing metal-insulator transitions with ultracold atoms in two-dimensional optical lattices in the presence of artificial gauge potentials. For Abelian gauges, such transitions occur when the magnetic flux penetrating the lattice plaquette is an irrational multiple of the magnetic flux quantum. Here we present the first study of these transitions for non-Abelian U(2) gauge fields. In contrast to the Abelian case, the spectrum and localization transition in the non-Abelian case is strongly influenced by atomic momenta. In addition to determining the localization boundary, the momentum fragments the spectrum. Other key characteristics of the non-Abelian case includemore » the absence of localization for certain states and satellite fringes around the Bragg peaks in the momentum distribution and an interesting possibility that the transition can be tuned by the atomic momenta.« less
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Minimally invasive options for salivary calculi.
Witt, Robert L; Iro, Heinrich; Koch, Michael; McGurk, Mark; Nahlieli, Oded; Zenk, Johannes
2012-06-01
The aim of this study was to review the advantages, limitations, and international interdisciplinary expert perspectives and contrasts of salivary gland endoscopy and transoral techniques in the diagnosis and management of salivary gland calculi and their adaptation in North America. The transition from transcervical approaches to strictly sialendoscopic approaches is a broad chasm and often not feasible. Sialendoscopy, sialendoscopy-assisted, intraoral, and transcervical approaches all have surgical value. Diagnostic sialendoscopy, interventional sialendoscopy, sialendoscopy-assisted, and transoral techniques have been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage blockages precluding sialoadenectomy in most cases. A flexible methodology is required. Multiple or combined measured may prove effective. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
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DOT National Transportation Integrated Search
2001-08-01
This study assesses how to manage the effects or outcomes of organizational change on job security and employee commitment in transit systems using trust-building, empowerment, employee reassurance, and job redesign strategies. The major findings are...
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NASA Technical Reports Server (NTRS)
Franklin, J. A.; Innis, R. C.
1980-01-01
Flight experiments were conducted to evaluate two control concepts for configuration management during the transition to landing approach for a powered-lift STOL aircraft. NASA Ames' augmentor wing research aircraft was used in the program. Transitions from nominal level-flight configurations at terminal area pattern speeds were conducted along straight and curved descending flightpaths. Stabilization and command augmentation for attitude and airspeed control were used in conjunction with a three-cue flight director that presented commands for pitch, roll, and throttle controls. A prototype microwave system provided landing guidance. Results of these flight experiments indicate that these configuration management concepts permit the successful performance of transitions and approaches along curved paths by powered-lift STOL aircraft. Flight director guidance was essential to accomplish the task.
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DOT National Transportation Integrated Search
2017-08-01
Transit ridership has long been studied, and the findings are concisely elucidated by Taylor & Fink (2003) when they say To sum, transit ridership is largely, though not completely, a product of factors outside the control of transit managers. ...
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Public transit risk management : a handbook for public transit executives
DOT National Transportation Integrated Search
1978-12-01
Transit is seen by insurers as a risk with high loss potential. Since people are transported in large numbers, a single accident may yield many claims. One solution to this insurance situation that has been employed by transit system operators is to ...
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Study of emergency setting for urban facility using microsimulation tool
NASA Astrophysics Data System (ADS)
Campisi, Tiziana; Canale, Antonino; Tesoriere, Giovanni
2017-11-01
Today Public transport is growing not only in terms of high passenger capacity but also considering high efficiency and it has become one of the preferred alternatives to automobile travel. This is evident, as for example, in the case of airport terminal working and management. The same could be for Bus Transport station considering roadway. As a result, many railway stations experience high levels of pedestrian congestion especially during the morning and afternoon peak periods. Traditional design and evaluation procedures for pedestrian transit facilities aim to maintain a desirable Pedestrian Level-Of-Service (PLOS) for the individual pedestrian areas or sub precincts. More in general, transit facilities and their sub-precincts interact with one another so that pedestrian circulation might be better assessed from a broader systems perspective. Microsimulation packages that can model pedestrians (e.g. VISSIM-VISWALK) can be employed to assess these interactions. This research outlines a procedure for the potential implementation of pedestrian flow analysis in a bus/rail transit station using micro-simulation. Base model data requirements are identified which include static (facility layout and locations of temporary equipment) and dynamic data (pedestrian demand and public transport services). Possible model calibration criteria would be also identified. A VISSIM micro-simulation base model would be developed for one of the main Airport terminal in Sicily (Italy) for investigating proposed station operational and infrastructure changes. This case study provided a good example for the potential implementation of micro-simulation models in the analysis of pedestrian circulation.
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Biodiesel Mass Transit Demonstration
DOT National Transportation Integrated Search
2010-04-01
The Biodiesel Mass Transit Demonstration report is intended for mass transit decision makers and fleet managers considering biodiesel use. This is the final report for the demonstration project implemented by the National Biodiesel Board under a gran...
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Ingested razor blades within the appendix: A rare case report.
Cui, Jason; Cross, Trent; Lockwood, David
2018-01-01
Foreign body ingestion is a common clinical presentation with less than 1% of the cases requiring surgical intervention. In this report, we present a rare case of razor blades lodged in the appendix as a result of intentional ingestion. A 25 year old male prisoner presented to our hospital with persistent right iliac fossa pain after razor blade ingestion. After 5 days of conservative management, there was no sign of transition on serial X-Rays. Laparoscopy with intraoperative image intensification confirmed the presence of the razor blades in the appendix and appendicectomy was subsequently performed without complications. Most ingested objected with diameter less than 2.5 cm and length less than 6 cm can pass through the gastrointestinal tract spontaneously in less than one week. The entry of foreign objects into the appendix is thought to be due to relative low motility of the caecum, the dependent position of the appendix and the size of the appendiceal orifice. Radiographic localisation to the appendiceal lumen was complicated by metallic artefact, but was consistent with failure to transit. Appendicectomy was felt to be the safest mode of retrieval. Ingested foreign body lodged in the appendix is a rare event. Once the exact location is confirmed, a simple laparoscopic appendicectomy can be performed to facilitate the removal. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Re-Entry: Managing Cross-Cultural Transitions.
ERIC Educational Resources Information Center
Adler, Nancy J.
1981-01-01
Studied the re-entry process of corporate and governmental employees (N=200) returning to Canada after working overseas. Research found re-entry into the original culture was a more difficult transition than moving to the foreign culture. Home-country managers tended to exhibit xenophobia in assessing the potential and actual effectiveness of…
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Twenty-Second Annual NASA Supply and Equipment Management Conference
NASA Technical Reports Server (NTRS)
1989-01-01
The status of actions from the 1988 conference is reviewed. Environmental safety issues, definitions, and regulations; contract transition, payload logistics transition, and safety and support equipment; supply products and services, bar code technology, and inventory accuracy; equipment management workshop topics; and contract property workshop topics are outlined.
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Quality Implementation in Transition: A Framework for Specialists and Administrators.
ERIC Educational Resources Information Center
Wald, Judy L.; Repetto, Jeanne B.
1995-01-01
Quality Implementation in Transition is a framework designed to guide transition specialists and administrators in the implementation of total quality management. The framework uses the tenets set forth by W. Edwards Deming and is intended to help professionals facilitate change within transition programs. (Author/JOW)
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Postpartum weight self-management: a concept analysis.
Ohlendorf, Jennifer M
2013-01-01
The aim of this concept analysis is to create a clear definition and framework to guide weight self-management research and promotion of healthy weight self-management during the postpartum period. A woman's ability to manage her weight through the postpartum transition has lifelong implications for her weight status. This concept analysis was guided by Walker and Avant (2005). A broad search of sources was performed, yielding 56 articles in which postpartum weight self-management was the main focus. From consideration of the attributes of postpartum weight self-management, a descriptive, situation-specific theory emerged: Postpartum weight self-management is a process by which the transition to motherhood is viewed by the woman as an opportunity to intentionally engage in healthy weight self-management behaviors by minimizing the salient inhibitors and maximizing the salient facilitators to action. This analysis provides a clarification of the process concept of postpartum weight self-management and its consequences, giving direction for measurement, clinical application, and further research. Future nursing interventions and research should be aimed at helping women to view the postpartum period as a normative transition in which they have the opportunity to take charge of their own health and the health of their family.
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Baeza, Andres; Bouma, Menno J.; Dhiman, Ramesh C.; Baskerville, Edward B.; Ceccato, Pietro; Yadav, Rajpal Singh; Pascual, Mercedes
2013-01-01
In arid areas, people living in the proximity of irrigation infrastructure are potentially exposed to a higher risk of malaria due to changes in ecohydrological conditions that lead to increased vector abundance. However, irrigation provides a pathway to economic prosperity that over longer time scales is expected to counteract these negative effects. A better understanding of this transition between increased malaria risk and regional elimination, in particular whether it is slow or abrupt, is relevant to sustainable development and disease management. By relying on space as a surrogate for stages of time, we investigate this transition in a semidesert region of India where a megairrigation project is underway and expected to cover more than 1,900 million hectares and benefit around 1 million farmers. Based on spatio-temporal epidemiological cases of Plasmodium vivax malaria and land-use irrigation from remote sensing sources, we show that this transition is characterized by an enhanced risk in areas adjacent to the trunk of the irrigation network, despite a forceful and costly insecticide-based control. Moreover, this transition between climate-driven epidemics and sustained low risk has already lasted a decade. Given the magnitude of these projects, these results suggest that increased health costs have to be planned for over a long time horizon. They further highlight the need to integrate assessments of both health and environmental impacts to guide adaptive mitigation strategies. Our results should help to define and track these transitions in other arid parts of the world subjected to similar tradeoffs. PMID:23942131
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Zink, Therese; Kralewski, John; Dowd, Bryan
Restructuring primary care is essential to achieve the triple aim. This case study examines the human factors of extensive redesign on 2 midsized primary care clinics (clinics A and B) in the Midwest United States that are owned by a large health care system. The transition occurred when while the principles for patient-centered medical home were being rolled out nationally, and before the Affordable Care Act. After the transition, interviews and discussions were conducted with 5 stakeholder groups: health system leaders, clinic managers, clinicians, nurses, and reception staff. Using a culture assessment instrument, the responses of personnel at clinics A and B were compared with comparison clinics from another health system that had not undergone transition. Patient satisfaction scores are presented. Clinics A and B were similar in size and staffing. Three human factor themes emerged from interviews: responses to change, professional and personal challenges due to role redefinition, and the importance of communication. The comparison clinics had an equal or higher mean culture scores compared with the transition clinics (A and B). Patient satisfaction in improved in Clinic A. The transition took more time than expected. Health system leaders underestimated the stress and the role adjustments for clinicians and nurses. Change leaders need to anticipate the challenge of role redefinition until health profession schools graduate trainees with more experience in new models of team-based care. Incorporating experience with team based, interprofessional care into training is essential to properly prepare future health professionals. © Copyright 2017 by the American Board of Family Medicine.
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Safety Management Information Statistics (SAMIS) - 1990 Annual Report.
DOT National Transportation Integrated Search
1992-04-01
The report is a compilation and analysis of mass transit accident and casualty statistics reported by transit systems in the United States during 1990, under the Federal Transit Administration's (FTA's) Section 15 reporting system.
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Do the benefits of family-to-work transitions come at too great a cost?
Carlson, Dawn S; Kacmar, K Michele; Zivnuska, Suzanne; Ferguson, Merideth
2015-04-01
This research examines the impact of role boundary management on the work-family interface, as well as on organizational (job embeddedness) and family (relationship tension) outcomes. First, we integrate conservation of resources theory with crossover theory, to build a theoretical model of work-family boundary management. Second, we extend prior work by exploring positive and negative paths through which boundary management affects work and family outcomes. Third, we incorporate spouse perceptions to create a dynamic, systems-perspective explanation of the work-family interface. Using a matched sample of 639 job incumbents and their spouses, we found that family-to-work boundary transitions was related to the job incumbents' work-to-family conflict, work-to-family enrichment, and job embeddedness as well as the boundary management strain transmitted to the spouse. We also found that the boundary management strain transmitted to the spouse mediated the relationship between family-to-work boundary transitions and both work-to-family conflict and work-to-family enrichment. Finally, we found significant indirect effects between family-to-work boundary transitions and job embeddedness and relationship tension through both the boundary management strain transmitted to the spouse and the incumbent's work-family conflict, but not through work-family enrichment. Thus, family-to-work boundary transitions offer some benefits to the organization by contributing to job embeddedness, but they also come at a cost in that they are associated with work-family conflict and relationship tension. We discuss the study's implications for theory, research, and practice while suggesting new research directions. (c) 2015 APA, all rights reserved).
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Coombs, Maureen A; Parker, Roses; de Vries, Kay
2017-07-01
Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.
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Pelekhaty, Stacy; Menaker, Jay
2018-03-12
Prader-Willi Syndrome (PWS) is a genetic condition that results in a constellation of symptoms and typically results in hyperphagia and obesity in adulthood. Critically ill adults with PWS present a unique challenge to the nutrition professional, particularly when they require support modalities such as extracorporeal membrane oxygenation (ECMO). The purpose of this case study is to review the nutrition care of a critically ill adult patient with PWS who required venovenous ECMO. The patient was successfully managed with a hypocaloric, high-protein approach, which did not result in the diagnosis of malnutrition during his hospitalization. The patient was ultimately transitioned off extracorporeal life support and discharged to a rehabilitation facility. © 2018 American Society for Parenteral and Enteral Nutrition.
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Karlsson, Agneta; Arman, Maria; Wikblad, Karin
2008-04-01
Becoming autonomous is an important aspect of teenagers' psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support. The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes. Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis. Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes. The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme "hovering between individual actions and support of others". The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme "confirmation of others" showed that parental encouragement increased the certainty of teenagers' standpoints; peers' acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers' self-esteem. In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.
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41 CFR 105-8.150-4 - Transition plan.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Transition plan. 105-8... Transition plan. In the event that structural changes to facilities will be undertaken to achieve program accessibility, the agency shall develop, by March 9, 1992; the transition plan setting forth the steps necessary...
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Linson, Jeremy; Latzko, Michael; Ahmed, Bestoun; Awad, Ziad
2016-07-01
We present a case of emergent thoracoscopic management of volvulus of the gastric conduit following minimally invasive Ivor-Lewis esophagectomy. The patient is a 69-year-old Caucasian male with a history of adenocarcinoma of the lower third of the esophagus. Initial presentation was dysphagia with solid foods, which progressed in severity until he was unable to swallow anything. EUS demonstrated a partially obstructing mass at 33 cm; biopsy revealed poorly differentiated adenocarcinoma, stage T3N2Mx. PET scan did not reveal any metastatic disease. Preoperative management included neo-adjuvant chemoradiation therapy (5-FU and cisplatin) and early placement of a jejunal feeding tube. Intra-operative leak test was performed as a matter of routine following completion of the esophagogastric anastomosis. A nasogastric tube was placed intra-operatively and removed on POD2 according to our standard pathway. Postoperatively, the patient progressed without difficulty to POD4, when we routinely obtain an upper GI swallow study. This demonstrated a lack of transit of contrast through the distal neo-esophagus. Follow-up endoscopy revealed volvulus of the gastric conduit with obliteration of the lumen. We immediately took the patient to the OR for thoracoscopic detorsion, which we accomplished successfully by entering the existing trochar sites and using blunt dissection.␣Upon entering the thoracic cavity, the staple line that had been oriented anteriorly was now posterior. Attachments were gently teased away from the chest wall and the conduit was detorsed and anchored to the chest wall in the correct orientation with silk suture. Intra-operative endoscopy demonstrated a patent conduit. Postoperative upper GI fluoroscopy now showed good transit of contrast. The patient continued to improve and was eventually advanced to mechanical soft diet and discharged on postoperative day 9. Early intervention is indicated in cases of volvulus of the gastric conduit following Ivor-Lewis esophagectomy.
