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Sample records for american intensively managed

  1. Biology and management of insect pests in North American intensively managed hardwood forest systems.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David R.; Nebeker, T., E.; Hart, E., R.; Mattson, W., J.

    2005-01-01

    Annu. Rev. Entomol. 50:1-29. Abstract Increasing demand for wood and wood products is putting stress on traditional forest production areas, leading to long-term economic and environmental concerns. Intensively managed hardwood forest systems (IMHFS), grown using conventional agricultural as well as forestry methods, can help alleviate potential problems in natural forest production areas. Although IMHFS can produce more biomass per hectare per year than natural forests, the ecologically simplified, monocultural systems may greatly increase the crops susceptibility to pests. Species in the genera Populus and Salix comprise the greatest acreage in IMHFS in North America, but other species, including Liquidambar styracifua and Platanus occidentalis, are also important. We discuss life histories, realized and potential damage, and management options for the most economically infuential pests that affect these hardwood species. The substantial inherent challenges associated with pest management in the monocultural environments created by IMHFS are reviewed. Finally, we discuss ways to design IMHFS that may reduce their susceptibility to pests, increase their growth and productivity potential, and create a more sustainable environment.

  2. American Society of Radiation Oncology Recommendations for Documenting Intensity-Modulated Radiation Therapy Treatments

    International Nuclear Information System (INIS)

    Holmes, Timothy; Das, Rupak; Low, Daniel; Yin Fangfang; Balter, James; Palta, Jatinder; Eifel, Patricia

    2009-01-01

    Despite the widespread use of intensity-modulated radiation therapy (IMRT) for approximately a decade, a lack of adequate guidelines for documenting these treatments persists. Proper IMRT treatment documentation is necessary for accurate reconstruction of prior treatments when a patient presents with a marginal recurrence. This is especially crucial when the follow-up care is managed at a second treatment facility not involved in the initial IMRT treatment. To address this issue, an American Society for Radiation Oncology (ASTRO) workgroup within the American ASTRO Radiation Physics Committee was formed at the request of the ASTRO Research Council to develop a set of recommendations for documenting IMRT treatments. This document provides a set of comprehensive recommendations for documenting IMRT treatments, as well as image-guidance procedures, with example forms provided.

  3. [Quality management in intensive care medicine].

    Science.gov (United States)

    Martin, J; Braun, J-P

    2013-09-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

  4. Dissemination of an effective weight management program for Mexican American children in schools

    Science.gov (United States)

    The rates of child obesity are epidemic in the United States, and Mexican American children are at particular risk. We have found an intensive, multi-component, school-based, weight management intervention to be efficacious at reducing standardized body mass index (zBMI) in overweight children. Our ...

  5. Evolution of Sustainability in American Forest Resource Management Planning in the Context of the American Forest Management Textbook

    Directory of Open Access Journals (Sweden)

    Thomas J. Straka

    2009-10-01

    Full Text Available American forest resource management and planning goes back to the European roots of American Forestry. Timber management plans, documents based on forest regulation for timber production, were the foundation of American forestry. These types of management plans predominated until World War II. Multiple use forestry developed after World War II and issues like recreation, wildlife, water quality, and wilderness became more important. In the 1970’s harvest scheduling became part of the planning process, allowing for optimization of multiple goals. By 2001 social, environmental, and economic goals were integrated into the timber production process. American forestry experienced distinct historical periods of resource planning, ranging from classic sustained yield timber production, to multiple use-sustained yield, to sustainable human-forest systems. This article traces the historical changes in forest management planning philosophy using the forest management textbooks of the time. These textbooks provide insight into the thought process of the forestry profession as changes in the concept of sustainability occurred.

  6. Contingency management for patients with dual disorders in intensive outpatient treatment for addiction.

    Science.gov (United States)

    Kelly, Thomas M; Daley, Dennis C; Douaihy, Antoine B

    2014-01-01

    This quality improvement program evaluation investigated the effectiveness of contingency management for improving retention in treatment and positive outcomes among patients with dual disorders in intensive outpatient treatment for addiction. The effect of contingency management was explored among a group of 160 patients exposed to contingency management (n = 88) and not exposed to contingency management (no contingency management, n = 72) in a six-week partial hospitalization program. Patients referred to the partial hospitalization program for treatment of substance use and comorbid psychiatric disorders received diagnoses from psychiatrists and specialist clinicians according to the Diagnostic and Statistical Manual of the American Psychiatric Association. A unique application of the contingency management "fishbowl" method was used to improve the consistency of attendance at treatment sessions, which patients attended 5 days a week. Days attending treatment and drug-free days were the main outcome variables. Other outcomes of interest were depression, anxiety and psychological stress, coping ability, and intensity of drug cravings. Patients in the contingency management group attended more treatment days compared to patients in the no contingency management group; M = 16.2 days (SD = 10.0) versus M = 9.9 days (SD = 8.5), respectively; t = 4.2, df = 158, p contingency management and self-reported drug-free days. Contingency management is a valuable adjunct for increasing retention in treatment among patients with dual disorders in partial hospitalization treatment. Exposure to contingency management increases retention in treatment, which in turn contributes to increased drug-free days. Interventions for coping with psychological stress and drug cravings should be emphasized in intensive dual diagnosis group therapy.

  7. Intensive Care Unit Nurses' Beliefs About Delirium Assessment and Management.

    Science.gov (United States)

    Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara

    2016-10-01

    Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.

  8. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

  9. Intensive Care Management of Patients with Cirrhosis.

    Science.gov (United States)

    Olson, Jody C

    2018-06-01

    Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU. Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization. Given an increasing burden on the healthcare system, it is imperative that we strive to improve our management cirrhotic patients in the intensive care unit. Large studies evaluating the management of patients in the intensive care setting are lacking. To date, most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient. Future research is required to answer important management questions.

  10. 76 FR 53149 - North American Waterfowl Management Plan

    Science.gov (United States)

    2011-08-25

    ... fundamental objectives for waterfowl management from a list of 31 candidate objectives. During Round Two... American Waterfowl Management Plan AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of document... availability of the draft North American Waterfowl Management Plan Revision (draft Plan Revision) for public...

  11. Erythroneura lawsoni abundance and feeding injury levels are influenced by foliar nutrient status in intensively managed American sycamore.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David, Robert: Aubrey, Doug, Patric; Bentz, Jo-Ann

    2010-01-01

    Abstract 1 Abundance and feeding injury of the leafhopper Erythroneura lawsoni Robinson was measured in an intensively-managed American sycamore Platanus occidentalis L. plantation. Trees were planted in spring 2000 in a randomized complete block design, and received one of three annual treatments: (i) fertilization (120 kg N/ha/year); (ii) irrigation (3.0 cm/week); (iii) fertilization + irrigation; or (iv) control (no treatment). 2 Foliar nutrient concentrations were significantly influenced by the treatments because only sulphur and manganese levels were not statistically greater in trees receiving fertilization. 3 Over 116 000 E. lawsoni were captured on sticky traps during the study. Leafhopper abundance was highest on nonfertilized trees for the majority of the season, and was positively correlated with foliar nutrient concentrations. Significant temporal variation in E. lawsoni abundance occurred, suggesting five discrete generations in South Carolina. 4 Significant temporal variation occurred in E. lawsoni foliar injury levels, with the highest injury ratings occurring in late June and August. Foliar injury was negatively correlated with foliar nutrient content, and higher levels of injury occurred more frequently on nonfertilized trees. 5 The results obtained in the present study indicated that increased E. lawsoni abundance occurred on trees that did not receive fertilization. Nonfertilized trees experienced greater foliar injury, suggesting that lower foliar nutrient status may have led to increased levels of compensatory feeding.

  12. Financial Management and Culture: The American Indian Case

    Science.gov (United States)

    Danes, Sharon M.; Garbow, Jennifer; Jokela, Becky Hagen

    2016-01-01

    Study investigates distal and proximal contextual influences of the American Indian culture that affect financial decisions and behaviors. Primary household financial managers were interviewed. Study was grounded in Deacon and Firebaugh's "Family Resource Management" theory. Findings indicated that American Indians view many concepts…

  13. Strategically oriented management and controlling of resource intensive projects

    International Nuclear Information System (INIS)

    Kemmeter, Sascha

    2015-01-01

    The book on strategically oriented management and controlling of resource intensive projects covers the following issues: frame of project management and project controlling, classification of the decommissioning of nuclear facilities as resource intensive projects, research design for case studies, results of the study of project management specific characteristics of decommissioning, reference model for the project management of nuclear facility decommissioning.

  14. Japanese and American Management: Theory Z and Beyond

    OpenAIRE

    George W England

    1983-01-01

    This article analyzes studies comparing Japanese and American managers, workers, and societies in order to consider questions raised by William Ouchi's book, Theory Z: How American Business Can Meet the Japanese Challenge. The analysis results in 2 general observations: 1) Theory Z management is not likely to become the accepted norm in American companies to the extent that it has in Japan, and 2) the major conceptual or theoretical lesson we can learn from the Japanese is the potential value...

  15. Intensive management in grasslands causes diffuse water pollution at the farm scale.

    Science.gov (United States)

    Peukert, Sabine; Griffith, Bruce A; Murray, Phillip J; Macleod, Christopher J A; Brazier, Richard E

    2014-11-01

    Arable land use is generally assumed to be the largest contributor to agricultural diffuse pollution. This study adds to the growing evidence that conventional temperate intensively managed lowland grasslands contribute significantly to soil erosion and diffuse pollution rates. This is the first grassland study to monitor hydrological characteristics and multiple pollutant fluxes (suspended sediment [SS] and the macronutrients: total oxidized nitrogen-N [TON], total phosphorus [TP], and total carbon [TC]) at high temporal resolution (monitoring up to every 15 min) over 1 yr. Monitoring was conducted across three fields (6.5-7.5 ha) on the North Wyke Farm Platform, UK. The estimated annual erosion rates (up to 527.4 kg ha), TP losses (up to 0.9 kg ha), and TC losses (up to 179 kg ha) were similar to or exceeded the losses reported for other grassland, mixed land-use, and arable sites. Annual yields of TON (up to 3 kg ha) were less than arable land-use fluxes and earlier grassland N studies, an important result as the study site is situated within a Nitrate Vulnerable Zone. The high-resolution monitoring allowed detailed "system's functioning" understanding of hydrological processes, mobilization- transport pathways of individual pollutants, and the changes of the relative importance of diffuse pollutants through flow conditions and time. Suspended sediment and TP concentrations frequently exceeded water quality guidelines recommended by the European Freshwater Fisheries Directive (25 mg L) and the European Water Framework Directive (0.04 mg soluble reactive P L), suggesting that intensively managed grasslands pose a significant threat to receiving surface waters. Such sediment and nutrient losses from intensively managed grasslands should be acknowledged in land management guidelines and advice for future compliance with surface water quality standards. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of

  16. Growth performance, carcass yield and gait score of Marshal broiler chicken reared on intensive and semi intensive management systems

    Directory of Open Access Journals (Sweden)

    Oluwadiya, B. O.

    2017-06-01

    Full Text Available The rearing system used in highly productive farms is often subjected to harsh criticism, one of the reasons being its failure to provide adequate welfare. A number of attempts have been made to introduce new technologies in rearing poultry for meat production aiming at improving rearing conditions, protecting the environment and enhancing the quality of poultry products. Given the above, one hundred and sixty eight unsexed 14-day old Marshall broiler chicks were used in a completely randomized design study to compare the effect of management systems (intensive and semi intensive on the growth performance, carcass characteristics and gait score of broiler chickens. The experiment lasted for 42 d. Data were collected on weight gain, feed intake, feed conversion ratio, carcass yield and gait score. Result showed that birds on the intensive management system recorded higher weight gain (P 0.05; 66.94%, 11.44% than those in semi-intensive system (54.55%, 10.92%, respectively. For the gait score broiler birds on semi intensive management system recorded reduced number of cases of severe and slight leg problems (P < 0.05, 25.76% vs 49.3%. It was concluded that broiler birds should be reared on intensive management system for better growth performance and carcass yield. However, birds reared on semi intensive management system had fewer leg problems compared to birds reared on intensive management system. The fewer severe leg problems observed in birds on semi intensive management system will help improve their market value thereby making birds more profitable to rear on semi intensive management system.

  17. When East meets West: intensive care unit experiences among first-generation Chinese American parents.

    Science.gov (United States)

    Lee, Shih-Yu; Weiss, Sandra J

    2009-01-01

    To explore the experiences of first-generation Chinese American parents while their infants are cared for in intensive care units (ICUs). Because the study focus was on understanding the experiences of parents, a phenomenological approach was used, with open-ended questions that encouraged participants to describe events they perceived to be important. The data analysis procedure suggested by van Manen was used for the qualitative data analysis. A convenience sample of 25 first-generation Chinese American families, with infants hospitalized in the intensive care units of three teaching hospitals in the San Francisco area. Seven themes were identified: perceived incompetence, self-blame, blame from others, filial piety, lack of support in the US, communication issues, and cultural differences. Both fathers and mothers experienced stress related to all identified themes. Findings suggest the need for more resources to educate and support families as well as culturally competent care within pediatric ICUs. Further study is critical to understand how the Chinese American's personal and family characteristics may influence stress perceptions when coping with their children's hospitalization. This study can help healthcare providers to understand Chinese American parents' perceptions while their infants are hospitalized in the ICU, which can enhance cultural competence care services.

  18. Nurses' knowledge and barriers regarding pain management in intensive care units.

    Science.gov (United States)

    Wang, Hsiang-Ling; Tsai, Yun-Fang

    2010-11-01

    To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.

  19. Management Studies, Cultural Criticism and American Dreams

    DEFF Research Database (Denmark)

    Guthey, Eric

    2005-01-01

    The article reviews three books related to industrial management, including "False Prophets: The Gurus Who Created Modern Management and Why Their Ideas Are Bad for Business Today," by James Hoopes, "Organization and Innovation: Guru Schemes and American Dreams," by David Knights and Darren Mc...

  20. Vocal Music Therapy for Chronic Pain Management in Inner-City African Americans: A Mixed Methods Feasibility Study.

    Science.gov (United States)

    Bradt, Joke; Norris, Marisol; Shim, Minjung; Gracely, Edward J; Gerrity, Patricia

    2016-01-01

    To date, research on music for pain management has focused primarily on listening to prerecorded music for acute pain. Research is needed on the impact of active music therapy interventions on chronic pain management. The aim of this mixed methods research study was to determine feasibility and estimates of effect of vocal music therapy for chronic pain management. Fifty-five inner-city adults, predominantly African Americans, with chronic pain were randomized to an 8-week vocal music therapy treatment group or waitlist control group. Consent and attrition rates, treatment compliance, and instrument appropriateness/burden were tracked. Physical functioning (pain interference and general activities), self-efficacy, emotional functioning, pain intensity, pain coping, and participant perception of change were measured at baseline, 4, 8, and 12 weeks. Focus groups were conducted at the 12-week follow-up. The consent rate was 77%. The attrition rate was 27% at follow-up. We established acceptability of the intervention. Large effect sizes were obtained for self-efficacy at weeks 8 and 12; a moderate effect size was found for pain interference at week 8; no improvements were found for general activities and emotional functioning. Moderate effect sizes were obtained for pain intensity and small effect sizes for coping, albeit not statistically significant. Qualitative findings suggested that the treatment resulted in enhanced self-management, motivation, empowerment, a sense of belonging, and reduced isolation. This study suggests that vocal music therapy may be effective in building essential stepping-stones for effective chronic pain management, namely enhanced self-efficacy, motivation, empowerment, and social engagement. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Asthma Management Disparities: A Photovoice Investigation with African American Youth

    Science.gov (United States)

    Evans-Agnew, Robin

    2016-01-01

    Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…

  2. Maximizing Conservation and Production with Intensive Forest Management: It's All About Location

    Science.gov (United States)

    Tittler, Rebecca; Filotas, Élise; Kroese, Jasmin; Messier, Christian

    2015-11-01

    Functional zoning has been suggested as a way to balance the needs of a viable forest industry with those of healthy ecosystems. Under this system, part of the forest is set aside for protected areas, counterbalanced by intensive and extensive management of the rest of the forest. Studies indicate this may provide adequate timber while minimizing road construction and favoring the development of large mature and old stands. However, it is unclear how the spatial arrangement of intensive management areas may affect the success of this zoning. Should these areas be agglomerated or dispersed throughout the forest landscape? Should managers prioritize (a) proximity to existing roads, (b) distance from protected areas, or (c) site-specific productivity? We use a spatially explicit landscape simulation model to examine the effects of different spatial scenarios on landscape structure, connectivity for native forest wildlife, stand diversity, harvest volume, and road construction: (1) random placement of intensive management areas, and (2-8) all possible combinations of rules (a)-(c). Results favor the agglomeration of intensive management areas. For most wildlife species, connectivity was the highest when intensive management was far from the protected areas. This scenario also resulted in relatively high harvest volumes. Maximizing distance of intensive management areas from protected areas may therefore be the best way to maximize the benefits of intensive management areas while minimizing their potentially negative effects on forest structure and biodiversity.

  3. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  4. American Society for Pain Management Nursing position statement: pain management at the end of life.

    Science.gov (United States)

    Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

    2013-09-01

    Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. Intensive Care Nursing And Time Management

    OpenAIRE

    ÖZCANLI, Derya; İLGÜN, Seda

    2008-01-01

    Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...

  6. Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting.

    Science.gov (United States)

    Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne

    2014-12-01

    Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

    Science.gov (United States)

    Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

    2017-03-15

    Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager

  8. China's numerical management system for reducing national energy intensity

    International Nuclear Information System (INIS)

    Li, Huimin; Zhao, Xiaofan; Yu, Yuqing; Wu, Tong; Qi, Ye

    2016-01-01

    In China, the national target for energy intensity reduction, when integrated with target disaggregation and information feedback systems, constitutes a numerical management system, which is a hallmark of modern governance. This paper points out the technical weaknesses of China's current numerical management system. In the process of target disaggregation, the national target cannot be fully disaggregated to local governments, sectors and enterprises without omissions. At the same time, governments at lower levels face pressure for reducing energy intensity that exceeds their respective jurisdictions. In the process of information feedback, information failure is inevitable due to statistical inaccuracy. Furthermore, the monitoring system is unable to correct all errors, and data verification plays a limited role in the examination system. To address these problems, we recommend that the government: use total energy consumption as the primary indicator of energy management; reform the accounting and reporting of energy statistics toward greater consistency, timeliness and transparency; clearly define the responsibility of the higher levels of government. - Highlights: •We assess drawbacks of China's numerical management system for energy intensity. •The national energy intensity target cannot be fully disaggregated without omissions. •Data distortion is due to failures in statistics, monitoring and examination system. •Lower-level governments’ ability to meet energy target is weaker than their pressure. •We provide three policy recommendations for China's policy-makers.

  9. Engaging African American landowners in sustainable forest management

    Science.gov (United States)

    John Schelhas; Sarah Hitchner; Cassandra Johnson Gaither; Rory Fraser; Viniece Jennings; Amadou Diop

    2016-01-01

    The Sustainable Forestry and African American Land Retention Program is a comprehensive effort to address the long-standing problem of underparticipation of African Americans in forest management. We conducted rapid appraisal baseline research for pilot projects in this program in three Southern states using a carefully selected purposive sample to enhance our...

  10. How Do Managers Control Technology-Intensive Work?

    OpenAIRE

    Angelo Bernard Pinheiro

    2010-01-01

    Technology pervades every aspect of the modern business enterprise and demands new strategies for work management. Advances in internet and computing technologies, the emergence of the “knowledge worker”, globalization, resource scarcity, and intense competition have led corporations to accomplish their strategic goals and objectives through the implementation of projects. Project success is assured by the effective use of financial and human resources, a project management (PM) framework bac...

  11. Challenges of diabetes management in immigrant Korean Americans.

    Science.gov (United States)

    Nam, Soohyun; Song, Hee-Jung; Park, So-Youn; Song, Youngshin

    2013-01-01

    To examine challenges in diabetes self-management among Korean Americans to guide clinicians in providing culturally appropriate and population-targeted diabetes care. Five focus groups with 23 Korean Americans with type 2 diabetes, 30 to 75 years of age, were conducted. Open-ended questions were presented focusing on previous experiences in living with diabetes; digital recordings were transcribed verbatim; transcripts were coded and themes were identified. Most participants were reluctant to disclose diabetes because of social stigma and said that they did not know much about diabetes and its complications. Diabetes self-management is not always a top priority for Korean Americans over other family obligations or financial stability in their busy immigration lives. Many Korean Americans experience conflicts with family members in managing diabetes or would not request support from family members for their diabetes care. Traditional women's roles and demanding immigration life seem to leave women particularly vulnerable to a lack of self-care. Lack of English proficiency limits access to mainstream health care. Providing diabetes education at the community level is important to raise public awareness of diabetes and to eliminate social stigma. To facilitate family support for individuals with type 2 diabetes, it is appropriate to include the entire family in diabetes educational programs and to promote individual family members' health in the context of maintaining their role within the family. Future efforts should be made with full implementation of language services in various clinical encounters and diabetes education.

  12. Reading and analysis on management guidelines for hyperthyroidism published in 2011 by American Thyroid Association and American Association of Clinical Endocrinologists

    International Nuclear Information System (INIS)

    Meng Zhaowei; Tan Jian

    2011-01-01

    Recently, the American Thyroid Association and American Association of Clinical Endocrinologists published 'Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists', and created 100 evidence-based recommendations. The guideline systematically introduced the diagnoses and therapies of hyperthyroidism, emphasizing the indications, contraindications, preparations, methodologies and follow-up strategies. The guideline also provided detailed management principles for hyperthyroidism in children and pregnancy, Graves' ophthalmopathy and some unusual causes of hyperthyroidism. (authors)

  13. Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

    Science.gov (United States)

    Klaess, Cynthia C; Jungquist, Carla R

    2018-06-01

    Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  14. extensive and semi-intensive management systems in northern ghana

    African Journals Online (AJOL)

    management systems was positive and linearly correlated with eggs/oocysts of all the three intestinal parasites and became ... respectively was also positive but not significant under the semi-intensive system of management. Younger animals in the extensive ..... ruminants in Malaysia: Resistance to anthelmintics and the ...

  15. How Do Managers Control Technology-Intensive Work?

    Directory of Open Access Journals (Sweden)

    Angelo Bernard Pinheiro

    2010-08-01

    Full Text Available Technology pervades every aspect of the modern business enterprise and demands new strategies for work management. Advances in internet and computing technologies, the emergence of the “knowledge worker”, globalization, resource scarcity, and intense competition have led corporations to accomplish their strategic goals and objectives through the implementation of projects. Project success is assured by the effective use of financial and human resources, a project management (PM framework backed by senior management, and controls spanning the PM spectrum of initiation; planning; implementation; monitoring, measurement, and control; and closing. As an essential function of management, ‘control’ may be accomplished through a PM Plan, a project-matrix organization, competent and motivated people, and appropriate management tools and techniques. A PM Plan conforming to the Project Management Body of Knowledge (PMBOK framework incorporates controls for the key PM elements and, implemented properly, can assure project success

  16. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  17. haematological profiles of pigs raised under intensive management

    African Journals Online (AJOL)

    EZE J I

    values obtained could be used as reference values for pigs in South-eastern Nigeria. The clinical importance of the ... Key words: haematology, pigs, intensive management, south-eastern Nigeria ..... Medicine: A textbook of Diseases of Cattle ...

  18. Social Relation between Businessman and Community in Management of Intensive Shrimp Pond

    Science.gov (United States)

    Gumay Febryano, Indra; Sinurat, James; Lovinia Salampessy, Messalina

    2017-02-01

    Expansion of aquaculture, especially shrimp culture, is the primary cause of deforestation of mangrove along coastal zone. This phenomenon is pretty much related to social relation between businessman of intensive shrimp pond and community around coastal zone. The objective of this research is to explain social relation between businessman and community in managing intensive shrimp pond. This research is a kind of qualitative research and the method used is a case study. The result of this research shows that the behaviour of the majority of businessman of intensive shrimp pond is not accordingly with environmental concerns as they compelled conversion of mangrove and they disposed waste of shrimp pond into the sea. Such kind of behaviour caused degradation of water ecosystem and marginalizing local community. Corporate Social Responsibility (CSR) which was implemented by businessman of intensive shrimp pond in the area of social, religion, and education can downgrade the coming up of social turbulence. Otherwise, CSR in enabling economic community and environmental management was not conducted yet. CSR in environmental management can be conducted by businessman of intensive shrimp pond by considering the existence of mangrove and pond management and waste in a better way, so that environment around ponds is not polluted and the sustainability of shrimp pond business as well as income of community can be guaranteed. Accordingly with the result of this research, CSR is not only involving businessman of intensive shrimp pond and community, but also involving local government in terms of right and responsibility of citizen as well as management and development of community.

  19. A diabetes self-management program designed for urban American Indians.

    Science.gov (United States)

    Castro, Sarah; O'Toole, Mary; Brownson, Carol; Plessel, Kimberly; Schauben, Laura

    2009-10-01

    Although the American Indian population has a disproportionately high rate of type 2 diabetes, little has been written about culturally sensitive self-management programs in this population. Community and clinic partners worked together to identify barriers to diabetes self-management and to provide activities and services as part of a holistic approach to diabetes self-management, called the Full Circle Diabetes Program. The program activities and services addressed 4 components of holistic health: body, spirit, mind, and emotion. Seven types of activities or services were available to help participants improve diabetes self-management; these included exercise classes, educational classes, and talking circles. Ninety-eight percent of program enrollees participated in at least 1 activity, and two-thirds participated in 2 or more activities. Program participation resulted in a significant improvement in knowledge of resources for managing diabetes. The Full Circle Diabetes Program developed and implemented culturally relevant resources and supports for diabetes self-management in an American Indian population. Lessons learned included that a holistic approach to diabetes self-management, community participation, and stakeholder partnerships are needed for a successful program.

  20. Position of the American Dietetic Association: weight management.

    Science.gov (United States)

    Seagle, Helen M; Strain, Gladys Witt; Makris, Angela; Reeves, Rebecca S

    2009-02-01

    It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Given the increasing incidence of overweight and obesity along with the escalating health care costs associated with weight-related illnesses, health care providers must discover how to effectively treat this complex condition. Food and nutrition professionals should stay current and skilled in weight management to assist clients in preventing weight gain, optimizing individual weight loss interventions, and achieving long-term weight loss maintenance. Using the American Dietetic Association's Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for weight management. The evidence supporting the value of portion control, eating frequency, meal replacements, and very-low-energy diets are discussed as well as physical activity, behavior therapy, pharmacotherapy, and surgery. Public policy changes to create environments that can assist all populations to achieve and sustain healthful lifestyle behaviors are also reviewed.

  1. The state of American management.

    Science.gov (United States)

    Wriston, W B

    1990-01-01

    Every year, the president of the United States offers his State of the Union address. Here, from one of the most respected managers in America, is a report on the State of American Management. The state of management, says Walter B. Wriston, is good. Despite the predictions of America's decline, our economy continues to prosper. That is because of this fundamental truth: the United States is the only country in the world that renews itself daily. This is the Age of Pluralism, and U.S. business is based on pluralism. The spirit of the entrepreneur has entered the mainstream of U.S. management, transforming bureaucracy and emphasizing leadership. Today's top executives need to be more like politicians than the number-crunchers of yesterday. At the same time, information is flowing more freely, so corporations are eliminating layers of managers who were really just transmission lines. And top managers are learning to listen to the people who are closest to the work. Everyone today is a knowledge worker. The accelerating pace of knowledge has put a greater premium than ever on talent. Globalization is a big part of this new world. From the manager's viewpoint, globalization means that "you're in a marketplace where you're suddenly waking up with a guy...from a country you're not too sure where it is, who's eating your lunch in your hometown." To understand global competition, managers in large and small companies need broad vision. Finally, to deal with change, U.S. managers must confront some issues at home. For instance, our accounting systems are obsolete, both in companies and in our national accounts.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Cultural similarities and differences in the perception of emotional valence and intensity: a comparison of Americans and Hong Kong Chinese.

    Science.gov (United States)

    Zhu, Zhuoying; Ho, Samuel M Y; Bonanno, George A

    2013-01-01

    Despite being challenged for their ecological validity, studies of emotion perception have often relied on static, posed expressions. One of the key reasons is that dynamic, spontaneous expressions are difficult to control because of the existence of display rules and frequent co-occurrence of non-emotion related facial movements. The present study investigated cross-cultural patterns in the perception of emotion using an expressive regulation paradigm for generating facial expressions. The paradigm largely balances out the competing concerns for ecological and internal validity. Americans and Hong Kong Chinese (expressors) were presented with positively and negatively valenced pictures and were asked to enhance, suppress, or naturally display their facial expressions according to their subjective emotions. Videos of naturalistic and dynamic expressions of emotions were rated by Americans and Hong Kong Chinese (judges) for valence and intensity. The 2 cultures agreed on the valence and relative intensity of emotion expressions, but cultural differences were observed in absolute intensity ratings. The differences varied between positive and negative expressions. With positive expressions, ratings were higher when there was a cultural match between the expressor and the judge and when the expression was enhanced by the expressor. With negative expressions, Chinese judges gave higher ratings than their American counterparts for Chinese expressions under all 3 expressive conditions, and the discrepancy increased with expression intensity; no cultural differences were observed when American expressions were judged. The results were discussed with respect to the "decoding rules" and "same-culture advantage" approaches of emotion perception and a negativity bias in the Chinese collective culture.

  3. Reimbursement for pediatric diabetes intensive case management: a model for chronic diseases?

    Science.gov (United States)

    Beck, Joni K; Logan, Kathy J; Hamm, Robert M; Sproat, Scott M; Musser, Kathleen M; Everhart, Patricia D; McDermott, Harrold M; Copeland, Kenneth C

    2004-01-01

    Current reimbursement policies serve as potent disincentives for physicians who provide evaluation and management services exclusively. Such policies threaten nationwide availability of care for personnel-intensive services such as pediatric diabetes. This report describes an approach to improving reimbursement for highly specialized, comprehensive pediatric diabetes management through prospective contracting for services. The objective of this study was to determine whether pediatric diabetes intensive case management services are cost-effective to the payer, the patient, and a pediatric diabetes program. A contract with a third-party payer was created to reimburse for 3 key pediatric diabetes intensive case management components: specialty education, 24/7 telephone access to an educator (and board-certified pediatric endocrinologist as needed), and quarterly educator assessments of self-management skills. Data were collected and analyzed for 15 months after signing the contract. Within the first 15 months after the contract was signed, 22 hospital admissions for diabetic ketoacidosis (DKA) occurred in 16 different patients. After hospitalizations for DKA, all 16 patients were offered participation in the program. All were followed during the subsequent 1 to 15 months of observation. Ten patients elected to participate, and 6 refused participation. Frequency of rehospitalization, emergency department visits, and costs were compared between the 2 groups. Among the 10 participating patients, there was only 1 subsequent DKA admission, whereas among the 6 who refused participation, 5 were rehospitalized for DKA on at least 1 occasion. The 10 patients who participated in the program had greater telephone contact with the team compared with those who did not (16 crisis-management calls vs 0). Costs (education, hospitalization, and emergency department visits) per participating patient were approximately 1350 dollars less than those for nonparticipating patients

  4. A retrospective review of intensive care management of ...

    African Journals Online (AJOL)

    Background: Organophosphate (OP) compounds are used as insecticides. Given the widespread availability and use of these chemicals, OP poisoning is quite common following either accidental or intentional exposures. Immediate intensive care management can save lives in these patients. We aimed to investigate ...

  5. Development of a Faith-Based Stress Management Intervention in a Rural African American Community.

    Science.gov (United States)

    Bryant, Keneshia; Moore, Todd; Willis, Nathaniel; Hadden, Kristie

    2015-01-01

    Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities. To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community. The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB). The community identified the key concepts that should be included in a stress management intervention. The faith-based "Trinity Life Management" stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress-distress-depression continuum.

  6. The World's Best Anglo-American Universities' Knowledge Management Attributes

    Science.gov (United States)

    Tower, Greg; Plummer, Julie; Ridgewell, Brenda; Goforth, Emily; Tower, Spence

    2009-01-01

    Key knowledge management attributes of the world's most prestigious Anglo-American universities are surprisingly under-reported especially by best ranked USA institutions. This leads to calls for more transparency.

  7. High-intensity interval training vs. moderate-intensity continuous training in the prevention/management of cardiovascular disease

    OpenAIRE

    Hussain, S; Macaluso, A; Pearson, S

    2016-01-01

    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease, but more recently high-intensity interval training (HIIT) has emerged into the clinical environment has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superi...

  8. Comprehensive long-term management program for asthma: effect on outcomes in adult African-Americans.

    Science.gov (United States)

    Kelso, T M; Abou-Shala, N; Heilker, G M; Arheart, K L; Portner, T S; Self, T H

    1996-06-01

    To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (> or = 5) emergency department (ED) visits or hospitalizations (> or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management

  9. Effects of intensive forest management practices on insect infestation levels and loblolly pine growth

    Science.gov (United States)

    John T. Nowak; C. Wayne Berisford

    2000-01-01

    Intensive forest management practices have been shown to increase tree growth and shorten rotation time. However, they may also lead to an increased need for insect pest management because of higher infestation levels and lower action thresholds. To investigate the relationship between intensive management practices arid insect infestation, maximum growth potential...

  10. The Impact of Arab American Culture on Diabetes Self-management Education.

    Science.gov (United States)

    Bertran, Elizabeth A; Fritz, Heather; Abbas, Malak; Tarakji, Sandra; DiZazzo-Miller, Rosanne; Pociask, Fredrick D; Lysack, Catherine L; Arnetz, Judith; Jaber, Linda A

    2015-12-01

    The purpose of this study was to better understand barriers and facilitators of diabetes self-management education (DSME) among Arab American patients with diabetes. Little is known about the impact of Arab culture on DSME. Arab American adults (N = 23) with medically managed diabetes participated in 1 of 3 focus groups. An Arabic-speaking, trained moderator conducted video-recorded sessions. Verbatim Arabic transcripts were translated into English. Transcripts underwent a qualitative content analysis approach. Arab American cultural traditions such as food sharing, religious beliefs, and gender roles both facilitated and at times impeded DSME. Patients also held conflicting views about their interactions with their providers; some participants praised the authoritative patient-physician relationship style while others perceived the gaps in communication to be a product of Arab culture. Participants expressed that lack of available educational and supportive resources are key barriers to DSME. Arab American culture affects DSM activities, and culturally sensitive educational resources are lacking. Development of DSME programs tailored to address relevant aspects of Arab culture might improve DSME outcomes in Arab American population. © 2015 The Author(s).

  11. African Americans' Perceptions of Pain and Pain Management: A Systematic Review.

    Science.gov (United States)

    Booker, Staja Q

    2016-01-01

    The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient-provider relationship, and (f) treatment approaches. These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education. © The Author(s) 2014.

  12. Talent Management Programmes at British, American and Canadian Universities: Comparative Study

    Science.gov (United States)

    Boichenko, Maryna

    2015-01-01

    The article deals with the peculiarities of talent management programmes implementation at the top British, American and Canadian universities. The essence of the main concepts of research--talent and talent management--has been revealed. Talent management is referred to as the systematic attraction, identification, development, engagement,…

  13. Native American Religious Freedom and Federal Land Management.

    Science.gov (United States)

    Dahl, Eric William

    1990-01-01

    Explains the importance of specific locations to the performance of ceremonies and rituals in traditional Native American religions. Discusses recent court decisions in favor of federal land management agencies denying protection to sacred sites because of economic or development considerations. Contains 15 references. (SV)

  14. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

    Science.gov (United States)

    Bahn, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

    2011-01-01

    Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

  15. Knowledge intensive organisations: on the frontiers of knowledge management: Guest editorial

    NARCIS (Netherlands)

    Millar-Schijf, Carla C.J.M.; Lockett, Martin; Mahon, John F.

    2016-01-01

    Purpose This paper aims to further research on leadership and knowledge management through formal knowledge strategies in knowledge-intensive organizations (KIOs), and analyse knowledge management challenges and approaches within KIOs, especially tacit knowledge. Design/methodology/approach This

  16. Managed care and its impact on American urology.

    Science.gov (United States)

    Holtgrewe, H L

    1998-05-01

    America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.

  17. Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii.

    Science.gov (United States)

    Finucane, Melissa L; McMullen, Carmit K

    2008-01-01

    The purpose of this study was to identify the cultural values, traditions, and perceptions of diabetes risk and self-care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes. This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans. Several aspects of Filipino American culture were identified as central to understanding the challenges of engaging in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the family and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social meanings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causality and its management. Respondents also emphasized the role of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant. Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engagement in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies.

  18. Forest Management Intensity Affects Aquatic Communities in Artificial Tree Holes.

    Science.gov (United States)

    Petermann, Jana S; Rohland, Anja; Sichardt, Nora; Lade, Peggy; Guidetti, Brenda; Weisser, Wolfgang W; Gossner, Martin M

    2016-01-01

    Forest management could potentially affect organisms in all forest habitats. However, aquatic communities in water-filled tree-holes may be especially sensitive because of small population sizes, the risk of drought and potential dispersal limitation. We set up artificial tree holes in forest stands subject to different management intensities in two regions in Germany and assessed the influence of local environmental properties (tree-hole opening type, tree diameter, water volume and water temperature) as well as regional drivers (forest management intensity, tree-hole density) on tree-hole insect communities (not considering other organisms such as nematodes or rotifers), detritus content, oxygen and nutrient concentrations. In addition, we compared data from artificial tree holes with data from natural tree holes in the same area to evaluate the methodological approach of using tree-hole analogues. We found that forest management had strong effects on communities in artificial tree holes in both regions and across the season. Abundance and species richness declined, community composition shifted and detritus content declined with increasing forest management intensity. Environmental variables, such as tree-hole density and tree diameter partly explained these changes. However, dispersal limitation, indicated by effects of tree-hole density, generally showed rather weak impacts on communities. Artificial tree holes had higher water temperatures (on average 2°C higher) and oxygen concentrations (on average 25% higher) than natural tree holes. The abundance of organisms was higher but species richness was lower in artificial tree holes. Community composition differed between artificial and natural tree holes. Negative management effects were detectable in both tree-hole systems, despite their abiotic and biotic differences. Our results indicate that forest management has substantial and pervasive effects on tree-hole communities and may alter their structure and

  19. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  20. The Effects of Tax Avoidance, Accrual Earnings Management, Real Earnings Management, and Capital Intensity on the Cost of Equity

    Directory of Open Access Journals (Sweden)

    Amrie Firmansyah

    2018-03-01

    Full Text Available This study aims to examine the effects of tax avoidance, accrual profit management, real profit management, and capital intensity on equity costs. The population of this study is a manufacturing company listed on the Indonesia Stock Exchange which amounted to 146 companies. The sampling technique used was purposive sampling and resulted in 420 units of analysis. This type of research is quantitative causality by performing hypothesis testing analysis is done by using multiple linear regression model. The findings of this research are tax avoidance will add to the risks that must be borne by investors thus increasing uncertainty over their investment. Investors consider that accrual profit management actions are opportunistic as risk-taking actions as well as real profit management actions. While on Capital Intensity, investors assume the information on the company’s fixed assets is not useful in making investment decisions. The conclusions that can be taken are tax avoidance, accrual profit management, and earnings management real positive to the cost of equity. However, capital intensity has a negative effect.

  1. Energy resource management for energy-intensive manufacturing industries

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, C.W.; Levangie, J.

    1981-10-01

    A program to introduce energy resource management into an energy-intensive manufacturing industry is presented. The food industry (SIC No. 20) was chosen and 20 companies were selected for interviews, but thirteen were actually visited. The methodology for this program is detailed. Reasons for choosing the food industry are described. The substance of the information gained and the principal conclusions drawn from the interviews are given. Results of the model Energy Resource Management Plan applied to three companies are compiled at length. Strategies for dissemination of the information gained are described. (MCW)

  2. Challenges in participatory primary stress management interventions in knowledge intensive SMEs

    DEFF Research Database (Denmark)

    Gish, Liv; Ipsen, Christine

    2013-01-01

    relevant change processes. This paper presents the outline of our research and development project on participatory primary stress management interventions in knowledge intensive SMEs, as well as the preliminary results and related implications. The research and development project is conducted in order...... to develop an operational model which SMEs can use when they want to initiate participatory primary stress management interventions in their company. The development project builds on a process model for participatory primary interventions in larger knowledge intensive companies and the premises behind......While knowledge intensive SMEs have recognized the need for change with respect to productivity and wellbeing, and to some extend have access to tools and methods for enabling this, they still lack process competences and are uncertain about how to approach primary stress interventions and initiate...

  3. Normative cultural values and the experiences of Mexican-American mothers in the neonatal intensive care unit.

    Science.gov (United States)

    Cleveland, Lisa M; Horner, Sharon D

    2012-04-01

    To explore the experiences of Mexican-American mothers who have had infants in the neonatal intensive care unit (NICU). A convenience sample of 15 English-speaking, Mexican-American women was interviewed. The study used an exploratory qualitative approach. Data collection was conducted through audiotaped, transcribed, semistructured, individual interviews and field notes. The 5 normative cultural values for Latino families-(1) simpatia, (2) personalismo, (3) respeto, (4) familismo, and (5) fatalismo-were used as a sensitizing framework to guide data interpretation. The women's discussions of their NICU experiences clearly reflect the 5 normative Latino cultural values. Positive and negative exemplars of these values are provided as evidence. These findings can be used to inform nursing care provided for Mexican-American mothers and their infants by assisting nurses to customize care to meet the cultural needs of this population.

  4. Strategies to address management challenges in larger intensive care units.

    Science.gov (United States)

    Matlakala, M C; Bezuidenhout, M C; Botha, A D H

    2015-10-01

    To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

  5. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  6. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units.

    Science.gov (United States)

    Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J

    2016-01-01

    Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments. ©2016 American Association of Critical-Care Nurses.

  7. Cultural and family challenges to managing type 2 diabetes in immigrant Chinese Americans.

    Science.gov (United States)

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

    2009-10-01

    Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted.

  8. Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

    Science.gov (United States)

    Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

    2015-01-01

    The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis

  9. [Interest of psychiatric guidelines in managing agitation in intensive care].

    Science.gov (United States)

    Lazignac, Coralie; Ricou, Bara; Dan, Liviu; Virgillito, Salvatore; Adam, Eric; Seyedi, Majid; Cicotti, Andrei; Azi, Amine; Damsa, Cristian

    2007-02-14

    This paper discusses the importance of psychiatric guidelines and the position of the psychiatrist in the management of agitation in the intensive care unit. The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in psychiatry, but also in intensive care. Psychiatric experts' recommendations for managing agitation are given, which is useful to create an open discussion with the intensivists. The use of sedative medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitated patients, an equilibrium needs to be found between the subjective dimension and the available data from evidence based medicine.

  10. Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

    Science.gov (United States)

    Mohamed, Somaia

    2013-03-01

    There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

  11. Skills and Strategies of African American Parents in the Management of ADHD: A Qualitative Study.

    Science.gov (United States)

    Saulsberry, Alexandria; Bansa, Melishia; DeFrino, Daniela; Dallas, Constance M

    2017-08-01

    The purpose of this study is to use a strengths-based approach to determine African American parents' skills and strategies for management of children with ADHD. Four focus groups were conducted to identify African American parent beliefs about appropriate ADHD management. Sixteen parents participated and reported having a total of 21 children diagnosed with ADHD. Participants discussed several parenting challenges but advocated for the child by working closely with the child's school and physician. They also managed relationships with family members to protect the child from possible physical or emotional harm. However, parents desired more social support for management of ADHD. African American parents possess key skills and strategies in their management of children with ADHD. Further research is needed to determine the roles and responsibilities of extended family members for children with this disorder, and to identify the social supports parents access to aid with ADHD management.

  12. Machismo as a Factor Affecting the Use of Power and Communication in the Managing of Personnel Disputes: Brazilian Versus American Men Managers.

    Science.gov (United States)

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

    Acknowledging that the Latin American cultural concept of "machismo" influences the way in which Brazilian managers tend to use authority rather than communication when resolving disputes with subordinates, a study compared Brazilian and American male managers' self-reported preferences for resolving disputes with employees and peer…

  13. Pleasing the masses: messages for daily life management in African American women's popular media sources.

    Science.gov (United States)

    Black, Angela Rose; Peacock, Nadine

    2011-01-01

    Using African American women's insights on their own health experiences, we explored how their daily life management was linked to the "strong Black woman" (SBW) script, and the health implications of that script. Using the search term "strong Black woman," we identified 20 articles from African American women's magazines and 10 blog sites linked to the SBW script and analyzed their content. We created thematic categories (role management, coping, and self-care) and extracted issues relevant to African American women's health. Adherence to the SBW script was linked to women's daily life management and health experiences. Themes such as self-sacrificial role management ("please the masses"), emotional suppression ("game face"), and postponement of self-care ("last on the list") incited internal distress and evinced negative health consequences. Scientists, activists, and health care professionals would be aided in forming initiatives aimed at reducing health disparities among African American women by heeding the insights on their health experiences that they express in popular media sources.