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Regional Management of an Aquifer for Mining Under Fuzzy Environmental Objectives
NASA Astrophysics Data System (ADS)
BogáRdi, IstváN.; BáRdossy, AndráS.; Duckstein, Lucien
1983-12-01
A methodology is developed for the dynamic multiobjective management of a multipurpose regional aquifer. In a case study of bauxite mining in Western Hungary, ore deposits are often under the piezometric level of a karstic aquifer, while this same aquifer also provides recharge flows for thermal springs. N + 1 objectives are to be minimized, the first one being total discounted cost of control by dewatering or grouting; the other N objectives consist of the flow of thermal springs at N control points. However, there is no agreement among experts as to a set of numerical values that would constitute a "sound environment"; for this reason a fuzzy set analysis is used, and the N environmental objectives are combined into a single fuzzy membership function. The constraints include ore availability, various capacities, and the state transition function that describes the behavior of both piezometric head and underground flow. The model is linearized and solved as a biobjective dynamic program by using multiobjective compromise programming. A numerical example with N = 2 appears to lead to realistic control policies. Extension of the model to the nonlinear case is discussed.
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1997-04-25
the community, as with the Systems Engineering Capability Maturity Model ? • Should it be built by a small working group ? • What role should... collaborating on the development of the transition package concept for requirements management with two organizations. When participants in the workshop...34 learning " and approaches it as a qualitative activity among qualified peers [Spendolini 92]. In the spirit of this style of
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Wagner, Robert H; Savir-Baruch, Bital; Halama, James R; Venu, Mukund; Gabriel, Medhat S; Bova, Davide
2017-09-01
Chronic constipation and gastrointestinal motility disorders constitute a large part of a gastroenterology practice and have a significant impact on a patient's quality of life and lifestyle. In most cases, medications are prescribed to alleviate symptoms without there being an objective measurement of response. Commonly used investigations of gastrointestinal transit times are currently limited to radiopaque markers or electronic capsules. Repeated use of these techniques is limited because of the radiation exposure and the significant cost of the devices. We present the proof of concept for a new device to measure gastrointestinal transit time using commonly available and inexpensive materials with only a small amount of radiotracer. Methods: We assembled gelatin capsules containing a 67 Ga-citrate-radiolabeled grain of rice embedded in paraffin for use as a point-source transit device. It was tested for stability in vitro and subsequently was given orally to 4 healthy volunteers and 10 patients with constipation or diarrhea. Imaging was performed at regular intervals until the device was excreted. Results: The device remained intact and visible as a point source in all subjects until excretion. When used along with a diary of bowel movement times and dates, the device could determine the total transit time. The device could be visualized either alone or in combination with a barium small-bowel follow-through study or a gastric emptying study. Conclusion: The use of a point-source transit device for the determination of gastrointestinal transit time is a feasible alternative to other methods. The device is inexpensive and easy to assemble, requires only a small amount of radiotracer, and remains inert throughout the gastrointestinal tract, allowing for accurate determination of gastrointestinal transit time. Further investigation of the device is required to establish optimum imaging parameters and reference values. Measurements of gastrointestinal transit time may be useful in managing patients with dysmotility and in selecting the appropriate pharmaceutical treatment. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.
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Hammett, Theodore M; Donahue, Sara; LeRoy, Lisa; Montague, Brian T; Rosen, David L; Solomon, Liza; Costa, Michael; Wohl, David; Rich, Josiah D
2015-08-01
One in seven people living with HIV in the USA passes through a prison or jail each year, and almost all will return to the community. Discharge planning and transitional programs are critical but challenging elements in ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission. This paper describes facilitators and challenges of in-prison care, transitional interventions, and access to and continuity of care in the community in Rhode Island and North Carolina based on qualitative data gathered as part of the mixed-methods Link Into Care Study of prisoners and releasees with HIV. We conducted 65 interviews with correctional and community-based providers and administrators and analyzed the transcripts using NVivo 10 to identify major themes. Facilitators of effective transitional systems in both states included the following: health providers affiliated with academic institutions or other entities independent of the corrections department; organizational philosophy emphasizing a patient-centered, personal, and holistic approach; strong leadership with effective "champions"; a team approach with coordination, collaboration and integration throughout the system, mutual respect and learning between corrections and health providers, staff dedicated to transitional services, and effective communication and information sharing among providers; comprehensive transitional activities and services including HIV, mental health and substance use services in prisons, timely and comprehensive discharge planning with specific linkages/appointments, supplies of medications on release, access to benefits and entitlements, case management and proactive follow-up on missed appointments; and releasees' commitment to transitional plans. These elements were generally present in both study states but their absence, which also sometimes occurred, represent ongoing challenges to success. The qualitative findings on the facilitators and challenges of the transitional systems were similar in the two states despite differences in context, demographics of target population, and system organization. Recommendations for improved transitional systems follow from the analysis of the facilitators and challenges.
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Undurraga, Eduardo A.; Meltzer, Martin I.; Tran, Cuc H.; Atkins, Charisma Y.; Etheart, Melissa D.; Millien, Max F.; Adrien, Paul; Wallace, Ryan M.
2017-01-01
Haiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area (N = 2,289) in 2014–2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568–$80,290) than the no-bite-case-management (NBCM) scenario ($15,988–$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891–$4,735, NBCM: $5,980–$8,453; 2015, HARSP: $3,534–$7,171, NBCM: $7,298–$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination. PMID:28719253
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Undurraga, Eduardo A; Meltzer, Martin I; Tran, Cuc H; Atkins, Charisma Y; Etheart, Melissa D; Millien, Max F; Adrien, Paul; Wallace, Ryan M
2017-06-01
AbstractHaiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area ( N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.
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Sackett, Kay; Carter, Melondie; Stanton, Marietta
2014-01-01
The purpose of this study was to determine the prevalence of complementary and alternative medicine (CAM), folk medicine, and other nontraditional therapy use by the elderly population. For all case managers who coordinate health care for the elderly as they transition from one setting to another and participate in health promotion and prevention activities. A computerized database search of MEDLINE, CINAHL, ProQuest, and PsycINFO was completed before writing the integrative review. Six hundred ninety-seven abstracts were identified. Forty-five articles were further screened. Twenty-five articles met the criteria for inclusion. The integrative review is composed of 25 articles. Support for folk medicine and CAM use by older adults is located at Levels 5 and 6 of Melynk and Fine-Overholt's Hierarchy of Evidence. Folk medicine and CAM are used by the elderly for self-care purposes. A combination of both nontraditional and traditional medical interventions is used by the elderly. Although the choice to use folk medicine and CAM seems to transcend culture, the specific therapies chosen often emerge from the individual's cultural or ethnic heritage. Traditional health care providers may be unaware of elders' use of CAM or folk medicine alternatives. Case managers as coordinators of care across the health continuum are in a unique position to encourage, support, and enhance the use of folk medicine and CAM that complements traditional medical interventions for the elderly.
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[Changing economic environment of hospitals: management challenges of the 1990s].
Rotstein, Z; Noy, S; Goldman, B; Shani, M
1990-12-16
The modern hospital is an organization which is influenced by the external environment in which it functions. A major relevant area is the economic environment. In recent years the western world has been facing the challenge of rising costs of health care and an increase in their proportion to the gross national product of most countries. Consequently, hospitals as major providers of health care are under pressure from governments and health insurance companies to cut costs and to "produce" more efficiently. Since hospitals worldwide are finding it hard and painful to function in the new environment in which attitudes to hospitals are changing, a potential managerial-economic crisis may be the next phase. How can the hospital adapt to these changes? First, by adopting managerial attitudes and the tools of the business sector. These include: the strategic planning process, hospital operative autonomy, creating medical-economic responsibility centers as departments, cost-accounting for medical procedures, and case-mix budgeting. Management information systems are necessary during the transition. The hospital information system should include functions at the operative level, such as outpatient visits, and admissions and discharges of patients; and also clinical, diagnostic and laboratory procedures related to the patient case-mix. The second level is a management information system which includes salaries of personnel, case-mix budgeting with variance analysis, prices of procedures and epidemiological data. The authors believe that only the managerial approach combining medical and economic disciplines can meet the challenges of the changing modern economic environment.
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Heat transfer and fluid mechanics measurements in transitional boundary layer flows
NASA Technical Reports Server (NTRS)
Wang, T.; Simon, T. W.; Buddhavarapu, J.
1985-01-01
Experimental results are presented to document hydrodynamic and thermal development of flat-plate boundary layers undergoing natural transition. Local heat transfer coefficients, skin friction coefficients and profiles of velocity, temperature and Reynolds normal and shear stresses are presented. A case with no transition and transitional cases with 0.68% and 2.0% free-stream disturbance intensities were investigated. The locations of transition are consistent with earlier data. A late-laminar state with significant levels of turbulence is documented. In late-transitional and early-turbulent flows, turbulent Prandtl number and conduction layer thickness values exceed, and the Reynolds analogy factor is less than, values previously measured in fully turbulent flows.
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Exposing Baccalaureate Nursing Students to Transitional Care.
OʼConnor, Melissa; Arcamone, Angelina; Amorim, Frances; Hoban, Mary Beth; Boyd, Regina M; Fowler, Lauren; Marcelli, Theresa; Smith, Jacalyn; Nassar, Kathleen; Fitzpatrick, M Louise
2016-10-01
Management and facilitation of care transitions from hospital to alternative settings requires skill and attention to avoid adverse events. Several interprofessional organizations and nurse leaders have called for the expansion and redesign of undergraduate nursing curricula to include care transitions. Yet there is little evidence describing how undergraduate baccalaureate nursing students are educated on this critical topic or how successful they are in improving student knowledge about care transitions. To address this gap, an in-classroom and clinical experience was implemented to prepare students to manage and facilitate care transitions from the hospital to alternative settings-including the home. Perceptions of undergraduate nursing students and home healthcare nurse preceptors were assessed via an electronic survey that was emailed to participants. Forty-eight responses to the survey were received. Students agreed this experience contributed to their understanding of caring for adults and older adults who are experiencing a care transition and they had a good understanding of care transitions to apply to their future nursing courses. Home healthcare nurse preceptors agreed they were able to demonstrate transitional care and that students were engaged. Future work should include expanding transitional care immersion to other care settings as well as the inclusion of additional healthcare disciplines in care transition education.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Maloney, J.; Kiepper, A.F.; Simonetta, R.J.
The volume examines monitoring and reporting procedures applicable to performance and productivity. The managers of three transit systems of varying sizes discuss how productivity has been increased within their systems. The Pittsburgh discussion reviews a variety of capital projects and management improvement initiatives undertaken by Port Authority Transit, including development of maintenance manuals and an absenteeism reduction project. The Houston discussion describes how the property used a management study to identify needed organizational change and restructuring. The Ann Arbor discussion focuses on a set of service standards and performance indicators adopted to focus the management improvement process.
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Maintenance manager's manual for small transit agencies. Special report 1985-1986
DOE Office of Scientific and Technical Information (OSTI.GOV)
Fowler, W.
1988-03-01
This publication contains information to assist operators of transit agencies providing public transportation in rural and smaller urban areas to better manage their vehicle maintenance programs. The report includes discussions of maintenance management, maintenance programs preventive maintenance, recordkeeping, selection of type of maintenance operation, in-house maintenance, and maintenance practices. Also included are appendixes giving supplementary information about tire loads; lubrication oil; mechanic hand tools; shop tools; mechanic aptitude tests; technical training resources; maintenance management training resources; and lists of manufacturers of air-conditioning systems, wheelchair lifts and wheelchair ramps.
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Mao, Rui; Ying, Peng-Qing; Xie, Dong; Dai, Chen-Yang; Zha, Jun-Yan; Chen, Tao; Jiang, Ge-Ning; Fei, Ke
2016-01-01
Background Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after lung surgery. Tentative closure of the fistula and irrigation have been the conventional treatments, but are also surgically challenging and associated with a considerable failure rate. This study reports on a conservative practice of this difficult issue, in aim to examine its outcomes. Method All enrolled cases were handled consecutively from September 2006 to June 2015. The empyema was first properly drained till disseminated pneumonia controlled. After conducting lavage, tube drainage was gradually transited to postural drainage. During the follow-up, information on tube removal, fistula healing, and survival were recorded. Results Thirteen cases were enrolled, including 9 rights and 4 lefts. The primary diseases were lung cancer [10], lung abscess [1], organizing pneumonia [1], and aspergillosis [1]. Early fistula (≤30 days postoperatively) occurred in 8 cases and late fistula (>30 days postoperatively) in 5 cases. Two patients underwent debridement to ascertain complete drainage. Chest tubes retained from 7 to 114 days (mean 40.54±30.49 days) before removal. At follow-up, we observed gradually narrowing-down of all residual cavities, and symptoms of fistula and empyema eventually disappeared in all patients. No complication or death occurred during the follow-up. Conclusions Conservative management by a combination of tube and postural drainage provides an effective and safe treatment for empyema-complicated post-lobectomy BPFs. PMID:27499946
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National ITS architecture transit guidelines : executive summary
DOT National Transportation Integrated Search
1997-01-01
This booklet is intended for transit board members and senior management. It provides general information on ITS and the National ITS Architecture with respect to transit, and highlights the benefits of each. Section 2 briefly discusses the Intermoda...
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Answering Aggregation Questions in Contingency Valuation of Rural Transit Benefits
DOT National Transportation Integrated Search
2001-08-01
While the qualitative benefits of transit are relatively well known, quantifying the benefits of transit is still a developing methodology. Quantifying benefits offers improved operational management and planning as well as better information for pol...
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State-dependent resource harvesting with lagged information about system states
Johnson, Fred A.; Fackler, Paul L.; Boomer, G Scott; Zimmerman, Guthrie S.; Williams, Byron K.; Nichols, James D.; Dorazio, Robert
2016-01-01
Markov decision processes (MDPs), which involve a temporal sequence of actions conditioned on the state of the managed system, are increasingly being applied in natural resource management. This study focuses on the modification of a traditional MDP to account for those cases in which an action must be chosen after a significant time lag in observing system state, but just prior to a new observation. In order to calculate an optimal decision policy under these conditions, possible actions must be conditioned on the previous observed system state and action taken. We show how to solve these problems when the state transition structure is known and when it is uncertain. Our focus is on the latter case, and we show how actions must be conditioned not only on the previous system state and action, but on the probabilities associated with alternative models of system dynamics. To demonstrate this framework, we calculated and simulated optimal, adaptive policies for MDPs with lagged states for the problem of deciding annual harvest regulations for mallards (Anas platyrhynchos) in the United States. In this particular example, changes in harvest policy induced by the use of lagged information about system state were sufficient to maintain expected management performance (e.g. population size, harvest) even in the face of an uncertain system state at the time of a decision.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-05-15
... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces AGENCY: Office... Defense announces the following Federal Advisory Committee meeting of the Department of Defense Task Force...