  14. The impact of leadership, management and power in an international knowledge-intensive organization

    Directory of Open Access Journals (Sweden)

    Senni Kirjavainen

    Full Text Available The shift to knowledge economies and the boom of knowledge-intensive organizations with their expert employees pose new challenges for leadership and management of development work. What is the appropriate amount and form of managerial control that is needed in knowledge-intensive development work? This paper focuses on illuminating the kind of leadership and management efforts that either support or hinder advancing development projects. The results highlight the paradoxical role of power and control, and reveal that employees need freedom and yet strong guidance and managerial commitment to develop work in order to stay motivated. Implications for leading knowledge-intensive development are discussed.

  15. Intensive care management of severe tetanus at the university of ...

    African Journals Online (AJOL)

    Intensive care management of severe tetanus at the university of Benin teaching ... Journal Home > Vol 14, No 1 (2015) > ... Open Access DOWNLOAD FULL TEXT ... protocol in the centre, in line with evidence-based medical principles.

  16. Habitat restoration as a management tool for invasive American bullfrog

    OpenAIRE

    Devisscher, Sander; Adriaens, Tim; Louette, Gerald

    2012-01-01

    The control of invasive alien species is essential for securing native biodiversity. As for the American bullfrog, Lithobates catesbeianus, suspected to cause ecological damage to native amphibians around the globe, comprehensive management techniques are currently absent. We investigated two contrasting approaches to control the species in permanent, small and shallow water bodies in Flanders (northern Belgium). Small and isolated populations were actively managed through trapping with doubl...

  17. Chinese American Parents' Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting.

    Science.gov (United States)

    Kim, Su Yeong; Shen, Yishan; Huang, Xuan; Wang, Yijie; Orozco-Lapray, Diana

    2014-12-01

    This study examined whether Chinese American parents' acculturation and enculturation were related to parenting practices (punitive parenting, democratic child participation, and inductive reasoning) indirectly through the mediation of parents' bicultural management difficulty and parental depressed mood. Data came from a two-wave study of Chinese American families in Northern California. Mothers and fathers were assessed when their children were in early adolescence and then again in middle adolescence (407 mothers and 381 fathers at Wave 1; 308 mothers and 281 fathers at Wave 2). For both waves, we examined cross-sectional models encompassing both direct and indirect links from parental cultural orientations to parenting practices. We also used individual fixed-effects techniques to account for selection bias in testing model relationships at Wave 2. At Wave 1, via bicultural management difficulty and depressive symptoms, American orientation was related to less punitive parenting and more inductive reasoning for both parents, and Chinese orientation was related to more punitive parenting and less inductive reasoning for fathers. The findings indicate that bicultural management difficulty and parental depressed mood are important mechanisms to be considered when studying the relation between Chinese American parents' acculturation/enculturation and parenting.

  18. Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project.

    Science.gov (United States)

    Moore, Kelly; Jiang, Luohua; Manson, Spero M; Beals, Janette; Henderson, William; Pratte, Katherine; Acton, Kelly J; Roubideaux, Yvette

    2014-11-01

    We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. A1c levels decreased an average of 0.2% (P risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts.

  19. Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Vincent Y. T. [Dept. of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong (China)

    2017-04-15

    While high-intensity focused ultrasound has been used for some time in the management of uterine fibroids, its effectiveness and safety in managing adenomyosis is less well established. A literature review was performed of all eligible reports using this modality as a treatment for adenomyosis. Relevant publications were obtained from the PubMed electronic database from inception through March 2016. Eleven articles, including information from 1,150 treatments and follow-up data from 990 patients, were reviewed. High-intensity focused ultrasound appears to be effective and safe in the management of symptomatic adenomyosis, and can be considered as an alternative uterine-sparing option for women with this condition.

  20. Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

    International Nuclear Information System (INIS)

    Cheng, Vincent Y. T.

    2017-01-01

    While high-intensity focused ultrasound has been used for some time in the management of uterine fibroids, its effectiveness and safety in managing adenomyosis is less well established. A literature review was performed of all eligible reports using this modality as a treatment for adenomyosis. Relevant publications were obtained from the PubMed electronic database from inception through March 2016. Eleven articles, including information from 1,150 treatments and follow-up data from 990 patients, were reviewed. High-intensity focused ultrasound appears to be effective and safe in the management of symptomatic adenomyosis, and can be considered as an alternative uterine-sparing option for women with this condition

  1. Strategic Management of Quality: An American and British Perspective.

    Science.gov (United States)

    Weller, L. David; McElwee, Gerard

    1997-01-01

    Total Quality Management is being implemented in American and British schools to improve educational outcomes. The 14 points of Deming's quality model and Porter's models of competition and drivers of cost provide a systematic, structured template to promote educational excellence and meet the demands of social, political, and economic forces.…

  2. [Effects of intensive management on soil C and N pools and soil enzyme activities in Moso bamboo plantations.

    Science.gov (United States)

    Yang, Meng; Li, Yong Fu; Li, Yong Chun; Xiao, Yong Heng; Yue, Tian; Jiang, Pei Kun; Zhou, Guo Mo; Liu, Juan

    2016-11-18

    In order to elucidate the effects of intensive management on soil carbon pool, nitrogen pool, enzyme activities in Moso bamboo (Phyllostachys pubescens) plantations, we collected soil samples from the soil surface (0-20 cm) and subsurface (20-40 cm) layers in the adjacent Moso bamboo plantations with extensive and intensive managements in Sankou Township, Lin'an City, Zhejiang Province. We determined different forms of C, N and soil invertase, urease, catalase and acid phosphatase activities. The results showed that long-term intensive management of Moso bamboo plantations significantly decreased the content and storage of soil organic carbon (SOC), with the SOC storage in the soil surface and subsurface layers decreased by 13.2% and 18.0%, respectively. After 15 years' intensive management of Masoo bamboo plantations, the contents of soil water soluble carbon (WSOC), hot water soluble carbon (HWSOC), microbial carbon (MBC) and readily oxidizable carbon (ROC) were significantly decreased in the soil surface and subsurface layers. The soil N storage in the soil surface and subsurface layers in intensively managed Moso bamboo plantations increased by 50.8% and 36.6%, respectively. Intensive management significantly increased the contents of nitrate-N (NO 3 - -N) and ammonium-N (NH 4 + -N), but decreased the contents of water-soluble nitrogen (WSON) and microbial biomass nitrogen (MBN). After 15 years' intensive management of Masoo bamboo plantations, the soil invertase, urease, catalase and acid phosphatase activities in the soil surface layer were significantly decreased, the soil acid phosphatase activity in the soil subsurface layer were significantly decreased, and other enzyme activities in the soil subsurface layer did not change. In conclusion, long-term intensive management led to a significant decline of soil organic carbon storage, soil labile carbon and microbial activity in Moso bamboo plantations. Therefore, we should consider the use of organic

  3. Does management intensity in inter rows effect soil physical properties in Austrian and Romanian vineyards?

    Science.gov (United States)

    Bauer, Thomas; Strauss, Peter; Stiper, Katrin; Klipa, Vladimir; Popescu, Daniela; Winter, Silvia; Zaller, Johann G.

    2016-04-01

    Successful viticulture is mainly influenced by soil and climate. The availability of water during the growing season highly influences wine quality and quantity. To protect soil from being eroded most of the winegrowers keep the inter row zones of the vineyards green. Greening also helps to provide water-stress to the grapes for harvesting high quality wines. However, these greening strategies concerning the intensity of inter row management differ from farm to farm and are mainly based on personal experience of the winegrowers. However to what extent different inter row management practices affect soil physical properties are not clearly understood yet. To measure possible effects of inter row management in vineyards on soil physical parameters we selected paired vineyards with different inter row management in Austria and Romania. In total more than 7000 soil analysis were conducted for saturated and unsaturated hydraulic conductivity, soil water retention, water stable aggregates, total organic carbon, cation exchange capacity, potassium, phosphorous, soil texture, bulk density and water infiltration. The comparison between high intensity management with at least one soil disturbance per year, medium intensity with one soil disturbance every second inter row per year and low intensity management with no soil disturbance since at least 5 years indicates that investigated soil physical properties did not improve for the upper soil layer (3-8cm). This is in contrast to general perceptions of improved soil physical properties due to low intensity of inter row management, i.e. permanent vegetated inter rows. This may be attributed to long term and high frequency mechanical stress by agricultural machinery in inter rows.

  4. Management of Tracheostomy: A Survey of Dutch Intensive Care Units

    NARCIS (Netherlands)

    Veelo, Denise P.; Schultz, Marcus J.; Phoa, Kai Y. N.; Dongelmans, Dave A.; Binnekade, Jan M.; Spronk, Peter E.

    2008-01-01

    OBJECTIVE: To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. METHODS: We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have : 5 beds suitable for mechanical ventilation. The survey asked for

  5. An Electronic Asthma Self-Management Intervention for Young African American Adults.

    Science.gov (United States)

    Speck, Aimee L; Hess, Michael; Baptist, Alan P

    2016-01-01

    Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P young African American adults. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. Endangered Species and North American Waterfowl Management Plan Joint Venture Areas

    National Research Council Canada - National Science Library

    Allred, Karla

    1996-01-01

    ...) Endangered Species Recovery Plans that meet the recovery plan requirements; and the percent of Corps acreage included within North American Waterfowl Management Joint Venture Implementation Plans where proposed work has been accomplished...

  7. Surveyed opinion of American trauma surgeons in management of colon injuries.

    Science.gov (United States)

    Eshraghi, N; Mullins, R J; Mayberry, J C; Brand, D M; Crass, R A; Trunkey, D D

    1998-01-01

    Primary repair or resection and anastomosis of colon wounds have been advocated in many recent studies, but the proportion of trauma surgeons accepting these recommendations is unknown. To determine the current preferences of American trauma surgeons for colon injury management. Four hundred forty-nine members of the American Association for the Surgery of Trauma were surveyed regarding their preferred management of eight types of colon wounds among three options: diverting colostomy (DC), primary repair (PR), or resection and anastomosis (RA). The influence of selected patient factors and surgeons' characteristics on the choice of management was also surveyed. Seventy-three percent of surgeons completed the survey. Ninety-eight percent chose PR for at least one type of injury. Thirty percent never selected DC. High-velocity gunshot wound was the only injury for which the majority (54%) would perform DC. More than 55% of the surgeons favored RA when the isolated colon injury was a contusion with possible devascularization, laceration greater than 50% of the diameter, or transection. Surgeons who managed five or fewer colon wounds per year chose DC more frequently (p colon wounds per year. The prevailing opinion of trauma surgeons favors primary repair or resection of colon injuries, including anastomosis of unprepared bowel. Surgeons who manage fewer colon wounds prefer colostomy more frequently.

  8. Management intensity and vegetation complexity affect web-building spiders and their prey.

    Science.gov (United States)

    Diehl, Eva; Mader, Viktoria L; Wolters, Volkmar; Birkhofer, Klaus

    2013-10-01

    Agricultural management and vegetation complexity affect arthropod diversity and may alter trophic interactions between predators and their prey. Web-building spiders are abundant generalist predators and important natural enemies of pests. We analyzed how management intensity (tillage, cutting of the vegetation, grazing by cattle, and synthetic and organic inputs) and vegetation complexity (plant species richness, vegetation height, coverage, and density) affect rarefied richness and composition of web-building spiders and their prey with respect to prey availability and aphid predation in 12 habitats, ranging from an uncut fallow to a conventionally managed maize field. Spiders and prey from webs were collected manually and the potential prey were quantified using sticky traps. The species richness of web-building spiders and the order richness of prey increased with plant diversity and vegetation coverage. Prey order richness was lower at tilled compared to no-till sites. Hemipterans (primarily aphids) were overrepresented, while dipterans, hymenopterans, and thysanopterans were underrepresented in webs compared to sticky traps. The per spider capture efficiency for aphids was higher at tilled than at no-till sites and decreased with vegetation complexity. After accounting for local densities, 1.8 times more aphids were captured at uncut compared to cut sites. Our results emphasize the functional role of web-building spiders in aphid predation, but suggest negative effects of cutting or harvesting. We conclude that reduced management intensity and increased vegetation complexity help to conserve local invertebrate diversity, and that web-building spiders at sites under low management intensity (e.g., semi-natural habitats) contribute to aphid suppression at the landscape scale.

  9. Critics horizons of school management: Latin American perspective

    Directory of Open Access Journals (Sweden)

    Beatriz RAMÍREZ ARISTIZÁBAL

    2018-01-01

    Full Text Available Modernity has defined a way to be school as a stage in which the State devises certain ways of behaviour, citizen education and institution conception specific for a determined social order. Consequently, the direction of the school becomes a key strategy of the hegemonic project. This article aims to outline some signs that demonstrate an alternative school management in order to contribute to the school of thought on Latin-American perspectives in education. It aims to offer other keys on the perception of the Colombian reality on school management from a critical position that allows the creation of scenarios full of learning possibilities in the inside and outside of the school.

  10. [Quality assurance and quality management in intensive care].

    Science.gov (United States)

    Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

    2015-11-01

    Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

  11. [Economic impact of AFId management with modern management system in Intensive Care patients: comparison between ICUs].

    Science.gov (United States)

    Fuoco, Giovanni; Di Giulio, Paola

    2016-01-01

    . Economic impact of AFId management with modern management systems in Intensive Care patients: comparison between ICUs. Acute fecal incontinence associated with diarrhea (AFId) affects up to 40% of intensive care unit (ICU) patients and may be responsible for pressure ulcers (PU). The FMS (Fecal Management System) though improving the management of these patients is not often provided due to its cost. To measure the costs of the use of FMS compared to routine care in three intensive care units (ICU) of Piedmont (Italy). All patients admitted from January to June 2016, > 18 years with at least three AFId episodes in the previous 24 hours were included. The costs for hygiene, medications and nursing time spent were calculated on 10 patients without FMS, accounting for the mean number of diarrhea attacks (3.04 per day), and mean days of FMS use. The FMS generated savings compared to routine care in nursing time, equipments for hygiene and pressure sores medications in patients with sacral sores. Savings depended on length of use (LoU) of the device: ICU with 10 patients (7 with PUs), mean LoU FMS 11.9 days, savings 1.210 euros; ICU with 10 patients (2 with PUs), mean LoU FMS 17.3 days, savings 5.317 euros; ICU with 45 patients (11 with PUs) mean LoU FMS 9.3 days, cost increase 1.057 euros. The cost of FMS is quickly amortised in patients with PUs. No FMS patients developed a new PUs. The FMS gives rise to savings when used in patients with PUs or for more than 10 days. The savings related to the prevention of PUs should be also added.

  12. Effects of inter-row management intensity on wild bee, plant and soil biota diversity in vineyards

    Science.gov (United States)

    Kratschmer, Sophie; Pachinger, Bärbel; Winter, Silvia; Zaller, Johann G.; Buchholz, Jacob; Querner, Pascal; Strauß, Peter; Bauer, Thomas; Stiper, Katrin

    2016-04-01

    Vineyards may provide a range of essential ecosystem services, which interact with a diverse community of above- and belowground organisms. Intensive soil management like frequent tilling has resulted in the degradation of habitat quality with consequences on biodiversity and ecosystem services. This study is part of the European BiodivERsA project "VineDivers - Biodiversity-based ecosystem services in vineyards". We study the effects of different soil management intensities on above- and below-ground biodiversity (plants, insect pollinators, and soil biota), their interactions and the consequences for ecosystem services. We investigated 16 vineyards in Austria assessing the diversity of (1) wild bees using a semi-quantitative transect method, (2) earthworms by hand sorting, (3) Collembola (springtails) via pitfall trapping and soil coring, (4) plants by relevés and (5) litter decomposition (tea bag method). Management intensity differed in tillage frequency from intermediate intensity resulting in temporary vegetation cover to no tillage in permanent vegetation cover systems. First results show opposed relationships between the biodiversity of selected species groups and management intensity. We will discuss possible explanations and evaluate ecological interactions between wild bee, plant and soil biota diversity.

  13. Values expressed through intergenerational family food and nutrition management systems among African American women.

    Science.gov (United States)

    Ahye, Brenda A; Devine, Carol M; Odoms-Young, Angela M

    2006-01-01

    This grounded theory investigation aimed to understand intergenerational family roles and the food management strategies of African American women from a social-ecological perspective. Thirty women from 10 low/moderate-income 3-generation urban families participated in interviews covering roles, health, nutrition, and food management strategies. Four dynamic family systems for managing food and nutrition emerged from qualitative data analysis. Participants expressed values of responsibility, social connections, caretaking, reward, and equal opportunity, and fulfilling responsibilities for family care, connections, and finances. These values and systems provide a basis for culturally appropriate, interpersonal-level nutrition interventions among African American women that build on family structures, needs, and resources.

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

    Science.gov (United States)

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

    2018-06-01

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

  15. Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis.

    Science.gov (United States)

    Guillemette, L; Durksen, A; Rabbani, R; Zarychanski, R; Abou-Setta, A M; Duhamel, T A; McGavock, J M; Wicklow, B

    2017-07-01

    Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia; however, it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity. We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov up to February 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified randomized controlled trials evaluating intensive glycemic management interventions for hyperglycemia in pregnancy and included four of the 383 citations initially identified. Two reviewers independently extracted study data and evaluated internal validity of the studies using the Cochrane Collaboration's Risk of Bias tool. Data were pooled using random-effects models. Statistical heterogeneity was quantified using the I 2 test. The primary outcome was age- and sex-adjusted childhood obesity. Secondary outcomes included childhood weight and waist circumference and maternal hypoglycemia during the trial (safety outcome). The four eligible trials (n=767 children) similarly used lifestyle and insulin to manage gestational hyperglycemia, but only two measured offspring obesity and waist circumference and could be pooled for these outcomes. We found no association between intensive gestational glucose management and childhood obesity at 7-10 years of age (relative risk 0.89, 95% confidence interval (CI) 0.65 to 1.22; two trials; n=568 children). Waist circumference also did not differ between treatment and control arms (mean difference, -2.68 cm; 95% CI, -8.17 to 2.81 cm; two trials; n=568 children). Intensive gestational glycemic management is not associated with reduced childhood obesity in offspring, but randomized data is scarce. Long-term follow-up of trials should be prioritized and comprehensive

  16. Evaluation of best management practices under intensive irrigation using SWAT model

    OpenAIRE

    Dechmi, Farida; Skhiri, Ahmed

    2013-01-01

    Land management practices such as conservation tillage and optimum irrigation are routinely used to reduce non-point source pollution and improve water quality. The calibrated and validated SWAT-IRRIG model is the first modified SWAT version that reproduces well the irrigation return flows (IRF) when the irrigation source is outside of the watershed. The application of this SWAT version in intensive irrigated systems permits to better evaluate the best management practices (BMPs) in such syst...

  17. Evaluation of corporate energy management practices of energy intensive industries in Turkey

    International Nuclear Information System (INIS)

    Ates, Seyithan Ahmet; Durakbasa, Numan M.

    2012-01-01

    Turkey is one of a number of countries who still lack a national management standard for energy. Industrial energy consumption accounts for 42% of Turkey's total energy consumption. With the help of a questionnaire and analytical framework, this paper investigates Industrial Energy Management Practice in Turkey and highlights significant bottlenecks and shortcomings of energy intensive industries in terms of energy management application. The survey was carried out as a multiple case study of the Turkish iron, steel, cement, paper, ceramics and textile industries. Outcomes of the questionnaire are evaluated according to the analytical framework which covers company characteristics, regulations, external relations of the companies and internal organizational conditions. After analyzing these elements on the basis of a minimum requirement list, it was found that only 22% of the surveyed companies actually practice corporate energy management in Turkey. The main barriers to proper energy management implementation were identified as lack of synergy between the stakeholders, the extent and scope of energy manager courses, and inadequate awareness of and lack of financial support for energy management activities. As a guideline to overcome present obstacles, a set of policy options are offered: strengthening and restructuring of legal and institutional frameworks, promotion of energy efficiency, education, training and capacity building and facilitating implementation of the international energy management standard ISO 50001. -- Highlights: ► Developing an analytical scheme to assess degree of Energy Management Application. ► Investigation of Energy Management Practices in Turkish Energy Intensive Industries. ► Analysis of challenges which hinder full implementation of energy management in Turkey. ► Presenting a set of essential policy options thought for all stakeholders.

  18. Strategically oriented management and controlling of resource intensive projects; Strategieorientiertes Management und Controlling ressourcenintensiver Projekte. Fallstudienanalyse und Konzeption eines Referenzmodells zum Projektmanagement der Stilllegung kerntechnischer Anlagen

    Energy Technology Data Exchange (ETDEWEB)

    Kemmeter, Sascha

    2015-07-01

    The book on strategically oriented management and controlling of resource intensive projects covers the following issues: frame of project management and project controlling, classification of the decommissioning of nuclear facilities as resource intensive projects, research design for case studies, results of the study of project management specific characteristics of decommissioning, reference model for the project management of nuclear facility decommissioning.

  19. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography.

    Science.gov (United States)

    Hales, Caz; de Vries, Kay; Coombs, Maureen

    2016-06-01

    Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

  20. Two-year outcome of team-based intensive case management for patients with schizophrenia.

    Science.gov (United States)

    Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

    1995-12-01

    Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

  1. American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance Use Disorders

    OpenAIRE

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St. Marie, Barbara; Strobbe, Stephen; Turner, Helen N.

    2012-01-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high qu...

  2. Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives.

    Science.gov (United States)

    Singh, Jasvinder A; Herbey, Ivan; Bharat, Aseem; Dinnella, Janet E; Pullman-Mooar, Sally; Eisen, Seth; Ivankova, Nataliya

    2017-11-01

    To explore gout self-management and associated challenges and solutions in African Americans. We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m 2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout. © 2017, American College of Rheumatology.

  3. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Wijdicks, Eelco F M; Sheth, Kevin N; Carter, Bob S; Greer, David M; Kasner, Scott E; Kimberly, W Taylor; Schwab, Stefan; Smith, Eric E; Tamargo, Rafael J; Wintermark, Max

    2014-04-01

    There are uncertainties surrounding the optimal management of patients with brain swelling after an ischemic stroke. Guidelines are needed on how to manage this major complication, how to provide the best comprehensive neurological and medical care, and how to best inform families facing complex decisions on surgical intervention in deteriorating patients. This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere. The writing group used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. The panel reviewed the most relevant articles on adults through computerized searches of the medical literature using MEDLINE, EMBASE, and Web of Science through March 2013. The evidence is organized within the context of the American Heart Association framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive American Heart Association internal peer review. Clinical criteria are available for hemispheric (involving the entire middle cerebral artery territory or more) and cerebellar (involving the posterior inferior cerebellar artery or superior cerebellar artery) swelling caused by ischemic infarction. Clinical signs that signify deterioration in swollen supratentorial hemispheric ischemic stroke include new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size. In swollen cerebellar infarction, a decrease in level of consciousness occurs as a result of brainstem compression and therefore may

  4. Enhancing the Biodiversity of Ditches in Intensively Managed UK Farmland.

    Directory of Open Access Journals (Sweden)

    Rosalind F Shaw

    Full Text Available Drainage ditches, either seasonally flooded or permanent, are commonly found on intensively managed lowland farmland in the UK. They are potentially important for wetland biodiversity but, despite their ubiquity, information on their biodiversity and management in the wider countryside is scarce. We surveyed 175 ditches for their physical and chemical characteristics, spatial connectivity, plant communities and aquatic invertebrates in an area of intensively managed farmland in Oxfordshire, UK and collected information on ditch management from farmer interviews. Water depth and shade had a small impact on the diversity of plant and invertebrate communities in ditches. Increased shade over the ditch channel resulted in reduced taxonomic richness of both channel vegetation and aquatic invertebrates and channel vegetation cover was lower at shaded sites. Invertebrate taxonomic richness was higher when water was deeper. Spatial connectivity had no detectable impact on the aquatic invertebrate or plant communities found in ditches. The number of families within the orders Ephemeroptera, Plecoptera and Trichoptera (EPT, which contain many pollution-sensitive species, declined with decreasing pH of ditch water. As time since dredging increased, the number of EPT families increased in permanent ditches but decreased in temporary ditches. Whether or not a ditch was in an agri-environment scheme had little impact on the reported management regime or biodiversity value of the ditch. Measures for increasing the amount of water in ditches, by increasing the water depth or promoting retention of water in ditches, could increase the biodiversity value of ditches in agricultural land. Some temporary ditches for specialised species should be retained. Reducing the amount of shade over narrow ditches by managing adjacent hedgerows is also likely to increase the species diversity of plant and invertebrate communities within the ditch. We recommend that to preserve

  5. Enhancing the Biodiversity of Ditches in Intensively Managed UK Farmland.

    Science.gov (United States)

    Shaw, Rosalind F; Johnson, Paul J; Macdonald, David W; Feber, Ruth E

    2015-01-01

    Drainage ditches, either seasonally flooded or permanent, are commonly found on intensively managed lowland farmland in the UK. They are potentially important for wetland biodiversity but, despite their ubiquity, information on their biodiversity and management in the wider countryside is scarce. We surveyed 175 ditches for their physical and chemical characteristics, spatial connectivity, plant communities and aquatic invertebrates in an area of intensively managed farmland in Oxfordshire, UK and collected information on ditch management from farmer interviews. Water depth and shade had a small impact on the diversity of plant and invertebrate communities in ditches. Increased shade over the ditch channel resulted in reduced taxonomic richness of both channel vegetation and aquatic invertebrates and channel vegetation cover was lower at shaded sites. Invertebrate taxonomic richness was higher when water was deeper. Spatial connectivity had no detectable impact on the aquatic invertebrate or plant communities found in ditches. The number of families within the orders Ephemeroptera, Plecoptera and Trichoptera (EPT), which contain many pollution-sensitive species, declined with decreasing pH of ditch water. As time since dredging increased, the number of EPT families increased in permanent ditches but decreased in temporary ditches. Whether or not a ditch was in an agri-environment scheme had little impact on the reported management regime or biodiversity value of the ditch. Measures for increasing the amount of water in ditches, by increasing the water depth or promoting retention of water in ditches, could increase the biodiversity value of ditches in agricultural land. Some temporary ditches for specialised species should be retained. Reducing the amount of shade over narrow ditches by managing adjacent hedgerows is also likely to increase the species diversity of plant and invertebrate communities within the ditch. We recommend that to preserve or enhance the

  6. Conflict management styles of Asian and Asian American nurses: implications for the nurse manager.

    Science.gov (United States)

    Xu, Yu; Davidhizar, Ruth

    2004-01-01

    Foreign nurses and American nurses who are culturally diverse make up an increasing number of the US nursing workforce. Of foreign nurses, Asians constitute the largest number. Conflict is an inevitable aspect of human relations in health care settings. Nurses and other health team members with diverse cultural background bring to the workplace different conflict behaviors that directly impact the outcomes of conflicts. It is essential for health care team members and managers to be cognizant of different conflict behaviors as well as different conflict management styles so that strategies can be designed to build a culturally diverse health care team that is able to effectively achieve group and organizational objectives.

  7. A comprehensive approach to quality management of intensive care services.

    Science.gov (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar

    2010-01-01

    The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

  8. EGG PRODUCTION AND HATCHABILITY OF LOCAL DUCKS UNDER SEMI INTENSIVE VS EXTENSIVE MANAGEMENTS

    Directory of Open Access Journals (Sweden)

    P. Widiyaningrum

    2016-06-01

    Full Text Available The study aimed to compare the egg production and hatchability of local ducks under different management systems, namely semi-intensive and extensive. The research conducted was an experimental one-way classification with two treatments. Each treatment used 15 male and 120 females (mating ratio 1:8, and ducks aged 13-14 months. Eggs production was recorded during three weeks period. About 300 eggs were selected from each treatment to be hatched. Fertility was observed at 4th days of hatching process using egg candler. Data of eggs production, eggs weight, fertility, and hatchability were analyzed using unpaired two sample Student’s t-test. The results showed that average of egg weight, fertility and hatchability were not different under two management system, but egg production in the semi-intensive maintenance was significantly higher (P<0.05 than those in the extensive system. Egg production in the semi-intensive was 12.3% higher than those in the extensive. In conclusion, the semi-intensive system that is applied in this study the number of eggs production but did not affect the average of egg weight, fertility and hatchability.

  9. Intensive olive orchards on sloping land: good water and pest management are essential.

    Science.gov (United States)

    Metzidakis, I; Martinez-Vilela, A; Castro Nieto, G; Basso, B

    2008-11-01

    There is intensive cultivation of olives on sloping land in Jaen-Granada (Spain), Basilicata (Italy) and Western Crete (Greece). The intensive olive groves here are characterised by a tree density of about 250treesha(-1), yearly fertilisation and pruning, several chemical sprays for pest control, soil tillage once to thrice per year and irrigation up to 2700m3ha(-1)yr(-1). Intensive management results in high yields of 3600-6500kgha(-1) but also higher labour costs of 1154-1590euroha(-1)yr(-1), varying per area. The major environmental concerns in this system are related to chemical residues in the fruit, the extinction of useful insects, the depletion of groundwater resources, the pollution of soil and water and the erosion of soil. This paper describes the impact of intensive orchard management on natural resources and gives recommendations for soil and water conservation, reduction of chemicals use and biodiversity enhancement. The specific recommendations for the relevant stakeholders--farmers, technicians, agricultural services and policy makers--are based on the experimental evaluation of different agricultural practices and a socio-economic analysis of local and global production and markets.

  10. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

    Science.gov (United States)

    Krumholz, Harlan M; Currie, Peter M; Riegel, Barbara; Phillips, Christopher O; Peterson, Eric D; Smith, Renee; Yancy, Clyde W; Faxon, David P

    2006-09-26

    Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness. The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework. The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some

  11. Effects of genetics, management intensity, and seedling density on early stocking in loblolly pine

    Science.gov (United States)

    Scott D. Roberts; Randall J. Rousseau; B. Landis Herrin

    2015-01-01

    Rapid establishment and early tree growth can be key factors in successful plantation management. This generally entails planting good quality planting stock at a seedling density appropriate for the management objectives and then managing at an appropriate intensity with a goal of fully occupying the site as quickly as possible within the context of those objectives....

  12. Adapting Hypertension Self-Management Interventions to Enhance their Sustained Effectiveness among Urban African Americans

    OpenAIRE

    Ameling, Jessica M.; Ephraim, Patti L.; Bone, Lee R.; Levine, David M.; Roter, Debra L.; Wolff, Jennifer L.; Hill-Briggs, Felicia; Fitzpatrick, Stephanie L.; Noronha, Gary J.; Fagan, Peter J.; Lewis-Boyer, LaPricia; Hickman, Debra; Simmons, Michelle; Purnell, Leon; Fisher, Annette

    2014-01-01

    African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions’ cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community ...

  13. Home-Based Diabetes Symptom Self-Management Education for Mexican Americans with Type 2 Diabetes

    Science.gov (United States)

    García, Alexandra A.; Brown, Sharon A.; Horner, Sharon D.; Zuñiga, Julie; Arheart, Kristopher L.

    2015-01-01

    This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated…

  14. Spatial distribution of diuron sorption affinity as affected by soil, terrain and management practices in an intensively managed apple orchard.

    Science.gov (United States)

    Umali, Beng P; Oliver, Danielle P; Ostendorf, Bertram; Forrester, Sean; Chittleborough, David J; Hutson, John L; Kookana, Rai S

    2012-05-30

    We investigated how the sorption affinity of diuron (3'-(3,4-dichlorophenyl)-1,1-dimenthyl-urea), a moderately hydrophobic herbicide, is affected by soil properties, topography and management practices in an intensively managed orchard system. Soil-landscape analysis was carried out in an apple orchard which had a strong texture contrast soil and a landform with relief difference of 50 m. Diuron sorption (K(d)) affinity was successfully predicted (R(2)=0.79; pdiuron K(d) with TOC, pH(w), slope and WI as key variables. Mean diuron K(d) values were also significantly different (pdiuron than soil in the alleys. Younger stands, which were found to have lower TOC than in the older stands, also had lower diuron K(d) values. In intensively managed orchards, sorption affinity of pesticides to soils was not only affected by soil properties and terrain attributes but also by management regime. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Simulation of the Effect of Intensive Forest Management on Forest Production in Sweden

    Directory of Open Access Journals (Sweden)

    Ola Rosvall

    2011-03-01

    Full Text Available The effects of intensifying the management of 15% of the Swedish forest land on potential future forest production over a 100-year period were investigated in a simulation study. The intensive management treatments, which were introduced over a period of 50 years, were: intensive fertilization of Norway spruce (IntFert; bulking-up Norway spruce elite populations using somatic embryogenesis (SE-seedlings; planting of lodgepole pine, hybrid larch, and Sitka spruce (Contorta, Larch, and Sitka; fertilization with wood ash on peatlands (Wood ash; and conventional fertilization in mature forests (ConFert. Potential sites for applying intensive forest management (IFM to sites with low nature conservation values were determined with a nature conservation score (NCS. Four different scenarios were simulated: “Base scenario”, which aimed at reducing the negative impact on nature conservation values, “Fast implementation”, “No IntFert” (IntFert was not used, and “Large Forest Companies”, where the majority of plots were selected on company land. Total yields during the 100-year simulation period were about 85–92% higher for the intensive forest management scenarios than for the reference scenario (business as usual. In the “No IntFert” scenario total production was 1.8% lower and in the “Large Forest Companies” scenario total production was 4.8% lower than in the “Base scenario”. “Fast implementation” of IFM increased yield by 15% compared to the “Base scenario”. Norway spruce SE-seedlings and IntFert gave the highest yields, measured as total production during the 100-year simulation period, but relative to the yields in the reference scenario, the highest increases in yield were for Contorta. The “Base scenario” and “No IntFert” gave the highest yields for plots with the lowest NCS, but plots with higher NCS had to be used in the “Fast implementation” and “Large Forest Companies” scenarios. More than

  16. High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease.

    Science.gov (United States)

    Hussain, Syed R; Macaluso, Andrea; Pearson, Stephen J

    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions, such as coronary artery disease, heart failure, stroke, and hypertension. Despite this, however, the efficacy of HIIT in reversing the specific symptoms and risk factors of these cardiovascular pathologies is not well understood. HIIT is often perceived as very strenuous, which could render it unsafe for those at risk of or afflicted with CVD, but these issues are also yet to be reviewed. Furthermore, the optimal HIIT protocol for each of the CVD cohorts has not been established. Thus, the purpose of this review article is to (1) evaluate the efficacy of HIIT relative to MICT in the prevention and management of cardiovascular conditions, and (2) explore any potential safety issues surrounding the suitability and/or tolerability of HIIT for patients with CVD, and the potential optimal prescriptive variables of HIIT for application in the clinical environment.

  17. Reproductive Performance of Saanen Goats under Rural or Intensive Management Systems in Elazığ Region, Turkey

    Directory of Open Access Journals (Sweden)

    Yaşar Akar

    2013-01-01

    Full Text Available This study was carried out to compare the reproductive performance of Saanen goats under rural (n:75 and intensive (n:206 management systems in Elazığ region. Single and multiple births, stillbirth, dystocia, abortion and kids survival rates were determined in both the goat flocks between February 1 and April 30 2011. Percentages of single and multiple births, stillbirth, dystocia and abortion were not statistically different between the flocks. However, the kids survival rates of intensive management system (74.05% were lower than rural management system (88.88%, (P<0.003. Overall percentage of single and multiple births, stillbirth, dystocia, abortion and kids survival in all goats were 45.08, 54.92, 17.62, 12.29, 13.16 and 78.40%, respectively. Our results show that rural and intensive management systems do not have an important effect on reproductive performance of Saanen goats.

  18. [Morbidity and mortality after intensive care management of hemorrhagic stroke in Djibouti].

    Science.gov (United States)

    Benois, A; Raynaud, L; Coton, T; Petitjeans, F; Hassan, A; Ilah, A; Sergent, H; Grassin, F; Leberre, J

    2009-02-01

    Prospective data on management and outcome of stroke in Africa is scarce. The purpose of this prospective descriptive study is to present epidemiologic, clinical and outcome data for a series of patients with hemorrhagic stroke in Djibouti. All patients admitted to the intensive care unit of the Bouffard Medical-Surgical Center in Djibouti for cerebral hemorrhage documented by CT-scan of the brain were recruited in this study. A total of 18 patients including 16 men were enrolled. The median patient age in this series was 51.5 years [range, 20-72]. The median duration of intensive care was 3 days [range, 1-38]. Mean Glasgow score at time of admission was 9 [range, 3-14]. Five patients were brought in by emergency medical airlift. The main risk factors for stroke were arterial hypertension, smoking, and regular khat use. Mechanical ventilation was performed in 10 patients with a survival rate of 40%. Six patients (33%) died in the intensive care unit. Hospital mortality within one month was 39% and mortality at 6 months was 44.4%. One-year survival for patients with a Glasgow score < or = 7 at the time of admission was 33%. Arterial hypertension, khat use, and smoking appeared to be major risk factors for male Djiboutians. Neurologic intensive care techniques provided hospital mortality rates similar to those reported in hospitals located in Western countries. Functional outcome in local survivors appeared to be good despite the absence of functional intensive care. These data argue against the passive, fatalistic approach to management of hemorrhagic stroke and for primary prevention of cardiovascular risk factors.

  19. Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

    Science.gov (United States)

    Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

    2010-01-01

    This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

  20. Intensive management modifies soil CO2 efflux in 6-year-old Pinus taeda L. stands

    Science.gov (United States)

    Lisa J. Samuelson; Kurt Johnsen; Tom Stokes; Weinlang Lu

    2004-01-01

    Intensive forestry may reduce net CO2 emission into atmosphere by storing carbon in living biomass, dead organic matter and soil, and durable wood products. Because quantification of belowground carbon dynamics is important for reliable estimation of the carbon sequestered by intensively managed plantations, we examined soil CO2...

  1. [Activity-based costing methodology to manage resources in intensive care units].

    Science.gov (United States)

    Alvear V, Sandra; Canteros G, Jorge; Jara M, Juan; Rodríguez C, Patricia

    2013-11-01

    An accurate estimation of resources use by individual patients is crucial in hospital management. To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

  2. Listening to Neglected Voices - American Indian Perspectives on Natural Resource Management

    Science.gov (United States)

    David N. Bengston

    2004-01-01

    Forestry agencies must ensure that the views of all citizens in our increasingly diverse society are included in decisionmaking. But gaining clear insights into the perspectives of ethnic and minority communities is often difficult. This article summarizes an analysis of news articles about resource management issues written by American Indians and published in Indian...

  3. Overview of American Heart Association / American College of Cardiology guidelines 2017 for management of patients with valvular heart disease

    Directory of Open Access Journals (Sweden)

    M.Т. Vatutin

    2017-12-01

    Full Text Available n June 2017, Circulation journal published updated recommendations of the American Heart Association and the American College of Cardiology (AHA / ACC on the management of patients with valvular heart disease. The main provisions of this manual are set out in this message. It should be emphasized that the recommendations written by leading US experts in this field are set out clearly, using a variety of tables and figures, which will undoubtedly make them a desktop guide to action for most practitioners in the following years. As usual, when creating such guidelines, the authors were guided by evidence-based methodology using the classes of recommendations and levels of evidence.

  4. An Analysis of Intensive Mode Pedagogy in Management Education in India

    Science.gov (United States)

    Mishra, Sita; Nargundkar, Rajendra

    2015-01-01

    Purpose: Management education is at its peak in India. But pedagogy and modes of delivery are not always innovative compared to top international Business Schools. It is through experimentation that the paper may be able to discover what works best in our context. The purpose of this paper is to determine the effectiveness of intensive mode of…

  5. Roadless area-intensive management tradeoffs on the Sierra National Forest, California

    Science.gov (United States)

    Robert J. Hrubes; Kent P. Connaughton; Robert W. Sassaman

    1979-01-01

    This hypothesis was tested by a linear programing model: Roadless areas on the Sierra National Forest precluded from planned future development would be candidates for wilderness designation, and the associated loss in present and future timber harvests could be offset by investing in more intensive management. The results of this simulation test suggest that levels of...

  6. Integral Management of Irrigation Water in Intensive Horticultural Systems of Almería

    OpenAIRE

    Pedro Garcia-Caparros; Juana Isabel Contreras; Rafael Baeza; Maria Luz Segura; Maria Teresa Lao

    2017-01-01

    The development of intensive horticulture in Almería, with a huge increase in greenhouse surface area, is related to three essential factors: climatic characteristics, groundwater use and mulching sandy soil. The purpose of the present paper is to draw a picture of the integral management of water irrigation in the intensive horticultural systems in the region, by identifying the most significant water resource contributions and alternative water resources. Results indicate that the use of gr...

  7. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

    Science.gov (United States)

    The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promot...

  8. Native American Technical Assistance and Training for Renewable Energy Resource Development and Electrical Generation Facilities Management

    Energy Technology Data Exchange (ETDEWEB)

    A. David Lester

    2008-10-17

    The Council of Energy Resource Tribes (CERT) will facilitate technical expertise and training of Native Americans in renewable energy resource development for electrical generation facilities, and distributed generation options contributing to feasibility studies, strategic planning and visioning. CERT will also provide information to Tribes on energy efficiency and energy management techniques.This project will provide facilitation and coordination of expertise from government agencies and private industries to interact with Native Americans in ways that will result in renewable energy resource development, energy efficiency program development, and electrical generation facilities management by Tribal entities. The intent of this cooperative agreement is to help build capacity within the Tribes to manage these important resources.

  9. Exploring Predictors of Information Use to Self-Manage Blood Pressure in Midwestern African American Women with Hypertension.

    Science.gov (United States)

    Jones, Lenette M; Veinot, Tiffany; Pressler, Susan J; Coleman-Burns, Patricia; McCall, Alecia

    2018-06-01

    Self-management of hypertension requires patients to find, understand, and use information to lower their blood pressure. Little is known about information use among African American women with hypertension, therefore the purpose of this study was to examine predictors of self-reported information use to self-manage blood pressure. Ninety-four Midwestern African American women (mean age = 59) completed questionnaires about information behaviors (seeking, sharing, use) and personal beliefs (attitude, social norms) related to self-management of blood pressure. Linear regression was used to identify significant predictors of information use. The total variance explained by the model was 36%, F(7, 79) = 6.29, p < .001. Information sharing was the only significant predictor (beta = .46, p < .001). These results provide evidence that information sharing is a potential health behavior to support intervention strategies for African American women with hypertension.

  10. School-Based Management: The Changing Locus of Control in American Public Education.

    Science.gov (United States)

    Drury, Darrel; Levin, Douglas

    School-based management is a reinvention and countermovement to a broader historical trend to centralize and standardize American education. The present study represents one component of the Organisation for Economic Cooperation and Development's project to investigate how schools in 12 member nations can most effectively respond to recent…

  11. The American Oystercatcher (Haematopus palliatus) Working Group: 15 years of collaborative focal species research and management

    Science.gov (United States)

    Simons, Theodore R.

    2017-01-01

    The American Oystercatcher (Haematopus palliatus) Working Group formed spontaneously in 2001 as coastal waterbird biologists recognized the potential for American Oystercatchers to serve as focal species for collaborative research and management. Accomplishments over the past 15 years include the establishment of rangewide surveys, color-banding protocols, mark-resight studies, a revision of the Birds of North America species account, and new mechanisms for sharing ideas and data. Collaborations among State, Federal, and private sector scientists, natural resource managers, and dedicated volunteers have provided insights into the biology and conservation of American Oystercatchers in the United States and abroad that would not have been possible without the relationships formed through the Working Group. These accomplishments illustrate how broad collaborative approaches and the engagement of the public are key elements of effective shorebird conservation programs.

  12. RESOURCE MANAGEMENT AMONG INTENSIVE CARE NURSES: AN ETHNOGRAPHIC STUDY.

    Science.gov (United States)

    Heydari, Abbas; Najar, Ali Vafaee; Bakhshi, Mahmoud

    2015-12-01

    Nurses are the main users of supplies and equipment applied in the Intensive Care Units (ICUs) which are high-priced and costly. Therefore, understanding ICU nurses' experiences about resource management contributes to the better control of the costs. This study aimed to investigate the culture of nurses' working environment regarding the resource management in the ICUs in Iran. In this study, a focused ethnographic method was used. Twenty-eight informants among ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations as a participant observer was used for data gathering. Data analysis was performed using the methods described by Miles and Huberman (1994). Two main themes describing the culture of ICU nurses regarding resource management included (a) consumption monitoring and auditing, and (b) prudent use. The results revealed that the efforts for resource management are conducted in the conditions of scarcity and uncertainty in supply. ICU nurses had a sense of futurism in the supply and use of resources in the unit and do the planning through taking the rules and guidelines as well as the available resources and their values into account. Improper storage of some supplies and equipment was a reaction to this uncertain condition among nurses. To manage the resources effectively, improvement of supply chain management in hospital seems essential. It is also necessary to hold educational classes in order to enhance the nurses' awareness on effective supply chain and storage of the items in the unit stock.

  13. Validity of the Family Asthma Management System Scale with an Urban African-American Sample

    Science.gov (United States)

    Klinnert, Mary D.; Holsey, Chanda Nicole; McQuaid, Elizabeth L.

    2011-01-01

    Objective To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Methods Forty-three children, ages 8–13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. Results The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. Conclusions The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample. PMID:19776230

  14. PanDA Beyond ATLAS: Workload Management for Data Intensive Science

    CERN Document Server

    Schovancova, J; The ATLAS collaboration; Klimentov, A; Maeno, T; Nilsson, P; Oleynik, D; Panitkin, S; Petrosyan, A; Vaniachine, A; Wenaus, T; Yu, D

    2013-01-01

    The PanDA Production ANd Distributed Analysis system has been developed by ATLAS to meet the experiment's requirements for a data-driven workload management system for production and distributed analysis processing capable of operating at LHC data processing scale. After 7 years of impressively successful PanDA operation in ATLAS there are also other experiments which can benefit from PanDA in the Big Data challenge, with several at various stages of evaluation and adoption. The new project "Next Generation Workload Management and Analysis System for Big Data" is extending PanDA to meet the needs of other data intensive scientific applications in HEP, astro-particle and astrophysics communities, bio-informatics and other fields as a general solution to large scale workload management. PanDA can utilize dedicated or opportunistic computing resources such as grids, clouds, and High Performance Computing facilities, and is being extended to leverage next generation intelligent networks in automated workflow mana...

  15. Conceptual Model of Weight Management in Overweight and Obese African-American Females.

    Science.gov (United States)

    Sutton, Suzanne M; Magwood, Gayenell S; Nemeth, Lynne S; Jenkins, Carolyn M

    2017-04-01

    Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings. © 2016 Wiley Periodicals, Inc.

  16. Cross-Cultural Communication And Dimensions: A Hybrid Analysis Of Horizontal And Vertical Individualist And Collectivist Tendencies Among African American And European American Management Students

    OpenAIRE

    Ephraim Okoro; Peter W. Cardon; Bryan Marshall; Otis Thomas

    2011-01-01

    This article describes research about horizontal and vertical individualism and collectivism (HVIC) among African American and European American university students. The survey is based on the work of Harry Triandis (1995), one of the seminal researchers of individualism and collectivism (I-C). The survey of attitude and scenario items, developed by Harry Triandis (1995), was administered to undergraduate management students in three universities in the Eastern and Southeastern United States...

  17. The Effects of Tax Avoidance, Accrual Earnings Management, Real Earnings Management, and Capital Intensity on the Cost of Equity

    OpenAIRE

    Amrie Firmansyah; Ahmad Sigid Febriyanto

    2018-01-01

    This study aims to examine the effects of tax avoidance, accrual profit management, real profit management, and capital intensity on equity costs. The population of this study is a manufacturing company listed on the Indonesia Stock Exchange which amounted to 146 companies. The sampling technique used was purposive sampling and resulted in 420 units of analysis. This type of research is quantitative causality by performing hypothesis testing analysis is done by using multiple linear regressio...

  18. Connecting Hydrologic Research and Management in American Samoa through Collaboration and Capacity Building

    Science.gov (United States)

    Shuler, C. K.; El-Kadi, A. I.; Dulai, H.; Glenn, C. R.; Mariner, M. K. E.; DeWees, R.; Schmaedick, M.; Gurr, I.; Comeros, M.; Bodell, T.

    2017-12-01

    In small-island developing communities, effective communication and collaboration with local stakeholders is imperative for successful implementation of hydrologic or other socially pertinent research. American Samoa's isolated location highlights the need for water resource sustainability, and effective scientific research is a key component to addressing critical challenges in water storage and management. Currently, aquifer degradation from salt-water-intrusion or surface-water contaminated groundwater adversely affects much of the islands' municipal water supply, necessitating an almost decade long Boil-Water-Advisory. This presentation will share the approach our research group, based at the University of Hawaii Water Resources Research Center, has taken for successfully implementing a collaboration-focused water research program in American Samoa. Instead of viewing research as a one-sided activity, our program seeks opportunities to build local capacity, develop relationships with key on-island stakeholders, and involve local community through forward-looking projects. This presentation will highlight three applications of collaborative research with water policy and management, water supply and sustainability, and science education stakeholders. Projects include: 1) working with the island's water utility to establish a long-term hydrological monitoring network, motivated by a need for data to parameterize numerical groundwater models, 2) collaboration with the American Samoa Environmental Protection Agency to better understand groundwater discharge and watershed scale land-use impacts for management of nearshore coral reef ecosystems, and 3) participation of local community college and high school students as research interns to increase involvement in, and exposure to socially pertinent water focused research. Through these innovative collaborative approaches we have utilized resources more effectively, and focused research efforts on more pertinent

  19. Adapting hypertension self-management interventions to enhance their sustained effectiveness among urban African Americans.

    Science.gov (United States)

    Ameling, Jessica M; Ephraim, Patti L; Bone, Lee R; Levine, David M; Roter, Debra L; Wolff, Jennifer L; Hill-Briggs, Felicia; Fitzpatrick, Stephanie L; Noronha, Gary J; Fagan, Peter J; Lewis-Boyer, LaPricia; Hickman, Debra; Simmons, Michelle; Purnell, Leon; Fisher, Annette; Cooper, Lisa A; Aboumatar, Hanan J; Albert, Michael C; Flynn, Sarah J; Boulware, L Ebony

    2014-01-01

    African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions' cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members. The process required substantial time and resources, and the adapted interventions will be tested in a randomized controlled trial.

  20. Stormwater management the American way: why no policy transfer?

    Directory of Open Access Journals (Sweden)

    David P. Dolowitz

    2015-09-01

    Full Text Available From the 1940s until the 1980s the federal government gradually extended its authority over the structure of the American stormwater management system. The goal was to improve the water quality of the nation’s waterways by regulating the pollution loads entering the system, primarily through the use of gray infrastructure. However during the1980s the Environmental Protection Agency (EPA began to explore new approaches toward the regulation of stormwater pollution. Instead of focusing only on gray mechanisms, the EPA began developing and promoting the use of low impact development (LID techniques as an element municipal governments could use to achieve their total maxim daily load of pollutants allowable under the National Pollutant Discharge Elimination System permit system. In light of the incentive offered by the EPA for the use of LID in the management of stormwater, it should be expected to provide a perfect area to observe policy transfer between federal, state and local governments; but it does not. This article will establish why the EPA began promoting a green approach to stormwater management and why this has not led to a widespread transfer of best management practices in the ways the literatures associated with federalism and policy transfer would suggest.

  1. Structure, Process, and Culture of Intensive Care Units Treating Patients with Severe Traumatic Brain Injury: Survey of Centers Participating in the American College of Surgeons Trauma Quality Improvement Program.

    Science.gov (United States)

    Alali, Aziz S; McCredie, Victoria A; Mainprize, Todd G; Gomez, David; Nathens, Avery B

    2017-10-01

    Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI. One hundred forty-two TMDs (76%) completed the survey. Severe TBI patients are admitted to dedicated neurocritical care units in 52 hospitals (37%), trauma ICUs in 44 hospitals (31%), general ICUs in 34 hospitals (24%), and surgical ICUs in 11 hospitals (8%). Fifty-seven percent are closed units. Board-certified intensivists directed 89% of ICUs, whereas 17% were led by neurointensivists. Sixty percent of ICU directors were general surgeons. Thirty-nine percent of hospitals had critical care fellowships and 11% had neurocritical care fellowships. Fifty-nine percent of ICUs had standard order sets and 61% had standard protocols specific for TBI, with the most common protocol relating to intracranial pressure management (53%). Only 43% of TMDs were satisfied with the current level of neurosurgeons' engagement in the ICU management of TBI; 46% believed that neurosurgeons should be more engaged; 11% believed they should be less engaged. In the largest survey of North American ICUs caring for TBI patients, there is substantial variation in the current approaches to ICU care for TBI, highlighting multiple opportunities for comparative effectiveness research.

  2. Effects of ecological compensation meadows on arthropod diversity in adjacent intensively managed grassland

    NARCIS (Netherlands)

    Albrecht, M.; Duelli, P.; Obrist, M.K.; Müller, C.; Schüpbach, B.; Kleijn, D.; Schmid, B.

    2010-01-01

    An important goal of ecological compensation areas (ECAs) is to increase biodiversity in adjacent intensively managed farmland and the agricultural landscape at large. We tested whether this goal can be achieved in the case of the agri-environmental restoration scheme implemented for Swiss grassland

  3. Acculturation and Bicultural Efficacy Effects on Chinese American Immigrants’ Diabetes and Health Management

    Science.gov (United States)

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

    2016-01-01

    The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N=162) recruited for a larger community-based diabetes intervention study (Chesla et al., 2013). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants’ diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study. PMID:27412776

  4. Acculturation and bicultural efficacy effects on Chinese American immigrants' diabetes and health management.

    Science.gov (United States)

    Chun, Kevin M; Kwan, Christine M L; Strycker, Lisa A; Chesla, Catherine A

    2016-10-01

    The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N = 162) recruited for a larger community-based diabetes intervention study (Chesla et al. in Res Nurs Health 36(4):359-372, 2013. doi: 10.1002/nur.21543 ). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants' diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study.

  5. Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans.

    Science.gov (United States)

    Scisney-Matlock, Margaret; Bosworth, Hayden B; Giger, Joyce Newman; Strickland, Ora L; Harrison, R Van; Coverson, Dorothy; Shah, Nirav R; Dennison, Cheryl R; Dunbar-Jacob, Jacqueline M; Jones, Loretta; Ogedegbe, Gbenga; Batts-Turner, Marian L; Jamerson, Kenneth A

    2009-05-01

    African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.

  6. Integral Management of Irrigation Water in Intensive Horticultural Systems of Almería

    Directory of Open Access Journals (Sweden)

    Pedro Garcia-Caparros

    2017-12-01

    Full Text Available The development of intensive horticulture in Almería, with a huge increase in greenhouse surface area, is related to three essential factors: climatic characteristics, groundwater use and mulching sandy soil. The purpose of the present paper is to draw a picture of the integral management of water irrigation in the intensive horticultural systems in the region, by identifying the most significant water resource contributions and alternative water resources. Results indicate that the use of groundwater for the irrigation of horticultural crops in the greenhouses presents a high degree of overexploitation of the aquifers, but due to the continuous search for alternative water resources, such as desalinated and reclaimed water, as well as in-depth knowledge of the integral management of water irrigation through automated fertigation and localized irrigation systems, the current status of the water resources could be sustainable. Moreover, being conscious of the pollution generated by agricultural leachates, the horticultural system of Almería is implementing complementary sustainable systems such as recirculation, cascade cropping systems and phytodepuration for the reuse of the leachate. Considering all these factors, it can be concluded that the intensive horticultural system is on the right path towards respecting the environment and being sustainable in terms of water use.

  7. Adapting Hypertension Self-Management Interventions to Enhance their Sustained Effectiveness among Urban African Americans

    Science.gov (United States)

    Ameling, Jessica M.; Ephraim, Patti L.; Bone, Lee R.; Levine, David M.; Roter, Debra L.; Wolff, Jennifer L.; Hill-Briggs, Felicia; Fitzpatrick, Stephanie L.; Noronha, Gary J.; Fagan, Peter J.; Lewis-Boyer, LaPricia; Hickman, Debra; Simmons, Michelle; Purnell, Leon; Fisher, Annette; Cooper, Lisa A.; Aboumatar, Hanan J.; Albert, Michael C.; Flynn, Sarah J.; Boulware, L. Ebony

    2014-01-01

    African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions’ cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members. The process required substantial time and resources, and the adapted interventions will be tested in a randomized controlled trial. PMID:24569158

  8. PanDA Beyond ATLAS : A Scalable Workload Management System For Data Intensive Science

    CERN Document Server

    Borodin, M; The ATLAS collaboration; Jha, S; Golubkov, D; Klimentov, A; Maeno, T; Nilsson, P; Oleynik, D; Panitkin, S; Petrosyan, A; Schovancova, J; Vaniachine, A; Wenaus, T

    2014-01-01

    The LHC experiments are today at the leading edge of large scale distributed data-intensive computational science. The LHC's ATLAS experiment processes data volumes which are particularly extreme, over 140 PB to date, distributed worldwide at over of 120 sites. An important element in the success of the exciting physics results from ATLAS is the highly scalable integrated workflow and dataflow management afforded by the PanDA workload management system, used for all the distributed computing needs of the experiment. The PanDA design is not experiment specific and PanDA is now being extended to support other data intensive scientific applications. PanDA was cited as an example of "a high performance, fault tolerant software for fast, scalable access to data repositories of many kinds" during the "Big Data Research and Development Initiative" announcement, a 200 million USD U.S. government investment in tools to handle huge volumes of digital data needed to spur science and engineering discoveries. In this talk...

  9. Bench-to-bedside review: leadership and conflict management in the intensive care unit.

    Science.gov (United States)

    Strack van Schijndel, Rob J M; Burchardi, Hilmar

    2007-01-01

    In the management of critical care units, leadership and conflict management are vital areas for the successful performance of the unit. In this article a practical approach to define competencies for leadership and principles and practices of conflict management are offered. This article is, by lack of relevant intensive care unit (ICU) literature, not evidence based, but it is the result of personal experience and a study of literature on leadership as well on conflicts and negotiations in non-medical areas. From this, information was selected that was recognisable to the authors and, thus, also seems to be useful knowledge for medical doctors in the ICU environment.

  10. Effects of taxation on the planning and implementation of intensive timber management

    Science.gov (United States)

    David B. Field

    1977-01-01

    Taxes on forest properties and on income from timber disposal impose one of the most significant kinds of cost burden faced by owners of interests in forest lands. Local property taxes impose annual charges regardless of the level of management, and may even be increased by intensive practices. Federal and state income taxes are usually second in impact only to...

  11. Management intensity affects traits of soil microarthropod community in montane spruce forest

    Czech Academy of Sciences Publication Activity Database

    Farská, Jitka; Prejzková, Kristýna; Rusek, Josef

    2014-01-01

    Roč. 75, March (2014), s. 71-79 ISSN 0929-1393 R&D Projects: GA ČR GA526/03/1259; GA ČR GAP504/12/1218; GA MŠk LC06066 Grant - others:GAJU(CZ) 143/2010/P Institutional support: RVO:60077344 Keywords : Oribatida * Collembola * spruce forest * trait * management intensity Subject RIV: EH - Ecology, Behaviour Impact factor: 2.644, year: 2014

  12. The Risk of Hepatotoxicity, New Onset Diabetes and Rhabdomyolysis in the Era of High-Intensity Statin Therapy: Does Statin Type Matter?

    Science.gov (United States)

    Benes, Lane B; Bassi, Nikhil S; Davidson, Michael H

    The 2013 American College of Cardiology/American Heart Association guidelines on cholesterol management have placed greater emphasis on high-intensity statin dosing for those with known cardiovascular disease or diabetes mellitus. Differences in risk of hepatotoxicity, new onset diabetes and rhabdomyolysis specifically between the high-intensity statins and the most common moderate-intensity statin, simvastatin, were not found to a significant degree in this review. Rather, baseline characteristics and drug-drug interactions (DDIs) appear to be more important regarding the risk of these adverse effects. Pharmacogenetic differences in statin metabolism may explain individual susceptibility, however genetic testing is not felt to be cost effective at this time. More importantly, statin choice should consider concomitant use of the many prevalent CYP3A4 inhibitors or inducers, and when present, rosuvastatin selection is recommended to reduce DDIs and risk of statin-induced adverse effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Moving On: Farmer Education in Integrated Insect Pest and Disease Management

    NARCIS (Netherlands)

    Jiggins, J.L.S.; Mancini, F.

    2009-01-01

    This chapter explores intensive hands-on occupational education for farmers in selected European, African, Latin American countries and in south India. An Indian case study of Farmer Field Schools for Integrated Pest and Production Management (IPPM) to ensure food security and livelihood improvement

  14. American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

    Science.gov (United States)

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N

    2012-10-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

  15. Managing One's Symptoms: A Qualitative Study of Low-Income African Americans With Advanced Cancer.

    Science.gov (United States)

    Yeager, Katherine A; Sterk, Claire E; Quest, Tammie E; DiIorio, Colleen; Vena, Catherine; Bauer-Wu, Susan

    2016-01-01

    African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

  16. 76 FR 13438 - AccessTel, Inc., American Asset Management Corp., DME Interactive Holdings, Inc., DocuPort, Inc...

    Science.gov (United States)

    2011-03-11

    ... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] AccessTel, Inc., American Asset Management Corp., DME Interactive Holdings, Inc., DocuPort, Inc., and iCarbon Corp., Order of Suspension of... Asset Management Corp. because it has not filed any periodic reports since the period ended March 31...

  17. Management of infections in critically ill returning travellers in the intensive care unit-II

    DEFF Research Database (Denmark)

    Rello, Jordi; Manuel, Oriol; Eggimann, Philippe

    2016-01-01

    This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emerge...

  18. A method of forest management for the planned introduction of intensive husbandry in virgin forest stands

    Science.gov (United States)

    B. Dolezal

    1978-01-01

    The method proposed is derived from long experience of intensive management in forest stands of Central Europe and from our proposal for management in virgin Iranian forests of the Caspian Region. The method establishes the need for systematic planning of stand conversion to insure both sustained yield and the harvesting of sufficient timber to sustain economic...

  19. Cultural differences in affect intensity perception in the context of advertising.

    Science.gov (United States)

    Pogosyan, Marianna; Engelmann, Jan B

    2011-01-01

    Cultural differences in the perception of positive affect intensity within an advertising context were investigated among American, Japanese, and Russian participants. Participants were asked to rate the intensity of facial expressions of positive emotions, which displayed either subtle, low intensity, or salient, high intensity expressions of positive affect. In agreement with previous findings from cross-cultural psychological research, current results demonstrate both cross-cultural agreement and differences in the perception of positive affect intensity across the three cultures. Specifically, American participants perceived high arousal (HA) images as significantly less calm than participants from the other two cultures, while the Japanese participants perceived low arousal (LA) images as significantly more excited than participants from the other cultures. The underlying mechanisms of these cultural differences were further investigated through difference scores that probed for cultural differences in perception and categorization of positive emotions. Findings indicate that rating differences are due to (1) perceptual differences in the extent to which HA images were discriminated from LA images, and (2) categorization differences in the extent to which facial expressions were grouped into affect intensity categories. Specifically, American participants revealed significantly higher perceptual differentiation between arousal levels of facial expressions in high and intermediate intensity categories. Japanese participants, on the other hand, did not discriminate between high and low arousal affect categories to the same extent as did the American and Russian participants. These findings indicate the presence of cultural differences in underlying decoding mechanisms of facial expressions of positive affect intensity. Implications of these results for global advertising are discussed.

  20. Cultural differences in affect intensity perception in the context of advertising

    Directory of Open Access Journals (Sweden)

    Marianna ePogosyan

    2011-11-01

    Full Text Available Cultural differences in the perception of positive affect intensity within an advertising context were investigated among American, Japanese and Russian participants. Participants were asked to rate the intensity of facial expressions of positive emotions, which displayed either subtle, low intensity or salient, high intensity expressions of positive affect. In agreement with previous findings from cross-cultural psychological research, current results demonstrate both cross-cultural agreement and differences in the perception of positive affect intensity across the three cultures. Specifically, American participants perceived high arousal images as significantly less calm than participants from the other two cultures, while the Japanese participants perceived low arousal images as significantly more excited than participants from the other cultures. The underlying mechanisms of these cultural differences were further investigated through difference scores that probed for cultural differences in perception and categorization of positive emotions. Findings indicate that rating differences are due to (1 perceptual differences in the extent to which high arousal images were discriminated from low arousal images, and (2 categorization differences in the extent to which facial expressions were grouped into affect intensity categories. Specifically, American participants revealed significantly higher perceptual differentiation between arousal levels of facial expressions in high and intermediate intensity categories. Japanese participants, on the other hand, did not discriminate between high and low arousal affect categories to the same extent as did the American and Russian participants. These findings indicate the presence of cultural differences in underlying decoding mechanisms of facial expressions of positive affect intensity. Implications of these results for cross-cultural communication and global advertising are discussed.

  1. CONTINUOUS GLUCOSE MONITORING: A CONSENSUS CONFERENCE OF THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

    Science.gov (United States)

    Fonseca, Vivian A; Grunberger, George; Anhalt, Henry; Bailey, Timothy S; Blevins, Thomas; Garg, Satish K; Handelsman, Yehuda; Hirsch, Irl B; Orzeck, Eric A; Roberts, Victor Lawrence; Tamborlane, William

    2016-08-01

    Barriers to continuous glucose monitoring (CGM) use continue to hamper adoption of this valuable technology for the management of diabetes. The American Association of Clinical Endocrinologists and the American College of Endocrinology convened a public consensus conference February 20, 2016, to review available CGM data and propose strategies for expanding CGM access. Conference participants agreed that evidence supports the benefits of CGM in type 1 diabetes and that these benefits are likely to apply whenever intensive insulin therapy is used, regardless of diabetes type. CGM is likely to reduce healthcare resource utilization for acute and chronic complications, although real-world analyses are needed to confirm potential cost savings and quality of life improvements. Ongoing technological advances have improved CGM accuracy and usability, but more innovations in human factors, data delivery, reporting, and interpretation are needed to foster expanded use. The development of a standardized data report using similar metrics across all devices would facilitate clinician and patient understanding and utilization of CGM. Expanded CGM coverage by government and private payers is an urgent need. CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes. A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology ASPIRE = Automation to Simulate Pancreatic Insulin Response CGM = continuous glucose monitoring HRQOL = health-related quality of life ICER = incremental cost-effectiveness ratio JDRF = Juvenile Diabetes Research Foundation MARD = mean absolute relative difference MDI = multiple daily injections QALY = quality-adjusted life years RCT = randomized, controlled trial SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR = Sensor

  2. Utilizing a diabetic registry to manage diabetes in a low-income Asian American population.

    Science.gov (United States)

    Seto, Winnie; Turner, Barbara S; Champagne, Mary T; Liu, Lynn

    2012-08-01

    Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management.

  3. Arbuscular mycorrhiza and their effect on the soil structure in farms with agroecological and intensive management

    Directory of Open Access Journals (Sweden)

    Juan David Lozano Sánchez

    2015-10-01

    Full Text Available Arbuscular mycorrhizal fungi help to reduce the damage caused by erosion and maintain soil structure through the production of mycelium and adhering substances. This study evaluated the structural stability; estimated the diversity and density of mycorrhizal spores present in three systems of soil (eroded, forest and coffee plantations in the rural area of Dagua, Valle del Cauca, Colombia. The systems evaluated were classified as farms with intensive or agroecological management. There were 25 morphospecies of mycorrhiza grouped in 13 genera, being Glomus and Entrophospora the most representative. The mean index values of mean weight (DPM and geometric (DGM diameters and diversity of mycorrhizal spores were statistically higher in farms with agroecological management than in farms with intensive management. The aggregate stability analysis revealed that eroded soils have significantly lower stability than forest and crop soils. A statistically significant correlation was found between diversity (r = 0.579 and spore density (r = 0.66 regarding DGM, and DPM with Shannon diversity (r = 0.54. Differences in practices, use and soil management affect mycorrhizal diversity found on farms and its effect such as particle aggregation agent generates remarkable changes in the stability and soil structure of evaluated areas. It is concluded, that agroecological management tends to favour both mycorrhizae and the structure of soils.

  4. Customized recommendations for production management clusters of North American automatic milking systems.

    Science.gov (United States)

    Tremblay, Marlène; Hess, Justin P; Christenson, Brock M; McIntyre, Kolby K; Smink, Ben; van der Kamp, Arjen J; de Jong, Lisanne G; Döpfer, Dörte

    2016-07-01

    Automatic milking systems (AMS) are implemented in a variety of situations and environments. Consequently, there is a need to characterize individual farming practices and regional challenges to streamline management advice and objectives for producers. Benchmarking is often used in the dairy industry to compare farms by computing percentile ranks of the production values of groups of farms. Grouping for conventional benchmarking is commonly limited to the use of a few factors such as farms' geographic region or breed of cattle. We hypothesized that herds' production data and management information could be clustered in a meaningful way using cluster analysis and that this clustering approach would yield better peer groups of farms than benchmarking methods based on criteria such as country, region, breed, or breed and region. By applying mixed latent-class model-based cluster analysis to 529 North American AMS dairy farms with respect to 18 significant risk factors, 6 clusters were identified. Each cluster (i.e., peer group) represented unique management styles, challenges, and production patterns. When compared with peer groups based on criteria similar to the conventional benchmarking standards, the 6 clusters better predicted milk produced (kilograms) per robot per day. Each cluster represented a unique management and production pattern that requires specialized advice. For example, cluster 1 farms were those that recently installed AMS robots, whereas cluster 3 farms (the most northern farms) fed high amounts of concentrates through the robot to compensate for low-energy feed in the bunk. In addition to general recommendations for farms within a cluster, individual farms can generate their own specific goals by comparing themselves to farms within their cluster. This is very comparable to benchmarking but adds the specific characteristics of the peer group, resulting in better farm management advice. The improvement that cluster analysis allows for is

  5. Enhancing the diversity of breeding invertebrates within field margins of intensively managed grassland: Effects of alternative management practices.

    Science.gov (United States)

    Fritch, Rochelle A; Sheridan, Helen; Finn, John A; McCormack, Stephen; Ó hUallacháin, Daire

    2017-11-01

    Severe declines in biodiversity have been well documented for many taxonomic groups due to intensification of agricultural practices. Establishment and appropriate management of arable field margins can improve the diversity and abundance of invertebrate groups; however, there is much less research on field margins within grassland systems. Three grassland field margin treatments (fencing off the existing vegetation "fenced"; fencing with rotavation and natural regeneration "rotavated" and; fencing with rotavation and seeding "seeded") were compared to a grazed control in the adjacent intensively managed pasture. Invertebrates were sampled using emergence traps to investigate species breeding and overwintering within the margins. Using a manipulation experiment, we tested whether the removal of grazing pressure and nutrient inputs would increase the abundance and richness of breeding invertebrates within grassland field margins. We also tested whether field margin establishment treatments, with their different vegetation communities, would change the abundance and richness of breeding invertebrates in the field margins. Exclusion of grazing and nutrient inputs led to increased abundance and richness in nearly all invertebrate groups that we sampled. However, there were more complex effects of field margin establishment treatment on the abundance and richness of invertebrate taxa. Each of the three establishment treatments supported a distinct invertebrate community. The removal of grazing from grassland field margins provided a greater range of overwintering/breeding habitat for invertebrates. We demonstrate the capacity of field margin establishment to increase the abundance and richness in nearly all invertebrate groups in study plots that were located on previously more depauperate areas of intensively managed grassland. These results from grassland field margins provide evidence to support practical actions that can inform Greening (Pillar 1) and agri

  6. [Investigation of doctors' and nurses' perceptions and implementation of delirium management in intensive care unit].

    Science.gov (United States)

    Luo, H B; Wang, X T; Tang, B; Zhu, Z N; Guo, H L; Li, Z Z; Sun, J H; Liu, D W

    2017-12-01

    Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management( P delirium assessment" ( P delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.

  7. Outpatient management of intensively treated acute leukemia patients-the patients' perspective

    DEFF Research Database (Denmark)

    Jepsen, Lene Østergaard; Høybye, Mette Terp; Hansen, Dorte Gilså

    2016-01-01

    , responsibility and the home were performed. Twenty-two patients were interviewed the first time, and 15 of these were interviewed the second time. The data were analyzed in an everyday life relational perspective. RESULTS: Outpatient management facilitates time to be administrated by the patients and thereby...... the possibility of maintaining everyday life, which was essential to the patients. The privacy ensured by the home was important to patients, and they accepted the necessary responsibility that came with it. However, time spent together with fellow patients and their relatives was an important and highly valued...... part of their social life. CONCLUSIONS: Approached from the patient perspective, outpatient management provided a motivation for patients as it ensured their presence at home and provided the possibility of taking part in everyday life of the family, despite severe illness and intensive treatment...

  8. Consequences of More Intensive Forestry for the Sustainable Management of Forest Soils and Waters

    Directory of Open Access Journals (Sweden)

    Eva Ring

    2011-02-01

    Full Text Available Additions of nutrients, faster growing tree varieties, more intense harvest practices, and a changing climate all have the potential to increase forest production in Sweden, thereby mitigating climate change through carbon sequestration and fossil fuel substitution. However, the effects of management strategies for increased biomass production on soil resources and water quality at landscape scales are inadequately understood. Key knowledge gaps also remain regarding the sustainability of shorter rotation periods and more intensive biomass harvests. This includes effects of fertilization on the long-term weathering and supply of base cations and the consequences of changing mineral availability for future forest production. Furthermore, because soils and surface waters are closely connected, management efforts in the terrestrial landscape will potentially have consequences for water quality and the ecology of streams, rivers, and lakes. Here, we review and discuss some of the most pertinent questions related to how increased forest biomass production in Sweden could affect soils and surface waters, and how contemporary forestry goals can be met while minimizing the loss of other ecosystem services. We suggest that the development of management plans to promote the sustainable use of soil resources and water quality, while maximizing biomass production, will require a holistic ecosystem approach that is placed within a broader landscape perspective.

  9. Analysis of the 2015 American and European guidelines for the management of infective endocarditis.

    Science.gov (United States)

    Tattevin, P; Mainardi, J-L

    2016-12-01

    The optimal management of infective endocarditis requires a broad range of expertise (infectious disease specialists, cardiologists, microbiologists, cardiac surgeons, and intensivists). Given the low level of evidence currently available to support the management of infective endocarditis, international guidelines have always been particularly awaited and rather well implemented. Their cautious analysis of the medical literature and the range of expertise combined within the groups in charge of these guidelines are usually broadly acknowledged and respected. The publications, a few weeks apart, of the 2015 updates of the American and European guidelines, was quite disturbing. Indeed, several discrepancies on major therapeutic propositions were observed, including empirical treatment (penicillin M+penicillin A+gentamicin for Europeans in acutely ill patients; penicillin A+beta-lactamase inhibitor+gentamicin for Americans), or first-line treatment for the most common pathogen responsible for endocarditis in 2016, Staphylococcus aureus (trimethoprim-sulfamethoxazole+clindamycin as an alternative in the European guidelines, while this regimen is not even mentioned in the American guidelines). Other discrepancies were observed, although less significant: the role of positron emission tomography labelled with 18 F-fluorodeoxyglucose and administration modalities for aminoglycosides. We aimed to detail the main changes brought upon by these guidelines, their discrepancies, and the 'pros' and 'cons' that may help you select the best treatment regimen for your patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Critical Zone Services as a Measure for Evaluating the Trade-offs in Intensively Managed Landscapes

    Science.gov (United States)

    Richardson, M.; Kumar, P.

    2015-12-01

    The Critical Zone includes the range of biophysical processes occurring from the top of the vegetation canopy to the weathering zone below the groundwater table. These services (Field et al. 2015) provide a measure to value processes that support the goods and services from our landscapes. In intensively managed landscapes the provisioning and regulating services are being altered through anthropogenic energy inputs so as to derive more agricultural productivity from the landscapes. Land use change and other alterations to the environment result in positive and/or negative net Critical Zone services. Through studies in the Critical Zone Observatory for Intensively Managed Landscapes (IMLCZO), this research seeks to answer questions such as: Are perennial bioenergy crops or annual replaced crops better for the land and surrounding environment? How do we evaluate the products and services from the land for the energy and resources we put in? Before the economic valuation of Critical Zone services, these questions seemed abstract. However, with developments such as Critical Zone services and life cycle assessments, they are more concrete. To evaluate the trade-offs between positive and negative impacts, life cycle assessments are used to create an inventory of all the energy inputs and outputs in a landscape management system. Total energy is computed by summing the mechanical energy used to construct tile drains, fertilizer, and other processes involved in intensely managed landscapes and the chemical energy gained by the production of biofuels from bioenergy crops. A multi-layer canopy model (MLCan) computes soil, water, and nutrient outputs for each crop type, which can be translated into Critical Zone services. These values are then viewed alongside the energy inputs into the system to show the relationship between agricultural practices and their corresponding ecosystem and environmental impacts.

  11. Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

    Science.gov (United States)

    Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L

    2016-04-01

    The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

  12. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative.

    Science.gov (United States)

    Brown, Sharon A.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2002-01-01

    In a culturally competent diabetes self-management intervention in Starr County, Texas, bilingual Mexican American nurses, dieticians, and community workers provided weekly instruction on nutrition, self-monitoring, exercise and other self-care topics. A biweekly support group promoted behavior change. Interviews and examinations with 256 Mexican…

  13. Impacts of Climate Variability on Latin American Small-scale Fisheries

    Directory of Open Access Journals (Sweden)

    Omar Defeo

    2013-12-01

    Full Text Available Small-scale fisheries (SSFs are social-ecological systems that play a critical role in terms of food security and poverty alleviation in Latin America. These fisheries are increasingly threatened by anthropogenic and climatic drivers acting at multiple scales. We review the effects of climate variability on Latin American SSFs, and discuss the combined effects of two additional human drivers: globalization of markets and governance. We show drastic long-term and large-scale effects of climate variability, e.g., sea surface temperature anomalies, wind intensity, sea level, and climatic indices, on SSFs. These variables, acting in concert with economic drivers, have exacerbated stock depletion rates in Latin American SSFs. The impact of these drivers varied according to the life cycle and latitudinal distribution of the target species, the characteristics of the oceanographic systems, and the inherent features of the social systems. Our review highlights the urgent need to improve management and governance systems to promote resilience as a way to cope with the increasing uncertainty about the impacts of climate and globalization of markets on Latin American SSFs.

  14. Irrigation and fertilization effects on Nantucket Pine Tip Moth (Lepidoptera: Tortricidae) Damage levels and pupal weight in an intensively-managed pine plantation.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David, R.; Nowak, John, T.; Fettig, Christopher, J.

    2003-10-01

    The widespread application of intensive forest management practices throughout the southeastern U.S. has increased loblolly pine, Pinus taeda L., yields and shortened conventional rotation lengths. Fluctuations in Nantucket pine tip moth, Rhyacionia frustrana (Comstock), population density and subsequent damage levels have been linked to variations in management intensity. We examined the effects of two practices, irrigation and fertilization, on R. frustrana damage levels and pupal weights in an intensively-managed P. taeda plantation in South Carolina. Trees received intensive weed control and one of the following treatments; irrigation only. fertilization only, irrigation + fertilization, or control. Mean whole-tree tip moth damage levels ranged from <1 to 48% during this study. Damage levels differed significantly among treatments in two tip moth generations in 2001, but not 2000. Pupal weight was significantly heavier in fertilization compared to the irrigation treatment in 2000, but no significant differences were observed in 2001. Tree diameter. height. and aboveground volume were significantly greater in the irrigation + fertilization than in the irrigation treatment after two growing seasons. Our data suggest that intensive management practices that include irrigation and fertilization do not consistently increase R. frustrana damage levels and pupal weights as is commonly believed. However, tip moth suppression efforts in areas adjacent to our study may have partially reduced the potential impacts of R. frustrana on this experiment.

  15. Optimal Multi-scale Demand-side Management for Continuous Power-Intensive Processes

    Science.gov (United States)

    Mitra, Sumit

    With the advent of deregulation in electricity markets and an increasing share of intermittent power generation sources, the profitability of industrial consumers that operate power-intensive processes has become directly linked to the variability in energy prices. Thus, for industrial consumers that are able to adjust to the fluctuations, time-sensitive electricity prices (as part of so-called Demand-Side Management (DSM) in the smart grid) offer potential economical incentives. In this thesis, we introduce optimization models and decomposition strategies for the multi-scale Demand-Side Management of continuous power-intensive processes. On an operational level, we derive a mode formulation for scheduling under time-sensitive electricity prices. The formulation is applied to air separation plants and cement plants to minimize the operating cost. We also describe how a mode formulation can be used for industrial combined heat and power plants that are co-located at integrated chemical sites to increase operating profit by adjusting their steam and electricity production according to their inherent flexibility. Furthermore, a robust optimization formulation is developed to address the uncertainty in electricity prices by accounting for correlations and multiple ranges in the realization of the random variables. On a strategic level, we introduce a multi-scale model that provides an understanding of the value of flexibility of the current plant configuration and the value of additional flexibility in terms of retrofits for Demand-Side Management under product demand uncertainty. The integration of multiple time scales leads to large-scale two-stage stochastic programming problems, for which we need to apply decomposition strategies in order to obtain a good solution within a reasonable amount of time. Hence, we describe two decomposition schemes that can be applied to solve two-stage stochastic programming problems: First, a hybrid bi-level decomposition scheme with

  16. Crew resource management training in the intensive care unit. A multisite controlled before–after study

    NARCIS (Netherlands)

    Kemper, Peter F.; de Bruijne, Martine; van Dyck, C.; Wagner, Cordula

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these

  17. Crew resource management training in the intensive care unit: a multisite controlled before-after study.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.

    2016-01-01

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these

  18. Modeling and Synthesis Support for the North American Carbon Program

    Science.gov (United States)

    Baskaran, L.; Cook, R. B.; Thornton, P. E.; Post, W. M.; Wilson, B. E.; Dadi, U.

    2007-12-01

    The Modeling and Synthesis Thematic Data Center (MAST-DC) supports the North American Carbon Program by providing data products and data management services needed for modeling and synthesis activities. The overall objective of MAST-DC is to provide advanced data management support to NACP investigators doing modeling and synthesis, thereby freeing those investigators from having to perform data management functions. MAST-DC has compiled a number of data products for North America, including sub-pixel land-water content, daily meteorological data, and soil, land cover, and elevation data. In addition, we have developed an internet-based WebGIS system that enables users to browse, query, display, subset, and download spatial data using a standard web browser. For the mid-continent intensive, MAST-DC is working with a group of data assimilation modelers to generate a consistent set of meteorological data to drive bottom-up models.

  19. Hispanic American Psychocultural Dispositions Relevant to Personnel Management.

    Science.gov (United States)

    1984-07-01

    literature on Hispanic Americans (Lisansky, 1981), make this need for empirical clarification especially unequivocal. The economic, educational, and...money/dinero respect/respecto advancement/avance dignity/dignidad education/ educacion ACHIEVEMENT MOTIVATION LEADERSHIP VALUES duty/obi lgac ion boss...although interestingly, the Anglo Americans gave more attention to Hispanic origin than the Mexican Americans ( especially the Los Angeles Mexicans). There

  20. Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital.

    Science.gov (United States)

    Kosmidis, Dimitrios; Koutsouki, Sotiria; Lampiri, Klairi; Nagy, Eva Ottilia; Papaioannou, Vasilios; Pneumatikos, Ioannis; Anastassopoulos, George

    2017-11-01

    Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

  1. The CEO of Anglo American on getting serious about safety.

    Science.gov (United States)

    Carroll, Cynthia

    2012-06-01

    When Carroll became the EO of Anglo American, in 2007, the company had suffered 200 worker fatalities over the previous five years. Some company veterans insisted that deaths were inevitable at such a large mining company, given the dangerous nature of the business. Carroll fundamentally rejected that assumption. She undertook a tour of operations in Australia, Chile, Colombia, Venezuela, and South Africa. The platinum business in South Africa had the worst track record in terms of safety, and Carroll was troubled by her conversations with its local managers. Immediately after her visit, another worker died. That was it. She ordered the world's largest platinum mine, which employed 30,000 people, to be shut down immediately. Intensive retraining began, and 3,000 leaders and 12,000 line managers, supervisors, and frontline employees have been through the program since 2008. Carroll also initiated the Tripartite Alliance, a collaboration with the South African Department of Mineral Resources and the National Union of Mineworkers, to study global best practices in safety and make recommendations. By 2011 she had reduced fatalities at Anglo American by 62% and had cut time lost owing to injuries by half.

  2. Perceptions of guided imagery for stress management in pregnant African American women.

    Science.gov (United States)

    Jallo, Nancy; Salyer, Jeanne; Ruiz, R Jeanne; French, Elise

    2015-08-01

    Maternal stress during pregnancy has been associated with numerous adverse pregnancy, birth, and health outcomes. Pregnant African American women have been reported to have higher levels of stress compared to other ethnic or racial groups underscoring the need for effective interventions to reduce stress in this population. The purpose of this study was to gain an in-depth understanding of the perceptions of guided imagery (GI) as a technique for stress management in a cohort of pregnant African American women who participated in a GI intervention as part of a larger mixed methods randomized controlled trial. The 12week intervention was a professionally recorded compact disc with four tracks developed and sequenced to reduce stress and associated symptoms. The findings from this descriptive phenomenologic study were derived from daily logs and interviews from 36 participants randomized to the GI group. Participants described the stressful nature of their lives. Results demonstrated pregnant African American women perceived the intervention as beneficial in reducing stress and the associated symptoms. The emergent themes suggested the intervention offered a respite from their stressful lives, reduced the negative emotional responses to stress and enhanced well-being, benefited other areas of their daily life, and provided an opportunity to connect with their baby. The study results support the perceived efficacy of GI as a stress coping intervention. GI is an economic as well as easy to implement, access and use technique that has potential stress coping benefits as perceived by pregnant African American women. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Challenges encountered by critical care unit managers in the large intensive care units.

    Science.gov (United States)

    Matlakala, Mokgadi C; Bezuidenhout, Martie C; Botha, Annali D H

    2014-04-04

    Nurses in intensive care units (ICUs) are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  4. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-04-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  5. Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

    Science.gov (United States)

    Coleman, Christopher Lance; Holzemer, William L; Eller, Lucille Sanzero; Corless, Inge; Reynolds, Nancy; Nokes, Kathleen M; Kemppainen, Jeanne K; Dole, Pam; Kirksey, Kenn; Seficik, Liz; Nicholas, Patrice; Hamilton, Mary Jane

    2006-01-01

    The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

  6. Emerging Themes in the Ecology and Management of North American Forests

    International Nuclear Information System (INIS)

    Sharik, T.L.; Adair, W.; Baker, F.A.

    2010-01-01

    The 7th North American Forest Ecology Workshop, consisting of 149 presentations in 16 oral sessions and a poster session, reflected a broad range of topical areas currently under investigation in forest ecology and management. There was an overarching emphasis on the role of disturbance, both natural and anthropogenic, in the dynamics of forest ecosystems, and the recognition that legacies from past disturbances strongly influence future trajectories. Climate was invoked as a major driver of ecosystem change. An emphasis was placed on application of research findings for predicting system responses to changing forest management initiatives. Several needs emerged from the discussions regarding approaches to the study of forest ecosystems, including (1) consideration of variable spatial and temporal scales, (2) long-term monitoring, (3) development of universal databases more encompassing of time and space to facilitate meta-analyses, (4) combining field studies and modeling approaches, (5) standardizing methods of measurement and assessment, (6) guarding against oversimplification or over generalization from limited site-specific results, (7) greater emphasis on plant-animal interactions, and (8) better alignment of needs and communication of results between researchers and managers.

  7. Emerging Themes in the Ecology and Management of North American Forests

    Directory of Open Access Journals (Sweden)

    Terry L. Sharik

    2010-01-01

    Full Text Available The 7th North American Forest Ecology Workshop, consisting of 149 presentations in 16 oral sessions and a poster session, reflected a broad range of topical areas currently under investigation in forest ecology and management. There was an overarching emphasis on the role of disturbance, both natural and anthropogenic, in the dynamics of forest ecosystems, and the recognition that legacies from past disturbances strongly influence future trajectories. Climate was invoked as a major driver of ecosystem change. An emphasis was placed on application of research findings for predicting system responses to changing forest management initiatives. Several “needs” emerged from the discussions regarding approaches to the study of forest ecosystems, including (1 consideration of variable spatial and temporal scales, (2 long-term monitoring, (3 development of universal databases more encompassing of time and space to facilitate meta-analyses, (4 combining field studies and modeling approaches, (5 standardizing methods of measurement and assessment, (6 guarding against oversimplification or overgeneralization from limited site-specific results, (7 greater emphasis on plant-animal interactions, and (8 better alignment of needs and communication of results between researchers and managers.

  8. Emerging themes in the ecology and management of North American forests

    Science.gov (United States)

    Sharik, Terry L.; Adair, William; Baker, Fred A.; Battaglia, Michael; Comfort, Emily J.; D'Amato, Anthony W.; Delong, Craig; DeRose, R. Justin; Ducey, Mark J.; Harmon, Mark; Levy, Louise; Logan, Jesse A.; O'Brien, Joseph; Palik, Brian J.; Roberts, Scott D.; Rogers, Paul C.; Shinneman, Douglas J.; Spies, Thomas; Taylor, Sarah L.; Woodall, Christopher; Youngblood, Andrew

    2010-01-01

    The 7th North American Forest Ecology Workshop, consisting of 149 presentations in 16 oral sessions and a poster session, reflected a broad range of topical areas currently under investigation in forest ecology and management. There was an overarching emphasis on the role of disturbance, both natural and anthropogenic, in the dynamics of forest ecosystems, and the recognition that legacies from past disturbances strongly influence future trajectories. Climate was invoked as a major driver of ecosystem change. An emphasis was placed on application of research findings for predicting system responses to changing forest management initiatives. Several “needs” emerged from the discussions regarding approaches to the study of forest ecosystems, including (1) consideration of variable spatial and temporal scales, (2) long-term monitoring, (3) development of universal databases more encompassing of time and space to facilitate meta-analyses, (4) combining field studies and modeling approaches, (5) standardizing methods of measurement and assessment, (6) guarding against oversimplification or overgeneralization from limited site-specific results, (7) greater emphasis on plant-animal interactions, and (8) better alignment of needs and communication of results between researchers and managers.