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Fixed and equilibrium endpoint problems in uneven-aged stand management
Robert G. Haight; Wayne M. Getz
1987-01-01
Studies in uneven-aged management have concentrated on the determination of optimal steady-state diameter distribution harvest policies for single and mixed species stands. To find optimal transition harvests for irregular stands, either fixed endpoint or equilibrium endpoint constraints can be imposed after finite transition periods. Penalty function and gradient...
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DOT National Transportation Integrated Search
1974-02-01
The volume presents the plans for implementing the Satellite-Based Advanced Air Traffic Management System (SAATMS) described in Volumes II, III, and IV. Two plans are presented: an RDT&E plan and a transition plan. The RDT&E plan is presented as a se...
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Efficacy of Using Career and Self-Construction to Help Learners Manage Career-Related Transitions
ERIC Educational Resources Information Center
Cook, A.; Maree, J. G.
2016-01-01
This article explores the extent to which an intervention programme helped learners from two contrasting educational settings manage career-related transitions. Forty-two learners from two schools were selected, using convenience and purposive sampling, to take part in an intervention programme. Two comparison groups comprised of 45 learners from…
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Challenges of Engineering Higher Education in a Transitional Economy: A Russian Experience
ERIC Educational Resources Information Center
Matveev, Alexei; Matveev, Olga; Zhukov, Vassily
2005-01-01
Education and training serve as critical elements of advancement of a nation's economy in transition. The restructuring of the power engineering industry in Russia has called for a fast implementation of new management system in electric power engineering and radical training of professional managers at different levels in organizations.…
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USDA-ARS?s Scientific Manuscript database
State and transition models (STMs) are used for communicating about ecosystem change in rangelands and other ecosystems, especially the implications for management. The fundamental premise that rangelands can exhibit multiple states is now widely accepted. The current application of STMs for managem...
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ERIC Educational Resources Information Center
Wang, Yan; Ye, Feifei; Pilarzyk, Tom
2014-01-01
This study used a strategic enrollment management (SEM) approach to studying high school students' transition to a two-year college and their initial college success. Path analyses suggested two important findings: (a) clear career choices among students, family influence, academic preparedness, and college recruitment efforts predicted earlier…
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NASA Technical Reports Server (NTRS)
McNeill, Justin
1995-01-01
The Multimission Image Processing Subsystem (MIPS) at the Jet Propulsion Laboratory (JPL) has managed transitions of application software sets from one operating system and hardware platform to multiple operating systems and hardware platforms. As a part of these transitions, cost estimates were generated from the personal experience of in-house developers and managers to calculate the total effort required for such projects. Productivity measures have been collected for two such transitions, one very large and the other relatively small in terms of source lines of code. These estimates used a cost estimation model similar to the Software Engineering Laboratory (SEL) Effort Estimation Model. Experience in transitioning software within JPL MIPS have uncovered a high incidence of interface complexity. Interfaces, both internal and external to individual software applications, have contributed to software transition project complexity, and thus to scheduling difficulties and larger than anticipated design work on software to be ported.
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Large-scale factors in tropical and extratropical cyclone transition and extreme weather events.
Pezza, Alexandre Bernardes; Simmonds, Ian
2008-12-01
Transition mechanisms characterizing changes from hurricanes to midlatitude cyclones and vice-versa (extratropical and tropical transition) have become a topic of increasing interest, partially because of their association with recent unusual storms that have developed in different ocean basins of both hemispheres. The aim of this work is to discuss some recent cases of transition and highly unusual hurricane developments and to address some of their wider implications for climate science. Frequently those dramatic cyclones are responsible for severe weather, potentially causing significant damage to property and infrastructure. An additional manifestation discussed here is their association with cold surges, a topic that has been very little explored in the literature. In the Southern Hemisphere, the first South Atlantic hurricane, Catarina, developed in March 2004 under very unusual large-scale conditions. That exceptional cyclone is viewed as a case of tropical transition facilitated by a well-developed blocking structure. A new index for monitoring tropical transition in the subtropical South Atlantic is discussed. This "South Atlantic index" is used to show that the unusual flow during and prior to Catarina's genesis can be attributed to tropical/extratropical interaction mechanisms. The "Donald Duck" case in Australia and Vince in the North Atlantic have also been examined and shown to belong to a category of hybrid-transitioning systems that will achieve at least partial tropical transition. While clearly more research is needed on the topic of transition, as we gain further insight, it is becoming increasingly apparent that features of large-scale circulation do play a fundamental role. A complex interaction between an extratropical transition case and an extreme summer cold surge affecting southeastern Australia is discussed as an example of wider climate implications.
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NASA Technical Reports Server (NTRS)
Eppink, Jenna L.
2017-01-01
Stereo particle image velocimetry measurements were performed downstream of a forward-facing step in a stationary-crossflow dominated flow. Three different step heights were studied with the same leading-edge roughness configuration to determine the effect of the step on the evolution of the stationary-crossflow. Above the critical step height, which is approximately 68% of the boundary-layer thickness at the step, the step caused a significant increase in the growth of the stationary crossflow. For the largest step height studied (68%), premature transition occurred shortly downstream of the step. The stationary crossflow amplitude only reached approximately 7% of U(sub e) in this case, which suggests that transition does not occur via the high-frequency secondary instabilities typically associated with stationary crossflow transition. The next largest step of 60% delta still caused a significant impact on the growth of the stationary crossflow downstream of the step, but the amplitude eventually returned to that of the baseline case, and the transition front remained the same. The smallest step height (56%) only caused a small increase in the stationary crossflow amplitude and no change in the transition front. A final case was studied in which the roughness on the leading edge of the model was enhanced for the lowest step height case to determine the impact of the stationary crossflow amplitude on transition. The stationary crossflow amplitude was increased by approximately four times, which resulted in premature transition for this step height. However, some notable differences were observed in the behavior of the stationary crossflow mode, which indicate that the interaction mechanism which results in the increased growth of the stationary crossflow downstream of the step may be different in this case compared to the larger step heights.
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VA's expansion of supportive housing: successes and challenges on the path toward Housing First.
Austin, Erika Laine; Pollio, David E; Holmes, Sally; Schumacher, Joseph; White, Bert; Lukas, Carol Vandeusen; Kertesz, Stefan
2014-05-01
The U.S. Department of Veterans Affairs (VA) is transitioning to a Housing First approach to placement of veterans in permanent supportive housing through the use of rental vouchers, an ambitious organizational transformation. This qualitative study examined the experiences of eight VA facilities undertaking this endeavor in 2012. A multidisciplinary team interviewed facility leadership, midlevel managers, and frontline staff (N=95 individuals) at eight VA facilities representing four U.S. regions. The team used a semistructured interview protocol and the constant comparative method to explore how individuals throughout the organizations experienced and responded to the challenges of transitioning to a Housing First approach. Frontline staff faced challenges in rapidly housing homeless veterans because of difficult rental markets, the need to coordinate with local public housing authorities, and a lack of available funds for move-in costs. Staff sought to balance their time spent on housing activities with intensive case management of highly vulnerable veterans. Finding low-demand sheltering options (that is, no expectations regarding sobriety or treatment participation, as in the Housing First model) for veterans waiting for housing presented a significant challenge to implementation of Housing First. Facility leadership supported Housing First implementation through resource allocation, performance monitoring, and reliance on midlevel managers to understand and meet the challenges of implementation. The findings highlight the considerable practical challenges and innovative solutions arising from a large-scale effort to implement Housing First, with particular attention to the experiences of individuals at all levels within an organization.
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Jeffs, Lianne; Kitto, Simon; Merkley, Jane; Lyons, Renee F; Bell, Chaim M
2012-01-01
To explore patients' and family members' perspectives on how safety threats are detected and managed across care transitions and strategies that improve care transitions from acute care hospitals to complex continuing care and rehabilitation health care organizations. Poorly executed care transitions can result in additional health care spending due to adverse outcomes and delays as patients wait to transfer from acute care to facilities providing different levels of care. Patients and their families play an integral role in ensuring they receive safe care, as they are the one constant in care transitions processes. However, patients' and family members' perspectives on how safety threats are detected and managed across care transitions from health care facility to health care facility remain poorly understood. This qualitative study used semistructured interviews with patients (15) and family members (seven) who were transferred from an acute care hospital to a complex continuing care/rehabilitation care facility. Data were analyzed using a directed content analytical approach. OUR RESULTS REVEALED THREE KEY OVERARCHING THEMES IN THE PERCEPTIONS: lacking information, getting "funneled through" too soon, and difficulty adjusting to the shift from total care to almost self-care. Several patients and families described their expectations and experiences associated with their interfacility care transitions as being uninformed about their transfer or that transfer happened too early. In addition, study participants identified the need for having a coordinated approach to care transitions that engages patients and family members. Study findings provide patients' and family members' perspectives on key safety threats and how to improve care transitions. Of particular importance is the need for patients and family members to play a more active role in their care transition planning and self-care management.
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Small City Transit : Xenia, Ohio : Transit Service for a Rebuilding Community
DOT National Transportation Integrated Search
1976-03-01
Xenia, Ohio is an illustration of a transit service which evolved from a freefare emergency service to a demonstration of para-transit services. This case study is one of thirteen examples of a transit service in a small community. The background of ...
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Evaluating early-warning indicators of critical transitions in natural aquatic ecosystems
Gsell, Alena Sonia; Scharfenberger, Ulrike; Ozkundakci, Deniz; Walters, Annika W.; Hansson, Lars-Anders; Janssen, Annette B. G.; Noges, Peeter; Reid, Philip; Schindler, Daniel; van Donk, Ellen; Dakos, Vasilis; Adrian, Rita
2016-01-01
Ecosystems can show sudden and persistent changes in state despite only incremental changes in drivers. Such critical transitions are difficult to predict, because the state of the system often shows little change before the transition. Early-warning indicators (EWIs) are hypothesized to signal the loss of system resilience and have been shown to precede critical transitions in theoretical models, paleo-climate time series, and in laboratory as well as whole lake experiments. The generalizability of EWIs for detecting critical transitions in empirical time series of natural aquatic ecosystems remains largely untested, however. Here we assessed four commonly used EWIs on long-term datasets of five freshwater ecosystems that have experienced sudden, persistent transitions and for which the relevant ecological mechanisms and drivers are well understood. These case studies were categorized by three mechanisms that can generate critical transitions between alternative states: competition, trophic cascade, and intraguild predation. Although EWIs could be detected in most of the case studies, agreement among the four indicators was low. In some cases, EWIs were detected considerably ahead of the transition. Nonetheless, our results show that at present, EWIs do not provide reliable and consistent signals of impending critical transitions despite using some of the best routinely monitored freshwater ecosystems. Our analysis strongly suggests that a priori knowledge of the underlying mechanisms driving ecosystem transitions is necessary to identify relevant state variables for successfully monitoring EWIs.
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Evaluating early-warning indicators of critical transitions in natural aquatic ecosystems.
Gsell, Alena Sonia; Scharfenberger, Ulrike; Özkundakci, Deniz; Walters, Annika; Hansson, Lars-Anders; Janssen, Annette B G; Nõges, Peeter; Reid, Philip C; Schindler, Daniel E; Van Donk, Ellen; Dakos, Vasilis; Adrian, Rita
2016-12-13
Ecosystems can show sudden and persistent changes in state despite only incremental changes in drivers. Such critical transitions are difficult to predict, because the state of the system often shows little change before the transition. Early-warning indicators (EWIs) are hypothesized to signal the loss of system resilience and have been shown to precede critical transitions in theoretical models, paleo-climate time series, and in laboratory as well as whole lake experiments. The generalizability of EWIs for detecting critical transitions in empirical time series of natural aquatic ecosystems remains largely untested, however. Here we assessed four commonly used EWIs on long-term datasets of five freshwater ecosystems that have experienced sudden, persistent transitions and for which the relevant ecological mechanisms and drivers are well understood. These case studies were categorized by three mechanisms that can generate critical transitions between alternative states: competition, trophic cascade, and intraguild predation. Although EWIs could be detected in most of the case studies, agreement among the four indicators was low. In some cases, EWIs were detected considerably ahead of the transition. Nonetheless, our results show that at present, EWIs do not provide reliable and consistent signals of impending critical transitions despite using some of the best routinely monitored freshwater ecosystems. Our analysis strongly suggests that a priori knowledge of the underlying mechanisms driving ecosystem transitions is necessary to identify relevant state variables for successfully monitoring EWIs.
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3 CFR - Managing Government Records
Code of Federal Regulations, 2012 CFR
2012-01-01
... opportunities for agency records management. Greater reliance on electronic communication and systems has... improving or maintaining its records management program, particularly with respect to managing electronic... litigation; and (vi) transitioning from paper-based records management to electronic records management where...
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Mass transit : project management oversight benefits and future funding requirements
DOT National Transportation Integrated Search
2000-09-01
To meet the nation's transportation needs, many states, cities, and localities are building or planning mass transit projects to replace aging infrastructure or add new capacity. These transit projects are very costly and require large investments of...
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Code of Federal Regulations, 2011 CFR
2011-07-01
... 219.35 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE PLANNING National Forest System Land and Resource Management Planning Applicability and Transition § 219.35 Transition. (a.... (b) Until the Department promulgates superseding planning regulations pursuant to the National Forest...
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ITS deployment guidance for transit systems : executive edition
DOT National Transportation Integrated Search
1997-04-01
This booklet is intended for transit board members and senior management. It provides general information on ITS and the National ITS Architecture with respect to transit, and highlights the benefits of each. Section 2 briefly discusses the Intermoda...
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Developing useful transit-related crime and incident data
DOT National Transportation Integrated Search
2000-04-01
Transit agencies have an obligation to provide a reasonably safe and secure system for their patrons and employees. Transit management must make decisions regarding the best use of police, security personnel, and other resources to reduce crime and i...
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Managing Change and Transition, Creating a Future
ERIC Educational Resources Information Center
Liu, Karen
2008-01-01
Beginning in childhood and on into adulthood, people experience many transitions and changes in their lives. Some people cope with change better than others and make transitions easily; some people may experience a longer transition in order to integrate change. Most people have a fear of change due to uncertainty. Once a person releases that…
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Adherence to Attention-Deficit/Hyperactivity Disorder Medication During the Transition to College.