  9. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Carnethon, Mercedes R; Pu, Jia; Howard, George; Albert, Michelle A; Anderson, Cheryl A M; Bertoni, Alain G; Mujahid, Mahasin S; Palaniappan, Latha; Taylor, Herman A; Willis, Monte; Yancy, Clyde W

    2017-11-21

    Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines. © 2017 American Heart Association, Inc.

  10. The management of hypertension in African Americans.

    Science.gov (United States)

    Ferdinand, Keith C; Armani, Annemarie M

    2007-06-01

    The prevalence of hypertension in blacks in the United States is among the highest in the world. Compared with whites, blacks develop hypertension at an earlier age, their average blood pressures are much higher and they experience worse disease severity. Consequently, blacks have a 1.3 times greater rate of nonfatal stroke, 1.8 times greater rate of fatal stroke, 1.5 times greater rate of heart disease death, 4.2 times greater rate of end-stage kidney disease, and a 50% higher frequency of heart failure; overall, mortality due to hypertension and its consequences is 4 to 5 times more likely in African Americans than in whites. The increased prevalence of hypertension and excessive target organ damage is due to a combination of genetic and, most likely, environmental factors. There are no clinical trial data at present to suggest that lower-than-usual BP targets should be set for high-risk demographic groups such as African Americans. The primary means of prevention and early treatment of hypertension in African Americans will be the appropriate use of lifestyle modification. The International Society of Hypertension in Blacks guidelines realize that most patients will require combination therapy, many of them first-line, to reach appropriate BP goals. Although certain classes and combinations of antihypertensive agents have been well-established to be effective, the choice of drugs for combination therapy in African American patients may be different. Within the African American group, the responsiveness to monotherapy with ACE inhibitors, angiotensin receptor blockers, and beta blockers may be less than the responsiveness to diuretics and calcium channel blockers, but these differences are corrected when diuretics are added to the neurohormonal antagonists. Of note, African American patients with systolic BP >15 mm Hg or a diastolic BP >10 mm Hg above goal should be treated with first-line combination therapy.

  11. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: The case of an Italian urban area

    Energy Technology Data Exchange (ETDEWEB)

    Di Maria, Francesco, E-mail: francesco.dimaria@unipg.it; Micale, Caterina

    2014-11-15

    Highlights: • Waste management scenarios starting from different SS intensity were analyzed by LCA. • Several experimental data were utilized for the inventory. • Collection activities influences marginally global impact. • Maximum global environmental gain was achieved by SRF for coke substitution. - Abstract: Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process.

  12. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: The case of an Italian urban area

    International Nuclear Information System (INIS)

    Di Maria, Francesco; Micale, Caterina

    2014-01-01

    Highlights: • Waste management scenarios starting from different SS intensity were analyzed by LCA. • Several experimental data were utilized for the inventory. • Collection activities influences marginally global impact. • Maximum global environmental gain was achieved by SRF for coke substitution. - Abstract: Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process

  13. Sleep behaviors in older African American females reporting nonmalignant chronic pain: understanding the psychosocial implications of general sleep disturbance.

    Science.gov (United States)

    Baker, Tamara A; Whitfield, Keith E

    2014-01-01

    This study examined factors that influence sleep quality in older African American women (N = 181) reporting chronic pain. Participants completed a series of questions assessing demographic and behavioral characteristics, health status, pain intensity, and sleep disturbance. Findings indicated that younger participants and those experiencing poorer physical functioning reported more difficulty sleeping due to pain. Similarly, participants who reported being awakened from sleep due to pain were younger and experienced greater pain intensity. Understanding the relationship between sleep and pain in this group of women may be useful in promoting effective disease management and sleep awareness among patients, caregivers, and healthcare professionals.

  14. The Effects of Telecommuting Intensity on Employee Health.

    Science.gov (United States)

    Henke, Rachel Mosher; Benevent, Richele; Schulte, Patricia; Rinehart, Christine; Crighton, K Andrew; Corcoran, Maureen

    2016-11-01

    To investigate the influence of the intensity of telecommuting on employee health. Study design comprised a longitudinal analysis of employee demographic data, medical claims, health risk assessment data, and remote connectivity hours. Data from Prudential Financial served as the setting. Active employees ages 18 to 64 years who completed the health risk assessment between 2010 and 2011 were the study subjects. Measures included telecommuting status and intensity, and eight indicators of health risk status (obesity, depression, stress, tobacco use, alcohol abuse, poor nutrition, physical inactivity, and an overall risk measure), with employee age, sex, race-ethnicity, job grade, management status, and work location as control variables. Health risks were determined for nontelecommuters and telecommuters working remotely ≤8, 9 to 32, 33 to 72, and ≥73 hours per month. Longitudinal models for each health risk were estimated, controlling for demographic and job characteristics. Telecommuting health risks varied by telecommuting intensity. Nontelecommuters were at greater risk for obesity, alcohol abuse, physical inactivity, and tobacco use, and were at greater overall risk than at least one of the telecommuting groups. Employees who telecommuted ≤8 hours per month were significantly less likely than nontelecommuters to experience depression. There was no association between telecommuting and stress or nutrition. Results suggest that employees may benefit from telecommuting opportunities. © 2016 by American Journal of Health Promotion, Inc.

  15. The practice of intensive care in Latin America: a survey of academic intensivists.

    Science.gov (United States)

    Castro, Ricardo; Nin, Nicolas; Ríos, Fernando; Alegría, Leyla; Estenssoro, Elisa; Murias, Gastón; Friedman, Gilberto; Jibaja, Manuel; Ospina-Tascon, Gustavo; Hurtado, Javier; Marín, María Del Carmen; Machado, Flavia R; Cavalcanti, Alexandre Biasi; Dubin, Arnaldo; Azevedo, Luciano; Cecconi, Maurizio; Bakker, Jan; Hernandez, Glenn

    2018-02-21

    Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated. Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%); Argentina (19%); Chile (17%); Uruguay (12%); Ecuador (9%); Mexico (7%); Colombia (5%); and Bolivia, Peru, Guatemala, and Paraguay combined (2%). Latin American intensivists were predominantly male (68%) young adults (median age, 40 [IQR, 35-48] years) with a median clinical ICU experience of 10 (IQR, 5-20) years. The median weekly workload was 60 (IQR, 47-70) h. ICU formal training was between 2 and 4 years. Only 63% of academic ICUs performed multidisciplinary rounds. Most intensivists (85%) reported adequate conditions to manage patients with septic shock in their units. Unsatisfactory conditions were attributed to insufficient technology (11%), laboratory support (5%), imaging resources (5%), and drug shortages (5%). Seventy percent of intensivists participated in research, and 54% read scientific studies regularly, whereas 32% read no more than one scientific study per month. Research grants and pharmaceutical sponsorship are unusual funding sources in Latin

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

    Science.gov (United States)

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

    2012-01-01

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

  17. Severe fire weather and intensive forest management increase fire severity in a multi-ownership landscape.

    Science.gov (United States)

    Zald, Harold S J; Dunn, Christopher J

    2018-04-26

    Many studies have examined how fuels, topography, climate, and fire weather influence fire severity. Less is known about how different forest management practices influence fire severity in multi-owner landscapes, despite costly and controversial suppression of wildfires that do not acknowledge ownership boundaries. In 2013, the Douglas Complex burned over 19,000 ha of Oregon & California Railroad (O&C) lands in Southwestern Oregon, USA. O&C lands are composed of a checkerboard of private industrial and federal forestland (Bureau of Land Management, BLM) with contrasting management objectives, providing a unique experimental landscape to understand how different management practices influence wildfire severity. Leveraging Landsat based estimates of fire severity (Relative differenced Normalized Burn Ratio, RdNBR) and geospatial data on fire progression, weather, topography, pre-fire forest conditions, and land ownership, we asked (1) what is the relative importance of different variables driving fire severity, and (2) is intensive plantation forestry associated with higher fire severity? Using Random Forest ensemble machine learning, we found daily fire weather was the most important predictor of fire severity, followed by stand age and ownership, followed by topographic features. Estimates of pre-fire forest biomass were not an important predictor of fire severity. Adjusting for all other predictor variables in a general least squares model incorporating spatial autocorrelation, mean predicted RdNBR was higher on private industrial forests (RdNBR 521.85 ± 18.67 [mean ± SE]) vs. BLM forests (398.87 ± 18.23) with a much greater proportion of older forests. Our findings suggest intensive plantation forestry characterized by young forests and spatially homogenized fuels, rather than pre-fire biomass, were significant drivers of wildfire severity. This has implications for perceptions of wildfire risk, shared fire management responsibilities, and developing

  18. Implementing the 2012 North American Waterfowl Management Plan revision: Populations, habitat, and people

    Science.gov (United States)

    Humburg, Dale D.; Anderson, Michael G.; Brasher, Michael G.; Carter, Michael F.; Eadie, John M.; Fulton, David C.; Johnson, Fred A.; Runge, Michael C.; Vrtiska, Mark P.

    2018-01-01

    The North American Waterfowl Management Plan (NAWMP) has established a model for wildlife conservation planning over the last 3 decades. Management at a continental scale, leveraged funding, regional partnerships, and a strong science basis have been notable features. Periodic updates to the NAWMP occurred since implementation in 1986; however, a fundamental revision was accomplished in 2012 after extensive stakeholder engagement. An explicit fundamental goal for waterfowl conservation supporters was added in 2012, complementing existing goals for sustainable populations and sufficient habitat found in previous updates. We present a synopsis of progress toward implementation of the 2012 NAWMP and challenge the waterfowl management community to continue with meaningful steps toward achieving NAWMP goals. Adding goals and objectives for supporters increases potential relevance of NAWMP; however, it also presents a level of complexity that was not entirely anticipated. Additionally, the 2012 NAWMP recognized that traditional support from waterfowl hunters alone will not be sufficient to support waterfowl conservation in the future. Simultaneous consideration of multiple objectives, although implicit before, now is a specific focus for habitat and harvest management affecting hunters and other users of the waterfowl resource. The waterfowl management community is faced with revisiting objectives and management actions related to harvest regulations, landscape priorities, habitat conservation, and public engagement to garner broader support. These persistent management challenges are tangible and relevant candidates for greater integration. Ultimately, the structures and processes supporting waterfowl management also will need to be reconsidered.

  19. Experiences addressing health-related financial challenges with disease management among African American women with asthma

    Science.gov (United States)

    Patel, Minal R.; Caldwell, Cleopatra H.; Id-Deen, Effat; Clark, Noreen M.

    2018-01-01

    Objective Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. Methods In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Results Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Conclusions Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available. PMID:24471517

  20. Experiences addressing health-related financial challenges with disease management among African American women with asthma.

    Science.gov (United States)

    Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M

    2014-06-01

    Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.

  1. Sustainability of High Intensity Forest Management with Respect to Water QuaIity and Site Nutrient Reserves

    Science.gov (United States)

    Virginia R. Tolbert; Carl C. Trettin; Dale W. Johnson; John W. Parsons; Allan E. Houston; David A. Mays

    2001-01-01

    Ensuring sustainability of intensively managed woody crops requires determining soil and water quality effects using a combination of field data and modeling projections. Plot- and catchrnent-scale research, models, and meta-analyses are addressing nutrient availability, site quality, and measures to increase short-rotation woody crop (SRWC) productivity and site...

  2. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review

  3. Climate Change Effects of Forest Management and Substitution of Carbon-Intensive Materials and Fossil Fuels

    Science.gov (United States)

    Sathre, R.; Gustavsson, L.; Haus, S.; Lundblad, M.; Lundström, A.; Ortiz, C.; Truong, N.; Wikberg, P. E.

    2016-12-01

    Forests can play several roles in climate change mitigation strategies, for example as a reservoir for storing carbon and as a source of renewable materials and energy. To better understand the linkages and possible trade-offs between different forest management strategies, we conduct an integrated analysis where both sequestration of carbon in growing forests and the effects of substituting carbon intensive products within society are considered. We estimate the climate effects of directing forest management in Sweden towards increased carbon storage in forests, with more land set-aside for protection, or towards increased forest production for the substitution of carbon-intensive materials and fossil fuels, relative to a reference case of current forest management. We develop various scenarios of forest management and biomass use to estimate the carbon balances of the forest systems, including ecological and technological components, and their impacts on the climate in terms of cumulative radiative forcing over a 100-year period. For the reference case of current forest management, increasing the harvest of forest residues is found to give increased climate benefits. A scenario with increased set-aside area and the current level of forest residue harvest begins with climate benefits compared to the reference scenario, but the benefits cannot be sustained for 100 years because the rate of carbon storage in set-aside forests diminishes over time as the forests mature, but the demand for products and fuels remains. The most climatically beneficial scenario, expressed as reduced cumulative radiative forcing, in both the short and long terms is a strategy aimed at high forest production, high residue recovery rate, and high efficiency utilization of harvested biomass. Active forest management with high harvest level and efficient forest product utilization will provide more climate benefit, compared to reducing harvest and storing more carbon in the forest. Figure

  4. African American and Hispanic American sportsmen in the north central region

    Science.gov (United States)

    Allan Marsinko; John Dwyer

    2003-01-01

    Public forest managers need an awareness and understanding of their clients in order to better address their needs for recreational uses of forest lands. This study examines and characterizes African American and Hispanic American sportsmen (hunters and anglers) in the North Central Region of the United Stares (IA, IL, IN, MI, MN, MO, WI) and compares them to African...

  5. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Baddour, Larry M; Wilson, Walter R; Bayer, Arnold S; Fowler, Vance G; Tleyjeh, Imad M; Rybak, Michael J; Barsic, Bruno; Lockhart, Peter B; Gewitz, Michael H; Levison, Matthew E; Bolger, Ann F; Steckelberg, James M; Baltimore, Robert S; Fink, Anne M; O'Gara, Patrick; Taubert, Kathryn A

    2015-10-13

    Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management. © 2015 American Heart Association, Inc.

  6. Screening for cancer: advice for high-value care from the American College of Physicians.

    Science.gov (United States)

    Wilt, Timothy J; Harris, Russell P; Qaseem, Amir

    2015-05-19

    Cancer screening is one approach to reducing cancer-related morbidity and mortality rates. Screening strategies vary in intensity. Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value. Screening strategies for asymptomatic, average-risk adults for 5 common types of cancer were evaluated by reviewing clinical guidelines and evidence syntheses from the American College of Physicians (ACP), U.S. Preventive Services Task Force, American Academy of Family Physicians, American Cancer Society, American Congress of Obstetricians and Gynecologists, American Gastroenterological Association, and American Urological Association. "High value" was defined as the lowest screening intensity threshold at which organizations agree about screening recommendations for each type of cancer and "low value" as agreement about not recommending overly intensive screening strategies. This information is supplemented with additional findings from randomized, controlled trials; modeling studies; and studies of costs or resource use, including information found in the National Cancer Institute's Physician Data Query and UpToDate. The ACP provides high-value care screening advice for 5 common types of cancer; the specifics are outlined in this article. The ACP strongly encourages clinicians to adopt a cancer screening strategy that focuses on reaching all eligible persons with these high-value screening options while reducing overly intensive, low-value screening.

  7. International Human Resources Management of Japanese, American, and European Firms in Asia : The Roles of Headquarters and Subsidiaries

    OpenAIRE

    Hiromichi Shibata; Andrew Doyle

    2006-01-01

    The main role of the headquarters international human resources departments/business units of seven Japanese firms we researched is to manage the Japanese expatriates at their subsidiaries in Asia; they have little involvement with the management of local employees. The headquarters international human resources departments/business units at five researched American firms tend to maintain strong company value/mission that drives use of their performance appraisal/promotion systems for employe...

  8. Leptospirosis in American Samoa 2010: epidemiology, environmental drivers, and the management of emergence.

    Science.gov (United States)

    Lau, Colleen L; Dobson, Annette J; Smythe, Lee D; Fearnley, Emily J; Skelly, Chris; Clements, Archie C A; Craig, Scott B; Fuimaono, Saipale D; Weinstein, Philip

    2012-02-01

    Leptospirosis has recently been reported as an emerging disease worldwide, and a seroprevalence study was undertaken in American Samoa to better understand the drivers of transmission. Antibodies indicative of previous exposure to leptospirosis were found in 15.5% of 807 participants, predominantly against three serovars that were not previously known to occur in American Samoa. Questionnaires and geographic information systems data were used to assess behavioral factors and environmental determinants of disease transmission, and logistic regression was used to identify factors associated with infection. Many statistically significant factors were consistent with previous studies, but we also showed a significant association with living at lower altitudes (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.03-2.28), and having higher numbers of piggeries around the home (OR = 2.63, 95% CI: 1.52-4.40). Our findings support a multifaceted approach to combating the emergence of leptospirosis, including modification of individual behavior, but importantly also managing the evolving environmental drivers of risk.

  9. Stress Management-Augmented Behavioral Weight Loss Intervention for African American Women: A Pilot, Randomized Controlled Trial

    Science.gov (United States)

    Cox, Tiffany L.; Krukowski, Rebecca; Love, ShaRhonda J.; Eddings, Kenya; DiCarlo, Marisha; Chang, Jason Y.; Prewitt, T. Elaine; West, Delia Smith

    2013-01-01

    The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week…

  10. Challenges in the management of Chagas disease in Latin-American migrants in Europe.

    Science.gov (United States)

    Monge-Maillo, B; López-Vélez, R

    2017-05-01

    Chagas disease is endemic in Latin America. Due to migration the infection has crossed borders and it is estimated that 68,000-120,000 people with Chagas disease are currently living in Europe and 30% of them may develop visceral involvement. However, up to 90% of Chagas disease cases in Europe remain undiagnosed. The challenges which have to be overcome in Chagas disease in non-endemic countries are focused on related downing barriers to health care access, and related to screening, diagnostic tools and therapeutic management. The aim of this review is to highlight how healthcare management for Latin American migrants with Chagas disease in Europe may be improved. Medical literature was searched using PubMed. No limits were placed with respect to the language or date of publication although most of the articles selected were articles published in the last five years. Chosen search terms were "Chagas disease" AND ("migrants" OR "screening" OR "transmission" OR "treatment"; OR "knowledge" OR "non-endemic countries"); migrants AND ("Public health" OR "Health Service Accessibility" OR "Delivery of Health care"); and "Congenital Chagas disease". Healthcare management of migrant populations with Chagas disease in Europe has to be improved: -Surveillance programmes are needed to measure the burden of the disease; -screening programmes are needed; -administrative and cultural barriers in the access to health care for migrants should be reduced; -education programmes on Chagas disease should be performed -research on new diagnostic tools and therapeutic options are required. This review highlights the needs of profound changes in the health care of Latin American migrants with Chagas disease in Europe. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  11. [Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard].

    Science.gov (United States)

    Lorenzo Torrent, R; Sánchez Palacios, M; Santana Cabrera, L; Cobian Martinez, J L; García del Rosario, C

    2010-10-01

    The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel. Copyright © 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  12. Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States.

    Science.gov (United States)

    Long, Everett; Ponder, Monica; Bernard, Stephanie

    2017-05-01

    Perceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40-65, living in the Southeastern United States. In-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM). Participants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management-noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations. The findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors. Public health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

  14. Low-intensity beam diagnostics with particle detectors

    Energy Technology Data Exchange (ETDEWEB)

    Rovelli, A.; Ciavola, G.; Cuttone, G.; Finocchiaro, P.; Raia, G. [INFN-LNS, Via S. Sofia 44/A Catania, 95125 (Italy); De Martinis, C.; Giove, D. [INFN-LASA, Via F.lli Cervi 201 Segrate (Midway Islands), 20090 (Italy)

    1997-01-01

    The measure of low intensity beams at low-medium energy is one of the major challenge in beam diagnostics. This subject is of great interest for the design of accelerator-based medical and radioactive beam facilities. In this paper we discuss new developments in image-based devices to measure low-intensity beams. All the investigated devices must guarantee measurement of the total beam current and its transverse distribution. {copyright} {ital 1997 American Institute of Physics.}

  15. Low-intensity beam diagnostics with particle detectors

    International Nuclear Information System (INIS)

    Rovelli, A.; Ciavola, G.; Cuttone, G.; Finocchiaro, P.; Raia, G.; De Martinis, C.; Giove, D.

    1997-01-01

    The measure of low intensity beams at low-medium energy is one of the major challenge in beam diagnostics. This subject is of great interest for the design of accelerator-based medical and radioactive beam facilities. In this paper we discuss new developments in image-based devices to measure low-intensity beams. All the investigated devices must guarantee measurement of the total beam current and its transverse distribution. copyright 1997 American Institute of Physics

  16. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer

    OpenAIRE

    Haugen, Bryan R; Alexander, Erik K; Bible, Keith C; Doherty, Gerard M; Mandel, Susan J; Nikiforov, Yuri E; Pacini, Furio; Randolph, Gregory W; Sawka, Anna M; Schlumberger, Martin; Schuff, Kathryn G; Sherman, Steven I; Sosa, Julie Ann; Steward, David L; Tuttle, R. Michael

    2016-01-01

    Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and d...

  17. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  18. Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model.

    Science.gov (United States)

    Dodek, Peter M; Wong, Hubert; Jaswal, Danny; Heyland, Daren K; Cook, Deborah J; Rocker, Graeme M; Kutsogiannis, Demetrios J; Dale, Craig; Fowler, Robert; Ayas, Najib T

    2012-02-01

    The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P organizational and safety culture. Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Spanish recruitment programmes for Latin Americans in countries of origin: a flexible management framework

    Directory of Open Access Journals (Sweden)

    Ana Mª López-Sala

    2014-09-01

    Full Text Available In the past decade, countries whose markets needed seasonal labour have sought new ways of importing foreign workers through channelling and recruitment programmes in countries of origin. This article seeks to demonstrate that, in the case of Spain, the effective development of this process has only been possible because of a flexible and dynamic system in which bilateral agreements have played a major role, among them those signed with some Latin American countries. Flexible management of these programmes has been implemented via legislation, via the institutions and actors involved, and via the immigrants themselves, who have managed (or been forced to adapt to the changes of a labour market conditioned by the globalisation of labour and capital.

  20. Diabetes connect: African American men's preferences for a community-based diabetes management program.

    Science.gov (United States)

    Crabtree, Krysia; Sherrer, Nathan; Rushton, Tullia; Willig, Amanda; Agne, April; Shelton, Tanya; Cherrington, Andrea

    2015-02-01

    The purpose of the study is to explore African American men's perceptions of how community-based, community-health worker (CHW)-delivered diabetes interventions might best be implemented. Four 90-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of diabetes management and preferences for community-based programs. Participants were recruited from the diabetes education database at a safety-net health system in Jefferson County, AL. Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach. There were 25 male participants. Mean years living with diabetes was 9.6 (range, 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions, and institutional frustrations with the health system that contributed to self-management barriers. Their preferred CHW responsibilities were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns included the need for confidentiality and fears of being stereotyped. Participants identified critical self-management strategies but endure hardships that present barriers to daily diabetes management. Preferences for community-based programs and suggested CHW responsibilities could help to overcome many of those barriers by increasing access and providing support. © 2014 The Author(s).

  1. [Necrotizing fasciitis: results of a survey on management practices in French-speaking intensive care units].

    Science.gov (United States)

    de Prost, N; Bosc, R; Brun-Buisson, C; Chosidow, O; Decousser, J-W; Dhonneur, G; Lepeule, R; Rahmouni, A; Sbidian, E; Amathieu, R

    2014-12-01

    Necrotizing fasciitis (NF) are rare and severe soft tissue infections associated with a high mortality rate. In order to assess the management of NF in French-speaking intensive care units (ICUs), we conducted a survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). Online self-administered survey. A link to an online survey was sent by email to 4620 anesthesiologists and/or intensivists and was available online from January to February 2014. One hundred and seventy-five physicians (3.8%) who worked in 135 ICUs filled out the online survey. Among respondents, 42% reported having managed up to two patients with NF during the previous year; 59% and 72% of respondents reported not having a surgical and a medical specialist consultant, respectively. A delayed access to the operating room (OR) of more than 6hours was reported in 31% of cases and access to the OR was reported not to be routinely considered as a priority in 13% of cases. Only 17% of respondents reported that time to transfer to the OR was never a cause for delayed surgery. The main causes for delayed surgery were: delayed diagnosis (45%), delayed validation of surgical intervention (37%), and difficulty of access to the OR (8%). Finally, 83% of respondents estimated that creating dedicated multidisciplinary teams for managing NFs could lead to improving outcomes. This survey illustrates the heterogeneous management of NF in French-speaking ICUs and points out several logistical aspects that should be improved to reduce the time to the first surgical debridement. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  2. Lion (Panthera leo) populations are declining rapidly across Africa, except in intensively managed areas

    OpenAIRE

    Bauer, Hans; Chapron, Guillaume; Nowell, Kristin; Henschel, Philipp; Funston, Paul; Hunter, Luke T. B.; Macdonald, David W.; Packer, Craig

    2015-01-01

    At a regional scale, lion populations in West, Central, and East Africa are likely to suffer a projected 50% decline over the next two decades, whereas lion populations are only increasing in southern Africa. Many lion populations are either now gone or expected to disappear within the next few decades to the extent that the intensively managed populations in southern Africa may soon supersede the iconic savannah landscapes in East Africa as the most successful sites for lion conservation. Th...

  3. Weight Loss Maintenance in African American Women: A Systematic Review of the Behavioral Lifestyle Intervention Literature

    Directory of Open Access Journals (Sweden)

    Lisa M. Tussing-Humphreys

    2013-01-01

    Full Text Available We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions.

  4. Pursuing the American Dream: The Effect of Immigrant Settlement among Asian Americans and Occupational Disparities in Management

    Directory of Open Access Journals (Sweden)

    Hideki Morooka

    2013-06-01

    Full Text Available It is well established that Asian Americans are fairly represented in professional occupations due to their high educational attainment. However, the representation of Asian Americans in managerial occupations is still small. Despite the dramatic increase of Asian Americans as a percentage of the population in recent decades, not many studies have been conducted to investigate the association between immigrant settlement and occupational disparities in managerial occupations of Asian Americans by ethnicities as well as immigrant generations. In this paper, I examine the characteristics that influence Asian Americans who embark on managerial occupations as compared to other occupations by nativity and the length of their residence in the United States. I also compare trends of native-born Asian Americans with those of native-born non-Hispanic whites to examine whether an occupational disparity has been approaching convergence.

  5. Open source electronic health record and patient data management system for intensive care.

    Science.gov (United States)

    Massaut, Jacques; Reper, Pascal

    2008-01-01

    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  6. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    Science.gov (United States)

    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  7. AMERICAN DREAM: THE AMERICAN HEGEMONIC CULTURE AND ITS IMPLICATIONS TO THE WORLD

    Directory of Open Access Journals (Sweden)

    Kasiyarno .

    2014-02-01

    Full Text Available A nation could be a great one as long as it has a great dream. The best example for this is America. Through its long history, it manages to realize a dream to be a superpower. It can be said that “American Dream” is one of the most significant features for the growth of a “constantly eyeing for winner” culture. American Studies experts call it as a “hegemonic culture” in which American norms, values and cultural practices are considered superior against the world culture. Globalizing the culture has been the most effective engine to spread American cultural values and to shape the global civilizations. Using American Studies perspective, this paper attempts to review the extent to which the “American Dream” has successfully established Americanization, as well as how the hegemonic culture has influenced the lives of peoples across the world in the form of popular culture.

  8. 78 FR 75392 - American Beacon Funds, et al.; Notice of Application

    Science.gov (United States)

    2013-12-11

    ... Asset Management LLC; (b) American Beacon Balanced Fund--the Manager, Barrow, Hanley, Mewhinney... Beacon Funds, et al.; Notice of Application December 5, 2013. AGENCY: Securities and Exchange Commission...) (order). Applicants: American Beacon Funds and American Beacon Select Funds (collectively, the ``Trusts...

  9. Classroom Management Training for Teachers in Urban Environments Serving Predominately African American Students: A Review of the Literature

    Science.gov (United States)

    Larson, Kristine E.

    2016-01-01

    The purpose of this paper was to review the literature in terms of professional development activities that researchers have enlisted to reduce student problem behaviors and improve classroom management competencies among teachers who work in urban environments serving predominately African American students. First, the author conducted a…

  10. Information Architecture Used to Manage Multi-Domain Data Analysis in Intensively Managed Landscape - Critical Zone Observatory

    Science.gov (United States)

    Kooper, R.; Angelo, B.; Marini, L.; Kumar, P.; Muste, M.

    2016-12-01

    The Intensively Managed Landscapes-Critical Zone Observatory (IML-CZO) is a multi-agency partnership that aims to understand the coevoluationary dynamics of change in the context of the landscape, soil, and biota. The Data Management aspect of IML-CZO provides data preservation and analysis for each of the scientific domains as they pursue environmental monitoring throughout the midwestern United States. Data Management is facilitated via data ingestion and storage through Clowder, an open-source, scalable data repository for organizing and analyzing data; and Geodashboard, a web application that provides exploring, querying, visualizing and downloading the data ingested into Clowder. The data collected covers many domains including geology, hydrology, and bioengineering. The data across these domains varies greatly; from real-time streams of environmental measurements to individual soil samples that are sent through a series of laboratories for analysis. All data can be uploaded to Clowder where metadata can be extracted or dynamically calculated based on the nature of the information. Geodashboard was created to provide scientists with a tool to explore data across these varying domains, and to visualize the extracted data from Clowder. Once Clowder has extracted the data, it is available for querying from a REST API for standardized and streamlined access. Users are able to explore the data on multiple axis, and are able to download data across multiple domains in a standardized format for further analysis and research. IML-CZO's Clowder has over 60 users and over 180 datasets. There are over 1.1 million extracted data points that date back to 1992, and it is continually growing.

  11. Role delineation study for the American Society for Pain Management Nursing.

    Science.gov (United States)

    Willens, Joyce S; DePascale, Christine; Penny, James

    2010-06-01

    task). The consequences of the degree would be the inability of the newly certified pain management nurse to perform duties or tasks in each domain was rated from 0 (no harm) to 4 (extreme harm). The first domain received the highest average frequency rating. The pharmacologic domain received the highest mean rating on consequence. The reliability of all scales was 0.95 or higher, which indicated that the questionnaire consistently measured what it was intended to measure. The quality of the questionnaire is an indicator that certification is one measure of nursing excellence. (c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Can MHA graduates tackle financial management? Lessons from American corporate industry.

    Science.gov (United States)

    Hepner, J O; Ameiss, A P

    1984-01-01

    American industry, the major purchaser of medical services, is beginning to use its buying power to intervene in the healthcare system. Management committees hav been established to develop cost analysis and containment approaches to the utilization of medical services. With innovations by corporate industry, does the hospital CEO see an advocate or yet another adversary in addition to government regulation? Specifically, what preparation do master's degree graduates have, prior to their subsequent job experience, to make an informed contribution in financial decision making? Research was conducted to obtain data from health administration graduate programs in the United States and Canada to help find answers to these questions. This study addresses the strengths and weaknesses of the two major inputs to health financial management education--the proper mix and delivery of course presentations, and the student's motivation, maturity, and academic background. In some respects, both have been found wanting--not only from the findings of this investigation, but also by the AUPHA Task Force on Financial Management in the curriculum. About one-fourth of the entrants to master's degree programs have a business school background which includes courses in accounting, economics, and finance. However, the remaining 75% have other academic backgrounds, which suggests that teaching financially oriented courses to these graduate students is a major problem. The question of whether a health administration graduate with some finance training or a pure finance graduate is more desirable remains unanswered. This is especially true in meshing the immediate needs of the healthcare marketplace for financial management personnel and the long-range career goals of the graduate. This article presents the survey results and seven recommendations for action.

  13. The mechanism and theoretical basis of the management of intensity of the heat transfer control through periodic influences on the turbulent boundary layer

    Science.gov (United States)

    Kovalnogov, Vladislav N.; Fedorov, Ruslan V.; Khakhaleva, Larisa V.; Chukalin, Andrey V.; Bondarenko, Aleksandr A.; Kovrizhnykh, Evgeny N.

    2017-07-01

    Generalization of classical model of a displacement way on the transfer of heat exchange and mass exchange of a stream in the boundary layer, confirmed by the control action of the different nature, is undertaken. Here are given the results of numerical research which have allowed explaining the mechanism, to reveal efficiency and limits of various ways of management of intensity in exchange processes. The possibility of management of intensity in processes of a thermolysis and friction by use of the perforated surface with the damping cavities is analyzed.

  14. Diagnosis and management of tetanus outside the intensive care unit: a case report

    Science.gov (United States)

    Bravo, T. E.; Siregar, M. L.; Jamil, K. F.

    2018-03-01

    Tetanus is an acute, toxin-mediated disease caused by Clostridium tetani infection. Under favorable anaerobic conditions, such as in the unclean environment, necrotic wounds, this ubiquitous bacillus may produce tetanospasmin, an extremely potent neurotoxin. A 38-year-old man was admitted to an emergency room, at Zainoel Abidin General Hospital, with the main complaint of back-muscle stiffness. Based on physical examination, he was fully alert with a slightly rapid breathing, trismus with the maximum oral cavity opening was only about one finger width, but rhisus sardonicus was not evident. Ten days before admission, while gardening, his left foot accidentally stabbed by wooden tree stake. We immediately started a single dose of tetanus immunoglobulin followed by intravenous metronidazole, penicillin G, and intravenous diazepam. Tetanus diagnosed by physical clinical finding. The management of tetanus patients including the use of immunoglobulin and antibiotic therapy, analgesia, sedation and neuromuscular blockade management and mechanical ventilation, the care was delivered outside the Intensive care unit.

  15. Organic matter decomposition and microarthropod community structure in corn fields under low input and intensive management in Guaíra (SP

    Directory of Open Access Journals (Sweden)

    G.S Rodrigues

    1997-01-01

    Full Text Available The rate of organic matter decomposition and the structure of the communities of microarthropods were compared between two corn fields receiving contrasting agricultural management practices (low input and intensive farming. The rate of decomposition tended to be higher in the intensively managed field in the beginning of the growing season, but decreased to a level significantly lower than the observed in the low input field by the end of the growing season. This suggested that the biological community associated with the decomposition process could be negatively influenced in the intensively managed field. Analyses of the structure of microarthropod communities indicated differences between the two areas. The microarthropod populations present in the intensively managed field suffered abrupt decrease in numbers as the season progressed.A taxa de decomposição da matéria orgânica e a estrutura da comunidade de microartrópodes foram comparadas entre dois campos cultivados com milho mas recebendo manejos distintos, sendo um campo manejado intensivamente e outro com baixo uso de insumos. A taxa de decomposição foi mais alta no campo intensivamente manejado no início da cultura, mas decresceu para um nível significativamente inferior àquela observada no campo com baixo uso de insumos ao final da estação. Tal tendência sugeriu que a estrutura da comunidade dos organismos associados ao processo de decomposição poderia estar sendo negativamente influenciada no campo intensivamente manejado. Análises da estrutura das comunidades de microartrópodes indicaram que diferentes comunidades estavam presentes nos dois campos. As populações de microartrópodes presentes no campo sob manejo intensivo sofreram queda abrupta em números, sendo praticamente eliminadas já no segundo mês de desenvolvimento da cultura.

  16. Zoning of the Russian Federation territory based on forest management and forest use intensity

    Directory of Open Access Journals (Sweden)

    A. A. Маrtynyuk

    2016-02-01

    zoned due to forest management and forest use intensity.

  17. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: the case of an Italian urban area.

    Science.gov (United States)

    Di Maria, Francesco; Micale, Caterina

    2014-11-01

    Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. American Head and Neck Society

    Science.gov (United States)

    ... research and insights. Comments This field is for validation purposes and should be left unchanged. This iframe ... and Announcements Copyright ©2016 · American Head and Neck Society · Privacy and Return Policy Managed by BSC Management, ...

  19. American Sammys and French Poilus in the Great War: sport, masculinities and vulnerability.

    Science.gov (United States)

    Terret, Thierry

    2011-01-01

    The violence and duration of fighting throughout the Great War created an intense feeling of vulnerability among the men engaged in battle, which challenged their perception of manliness. When the Americans joined the war in 1917, the balance between the two opposing armies was modified and the psychological crises of French soldiers brought to an end. The confidence shown by the American soldiers and their first successes on the battlefield changed the way the French Poilus perceived their new allies. From scepticism to admiration, Frenchmen's feelings extended beyond the fighting. Indeed, by living with American soldiers in the trenches and camps behind the front, French soldiers discovered a new culture where games and sport played a major role and contributed to building manliness. The Foyers Franco-Americains du Soldat (Franco-American hostels for soldiers) provided an ideal place for the cultural transfer of a model of masculinity from Sammys to Poilus. The foyers were managed by the American YMCA and eventually reached the number of 1,500 in France during the war. These hostels afforded soldiers numerous opportunities to develop cultural and sports practices, by bringing together Americans and Frenchmen. Mainly based on the archives of the American Expeditionary Forces, the YMCA and the French Army, the paper argues that the Foyers du Soldat brought to light a new model of masculinity based on sport, which challenged the Frenchmen's vision. It aims to show the rapid transformation of masculine identity within a context of extreme vulnerability and confirms the changes in representations of men in French society at this time.

  20. Alarm management in a single-patient room intensive care units

    NARCIS (Netherlands)

    van Pul, C.; Joshi, R.; Dijkman, W.; van de Mortel, H.; Mohns, T.; Andriessen, P.; Chen, Wei; Carlos Augusto, Juan; Seoane, Fernando; Lehocki, Fedor; Wolf, Klaus-Henderik; Arends, Johan; Ungureanu, Constantin; Wichert, Reiner

    2015-01-01

    An international trend in intensive care is the shift from open, bay area intensive care units towards single-patient room care, since this is considered optimal for patient healing and family privacy. However, in the intensive care setting, an increasing number of devices and parameters are being

  1. Intensive use of an intertidal mudflat by foraging adult American horseshoe crabs Limulus polyphemus in the Great Bay estuary, New Hampshire

    Directory of Open Access Journals (Sweden)

    Wan-Jean LEE

    2010-10-01

    Full Text Available Although concerns about harvesting levels of the American Horseshoe Crab, Limulus polyphemus have prompted increased research into its ecology, current understanding of the species’ foraging ecology is mostly limited to mid-Atlantic populations. This study elucidates the spatial and temporal pattern of Limulus foraging on an intertidal mudflat of a northern New England estuary. A novel survey method was used to monitor Limulus foraging activity without disturbing the sediment. A fixed 50 m´2 m transect was monitored with monthly surveys of the number of Limulus feeding pits from June to October 2009, May and June 2010. Snorkelling surveys were also carried out to observe individual behavior and examine the spatial scale of activity of individual animals. Results showed frequent and intensive use of the mudflat by foraging Limulus. Limulus were actively foraging within the survey area during all months surveyed. Foraging patterns exhibited a seasonal pattern with activity levels peaking in August 2009 and increased significantly towards the end of the study in June 2010. It was also shown that Limulus intertidal foraging persisted and peaked after the spring breeding season. Observations of foraging Limulus revealed that individual predators dig multiple pits within a single high tide, with little disturbance to the sediment in between. In addition to altering the perception of Limulus as a subtidal predator outside of the breeding season, findings from this study suggests a segregation of spawning and feeding habitats, thus underscoring the need to consider a wider range of critical habitats in the management of Limulus populations [Current Zoology 56 (5: 611–617, 2010].

  2. American Board of Obesity Medicine (ABOM)

    Science.gov (United States)

    ... not trained in how to manage it. The American Board of Obesity Medicine certifies physicians looking to bridge this gap. ... an ABOM diplomate. APPLY NOW OUR MISSION The American Board of Obesity Medicine (ABOM) serves the public and the field ...

  3. Open-Label Randomized Trial of Titrated Disease Management for Patients with Hypertension: Study Design and Baseline Sample Characteristics

    Science.gov (United States)

    Jackson, George L.; Weinberger, Morris; Kirshner, Miriam A.; Stechuchak, Karen M.; Melnyk, Stephanie D.; Bosworth, Hayden B.; Coffman, Cynthia J.; Neelon, Brian; Van Houtven, Courtney; Gentry, Pamela W.; Morris, Isis J.; Rose, Cynthia M.; Taylor, Jennifer P.; May, Carrie L.; Han, Byungjoo; Wainwright, Christi; Alkon, Aviel; Powell, Lesa; Edelman, David

    2016-01-01

    Despite the availability of efficacious treatments, only half of patients with hypertension achieve adequate blood pressure (BP) control. This paper describes the protocol and baseline subject characteristics of a 2-arm, 18-month randomized clinical trial of titrated disease management (TDM) for patients with pharmaceutically-treated hypertension for whom systolic blood pressure (SBP) is not controlled (≥140mmHg for non-diabetic or ≥130mmHg for diabetic patients). The trial is being conducted among patients of four clinic locations associated with a Veterans Affairs Medical Center. An intervention arm has a TDM strategy in which patients' hypertension control at baseline, 6, and 12 months determines the resource intensity of disease management. Intensity levels include: a low-intensity strategy utilizing a licensed practical nurse to provide bi-monthly, non-tailored behavioral support calls to patients whose SBP comes under control; medium-intensity strategy utilizing a registered nurse to provide monthly tailored behavioral support telephone calls plus home BP monitoring; and high-intensity strategy utilizing a pharmacist to provide monthly tailored behavioral support telephone calls, home BP monitoring, and pharmacist-directed medication management. Control arm patients receive the low-intensity strategy regardless of BP control. The primary outcome is SBP. There are 385 randomized (192 intervention; 193 control) veterans that are predominately older (mean age 63.5 years) men (92.5%). 61.8% are African American, and the mean baseline SBP for all subjects is 143.6mmHg. This trial will determine if a disease management program that is titrated by matching the intensity of resources to patients' BP control leads to superior outcomes compared to a low-intensity management strategy. PMID:27417982

  4. The Implementation of Pain Management and Assessment in Neonatal Intensive Care Units of Teaching Hospitals Affiliated to Tehran University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    O Rahimi

    2017-06-01

    Full Text Available BACKGROUND AND OBJECTIVE: Neonatal pain causes changes in the structure and function of brain in addition to acute physiologic symptoms and is followed by delayed development of infants. This study aims to determine the implementation of pain management and assessment in neonatal intensive care units. METHODS: This cross-sectional study was conducted among 138 nurses working in neonatal intensive care units through census. The data were collected using researcher – made questionnaire including two parts: pain management and assessment and demographic information. The minimum and maximum scores were 0 and 552, respectively, shown in the form of percentage. FINDINGS: At a response rate of 80.23%, the mean age of participants was 31.76±5.41 years and the mean experience of nurses working in a neonatal intensive care unit was 4.36 ± 3.58 years. The cases of implementation of pain management and assessment were as follows: care management for pain reduction (72.8%, allow parents to relieve pain (68.5%, swaddling (66.7%, pain assessment while implementing therapeutic and caring measures (62.9%, the use of sucrose solution (61.6%, teaching parents about observing pain symptoms in the infant’s face (58.7%, recording infant’s pain behaviors and the method for relieving the pain (52.4%, pain assessment at least every 4 hours (52.2% and the use of valid tools for pain assessment (36.8%. CONCLUSION: According to the results of this study, pain management and assessment was implemented in more than half of the cases.

  5. Safety and efficacy of an intensive insulin protocol in a burn-trauma intensive care unit.

    Science.gov (United States)

    Cochran, Amalia; Davis, Lynn; Morris, Stephen E; Saffle, Jeffrey R

    2008-01-01

    Aggressive glycemic management in critically ill patients with acute burn injury or life-threatening soft-tissue infections has not been thoroughly evaluated. An intensive insulin protocol with target glucose values of less than 120 mg/dl was implemented in October 2005 in our regional Burn-Trauma intensive care unit. We reviewed our initial experience with this protocol to evaluate the safety and efficacy of aggressive glycemic control in these patient groups. Patients were placed on the intensive insulin protocol based upon the need for glycemic management during their hospitalization for burn or soft-tissue disease. Patient information prospectively collected while on protocol included all measured blood glucose values, total daily insulin use, and incidence of hypoglycemic episodes, defined as serum glucose patients (17 burns, 13 soft-tissue infections) were placed on the intensive insulin protocol during the first 16 months of use. The mean daily blood glucose level for burn patients was 115.9 mg/dl and for soft-tissue disease patients was 119.5 mg/dl. There was a 5% incidence of hypoglycemic episodes per protocol day. All hypoglycemic episodes were treated by holding the insulin infusion, and no episode had known adverse effects. Hyperglycemia in critically ill patients with burns and extensive soft-tissue disease can be effectively managed with an insulin protocol that targets blood glucose values of less than 120 mg/dl with minimal incidence of hypoglycemia. A multicenter prospective randomized trial would provide the ideal forum for evaluating clinical outcome benefits of using an intensive insulin protocol.