Schaefer, Megan R; Rawlinson, Alana Resmini; Wagoner, Scott T; Shapiro, Steven K; Kavookjian, Jan; Gray, Wendy N
2017-06-01
The present study explores the medication self-management experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) during their transition to young adulthood in college. Participants were college freshmen with ADHD prescribed daily medication for their condition. Ten individual interviews were conducted using a semistructured interview script. Measures related to ADHD medication management were also completed. Qualitative data were analyzed via directed content analysis and quantitative data via descriptive statistics. Five themes emerged from interviews: (1) transitions to independence are often abrupt, and many adolescents lack critical self-management skills; (2) volitional nonadherence is high due to inaccurate disease beliefs, perceived academic demands, and medication side effects; (3) poor self-management negatively impacts school performance; (4) peer pressure to share medication affects social functioning and adherence; and (5) social support is greatly needed. Common barriers to adherence included "don't feel like taking medication" (90%) and "difficulties in sticking to a fixed medication schedule" (80%). Participants with ADHD were not prepared to manage their chronic illness independently in context of increased demands and newfound freedom, resulting in negative academic consequences. Social factors also play an influential role in ADHD self-management, particularly related to the isolation associated with sharing the medication and its side effects. Intervention programs targeting medication self-management during the transition to independence are greatly needed for young adults with ADHD as high academic performance in college is critical for future success. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Graduation Day: Healthcare Transition From Pediatric to Adult.
Green Corkins, Kelly; Miller, Michelle A; Whitworth, John R; McGinnis, Carol
2018-02-01
Because more patients with pediatric-onset chronic conditions are surviving into adulthood, they are graduating from pediatric healthcare to self-management and adult healthcare. This transfer of care needs to be a process of transitioning medical and nutrition care. Despite having position statements from professional organizations and several proposed models, issues in the transition process have been well described, and gaps in transition care persist. Healthcare providers need to be aware of special needs of emerging adults related to education on chronic condition and self-management skills, emotional support before and after transition, and legal rights for both the patient and the parent if the emerging adult is not developmentally appropriate to make his or her own healthcare decisions. Both pediatric and adult providers need to be in active communication with each other and the patient to develop trusting relationships and actively support the transition of care. This review of literature describes several models for transitioning, measureable outcomes, insurance provider issues, and legal issues pertaining to healthcare transition. © 2018 American Society for Parenteral and Enteral Nutrition.
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A Statewide Survey Report of Roles and Responsibilities in Current Utah Care Management Processes.
Luther, Brenda; Martial, Marc-Aurel; Barra, Joyce
Measure current roles and responsibilities of care managers in the state of Utah. All settings of health care including inpatient, outpatient, community, payer, post-acute, and transitional care settings. A quantitative descriptive survey design was used to assess and describe current care management roles and responsibilities of 191 care managers within the state of Utah. Quantitative variables of roles and responsibilities were collected an electronic database (REDCap). Major results conclude that care managers spend most of their time on direct patient interactions including discharge planning, population care, and utilization review. These care managers are highly experienced in their field, with most being in their professional practice for more than 10 years. Most of the care managers are bachelor's prepared nurses. To create or expand care management processes to meet the goals of health care reform, systems first need to know what care managers/coordinators are doing and where their current focus on care presides. Educators, leaders, and, indeed, the care managers themselves are a part of preparing this dynamic workforce. The major responsibility of care management continues to be direct patient interactions, meaning that care managers are performing vital interpersonal patient interaction needed to achieve highly personalized patient care with assurances of quality and safety. No matter the name-care management, case management, or care coordination-these activities are an essential part of health care, with highly specialized skills that promote patient engagement and activation.
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Preparing Adolescents With Chronic Disease for Transition to Adult Care: A Technology Program
Terrones, Laura; Tompane, Trevor; Dillon, Lindsay; Pian, Mark; Gottschalk, Michael; Norman, Gregory J.; Bartholomew, L. Kay
2014-01-01
BACKGROUND: Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. METHODS: Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. RESULTS: MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. CONCLUSIONS: Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD. PMID:24843066
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Multistate modeling of habitat dynamics: Factors affecting Florida scrub transition probabilities
Breininger, D.R.; Nichols, J.D.; Duncan, B.W.; Stolen, Eric D.; Carter, G.M.; Hunt, D.K.; Drese, J.H.
2010-01-01
Many ecosystems are influenced by disturbances that create specific successional states and habitat structures that species need to persist. Estimating transition probabilities between habitat states and modeling the factors that influence such transitions have many applications for investigating and managing disturbance-prone ecosystems. We identify the correspondence between multistate capture-recapture models and Markov models of habitat dynamics. We exploit this correspondence by fitting and comparing competing models of different ecological covariates affecting habitat transition probabilities in Florida scrub and flatwoods, a habitat important to many unique plants and animals. We subdivided a large scrub and flatwoods ecosystem along central Florida's Atlantic coast into 10-ha grid cells, which approximated average territory size of the threatened Florida Scrub-Jay (Aphelocoma coerulescens), a management indicator species. We used 1.0-m resolution aerial imagery for 1994, 1999, and 2004 to classify grid cells into four habitat quality states that were directly related to Florida Scrub-Jay source-sink dynamics and management decision making. Results showed that static site features related to fire propagation (vegetation type, edges) and temporally varying disturbances (fires, mechanical cutting) best explained transition probabilities. Results indicated that much of the scrub and flatwoods ecosystem was resistant to moving from a degraded state to a desired state without mechanical cutting, an expensive restoration tool. We used habitat models parameterized with the estimated transition probabilities to investigate the consequences of alternative management scenarios on future habitat dynamics. We recommend this multistate modeling approach as being broadly applicable for studying ecosystem, land cover, or habitat dynamics. The approach provides maximum-likelihood estimates of transition parameters, including precision measures, and can be used to assess evidence among competing ecological models that describe system dynamics. ?? 2010 by the Ecological Society of America.
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Preparing adolescents with chronic disease for transition to adult care: a technology program.
Huang, Jeannie S; Terrones, Laura; Tompane, Trevor; Dillon, Lindsay; Pian, Mark; Gottschalk, Michael; Norman, Gregory J; Bartholomew, L Kay
2014-06-01
Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD. Copyright © 2014 by the American Academy of Pediatrics.
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Birnkrant, David J; Bushby, Katharine; Bann, Carla M; Apkon, Susan D; Blackwell, Angela; Colvin, Mary K; Cripe, Linda; Herron, Adrienne R; Kennedy, Annie; Kinnett, Kathi; Naprawa, James; Noritz, Garey; Poysky, James; Street, Natalie; Trout, Christina J; Weber, David R; Ward, Leanne M
2018-01-01
Improvements in the function, quality of life, and longevity of patients with Duchenne muscular dystrophy (DMD) have been achieved through a multidisciplinary approach to management across a range of health-care specialties. In part 3 of this update of the DMD care considerations, we focus on primary care, emergency management, psychosocial care, and transitions of care across the lifespan. Many primary care and emergency medicine clinicians are inexperienced at managing the complications of DMD. We provide a guide to the acute and chronic medical conditions that these first-line providers are likely to encounter. With prolonged survival, individuals with DMD face a unique set of challenges related to psychosocial issues and transitions of care. We discuss assessments and interventions that are designed to improve mental health and independence, functionality, and quality of life in critical domains of living, including health care, education, employment, interpersonal relationships, and intimacy. PMID:29398641
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A case study in the practical use of LANDSAT data
NASA Technical Reports Server (NTRS)
Cox, S.
1982-01-01
The use of computer aided classification of LANDSAT data in developing water quality plans for New Jersey watersheds is used to exemplify how a state natural resource management program benefits from satellite imagery. The transition of a research and development system into an operational remote sensing system to help decision makers is demonstrated. Nontechnial issues that can assist (or hinder) an agency in adopting a new technology are examined. The progress of LANDSAT use by state government from the earliest stage of curiosity through to incorporation in actual state planning methods is charted. Potential applications of LANDSAT data to real information needs and solutions to management problems are examined. The problems and mistakes that occurred in using LANDSAT data in the past are discussed as well as the ways by which these problems were overcome.
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Aspect-Oriented Model-Driven Software Product Line Engineering
NASA Astrophysics Data System (ADS)
Groher, Iris; Voelter, Markus
Software product line engineering aims to reduce development time, effort, cost, and complexity by taking advantage of the commonality within a portfolio of similar products. The effectiveness of a software product line approach directly depends on how well feature variability within the portfolio is implemented and managed throughout the development lifecycle, from early analysis through maintenance and evolution. This article presents an approach that facilitates variability implementation, management, and tracing by integrating model-driven and aspect-oriented software development. Features are separated in models and composed of aspect-oriented composition techniques on model level. Model transformations support the transition from problem to solution space models. Aspect-oriented techniques enable the explicit expression and modularization of variability on model, template, and code level. The presented concepts are illustrated with a case study of a home automation system.
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They Give Us Homework! Transition to Higher Education: The Case of Initial Teacher Training
ERIC Educational Resources Information Center
Murtagh, Lisa
2010-01-01
This article examines some issues surrounding transition to higher education. It is based on the case study of a cohort of Year 1 students in a modern university in England. The purpose of the study was to ascertain any potential transitional issues and therefore any areas for development in our Year 1 programmes to aid student progress. Data were…
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Role of the registered nurse in primary health care: meeting health care needs in the 21st century.
Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura
2015-01-01
There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.
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Reduction of energy usage in postharvest horticulture through management of ethylene.
Wills, Ron B H; Golding, John B
2015-05-01
Cool chain management is the preferred technology to extend the postharvest life of horticultural produce, but with rising energy costs and community pressure to reduce greenhouse gas emissions, there is a need to use less energy-intensive technologies. Minimising the level of ethylene around horticultural produce inhibits ripening and senescence and therefore has the potential to reduce the use of refrigeration. The long-distance transport of bananas within Australia and from Central America to Europe is used as a case study to show that the need for refrigeration could be reduced if the appropriate concentrations of ethylene were maintained around fruit during transit. Data are also presented to show a similar benefit of ethylene control with green beans, as well as another study showing that apples treated with the ethylene action inhibitor 1-methylcyclopropene could be stored at a higher temperature without loss of quality to the consumer. The range of technologies available to manage ethylene levels is discussed. © 2014 Society of Chemical Industry.
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Harrison, Lindsay
2012-01-01
Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency. Copyright © Taylor & Francis Group, LLC
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Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain.
Brault, J S; Smith, J; Currier, B L
2001-01-15
Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome). To describe the clinical presentation, diagnostic evaluation, and management of facet-related low back pain in a 17-year-old cheerleader and its successful surgical treatment with resection of a contralateral anomalous articulation. Lumbosacral transitional vertebrae are common in the general population. Bertolotti's syndrome is mechanical low back pain associated with these transitional segments. Little is known about the pathophysiology and mechanics of these vertebral segments and their propensity to be pain generators. Treatment of this syndrome is controversial, and surgical intervention has been infrequently reported. A retrospective chart analysis and radiographic review were performed. Repeated fluoroscopically guided injections implicated a symptomatic L6-S1 facet joint contralateral to an anomalous lumbosacral articulation. Eventually, a successful surgical outcome was achieved with resection of the anomalous articulation. Clinicians should consider the possibility that mechanical low back pain may occur from a facet contralateral to a unilateral anomalous lumbosacral articulation, even in a young patient. Although reports of surgical treatment of Bertolotti's syndrome are infrequent, resection of the anomalous articulation provided excellent results in this patient, presumably because of reduced stresses on the symptomatic facet.
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NSI directed to continue SPAN's functions
NASA Technical Reports Server (NTRS)
Rounds, Fred
1991-01-01
During a series of network management retreats in June and July 1990, representatives from NASA Headquarters Codes O and S agreed on networking roles and responsibilities for their respective organizations. The representatives decided that NASA Science Internet (NSI) will assume management of both the Space Physics Analysis Network (SPAN) and the NASA Science Network (NSN). SPAN is now known as the NSI/DECnet, and NSN is now known as the NSI/IP. Some management functions will be distributed between Ames Research Center (ARC) and Goddard Space Flight Center (GSFC). NSI at ARC has the lead role for requirements generation and networking engineering. Advanced Applications and the Network Information Center is being developed at GSFC. GSFC will lead the NSI User Services, but NSI at Ames will continue to provide the User Services during the transition. The transition will be made as transparent as possible for the users. DECnet service will continue, but is now directly managed by NSI at Ames. NSI will continue to work closely with routing center managers at other NASA centers, and has formed a transition team to address the change in management. An NSI/DECnet working group had also been formed as a separate engineering group within NSI to plan the transition to Phase 5, DECnet's approach to Open System Integration (OSI). Transition is not expected for a year or more due to delays in produce releases. Plans to upgrade speeds in tail circuits and the backbone are underway. The proposed baseline service for new connections is up to 56 Kbps; 9.6 Kbps lines will gradually be upgraded as requirements dictate. NSI is in the process of consolidating protocol traffic, tail circuits, and the backbone. Currently NSI's backbone is fractional T1; NSI will go to full T1 service as soon as it is feasible.
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A Novel Quantitative Approach to Concept Analysis: The Internomological Network
Cook, Paul F.; Larsen, Kai R.; Sakraida, Teresa J.; Pedro, Leli
2012-01-01
Background When a construct such as patients’ transition to self-management of chronic illness is studied by researchers across multiple disciplines, the meaning of key terms can become confused. This results from inherent problems in language where a term can have multiple meanings (polysemy) and different words can mean the same thing (synonymy). Objectives To test a novel quantitative method for clarifying the meaning of constructs by examining the similarity of published contexts in which they are used. Method Published terms related to the concept transition to self-management of chronic illness were analyzed using the internomological network (INN), a type of latent semantic analysis to calculate the mathematical relationships between constructs based on the contexts in which researchers use each term. This novel approach was tested by comparing results to those from concept analysis, a best-practice qualitative approach to clarifying meanings of terms. By comparing results of the two methods, the best synonyms of transition to self-management, as well as key antecedent, attribute, and consequence terms, were identified. Results Results from INN analysis were consistent with those from concept analysis. The potential synonyms self-management, transition, and adaptation had the greatest utility. Adaptation was the clearest overall synonym, but had lower cross-disciplinary use. The terms coping and readiness had more circumscribed meanings. The INN analysis confirmed key features of transition to self-management, and suggested related concepts not found by the previous review. Discussion The INN analysis is a promising novel methodology that allows researchers to quantify the semantic relationships between constructs. The method works across disciplinary boundaries, and may help to integrate the diverse literature on self-management of chronic illness. PMID:22592387
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Fratini, C F; Elle, M; Jensen, M B; Mikkelsen, P S
2012-01-01
To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management cycle'. But Danish municipalities and utility companies are struggling to bring such solutions into practice. 'Green infrastructure', for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities to create the basis for managing and catalysing the technical and organizational innovation necessary for a sustainable transition towards climate change adaptation in urban areas.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-12-08
... DEPARTMENT OF DEFENSE Office of the Secretary Meeting of the Department of Defense Task Force on... Forces (Subsequently Referred to as the Task Force) AGENCY: Department of Defense. ACTION: Notice... forthcoming meeting of the Department of Defense Task Force on the Care, Management, and Transition of...