  6. Ecology and management of the commercially harvested American matsutake.

    Science.gov (United States)

    David Hosford; David Pilz; Randy Molina; Michael. Amaranthus

    1997-01-01

    The commercial harvest of American matsutake (Tricholoma magnivelare) from forests in the Pacific Northwest has increased dramatically in the last decade. The similarity of this mushroom to the Japanese matsutake (T. matsutake) has prompted its harvest to meet increasing demands for matsutake in Japan. The American matsutake is...

  7. Presentation and management of organophosphate poisoning in an intensive care unit

    International Nuclear Information System (INIS)

    Asghar, S.P.; Ather, N.; Farooq, M.; Sarah, S.; Ijaz, A.

    2014-01-01

    To determine the various demographic factors, clinical features, management and outcome of organophosphate poisoning in an intensive care unit (ICU) setting. Study Design: Descriptive quantitative study. Place and Duration of study: ICU of PNS Shifa hospital, Karachi. From February 2008-February 2010. Patients and Methods: Total of 40 patients were admitted in the ICU of PNS Shifa hospital, Karachi from Feb 2008- Feb 2010 with the history of organophosphate (OP) ingestion. A complete history was taken from the patients and relatives. Baseline laboratory investigations were done. All the data was tabulated on a structured performed after tasking consent from the relatives. Variables of the study were demographic factors as gender, age, cause and mode of poisoning, clinical course, ICU management and its outcome. Results: Out of 40 patients 32 (80%) were females and 8 (20%) were males. The age varied from 12-56 years. Twenty eight (70%) were in the 14-28 years age group. Twenty nine (72%) had poison for suicidal purpose and rest had the insecticide accidently. Twenty six (62%) of them were unmarried. In 38 (95%) patients the clinical features of parasympathetic overactivity was observed. All these patients were given atropine and pralidoxime. Fifteen (37%) patients required mechanical ventilation. Five (12%) out of these patients developed ventilator associated pneumonia. The time duration of mechanical ventilation was 1-3 weeks. All the patients were successfully recovered. Total duration of hospital stay on our patients was 2-4 weeks. Conclusion: Early and aggressive management of organophosphate poisoning in an ICU setting reduces not only the mortality but also decreases the duration of hospital stay. (author)

  8. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    Science.gov (United States)

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  9. Effectiveness of classroom based crew resource management training in the intensive care unit: Study design of a controlled trial

    NARCIS (Netherlands)

    Kemper, P.F.; de Bruijne, M.C.; van Dyck, C.; Wagner, C.

    2011-01-01

    Background: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and

  10. Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; Wagner, C.

    2011-01-01

    Background: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and

  11. Diabetes rehabilitation : development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

    NARCIS (Netherlands)

    Keers, JC; Blaauwwiekel, EE; Hania, M; Bouma, J; Scholten-Jaegers, SMHJ; Sanderman, R; Links, TP

    For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of

  12. Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement.

    Science.gov (United States)

    Lopez-Jimenez, Francisco; Kramer, Valerie Carroll; Masters, Barbara; Stuart, Patricia Mickey W; Mullooly, Cathy; Hinshaw, Ling; Haas, Linda; Warwick, Kathy

    2012-01-01

    Diabetes mellitus is a highly prevalent condition in patients participating in cardiopulmonary rehabilitation. However, research and subsequent guidelines specifically applicable to patients with diabetes, participating in cardiopulmonary rehabilitation, are limited. Recognizing this limitation, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) initiated this statement, with the goal of developing a template that incorporated recommendations provided in the AACVPR Core Components and the American Association of Diabetes Educators 7 Self-Care Behaviors. This statement describes key processes regarding evaluation, interventions, and expected outcomes in each of the core components for the management of patients with diabetes in a cardiopulmonary rehabilitation program.

  13. 76 FR 26725 - Notice of a Regional Project Waiver of Section 1605 (Buy American) of the American Recovery and...

    Science.gov (United States)

    2011-05-09

    ... Resources Management has concurred on this decision to make an exception to the requirements of Section 1605... (Buy American) of the American Recovery and Reinvestment Act of 2009 (ARRA) to the City of South... granting a waiver of the Buy American requirements of ARRA Section 1605 under the authority of Section 1605...

  14. From Higher Aims to Hired Hands: The Social Transformation of American Business Schools and the Unfulfilled Promise of Management as a Profession

    Science.gov (United States)

    Khurana, Rakesh

    2010-01-01

    Is management a profession? Should it be? Can it be? This major work of social and intellectual history reveals how such questions have driven business education and shaped American management and society for more than a century. The book is also a call for reform. Rakesh Khurana shows that university-based business schools were founded to train a…

  15. Total quality management in American industry.

    Science.gov (United States)

    Widtfeldt, A K; Widtfeldt, J R

    1992-07-01

    The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.

  16. Human resource management and unit performance in knowledge-intensive work.

    Science.gov (United States)

    Kehoe, Rebecca R; Collins, Christopher J

    2017-08-01

    To clarify the potential value of a targeted system of human resource (HR) practices, we explore the unique effects of a relationship-oriented HR system and the more commonly studied high commitment HR system on unit performance in the context of knowledge-intensive work. We develop theoretical arguments suggesting that the high commitment HR system contributes to unit performance through its positive effects on employees' collective organizational commitment, general and firm-specific human capital, and access to knowledge. We argue that the relationship-oriented HR system contributes to unit performance through its positive effects on employees' collective access to knowledge by fostering a social context and interpersonal exchange conditions which support employees' ongoing access to knowledge flows within and outside their unit and broader organization. Based on unit-level data collected from a matched sample of employees and managers in 128 units in the science and engineering division of a large hydroelectric power organization, our results suggest that the targeted, relationship-oriented HR system is related to firm performance and may complement a broader, high commitment approach to managing knowledge workers. Specifically, the positive relationship between the high commitment HR system and unit performance is mediated by employees' collective organizational commitment, firm-specific human capital, and access to knowledge in other organizational units; whereas the positive relationship between the relationship-oriented HR system and unit performance is mediated by units' access to knowledge within the unit, in other units, and outside the organization. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  17. A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Hermansen, I.L.; Botti, M

    2012-01-01

    Abstract: ABSTRACT Background: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20 to 80%. Objectives: The purpose was to assess...... the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. Methods: The American Pain Society's Patient Outcome...... Questionnaire was used in a consecutive cohort of Danish patients who had undergone gastrointestinal, gynaecological, orthopaedic or urological surgery in the previous 48 hours. Results: Findings indicated uncontrolled pain in 45.5% of patients, who experienced moderate to severe intensity average pain...

  18. Determining Nutrient Requirements For Intensively Managed Loblolly Pine Stands Using the SSAND (Soil Supply and Nutrient Demand) Model

    Science.gov (United States)

    Hector G. Adegbidi; Nicholas B. Comerford; Hua Li; Eric J. Jokela; Nairam F. Barros

    2002-01-01

    Nutrient management represents a central component of intensive silvicultural systems that are designed to increase forest productivity in southern pine stands. Forest soils throughout the South are generally infertile, and fertilizers may be applied one or more times over the course of a rotation. Diagnostic techniques, such as foliar analysis and soil testing are...

  19. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

    Directory of Open Access Journals (Sweden)

    Flynn SJ

    2013-08-01

    Full Text Available Sarah J Flynn,1,2 Jessica M Ameling,1,2 Felicia Hill-Briggs,1–3 Jennifer L Wolff,4,5 Lee R Bone,1,3 David M Levine,1,4 Debra L Roter,3 LaPricia Lewis-Boyer,1,2 Annette R Fisher,6 Leon Purnell,6 Patti L Ephraim,2,7 Jeffrey Barbers,1,2 Stephanie L Fitzpatrick,1,2 Michael C Albert,1,8 Lisa A Cooper,1,2 Peter J Fagan,9,10 Destiny Martin,1 Hema C Ramamurthi,1,2 L Ebony Boulware1,2,7 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 3Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Community and Provider Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; 7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 8Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 9Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 10Johns Hopkins HealthCare LLC, Glen Burnie, MD, USA Introduction: We aimed to inform the design of behavioral interventions by identifying patients’ and their family members’ perceived facilitators and barriers to hypertension self-management. Materials and methods: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients’ hypertension self-management. We recruited African American patients with hypertension (n = 18 and their family members (n = 12 from an urban, community-based clinical

  20. [Quality assurance concepts in intensive care medicine].

    Science.gov (United States)

    Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M

    2015-11-01

    Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

  1. Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).

    Science.gov (United States)

    Zulman, Donna M; Ezeji-Okoye, Stephen C; Shaw, Jonathan G; Hummel, Debra L; Holloway, Katie S; Smither, Sasha F; Breland, Jessica Y; Chardos, John F; Kirsh, Susan; Kahn, James S; Asch, Steven M

    2014-12-01

    We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. Employing partnered research to redesign care for high-need, high

  2. Prevalence of Primary Dysmenorrhea and Factors Associated with Its Intensity Among Undergraduate Students: A Cross-Sectional Study.

    Science.gov (United States)

    Habibi, Nahal; Huang, Mary Soo Lee; Gan, Wan Ying; Zulida, Rejali; Safavi, Sayyed Morteza

    2015-12-01

    Primary dysmenorrhea is a womanhood problem around the world and negatively affects quality of life. This study was designed to investigate the prevalence of primary dysmenorrhea and to determine the factors associated with its intensity. A cross-sectional study was carried out among 311 undergraduate female students aged 18 to 27 years in Isfahan University of Medical Sciences, Iran. Socio-demographic characteristics and menstrual factors were obtained through interviews with the help of a pretested questionnaire. The prevalence of primary dysmenorrhea was 89.1%. Residing at home, younger age, lower number of years of formal education for the mother, positive family history of dysmenorrhea, higher severity of bleeding, and shorter menstrual period intervals were significantly associated with the higher intensity of primary dysmenorrhea. Primary dysmenorrhea is a common health concern among young women. Being aware of the factors that are associated with its intensity makes it possible for health professionals to organize better focused programs to reduce the adverse effects of dysmenorrhea. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  3. Federalism and managed care: introductory comments to the American Association of Law Schools' Section on Law, Medicine and Health Care on the role of the states in managed care regulation.

    Science.gov (United States)

    Blum, J D

    1999-01-01

    This section of the Annals of Health Law represents a compilation of materials concerning the state regulation of managed care. The following materials were first presented at the annual meeting of the American Association of Law Schools ("AALS"), Section on Law, Medicine and Health Care in January 1999. Chairman John Blum introduces the subject and questions the dual role assumed by state and federal authorities in regulating managed care.

  4. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer

    Science.gov (United States)

    Alexander, Erik K.; Bible, Keith C.; Doherty, Gerard M.; Mandel, Susan J.; Nikiforov, Yuri E.; Pacini, Furio; Randolph, Gregory W.; Sawka, Anna M.; Schlumberger, Martin; Schuff, Kathryn G.; Sherman, Steven I.; Sosa, Julie Ann; Steward, David L.; Tuttle, R. Michael; Wartofsky, Leonard

    2016-01-01

    Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy

  5. Computer versus paper system for recognition and management of sepsis in surgical intensive care.

    Science.gov (United States)

    Croft, Chasen A; Moore, Frederick A; Efron, Philip A; Marker, Peggy S; Gabrielli, Andrea; Westhoff, Lynn S; Lottenberg, Lawrence; Jordan, Janeen; Klink, Victoria; Sailors, R Matthew; McKinley, Bruce A

    2014-02-01

    A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes. A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs-sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria. In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system. A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system

  6. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.

    Science.gov (United States)

    Mularski, Richard A; Reinke, Lynn F; Carrieri-Kohlman, Virginia; Fischer, Mark D; Campbell, Margaret L; Rocker, Graeme; Schneidman, Ann; Jacobs, Susan S; Arnold, Robert; Benditt, Joshua O; Booth, Sara; Byock, Ira; Chan, Garrett K; Curtis, J Randall; Donesky, Doranne; Hansen-Flaschen, John; Heffner, John; Klein, Russell; Limberg, Trina M; Manning, Harold L; Morrison, R Sean; Ries, Andrew L; Schmidt, Gregory A; Selecky, Paul A; Truog, Robert D; Wang, Angela C C; White, Douglas B

    2013-10-01

    In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement.

  7. Comparison of net global warming potential and greenhouse gas intensity affected by management practices in two dryland cropping sites

    Science.gov (United States)

    Little is known about the effect of management practices on net global warming potential (GWP) and greenhouse gas intensity (GHGI) that account for all sources and sinks of greenhouse gas (GHG) emissions in dryland cropping systems. The objective of this study was to compare the effect of a combinat...

  8. The Japanese and the American First-Line Supervisor.

    Science.gov (United States)

    Bryan, Leslie A., Jr.

    1982-01-01

    Compares the American and Japanese first-line supervisor: production statistics, supervisory style, company loyalty, management style, and communication. Also suggests what Americans might learn from the Japanese methods. (CT)

  9. Effect of Professionalism, Competence, Knowledge of Financial Management, and Intensity Guidance Apparatus Inspectorate for Quality of Financial Statements (Study on Inspectorate Regencies/Cities in Aceh

    Directory of Open Access Journals (Sweden)

    Darwanis Darwanis

    2016-04-01

    Full Text Available This research aims to: 1. Examine the influence of professionalism, competence, knowledge of financial management and intensity guidance apparatus Inspectorate together to the quality of the financial statements of Regions; 2. Examine the effect of professionalism partially on the quality of the financial statements of Regions; 3. Test the effect of partial competencies to the quality of the financial statements of Regions; 4. Examine the effect of knowledge of financial management partially on the quality of the financial statements of Regions; 5. The authorities test the effects of intensity guidance apparatus partially on the quality of the financial statements of Regions. The object of this research is the Government Internal Supervisory Apparatus (APIP working in the Inspectorate districts/cities in Aceh amounted to 23 people who perform inspection tasks.  The source of data in this study uses primary data which is the result of the acquisition of questionnaires from survey respondent, while research data collection techniques are done with documentation techniques. The analytical method used is Multiple Linear Regression Analysis. The results showed that: 1. Professionalism, competence, knowledge of financial management and intensity guidance apparatus jointly affect the quality of financial reporting area. 2. Professionalism partially affects the quality of financial reporting area. 3. Competence partially affects the quality of financial reporting area. 4. Knowledge of financial management partially affects the quality of financial reporting area. 5. The intensity guidance apparatus partially affects the quality of financial reporting area.

  10. Anthropogenic Reorganization of Critical Zone in Intensively Managed Landscapes

    Science.gov (United States)

    Kumar, P.; Anders, A. M.; Bettis, E. A., III; Blair, N. E.; Filley, T. R.; Grimley, D. A.; Le, P. V.; Lin, H.; Lin, Y. F. F.; Keefer, D. A.; Keefer, L. L.; Muste, M.; Packman, A. I.; Papanicolaou, T.; Rhoads, B. L.; Richardson, M.; Schnoebelen, D. J.; Stumpf, A.; Ward, A. S.; Wilson, C. G.; Woo, D.; Yan, Q.; Goodwell, A. E.

    2016-12-01

    Intensification of industrial agricultural practices has resulted in some of the most profound global impacts in the Anthropocene. These include eutrophication of lakes, rivers, and oceans from nutrient loading, degradation of arable land from the loss of fertile organic soils through erosion, and loss and degradation of soil organic matter from mechanical impacts on the soil, among others. As we prepare to feed additional 2 billion people by 2050 along with the emerging practices of farming for bioenergy production, these practices will intensify further whose goal is to overcome bio-geo-physical rate limitations and rate limiting states to enhance agricultural productivity. These rate-enhancing efforts generally target the fast response production processes, creating an imbalance with the slower assimilative processes in the Critical Zone that cascade through complex inter-dependencies across carbon, soil, water, nutrient and ecological systems. These imbalances modify stores and create gradients for flux, which over time reorganize the landscape, both in structure and function. In this presentation we show how these reorganizations are occurring in the Critical Zone of intensively managed landscapes, and argue that an integrated understanding of such profound changes are necessary for developing sustainable solutions for maintaining agricultural productivity and mitigating agriculture based environmental impacts.

  11. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

    Science.gov (United States)

    Scholz, Stefan M; Andermatt, Peter; Tobler, Benno L; Spinnler, Dieter

    2016-09-01

    Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p accident victims.

  12. [What's new in the 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis].

    Science.gov (United States)

    Guan, H X

    2017-10-01

    The 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis has been officially published in October of 2016, five years after the publication of the previous version. Revised contents in the new guideline are summarized in this review.

  13. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines

    Science.gov (United States)

    In 2013, the American Heart Association and American College of Cardiology published the "Guideline on Lifestyle Management to Reduce Cardiovascular Risk," which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the America...

  14. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Emiliana Motta

    Full Text Available Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU, in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

  15. An Analysis of the Perceptions of "U.S. News and World Report" College Ranking Systems by Enrollment Managers of American Jesuit Colleges and Universities

    Science.gov (United States)

    Stoltz, Adam C.

    2012-01-01

    The focus of this study involves the perceptions held by enrollment managers at the American Jesuit Catholic colleges and universities of national rankings of colleges and universities and the strategic use of this information. Enrollment management emerged within colleges and universities in response to increasing competition for incoming…

  16. Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

    Science.gov (United States)

    Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

    2015-01-01

    Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is

  17. Managing the overflow of intensive care patients

    NARCIS (Netherlands)

    van Rijsbergen, M.; Boucherie, Richardus J.; van Houdenhoven, M.; Litvak, Nelli

    2005-01-01

    Many hospitals in the Netherlands are confronted with capacity problems at their Intensive Care Units (ICUs) resulting in cancelling operations, overloading the staff with extra patients, or rejecting emergency patients. In practice, the last option is a common choice because juridically, as well as

  18. High-intensity interval training evokes larger serum BDNF levels compared with intense continuous exercise.

    Science.gov (United States)

    Saucedo Marquez, Cinthia Maria; Vanaudenaerde, Bart; Troosters, Thierry; Wenderoth, Nicole

    2015-12-15

    Exercise can have a positive effect on the brain by activating brain-derived neurotrophic factor (BDNF)-related processes. In healthy humans there appears to be a linear relationship between exercise intensity and the positive short-term effect of acute exercise on BDNF levels (i.e., the highest BDNF levels are reported after high-intensity exercise protocols). Here we performed two experiments to test the effectiveness of two high-intensity exercise protocols, both known to improve cardiovascular health, to determine whether they have a similar efficacy in affecting BDNF levels. Participants performed a continuous exercise (CON) protocol at 70% of maximal work rate and a high-intensity interval-training (HIT) protocol at 90% of maximal work rate for periods of 1 min alternating with 1 min of rest (both protocols lasted 20 min). We observed similar BDNF kinetics in both protocols, with maximal BDNF concentrations being reached toward the end of training (experiment 1). We then showed that both exercise protocols significantly increase BDNF levels compared with a rest condition (CON P = 0.04; HIT P exercise are slightly more effective than continuous high-intensity exercise for elevating serum BDNF. Additionally, 73% of the participants preferred the HIT protocol (P = 0.02). Therefore, we suggest that the HIT protocol might represent an effective and preferred intervention for elevating BDNF levels and potentially promoting brain health. Copyright © 2015 the American Physiological Society.

  19. Simulation Based Exploration of Critical Zone Dynamics in Intensively Managed Landscapes

    Science.gov (United States)

    Kumar, P.

    2017-12-01

    The advent of high-resolution measurements of topographic and (vertical) vegetation features using areal LiDAR are enabling us to resolve micro-scale ( 1m) landscape structural characteristics over large areas. Availability of hyperspectral measurements is further augmenting these LiDAR data by enabling the biogeochemical characterization of vegetation and soils at unprecedented spatial resolutions ( 1-10m). Such data have opened up novel opportunities for modeling Critical Zone processes and exploring questions that were not possible before. We show how an integrated 3-D model at 1m grid resolution can enable us to resolve micro-topographic and ecological dynamics and their control on hydrologic and biogeochemical processes over large areas. We address the computational challenge of such detailed modeling by exploiting hybrid CPU and GPU computing technologies. We show results of moisture, biogeochemical, and vegetation dynamics from studies in the Critical Zone Observatory for Intensively managed Landscapes (IMLCZO) in the Midwestern United States.

  20. Perceptions of African American Faculty in Kinesiology-Based Programs at Predominantly White American Institutions of Higher Education

    Science.gov (United States)

    Burden, Joe W., Jr.; Harrison, Louis, Jr.; Hodge, Samuel R.

    2005-01-01

    The purpose of this study was to examine the perceptions of African American faculty on their organizational socialization in kinesiology-based (i.e., sport pedagogy, exercise physiology, motor behavior, sport management/history) programs at predominantly White American (1) institutions of higher education (PW-IHE). Participants were 9 African…

  1. Smartphone Usage, Social Media Engagement, and Willingness to Participate in mHealth Weight Management Research among African American Women

    Science.gov (United States)

    James, Delores C. S.; Harville, Cedric, II

    2018-01-01

    Background: African American women (AAW) are in a unique position to be recruited into mobile (mHealth) weight management research and programs due to their high rates of obesity and their high ownership of smartphones. Aim: This study examined smartphone usage, social media engagement, and willingness to participate in mHealth weight management…

  2. Contemporary review on the inequities in the management of lung cancer among the African-American population.

    Science.gov (United States)

    Kim, Anthony W; Liptay, Michael J; Higgins, Robert S D

    2008-06-01

    Lung cancer is the leading cause of cancer-related mortality. Nonsmall-cell lung cancer (NSCLC) constitutes approximately 80% of all the lung cancers observed. Despite the aggressive nature of this disease, totally adequate and fully comprehensive treatment yielding outstanding outcomes and survival has yet to be discovered. A uniform means by which to manage NSCLC is only in evolution. Without a universally accepted algorithm upon which clinical decisions can be referenced or compared, differences in the treatment of this disease process can and will exist. Racial bias in the management of NSCLC is being realized as a cause of a substandard delivery of adequate care. Whether this is a newly emerging phenomenon or simply one that is being exposed is unclear. Nevertheless, this inequity in management ranges from the early-to-late stages of NSCLC. The purpose of this manuscript is to explore the reasons behind the differences in the receipt of care for NSCLC that exists between the African-American and Caucasian population.

  3. Building waste management core indicators through Spatial Material Flow Analysis: net recovery and transport intensity indexes.

    Science.gov (United States)

    Font Vivanco, David; Puig Ventosa, Ignasi; Gabarrell Durany, Xavier

    2012-12-01

    In this paper, the material and spatial characterization of the flows within a municipal solid waste (MSW) management system are combined through a Network-Based Spatial Material Flow Analysis. Using this information, two core indicators are developed for the bio-waste fraction, the Net Recovery Index (NRI) and the Transport Intensity Index (TII), which are aimed at assessing progress towards policy-related sustainable MSW management strategies and objectives. The NRI approaches the capacity of a MSW management system for converting waste into resources through a systematic metabolic approach, whereas the TII addresses efficiency in terms of the transport requirements to manage a specific waste flow throughout the entire MSW management life cycle. Therefore, both indicators could be useful in assessing key MSW management policy strategies, such as the consecution of higher recycling levels (sustainability principle) or the minimization of transport by locating treatment facilities closer to generation sources (proximity principle). To apply this methodological approach, the bio-waste management system of the region of Catalonia (Spain) has been chosen as a case study. Results show the adequacy of both indicators for identifying those points within the system with higher capacity to compromise its environmental, economic and social performance and therefore establishing clear targets for policy prioritization. Moreover, this methodological approach permits scenario building, which could be useful in assessing the outcomes of hypothetical scenarios, thus proving its adequacy for strategic planning. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. The annual variation in stomatal ammonia compensation point of rye grass (Lolium perenne L.) leaves in an intensively managed grassland

    NARCIS (Netherlands)

    Hove, van L.W.A.; Heeres, P.; Bossen, M.E.

    2002-01-01

    The stomatal ammonia compensation point for ammonia (NH3) of an intensively managed pasture of rye grass (Lolium perenne L.) was followed from mid January till November 2000. Leaf samples were taken every week. Simultaneously, the ambient NH3 concentration was measured. Meteorological data

  5. Do intensity ratings and skin conductance responses reliably discriminate between different stimulus intensities in experimentally induced pain?

    Science.gov (United States)

    Breimhorst, Markus; Sandrock, Stephan; Fechir, Marcel; Hausenblas, Nadine; Geber, Christian; Birklein, Frank

    2011-01-01

    The present study addresses the question whether pain-intensity ratings and skin conductance responses (SCRs) are able to detect different intensities of phasic painful stimuli and to determine the reliability of this discrimination. For this purpose, 42 healthy participants of both genders were assigned to either electrical, mechanical, or laser heat-pain stimulation (each n = 14). A whole range of single brief painful stimuli were delivered on the right volar forearm of the dominant hand in a randomized order. Pain-intensity ratings and SCRs were analyzed. Using generalizability theory, individual and gender differences were the main contributors to the variability of both intensity ratings and SCRs. Most importantly, we showed that pain-intensity ratings are a reliable measure for the discrimination of different pain stimulus intensities in the applied modalities. The reliability of SCR was adequate when mechanical and heat stimuli were tested but failed for the discrimination of electrical stimuli. Further studies are needed to reveal the reason for this lack of accuracy for SCRs when applying electrical pain stimuli. Our study could help researchers to better understand the relationship between pain and activation of the sympathetic nervous system. Pain researchers are furthermore encouraged to consider individual and gender differences when measuring pain intensity and the concomitant SCRs in experimental settings. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. Energy resource management under the influence of the weekend transition considering an intensive use of electric vehicles

    DEFF Research Database (Denmark)

    Sousa, T.; Morais, Hugo; Pinto, T.

    2015-01-01

    Energy resource scheduling is becoming increasingly important, as the use of distributed resources is intensified and of massive electric vehicle is envisaged. The present paper proposes a methodology for day-ahead energy resource scheduling for smart grids considering the intensive use of distri......Energy resource scheduling is becoming increasingly important, as the use of distributed resources is intensified and of massive electric vehicle is envisaged. The present paper proposes a methodology for day-ahead energy resource scheduling for smart grids considering the intensive use...... of distributed generation and Vehicle-to-Grid (V2G). This method considers that the energy resources are managed by a Virtual Power Player (VPP) which established contracts with their owners. It takes into account these contracts, the users' requirements subjected to the VPP, and several discharge price steps...

  7. American Academy of Audiology

    Science.gov (United States)

    ... Certification Meetings & Events Employee Resources Research Academia Practice Management Reimbursement Coding Compliance Resources and Tools Publications & News News Audiology Today Journal of the American Academy of Audiology Books Brochures Multimedia Guidelines and Standards ...

  8. The response of sward-dwelling arthropod communities to reduced grassland management intensity in pastures

    Directory of Open Access Journals (Sweden)

    Helden Alvin J.

    2015-12-01

    Full Text Available We compared arthropod taxon richness, diversity and community structure of two replicated grassland husbandry experiments to investigate effects of reduced management intensity, as measured by nutrient input levels (390, 224 and 0 kg/ha per year N in one experiment, and 225 and 88 kg/ha per year N in another. Suction sampling was used to collect Araneae, Coleoptera, Hemiptera and Hymenoptera, with Araneae and Coleoptera also sampled with pitfall trapping. Univariate analyses found no significant differences in abundance and species density between treatments. However, with multivariate analysis, there were significant differences in arthropod community structure between treatments in both experiments.

  9. The role of models in managing the uncertainty of software-intensive systems

    International Nuclear Information System (INIS)

    Littlewood, Bev; Neil, Martin; Ostrolenk, Gary

    1995-01-01

    It is increasingly argued that uncertainty is an inescapable feature of the design and operational behaviour of software-intensive systems. This paper elaborates the role of models in managing such uncertainty, in relation to evidence and claims for dependability. Personal and group models are considered with regard to abstraction, consensus and corroboration. The paper focuses on the predictive property of models, arguing for the need for empirical validation of their trustworthiness through experimentation and observation. The impact on trustworthiness of human fallibility, formality of expression and expressiveness is discussed. The paper identifies two criteria for deciding the degree of trust to be placed in a model, and hence also for choosing between models, namely accuracy and informativeness. Finally, analogy and reuse are proposed as the only means by which empirical evidence can be established for models in software engineering

  10. Knowledge Sharing in Knowledge-Intensive Firms

    DEFF Research Database (Denmark)

    Gupta, Akshey; Michailova, Snejina

    2004-01-01

    This paper is a study of the knowledge-sharing difficulties experienced by three departments in a knowledge-intensive firm. The case organization is a global consulting firm that has been on the forefront of knowledge management and has won several knowledge management related international accla...

  11. Acute intensive care unit management of mustard gas victims: the Turkish experience.

    Science.gov (United States)

    Kilic, Ertugrul; Ortatatli, Mesut; Sezigen, Sermet; Eyison, Rusen Koray; Kenar, Levent

    2018-05-07

    Sulphur mustard (SM) is an highly toxic and vesicant chemical weapon that was used in various military conflicts several times in the history. The severity of ocular, dermal, and pulmonary symptoms that may appear following a characteristic asymptomatic period are depending on the SM concentration and exposure duration. The aim of this study is to present the clinical features and share the intensive care unit (ICU) experiences for the medical management of mustard gas victims. Thirteen Free Syrian Army soldiers near Al-Bab region of North Syria were reportedly exposed to oily blackish smoke with garlic smell due to the explosion of a trapped bomb without causing any blast or thermal effect on 26th November 2016. None of them wore any chemical protective suits or gas masks during explosion. Since they observed skin lesions including bullous formation next day, they were admitted to the Turkish Field Hospital at the Turkish - Syrian border and then evacuated to the State Hospital of Gaziantep Province, Turkey for further management. Eight victims who were very close to point of explosion suffered burning eyes, sore throat, dry cough and dyspnoea after the chemical attack. On admission to hospital, all cases had conjunctivitis, hoarseness and bullae on various body areas. Blepharospasm and opacity were found in 8 patients and 5 of them had corneal erosions and periorbital oedema. Temporary loss of vision in 4 cases lasted for 24 h. Multiple fluid-filled blisters were observed especially on the scalp, neck, arms and hands, where direct skin exposure to the agent occurred. A definitive clinical care and infection prophylaxis measures along with the burn treatment and bronchodilators for respiratory effects were applied in ICU. Two patients received granulocyte-colony-stimulating factor due to the SM-mediated bone marrow suppression on the 16th day of exposure and one of them died because of necrotic bronchial pseudomembrane obstruction resulting in cardiopulmonary

  12. 75 FR 65012 - Nationwide Categorical Waivers Under Section 1605 (Buy American) of the American Recovery and...

    Science.gov (United States)

    2010-10-21

    ... directional sensors and DC300 facility controllers for a parking guidance system which integrates with American designed intelligent parking guidance system software allowing real-time updates to a central location and via the Internet; (4) load Management Ripple Control Receivers for an existing load management...

  13. Knowledge Management without Management -- Shadow IT in Knowledge-intensive Manufacturing Practices

    DEFF Research Database (Denmark)

    Steinhueser, Melanie; Waizenegger, Lena; Vodanovich, Shahper

    2017-01-01

    The voluntary use of private device by employees without formal approval of the IT department, commonly termed Shadow IT, is an increasingly widespread phenomenon. In this paper, we study the role of private smartphones (and related applications like WhatsApp) in knowledge-intensive practices...

  14. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

    2013-03-01

    The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

  15. Nuclear energy = more jobs. [Capital-intensive vs labor-intensive systems

    Energy Technology Data Exchange (ETDEWEB)

    Brookes, L G

    1979-07-01

    In the April 1979 issue of Energy Manager, Dr. David Elliott of Open University says capital-intensive systems employ less labor per unit of output, concluding that nuclear energy represented a poor bargain in terms of money invested per job created. Responding to this earlier article, Dr. Brookes argues that capital-intensive systems may employ less labor per unit of output, but they also produce more output and income per worker. Dr. Brookes uses a simple analysis to illustrate how progress results by increasing capital investment and disagrees strongly with Elliotts conclusions - says output must become more capital-intensive to provide more employment opportunities. Further, he feels that Elliott and other antinuclear and environmentalist writers have fallen into the trap of the fallacy of composition - assuming that what is true for a small number of constituent parts taken singly is true also for the total system taken as a whole. Examples can be found in economics of microeconomic elements which do not add up to the expected macroeconomic composition, which explains why some capital-intensive strategies are good and others are not. The excess income produced by capital-intensive energy strategies supports the service and public administration sectors. 3 figures, 1 table. (DCK)

  16. Blood metabolites and some fertility parameters in dairy cows under intensive management system

    International Nuclear Information System (INIS)

    Osman, Awad Ali

    1998-08-01

    Dairy farms (1, 2, 3 and 4) of the intensive management system were selected. They are located 50 kilometers south of Khartoum state in a semi-arid zone. The effect of management on some fertility parameters, blood metabolites and minerals were investigated. Changes in blood metabolites with stage of lactation were also monitored. Other parameters studied were body weight, body condition score at calving. The results revealed that days to first P 4 rise after calving and number of services per conception (NSPC) were lower in the farm s contained the cross-bred (Fresian X Zebu) compared to the farm contained the pure Fresian breed. The pure Fresian cows showed heavier weights and less body score at calving compared to the cross breed. Blood metabolites reflected the nutritional status of the dairy cows under study, plasma total protein, albumin, globulin, urea and Glucose did not show significant changes either either either between farms or in response to lactation stages. However, high levels of Globulins might indicate inflammation due to some diseases such as mastitis, metritis and lameness. Plasma level of Calcium and Phosphorous did not change significantly either between farms or due to stages of lactation.(Author)

  17. Contemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study.

    Science.gov (United States)

    Keihani, Sorena; Xu, Yizhe; Presson, Angela P; Hotaling, James M; Nirula, Raminder; Piotrowski, Joshua; Dodgion, Christopher M; Black, Cullen M; Mukherjee, Kaushik; Morris, Bradley J; Majercik, Sarah; Smith, Brian P; Schwartz, Ian; Elliott, Sean P; DeSoucy, Erik S; Zakaluzny, Scott; Thomsen, Peter B; Erickson, Bradley A; Baradaran, Nima; Breyer, Benjamin N; Miller, Brandi; Santucci, Richard A; Carrick, Matthew M; Hewitt, Timothy; Burks, Frank N; Kocik, Jurek F; Askari, Reza; Myers, Jeremy B

    2018-03-01

    The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. From 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy. A total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy. Expectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of

  18. Veterans Affairs Intensive Case Management for older veterans.

    Science.gov (United States)

    Mohamed, Somaia; Neale, Michael S; Rosenheck, Robert

    2009-08-01

    There is a growing need for information on evidence-based practices that may potentially address needs of elderly people with severe mental illness (SMI), and more specifically on community-based services such as assertive community treatment (ACT). This study examines national evaluation data from fiscal year 2001-2005 from Veterans Affairs Mental Health Intensive Case Management (MHICM) program (N = 5,222), an ACT-based service model, to characterize the age distribution of participants and the distinctive needs, patterns of service delivery, and treatment outcomes for elderly veterans. Altogether, 24.8% of participants were 55-64 years; 7.4% 65-74 years; and 2.8% were older than 75. Veterans over 75 formed a distinct subgroup that had a later age of onset of primarily nonpsychotic illnesses without comorbid substance abuse and had experienced more limited lifetime hospital treatment than younger participants. Older veterans were less symptomatic and more satisfied with their social relationships than younger clients. They mostly live independently or in minimally restrictive housing, but they received less recovery-focused services and more crisis intervention and medical services. They thus do not appear to be young patients with SMI who have aged but rather constitute a distinct group with serious late-onset problems. It is possible that MHICM services keep them in the community and avoid costly nursing home placement while providing a respite service that reduces family burden. These data highlight the unique characteristics of older veterans receiving ACT-like services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup.

  19. Cultural expressions of bodily awareness among chronically ill Filipino Americans.

    Science.gov (United States)

    Becker, Gay

    2003-01-01

    To describe Filipino Americans' cultural traditions surrounding bodily awareness, especially how the principle of balance informs their views, and the link to self-management of chronic illness. This qualitative study used semistructured interviews with 85 Filipino Americans between the ages of 46 and 97 years. Volunteers were recruited from numerous health care sites in 1 geographic location in the United States. Respondents had 1 or more chronic illnesses. Taped and transcribed interviews were coded and evaluated for themes. The concept of balance was central to Filipino Americans' portrayal of bodily awareness of signs and symptoms related to chronic illnesses, as well as to actions they took to manage their chronic illnesses. Efforts were made to control chronic illnesses through a variety of self-care practices. Diet posed a particular challenge because of the symbolic importance of food in Filipino culture and its use in the maintenance of social relationships. The ways in which Filipino Americans combine attention to the body, values of balance and harmony, and emphasis on social well-being result in heightened attention to bodily processes. Filipino Americans' emphasis on bodily awareness suggests that this particular cultural strength can be used to enhance chronic illness management. Awareness of the cultural traditions of Filipino Americans can facilitate patient education about how to manage chronic illnesses.

  20. Estimation of stress intensity factors for circumferential cracked pipes under welding residual stress filed

    International Nuclear Information System (INIS)

    Oh, Chang Young; Kim, Yun Jae; Oh, Young Jin; Song, Tae Kwang; Kim, Yong Beum; Oh, Young Jin; Song, Tae Kwang; Kim, Yong Beum

    2012-01-01

    Recently, stress corrosion cracking(SCC) have been found in dissimilar metal welds of nozzles in some pressurized water reactors and on low carbon stainless steel piping systems of boiling water reactors. The important factor of SCC is the residual stress field caused by weld. For the evaluation of crack growth analysis due to SCC, stress intensity factor under a residual stress field should be estimated. Several solutions for stress intensity factor under residual stress field were recommended in flaw assessment codes such as the American Society of Mechanical Engineers (ASME) Section XI, R6, American Petroleum Institute (API579). Some relevant works have been studied. Dong et al. evaluated stress intensity factors in welded structures. Miyazaki et al. estimated stress intensity factors of surface crack in simple stress fields. This paper presents a simple method to estimate stress intensity factors in welding residual stress field. For general application, results of structure integrity assessment codes KI solutions were compared Finite element analyses of welding simulation and cracked pipes are described. Comparison results of KI solutions and proposed simplified solution are presented in the works

  1. Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Martin, Naomi H; Ibrahim, Fowzia; Tom, Brian; Galloway, James; Wailoo, Allan; Tosh, Jonathan; Lempp, Heidi; Prothero, Louise; Georgopoulou, Sofia; Sturt, Jackie; Scott, David L

    2017-12-08

    Uncontrolled active rheumatoid arthritis can lead to increasing disability and reduced quality of life over time. 'Treating to target' has been shown to be effective in active established disease and also in early disease. However, there is a lack of nationally agreed treatment protocols for patients with established rheumatoid arthritis who have intermediate disease activity. This trial is designed to investigate whether intensive management of disease leads to a greater number of remissions at 12 months. Levels of disability and quality of life, and acceptability and cost-effectiveness of the intervention will also be examined. The trial is a 12-month, pragmatic, randomised, open-label, two-arm, parallel-group, multicentre trial undertaken at specialist rheumatology centres across England. Three hundred and ninety-eight patients with established rheumatoid arthritis will be recruited. They will currently have intermediate disease activity (disease activity score for 28 joints assessed using an erythrocyte sedimentation rate of 3.2 to 5.1 with at least three active joints) and will be taking at least one disease-modifying anti-rheumatic drug. Participants will be randomly selected to receive intensive management or standard care. Intensive management will involve monthly clinical reviews with a specialist health practitioner, where drug treatment will be optimised and an individualised treatment support programme delivered based on several principles of motivational interviewing to address identified problem areas, such as pain, fatigue and adherence. Standard care will follow standard local pathways and will be in line with current English guidelines from the National Institute for Health and Clinical Excellence. Patients will be assessed initially and at 6 and 12 months through self-completed questionnaires and clinical evaluation. The trial will establish whether the known benefits of intensive treatment strategies in active rheumatoid arthritis are also seen

  2. Time Management - New Religion of Our Age: 'Time' In Anglo-American Culture vs. 'Vrijeme' in Croatian Culture

    Directory of Open Access Journals (Sweden)

    Ksenija Juretić

    2004-11-01

    Full Text Available This research on time management within the project ‘Management in Entrepreneurship’ is based both on cognitive linguistics and the cultural dimension of time in international business. In accordance with our conceptualization and relationship to time, culture can be divided into monochronic time (M-time and polychronic time (P-time cultures. While M-time culture, which is best represented by the United States, emphasizes schedules, a precise reckoning of time, and promptness, P-time culture, Croatia, falling into this category, emphasizes the involvement of people rather than a rigid adherence to the clock. The results, so far, show how our conceptualization of time - on a subconscious level - influences our lives and how theories of time management can be transferred into teaching Business English in Croatia where, ‘having done something on time’ is definitely of less importance than to the American society.

  3. A study of the impact of long-term tobacco smoking on postoperative intensive care admission

    DEFF Research Database (Denmark)

    Møller, A M; Pedersen, T; Villebro, N

    2003-01-01

    , American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required...

  4. Evaluation of diabetes care management in primary clinics based on the guidelines of American Diabetes Association.

    Science.gov (United States)

    Albarrak, Ahmed Ismail; Mohammed, Rafiuddin; Assery, Bushra; Allam, Dalya; Morit, Sarah Al; Saleh, Reem Al; Zare'a, Reem

    2018-01-01

    There is a rapid increase in the incidence of diabetes mellitus in Saudi Arabia. Diabetes management is an essential constituent to prevent prognosis of diabetes complications. The main objective of this study was to assess diabetes care in primary clinics based on the guidelines of American Diabetes Association (ADA). A retrospective study at King Khaled University Hospitals, Riyadh, Saudi Arabia. A total of 200 patients were randomly selected from the databases of primary care clinics. An evaluation checklist was created based on the ADA treatment guidelines such as medical history, physical examination, laboratory evaluation, and referrals. The result showed that elements achieving the ADA targets for overall care were medical history (44.9%), physical examination (59.6%), laboratory evaluation (36.3%), and referrals (19.3%). The other subelement indicators such as referral to diabetes self-management education clinics (10%), dental examination (2%), HbA1c regular monitoring (33.5%), and blood pressure determination (100%) were documented with adherence to ADA standards. Diabetes management standards are an essential element in the success of the management plan. Most of the elements examined are not in full compliance with the ADA standard. Continues monitoring and self-review are recommended.

  5. Monitoring and Modeling Carbon Dynamics at a Network of Intensive Sites in the USA and Mexico

    Science.gov (United States)

    Birdsey, R.; Wayson, C.; Johnson, K. D.; Pan, Y.; Angeles, G.; De Jong, B. H.; Andrade, J. L.; Dai, Z.

    2013-05-01

    The Forest Services of the USA and Mexico, supported by NASA and USAID, have begun to establish a network of intensive forest carbon monitoring sites. These sites are used for research and teaching, developing forest management practices, and forging links to the needs of communities. Several of the sites have installed eddy flux towers to basic meteorology data and daily estimates of forest carbon uptake and release, the processes that determine forest growth. Field sampling locations at each site provide estimates of forest biomass and carbon stocks, and monitor forest dynamic processes such as growth and mortality rates. Remote sensing facilitates scaling up to the surrounding landscapes. The sites support information requirements for implementing programs such as Reducing Emissions from Deforestation and Forest Degradation (REDD+), enabling communities to receive payments for ecosystem services such as reduced carbon emissions or improved forest management. In addition to providing benchmark data for REDD+ projects, the sites are valuable for validating state and national estimates from satellite remote sensing and the national forest inventory. Data from the sites provide parameters for forest models that support strategic management analysis, and support student training and graduate projects. The intensive monitoring sites may be a model for other countries in Latin America. Coordination among sites in the USA, Mexico and other Latin American countries can ensure harmonization of approaches and data, and share experiences and knowledge among countries with emerging opportunities for implementing REDD+ and other conservation programs.

  6. Impact of parental weight status on a school-based weight management programme designed for Mexican-American children.

    Science.gov (United States)

    Moreno, J P; Johnston, C A; Hernandez, D C; LeNoble, J; Papaioannou, M A; Foreyt, J P

    2016-10-01

    While overweight and obese children are more likely to have overweight or obese parents, less is known about the effect of parental weight status on children's success in weight management programmes. This study was a secondary data analysis of a randomized controlled trial and investigated the impact of having zero, one or two obese parents on children's success in a school-based weight management programme. Sixty-one Mexican-American children participated in a 24-week school-based weight management intervention which took place in 2005-2006. Children's heights and weights were measured at baseline, 3, 6 and 12 months. Parental weight status was assessed at baseline. Repeated measures anova and ancova were conducted to compare changes in children's weight within and between groups, respectively. Within-group comparisons revealed that the intervention led to significant decreases in standardized body mass index (zBMI) for children with zero (F = 23.16, P weight management programme appears to be most efficacious for children with one or no obese parents compared to children with two obese parents. These results demonstrate the need to consider parental weight status when engaging in childhood weight management efforts. © 2015 World Obesity.

  7. Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

    Science.gov (United States)

    Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

    2017-10-01

    Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

  8. Mexican American Women's Adherence to Hemodialysis Treatment: A Social Constructivist Perspective

    Science.gov (United States)

    Tijerina, Mary S.

    2009-01-01

    Mexican Americans have as much as a six-times greater risk of end-stage renal disease (ESRD) than non-Hispanic white Americans, and women show a faster rate of decline in diabetic renal functioning. The leading treatment for ESRD is hemodialysis, an intensive, complex treatment regimen associated with high levels of patient nonadherence. Previous…

  9. Modeling Coupled Landscape Evolution and Soil Organic Carbon Dynamics in Intensively Management Landscapes

    Science.gov (United States)

    Yan, Q.; Kumar, P.

    2017-12-01

    Soil is the largest reservoir of carbon in the biosphere but in agricultural areas it is going through rapid erosion due disturbance arising from crop harvest, tillage, and tile drainage. Identifying whether the production of soil organic carbon (SOC) from the crops can compensate for the loss due to erosion is critical to ensure our food security and adapt to climate change. In the U.S. Midwest where large areas of land are intensively managed for agriculture practices, predicting soil quantity and quality are critical for maintaining crop yield and other Critical Zone services. This work focuses on modeling the coupled landscape evolutions soil organic carbon dynamics in agricultural fields. It couples landscape evolution, surface water runoff, organic matter transformation, and soil moisture dynamics to understand organic carbon gain and loss due to natural forcing and farming practices, such as fertilizer application and tillage. A distinctive feature of the model is the coupling of surface ad subsurface processes that predicts both surficial changes and transport along with the vertical transport and dynamics. Our results show that landscape evolution and farming practices play dominant roles in soil organic carbon (SOC) dynamics both above- and below-ground. Contrary to the common assumption that a vertical profile of SOC concentration decreases exponentially with depth, we find that in many situations SOC concentration below-ground could be higher than that at the surface. Tillage plays a complex role in organic matter dynamics. On one hand, tillage would accelerate the erosion rate, on the other hand, it would improve carbon storage by burying surface SOC into below ground. Our model consistently reproduces the observed above- and below-ground patterns of SOC in the field sites of Intensively Managed Landscapes Critical Zone Observatory (IMLCZO). This model bridges the gaps between the landscape evolution, below- and above-ground hydrologic cycle, and

  10. Review of Alternative Management Options of Vegetable Crop Residues to Reduce Nitrate Leaching in Intensive Vegetable Rotations

    Directory of Open Access Journals (Sweden)

    Laura Agneessens

    2014-12-01

    Full Text Available Vegetable crop residues take a particular position relative to arable crops due to often large amounts of biomass with a N content up to 200 kg N ha−1 left behind on the field. An important amount of vegetable crops are harvested during late autumn and despite decreasing soil temperatures during autumn, high rates of N mineralization and nitrification still occur. Vegetable crop residues may lead to considerable N losses through leaching during winter and pose a threat to meeting water quality objectives. However, at the same time vegetable crop residues are a vital link in closing the nutrient and organic matter cycle of soils. Appropriate and sustainable management is needed to harness the full potential of vegetable crop residues. Two fundamentally different crop residue management strategies to reduce N losses during winter in intensive vegetable rotations are reviewed, namely (i on-field management options and modifications to crop rotations and (ii removal of crop residues, followed by a useful and profitable application.

  11. Long-term intensive management increased carbon occluded in phytolith (PhytOC) in bamboo forest soils

    Science.gov (United States)

    Huang, Zhang-Ting; Li, Yong-Fu; Jiang, Pei-Kun; Chang, Scott X.; Song, Zhao-Liang; Liu, Juan; Zhou, Guo-Mo

    2014-01-01

    Carbon (C) occluded in phytolith (PhytOC) is highly stable at millennium scale and its accumulation in soils can help increase long-term C sequestration. Here, we report that soil PhytOC storage significantly increased with increasing duration under intensive management (mulching and fertilization) in Lei bamboo (Phyllostachys praecox) plantations. The PhytOC storage in 0-40 cm soil layer in bamboo plantations increased by 217 Mg C ha-1, 20 years after being converted from paddy fields. The PhytOC accumulated at 79 kg C ha-1 yr-1, a rate far exceeding the global mean long-term soil C accumulation rate of 24 kg C ha-1 yr-1 reported in the literature. Approximately 86% of the increased PhytOC came from the large amount of mulch applied. Our data clearly demonstrate the decadal scale management effect on PhytOC accumulation, suggesting that heavy mulching is a potential method for increasing long-term organic C storage in soils for mitigating global climate change.

  12. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit.

    Science.gov (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M

    2012-02-01

    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  13. 'Targeting' sedation: the lived experience of the intensive care nurse.

    Science.gov (United States)

    Everingham, Kirsty; Fawcett, Tonks; Walsh, Tim

    2014-03-01

    To discuss the findings from a phenomenological study that provides insights into the intensive care nurses' 'world' following changes in the sedation management of patients in an intensive care unit. Intensive care sedation practices have undergone significant changes. Patients, where possible, are now managed on lighter levels of sedation, often achieved through the performance of sedation holds (SHs). The performance of SHs is normally carried out by the bedside nurse but compliance is reported to be poor. There has been little exploration of the nurses' experiences of these changes and the implications of SHs and subsequent wakefulness on their delivery of care. Following ethical approval, 16 intensive care nurses, experienced and inexperienced, from within a general intensive care unit. A Heideggerian phenomenological approach was used. Data collection consisted of interviews guided by an aide memoir and a framework adapted from Van Manen informed the analysis. The findings reveal new insights into the world of the intensive care nurse in the light of the changes to sedation management. They demonstrate that there have been unforeseen outcomes from well-intentioned initiatives to improve the quality of patients' care. There were implications from the changes introduced for the nurses care delivery. The main themes that emerged were 'working priorities' and 'unintended consequences', in turn revealing embedded tensions between evidence-based targets and holistic care. Intensive care nurses find that the current approach to the changes in sedation management can threaten their professional obligation and personal desire to provide holistic care. The 'targeted' approach by healthcare organisations is perceived to militate against the patient-centred care they want to deliver. Sedation management is complex and needs further consideration particularly the potential constraints 'target-led' care has on nursing practice. © 2013 Blackwell Publishing Ltd.

  14. Resonant Self-Trapping and Absorption of Intense Bessel Beams

    International Nuclear Information System (INIS)

    Fan, J.; Parra, E.; Milchberg, H. M.

    2000-01-01

    We report the observation of resonant self-trapping and enhanced laser-plasma heating resulting from propagation of high intensity Bessel beams in neutral gas. The enhancement in absorption and plasma heating is directly correlated to the spatial trapping of laser radiation. (c) 2000 The American Physical Society

  15. An agent based architecture for high-risk neonate management at neonatal intensive care unit.

    Science.gov (United States)

    Malak, Jaleh Shoshtarian; Safdari, Reza; Zeraati, Hojjat; Nayeri, Fatemeh Sadat; Mohammadzadeh, Niloofar; Farajollah, Seide Sedighe Seied

    2018-01-01

    In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as

  16. Towards ethical decision support and knowledge management in neonatal intensive care.

    Science.gov (United States)

    Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

    2004-01-01

    Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

  17. The "invisible caregiver": multicaregiving among diabetic African-American grandmothers.

    Science.gov (United States)

    Carthron, Dana L; Bailey, Donald E; Anderson, Ruth A

    2014-01-01

    To explore the multicaregiving roles African-American grandmothers assume while self-managing their diabetes. This longitudinal, qualitative pilot study explored the challenges of self-managing diabetes among six African-American caregiving grandmothers. Data were collected at 5 times points across 18 months. Content analysis, guided by the Adaptive Leadership framework, was conducted using data matrices to facilitate within-case and cross-case analyses. Although participants initially stated they cared only for grandchildren, all had additional caregiving responsibilities. Four themes emerged which illustrated how African-American caregiving grandmothers put the care of dependent children, extended family and community before themselves. Using the Adaptive Leadership framework, technical and adaptive challenges arising from multicaregiving were described as barriers to diabetes self-management. When assisting these women to self-manage their diabetes, clinicians must assess challenges arising from multicaregiving. This might require developing collaborative work relationships with the client to develop meaningful and attainable goals. Copyright © 2014 Mosby, Inc. All rights reserved.

  18. Fears of American Children Following Terrorism

    Science.gov (United States)

    Burnham, Joy J.; Hooper, Lisa M.

    2008-01-01

    Two months after 9/11, the fears of children and adolescents in Grades 2-12 were examined utilizing the American Fear Survey Schedule for Children and Adolescents (FSSC-AM). Fear intensity scores and age and gender differences are reported. Terrorist-related content on the FSSC-AM (e.g., terrorist attacks, our country being invading by enemies)…

  19. Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Van Horn, Linda; Carson, Jo Ann S; Appel, Lawrence J; Burke, Lora E; Economos, Christina; Karmally, Wahida; Lancaster, Kristie; Lichtenstein, Alice H; Johnson, Rachel K; Thomas, Randal J; Vos, Miriam; Wylie-Rosett, Judith; Kris-Etherton, Penny

    2016-11-29

    In 2013, the American Heart Association and American College of Cardiology published the "Guideline on Lifestyle Management to Reduce Cardiovascular Risk," which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association's 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015-2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences. © 2016 American Heart Association, Inc.

  20. Coupling biophysical processes and water rights to simulate spatially distributed water use in an intensively managed hydrologic system

    Science.gov (United States)

    Han, Bangshuai; Benner, Shawn G.; Bolte, John P.; Vache, Kellie B.; Flores, Alejandro N.

    2017-07-01

    Humans have significantly altered the redistribution of water in intensively managed hydrologic systems, shifting the spatiotemporal patterns of surface water. Evaluating water availability requires integration of hydrologic processes and associated human influences. In this study, we summarize the development and evaluation of an extensible hydrologic model that explicitly integrates water rights to spatially distribute irrigation waters in a semi-arid agricultural region in the western US, using the Envision integrated modeling platform. The model captures both human and biophysical systems, particularly the diversion of water from the Boise River, which is the main water source that supports irrigated agriculture in this region. In agricultural areas, water demand is estimated as a function of crop type and local environmental conditions. Surface water to meet crop demand is diverted from the stream reaches, constrained by the amount of water available in the stream, the water-rights-appropriated amount, and the priority dates associated with particular places of use. Results, measured by flow rates at gaged stream and canal locations within the study area, suggest that the impacts of irrigation activities on the magnitude and timing of flows through this intensively managed system are well captured. The multi-year averaged diverted water from the Boise River matches observations well, reflecting the appropriation of water according to the water rights database. Because of the spatially explicit implementation of surface water diversion, the model can help diagnose places and times where water resources are likely insufficient to meet agricultural water demands, and inform future water management decisions.

  1. Blood metabolites and some fertility parameters in dairy cows under intensive management system

    Energy Technology Data Exchange (ETDEWEB)

    Osman, Awad Ali [Faculty of Animal Production, University of Khartoum, Khartoum (Sudan)

    1998-08-01

    Dairy farms (1, 2, 3 and 4) of the intensive management system were selected. They are located 50 kilometers south of Khartoum state in a semi-arid zone. The effect of management on some fertility parameters, blood metabolites and minerals were investigated. Changes in blood metabolites with stage of lactation were also monitored. Other parameters studied were body weight, body condition score at calving. The results revealed that days to first P{sup 4} rise after calving and number of services per conception (NSPC) were lower in the farm s contained the cross-bred (Fresian X Zebu) compared to the farm contained the pure Fresian breed. The pure Fresian cows showed heavier weights and less body score at calving compared to the cross breed. Blood metabolites reflected the nutritional status of the dairy cows under study, plasma total protein, albumin, globulin, urea and Glucose did not show significant changes either either either between farms or in response to lactation stages. However, high levels of Globulins might indicate inflammation due to some diseases such as mastitis, metritis and lameness. Plasma level of Calcium and Phosphorous did not change significantly either between farms or due to stages of lactation.(Author) 129 refs. , 12 tabs.

  2. Native American Conference on Petroleum Energy; November 16-17, 1996; Bartlesville, Oklahoma

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-04-27

    Thirty-three Native American tribal members, council members, and other interested parties gathered in Bartlesville, Oklahoma, to attend the Native American Conference on Petroleum Energy on October 16 and 17 1996, sponsored by the U.S. Department of Energy and BDM-Oklahoma, Inc. Tribes represented at the workshop included the Cherokee, Chickasaw, Hopi, Jicarilla Apache, Osage, Seminole, and Ute. Representatives of the Bureau of Indian Affairs (BIA), the Bureau of Land Management (BLM), and the Minerals Management Service (MMS) also attended. BDM-Oklahoma developed and organized the Native American Conference on Petroleum Energy to help meet the goals of the U.S. Department of Energy's Domestic Gas and Oil Initiative to help Native American Tribes become more self-sufficient in developing and managing petroleum resources.

  3. Working-life - A paradox in Knowledge-Intensive Companies

    DEFF Research Database (Denmark)

    Ipsen, Christine

    2004-01-01

    A Working-Life Paradox in Knowledge Intensive Companies Keywords: Knowledge work, knowledge management, working-life, consulting companies. The purpose of this article is to identify the influence knowledge-work has on working life of the personnel in knowledge-intensive companies, more precisely...

  4. Building waste management core indicators through Spatial Material Flow Analysis: Net recovery and transport intensity indexes

    International Nuclear Information System (INIS)

    Font Vivanco, David; Puig Ventosa, Ignasi; Gabarrell Durany, Xavier

    2012-01-01

    Highlights: ► Sustainability and proximity principles have a key role in waste management. ► Core indicators are needed in order to quantify and evaluate them. ► A systematic, step-by-step approach is developed in this study for their development. ► Transport may play a significant role in terms of environmental and economic costs. ► Policy action is required in order to advance in the consecution of these principles. - Abstract: In this paper, the material and spatial characterization of the flows within a municipal solid waste (MSW) management system are combined through a Network-Based Spatial Material Flow Analysis. Using this information, two core indicators are developed for the bio-waste fraction, the Net Recovery Index (NRI) and the Transport Intensity Index (TII), which are aimed at assessing progress towards policy-related sustainable MSW management strategies and objectives. The NRI approaches the capacity of a MSW management system for converting waste into resources through a systematic metabolic approach, whereas the TII addresses efficiency in terms of the transport requirements to manage a specific waste flow throughout the entire MSW management life cycle. Therefore, both indicators could be useful in assessing key MSW management policy strategies, such as the consecution of higher recycling levels (sustainability principle) or the minimization of transport by locating treatment facilities closer to generation sources (proximity principle). To apply this methodological approach, the bio-waste management system of the region of Catalonia (Spain) has been chosen as a case study. Results show the adequacy of both indicators for identifying those points within the system with higher capacity to compromise its environmental, economic and social performance and therefore establishing clear targets for policy prioritization. Moreover, this methodological approach permits scenario building, which could be useful in assessing the outcomes of

  5. Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.

    Science.gov (United States)

    Allan, Catherine K; Thiagarajan, Ravi R; Beke, Dorothy; Imprescia, Annette; Kappus, Liana J; Garden, Alexander; Hayes, Gavin; Laussen, Peter C; Bacha, Emile; Weinstock, Peter H

    2010-09-01

    Resuscitation of pediatric cardiac patients involves unique and complex physiology, requiring multidisciplinary collaboration and teamwork. To optimize team performance, we created a multidisciplinary Crisis Resource Management training course that addressed both teamwork and technical skill needs for the pediatric cardiac intensive care unit. We sought to determine whether participation improved caregiver comfort and confidence levels regarding future resuscitation events. We developed a simulation-based, in situ Crisis Resource Management curriculum using pediatric cardiac intensive care unit scenarios and unit-specific resuscitation equipment, including an extracorporeal membrane oxygenation circuit. Participants replicated the composition of a clinical team. Extensive video-based debriefing followed each scenario, focusing on teamwork principles and technical resuscitation skills. Pre- and postparticipation questionnaires were used to determine the effects on participants' comfort and confidence regarding participation in future resuscitations. A total of 182 providers (127 nurses, 50 physicians, 2 respiratory therapists, 3 nurse practitioners) participated in the course. All participants scored the usefulness of the program and scenarios as 4 of 5 or higher (5 = most useful). There was significant improvement in participants' perceived ability to function as a code team member and confidence in a code (P < .001). Participants reported they were significantly more likely to raise concerns about inappropriate management to the code leader (P < .001). We developed a Crisis Resource Management training program in a pediatric cardiac intensive care unit to teach technical resuscitation skills and improve team function. Participants found the experience useful and reported improved ability to function in a code. Further work is needed to determine whether participation in the Crisis Resource Management program objectively improves team function during real

  6. Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial.

    Science.gov (United States)

    Adams, Scott C; DeLorey, Darren S; Davenport, Margie H; Stickland, Michael K; Fairey, Adrian S; North, Scott; Szczotka, Alexander; Courneya, Kerry S

    2017-10-15

    Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise). The primary outcome was peak aerobic fitness (VO 2peak ) assessed via a treadmill-based maximal cardiorespiratory exercise test. Secondary endpoints included CVD risk (eg, Framingham Risk Score), arterial health, parasympathetic nervous system function, and blood-based biomarkers. Postintervention VO 2peak data were obtained for 61 participants (97%). HIIT participants attended 99% of the exercise sessions and achieved 98% of the target exercise intensity. Analysis of covariance demonstrated that HIIT was superior to UC for improving VO 2peak (adjusted between-group mean difference, 3.7 mL O 2 /kg/min; 95% confidence interval, 2.4-5.1 [PHIIT reduced the prevalence of modifiable CVD risk factors by 20% compared with UC. This randomized trial provides the first evidence that HIIT improves cardiorespiratory fitness, multiple pathways of CVD risk, and surrogate markers of mortality in TCS. These findings have important implications for the management of TCS. Further research concerning the long-term effects of HIIT on CVD morbidity and mortality in TCS is warranted. Cancer 2017;123:4057-65. © 2017 American Cancer Society. © 2017 American Cancer Society.

  7. Case management for high-intensity service users: towards a relational approach to care co-ordination.

    Science.gov (United States)

    McEvoy, Phil; Escott, Diane; Bee, Penny

    2011-01-01

    This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks. © 2010 Blackwell Publishing Ltd.

  8. Age-related patterns of vigorous-intensity physical activity in youth: The International Children's Accelerometry Database

    Directory of Open Access Journals (Sweden)

    Kirsten Corder

    2016-12-01

    Age-related declines in vigorous-intensity activity during youth appear relatively greater than those of moderate activity. However, due to a higher baseline, absolute moderate-intensity activity decreases more than vigorous. Overweight/obese individuals, girls, and North Americans appear especially in need of vigorous-intensity activity promotion due to low levels at 5.0–5.9 y and larger negative annual differences.

  9. 50 CFR 665.98 - Management area.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Management area. 665.98 Section 665.98 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... Management area. The American Samoa fishery management area is the EEZ seaward of the Territory of American...

  10. Three Essays on Bureaucracy at American Research Universities

    Science.gov (United States)

    Taggart, Gabel

    2017-01-01

    The three essays in this dissertation each examine how aspects of contemporary administrative structure within American research universities affect faculty outcomes. Specific aspects of administrative structure tested in this dissertation include the introduction of new administrative roles, administrative intensity (i.e., relative size of…

  11. A moral economy of American medicine in the managed-care era.

    Science.gov (United States)

    Sprinkle, R H

    2001-06-01

    The moral economy of American medicine has been transformed by contentious innovations in organization, administration, regulation, and finance. In many settings old fee-for-service incentives and disincentives have been replaced by those of "managed care", while in other settings they have been diluted or distorted. In the everyday care of patients, old and new may alternate or interact. These innovations may also be having secondary effects on participation in life-sciences research and the development and employment of new technologies, discouraging collective support for preliminary investigation and delaying adoption of improved goods and services until cost-reducing potential has already been realized. This motivational complexity, particularly in its moral dimensions, is hard to address using standard assumptions and methods. I argue for different assumptions, based on the clinical behavior of individual patients rather than the market behavior of aggregated consumers, and I describe a different method, based on an old idea in political economy. I then present a new way to explain the core obligations of clinicians, researchers, and planners and to interpret the policy problems they must now share.

  12. The future of intensive care medicine.

    Science.gov (United States)

    Blanch, L; Annane, D; Antonelli, M; Chiche, J D; Cuñat, J; Girard, T D; Jiménez, E J; Quintel, M; Ugarte, S; Mancebo, J

    2013-03-01

    Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  13. Delirium screening in intensive care: A life saving opportunity.

    Science.gov (United States)

    Lamond, E; Murray, S; Gibson, C E

    2018-02-01

    Delirium is described as 'acute brain failure' and constitutes a medical emergency which presents a hazard for people cared for in intensive care units. The Scottish intensive care society audit group recommend that all people cared for in intensive care units be screened for signs of delirium so that treatment and management of complications can be implemented at an early stage. There is inconsistent evidence about when and how the assessment of delirium is carried out by nursing staff in the intensive care setting. This narrative review explores the pathophysiology and current practices of delirium screening in intensive care. Consideration is given to the role of the nurse in detecting and managing delirium and some barriers to routine daily delirium screening are critically debated. It is argued that routine delirium screening is an essential element of safe, effective and person centred nursing care which has potential to reduce morbidity and mortality. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  14. Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment.

    Science.gov (United States)

    van Aken, Mieke A W; Oosterman, Joukje M; van Rijn, C M; Ferdek, Magdalena A; Ruigt, Gé S F; Peeters, B W M M; Braat, Didi D M; Nap, Annemiek W

    2017-10-01

    To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. High-intensity lower limb endurance training in chronic respiratory disease

    OpenAIRE

    Tanaka, Takako; Arizono, Shinichi; Hanada, Masatoshi; Senjyu, Hideaki

    2015-01-01

    High-intensity endurance training is mainly undertaken during pulmonary rehabilitation for patients with chronic respiratory disease. High-intensity endurance training is recommended in many clinical management guidelines. High-intensity endurance training involves training generally at an intensity of at 60-80% of the patient’s peak work capacity or higher. The effects of high-intensity lower limb endurance training have mostly been investigated in chronic obstructive pulmonary disease (COPD...

  16. Nitrogen deposition and its contribution to nutrient inputs to intensively managed agricultural ecosystems.

    Science.gov (United States)

    He, Chun-E; Wang, Xin; Liu, Xuejun; Fangmeier, Andreas; Christie, Peter; Zhang, Fusuo

    2010-01-01

    Interest in nitrogen inputs via atmospheric deposition to agricultural ecosystems has increased recently, especially on the North China Plain because of extremely intensive agricultural systems and rapid urbanization in this region. Nitrogen deposition may make a significant contribution to crop N requirements but may also impose a considerable nutrient burden on the environment in general. We quantified total N deposition at two locations, Dongbeiwang near Beijing and Quzhou in Hebei province, over a two-year period from 2005 to 2007 using an 15N tracer method, the integrated total N input (ITNI) system. Total airborne N inputs to a maize wheat rotation system at both locations ranged from 99 to 117 kg N x ha(-1) x yr(-1), with higher N deposition during the maize season (57-66 kg N/ha) than the wheat season (42-51 kg N/ha). Plant available N from deposition for maize and wheat was about 52 kg N x ha(-1) x yr(-1), accounting for 50% of the total N deposition or 31% of total N uptake by the two crop species. In addition, a correction factor was derived for the maize season to adjust values obtained from small pots (0.057 m2) compared with field trays (0.98 m2) because of higher plant density in the pots. The results indicate that atmospheric N deposition is a very important N input and must be taken into account when calculating nutrient budgets in very intensively managed agricultural ecosystems.

  17. How can primary care providers manage pediatric obesity in the real world?

    Science.gov (United States)

    Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

    2011-06-01

    To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  18. Challenges to Native American health care.

    Science.gov (United States)

    Noren, J; Kindig, D; Sprenger, A

    1998-01-01

    Native American health care programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the health care environment.

  19. Light intensity dependent Debye screening length in undoped photorefractive titanosillenite crystals

    OpenAIRE

    de Oliveira, I; Frejlich, J

    2012-01-01

    We report on the experimental evidence of the light intensity dependence of the Debye screening length l(s) in undoped photorefractive titanosillenite crystals (Bi12TiO20) by measuring the holographic gain and diffraction efficiency in a two-wave mixing experiment under 532 nm wavelength laser light. Debye length shows saturation at high values of the light intensity. Results are in agreement with the theoretical development. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/...

  20. A Survey of Self-Management and Intrusiveness of Illness in Native Americans with Diabetes Mellitus.

    Science.gov (United States)

    Chou, Ann F; Page, Evaren E; Norris, Ann I; Kim, Sue E; Thompson, David M; Roswell, Robert H

    2014-12-01

    Diabetes mellitus (DM) has emerged as an important focus of national public health efforts because of the rapid increase in the burden of this disease. In particular, DM disproportionately affects Native Americans. Adequate management of DM requires that patients participate as active partners in their own care and much of patient activation and empowerment can be attributed to their experience with DM and self-care. That is, the degree to which the patient feels the disease intrudes on his or her daily life would impact the motivation for self-care. We conducted a study in collaboration with 2 tribal nations in Oklahoma, collecting data on survey questions regarding intrusiveness of illness and self-management behaviors from a sample of 159 members of the Chickasaw and Choctaw Nations. Previously validated variables measuring intrusiveness of illness and self-care were included in the survey. Descriptive statistics and bivariate analyses illustrated the distribution of these variables and identified possible tribal and gender differences. Our findings showed that our sample adjusted well to DM and in general exhibited high compliance to self-care. However, our findings also revealed striking gender differences where female respondents were better adjusted to their disease, whereas male respondents reported higher adherence to self-management. Findings from our study, particularly those that describe tribal differences and gender disparities, can inform strategies for case management and patient interactions with providers and the health care system.

  1. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity.

    Science.gov (United States)

    Moran, Fidelma; Leonard, Tracey; Hawthorne, Stephanie; Hughes, Ciara M; McCrum-Gardner, Evie; Johnson, Mark I; Rakel, Barbara A; Sluka, Kathleen A; Walsh, Deirdre M

    2011-08-01

    Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P = .005 and .002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P TENS and No Current Placebo TENS groups at the hand (P = .001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r(2) = .33, P = .003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. A flux footprint analysis to understand ecosystem fluxes in an intensively managed landscape

    Science.gov (United States)

    Hernandez Rodriguez, L. C.; Goodwell, A. E.; Kumar, P.

    2017-12-01

    Flux tower studies in agricultural sites have mainly been done at plot scale, where the footprint of the instruments is small such that the data reveals the behaviour of the nearby crop on which the study is focused. In the Midwestern United States, the agricultural ecosystem and its associated drainage, evapotranspiration, and nutrient dynamics are dominant influences on interactions between the soil, land, and atmosphere. In this study, we address large-scale ecohydrologic fluxes and states in an intensively managed landscape based on data from a 25m high eddy covariance flux tower. We show the calculated upwind distance and flux footprint for a flux tower located in Central Illinois as part of the Intensively Managed Landscapes Critical Zone Observatory (IMLCZO). In addition, we calculate the daily energy balance during the summer of 2016 from the flux tower measurements and compare with the modelled energy balance from a representative corn crop located in the flux tower footprint using the Multi-Layer Canopy model, MLCan. The changes in flux footprint over the course of hours, days, and the growing season have significant implications for the measured fluxes of carbon and energy at the flux tower. We use MLCan to simulate these fluxes under land covers of corn and soybeans. Our results demonstrate how the instrument heights impact the footprint of the captured eddy covariance fluxes, and we explore the implication for hydrological analysis. The convective turbulent atmosphere during the daytime shows a wide footprint of more than 10 km2, which reaches 3km length for the 90% contribution, where buoyancy is the dominant mechanism driving turbulence. In contrast, the stable atmosphere during the night-time shows a narrower footprint that goes beyond 8km2 and grows in the direction of the prevalent wind, which exceeds 4 km in length. This study improves our understanding of agricultural ecosystem behaviour in terms of the magnitude and variability of fluxes and

  3. Is American business working for the poor?

    Science.gov (United States)

    Bane, M J; Ellwood, D T

    1991-01-01

    At first glance, poverty seems to have little to do with business. When most people--managers included--think about poverty, they assume that people are poor because they are isolated from the mainstream economy, not productive participants in it. But according to Harvard University professors Mary Jo Bane and David Ellwood, this is a misleading image of the true face of poverty in the United States today. Most poor adults--and a full 90% of poor children--live in families where work is the norm, not the exception. Poor people often work or want to work. But at the low-wage end of the American economy, having a job is no guarantee of avoiding poverty. Poverty is a business issue, then, because the American poor are part of the American work force. And this poses a problem for managers. In a more competitive and fast-changing economic environment, the performance of companies increasingly depends on the capabilities of their employees. In response to this human-resource challenge, more and more managers are embracing the language of "empowerment". And yet how can low-wage employees believe empowerment when their experience of work is, quite literally, impoverishment? It is unlikely that American companies can create the work force of the future with the poverty policies of the past. Fortunately, there are some simple policy mechanisms that can assist the working poor without putting an undue burden on business. Enacting them, however, requires managers to see poverty policy as one part of a national human-resource strategy that links the strategic concerns of companies to a broad social agenda.

  4. A Systematic Review of the Energy Cost and Metabolic Intensity of Yoga.

    Science.gov (United States)

    Larson-Meyer, D Enette

    2016-08-01

    With the increasing popularity of Hatha yoga, it is important to understand the energy cost and METs of yoga practice within the context of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) physical activity guidelines. This systematic review evaluated the energy cost and metabolic intensity of yoga practice including yoga asanas (poses/postures) and pranayamas (breath exercises) measured by indirect calorimetry. The English-speaking literature was surveyed via PubMed using the general terms "yoga" and "energy expenditure" with no date limitations. Thirteen manuscripts were initially identified with an additional four located from review of manuscript references. Of the 17 studies, 10 evaluated the energy cost and METs of full yoga sessions or flow through Surya Namaskar (sun salutations), eight of individual asanas, and five of pranayamas. METs for yoga practice averaged 3.3 ± 1.6 (range = 1.83-7.4 METs) and 2.9 ± 0.8 METs when one outlier (i.e., 7.4 METs for Surya Namaskar) was omitted. METs for individual asanas averaged 2.2 ± 0.7 (range = 1.4-4.0 METs), whereas that of pranayamas was 1.3 ± 0.3. On the basis of ACSM/AHA classification, the intensity of most asanas and full yoga sessions ranged from light (less than 3 METs) to moderate aerobic intensity (3-6 METs), with the majority classified as light intensity. This review suggests that yoga is typically classified as a light-intensity physical activity. However, a few sequences/poses, including Surya Namaskar, meet the criteria for moderate- to vigorous-intensity activity. In accordance with the ACSM/AHA guidelines, the practice of asana sequences with MET intensities higher than three (i.e., >10 min) can be accumulated throughout the day and count toward daily recommendations for moderate- or vigorous-intensity physical activity.

  5. The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management.

    Science.gov (United States)

    Paterson, Megan; Bell, Kirstine J; O'Connell, Susan M; Smart, Carmel E; Shafat, Amir; King, Bruce

    2015-09-01

    A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies.

  6. Activty- versus Variability-Based Management Accounting

    DEFF Research Database (Denmark)

    Israelsen, Poul

    Bogen var blandt finalisterne til modtagelse af 1994-prisen “Contribution to Management Accounting Literature Award”, som uddeles af "The Management Accounting Section of the American Accounting Association"......Bogen var blandt finalisterne til modtagelse af 1994-prisen “Contribution to Management Accounting Literature Award”, som uddeles af "The Management Accounting Section of the American Accounting Association"...

  7. A case of rhabdomyolysis after kidney transplantation successfully managed with intensive continuous dialysis.

    Science.gov (United States)

    Shahbazov, Rauf; Fox, Michael; Alejo, Jennifer L; Anjum, Malik A; Azari, Feredun; Doyle, Alden; Agarwal, Avinash; Brayman, Kenneth L

    2018-04-01

    Rhabdomyolysis is characterized by muscle cell death which can result in acute kidney injury from pigment nephropathy. We present a patient who developed rhabdomyolysis immediately after deceased donor kidney transplantation surgery and was managed with continuous renal replacement therapy that resulted in successful salvage of the kidney allograft. Patients who develop acute kidney failure requiring renal replacement therapy generally have a poor prognosis. It is worth noting that while continuous veno-venous hemofiltration (CVVHF) offers greater volume support and continuous clearance compared to hemodialysis (HD), recent studies have demonstrated no clinically significant improvement in clinical outcome between the two. Perhaps CVVHF is a better modality compared to HD in this setting to prevent further insult from pigment nephropathy to an allograft. A combination of early diagnosis and intensive continuous renal replacement therapy can be used for allograft salvage in a patient with rhabdomyolysis in the immediate post-kidney transplant period.

  8. Managing Family Conflict over Career Decisions: The Experience of Asian Americans

    Science.gov (United States)

    Ma, Pei-Wen Winnie; Desai, Uttara; George, Login S.; San Filippo, Alyssa A.; Varon, Samantha

    2014-01-01

    Conflict over career decisions is a main source of intergenerational conflict among Asian American families. This qualitative study explored the topic using consensual qualitative research methodology in a sample of eight Asian Americans. Results indicated that participants experienced feelings of guilt and indebtedness due to conflicting values,…

  9. Effects of extensive system versus semi-intensive and intensive systems on growth and carcass quality of dairy kids

    Directory of Open Access Journals (Sweden)

    Pedro Zurita Herrera

    2011-11-01

    Full Text Available The aim of this research was to study the effects of three different management systems on growth and carcass quality of 61 Murciano-Granadina breed kids and their interaction with sex. In the extensive system, 21 kids were allocated to suckle from their dams on free-range pasture with no additional feedstuff. In the semi-intensive system, 20 kids were suckled from their dams and had access to alfalfa hay and cereal straw (no free-range pasture. In the intensive system, 20 kids were separated from the dams at birth and then fed with milk replacer and alfalfa hay. Animals were slaughtered at 7.00 ± 1.00 kg of average BW. The semi-intensive system and extensive system kids grew faster than intensive system animals (127, 113 and 96 g/d, respectively. Differences in energy intake may explain these differences. Intensive system kids displayed the lowest real dressing percentages, calculated as 100 × (hot carcass weight/empty body weight, due to high development of empty gastrointestinal tract. The long leg and carcass were larger in extensive system kids than in kids from other management systems, presumably due to high physical activity on the free-range pastures. The carcasses and cuts from semi-intensive system and extensive system kids displayed more fat than those of intensive system kids. Males grew faster than females (122 and 103 g/d, respectively. Carcasses in male kids showed a higher content of bones but a lower content of fat than carcasses in female kids. The extensive system is feasible for producing kid meat from a dairy breed.

  10. The Ability of American Football Helmets to Manage Linear Acceleration With Repeated High-Energy Impacts.

    Science.gov (United States)

    Cournoyer, Janie; Post, Andrew; Rousseau, Philippe; Hoshizaki, Blaine

    2016-03-01

    Football players can receive up to 1400 head impacts per season, averaging 6.3 impacts per practice and 14.3 impacts per game. A decrease in the capacity of a helmet to manage linear acceleration with multiple impacts could increase the risk of traumatic brain injury. To investigate the ability of football helmets to manage linear acceleration with multiple high-energy impacts. Descriptive laboratory study. Laboratory. We collected linear-acceleration data for 100 impacts at 6 locations on 4 helmets of different models currently used in football. Impacts 11 to 20 were compared with impacts 91 to 100 for each of the 6 locations. Linear acceleration was greater after multiple impacts (91-100) than after the first few impacts (11-20) for the front, front-boss, rear, and top locations. However, these differences are not clinically relevant as they do not affect the risk for head injury. American football helmet performance deteriorated with multiple impacts, but this is unlikely to be a factor in head-injury causation during a game or over a season.

  11. Age-related patterns of vigorous-intensity physical activity in youth

    DEFF Research Database (Denmark)

    Corder, Kirsten; Sharp, Stephen J; Atkin, Andrew J

    2016-01-01

    the relative reduction was 6.0% (5.6%, 6.4%). The age-related decrease in vigorous-intensity activity remained after adjustment for moderate activity. A larger age-related decrease in vigorous activity was observed for girls (- 10.7%) versus boys (- 2.9%), non-white (- 12.9% to - 9.4%) versus white individuals......Physical activity declines during youth but most evidence reports on combined moderate and vigorous-intensity physical activity. We investigated how vigorous-intensity activity varies with age. Cross-sectional data from 24,025 participants (5.0-18.0 y; from 20 studies in 10 countries obtained 2008...... (- 6.1%), lowest maternal education (high school (- 2.0%)) versus college/university (ns) and for overweight/obese (- 6.1%) versus healthy-weight participants (- 8.1%). In addition to larger annual decreases in vigorous-intensity activity, overweight/obese individuals, girls and North Americans had...

  12. Development and influence of European and American university libraries

    Directory of Open Access Journals (Sweden)

    Irena Sapač

    2000-01-01

    Full Text Available The author compares the development of university libraries in Europe and in the United States of America. She finds that the university libraries in the United States of America have developed for three centuries under the influence of the European libraries, but now in the last century the European libraries have developed under the influence of the American ones. In times when there were no professional librarians, the American university libraries were managed by university professors, who were educated at European universities. The European management patterns were consequently applied also to the American libraries. The first books were also first brought from Europe. The Humboldt university also had a strong influence on the development of the American university libraries. Not until the second half of the 19th and especially the 20th century did the American university libraries achieve such high levels of cataloguing, classification, co-operation, organisation, computer networks, information holders, education and constructing library buildings that the European libraries started assuming their methods.

  13. Synopsis and Review of the American College of Cardiology Foundation/American Heart Association 2013 ST-Elevation Myocardial Infarction Guideline.

    Science.gov (United States)

    Brown, Helen F

    2014-01-01

    The "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" is a major revision of the 2004 guideline. This article provides a synopsis and review of the guideline focusing on changes in patient care and implementing processes to ensure quality care. The implementation of this guideline provides nursing with a unique opportunity to affect patients and families primarily by recognition of the event and education about lifestyle modification and disease management. Regionalization of emergency systems provides a novel situation for nursing to develop interdepartmental and system protocols.

  14. Mexican Americans Receive Less Intensive Stroke Rehabilitation Than Non-Hispanic Whites.

    Science.gov (United States)

    Morgenstern, Lewis B; Sais, Emma; Fuentes, Michael; Ifejika, Nneka L; Jiang, Xiaqing; Horn, Susan D; Case, Erin; Lisabeth, Lynda D

    2017-06-01

    Mexican Americans (MAs) have worse neurological, functional, and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine whether allocation of stroke rehabilitation services differed by ethnicity. Patients with stroke were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, TX, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for 3 months after stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using 2 sample t tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using χ 2 tests. Ethnic comparisons of rehabilitation services were compared using χ 2 tests, Fisher's exact tests, and logistic regression. Seventy-two subjects (50 MA and 22 non-Hispanic white [NHW]) were followed. Mean age, NHW-69 (SD 13), MA-66 (SD 11) years, sex (NHW 55% male, MA 50% male) and median presenting National Institutes of Health Stroke Scale did not differ significantly. There were no ethnic differences among the proportion of patients who were sent home without any rehabilitation services ( P =0.9). Among those who received rehabilitation, NHWs were more likely to get inpatient rehabilitation (73%) compared with MAs (30%), P =0.016. MAs (51%) were much more likely to receive home rehabilitation services compared with NHWs (0%) ( P =0.0017). In this population-based study, MAs were more likely to receive home-based rehabilitation, whereas NHWs were more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs. © 2017 American Heart Association, Inc.

  15. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  16. Management intensity alters decomposition via biological pathways

    Science.gov (United States)

    Wickings, Kyle; Grandy, A. Stuart; Reed, Sasha; Cleveland, Cory

    2011-01-01

    Current conceptual models predict that changes in plant litter chemistry during decomposition are primarily regulated by both initial litter chemistry and the stage-or extent-of mass loss. Far less is known about how variations in decomposer community structure (e.g., resulting from different ecosystem management types) could influence litter chemistry during decomposition. Given the recent agricultural intensification occurring globally and the importance of litter chemistry in regulating soil organic matter storage, our objectives were to determine the potential effects of agricultural management on plant litter chemistry and decomposition rates, and to investigate possible links between ecosystem management, litter chemistry and decomposition, and decomposer community composition and activity. We measured decomposition rates, changes in litter chemistry, extracellular enzyme activity, microarthropod communities, and bacterial versus fungal relative abundance in replicated conventional-till, no-till, and old field agricultural sites for both corn and grass litter. After one growing season, litter decomposition under conventional-till was 20% greater than in old field communities. However, decomposition rates in no-till were not significantly different from those in old field or conventional-till sites. After decomposition, grass residue in both conventional- and no-till systems was enriched in total polysaccharides relative to initial litter, while grass litter decomposed in old fields was enriched in nitrogen-bearing compounds and lipids. These differences corresponded with differences in decomposer communities, which also exhibited strong responses to both litter and management type. Overall, our results indicate that agricultural intensification can increase litter decomposition rates, alter decomposer communities, and influence litter chemistry in ways that could have important and long-term effects on soil organic matter dynamics. We suggest that future

  17. Impact of the new American and British guidelines on the management and treatment of dyslipidemia in a Spanish working population.

    Science.gov (United States)

    Brotons, Carlos; Calvo-Bonacho, Eva; Moral, Irene; García-Margallo, María Teresa; Cortés-Arcas, María Victoria; Puig, Mireia; Vázquez-Pirillo, Gastón; Ruilope, Luis Miguel

    2014-11-01

    The guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines. Observational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. A total of 258,676 workers were included (68.2% men; mean age, 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20 558 workers according to the American guidelines and in 13,222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8. The new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  18. Building waste management core indicators through Spatial Material Flow Analysis: Net recovery and transport intensity indexes

    Energy Technology Data Exchange (ETDEWEB)

    Font Vivanco, David, E-mail: font@cml.leidenuniv.nl [Institut de Ciencia i Tecnologia Ambientals (ICTA), Departament d' Enginyeria Quimica, Universitat Autonoma de Barcelona (UAB), 08193 Bellaterra, Barcelona (Spain); Institute of Environmental Sciences (CML), Leiden University, P.O. Box 9518, 2300 RA Leiden (Netherlands); Puig Ventosa, Ignasi [ENT Environment and Management, Carrer Sant Joan 39, First Floor, 08800 Vilanova i la Geltru, Barcelona (Spain); Gabarrell Durany, Xavier [Institut de Ciencia i Tecnologia Ambientals (ICTA), Departament d' Enginyeria Quimica, Universitat Autonoma de Barcelona (UAB), 08193 Bellaterra, Barcelona (Spain)

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer Sustainability and proximity principles have a key role in waste management. Black-Right-Pointing-Pointer Core indicators are needed in order to quantify and evaluate them. Black-Right-Pointing-Pointer A systematic, step-by-step approach is developed in this study for their development. Black-Right-Pointing-Pointer Transport may play a significant role in terms of environmental and economic costs. Black-Right-Pointing-Pointer Policy action is required in order to advance in the consecution of these principles. - Abstract: In this paper, the material and spatial characterization of the flows within a municipal solid waste (MSW) management system are combined through a Network-Based Spatial Material Flow Analysis. Using this information, two core indicators are developed for the bio-waste fraction, the Net Recovery Index (NRI) and the Transport Intensity Index (TII), which are aimed at assessing progress towards policy-related sustainable MSW management strategies and objectives. The NRI approaches the capacity of a MSW management system for converting waste into resources through a systematic metabolic approach, whereas the TII addresses efficiency in terms of the transport requirements to manage a specific waste flow throughout the entire MSW management life cycle. Therefore, both indicators could be useful in assessing key MSW management policy strategies, such as the consecution of higher recycling levels (sustainability principle) or the minimization of transport by locating treatment facilities closer to generation sources (proximity principle). To apply this methodological approach, the bio-waste management system of the region of Catalonia (Spain) has been chosen as a case study. Results show the adequacy of both indicators for identifying those points within the system with higher capacity to compromise its environmental, economic and social performance and therefore establishing clear targets for policy

  19. Report by a special panel of the American Nuclear Society: Protection and management of plutonium

    International Nuclear Information System (INIS)

    Bengelsdorf, H.