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ERIC Educational Resources Information Center
Harrington, Denis; Kearney, Arthur
2011-01-01
Purpose: This paper aims to consider the extent to which business school transition has created new opportunities in management development, knowledge transfer and knowledge creation. Design/methodology/approach: The paper is a critical review of knowledge exchange in a business school context with a particular focus on the "translation or…
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Young Children's Knowledge of Food Allergy and Transition to School
ERIC Educational Resources Information Center
Sanagavarapu, Prathyusha
2017-01-01
Children's knowledge of food allergies and their self-management is developmentally based, and is essential for their safe transition to school. Despite a growing number of children with food allergies starting school globally, to date, little is known about young children's knowledge of food allergy or their capacity to manage it, or their…
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Becky K. Kerns; Miles A. Hemstrom; David Conklin; Gabriel I. Yospin; Bart Johnson; Dominique Bachelet; Scott Bridgham
2012-01-01
Understanding landscape vegetation dynamics often involves the use of scientifically-based modeling tools that are capable of testing alternative management scenarios given complex ecological, management, and social conditions. State-and-transition simulation model (STSM) frameworks and software such as PATH and VDDT are commonly used tools that simulate how landscapes...
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Code of Federal Regulations, 2014 CFR
2014-01-01
... Management Agency (FEMA) or under a Memorandum of Understanding between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the homeless. 1955.72 Section 1955.72... between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the...
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Code of Federal Regulations, 2013 CFR
2013-01-01
... Management Agency (FEMA) or under a Memorandum of Understanding between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the homeless. 1955.72 Section 1955.72... between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the...
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Code of Federal Regulations, 2011 CFR
2011-01-01
... Management Agency (FEMA) or under a Memorandum of Understanding between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the homeless. 1955.72 Section 1955.72... between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the...
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Code of Federal Regulations, 2012 CFR
2012-01-01
... Management Agency (FEMA) or under a Memorandum of Understanding between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the homeless. 1955.72 Section 1955.72... between the Agency and the Department of Health and Human Services (HHS) for transitional housing for the...
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Effectively managing consumer fuel price driven transit demand.
DOT National Transportation Integrated Search
2013-05-01
This study presents a literature review of transit demand elasticities with respect to gas prices, describes features of a transit service area population that may be more sensitive to fuel prices, identifies where stress points in the family of tran...
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Remote sensing of rangeland biodiversity
USDA-ARS?s Scientific Manuscript database
Rangelands are managed based on state and transition models for an ecological site. Transitions to alternative ecological states are indicative of degrading rangelands. Three key variables may be remotely sensed to detect transitions between alternative states: amount of bare soil, presence of inva...
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5 CFR 550.187 - Transitional provisions.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Transitional provisions. 550.187 Section 550.187 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.187 Transitional provisions. (a...
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5 CFR 550.187 - Transitional provisions.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Transitional provisions. 550.187 Section 550.187 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.187 Transitional provisions. (a...
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5 CFR 550.187 - Transitional provisions.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Transitional provisions. 550.187 Section 550.187 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.187 Transitional provisions. (a...
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5 CFR 550.187 - Transitional provisions.
Code of Federal Regulations, 2012 CFR
2012-01-01
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5 CFR 550.187 - Transitional provisions.
Code of Federal Regulations, 2014 CFR
2014-01-01
... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Transitional provisions. 550.187 Section 550.187 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.187 Transitional provisions. (a...
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A Markov decision process for managing habitat for Florida scrub-jays
Johnson, Fred A.; Breininger, David R.; Duncan, Brean W.; Nichols, James D.; Runge, Michael C.; Williams, B. Ken
2011-01-01
Florida scrub-jays Aphelocoma coerulescens are listed as threatened under the Endangered Species Act due to loss and degradation of scrub habitat. This study concerned the development of an optimal strategy for the restoration and management of scrub habitat at Merritt Island National Wildlife Refuge, which contains one of the few remaining large populations of scrub-jays in Florida. There are documented differences in the reproductive and survival rates of scrubjays among discrete classes of scrub height (<120 cm or "short"; 120-170 cm or "optimal"; .170 cm or "tall"; and a combination of tall and optimal or "mixed"), and our objective was to calculate a state-dependent management strategy that would maximize the long-term growth rate of the resident scrub-jay population. We used aerial imagery with multistate Markov models to estimate annual transition probabilities among the four scrub-height classes under three possible management actions: scrub restoration (mechanical cutting followed by burning), a prescribed burn, or no intervention. A strategy prescribing the optimal management action for management units exhibiting different proportions of scrub-height classes was derived using dynamic programming. Scrub restoration was the optimal management action only in units dominated by mixed and tall scrub, and burning tended to be the optimal action for intermediate levels of short scrub. The optimal action was to do nothing when the amount of short scrub was greater than 30%, because short scrub mostly transitions to optimal height scrub (i.e., that state with the highest demographic success of scrub-jays) in the absence of intervention. Monte Carlo simulation of the optimal policy suggested that some form of management would be required every year. We note, however, that estimates of scrub-height transition probabilities were subject to several sources of uncertainty, and so we explored the management implications of alternative sets of transition probabilities. Generally, our analysis demonstrated the difficulty of managing for a species that requires midsuccessional habitat, and suggests that innovative management tools may be needed to help ensure the persistence of scrub-jays at Merritt Island National Wildlife Refuge. The development of a tailored monitoring program as a component of adaptive management could help reduce uncertainty about controlled and uncontrolled variation in transition probabilities of scrub-height and thus lead to improved decision making.
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On entropy change measurements around first order phase transitions in caloric materials.
Caron, Luana; Ba Doan, Nguyen; Ranno, Laurent
2017-02-22
In this work we discuss the measurement protocols for indirect determination of the isothermal entropy change associated with first order phase transitions in caloric materials. The magneto-structural phase transitions giving rise to giant magnetocaloric effects in Cu-doped MnAs and FeRh are used as case studies to exemplify how badly designed protocols may affect isothermal measurements and lead to incorrect entropy change estimations. Isothermal measurement protocols which allow correct assessment of the entropy change around first order phase transitions in both direct and inverse cases are presented.
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Understanding electron magnetic circular dichroism in a transition potential approach
NASA Astrophysics Data System (ADS)
Barthel, J.; Mayer, J.; Rusz, J.; Ho, P.-L.; Zhong, X. Y.; Lentzen, M.; Dunin-Borkowski, R. E.; Urban, K. W.; Brown, H. G.; Findlay, S. D.; Allen, L. J.
2018-04-01
This paper introduces an approach based on transition potentials for inelastic scattering to understand the underlying physics of electron magnetic circular dichroism (EMCD). The transition potentials are sufficiently localized to permit atomic-scale EMCD. Two-beam and three-beam systematic row cases are discussed in detail in terms of transition potentials for conventional transmission electron microscopy, and the basic symmetries which arise in the three-beam case are confirmed experimentally. Atomic-scale EMCD in scanning transmission electron microscopy (STEM), using both a standard STEM probe and vortex beams, is discussed.
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NREL Evaluates Performance of Fast-Charge Electric Buses
DOE Office of Scientific and Technical Information (OSTI.GOV)
2016-09-16
This real-world performance evaluation is designed to enhance understanding of the overall usage and effectiveness of electric buses in transit operation and to provide unbiased technical information to other agencies interested in adding such vehicles to their fleets. Initial results indicate that the electric buses under study offer significant fuel and emissions savings. The final results will help Foothill Transit optimize the energy-saving potential of its transit fleet. NREL's performance evaluations help vehicle manufacturers fine-tune their designs and help fleet managers select fuel-efficient, low-emission vehicles that meet their bottom line and operational goals. help Foothill Transit optimize the energy-saving potentialmore » of its transit fleet. NREL's performance evaluations help vehicle manufacturers fine-tune their designs and help fleet managers select fuel-efficient, low-emission vehicles that meet their bottom line and operational goals.« less
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Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard
2016-04-01
The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.
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NASA Astrophysics Data System (ADS)
Halbe, Johannes; Pahl-Wostl, Claudia; Adamowski, Jan
2018-01-01
Multiple barriers constrain the widespread application of participatory methods in water management, including the more technical focus of most water agencies, additional cost and time requirements for stakeholder involvement, as well as institutional structures that impede collaborative management. This paper presents a stepwise methodological framework that addresses the challenges of context-sensitive initiation, design and institutionalization of participatory modeling processes. The methodological framework consists of five successive stages: (1) problem framing and stakeholder analysis, (2) process design, (3) individual modeling, (4) group model building, and (5) institutionalized participatory modeling. The Management and Transition Framework is used for problem diagnosis (Stage One), context-sensitive process design (Stage Two) and analysis of requirements for the institutionalization of participatory water management (Stage Five). Conceptual modeling is used to initiate participatory modeling processes (Stage Three) and ensure a high compatibility with quantitative modeling approaches (Stage Four). This paper describes the proposed participatory model building (PMB) framework and provides a case study of its application in Québec, Canada. The results of the Québec study demonstrate the applicability of the PMB framework for initiating and designing participatory model building processes and analyzing barriers towards institutionalization.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Naime, Andre, E-mail: andre.naime.ibama@gmail.com
The environmental regulation of hazardous projects with risk-based decision-making processes can lead to a deficient management of human exposure to technological hazards. Such an approach for regulation is criticized for simplifying the complexity of decisions involving the economic, social, and environmental aspects of the installation and operation of hazardous facilities in urban areas. Results of a Brazilian case study indicate that oil and gas transmission pipelines may represent a threat to diverse communities if the relationship between such linear projects and human populations is overlooked by regulatory bodies. Results also corroborate known challenges to the implementation of EIA processes andmore » outline limitations to an effective environmental and risk management. Two preliminary topics are discussed to strengthen similar regulatory practices. Firstly, an effective integration between social impact assessment and risk assessment in EIA processes to have a more comprehensive understanding of the social fabric. Secondly, the advancement of traditional management practices for hazardous installations to pursue a strong transition from assessment and evaluation to management and control and to promote an effective interaction between land-use planning and environmental regulation.« less
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Guy, Christopher S.; Treanor, Hilary B.; Kappenman, Kevin M.; Scholl, Eric A.; Ilgen, Jason E.; Webb, Molly A. H.
2015-01-01
The global proliferation of dams within the last half century has prompted ecologists to understand the effects of regulated rivers on large-river fishes. Currently, much of the effort to mitigate the influence of dams on large-river fishes has been focused on downriver effects, and little attention has been given to upriver effects. Through a combination of field observations and laboratory experiments, we tested the hypothesis that abiotic conditions upriver of the dam are the mechanism for the lack of recruitment in Pallid Sturgeon (Scaphirhynchus albus), an iconic large-river endangered species. Here we show for the first time that anoxic upriver habitat in reservoirs (i.e., the transition zone between the river and reservoir) is responsible for the lack of recruitment in Pallid Sturgeon. The anoxic condition in the transition zone is a function of reduced river velocities and the concentration of fine particulate organic material with high microbial respiration. As predicted, the river upstream of the transition zone was oxic at all sampling locations. Our results indicate that transition zones are an ecological sink for Pallid Sturgeon. We argue that ecologists, engineers, and policy makers need to broaden the regulated-river paradigm to consider upriver and downriver effects of dams equally to comprehensively mitigate altered ecosystems for the benefit of large-river fishes, especially for the Pallid Sturgeon.
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Lacasse, P; Vanacker, N; Ollier, S; Ster, C
2018-02-01
The incidence of metabolic and infectious diseases varies greatly during the lactation cycle. Most new cases of clinical mastitis appear at the beginning of lactation, and the incidence increases with the level of milk production. In addition to mastitis, many other infectious diseases become clinically apparent during the first 2weeks of lactation. During this time, cows are in a negative energy balance and must mobilize body reserves to balance the deficit between food energy intake and energy required for milk production. The relationships between energy deficit and metabolic diseases, such as ketosis and hepatic lipidosis, are well known. Furthermore, cows in energy deficit have a weakened immune system and are therefore more susceptible to infections. There is now good evidence that the increase in circulating non-esterified fatty acids impairs immune cell functions. Therefore, management approaches that reduce the negative energy balance and the increase in non-esterified fatty acids at the beginning of lactation are likely to improve resistance to infection. Improving the nutrient supply through periparturient nutritional management has been the subject of considerable research. However, another way to reduce the imbalance between nutrient supply and demand is to temporarily decrease the latter. In this review, we examine how management strategies such as conjugated linoleic acid feeding, prepartum milking, or limiting postpartum milk production could be used to reduce metabolic perturbations and immunosuppression during the transition period. At this stage, it appears that reducing the amount of milk harvested postpartum by means of partial milking in the first days after calving is the most promising approach to reduce metabolic stress and immunosuppression without compromising the productivity of high-yielding dairy cows. Copyright © 2017. Published by Elsevier Ltd.
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DOT National Transportation Integrated Search
2005-04-01
This Guidebook was developed at the request of the transit industry. It provides best practices for both transit managers and technical staff with respect to planning, implementing and using geographic data in transit. The Guidebook discusses issues ...
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NASA Astrophysics Data System (ADS)
Sivapalan, M.; Elshafei, Y.; Srinivasan, V.
2014-12-01
A challenging research puzzle in the research on sustainable water management in the Anthropocene is why some societies successfully recover from "ecological destruction" to transition to "successful adaptation" over decadal timescales, while others fail. We present a conceptual modeling framework to understand and characterize these transitions. In this way, we aim to capture the potential drivers of the desired shift towards achieving sustainability of socio-hydrological systems. This is done through a synthesis of detailed socio-hydrological analyses of four river basins in three continents, carried out using different quantitative socio-hydrologic models: Murrumbidgee River Basin in eastern Australia, Lake Toolibin Catchment in Western Australia, Tarim River Basin in Western China and Kissimmee River Basin, in south-east United States. The case studies are analysed using either place-based models designed specifically to mimic observed long-term socio-hydrologic trends, or generic conceptual models with foundations in diverse strands of literature including sustainability science and resilience theory. A comparative analysis of the four case studies reveals a commonality in the building blocks employed to model these socio-hydrologic systems; including water balance, economic, environmental and human-feedback components. Each model reveals varying interpretations of a common organising principle that could explain the shift between productive (socio-economic) and restorative (environmental) forces that was evident in each of these systems observed over a long time frame. The emergent principle is related to the essential drivers of the human feedback component and rests with a general formulation of human well-being, as reflected by both their economic and environmental well-being. It is envisaged that the understanding of the system drivers gained from such a comparative study would enable more targeted water management strategies that can be administered in developing basins to achieve overall sustainability.