    1996-01-01

    The American Nuclear Society (ANS) established an independent and prestigious panel several months ago to take the matter up where the US National Academy of Science (NAS) left off. The challenge was to look at the broader issue of what to do with civil plutonium, as well as excess weapons material. In terms of approach, the report focused on several short- and long-term issues. The short-term focus was on the disposition of excess weapons plutonium, while the longer-range issue concerned the disposition of the plutonium being produced in the civil nuclear fuel cycle. For the short term, the ANS panel strongly endorsed the concept that all plutonium scheduled for release from the US and Russian weapons stocks should be converted to a form that is intensively radioactive in order to protect the plutonium from theft of seizure (the spent fuel standard). However, since the conversion will at best take several years to complete, the panel has concluded that immediate emphasis should be placed on the assurance that all unconverted materials are protected as securely as when they were part of the active weapon stockpiles. More importantly, the panel also recommended prompt implementation of the so-called reactor option for disposing of surplus US and Russian weapons plutonium. The longer-term issues covered by the panel were those posed by the growing stocks of both separated plutonium and spent fuel generated in the world's civil nuclear power programs. These issues included what fuel cycle policies should be prudently pursued in light of proliferation risks and likely future energy needs, what steps should be taken in regard to the increase in the demand for nuclear power in the future, and how civil plutonium in its various forms should be protected and managed to minimize proliferation. Overall, the panel concluded that plutonium is an energy resource that should be used and not a waste material to be disposed of

  20. Evaluation of harvest and information needs for North American sea ducks.

    Science.gov (United States)

    Koneff, Mark D; Zimmerman, Guthrie S; Dwyer, Chris P; Fleming, Kathleen K; Padding, Paul I; Devers, Patrick K; Johnson, Fred A; Runge, Michael C; Roberts, Anthony J

    2017-01-01

    Wildlife managers routinely seek to establish sustainable limits of sport harvest or other regulated forms of take while confronted with considerable uncertainty. A growing body of ecological research focuses on methods to describe and account for uncertainty in management decision-making and to prioritize research and monitoring investments to reduce the most influential uncertainties. We used simulation methods incorporating measures of demographic uncertainty to evaluate risk of overharvest and prioritize information needs for North American sea ducks (Tribe Mergini). Sea ducks are popular game birds in North America, yet they are poorly monitored and their population dynamics are poorly understood relative to other North American waterfowl. There have been few attempts to assess the sustainability of harvest of North American sea ducks, and no formal harvest strategy exists in the U.S. or Canada to guide management. The popularity of sea duck hunting, extended hunting opportunity for some populations (i.e., special seasons and/or bag limits), and population declines have led to concern about potential overharvest. We used Monte Carlo simulation to contrast estimates of allowable harvest and observed harvest and assess risk of overharvest for 7 populations of North American sea ducks: the American subspecies of common eider (Somateria mollissima dresseri), eastern and western populations of black scoter (Melanitta americana) and surf scoter (M. perspicillata), and continental populations of white-winged scoter (M. fusca) and long-tailed duck (Clangula hyemalis). We combined information from empirical studies and the opinions of experts through formal elicitation to create probability distributions reflecting uncertainty in the individual demographic parameters used in this assessment. Estimates of maximum growth (rmax), and therefore of allowable harvest, were highly uncertain for all populations. Long-tailed duck and American common eider appeared to be at high

  1. A Comparative Study of the Relationships between Conflict Management Styles and Job Satisfaction, Organizational Commitment, and Propensity to Leave the Job among Saudi and American Universities' Faculty Members

    Science.gov (United States)

    Alzahrani, Mohammed

    2013-01-01

    This study used Rahim Organizational Conflict Inventory-II, Form C to examine the preference for conflict management styles among Saudi and American faculty members. Additionally, the study examined the relationships between conflict management styles and job satisfaction, organizational commitment, and propensity to leave the job. A random sample…

  2. Coastal activities in American Samoa in 2012 for use in coastal management

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The American Samoa Coastal use Participatory Mapping Project was developed through a partnership between the American Samoa Government's Department of Commerce...

  3. Zen and the Art of Management

    Science.gov (United States)

    Pascale, Richard Tanner

    1978-01-01

    A study of Japanese-managed companies in the U.S. and Japan found that their decision-making processes are not much different from American companies. However, an eastern perspective on management and organizational communication emphasizes the value of the subtle arts employed by successful Japanese and American managers alike. (JG)

  4. Status of Neonatal Pain Assessment and Management in Jordan.

    Science.gov (United States)

    Abdel Razeq, Nadin M; Akuma, Akuma O; Jordan, Sue

    2016-08-01

    Current pain assessment and management in neonates need to be fully described before neonatal pain care can be optimized. This study's purpose was to report neonatal nurses' knowledge, existing pain assessment practice, and pharmacological pain management of neonates in Jordan. A cross-sectional descriptive study was conducted. Eighteen neonatal intensive care units in Jordan were included in the study. One hundred eighty-four neonatal nurses participated. Questionnaires were distributed by and returned to the neonatal intensive care units' managers between June and August 2014. Descriptive and inferential statistics were used to present study results. Of 240 questionnaires distributed, 184 useable responses were returned. Nurses' knowledge regarding neonates' neurological development, nociception, and need for neonatal pain management was suboptimal. The analgesics most commonly used to treat neonatal pain were acetaminophen (52%) and lidocaine (45%). Benzodiazepines, phenobarbitone, and muscles relaxants were also used. Most nurses (54%-97%) reported that pain emanating from most painful procedures was never or rarely treated. Circumcision, lumbar punctures, and chest tube insertion were assigned the highest pain scores (≥9), but were rarely accompanied by analgesia. Pain assessment scales were more likely to be used, and procedural pain was more likely to be treated, in private hospitals than public hospitals. Neonates who require special care still suffer unnecessary pain that could be avoided and managed by following best practice recommendations. Disparities between developed and developing countries in quality of neonatal pain care appear to exist. Resources for education and routine care are needed to address these discrepancies. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

    Science.gov (United States)

    Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

    2017-08-01

    This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

  6. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

    Science.gov (United States)

    Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

    2017-09-01

    This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

  7. Evidence-Based Management of Anticoagulant Therapy

    Science.gov (United States)

    Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

    2012-01-01

    Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

  8. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Hinkle, Janice L; Becker, Kyra J; Kim, Jong S; Choi-Kwon, Smi; Saban, Karen L; McNair, Norma; Mead, Gillian E

    2017-07-01

    At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers. © 2017 American Heart Association, Inc.

  9. A randomized controlled trial of intensive care management for disabled Medicaid beneficiaries with high health care costs.

    Science.gov (United States)

    Bell, Janice F; Krupski, Antoinette; Joesch, Jutta M; West, Imara I; Atkins, David C; Court, Beverly; Mancuso, David; Roy-Byrne, Peter

    2015-06-01

    To evaluate outcomes of a registered nurse-led care management intervention for disabled Medicaid beneficiaries with high health care costs. Washington State Department of Social and Health Services Client Outcomes Database, 2008-2011. In a randomized controlled trial with intent-to-treat analysis, outcomes were compared for the intervention (n = 557) and control groups (n = 563). A quasi-experimental subanalysis compared outcomes for program participants (n = 251) and propensity score-matched controls (n = 251). Administrative data were linked to describe costs and use of health services, criminal activity, homelessness, and death. In the intent-to-treat analysis, the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod. In the subanalysis, participants had fewer unplanned hospital admissions and lower associated costs; higher prescription drug costs; higher odds of long-term care service use; higher drug/alcohol treatment costs; and lower odds of homelessness. We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management. Among participants, care management may have the potential to increase access to needed care, slow growth in the number and therefore cost of unplanned hospitalizations, and prevent homelessness. These findings apply to start-up care management programs targeted at high-cost, high-risk Medicaid populations. © Health Research and Educational Trust.

  10. The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia.

    Science.gov (United States)

    Lichtner, Valentina; Dowding, Dawn; Closs, S José

    2015-12-24

    Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital. An exploratory study was conducted in four hospitals in the UK (11 wards), with observations of patients with dementia (n = 31), interviews of staff (n = 52) and patients' family members (n = 4) and documentary analysis. A thematic analysis was carried out, structured along dimensions of decision making. This paper focuses on the emergent themes related to the use of assessment tools and pain intensity scores. A variety of tools were used to record pain intensity, usually with numerical scales. None of the tools in actual use had been specifically designed for patients with cognitive impairment. With patients with more severe dementia, the patient's body language and other cues were studied to infer pain intensity and then a score entered on behalf of the patient. Information regarding the temporality of pain and changes in pain experience (rather than a score at a single point in time) seemed to be most useful to the assessment of pain. Given the inherent uncertainty of the meaning of pain scores for patients with dementia, numerical scales were used with caution. Numerical scores triggered action but their meaning was relative - to the patient, to the clinician, to the time of recording and to the purpose of documenting. There are implications for use of data and computerized decision support systems design. Decision support interventions should include personalized alerting cut-off scores for individual patients, display pain scores over time and integrate

  11. Shunt-dependent hydrocephalus: management style among members of the American Society of Pediatric Neurosurgeons.

    Science.gov (United States)

    Kraemer, Mark R; Sandoval-Garcia, Carolina; Bragg, Taryn; Iskandar, Bermans J

    2017-09-01

    OBJECTIVE The authors conducted a survey to evaluate differences in the understanding and management of shunt-dependent hydrocephalus among members of the American Society of Pediatric Neurosurgeons (ASPN). METHODS Surveys were sent to all 204 active ASPN members in September 2014. One hundred thirty responses were received, representing a 64% response rate. Respondents were asked 13 multiple-choice and free-response questions regarding 4 fundamental problems encountered in shunted-hydrocephalus management: shunt malfunction, chronic cerebrospinal fluid (CSF) overdrainage, chronic headaches, and slit ventricle syndrome (SVS). RESULTS Respondents agreed that shunt malfunction occurs most often as the result of ventricular catheter obstruction. Despite contrary evidence in the literature, most respondents (66%) also believed that choroid plexus is the tissue most often found in obstructed proximal catheters. However, free-text responses revealed that the respondents' understanding of the underlying pathophysiology of shunt obstruction was highly variable and included growth, migration, or adherence of choroid plexus, CSF debris, catheter position, inflammatory processes, and CSF overdrainage. Most respondents considered chronic CSF overdrainage to be a rare complication of shunting in their practice and reported wide variation in treatment protocols. Moreover, despite a lack of evidence in the literature, most respondents attributed chronic headaches in shunt patients to medical reasons (for example, migraines, tension). Accordingly, most respondents managed headaches with reassurance and/or referral to pain clinics. Lastly, there were variable opinions on the etiology of slit ventricle syndrome (SVS), which included early shunting, chronic overdrainage, and/or loss of brain compliance. Beyond shunt revision, respondents reported divergent SVS treatment preferences. CONCLUSIONS The survey shows that there is wide variability in the understanding and management of

  12. Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease.

    Science.gov (United States)

    Jagt-van Kampen, Charissa T; Colenbrander, Derk A; Bosman, Diederik K; Grootenhuis, Martha A; Kars, Marijke C; Schouten-van Meeteren, Antoinette Yn

    2018-01-01

    Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children's university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT. Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT. Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases). This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT.

  13. Silicone rubber curing by high intensity infrared radiation

    International Nuclear Information System (INIS)

    Huang, T.; Tsai, J.; Cherng, C.; Chen, J.

    1994-01-01

    A high-intensity (12 kW) and compact (80 cm) infrared heating oven for fast curing (12 seconds) of tube-like silicone rubber curing studies is reported. Quality inspection by DSC and DMA and results from pilot-scale curing oven all suggest that infrared heating provides a better way of vulcanization regarding to curing time, quality, cost, and spacing over conventional hot air heating. copyright 1995 American Institute of Physics

  14. Neutron intensity of fast reactor spent fuel

    Energy Technology Data Exchange (ETDEWEB)

    Takamatsu, Misao; Aoyama, Takafumi [Power Reactor and Nuclear Fuel Development Corp., Oarai, Ibaraki (Japan). Oarai Engineering Center

    1998-03-01

    Neutron intensity of spent fuel of the JOYO Mk-II core with a burnup of 62,500 MWd/t and cooling time of 5.2 years was measured at the spent fuel storage pond. The measured data were compared with the calculated values based on the JOYO core management code system `MAGI`, and the average C/E approximately 1.2 was obtained. It was found that the axial neutron intensity didn`t simply follow the burnup distribution, and the neutron intensity was locally increased at the bottom end of the fuel region due to an accumulation of {sup 244}Cm. (author)

  15. Relativistic focusing and ponderomotive channeling of intense laser beams

    International Nuclear Information System (INIS)

    Hafizi, B.; Ting, A.; Sprangle, P.; Hubbard, R. F.

    2000-01-01

    The ponderomotive force associated with an intense laser beam expels electrons radially and can lead to cavitation in plasma. Relativistic effects as well as ponderomotive expulsion of electrons modify the refractive index. An envelope equation for the laser spot size is derived, using the source-dependent expansion method with Laguerre-Gaussian eigenfunctions, and reduced to quadrature. The envelope equation is valid for arbitrary laser intensity within the long pulse, quasistatic approximation and neglects instabilities. Solutions of the envelope equation are discussed in terms of an effective potential for the laser spot size. An analytical expression for the effective potential is given. For laser powers exceeding the critical power for relativistic self-focusing the analysis indicates that a significant contraction of the spot size and a corresponding increase in intensity is possible. (c) 2000 The American Physical Society

  16. Management of patients in a dedicated burns intensive care unit (BICU) in a developing country.

    Science.gov (United States)

    Hashmi, Madiha; Kamal, Rehana

    2013-05-01

    In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU). This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented. A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR =32-7). 32% victims were children 50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36-33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%. Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death. Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality. Burn hazard awareness, prevention and educational programmes targeted at the

  17. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

    Science.gov (United States)

    Ross, Douglas S; Burch, Henry B; Cooper, David S; Greenlee, M Carol; Laurberg, Peter; Maia, Ana Luiza; Rivkees, Scott A; Samuels, Mary; Sosa, Julie Ann; Stan, Marius N; Walter, Martin A

    2016-10-01

    Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the

  18. Cost and benefits of a multidisciplinary intensive diabetes education programme

    NARCIS (Netherlands)

    Keers, J.C.; Groen, H.; Sluiter, W.J.; Bouma, J.; Links, T.P.

    OBJECTIVES: To determine the cost and benefits of an intensive diabetes education programme for patients with prolonged self-management problems and to determine the inclusion criteria for optimal outcomes. METHODS: Sixty-one participants of a multidisciplinary intensive diabetes education programme

  19. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE.

    Science.gov (United States)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R; Duick, Daniel S; Harrell, R Mack; Hegedüs, Laszlo; Paschke, Ralf; Valcavi, Roberto; Vitti, Paolo

    2016-05-01

    Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for

  20. A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study.

    Science.gov (United States)

    Nundy, Shantanu; Razi, Rabia R; Dick, Jonathan J; Smith, Bryan; Mayo, Ainoa; O'Connor, Anne; Meltzer, David O

    2013-03-11

    There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. The purpose of this pre-post study was to assess the feasibility and acceptability of a text message-based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. Hospitalized patients with ADHF were enrolled in an automated text message-based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. Of 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake

  1. Latin American Research Consortiums : a Comparative Analysis ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Latin American countries are implementing several policies to enhance innovation. ... foster research collaboration between different actors in the innovation system. ... adaptive water management: Innovative solutions from the Global South”.

  2. Environmental management in North American mining sector.

    Science.gov (United States)

    Asif, Zunaira; Chen, Zhi

    2016-01-01

    This paper reviews the environmental issues and management practices in the mining sector in the North America. The sustainable measures on waste management are recognized as one of the most serious environmental concerns in the mining industry. For mining activities, it will be no surprise that the metal recovery reagents and acid effluents are a threat to the ecosystem as well as hazards to human health. In addition, poor air quality and ventilation in underground mines can lead to occupational illness and death of workers. Electricity usage and fuel consumption are major factors that contribute to greenhouse gases. On the other hand, many sustainability challenges are faced in the management of tailings and disposal of waste rock. This paper aims to highlight the problems that arise due to poor air quality and acid mine drainage. The paper also addresses some of the advantages and limitations of tailing and waste rock management that still have to be studied in context of the mining sector. This paper suggests that implementation of suitable environmental management tools like life cycle assessment (LCA), cleaner production technologies (CPTs), and multicriteria decision analysis (MCD) are important as it ultimately lead to improve environmental performance and enabling a mine to focus on the next stage of sustainability.

  3. Aspirin is first-line treatment for migraine and episodic tension-type headache regardless of headache intensity.

    Science.gov (United States)

    Lampl, Christian; Voelker, Michael; Steiner, Timothy J

    2012-01-01

    (1) To establish whether pre-treatment headache intensity in migraine or episodic tension-type headache (ETTH) predicts success or failure of treatment with aspirin; and (2) to reflect, accordingly, on the place of aspirin in the management of these disorders. Stepped care in migraine management uses symptomatic treatments as first-line, reserving triptans for those in whom this proves ineffective. Stratified care chooses between symptomatic therapy and triptans as first-line on an individual basis according to perceived illness severity. We questioned the 2 assumptions underpinning stratified care in migraine that greater illness severity: (1) reflects greater need; and (2) is a risk factor for failure of symptomatic treatment but not of triptans. With regard to the first assumption, we developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity. To address the second, we reviewed individual patient data from 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre-treatment headache intensity. In migraine, for headache relief at 2 hours, a small (4.7%) and non-significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: -0.2%). In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (-4.2%) and aspirin 1000 mg (-9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (-14.2 and -3.6) again favored severe pain. In neither migraine nor ETTH does pre-treatment headache intensity predict success or failure of aspirin. This is not an arguable basis for stratified care in migraine. In both disorders, aspirin is first-line treatment regardless of headache intensity. © 2011 American Headache Society.

  4. Intensive Care Management of Myasthenia Gravis After Thymectomy ...

    African Journals Online (AJOL)

    Aim:To evaluate the management of post thymectomy myasthenia gravis (MG) patient in our centre; to highlight those aspects of patient care that could improve outcome and to serve as a bench mark for developing a standardized protocol for management. Method: A retrospective study of 5 cases of post thymectomy MG ...

  5. Training the Multi-Cultural Manager.

    Science.gov (United States)

    O'Neill, Vincent

    A West German electronics corporation designed a workshop to provide managers with fast access to the American culture through the cues provided in American language. The aim was to promote more effective communication with American business partners through sensitization to American communication styles, their principal modes of expression, their…

  6. A Case Study of the Development of African American Women Executives

    Science.gov (United States)

    Brooks Greaux, Lisa

    2010-01-01

    Even in an era when the country elected an African American man as President of the United States, there is still a paucity of African American women executives within Fortune 500 companies. Although more African American women have joined the ranks of corporate management over the last two decades, the numbers, when compared to those of White…

  7. Discriminatory Experiences and Depressive Symptoms among African American Women: Do Skin Tone and Mastery Matter?

    OpenAIRE

    Keith, Verna M.; Lincoln, Karen D.; Taylor, Robert Joseph; Jackson, James S.

    2010-01-01

    We apply structural equation modeling techniques to data from the National Survey of American Life to investigate the relationship between perceived discrimination and depressive symptoms among African American women ages 18–98 years (N=2,299). In addition, we evaluate whether or not personal mastery accounts for the intensity of African American women’s psychological response to discrimination and whether or not exposure to discrimination varies by skin complexion. Findings reveal that discr...

  8. Differences in the Intensity and Duration of Adolescents' Sports and Exercise across Physical and Social Environments

    Science.gov (United States)

    Dunton, Genevieve Fridlund; Berrigan, David; Ballard-Barbash, Rachel; Perna, Frank; Graubard, Barry I.; Atienza, Audie A.

    2012-01-01

    We used data from the American Time Use Survey (years 2003-06) to analyze whether the intensity and duration of high school students' (ages 15-18 years) sports and exercise bouts differed across physical and social environments. Boys' sports and exercise bouts were more likely to reach a vigorous intensity when taking place at school and with…

  9. Social justice in climate services: Engaging African American farmers in the American South

    Directory of Open Access Journals (Sweden)

    C. Furman

    2014-01-01

    Full Text Available This article contributes to efforts to develop more inclusive climate services, understood as institutional arrangements and processes that generate and disseminate science-based climate information to promote improved preparedness to climate impacts. Discussion on equity in climate services tends to focus on the specific challenges of women and the poor in developing countries. We seek to broaden this scope by considering a farming population in the southern United States, whose particular circumstances are shaped by rural poverty as well as by racial discrimination, namely African American farmers. The research is based on a phone survey, in-depth interviews, and a workshop, and was conducted in collaboration with a civil right organization that helped the research team gain trust and entry to this community. The findings show that farmers in this study are vulnerable to drought given their relatively limited access to resources and risk management mechanisms. Climate forecasts can help these farmers move from coping strategies to deal with the effects of climate anomalies to proactive planning to anticipate and mitigate those effects. Research participants were able to identify a range of options for using such information in risk management decisions. Provision of climate services to African American farmers, however, must be consistent with existing patterns of knowledge management. These patterns are shaped by major trends stemming from the transformation of rural Southern life. Social networks of mutual assistance and knowledge transmission have been eroded by the outmigration of African American farmers from rural areas. Additionally, their relationship with public agencies is marred by a legacy of racial inequities, which makes it difficult for well-meaning projects involving the same agencies to establish legitimacy in this community. We discuss how insights from research findings and research process have guided programmatic efforts

  10. Team working in intensive care: current evidence and future endeavors.

    Science.gov (United States)

    Richardson, Joanne; West, Michael A; Cuthbertson, Brian H

    2010-12-01

    It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

  11. Improving American Innovation,

    Science.gov (United States)

    1984-03-01

    Why has Jap~m succeeded: western technology and the Japanese ethos. New York: Cambridge University Press, 1982. (NC 462 MO634 Norman , Colin...productivity growth. Review of Economics and Statistics 64:627-34, N~ovember 1982. Smith, G. W. and W. N. Smallwood . Preparing for breakthroughs: the rewards of...recommendations. Edited by Charles E. Larsen and WI. Novis Smith. Washington: American Chemical Society, 1980. Kobert, Norman . Agressivn management style

  12. Young, black, and connected: Facebook usage among African American college students.

    Science.gov (United States)

    Lee, E Bun

    2012-01-01

    This article examines the extent and intensity of Facebook usage among African American college students and investigates their reasons for using Facebook. As expected, 98% of students in the survey had a Facebook account, and a large number of Facebook “friends.” Younger users spent significantly more time on Facebook than older ones. Our findings underscore the importance of cultural influence for African American online users. Displaying photographs and personal interests on Facebook signals racial identity among African American college students. Personality traits, such as self-esteem, trust in people, satisfaction with university life, and racial identity, were not significant predictors on the time spent on Facebook.

  13. Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis.

    Science.gov (United States)

    Coombs, Maureen; Mitchell, Marion; James, Stephen; Wetzig, Krista

    2017-10-01

    End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n = 54, 85·3%), from the public sector (n = 51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n = 39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n = 145, 77·5%), educational provision to support staff (n = 15, 8%) and organisational challenges (n = 27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death

  14. Impacts of sugarcane agriculture expansion over low-intensity cattle ranch pasture in Brazil on greenhouse gases.

    Science.gov (United States)

    Bento, Camila Bolfarini; Filoso, Solange; Pitombo, Leonardo Machado; Cantarella, Heitor; Rossetto, Raffaella; Martinelli, Luiz Antonio; do Carmo, Janaina Braga

    2018-01-15

    Sugarcane is a widespread bioenergy crop in tropical regions, and the growing global demand for renewable energy in recent years has led to a dramatic expansion and intensification of sugarcane agriculture in Brazil. Currently, extensive areas of low-intensity pasture are being converted to sugarcane, while management in the remaining pasture is becoming more intensive, i.e., includes tilling and fertilizer use. In this study, we assessed how such changes in land use and management practices alter emissions of greenhouse gases (GHG) such as CO 2 , N 2 O and CH 4 by measuring in situ fluxes for one year after conversion from low-intensity pasture to conventional sugarcane agriculture and management-intensive pasture. Results show that CO 2 and N 2 O fluxes increased significantly in pasture and sugarcane with tillage, fertilizer use, or both combined. Emissions were highly variable for all GHGs, yet, cumulatively, it was clear that annual emissions in CO 2 -equivalent (CO 2 -eq) were higher in management-intense pasture and sugarcane than in unmanaged pasture. Surprisingly, tilled pasture with fertilizer (management-intensive pasture) resulted in higher CO 2 -eq emissions than conventional sugarcane. We concluded that intensification of pasture management and the conversion of pasture to sugarcane can increase the emission factor (EF) estimated for sugarcane produced in Brazil. The role of management practices and environmental conditions and the potential for reducing emissions are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. American wild celery (Vallisneria americana): Ecological considerations for restoration

    Science.gov (United States)

    Korschgen, C.E.; Green, W.L.

    1988-01-01

    The success of vegetation management programs for waterfowl is dependent on knowing the physical and physiological requirements of target species. Lakes and riverine impoundments that contain an abundance of the American wildcelery (Vallisneria americana ) have traditionally been favored by canvasbacks (Aythya valisineria ) and other waterfowl as feeding areas during migration. Information on the ecology of American wildcelery is summarized to serve as a guide for potential wetland restoration projects. Techniques are described for transplanting winter buds. Management programs that employ these techniques should define objectives clearly and evaluate the water regime carefully before initiating major restoration.

  16. 76 FR 78703 - American Century Strategic Asset Allocations, Inc., et al.;

    Science.gov (United States)

    2011-12-19

    ...] American Century Strategic Asset Allocations, Inc., et al.; Notice of Application December 13, 2011. AGENCY... Century Strategic Asset Allocations, Inc. (``ACSAA''), American Century Investment Management, Inc... with its investment objectives, policies, strategies and limitations, in financial instruments that may...

  17. Pain still hurts : pain assessment and pain management in intensive care patients

    NARCIS (Netherlands)

    S.J.G.M. Ahlers (Sabine)

    2012-01-01

    textabstractIntensive care patients are subject to many factors that may influence the patients’ state of comfort or distress. Pain is the main cause of distress experienced by many adult intensive care patients, which can be caused by different factors like underlying disease, prolonged immobility

  18. Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement.

    Science.gov (United States)

    Bailey, Rahn K; Fileti, Cecelia Pozo; Keith, Jeanette; Tropez-Sims, Susanne; Price, Winston; Allison-Ottey, Sharon Denise

    2013-01-01

    Dairy foods contribute nine essential nutrients to the diet including calcium, potassium and vitamin D; nutrients identified by the 2010 Dietary Guidelines for Americans as being "of public health concern" within the U.S. population. Milk and milk product intake is associated with better diet quality and has been associated with a reduced risk of chronic diseases or conditions including hypertension, cardiovascular disease, metabolic syndrome, Type 2 Diabetes and osteoporosis. Some research also indicates dairy food intake may be linked to reduced body fat, when accompanied by energy-restriction. On average, both African Americans and Hispanic Americans consume less than the recommended levels of dairy foods, and perceived or actual lactose intolerance can be a primary reason for limiting or avoiding dairy intake. True lactose intolerance prevalence is not known because healthcare providers do not routinely measure for it, and no standardized assessment method exists. Avoiding dairy may lead to shortfalls of essential nutrients and increased susceptibility to chronic disease. This updated Consensus Statement aims to provide the most current information about lactose intolerance and health, with specific relevance to the African American and Hispanic American communities. Topics covered include diagnostic considerations, actual and recommended dairy food intake and levels of consumption of key dairy nutrients among African Americans and Hispanic Americans; prevalence of self-reported lactose intolerance among various racial/ethnic groups; the association between dairy food intake, lactose intolerance and chronic disease; and research-based management recommendations for those with lactose intolerance.

  19. Livestock grazing intensity affects abundance of Common shrews (Sorex araneus) in two meadows in Denmark

    Science.gov (United States)

    Schmidt, Niels M; Olsen, Henrik; Leirs, Herwig

    2009-01-01

    Background Current nature conservation in semi-natural grasslands often includes grazing and hay cutting, as well as the abandonment of draining. Semi-natural grassland and in particular meadows constitute important habitat type for a large number of animal species in today's fragmented and intensively cultivated landscape of Europe. Here we focus on the population characteristics of Common shrews Sorex araneus in relation to livestock grazing intensity in two wet meadows in western Denmark. Results High grazing intensity had a significant negative effect on Common shrew number compared to low grazing intensity and no grazing. Common shrew abundance was generally, but not significantly, higher on the low grazing intensity plots than on the ungrazed controls. No differences in body mass, sex ratio, or reproductive output between Common shrew individuals from the various grazing treatments were found. Conclusion No negative effects of low intensity grazing on Common shrew abundance were found compared to the ungrazed control. Low intensity grazing thus seems a suitable management regime for Common shrews, when grazing is needed as part of the meadow management scheme. High intensity grazing on the other hand is not a suitable management tool. PMID:19152713

  20. Livestock grazing intensity affects abundance of Common shrews (Sorex araneus in two meadows in Denmark

    Directory of Open Access Journals (Sweden)

    Olsen Henrik

    2009-01-01

    Full Text Available Abstract Background Current nature conservation in semi-natural grasslands often includes grazing and hay cutting, as well as the abandonment of draining. Semi-natural grassland and in particular meadows constitute important habitat type for a large number of animal species in today's fragmented and intensively cultivated landscape of Europe. Here we focus on the population characteristics of Common shrews Sorex araneus in relation to livestock grazing intensity in two wet meadows in western Denmark. Results High grazing intensity had a significant negative effect on Common shrew number compared to low grazing intensity and no grazing. Common shrew abundance was generally, but not significantly, higher on the low grazing intensity plots than on the ungrazed controls. No differences in body mass, sex ratio, or reproductive output between Common shrew individuals from the various grazing treatments were found. Conclusion No negative effects of low intensity grazing on Common shrew abundance were found compared to the ungrazed control. Low intensity grazing thus seems a suitable management regime for Common shrews, when grazing is needed as part of the meadow management scheme. High intensity grazing on the other hand is not a suitable management tool.

  1. International cooperation for disaster management -- Romanian-American experience in the achievement of a joint exercise using decision support tools for radiological emergency

    International Nuclear Information System (INIS)

    Qualls, J.R.; Botirca, R.; Gabor, A.; Miron, A.

    1995-01-01

    International coordination and cooperation is rewarding but at the same time very challenging. This paper will discuss the Romanian perspective on technology transfer, its problems and its advantages. Further, the discussion will take place in the context of preparing for an international conference while at the same time exchanging civil defense expertise. The American perspective on the same subject will also be presented with healthy doses of mutual explanations. The final portion of the paper will present the joint lessons learned from the newly created interfaces and what it holds for the future. The paper aims to present the Romanian and American experts' opinion about the demonstration of using computer technology for helping the international cooperation in the field of disaster management

  2. American Academy of Allergy, Asthma, and Immunology

    Science.gov (United States)

    ... reasons to celebrate its journals. Learn More about the American Academy Of Allergy, Asthma & Immunology Life Spectrum of Asthma Meeting School-based Asthma Management Program – (SAMPRO TM ) This central resource focuses on ...

  3. Critical Zone services as environmental assessment criteria in intensively managed landscapes

    Science.gov (United States)

    Richardson, Meredith; Kumar, Praveen

    2017-06-01

    The Critical Zone (CZ) includes the biophysical processes occurring from the top of the vegetation canopy to the weathering zone below the groundwater table. CZ services provide a measure for the goods and benefits derived from CZ processes. In intensively managed landscapes, cropland is altered through anthropogenic energy inputs to derive more productivity, as agricultural products, than would be possible under natural conditions. However, the actual costs of alterations to CZ functions within landscape profiles are unknown. Through comparisons of corn feed and corn-based ethanol, we show that valuation of these CZ services in monetary terms provides a more concrete tool for characterizing seemingly abstract environmental damages from agricultural production systems. Multiple models are combined to simulate the movement of nutrients throughout the soil system, enabling the measurement of agricultural anthropogenic impacts to the CZ's regulating services. Results indicate water quality and atmospheric stabilizing services, measured by soil carbon storage, carbon respiration, and nitrate leaching, among others, can cost more than double that of emissions estimated in previous studies. Energy efficiency in addition to environmental impact is assessed to demonstrate how the inclusion of CZ services is necessary in accounting for the entire life cycle of agricultural production systems. These results conclude that feed production systems are more energy efficient and less environmentally costly than corn-based ethanol.

  4. Professional Immigrant Women's Experiences of Managing Work and Family Conflicts: The Case of Chinese and Taiwanese Faculty in Research Intensive Universities

    OpenAIRE

    Li, Yun Ling

    2017-01-01

    This study investigates first-generation Chinese and Taiwanese immigrant women faculty's workplace experiences and their strategies for managing work and family demands. By looking at how immigration, ethnicity, gender, and work processes shape these women's ideology and practices, this study addresses the following questions: How do married Chinese and Taiwanese immigrant women in research-intensive universities handle work and family conflicts? How do they negotiate their gender-role expect...

  5. Intense Adrenal Enhancement: A CT Feature of Cardiogenic Shock

    International Nuclear Information System (INIS)

    Hrabak-Paar, Maja

    2016-01-01

    In this report, images of intense adrenal enhancement in a 79-year-old female patient with right-sided heart failure and severe tricuspid insufficiency are presented. Only two cases of intense adrenal enhancement as a sign of cardiogenic shock were previously reported in the literature. Intense adrenal enhancement could be one of the earliest CT signs of cardiogenic shock. Its presence should be immediately reported to the referring physician as a sign of significant hemodynamic instability warranting early critical-care management

  6. Intense Adrenal Enhancement: A CT Feature of Cardiogenic Shock

    Energy Technology Data Exchange (ETDEWEB)

    Hrabak-Paar, Maja, E-mail: maja.hrabak.paar@mef.hr [University of Zagreb School of Medicine, Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb (Croatia)

    2016-02-15

    In this report, images of intense adrenal enhancement in a 79-year-old female patient with right-sided heart failure and severe tricuspid insufficiency are presented. Only two cases of intense adrenal enhancement as a sign of cardiogenic shock were previously reported in the literature. Intense adrenal enhancement could be one of the earliest CT signs of cardiogenic shock. Its presence should be immediately reported to the referring physician as a sign of significant hemodynamic instability warranting early critical-care management.

  7. Cattle and elk responses to intensive timber harvest.

    Science.gov (United States)

    Michael J. Wisdom; Bruce K. Johnson; Martin Vavra; Jennifer M. Boyd; Priscilla K. Coe; John G. Kie; Alan A. Ager; Norman J. Cimon

    2004-01-01

    Forested habitats for cattle and elk (Cervus elaphus) in the western United States have changed substantially in response to intensive timber management during the latter half of the 20th century. Consequently, the subject of how elk and other ungulates respond to timber management is a high-profile, long-standing issue that continues to be studied...

  8. Tribal-federal collaboration in resource management

    Science.gov (United States)

    Ellen M. Donoghue; Sara A. Thompson; John C. Bliss

    2010-01-01

    The increase in collaborative projects involving American Indian tribes and natural resource management agencies in the United States reflects two emergent trends: 1) the use of collaborative approaches between agencies and groups in managing natural resources; and 2) the concurrent increased recognition of American Indian rights, institutionalization of consultation...

  9. Identification of Elizabethkingia meningoseptica from American bullfrog (Rana catesbeiana farmed in Sabah, Malaysia using PCR method and future management of outbreak

    Directory of Open Access Journals (Sweden)

    Zainuri, N.

    2013-01-01

    Full Text Available Aims: High demand for frog meat in Malaysia especially the American bullfrog (Rana catesbeiana has promoted intensive farming of the animal. However, the farming of American bullfrog is restricted by the occurrence of diseases. This study reports the first isolation of Elizabethkingia meningoseptica from specimens of American bullfrog that suffer from cataract and ‘red-leg’ syndrome.Methodology and Result: The pathogen was isolated from eyes and internal organs (liver, kidney and spleen of thediseased bullfrog specimens. All the bacterial isolates were subjected to phenotypic characterization and antibiotic susceptibility assay, and further identified by using the 16S rDNA sequencing analysis. We designed two pair of specific PCR primers (22-25 mers which are complimentary to the β-lactamase gene in the reference strain ofE. meningoseptica ATCC49470. The result showed all the bacterial isolates shared similar phenotypic characters and antibiotic susceptibility. BLAST analysis of the 16S rDNA sequences indicated that the bacterial isolates had very high sequence homology (100% with E. meningospetica ATCC49470 and E. meningoseptica isolates from mosquito. The two PCR primers were very specific to E. meningoseptica isolates of this study. Conclusion, significance and impact of study: This is the first isolation and characterization of bacterial pathogen, E. meningoseptica in cultured American bullfrog (Rana catesbeina that suffered from eye cataract and ‘red-leg’syndrome in Sabah, Malaysia. It is suspected that one of the possible transmission routes of the bacterial pathogen could be via mosquito bites. The findings suggest that there is urgent requirement for standard guideline of good farming practice to be adopted in frog farms throughout the country. Such a guideline can help in minimizing economic losses, preventing transmission of the zoonotic bacterial pathogen to farm workers, and sustaining the industry in Malaysia andupgrading

  10. Digenetic trematodes in South American sea lions from southern Brazilian waters.

    Science.gov (United States)

    Pereira, E M; Müller, G; Secchi, E; Pereira, J; Valente, A L S

    2013-10-01

    The aim of this work was to perform a systematic study to detect and quantify the digenetic trematode infections in South American sea lions from the southern Brazilian coast. Twenty-four South American sea lions, Otaria flavescens (Carnivora: Otaridae), were found dead along the coast of Rio Grande do Sul State, Brazil, between June 2010 and September of 2011. Two trematode species were found in the intestines of O. flavescens, i.e., Stephanoprora uruguayense (Digenea: Echinostomatidae) and Ascocotyle (Phagicola) longa (Digenea: Heterophyidae). Ascocotyle (P.) longa reached a prevalence of 33.3% and mean intensity of 248,500, whereas S. uruguayense showed a prevalence of 4.2% and mean intensity of 202. The 2 trematode species infecting sea lions were likely transmitted by feeding on mullets, Mugil platanus, that commonly harbor heterophyid metacercariae. The present work is the first report of digenetic trematodes infecting O. flavescens in Brazil. The high prevalence and mean intensity values of the 2 trematode species infecting sea lions in the present study suggest caution in human consumption of mullets and other fish, which can be infected with the metacercariae of these trematodes known to have zoonotic potential.

  11. The Cultural Relevance of Mindfulness Meditation as a Health Intervention for African Americans

    Science.gov (United States)

    Woods-Giscombé, Cheryl L.; Gaylord, Susan A.

    2014-01-01

    African Americans experience a disproportionate rate of stress-related health conditions compared to European Americans. Mindfulness meditation has been shown to be effective for managing stress and various stress-related health conditions. This study explored the cultural relevance of mindfulness meditation training for African Americans adults. Fifteen African American adults with past or current experience with mindfulness meditation training were interviewed. Participants felt that mindfulness meditation helped them with enhanced stress management, direct health improvement, and enhanced self-awareness and purposefulness. They felt that they would recommend it and that other African Americans would be open to the practice but suggested that its presentation may need to be adapted. They suggested emphasizing the health benefits, connecting it to familiar spiritual ideology and cultural practices, supplementing the reading material with African American writers, increasing communication (education, instructor availability, “buddy system,” etc.), and including African Americans as instructors and participants. By implementing minor adaptations that enhance cultural relevance, mindfulness meditation can be a beneficial therapeutic intervention for this population. PMID:24442592

  12. Refleksiv Sports Management

    DEFF Research Database (Denmark)

    Adamsen, Billy

    2013-01-01

    Sports management and its development is closely linked to the development of modern society and modern rationality. This article applies sociological theories and practical management philosophy to shed light on how sports management and its rationality in Denmark (Europe) and the United States...... have changed and undergone different phases for more than a century, and to show that, in late modernity, they are entering a new phase in which they seem to be more reflexive and communicative. This trend is evident in American sports management and will also soon be reflected in Danish sports...... management. My analysis of this development will also be based on a specific case study from the American world of sports, namely the story of Oakland Athletics baseball club’s reorganisation in the 1990s, because it both provides a rare insight into a modern sports organisation and demonstrates...

  13. Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

    Science.gov (United States)

    Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

    2016-01-01

    The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

  14. Effective Public Management

    Science.gov (United States)

    Bower, Joseph L.

    1977-01-01

    Argues that public management differs from private management not just in degree but in quality, so that American business is an inappropriate analogy for evaluating public management. In particular, "purpose,""organization," and "people" have different meaning and significance in public agencies and private businesses. (JG)

  15. A meta-analysis of the effects of common management actions on the nest success of North American birds.

    Science.gov (United States)

    Hartway, Cynthia; Mills, L Scott

    2012-08-01

    Management strategies for the recovery of declining bird populations often must be made without sufficient data to predict the outcome of proposed actions or sufficient time and resources necessary to collect these data. We quantitatively reviewed studies of bird management in Canada and the United States to evaluate the relative efficacy of 4 common management interventions and to determine variables associated with their success. We compared how livestock exclusion, prescribed burning, removal of predators, and removal of cowbirds (Molothrus ater) affect bird nest success and used meta-regression to evaluate the influence of species and study-specific covariates on management outcomes. On average, all 4 management interventions increased nest success. When common species and threatened, endangered, or declining species (as defined by long-term trend data from the North American Breeding Bird Survey) were analyzed together, predator removal was the most effective management option. The difference in mean nest success between treatment and control plots in predator-removal experiments was more than twice that of either livestock exclusion or prescribed burning. However, when we considered management outcomes from only threatened, endangered, or declining species, livestock exclusions resulted in the greatest mean increase in nest success, more than twice that of the 3 other treatments. Our meta-regression results indicated that between-species variation accounted for approximately 86%, 40%, 35%, and 7% of the overall variation in the results of livestock-exclusion, prescribed-burn, predator-removal, and cowbird-removal studies, respectively. However, the covariates we tested explained significant variation only in outcomes among prescribed-burn studies. The difference in nest success between burned and unburned plots displayed a significant, positive trend in association with time since fire and was significantly larger in grasslands than in woodlands. Our results

  16. Intellectual Capital at Risk: Data Management Practices and Data Loss by Faculty Members at Five American Universities

    Directory of Open Access Journals (Sweden)

    Jaime Schumacher

    2015-06-01

    Full Text Available A study of 56 professors at five American universities found that a majority had little understanding of principles, well-known in the field of data curation, informing the ongoing administration of digital materials and chose to manage and store work-related data by relying on the use of their own storage devices and cloud accounts. It also found that a majority of them had experienced the loss of at least one work-related digital object that they considered to be important in the course of their professional career. Despite such a rate of loss, a majority of respondents expressed at least a moderate level of confidence that they would be able to make use of their digital objects in 25 years. The data suggest that many faculty members are unaware that their data is at risk. They also indicate a strong correlation between faculty members’ digital object loss and their data management practices. University professors producing digital objects can help themselves by becoming aware that these materials are subject to loss. They can also benefit from awareness and use of better personal data management practices, as well as participation in university-level programmatic digital curation efforts and the availability of more readily accessible, robust infrastructure for the storage of digital materials.

  17. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

    Science.gov (United States)

    2015-11-01

    To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are

  18. Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?

    Science.gov (United States)

    Egi, Moritoki; Bellomo, Rinaldo; Reade, Michael C

    2009-01-01

    Since the first report that intensive insulin therapy reduced mortality in selected surgical critically ill patients, lowering of blood glucose levels has been recommended as a means of improving patient outcomes. In this initial Leuven trial, blood glucose control by protocol using insulin was applied to 98.7% of patients in the intensive group but to only 39.2% (P dimension of glucose management, a possible mechanism by which an intensive insulin protocol exerts its putative beneficial effects, and an important goal of glucose management in the intensive care unit. Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials.

  19. An Anaylsis of Pretest and Post Test Scores of Head Start African American, Hispanic American and European American Students Engaged in an Intensive Emergent Literacy Program.

    Science.gov (United States)

    Baumgarten, Thomas L.; Minix, Quinella

    The Texas Education Agency awarded twenty competitive grants to Head Start programs in the state. The focus of the grants was on emergent literacy and pre-reading skills. Teachers, mentors, and administrators underwent intensive training. To investigate whether children emerged from the grant programs ready to enter school reading, an outside…

  20. Review of American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.

    Directory of Open Access Journals (Sweden)

    Valentin V. Fadeyev

    2017-12-01

    Full Text Available Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves’ hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves’ disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves’ orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves’ hyperthyroidism with antithyroid drugs, the management of pregnant

  1. Lived experience of the intensive care unit for patients who experienced delirium.

    Science.gov (United States)

    Whitehorne, Karen; Gaudine, Alice; Meadus, Robert; Solberg, Shirley

    2015-11-01

    Delirium is a common occurrence for patients in the intensive care unit and can have a profound and lasting impact on them. Few studies describe the experience of intensive care patients who have had delirium. To understand the lived experience of intensive care for critically ill patients who experienced delirium. The study participants consisted of 7 men and 3 women, 46 to 70 years old, who had delirium according to the Confusion Assessment Method for the Intensive Care Unit. The van Manen method of hermeneutic phenomenology was used, and data collection entailed audio recorded semistructured interviews. Four themes were detected: "I can't remember," "Wanting to make a connection," "Trying to get it straight," and "Fear and safety concerns." Nurses working in intensive care units need to assess patients for delirium, assess the mental status of patients who have delirium, and help patients and patients' families learn about and deal with the psychological effects of the intensive care unit experience. ©2015 American Association of Critical-Care Nurses.

  2. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2013-03-01

    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  3. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2013-01-01

    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  4. French intensive truck garden

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, T D

    1983-01-01

    The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for complete soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.

  5. Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project.