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Markulev, Connie; McGorry, Patrick D; Nelson, Barnaby; Yuen, Hok Pan; Schaefer, Miriam; Yung, Alison R; Thompson, Andrew; Berger, Gregor; Mossaheb, Nilufar; Schlögelhofer, Monika; Smesny, Stefan; de Haan, Lieuwe; Riecher-Rössler, Anita; Nordentoft, Merete; Chen, Eric Yu Hai; Verma, Swapna; Hickie, Ian; Amminger, G Paul
2017-10-01
Recent research has indicated that preventative intervention is likely to benefit patients 'at-risk' for psychosis, both in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder. The strong preliminary results for the effectiveness of omega-3 polyunsaturated fatty acids (PUFAs), coupled with the falling transition rate in ultra high-risk (UHR) samples, mean that further study of such benign, potentially neuroprotective interventions is clinically and ethically required. Employing a multicentre approach, enabling a large sample size, this study will provide important information with regard to the use of omega-3 PUFAs in the UHR group. This trial is a 6-month, double-blind, randomized placebo-controlled trial of 1.4 g day -1 omega-3 PUFAs in UHR patients aged between 13 and 40 years. The primary hypothesis is that UHR patients receiving omega-3 PUFAs plus cognitive-behavioural case management (CBCM) will be less likely to transition to psychosis over a 6-month period compared to treatment with placebo plus CBCM. Secondary outcomes will examine symptomatic and functional changes, as well as examine if candidate risk factors predict response to omega-3 PUFA treatment in the UHR group. This is the protocol of the NeuraproE study. Utilizing a large sample, results from this study will be important in informing indicated prevention strategies for schizophrenia and other psychotic disorders, which may be the strongest avenue for reducing the burden, stigmatization, disability and economic consequences of these disorders. © 2015 Wiley Publishing Asia Pty Ltd.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Cartmell, D.B.
1995-09-01
Based on US Department of Energy (DOE), Richland Operations Office (RL) review, specific areas of Westinghouse Hanford Company (WHC), Transition Projects ``Draft`` Multi-Year Program Plan (MYPP) were revised in preparation for the RL approval ceremony on September 26, 1995. These changes were reviewed with the appropriate RL Project Manager. The changes have been incorporated to the MYPP electronic file, and hard copies replacing the ``Draft`` MYPP will be distributed after the formal signing. In addition to the comments received, a summary level schedule and outyear estimates for the K Basin deactivation beginning in FY 2001 have been included. The Kmore » Basin outyear waste data is nearing completion this week and will be incorporated. This exclusion was discussed with Mr. N.D. Moorer, RL, Facility Transition Program Support/Integration. The attached MYPP scope/schedule reflects the Integrated Target Case submitted in the April 1995 Activity Data Sheets (ADS) with the exception of B Plant and the Plutonium Finishing Plant (PFP). The 8 Plant assumption in FY 1997 reflects the planning case in the FY 1997 ADS with a shortfall of $5 million. PFP assumptions have been revised from the FY 1997 ADS based on the direction provided this past summer by DOE-Headquarters. This includes the acceleration of the polycube stabilization back to its originally planned completion date. Although the overall program repricing in FY 1996 allowed the scheduled acceleration to fall with the funding allocation, the FY 1997 total reflects a shortfall of $6 million.« less
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ERIC Educational Resources Information Center
Walahoski, Jill
2013-01-01
This mixed methods case study was designed to assess the preparedness of former Nebraska 4-H participants to successfully transition and adjust to college. The study also sought to understand the way that students' experiences in Nebraska 4-H may have influenced their readiness to transition to college. The initial quantitative stage of this case…
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Talanian, M.; Azari, F.; Agarwal, A.
2018-01-01
Introduction Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of progressive fibrotic change in response to prolonged, repetitive, and typically severe insult to the peritoneal mesothelium, often occurring in the setting of peritoneal dialysis (PD). Clear guidelines for successful management remain elusive. We describe the successful surgical management of EPS in a 28-year-old male s/p deceased donor kidney transplant for end-stage renal disease (ESRD) secondary to focal segmental glomerulosclerosis (FSGS). This patient received PD for 7 years but changed to hemodialysis (HD) in the year of transplant due to consistent signs and symptoms of underdialysis. EPS was visualized at the time of transplant. Despite successful renal transplantation, EPS progressed to cause small bowel obstruction (SBO) requiring PEG-J placement for enteral nutrition and gastric decompression. The patient subsequently developed a chronic gastrocutaneous fistula necessitating chronic TPN and multiple admissions for pain crises and bowel obstruction. He was elected to undergo surgical intervention due to deteriorating quality of life and failure to thrive. Surgical management included an exploratory laparotomy with extensive lysis of adhesions (LOA), repair of gastrocutaneous fistula, and end ileostomy with Hartmann's pouch. Postoperative imaging confirmed resolution of the SBO, and the patient was transitioned to NGT feeds and eventually only PO intake. He is continuing with PO nutrition, gaining weight, and free from dialysis. Conclusion Surgical intervention with LOA and release of small intestine can be successful for definitive management of EPS in the proper setting. In cases such as this, where management with enteral nutrition fails secondary to ongoing obstructive episodes, surgical intervention can be pursued in the interest of preserving quality of life. PMID:29682387
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Shahbazov, R; Talanian, M; Alejo, J L; Azari, F; Agarwal, A; Brayman, K L
2018-01-01
Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of progressive fibrotic change in response to prolonged, repetitive, and typically severe insult to the peritoneal mesothelium, often occurring in the setting of peritoneal dialysis (PD). Clear guidelines for successful management remain elusive. We describe the successful surgical management of EPS in a 28-year-old male s/p deceased donor kidney transplant for end-stage renal disease (ESRD) secondary to focal segmental glomerulosclerosis (FSGS). This patient received PD for 7 years but changed to hemodialysis (HD) in the year of transplant due to consistent signs and symptoms of underdialysis. EPS was visualized at the time of transplant. Despite successful renal transplantation, EPS progressed to cause small bowel obstruction (SBO) requiring PEG-J placement for enteral nutrition and gastric decompression. The patient subsequently developed a chronic gastrocutaneous fistula necessitating chronic TPN and multiple admissions for pain crises and bowel obstruction. He was elected to undergo surgical intervention due to deteriorating quality of life and failure to thrive. Surgical management included an exploratory laparotomy with extensive lysis of adhesions (LOA), repair of gastrocutaneous fistula, and end ileostomy with Hartmann's pouch. Postoperative imaging confirmed resolution of the SBO, and the patient was transitioned to NGT feeds and eventually only PO intake. He is continuing with PO nutrition, gaining weight, and free from dialysis. Surgical intervention with LOA and release of small intestine can be successful for definitive management of EPS in the proper setting. In cases such as this, where management with enteral nutrition fails secondary to ongoing obstructive episodes, surgical intervention can be pursued in the interest of preserving quality of life.
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Agile Port System Transition Support Transition Plan Development
2013-07-29
Operational Needs addressed • Proposed Solutions • Current Status • Risk • A Business Case for transition • Appropriate Funding Sources • Transition...13 3.1.6 Risk Table...18 3.2.6 Risk Table
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DOT National Transportation Integrated Search
2011-04-01
Many local governments and transit agencies in the United States face financial difficulties in providing adequate public transit service in individual systems, and in providing sufficient regional coordination to accommodate transit trips involving ...
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NASA Astrophysics Data System (ADS)
Sladonja, Barbara; Brščić, Kristina; Poljuha, Danijela; Fanuko, Neda; Grgurev, Marin
2012-06-01
Croatia, like many other transition countries has undergone radical changes in its nature protection models. This paper discusses a historical overview, present situation and future possibilities for nature conservation in Croatia. A conservative top-down approach to nature protection was applied in the past in Croatia and is now being replaced by a prevalent bottom-up approach. Social context is crucial to introducing participatory conservation, therefore special concern is given to the perception of the local population towards protected area management in Istria as a case study in Croatia. Survey data were used to assess the conservation knowledge of local populations and their perception towards Protected Areas (PAs), leadership activities and management authorities in Istria County. This paper examines the perceptions of 313 residents living in and around six natural PAs located in Istria. The results revealed a moderate general knowledge about PAs in Istria and environmental issues, and a low awareness of institutions managing PAs, eagerness to participate in the activities of PAs and general support for the conservation cause. Understanding the perception of local residents enables the creation of feasible, long-term strategies for the implementation of participatory conservation. The research identifies the need for greater human, technical and financial efforts to strengthen the management capabilities of local agencies responsible for PAs. The process of participatory conservation optimization in Croatia is underway and world experiences must be observed in order to create a congruent, site-specific model with the best possible results.
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Epithelial-to-mesenchymal transition in penile squamous cell carcinoma.
Masferrer, Emili; Ferrándiz-Pulido, Carla; Masferrer-Niubò, Magalí; Rodríguez-Rodríguez, Alfredo; Gil, Inmaculada; Pont, Antoni; Servitje, Octavi; García de Herreros, Antonio; Lloveras, Belen; García-Patos, Vicenç; Pujol, Ramon M; Toll, Agustí; Hernández-Muñoz, Inmaculada
2015-02-01
Epithelial-to-mesenchymal transition is a phenomenon in epithelial tumors that involves loss of intercellular adhesion, mesenchymal phenotype acquisition and enhanced migratory potential. While the epithelial-to-mesenchymal transition process has been extensively linked to metastatic progression of squamous cell carcinoma, studies of the role of epithelial-to-mesenchymal transition in squamous cell carcinoma containing high risk human papillomaviruses are scarce. Moreover, to our knowledge epithelial-to-mesenchymal transition involvement in human penile squamous cell carcinoma, which can arise through transforming HPV infections or independently of HPV, has not been investigated. We evaluated the presence of epithelial-to-mesenchymal transition markers and their relationship to HPV in penile squamous cell carcinoma. We assessed the expression of E-cadherin, vimentin and the epithelial-to-mesenchymal transition related transcription factors Twist, Zeb1 and Snail by immunohistochemical staining in 64 penile squamous cell carcinoma cases. HPV was detected by polymerase chain reaction amplification. Simultaneous loss of membranous E-cadherin expression and vimentin over expression were noted in 43.5% of penile squamous cell carcinoma cases. HPV was significantly associated with loss of membranous E-cadherin but not with epithelial-to-mesenchymal transition. Recurrence and mortality rates were significantly higher in cases showing epithelial-to-mesenchymal transition. Our findings indicate that in penile squamous cell carcinoma epithelial-to-mesenchymal transition is associated with poor prognosis but not with the presence of HPV. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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Kennedy, Margaret Q; Badger, Elizabeth; Pompeii, Lisa; Lipscomb, Hester J
2003-05-01
1. Through a community based program, nurses were hired by a rural medical center to facilitate care for injured workers in the community. This placed the nurses outside the industrial and insurance arenas. 2. Rapid access to care and expedited return to work were made possible largely through improved communication, facilitated by the nurse case coordinators, among all involved parties (i.e., workers, employers, health care providers, insurance carriers). 3. The program provides access to occupational health nurses, or case managers, to a large number of rural workers--many of whom work for small employers and would not have these services otherwise. 4. The simple administrative model has resulted in increased numbers of workers returning to work with decreasing numbers of transitional or modified duty days.
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Primary healthcare in transition--a qualitative study of how managers perceived a system change.
Maun, Andy; Nilsson, Kerstin; Furåker, Carina; Thorn, Jörgen
2013-10-03
Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system.
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Review of outcomes from a change in faculty clinic management in a U.S. dental school.
Nadershahi, Nader A; Salmon, Eric S; Fathi, Nava; Schmedders, Karl; Hargis, Jace
2010-09-01
Dental schools use a variety of clinic management models with the goals of promoting patient care, student education, and fiscal responsibility. In 2004, the University of the Pacific Arthur A. Dugoni School of Dentistry transitioned to a more generalist model with these goals in mind. The purpose of this study was to evaluate the outcomes of this clinic model change relative to the quantity of specific procedures completed by students. The quantity of procedures completed by each student from the classes of 1995 through 2009 were compiled from our electronic clinic management system and analyzed. The post-transition group (2004-09) showed a greater number of completed oral diagnosis and treatment planning and root planing procedures per student compared to the pre-transition group (1995-2003), but fewer crowns, root canals, operative procedures, and dentures. Because the higher procedure numbers were for low-cost procedures, our transition to a generalist model did not necessarily enhance clinic income but may support student learning and enhanced patient care.
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Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling
Lucchese, Marcello; Borisenko, Oleg; Mantovani, Lorenzo Giovanni; Cortesi, Paolo Angelo; Cesana, Giancarlo; Adam, Daniel; Burdukova, Elisabeth; Lukyanov, Vasily; Di Lorenzo, Nicola
2017-01-01
Objective To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. Methods A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. Results In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. Conclusion In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis. PMID:28601866
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ERIC Educational Resources Information Center
Page, Damien
2013-01-01
This article presents findings from a study of 14 heads of construction in further education colleges in England as they manage the transition of new construction lecturers from a culture of hypermasculinity to one of emotional labour and caring. It focuses firstly on the dilemmas faced by heads of construction at the recruitment stage before…
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USDA-ARS?s Scientific Manuscript database
Composted dairy manure (CDM) is among the management practices used in transitioning from a conventional to an organic agricultural system. The objectives of this study are to evaluate the impact of several organic nitrogen (N) sources on: (i) soil organic C (SOC) and soil total N (STN) content; (ii...
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A role for social workers in improving care setting transitions: a case study.
Barber, Ruth D; Coulourides Kogan, Alexis; Riffenburgh, Anne; Enguidanos, Susan
2015-01-01
High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.
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Lea, Jackie; Cruickshank, Mary
2015-04-01
The aim of this paper is to present the findings from the new graduate nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. Evidence indicates that workload, skill mix and organizational pressures are still of concern for new nursing graduates within the Australian context and internationally. Many graduates are expected by employers to have high levels of independence, well developed problem solving abilities and be able to assume management and leadership responsibilities early in their graduate year. An exploratory, descriptive, qualitative case study design was utilised to determine the particular support needs over time that would assist with a safe transition to the rural nursing workforce. The aims of the study were to: (1) Explore the new graduate nurses' perceptions and experience of the nature and timing of support throughout their Transition to Practice Program in a rural setting; (2) Identify the functional elements of rural graduate nurse transition programs and develop guidelines that will assist in the design of Transition to Practice Programs that match the rural context and capacity. A purposive sample of 15 new graduate nurses who had commenced a 12 month Transition to Practice Program within a rural health facility from northern New South Wales, Australia, participated in this study. In-depth individual interviews with the new graduate nurses were conducted at time intervals of three to four months, six to seven months and 10 to 11 months. One of the key findings of this study is that as the new graduate nurse making the transition to professional rural nursing practice moves along the transition continuum, there are particular and unique aspects of the rural nurse's role and responsibilities for which the new graduate nurse will require specific learning support during their transition. When the new graduate moves from the role of the student to the less familiar role of professional practitioner, it is important that a rural Transition to Practice Program offers an incrementally staged workload and responsibilities that recognises the graduate's beginning nurse status. The study contributes new knowledge to the discussion of issues concerning support mechanisms for new graduate nurses as they make the transition to rural nursing practice. © 2014 John Wiley & Sons Ltd.
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DOT National Transportation Integrated Search
2013-08-01
Public transit agencies play an important role in the provision of safe, reliable, and cost-effective transportation for the communities they serve. With the growing intensity and frequency of extreme weather events, such as hurricanes Irene and Sand...
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Transitioning the Allergy/Immunology Patient from Childhood to Adulthood.
Hoyte, Flavia C L
2017-06-01
Allergic disorders and immunodeficiencies are generally chronic and even lifelong conditions, often changing over time, making the cautious transition of care from childhood to adulthood particularly important. Many, but not all, patients can continue to receive their care from the same physician as they transition through adolescence and emerging adulthood, made possible because allergy/immunology training programs require cross-training in the care of both pediatric and adult patients. Although keeping the same physician makes the transition easier for many allergy/immunology patients, even these patients face psychosocial issues unique to adolescents and emerging adults, including increased autonomy, risk-taking behavior, and medical self-management. Successful transition for patients with chronic allergic and immunologic conditions involves an understanding of the natural history of these conditions by patients and physicians alike, a gradual increase in self-management depending on individual readiness, and careful communication between pediatric and adult specialists as care is transitioned. [Pediatr Ann. 2017;46(6):e229-e234.]. Copyright 2017, SLACK Incorporated.
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Supervision strategies for improved reliability of bus routes. Final report
DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
1991-09-01
The synthesis will be of interest to transit agency managers and supervisors, as well as to operating and planning personnel who are concerned with the reliability and scheduling of buses. Information is provided on service monitoring, service supervision and control, and supervision strategies. Reliability of transit service is critical to bus transit ridership. The extent of service supervision has an important bearing on reliability. The report describes the various procedures that are used by transit agencies to monitor and maintain bus service reliability. Most transit systems conduct checks of the number of riders at maximum load points and monitor schedulemore » adherence at these locations. Other supervisory actions include service restoration techniques, and strategies such as schedule control, headway control, load control, extraboard management, and personnel selection and training. More sophisticated technologies, such as automatic passenger counting (APC) systems and automatic vehicle location and control (AVLC), have been employed by some transit agencies and are described in the synthesis.« less
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NASA Technical Reports Server (NTRS)
Barker, R. E., Jr.; Campbell, K. W.
1985-01-01
The applicability of classical nucleation theory to second (and higher) order thermodynamic transitions in the Ehrenfest sense has been investigated and expressions have been derived upon which the qualitative and quantitative success of the basic approach must ultimately depend. The expressions describe the effect of temperature undercooling, hydrostatic pressure, and tensile stress upon the critical parameters, the critical nucleus size, and critical free energy barrier, for nucleation in a thermodynamic transition of any general order. These expressions are then specialized for the case of first and second order transitions. The expressions for the case of undercooling are then used in conjunction with literature data to estimate values for the critical quantities in a system undergoing a pseudo-second order transition (the glass transition in polystyrene). Methods of estimating the interfacial energy gamma in systems undergoing a first and second order transition are also discussed.
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Starting Strong V: Transitions from Early Childhood Education and Care to Primary Education
ERIC Educational Resources Information Center
OECD Publishing, 2017
2017-01-01
The transition from early childhood education to primary school is a big step for all children, and a step which more and more children are having to take. Quality transitions should be well-prepared and child-centred, managed by trained staff collaborating with one another, and guided by an appropriate and aligned curriculum. Transitions like…
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Hydroeconomic modeling of sustainable groundwater management
NASA Astrophysics Data System (ADS)
MacEwan, Duncan; Cayar, Mesut; Taghavi, Ali; Mitchell, David; Hatchett, Steve; Howitt, Richard
2017-03-01
In 2014, California passed legislation requiring the sustainable management of critically overdrafted groundwater basins, located primarily in the Central Valley agricultural region. Hydroeconomic modeling of the agricultural economy, groundwater, and surface water systems is critically important to simulate potential transition paths to sustainable management of the basins. The requirement for sustainable groundwater use by 2040 is mandated for many overdrafted groundwater basins that are decoupled from environmental and river flow effects. We argue that, for such cases, a modeling approach that integrates a biophysical response function from a hydrologic model into an economic model of groundwater use is preferable to embedding an economic response function in a complex hydrologic model as is more commonly done. Using this preferred approach, we develop a dynamic hydroeconomic model for the Kings and Tulare Lake subbasins of California and evaluate three groundwater management institutions—open access, perfect foresight, and managed pumping. We quantify the costs and benefits of sustainable groundwater management, including energy pumping savings, drought reserve values, and avoided capital costs. Our analysis finds that, for basins that are severely depleted, losses in crop net revenue are offset by the benefits of energy savings, drought reserve value, and avoided capital costs. This finding provides an empirical counterexample to the Gisser and Sanchez Effect.
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Application of Pyridostigmine in Pediatric Gastrointestinal Motility Disorders: A Case Series.
Manini, Mhd Louai; Camilleri, Michael; Grothe, Rayna; Di Lorenzo, Carlo
2018-04-01
Gastrointestinal (GI) motility disorders are common in children. Treatment is challenging with limited medical and surgical options. Pyridostigmine, an acetyl cholinesterase inhibitor, increases acetylcholine at the neuromuscular junction promoting intestinal contractions. Little is known about the role and dosing of pyridostigmine in pediatric GI motility disorders. We present a case series of children with GI dysmotility managed with oral pyridostigmine. Patients' diagnoses include chronic intestinal pseudo-obstruction, gastroparesis with delayed small bowel transit, chronic constipation with failure to thrive, and prolonged ileus after pelvic surgery with chronic opioid use. Pyridostigmine was effective and safe in all cases. Pyridostigmine decreased abdominal distention, increased bowel movement frequency, and improved enteral feeding tolerance. Effective dosing ranged between 0.25-2.0 mg/kg/day. One patient experienced cramping abdominal pain while on pyridostigmine, but pain resolved after medication was discontinued. We found oral pyridostigmine to be helpful in children with different GI motility problems. Pyridostigmine should be considered in such patients when other treatment interventions have not been beneficial.
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Catastrophic Regime Shift in Water Reservoirs and São Paulo Water Supply Crisis.
Coutinho, Renato M; Kraenkel, Roberto A; Prado, Paulo I
2015-01-01
The relation between rainfall and water accumulated in reservoirs comprises nonlinear feedbacks. Here we show that they may generate alternative equilibrium regimes, one of high water-volume, the other of low water-volume. Reservoirs can be seen as socio-environmental systems at risk of regime shifts, characteristic of tipping point transitions. We analyze data from stored water, rainfall, and water inflow and outflow in the main reservoir serving the metropolitan area of São Paulo, Brazil, by means of indicators of critical regime shifts, and find a strong signal of a transition. We furthermore build a mathematical model that gives a mechanistic view of the dynamics and demonstrates that alternative stable states are an expected property of water reservoirs. We also build a stochastic version of this model that fits well to the data. These results highlight the broader aspect that reservoir management must account for their intrinsic bistability, and should benefit from dynamical systems theory. Our case study illustrates the catastrophic consequences of failing to do so.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
None
This document presents guidance for implementing the process that the U.S. Department of Energy (DOE) Office of Legacy Management (LM) will use for assuming perpetual responsibility for a closed uranium mill tailings site. The transition process specifically addresses sites regulated under Title II of the Uranium Mill Tailings Radiation Control Act (UMTRCA) but is applicable in principle to the transition of sites under other regulatory structures, such as the Formerly Utilized Sites Remedial Action Program.
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Digital soil mapping as a tool for quantifying state-and-transition models
USDA-ARS?s Scientific Manuscript database
Ecological sites and associated state-and-transition models (STMs) are rapidly becoming important land management tools in rangeland systems in the US and around the world. Descriptions of states and transitions are largely developed from expert knowledge and generally accepted species and community...
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Managing Headship Transitions in U.S. Independent Schools
ERIC Educational Resources Information Center
Kane, Pearl Rock; Barbaro, Justin
2016-01-01
Headship transitions in U.S. independent schools represent critical organizational events that affect multiple school constituencies, including faculty, staff, and students. With recent projections forecasting a high level of impending headship transitions in independent schools, this paper seeks to capture how second-year U.S. independent school…
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Transit Marketing : Review of the State-of-the-Art and a Handbook of Current Practice
DOT National Transportation Integrated Search
1985-04-01
Over the past decade, marketing has been given increased emphasis as a way to improve both transit rideship and productivity. While there is near universal agreement among transit managers that some level of marketing is necessary, there is far from ...
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28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).
Code of Federal Regulations, 2014 CFR
2014-07-01
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...
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28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).
Code of Federal Regulations, 2012 CFR
2012-07-01
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...
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28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).
Code of Federal Regulations, 2011 CFR
2011-07-01
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...
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28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).
Code of Federal Regulations, 2010 CFR
2010-07-01
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...
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28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).
Code of Federal Regulations, 2013 CFR
2013-07-01
... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...
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Case study of a successful learner's epistemological framings of quantum mechanics
NASA Astrophysics Data System (ADS)
Dini, Vesal; Hammer, David
2017-06-01
Research on student epistemologies in introductory courses has highlighted the importance of understanding physics as "a refinement of everyday thinking" [A. Einstein, J. Franklin Inst. 221, 349 (1936), 10.1016/S0016-0032(36)91047-5]. That view is difficult to sustain in quantum mechanics, for students as for physicists. How might students manage the transition? In this article, we present a case study of a graduate student's approaches and reflections on learning over two semesters of quantum mechanics, based on a series of nine interviews. We recount his explicit grappling with the shift in epistemology from classical to quantum, and we argue that his success in learning largely involved his framing mathematics as expressing physical meaning. At the same time, we show he was not entirely stable in these framings, shifting away from them in particular during his study of scattering. The case speaks to literature on students' epistemologies, with respect to the roles of everyday thinking and mathematics. We discuss what this case suggests for further research, with possible implications for instruction.
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Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder
Graham, Donna M.; O’Connor, Kate M.; Hinchion, John; Coate, Linda E.; Burke, Louise; Power, Derek G.
2013-01-01
Background Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease. Case report We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later. Conclusion This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours. PMID:24936321
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DOT National Transportation Integrated Search
1976-03-01
Westport, Connecticut is an illustration of a fixed-route transit service operating in an affluent suburban community. This case study is one of thirteen examples of a transit service in a small community. The background of the community is discussed...
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Small City Transit : Sudbury, Massachusetts : A Short-Lived Suburban Transit Service.
DOT National Transportation Integrated Search
1976-03-01
Sudbury, Massachusetts, is an illustration of a over-extended fixed-route transit service which was rather short-lived. This case study is one of thirteen examples of a transit service in a small community. The background of the community is discusse...
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Small City Transit : Evansville, Indiana : A Low Subsidy Transit Service
DOT National Transportation Integrated Search
1976-03-01
Evansville, Indiana, is an illustration of a transit service in which a large percentage of operating costs are obtained from fare-box revenues. This case study is one of thirteen examples of a transit service in a small community. The background of ...
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Small City Transit : Eugene/Springfield, Oregon : Extensive County-Wide Transit Coverage
DOT National Transportation Integrated Search
1976-03-01
Eugene/Springfield, Oregon is an illustration of a fixed-route transit service with extensive county-wide coverage. This case study is one of thirteen examples of a transit service in a small community. The background of the community is discussed al...
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Söderberg, Siv; Skär, Lisa
2014-01-01
Young adults with mental illness who need continuing care when they turn 18 are referred from child and adolescent psychiatry to general adult psychiatry. During this process, young adults are undergoing multiple transitions as they come of age while they transfer to another unit in healthcare. The aim of this study was to explore expectations and experiences of transition from child and adolescent psychiatry to general adult psychiatry as narrated by young adults and relatives. Individual interviews were conducted with three young adults and six relatives and analysed according to grounded theory. The analysis resulted in a core category: managing transition with support, and three categories: being of age but not mature, walking out of security and into uncertainty, and feeling omitted and handling concerns. The young adults' and relatives' main concerns were that they might be left out and feel uncertainty about the new situation during the transition process. To facilitate the transition process, individual care planning is needed. It is essential that young adults and relatives are participating in the process to be prepared for the changes and achieve a successful transition. Knowledge about the simultaneous processes seems to be an important issue for facilitating transition. PMID:24829900
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The 2009 Sydney shark attacks: case series and literature review.
Rtshiladze, Michael Alexander; Andersen, Sean Peter; Nguyen, Dai Quoc Anh; Grabs, Anthony; Ho, Kevin
2011-05-01
There were 59 unprovoked shark attacks worldwide in 2008. Twelve of these occurred in Australia, ranking it as second only to the USA. In February 2009, two attacks occurred within 72 h in Sydney, Australia. The two patients involved survived severe limb trauma. Case 1 suffered bite trauma to the lower limb and hand and underwent staged debridement and early amputation. Case 2 presented with a hand severed at the level of the wrist that was initially replanted. However, it would succumb to progressive necrosis after 12 days. We discuss the aspects of these cases that contributed to the patients' survival and ultimately good functional outcomes. New paradigms for the management of major trauma patients have emerged over the last decade. We consider recent advances in the understanding of pre-hospital tourniquet use, rapid transit to the operating suite and damage control surgery, and examine how they impacted on the management of our patients. Very little is known about the microbiology of shark bites. Organisms from sea water, the patient's skin and the shark's mouth must all be considered when selecting appropriate antimicrobial prophylaxis. The planning of definitive surgery in severe limb trauma is dependent on the interactions of a number of factors including physical, psychological and social issues. The decision to ultimately replant or amputate the effected limb is best made in union with the patient and their family. © 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons.
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Ferris, M; Cohen, S; Haberman, C; Javalkar, K; Massengill, S; Mahan, J D; Kim, S; Bickford, K; Cantu, G; Medeiros, M; Phillips, A; Ferris, M T; Hooper, S R
2015-01-01
The Self-Management and Transition to Adulthood with Rx=Treatment (STARx) Questionnaire was developed to collect information on self-management and health care transition (HCT) skills, via self-report, in a broad population of adolescents and young adults (AYAs) with chronic conditions. Over several iterations, the STARx questionnaire was created with AYA, family, and health provider input. The development and pilot testing of the STARx Questionnaire took place with the assistance of 1219 AYAs with different chronic health conditions, in multiple institutions and settings over three phases: item development, pilot testing, reliability and factor structuring. The three development phases resulted in a final version of the STARx Questionnaire. The exploratory factor analysis of the third version of the 18-item STARx identified six factors that accounted for about 65% of the variance: Medication management, Provider communication, Engagement during appointments, Disease knowledge, Adult health responsibilities, and Resource utilization. Reliability estimates revealed good internal consistency and temporal stability, with the alpha coefficient for the overall scale being .80. The STARx was developmentally sensitive, with older patients scoring significantly higher on nearly every factor than younger patients. The STARx Questionnaire is a reliable, self-report tool with adequate internal consistency, temporal stability, and a strong, multidimensional factor structure. It provides another assessment strategy to measure self-management and transition skills in AYAs with chronic conditions. Copyright © 2015 Elsevier Inc. All rights reserved.
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Health information technology: transforming chronic disease management and care transitions.
Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B
2012-06-01
Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.
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Awake Craniotomy: A New Airway Approach.
Sivasankar, Chitra; Schlichter, Rolf A; Baranov, Dimitry; Kofke, W Andrew
2016-02-01
Awake craniotomies have been performed regularly at the University of Pennsylvania since 2004. Varying approaches to airway management are described for this procedure, including intubation with an endotracheal tube and use of a laryngeal mask airway, simple facemask, or nasal cannula. In this case series, we describe the successful use (i.e., no need for endotracheal intubation related to inadequate gas exchange) of bilateral nasopharyngeal airways in 90 patients undergoing awake craniotomies. The use of nasopharyngeal airways can ease the transition between the asleep and awake phases of the craniotomy without the need to stimulate the airway. Our purpose was to describe our experience and report adverse events related to this technique.
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AN/ASQ-197 provides commonality to Recce systems and avionics upgrades
NASA Astrophysics Data System (ADS)
Regan, Brendan P.
1993-02-01
In an attempt to strike a balance between increases in multi-role tactical air reconnaissance mission tasking and simultaneous decreases in defense spending, many users are evaluating upgrades to existing sensors and reconnaissance systems. At the heart of any cost-effective reconnaissance system upgrade must be a flexible reconnaissance management system, capable of filling multiple rolls in today's film backed reconnaissance system, while enabling successful transition to the Electro-Optical (EO) system of tomorrow. As a case in point this paper describes enhanced effectiveness and growth potential that Fairchild's AN/ASQ-197 Sensor Control-Data Display Set (SC-DDS) can provide.
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Barnes, Agnieszka Szot; Haker, Steven J; Mulkern, Robert V; So, Minna; D'Amico, Anthony V; Tempany, Clare M
2005-12-01
Brachytherapy targeted to the peripheral zone with magnetic resonance imaging (MRI) guidance is a prostate cancer treatment option with potentially fewer complications than other treatments. Follow-up MRI when failure is suspected is, however, difficult because of radiation-induced changes. Furthermore, MR spectroscopy (MRS) is compromised by susceptibility artifacts from radioactive seeds in the peripheral zone. We report a case in which combined MRI/MRS was useful for the detection of prostate cancer in the transitional zone in patients previously treated with MR-guided brachytherapy. We propose that MRI/MRS can help detect recurrent prostate cancer, guide prostate biopsy, and help manage salvage treatment decisions.
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Mahadevan, Meena; Blair, Dorothy; Raines, Emily Rose
2014-01-01
This study was conducted to explore the perceptions of 20 South Indian Hindu Brahmin women on the factors influencing their food habits upon immigrating to America. The competing demands of juggling a new career and managing their family's nutritional needs at the same time, all without the support of extended family members, played an important role in steering these women away from cooking traditional healthy meals, and resorting to fast foods instead. Intervention strategies should be directed toward improving the barriers to eating healthy that were specifically identified within the confines of shifting gender roles and limited family support networks.
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The medical librarian as chief information officer.
Greer, M C
1998-01-01
The position of chief information officer (CIO) is gaining popularity, especially in the health care field. The results of an informal electronic and telephone survey indicate that few medical librarians have made a career move to CIO even though this might seem like a logical step. This paper examines the qualities required of an effective information management executive, the role CIOs play within organizations, and the career advancement strategies for librarians interested in becoming CIOs. Questionnaire responses are reported from three medical librarians who have made the transition to CIO-type positions, and a case study illustrates the responsibilities of CIOs in health care organizations.
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ERIC Educational Resources Information Center
Weiwei, Huang
2016-01-01
As a theory based on the hypothesis of "happy man" about human nature, happiness management plays a significant guiding role in the optimization of the training model of local Chinese normal university students during the transitional period. Under the guidance of this theory, China should adhere to the people-oriented principle,…
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Chapter 5: Application of state-and-transition models to evaluate wildlife habitat
Anita T. Morzillo; Pamela Comeleo; Blair Csuti; Stephanie Lee
2014-01-01
Wildlife habitat analysis often is a central focus of natural resources management and policy. State-and-transition models (STMs) allow for simulation of landscape level ecological processes, and for managers to test âwhat ifâ scenarios of how those processes may affect wildlife habitat. This chapter describes the methods used to link STM output to wildlife habitat to...
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2014-04-01
All Hazards Risk Assessment Transition Project : Report on Capability Assessment Management System (CAMS) Automation...Prepared by: George Giroux Computer Applications Specialist Modis155 Queen Street, Suite 1206 Ottawa, ON K1P 6L1 Contract # THS 2335474-2 Project ...Under a Canadian Safety and Security Program (CSSP) targeted investigation (TI) project (CSSP-2012-TI- 1108), Defence Research and Development
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Rangifer management controls a climate-sensitive tundra state transition.
Bråthen, Kari Anne; Ravolainen, Virve Tuulia; Stien, Audun; Tveraa, Torkild; Ims, Rolf A
2017-12-01
Rangifer (caribou/reindeer) management has been suggested to mitigate the temperature-driven transition of Arctic tundra into a shrubland state, yet how this happens is uncertain. Here we study this much focused ecosystem state transition in riparian areas, where palatable willows (Salix) are dominant tall shrubs and highly responsive to climate change. For the state transition to take place, small life stages must become tall and abundant. Therefore we predicted that the performance of small life stages (potential recruits) of the tall shrubs were instrumental to the focal transition, where Rangifer managed at high population density would keep the small-stage shrubs in a "browse trap" independent of summer temperature. We used a large-scale quasi-experimental study design that included real management units that spanned a wide range of Rangifer population densities and summer temperatures in order to assess the relative importance of these two driving variables. Ground surveys provided data on density and height of the small shrub life stages, while the distributional limit (shrubline) of established shrublands (the tall shrub life stage) was derived from aerial photographs. Where Rangifer densities were above a threshold of approximately 5 animals/km 2 , we found, in accordance with the expectation of a "browse trap," that the small life stages of shrubs in grasslands were at low height and low abundance. At Rangifer densities below this threshold, the small life stages of shrubs were taller and more abundant indicating Rangifer were no longer in control of the grassland state. For the established shrubland state, we found that the shrubline was at a 100-m lower elevation in the management units where Rangifer had been browsing in summer as opposed to the migratory ranges with no browsing in summer. In both seasonal ranges, the shrubline increased 100 m per 1°C increment in temperature. Our study supports the proposal that Rangifer management within a sustainable range of animal densities can mitigate the much-focused transition from grassland to shrubland in a warming Arctic. © 2017 by the Ecological Society of America.
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Canadian Palliative Community Milrinone Infusions: A Case Series.
Reimche, Ruthanne; Salcedo, Daniel
2016-01-01
Abstract Symptom managementfor end-of-life heartfailure (HF) patients is a significant concern. Currently, Canadian practice does not support community milrinone therapy in end-of-life HF patients. Two patients had severe HF that was unresponsive to optimal medications. Further optimization and furosemide infusions were ineffective for symptom management. Both patients' symptoms were better controlled with optimal medication, furosemide, and milrinone infusions. A tailored discharge plan was developed to assist with community milrinone infusions. We discuss the challenges and successes of transitioning two patients to the community. By providing symptom management and meaningful patient and family experience, both patients were able to die in a setting of their choosing. Milrinone infusions as a bridge to end of life may improve symptoms and quality of life. Select patients may benefit from milrinone infusions with resources put in place; these end-of-life HF patients can be supported in the community.
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Pharmaceutical industry exposure in our hospitals: the final frontier.
Dean, Jessica; Loh, Erwin; Coleman, Justin J
2016-01-18
Despite recent changes in attitudes, most hospitals continue to experience pharmaceutical industry presence. Pharmaceutical industry presence may be necessary and beneficial in the context of sponsorship of clinical trials with appropriate governance. Doctors continue to hold positive attitudes towards market-oriented activities of the pharmaceutical and medical device industries. Despite evidence to the contrary, doctors believe they are able to effectively manage pharmaceutical sales representative interactions such that their own prescribing is not adversely impacted. Doctors also share a belief that small gifts and benefits are harmless. There may be significant financial burden associated with divestment of such sponsorship by hospitals. Change requires education and effective policies to manage pharmaceutical industry relationships and conflicts of interest. We discuss case studies involving students and public hospital doctors to show that divestment is possible without significant financial detriment. Health services need to be proactive in transitioning financial and cultural reliance on pharmaceutical industry sponsorship to other potentially less harmful sources.
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Secondary Special Education Teachers and Transition Specialists: Collaborative Efforts
ERIC Educational Resources Information Center
Jacobs, Jodee Elizabeth
2017-01-01
This qualitative case study explored how secondary special education teachers and transition specialists perceived their collaborative efforts when transitioning students with Autism Spectrum Disorder (ASD) from secondary to higher education. The theory of transition established the platform for this study. Two of the theoretical principles of…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Fisher, R; Wunderle, K; Lingenfelter, M
Purpose: Transitioning from a paper based to an online system for tracking fluoroscopic case information required by state regulation and to conform to NCRP patient dose tracking suggestions. Methods: State regulations require documentation of operator, equipment, and some metric of tube output for fluoroscopy exams. This information was previously collected in paper logs, which was cumbersome and inefficient for the large number of fluoroscopic units across multiple locations within the system. The “tech notes” feature within Siemens’ Syngo workflow RIS was utilized to create an entry form for technologists to input case information, which was sent to a third partymore » vendor for archiving and display though an online web based portal. Results: Over 55k cases were logged in the first year of implementation, with approximately 6,500 cases per month once fully online. A system was built for area managers to oversee and correct data, which has increased the accuracy of inputted values. A high-dose report was built to automatically send notifications when patients exceed trigger levels. In addition to meeting regulatory requirements, the new system allows for larger scale QC in fluoroscopic cases by allowing comparison of data from specific procedures, locations, equipment, and operators so that instances that fall outside of reference levels can be identified for further evaluation. The system has also drastically improved identification of operators without documented equipment specific training. Conclusion: The transition to online fluoroscopy logs has improved efficiency in meeting state regulatory requirements as well as allowed for identification of particular procedures, equipment, and operators in need of additional attention in order to optimize patient and personnel doses, while high dose alerts improve patient care and follow up. Future efforts are focused on incorporating case information from outside of radiology, as well as on automating processes for increased efficiencies.« less
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Importance of Teacher Transition Competencies as Rated by Special Educators.
ERIC Educational Resources Information Center
Blanchett, Wanda J.
2001-01-01
Seventy-four special educators who were involved in transition-related activities rated the importance of 30 transition-related teacher competencies. All competencies were identified by the majority of respondents as important. Competencies related to teaching money management skills and involving parents received the highest ratings. (Contains…
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Preparing International Students for the Re-Entry Transition.
ERIC Educational Resources Information Center
Arthur, Nancy
2003-01-01
Counselors play an integral role in assisting international students to manage cross-cultural transitions. Re-entry counseling can support international students to examine their transition experiences, provide education about re-entry, and help to develop anticipatory coping strategies. An example of a workshop is described as a method of…
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Phase-Adequate Engagement at the Post-School Transition
ERIC Educational Resources Information Center
Dietrich, Julia; Parker, Philip; Salmela-Aro, Katariina
2012-01-01
The transition from general education (e.g., high school) to vocational and tertiary education (e.g., college, vocational school) or to the labor market presents a number of developmental challenges. These challenges include making career choices and, more broadly, managing the transition. Coping with these challenges depends on the individual,…
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Strategies for Maintaining Appropriate Behavior in Inclusive Physical Education Settings
ERIC Educational Resources Information Center
Sanderson, Sonya; Heckaman, Kelly A.; Ernest, James M.; Johnson, Sherifa; Raab, Scot
2013-01-01
The typical physical education class period consists of a number of instructional activities linked together by brief transitory phases, or transitions (e.g., lining up, identifying teams, handing out equipment, etc.). Transitions can challenge even the most experienced physical educators, because without good classroom management, transitions can…
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ASD Transition to Mainstream Secondary: A Positive Experience?
ERIC Educational Resources Information Center
Neal, Sinead; Frederickson, Norah
2016-01-01
The transition to secondary school is considered difficult for children with autistic spectrum disorder (ASD), yet there has been little strength-based investigation of positive experiences of this population and the types of support they value most in managing anxiety about transition. The current article presents a qualitative exploration of the…
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Bridging the Transition from Primary to Secondary School
ERIC Educational Resources Information Center
Howe, Alan, Ed.; Richards, Val, Ed.
2011-01-01
The transition from primary to secondary school can often be a difficult time for children, and managing the transition smoothly has posed a problem for teachers at both upper primary and lower secondary level. At a time when "childhood" recedes and "adulthood" beckons, the inequalities between individual children can widen,…
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Managing Polarity, Paradox, and Dilemma during Leader Transition
ERIC Educational Resources Information Center
Manderscheid, Steven V.; Freeman, Peter D.
2012-01-01
Purpose: The purpose of this study is to review literature relevant to leader transition and the navigation of polarities, paradoxes, and dilemmas that exist in organizations. Furthermore, the researchers aim to critique the literature and provide suggestions for practitioners and researchers interested in leader transition through the lens of…
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Experimental analysis of the boundary layer transition with zero and positive pressure gradient
NASA Technical Reports Server (NTRS)
Arnal, D.; Jullen, J. C.; Michel, R.
1980-01-01
The influence of a positive pressure gradient on the boundary layer transition is studied. The mean velocity and turbulence profiles of four cases are examined. As the intensity of the pressure gradient is increased, the Reynolds number of the transition onset and the length of the transition region are reduced. The Tollmein-Schlichting waves disturb the laminar regime; the amplification of these waves is in good agreement with the stability theory. The three dimensional deformation of the waves leads finally to the appearance of turbulence. In the case of zero pressure gradient, the properties of the turbulent spots are studied by conditional sampling of the hot-wire signal; in the case of positive pressure gradient, the turbulence appears in a progressive manner and the turbulent spots are much more difficult to characterize.
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Laminar-turbulent transition tripped by step on transonic compressor profile
NASA Astrophysics Data System (ADS)
Flaszynski, Pawel; Doerffer, Piotr; Szwaba, Ryszard; Piotrowicz, Michal; Kaczynski, Piotr
2018-02-01
The shock wave boundary layer interaction on the suction side of transonic compressor blade is one of the main objectives of TFAST project (Transition Location Effect on Shock Wave Boundary Layer Interaction). The experimental and numerical results for the flow structure investigations are shown for the flow conditions as the existing ones on the suction side of the compressor profile. The two cases are investigated: without and with boundary layer tripping device. In the first case, boundary layer is laminar up to the shock wave, while in the second case the boundary layer is tripped by the step. Numerical results carried out by means of Fine/Turbo Numeca with Explicit Algebraic Reynolds Stress Model including transition modeling are compared with schlieren, Temperature Sensitive Paint and wake measurements. Boundary layer transition location is detected by Temperature Sensitive Paint.
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Randall, Ellen; Crooks, Valorie A; Goldsmith, Laurie J
2012-12-23
Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition included inadequate notification procedures, lack of formal assistance finding new physicians, and unsatisfactory experiences seeking care during unattachment. The participants' accounts reveal opportunities for a stronger system presence during transition and a need for further research into alternative models of primary care delivery.