    Science.gov (United States)

    Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana

    Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

  6. Lion (Panthera leo) populations are declining rapidly across Africa, except in intensively managed areas.

    Science.gov (United States)

    Bauer, Hans; Chapron, Guillaume; Nowell, Kristin; Henschel, Philipp; Funston, Paul; Hunter, Luke T B; Macdonald, David W; Packer, Craig

    2015-12-01

    We compiled all credible repeated lion surveys and present time series data for 47 lion (Panthera leo) populations. We used a Bayesian state space model to estimate growth rate-λ for each population and summed these into three regional sets to provide conservation-relevant estimates of trends since 1990. We found a striking geographical pattern: African lion populations are declining everywhere, except in four southern countries (Botswana, Namibia, South Africa, and Zimbabwe). Population models indicate a 67% chance that lions in West and Central Africa decline by one-half, while estimating a 37% chance that lions in East Africa also decline by one-half over two decades. We recommend separate regional assessments of the lion in the World Conservation Union (IUCN) Red List of Threatened Species: already recognized as critically endangered in West Africa, our analysis supports listing as regionally endangered in Central and East Africa and least concern in southern Africa. Almost all lion populations that historically exceeded ∼ 500 individuals are declining, but lion conservation is successful in southern Africa, in part because of the proliferation of reintroduced lions in small, fenced, intensively managed, and funded reserves. If management budgets for wild lands cannot keep pace with mounting levels of threat, the species may rely increasingly on these southern African areas and may no longer be a flagship species of the once vast natural ecosystems across the rest of the continent.

  7. High Intensity Source Laboratory (HISL)

    International Nuclear Information System (INIS)

    1992-01-01

    The High Intensity Source Laboratory (HISL) is a laboratory facility operated for the US Department of Energy (DOE) by EG ampersand G, Energy Measurements (EG ampersand G/EM). This document is intended as an overview -- primarily for external users -- of the general purposes and capabilities of HISL; numerous technical details are beyond its scope. Moreover, systems at HISL are added, deleted, and modified to suit current needs, and upgraded with continuing development. Consequently, interested parties are invited to contact the HISL manager for detailed, current, technical, and administrative information. The HISL develops and operates pulsed radiation sources with energies, intensities, and pulse widths appropriate for several applications. Principal among these are development, characterization, and calibration of various high-bandwidth radiation detectors and diagnostic systems. Hardness/vulnerability of electronic or other sensitive components to radiation is also tested. In this connection, source development generally focuses on attending (1) the highest possible intensities with (2) reasonably short pulse widths and (3) comprehensive output characterization

  8. Asian American Librarians and Chinese American Librarians: Their Impact on the Profession and on U.S. Communities

    Directory of Open Access Journals (Sweden)

    Jian-Zhong (Joe Zhou

    2003-10-01

    Full Text Available

    頁次:14-21

    Among 150,000 librarians working in the United States, about 5% were Asians and Pacific Islanders (API, who worked mainly in the academic and large public libraries. Most Asian librarians had the unique characters of bilingual and bicultural background. They not only played a key service role to the API communities in the U.S., but also served as a bridge between mainstream American culture and the Asian culture that bound the API community together for generations. The Chinese American librarians have been a major component of API librarians and their association -- Chinese American Librarians Association (CALA is one of the most active ones among U.S. minority librarians associations. Chinese American librarians worked in all areas of library profession, especially in the technical services and Asian Studies libraries. The representation of Chinese American librarians working in the management category has been below the national average, which was a common phenomenon among Asian American educators in general.

  9. Characteristics of Intrapreneurs in Scale-Intensive Service Firms

    Directory of Open Access Journals (Sweden)

    Katja Maria Hydle

    2014-01-01

    Full Text Available This empirical paper explores the work of employees in charge of service innovation when firms develop and launch new scale-intensive services by addressing two re- search questions: i How do employees responsible for service innovation work? and ii what are the related managerial implications when developing and launching new scale-intensive services? To this end, 21 qualitative, in-depth interviews were con- ducted with employees in five large scale-intensive service firms. The findings suggest that the involvement of internal professionals is an asset when new scale-intensive services are developed, and that internal professionals act as intrapreneurs when they are involved in the development of radically new scale-intensive services. This paper integrates understanding from the innovation management literature with knowledge of professionals from extant literature on professional service firms since we find that professionals in scale-intensive firms act as intrapreneurs. Thus, this pa- per extends the theory on determinants of innovation in scale-intensive service firms, blending insights from both findings and theory.

  10. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Barnason, Susan; White-Williams, Connie; Rossi, Laura P; Centeno, Mae; Crabbe, Deborah L; Lee, Kyoung Suk; McCabe, Nancy; Nauser, Julie; Schulz, Paula; Stamp, Kelly; Wood, Kathryn

    2017-06-01

    The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches. This synthesis of evidence expands the base of knowledge related to the development of patient self-management skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients. © 2017 American Heart Association, Inc.

  11. The Living, Dynamic and Complex Environment Care in Intensive Care Unit.

    Science.gov (United States)

    Backes, Marli Terezinha Stein; Erdmann, Alacoque Lorenzini; Büscher, Andreas

    2015-01-01

    to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care. Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units. built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions); "Providing a suitable environment" and "having relatives with concern" (context); "Mediating facilities and difficulties" (intervenienting conditions); "Organizing the environment and managing the dynamics of the unit" (strategy) and "finding it difficult to accept and deal with death" (consequences). confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  12. Management of Thyroid Peroxidase Antibody Euthyroid Women in Pregnancy: Comparison of the American Thyroid Association and the Endocrine Society Guidelines

    Directory of Open Access Journals (Sweden)

    L. Mehran

    2013-01-01

    Full Text Available The presence of thyroid autoantibodies is relatively high in women of childbearing age. There is evidence that positive thyroperoxidase antibody even in euthyroid women may increase the risk of spontaneous and recurrent pregnancy loss and preterm delivery. However, the evidence is not enough to justify recommendation on the screening of pregnant women for thyroid autoantibodies or LT4 supplementation for reducing maternal or fetal complications. In this paper we reviewed the related evidence and compared the new guidelines of the American Thyroid Association and Endocrine Society with respect to the screening and management of positive thyroperoxidase antibody in euthyroid pregnant women. As there was no major contradiction or disagreement between the two guidelines, either one of two guidelines may be used by clinicians for the appropriate management of thyroid autoimmunity during pregnancy.

  13. Resolving disease management problems in European-American and Latino couples with type 2 diabetes: the effects of ethnicity and patient gender.

    Science.gov (United States)

    Fisher, L; Gudmundsdottir, M; Gilliss, C; Skaff, M; Mullan, J; Kanter, R; Chesla, C

    2000-01-01

    The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 x 2, Ethnicity x Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity x Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences

  14. Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study.

    Science.gov (United States)

    Skillgate, Eva; Côté, Pierre; Cassidy, J David; Boyle, Eleanor; Carroll, Linda; Holm, Lena W

    2016-05-01

    To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash-associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery varies across patterns of health care. Population-based inception cohort. All adults (≥18y) injured in motor vehicle collisions who received treatment from a regulated health professional or reported their injuries to the single provincially administered motor vehicle insurer. Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days postcollision were used to define health care intensity. Not applicable. Self-perceived recovery. Individuals with high utilization health care had slower recovery independent of expectation of recovery and other confounders. Compared with individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization, regardless of the type of profession. For instance, those with high physician (hazard rate ratio [HRR]=.56; 95% confidence interval [CI], .42-.75), physician and high physiotherapy utilization (HRR=.68; 95% CI, .61-.77), physician and high chiropractor utilization (HRR=.74; 95% CI, .64-.85), and physician and high massage therapy utilization (HRR=.78; 95% CI, .68-.90) had significantly slower recovery. Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs focuses on reassurance and education instead of intensive care. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. A Closer Look: The American Taxpayer Relief Act of 2012

    Science.gov (United States)

    Balmer, Mary

    2013-01-01

    School districts may be affected by the American Taxpayer Relief Act of 2012 with regard to fixed assets management and education entities. The act avoids the scheduled increases to individual income tax rates for most Americans and extends a host of expired and expiring tax provisions for both individuals and businesses. The provisions described…

  16. Health literacy and its association with diabetes knowledge, self-efficacy and disease self-management among African Americans with diabetes mellitus.

    Science.gov (United States)

    McCleary-Jones, Voncella

    2011-01-01

    The purpose of this descriptive correlational study was to examine health literacy and its association with diabetes knowledge, perceived self-efficacy and disease self-management among African Americans with diabetes mellitus. Fifty English-speaking, adult African American participants with diabetes mellitus were recruited from a community health center and a church located in the Midwestern United States. Data were collected at a single point in time utilizing the Rapid Estimate of Adult Literacy in Medicine (REALM), Diabetes Knowledge Test (DKT), Diabetes Self-efficacy Scale, and Summary of Diabetes Self-care Activities (SDSCA) Questionnaire. Bivariate associations were identified for health literacy with diabetes knowledge level; diabetes knowledge level with dietary self-care activities; and self-efficacy with dietary, exercise, and foot care self-care activities. Diabetes knowledge level and self-efficacy were independent predictors for dietary self-care activities, while self efficacy was the sole independent predictor for foot self-care. Means for health literacy and diabetes self-care activities were influenced by demographic factors examined.

  17. [Structure and functional organization of integrated cardiac intensive care].

    Science.gov (United States)

    Scherillo, Marino; Miceli, Domenico; Tubaro, Marco; Guiducci, Umberto

    2007-05-01

    The early invasive strategy for the treatment of acute coronary syndromes and the increasing number of older and sicker patients requiring prolonged and more complex intensive care have induced many changes in the function of the intensive care units. These changes include the statement that specially trained cardiologists and cardiac nurses who can manage patients with acute cardiac conditions should staff the intensive care units. This document indicates the structure of the units and specific recommendations for the number of beds, monitoring system, respirators, pacemaker/defibrillators and additional equipment.

  18. Business resilience: Reframing healthcare risk management.

    Science.gov (United States)

    Simeone, Cynthia L

    2015-09-01

    The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

  19. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Chow, Sheryl L; Maisel, Alan S; Anand, Inder; Bozkurt, Biykem; de Boer, Rudolf A; Felker, G Michael; Fonarow, Gregg C; Greenberg, Barry; Januzzi, James L; Kiernan, Michael S; Liu, Peter P; Wang, Thomas J; Yancy, Clyde W; Zile, Michael R

    2017-05-30

    Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their

  20. American Women and American Studies.

    Science.gov (United States)

    Chmaj, Betty E.

    The American Studies Association (ASA) is an interprofessional group, representing a cross-section of persons from American literature, American history, the social sciences, philosophy, archeology, Black Studies, Urban Studies, American Studies, and others. This document by the ASA Commission on the Status of Women includes: (1) a report of the…

  1. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism.

    Science.gov (United States)

    Wilhelm, Scott M; Wang, Tracy S; Ruan, Daniel T; Lee, James A; Asa, Sylvia L; Duh, Quan-Yang; Doherty, Gerard M; Herrera, Miguel F; Pasieka, Janice L; Perrier, Nancy D; Silverberg, Shonni J; Solórzano, Carmen C; Sturgeon, Cord; Tublin, Mitchell E; Udelsman, Robert; Carty, Sally E

    2016-10-01

    Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Initial evaluation should include 25-hydroxyvitamin D measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease. Ex vivo aspiration of resected parathyroid tissue may be used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed

  2. Parsing the Gulf between Africans and African Americans

    Directory of Open Access Journals (Sweden)

    Ashly Nsangou

    2018-02-01

    Full Text Available The rise in African immigrants to the US provides an opportunity to assess relations between Africans and African Americans in college. An online survey of 322 current and recently-graduated college students (including 45 Africans, 160 African Americans, and 117 whites assessed respondents’ experiences of racism in US high schools and colleges. Semi-structured interviews of 30 students (10 African, 10 African American and 10 white students supplemented these data. Even within a sociopolitical context of more visible racial intolerance, Black intra-racial cohesion was absent. Although more first- and second-generation Africans (73% felt that they had been judged while living in the US compared to African Americans (34% or whites (20%, for 70–80% of respondents, this had occurred only in high school. Despite experiencing these judgments, Africans’ identity related more to their focus on education than their race, reflected in a higher proportion who felt intense family pressure to attend college (65% compared to African Americans (37% and whites (39%. Interview data confirmed previous reports in the literature that African Americans lack a sense of connection to Africans, attributed to Africans’ purported sense of superiority and disregard for African Americans’ ongoing struggle to end oppression. These mixed-methods data suggest that intermingling in the college environment has not resulted in first- and second-generation Africans and African Americans sharing a common in-group, race-based identity. We discuss the implications of overlooking ethnic distinctions due to presumptions of racial homogeneity that deprive Black individuals of their uniqueness.

  3. Birth to weaning kid traits from a complete diallel of Boer, Kiko, and Spanish meat goat breeds semi-intensively managed on humid subtropical pasture.

    Science.gov (United States)

    Browning, R; Leite-Browning, M L

    2011-09-01

    Boer, Kiko, and Spanish meat goats were semi-intensively managed in a complete 3-breed diallel mating scheme to evaluate genetic effects on preweaning kid performance. Over a 6-yr period, 1,547 kids were born in March and May with 1,173 kids raised by their dams to weaning at 3 mo of age. March-born kids were lighter (P 0.10). Maternal Boer effects were negative (P 0.5) for preweaning ADG or weaning weight. Heterosis for birth weight was exhibited (P genetic variation was observed between meat goat breeds for kid performance to weaning. Maternal breed effects were more influential than direct breed effects. Boer goats were not superior to Kiko or Spanish for preweaning kid performance when semi-intensively managed on humid, subtropical pasture. Kiko should be a preferred breed and to a lesser extent Spanish for enhancing birth to weaning kid performance. Findings of this study emphasize the importance of proper doe breed selection in achieving desired kid performance to weaning in meat goats.

  4. Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-07-01

    Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

  5. Management Education for Archivists, Information Managers, and Librarians: Is There a Global Core?

    Science.gov (United States)

    Evans, G. Edward

    1984-01-01

    Reports on an analysis of 35 American management textbooks that identifies 17 core concepts for management courses for information professionals. Each concept--accountability, accounting, authority, budgeting, change/innovation/creativity, communication, controlling, decision making, delegation and organization, ethics, fiscal management,…

  6. Gait Recognition and Walking Exercise Intensity Estimation

    Directory of Open Access Journals (Sweden)

    Bor-Shing Lin

    2014-04-01

    Full Text Available Cardiovascular patients consult doctors for advice regarding regular exercise, whereas obese patients must self-manage their weight. Because a system for permanently monitoring and tracking patients’ exercise intensities and workouts is necessary, a system for recognizing gait and estimating walking exercise intensity was proposed. For gait recognition analysis, αβ filters were used to improve the recognition of athletic attitude. Furthermore, empirical mode decomposition (EMD was used to filter the noise of patients’ attitude to acquire the Fourier transform energy spectrum. Linear discriminant analysis was then applied to this energy spectrum for training and recognition. When the gait or motion was recognized, the walking exercise intensity was estimated. In addition, this study addressed the correlation between inertia and exercise intensity by using the residual function of the EMD and quadratic approximation to filter the effect of the baseline drift integral of the acceleration sensor. The increase in the determination coefficient of the regression equation from 0.55 to 0.81 proved that the accuracy of the method for estimating walking exercise intensity proposed by Kurihara was improved in this study.

  7. Evaluation of fertilizer and water management effect on rice performance and greenhouse gas intensity in different seasonal weather of tropical climate.

    Science.gov (United States)

    Ku, Hyun-Hwoi; Hayashi, Keiichi; Agbisit, Ruth; Villegas-Pangga, Gina

    2017-12-01

    Intensively double cropping rice increases greenhouse gas (GHG) emission in tropical countries, and hence, finding better management practices is imperative for reducing global warming potential (GWP), while sustaining rice yield. This study demonstrated an efficient fertilizer and water management practice targeting seasonal weather conditions effects on rice productivity, nitrogen use efficiency (NUE), GWP, and GHG intensity (GHGI). Two-season experiments were conducted with two pot-scale experiments using urea and urea+cattle manure (CM) under continuous flooding (CF) during the wet season (2013WS), and urea with/without CaSiO 3 application under alternate wetting and drying (AWD) during the dry season (2014DS). In 2013WS, 120kgNha -1 of urea fertilizer resulted in lower CH 4 emission and similar rice production compared to urea+CM. In 2014DS, CaSiO 3 application showed no difference in yields and led to significant reduction of N 2 O emission, but increased CH 4 emission and GWP. Due to significant increases in GHG emissions in urea+CM and CaSiO 3 application, we compared a seasonal difference in a local rice cultivation to test two water management practices. CF was adopted during 2013WS while AWD was adopted during 2014DS. Greater grain yields and yield components and NUE were obtained in 2014DS than in 2013WS. Furthermore, higher grain yields contributed to similar values of GHGI although GWP of cumulative GHG emissions was increased in 2014DS. Thus, utilizing urea only application under AWD is a preferred practice to minimize GWP without yield decline for double cropping rice in tropical countries. Copyright © 2017. Published by Elsevier B.V.

  8. Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study.

    Science.gov (United States)

    Karlsdottir, Sigfridur Inga; Sveinsdottir, Herdis; Olafsdottir, Olof Asta; Kristjansdottir, Hildur

    2015-12-01

    Pregnant women expect childbirth to be painful. However, little is known about their expectations of the intensity of pain in childbirth (EIPC) and their attitudes to pain management. The design was a cross-sectional survey, with self-reported questionnaires used to collect data from low-risk pregnant women (N = 1111) early in pregnancy at 26 of the largest primary health care centres in Iceland. This consecutive national sample was stratified by residency. The mean score for the EIPC was 5.58 (SD = 1.38) measured on a 7 point scale. The strongest predictors of a high EIPC score were: negative attitude to the impending childbirth (OR = 2.39), low manifestation of a sense of security (OR = 1.80), and a positive attitude to pain management with medication (OR = 1.63). Women living outside the capital area were less likely to have a high EIPC (OR = 0.68). Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. The study detected multiple predictors of women's EIPC and attitude to pain management. Early and throughout pregnancy, midwives and health care professionals need to address these predictors in order to assist women to prepare themselves for the pain of labour. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Drug-Induced Anaphylaxis in Latin American Countries.

    Science.gov (United States)

    Jares, Edgardo José; Baena-Cagnani, Carlos E; Sánchez-Borges, Mario; Ensina, Luis Felipe C; Arias-Cruz, Alfredo; Gómez, Maximiliano; Cuello, Mabel Noemi; Morfin-Maciel, Blanca María; De Falco, Alicia; Barayazarra, Susana; Bernstein, Jonathan A; Serrano, Carlos; Monsell, Silvana; Schuhl, Juan; Cardona-Villa, Ricardo

    2015-01-01

    Information regarding the clinical features and management of drug-induced anaphylaxis (DIA) in Latin America is lacking. The objective of this study was to assess implicated medications, demographics, and treatments received for DIA in Latin American patients referred to national specialty centers for evaluation. A database previously used to compile information on drug-induced allergic reactions in 11 Latin American countries was used to identify and characterize patients presenting specifically with a clinical diagnosis of DIA. Information regarding clinical presentation, causative agent(s), diagnostic studies performed, treatment, and contributing factors associated with increased reaction severity was analyzed. There were 1005 patients evaluated for possible drug hypersensitivity reactions during the study interval, and 264 (26.3%) met criteria for DIA. DIA was more frequent in adults and in elderly females (N = 129 [76.6%] and N = 30 [75%], respectively) compared with children and/or adolescents (N = 21 [42.9%], P asthma (N = 22 vs 35 [38.6% vs 61.4%], P Latin American patients referred for evaluation of DIA, NSAIDs and antibiotics were implicated in approximately 80% of cases. Most of these reactions were treated in the emergency department. Epinephrine was administered in only 27.6% of all cases, although more frequently for anaphylactic shock. Dissemination of anaphylaxis guidelines among emergency department physicians should be encouraged to improve management of DIA. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  10. Derivation of Building Energy Use Intensity Targets for ASHRAE Standard 100

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, Terry R [ORNL

    2014-06-01

    The steps to develop the building energy use intensity targets for American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Standard 100, Energy Efficiency in Existing Buildings are outlined in this report. The analyses were conducted by Oak Ridge National Laboratory (ORNL) in collaboration with the ASHRAE Standard 100 committee and Dr. Alexander Zhivov, the subcommittee chair responsible for targets development.

  11. Management intensity and genetics affect loblolly pine seedling performance

    Science.gov (United States)

    Scott D. Roberts; Randall J. Rousseau; B. Landis Herrin

    2012-01-01

    Capturing potential genetic gains from tree improvement programs requires selection of the appropriate genetic stock and application of appropriate silvicultural management techniques. Limited information is available on how specific loblolly pine varietal genotypes perform under differing growing environments and management approaches. This study was established in...

  12. Racial Discrimination, Coping, Life Satisfaction, and Self-Esteem among African Americans.

    Science.gov (United States)

    Utsey, Shawn O.; Ponterotto, Joseph G.; Reynolds, Amy L.; Cancelli, Anthony A.

    2000-01-01

    Study examines the coping strategies used by African Americans in managing the stressful effects of racism. Results indicate that women preferred avoidance coping for racism experienced on a personal level. For African Americans in general, seeking social support and racism condition were the best predictors of racism-related stress. Life…

  13. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  14. Investigation and management of gastro-oesophageal reflux in United Kingdom neonatal intensive care units.

    Science.gov (United States)

    Rossor, Thomas; Andradi, Gwendolyn; Bhat, Ravindra; Greenough, Anne

    2018-01-01

    In 2004, wide variation in the investigation and management of gastro-oesophageal reflux (GOR) of infants on UK major neonatal units was demonstrated. Our aim was to resurvey neonatal practitioners to determine current practice and whether it was now evidence based. A questionnaire was sent to all 207 UK neonatal units. Responses were obtained from 84% of units. The most frequent 'investigation' was a trial of therapy (83% of units); pH studies were used in 38%, upper GI contrast studies in 19% and multichannel intraluminal impedance (MII)/pH studies in 5%. Only six units suggested a threshold for an abnormal pH study and two units for an abnormal MII study. Infants were commenced on antireflux medication without investigation always in 32% of units, often in 29%, occasionally in 19% and only never in 1%. Gaviscon was used as first line treatment in 60% of units, and other medications included ranitidine in 53%, thickening agents in 27%, proton pump inhibitors in 23%, domperidone in 22% and erythromycin in 6%. There remains a wide variation in diagnostic and treatment strategies for infants with suspected GOR on neonatal intensive care units, emphasising the need for randomised trials to determine appropriate GOR management. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  15. Does weight status influence perceptions of physical activity barriers among African-American women?

    Science.gov (United States)

    Genkinger, Jeanine M; Jehn, Megan L; Sapun, Marcella; Mabry, Iris; Young, Deborah Rohm

    2006-01-01

    Many African-American women fail to participate in regular physical activity. Weight status may influence physical activity barriers. This study examined the frequency and type of barriers. Participants in this study were enrolled in Project EXE-L (Exercising Ladies Excel), a six-month, church-based, randomized trial of moderate-intensity physical activity based in Baltimore city and county in Maryland. Participants were composed of African-American women who attended one of the participating churches, had friends who were church members, or who lived in neighborhoods surrounding one of the churches. Individuals who were between the ages of 25 and 70 years, were not regularly physically active (defined as not engaging in moderate-intensity activity more than three times per week), and were able to participate in moderate-intensity activity met eligibility criteria to participate in the trial. Barriers to physical activity were evaluated with the Steinhardt/Dishman Barriers for Habitual Physical Activity Scale at baseline. One hundred twenty women were classified as normal weight (body mass index [BMI]: or = 30 kg/m2). Obese participants were more likely to report "lack of motivation" as a barrier compared with normal-weight participants (63% vs 31%). Normal-weight and overweight participants were more likely to report no barriers compared with the obese (31%, 0%, 5%, respectively, P<.05). Barriers for African-American women may vary by BMI status. By defining these unique barriers, effective physical activity interventions can be developed.

  16. A comparison of Latin American energy-related CO2 emissions from 1970 to 2001

    International Nuclear Information System (INIS)

    Kuntsi-Reunanen, E.

    2007-01-01

    This study analyses CO 2 emission flows and energy use in the Latin American countries of Argentina, Brazil, Colombia, Mexico and Venezuela from the years 1971-2001. Results for the selected Latin American countries reveal that the changes in CO 2 intensities were quite similar in these countries. However, the energy use varied slightly, indicating differences in the energy utilization in the analysed countries. Examining the changes on energy use suggests that there were no significant changes in any of these countries' energy utilization during that period, but the energy markets are growing quite rapidly in all of these Latin American countries

  17. Efficient Identification of Low-Income Asian American Women at High Risk for Hepatitis B

    Science.gov (United States)

    Joseph, Galen; Nguyen, Kim; Nguyen, Tung; Stewart, Susan; Davis, Sharon; Kevany, Sebastian; Marquez, Titas; Pasick, Rena

    2015-01-01

    Hepatitis B disproportionately affects Asian Americans. Because outreach to promote testing and vaccination can be intensive and costly, we assessed the feasibility of an efficient strategy to identify Asian Americans at risk. Prior research with California’s statewide toll-free phone service where low-income women call for free cancer screening found 50% of English- and Spanish-speaking callers were willing to participate in a study on health topics other than cancer screening. The current study ascertained whether Asian Americans could be recruited. Among 200 eligible callers, 50% agreed to take part (95% confidence interval 43%–57%), a rate comparable to our previous study. Subsequent qualitative interviews revealed that receptivity to recruitment was due to trust in the phone service and women’s need for health services and information. This was a relatively low-intensity intervention in that, on average, only five minutes additional call time was required to identify women at risk and provide a brief educational message. Underserved women from diverse backgrounds may be reached in large numbers through existing communication channels. PMID:24185165

  18. Risk Assessment and Prevention of Hypertension in Filipino Americans.

    Science.gov (United States)

    Ma, Grace X; Lee, Minsun; Bhimla, Aisha; Tan, Yin; Gadegbeku, Crystal A; Yeh, Ming Chin; Aczon, Hermie

    2017-08-01

    Despite that Filipino Americans represent an important target group for hypertension, health behaviors associated with hypertension in this population have not been well studied. Two hundred Filipino Americans from eight community-based organizations completed the study. Information was collected to determine whether modifiable behavioral factors, as well as acculturation and demographic characteristics, were associated with hypertension status in Filipino Americans. Approximately 67% of Filipino Americans were hypertensive. Logistic regression analysis showed that adding salt, physical inactivity, and old age were significantly associated with hypertension status after controlling for other covariates. The present study confirmed a high rate of hypertension among Filipino Americans and demonstrates the association of hypertension status with behavioral factors. These findings highlight the need for targeted interventions to prevent and manage hypertension in this high-risk community by facilitating health behaviors, particularly, salt reduction and physical activity.

  19. Large extents of intensive land use limit community reorganization during climate warming.

    Science.gov (United States)

    Oliver, Tom H; Gillings, Simon; Pearce-Higgins, James W; Brereton, Tom; Crick, Humphrey Q P; Duffield, Simon J; Morecroft, Michael D; Roy, David B

    2017-06-01

    Climate change is increasingly altering the composition of ecological communities, in combination with other environmental pressures such as high-intensity land use. Pressures are expected to interact in their effects, but the extent to which intensive human land use constrains community responses to climate change is currently unclear. A generic indicator of climate change impact, the community temperature index (CTI), has previously been used to suggest that both bird and butterflies are successfully 'tracking' climate change. Here, we assessed community changes at over 600 English bird or butterfly monitoring sites over three decades and tested how the surrounding land has influenced these changes. We partitioned community changes into warm- and cold-associated assemblages and found that English bird communities have not reorganized successfully in response to climate change. CTI increases for birds are primarily attributable to the loss of cold-associated species, whilst for butterflies, warm-associated species have tended to increase. Importantly, the area of intensively managed land use around monitoring sites appears to influence these community changes, with large extents of intensively managed land limiting 'adaptive' community reorganization in response to climate change. Specifically, high-intensity land use appears to exacerbate declines in cold-adapted bird and butterfly species, and prevent increases in warm-associated birds. This has broad implications for managing landscapes to promote climate change adaptation. © 2017 John Wiley & Sons Ltd.

  20. Crew resource management training in the intensive care unit. A multisite controlled before-after study.

    Science.gov (United States)

    Kemper, Peter F; de Bruijne, Martine; van Dyck, Cathy; So, Ralph L; Tangkau, Peter; Wagner, Cordula

    2016-08-01

    There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non-technical skills. The present study evaluated the effectiveness of CRM in the ICU. Six ICUs participated in a paired controlled trial, with one pretest and two post-test measurements (after 3 and 12 months). Three ICUs received CRM training and were compared with a matched control unit. The 2-day classroom-based training was delivered to multidisciplinary groups (ie, ICU physicians, nurses, managers). All levels of Kirkpatrick's evaluation framework were assessed using a mixed method design, including questionnaires, observations and routinely administered patient outcome data. Level I-reaction: participants were very positive directly after the training. Level II-learning: attitudes towards behaviour aimed at optimising situational awareness were relatively high at baseline and remained stable. Level III-behaviour: self-reported behaviour aimed at optimising situational awareness improved in the intervention group. No changes were found in observed explicit professional oral communication. Level IV-organisation: patient outcomes were unaffected. Error management culture and job satisfaction improved in the intervention group. Patient safety culture improved in both control and intervention units. We can conclude that CRM, as delivered in the present study, does not change behaviour or patient outcomes by itself, yet changes how participants think about errors and risks. This indicates that CRM requires a combination with other initiatives in order to improve clinical outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Latin American protected areas: Protected from chemical pollution?

    Science.gov (United States)

    Rodríguez-Jorquera, Ignacio A; Siroski, Pablo; Espejo, Winfred; Nimptsch, Jorge; Choueri, Paloma Gusso; Choueri, Rodrigo Brasil; Moraga, Claudio A; Mora, Miguel; Toor, Gurpal S

    2017-03-01

    Protected areas (PAs) are critically important means to preserve species and maintain natural ecosystems. However, the potential impacts of chemical pollution on PAs are seldom mentioned in the scientific literature. Research on the extent of the occurrence of chemical pollution inside PAs and in-depth assessments of how chemical contaminants may adversely affect the maintenance of species abundance, species survival, and ecosystem functions are scarce to nonexistent. We investigated 1) the occurrence of chemical contaminants inside 119 PAs in Latin America from publically available databases, and 2) reviewed case studies of chemical contaminants and pollution in 4 Latin American PAs. Cases of chemical pollution and contamination inside Latin American PAs mostly originated from sources such as mining, oil, and gas extraction. To date, the focus of the research on chemical pollution research inside Latin American PAs has been primarily on the detection of contamination, typically limited to trace metals. Where management actions have occurred, they have been reactive rather than proactive. Protected areas established in wetlands are the most affected by chemical pollution. Based on the information from the pollution and/or contamination occurrence and the case studies analyzed, Latin American PAs are not well safeguarded from chemical pollution, resulting in both challenges and opportunities to conserve biodiversity and ecosystems. Integr Environ Assess Manag 2017;13:360-370. © 2016 SETAC. © 2016 SETAC.

  2. Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

    Science.gov (United States)

    Corizzo, C C; Baker, M C; Henkelmann, G C

    2000-09-01

    To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

  3. Workload modelling for data-intensive systems

    CERN Document Server

    Lassnig, Mario

    This thesis presents a comprehensive study built upon the requirements of a global data-intensive system, built for the ATLAS Experiment at CERN's Large Hadron Collider. First, a scalable method is described to capture distributed data management operations in a non-intrusive way. These operations are collected into a globally synchronised sequence of events, the workload. A comparative analysis of this new data-intensive workload against existing computational workloads is conducted, leading to the discovery of the importance of descriptive attributes in the operations. Existing computational workload models only consider the arrival rates of operations, however, in data-intensive systems the correlations between attributes play a central role. Furthermore, the detrimental effect of rapid correlated arrivals, so called bursts, is assessed. A model is proposed that can learn burst behaviour from captured workload, and in turn forecast potential future bursts. To help with the creation of a full representative...

  4. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  5. Perceptions and Concerns Regarding Diabetes Mellitus During Pregnancy Among American Indian Women.

    Science.gov (United States)

    Carson, L D; Henderson, J Neil; King, Kama; Kleszynski, Keith; Thompson, David M; Mayer, Patricia

    2014-12-01

    Diabetes among American Indian (AI) people is a. condition that creates excessive morbidity and mortality and is a significant health disparity. This research delineated culturally constructed models of diabetes mellitus (DM) among 97 pregnant women in 2 large AI Nations to Oklahoma. Analysis of data revealed intense anxiety, fear, and dread related to DM during pregnancy. The sample was stratified by DM status: (a) absence of DM ( n = 66), (b) DM prior to pregnancy ( n = 4), and (c) gestational ( n = 27). Structured and semistructured interviews elicited patient culturally based explanatory models (EMs) of etiology, course, and treatment. The research incorporated an integrated phenomenologic and ethnographic approach and yielded both quantitative and qualitative data. General findings comprised the following main categories of patients' concerns regarding DM as an illness: (a) care-seeking behaviors, (b) medical management, (c) adherence and self-management, (d) complications, and (e) the conceptual sense of DM as a "severe" and feared condition. Many findings varied according to acculturation status, but all included significant fear and anxiety surrounding (a) the health and well-being of the unborn child, (b) the use of insulin injections, (c) blindness, (d) amputation, and (e) death, but with (f) a paradoxically lowered anxiety level about diabetes severity overall, while at the same time expressing extreme dread of specific outcomes. The latter finding is considered consistent with the presence of chronic conditions that can usually be managed, yet still having risk if severe.

  6. 75 FR 67966 - Notice of a Project Waiver of Section 1605 (Buy American Requirement) of the American Recovery...

    Science.gov (United States)

    2010-11-04

    ...'') for the purchase of 40 lb/yd American Society of Civil Engineers (ASCE) crane railing, which is part... waiver based on the specific project circumstances. The Regional Administrator is making this... EPA's Office of Administration and Resources Management has concurred on this decision to make an...

  7. Intensive management – can the South really live without it?

    Science.gov (United States)

    James M. Guldin; T. Bently Wigley

    1998-01-01

    Over the past five years, the public and private sectors have debated the future of forest management and its implications for the next century. In the public sector, resource managers have debated the meaning and significance of "ecosystem management," a term coined in 1992 by then-Forest Service Chief F. Dale Robertson; he suggested that this approach to...

  8. Managing Diversity: Afghan-Americans And The Aftermath Of The Twin Towers Tragedy

    OpenAIRE

    Belal A. Kaifi; Wajma Aslami

    2011-01-01

    Ethnic and religious diversity is part of each society in the modern world and being an Afghan is another dimension of these differences in the United States. The research question for this study was to see if Afghan-Americans are experiencing more discriminatory practices as a result of the 9/11 events. The results of 502 Afghan-Americans demonstrated that they do report more discrimination in the post-9/11 era. Specifically, Afghan men have experienced more discrimination in the workplace a...

  9. Cross-cultural differences in item and background memory: examining the influence of emotional intensity and scene congruency.

    Science.gov (United States)

    Mickley Steinmetz, Katherine R; Sturkie, Charlee M; Rochester, Nina M; Liu, Xiaodong; Gutchess, Angela H

    2018-07-01

    After viewing a scene, individuals differ in what they prioritise and remember. Culture may be one factor that influences scene memory, as Westerners have been shown to be more item-focused than Easterners (see Masuda, T., & Nisbett, R. E. (2001). Attending holistically versus analytically: Comparing the context sensitivity of Japanese and Americans. Journal of Personality and Social Psychology, 81, 922-934). However, cultures may differ in their sensitivity to scene incongruences and emotion processing, which may account for cross-cultural differences in scene memory. The current study uses hierarchical linear modeling (HLM) to examine scene memory while controlling for scene congruency and the perceived emotional intensity of the images. American and East Asian participants encoded pictures that included a positive, negative, or neutral item placed on a neutral background. After a 20-min delay, participants were shown the item and background separately along with similar and new items and backgrounds to assess memory specificity. Results indicated that even when congruency and emotional intensity were controlled, there was evidence that Americans had better item memory than East Asians. Incongruent scenes were better remembered than congruent scenes. However, this effect did not differ by culture. This suggests that Americans' item focus may result in memory changes that are robust despite variations in scene congruency and perceived emotion.

  10. Evapotranspiration Power Law in Self-Organized and Human-Managed Ecosystems

    Science.gov (United States)

    Zeng, R.; Cai, X.

    2017-12-01

    Natural systems display a profound degree of self-organization, often apparent even to the untrained eye. However, in this age of increased coupling among human and natural systems, it is unclear to what degree natural organization principles continue to govern human-managed landscapes. Here we present an emerging characteristic of terrestrial evapotranspiration (ET), one of the key components of the water cycle and energy budget, adhered to by both naturally organized and intensively managed landscapes. We find that ET variance and ET mean for ecosystems throughout the world with diverse climate conditions, vegetation structures, and land covers and land uses organize themselves according to a specific power law curve. From multi-source observations, the ET power law curve stands true through varying spatial scales, from field to region. Moreover, a phenomenon of similar ecosystems gravitating toward particular segments of the power law curve, suggests that the feature of self-optimization of ecosystems establishes the ET power law together with climatic conditions. Perhaps surprisingly, we find that landscapes persistently follow the power law curve even upon human-induced transition from rain-fed to irrigated agriculture in the American High Plains and from wetland to agricultural land in American Midwest. As such, the ET power law can be an informative tool for predicting consequences of anthropogenic disturbances to the hydrologic cycle and understanding constraints to sustainable land use.

  11. Forest soil carbon is threatened by intensive biomass harvesting.

    Science.gov (United States)

    Achat, David L; Fortin, Mathieu; Landmann, Guy; Ringeval, Bruno; Augusto, Laurent

    2015-11-04

    Forests play a key role in the carbon cycle as they store huge quantities of organic carbon, most of which is stored in soils, with a smaller part being held in vegetation. While the carbon storage capacity of forests is influenced by forestry, the long-term impacts of forest managers' decisions on soil organic carbon (SOC) remain unclear. Using a meta-analysis approach, we showed that conventional biomass harvests preserved the SOC of forests, unlike intensive harvests where logging residues were harvested to produce fuelwood. Conventional harvests caused a decrease in carbon storage in the forest floor, but when the whole soil profile was taken into account, we found that this loss in the forest floor was compensated by an accumulation of SOC in deeper soil layers. Conversely, we found that intensive harvests led to SOC losses in all layers of forest soils. We assessed the potential impact of intensive harvests on the carbon budget, focusing on managed European forests. Estimated carbon losses from forest soils suggested that intensive biomass harvests could constitute an important source of carbon transfer from forests to the atmosphere (142-497 Tg-C), partly neutralizing the role of a carbon sink played by forest soils.

  12. LIDER VERSUS MANAGER, MANAGEMENT VERSUS LEADERSHIP

    Directory of Open Access Journals (Sweden)

    Angela-Olimpia LOBONEA OLTEAN

    2016-10-01

    Full Text Available There is a very pronounced tendency to confuse leadership with management. Also, the leader-manager issue is intensively discussed and researched. Specialty literature highlights the presence of five typical situations regarding the use of the leadership and management concepts, which are: superposition, contraposition, partial similarities between the spheres of these two concepts, leadership - part of management, management - part of leadership. We come with the premise for a new approach: whatever it will be named - management of the future or leadership, manager-leader or leader, the organization of the future will need a visionary, intuitive, authentic leader, with rigor and method, a good organizer and very well trained professionally.

  13. Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study.

    Science.gov (United States)

    Hartlieb, Kathryn Brogan; Naar, Sylvie; Ledgerwood, David M; Templin, Thomas N; Ellis, Deborah A; Donohue, Bradley; Cunningham, Phillippe B

    2015-12-07

    Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. To examine the effects of CM in improving adolescent weight loss when added to BST. The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. Youth weight. Linear mixed effects modeling was used in the analysis. CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (pcontingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

  14. Vertical Integration Spurs American Health Care Revolution.

    Science.gov (United States)

    Phillips, Richard C.

    1986-01-01

    Under new "managed health care systems," the classical functional separation of risk taker, claims payor, and provider are vertically integrated into a common entity. This evolution should produce a competitive environment with medical care rendered to all Americans on a more cost-effective basis. (CJH)

  15. Vitis phylogenomics: hybridization intensities from a SNP array outperform genotype calls.

    Directory of Open Access Journals (Sweden)

    Allison J Miller

    Full Text Available Understanding relationships among species is a fundamental goal of evolutionary biology. Single nucleotide polymorphisms (SNPs identified through next generation sequencing and related technologies enable phylogeny reconstruction by providing unprecedented numbers of characters for analysis. One approach to SNP-based phylogeny reconstruction is to identify SNPs in a subset of individuals, and then to compile SNPs on an array that can be used to genotype additional samples at hundreds or thousands of sites simultaneously. Although powerful and efficient, this method is subject to ascertainment bias because applying variation discovered in a representative subset to a larger sample favors identification of SNPs with high minor allele frequencies and introduces bias against rare alleles. Here, we demonstrate that the use of hybridization intensity data, rather than genotype calls, reduces the effects of ascertainment bias. Whereas traditional SNP calls assess known variants based on diversity housed in the discovery panel, hybridization intensity data survey variation in the broader sample pool, regardless of whether those variants are present in the initial SNP discovery process. We apply SNP genotype and hybridization intensity data derived from the Vitis9kSNP array developed for grape to show the effects of ascertainment bias and to reconstruct evolutionary relationships among Vitis species. We demonstrate that phylogenies constructed using hybridization intensities suffer less from the distorting effects of ascertainment bias, and are thus more accurate than phylogenies based on genotype calls. Moreover, we reconstruct the phylogeny of the genus Vitis using hybridization data, show that North American subgenus Vitis species are monophyletic, and resolve several previously poorly known relationships among North American species. This study builds on earlier work that applied the Vitis9kSNP array to evolutionary questions within Vitis vinifera

  16. Implications of American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus Among Several US Networks of Community Health Centers.

    Science.gov (United States)

    Akhabue, Ehimare; Rittner, Sarah S; Carroll, Joseph E; Crawford, Phillip M; Dant, Lydia; Laws, Reesa; Leo, Michael C; Puro, Jon; Persell, Stephen D

    2017-07-03

    Little is known about statin underutilization among diabetes mellitus patients cared for in community health centers, which tend to serve socioeconomically disadvantaged populations. Implications of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. We included 32 440 adults (45% male, 63% nonwhite, 29% uninsured/Medicaid) aged 40 to 75 years with diabetes mellitus who received care within 16 community health center groups in 11 states in the Community Health Applied Research Network during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel 2001 and ACC/AHA 2013 guidelines. More patients' treatments were concordant with the ACC/AHA (52.8%) versus the National Cholesterol Education Program Adult Treatment Panel (36.2%) guideline. Female sex was associated with lower concordance for both (odds ratio [OR] 0.90, CI 0.85-0.94; and OR 0.84, CI 0.80-0.88, respectively). Being insured, an Asian/Pacific Islander, or primarily Spanish speaking were associated with greater concordance for both guidelines: 35.5% (11 526/32 440) were concordant with neither guideline, the majority (79.7%) having no statin prescribed; 28.2% (9168/32 440) were concordant with ACC/AHA but not the National Cholesterol Education Program Adult Treatment Panel. 8.7% of these patients had a low-density lipoprotein cholesterol >160 mg/dL despite having a moderate- or high-intensity statin prescribed. And 11.6% (3772/32 440) were concordant with the National Cholesterol Education Program Adult Treatment Panel but not with ACC/AHA. Most of these patients had a low-density lipoprotein cholesterol between 70 and 99 mg/dL with no or a low-intensity statin prescribed. Opportunities exist to improve cholesterol management in diabetes mellitus patients in community health centers. Addressing care gaps could improve

  17. Food habits of American black bears as a metric for direct management of humanbear conflict in Yosemite Valley, Yosemite National Park, California

    Science.gov (United States)

    Greenleaf, S.S.; Matthews, S.M.; Wright, R.G.; Beecham, J.J.; Leithead, H.M.

    2009-01-01

    The management of human-American black bear (Ursus americanus) conflict has been of significant concern for Yosemite National Park (YNP) personnel since the 1920s. Park managers implemented the YNP Human-Bear Management Plan in 1975 in an effort to reduce human-bear conflicts, especially in the extensively developed Yosemite Valley (YV). We used scat analysis to estimate annual and seasonal food habits of black bears in YV during 2001-02. We assessed the success of efforts to reduce the availability of anthropogenic foods, including garbage, by examining changes in the diet compared to a study from 1974-78 (Graber 1981). We also quantified consumption of non-native fruit to address its possible contribution to human-bear conflicts. The annual percent volume of human-provided food and garbage in black bear scats in YV decreased from 21% to 6% between 1978 and 2002, indicating YNP efforts have been effective. We found high use of non-native apples by bears throughout YV. Non-native food sources could be contributing to habituation and food conditioning, given their proximity to developed areas of YV. We recommend that YNP managers continue to (1) adapt and improve their management tools to address changing circumstances, (2) quantify the success of new management tools, and (3) reduce the availability of non-native food sources. ?? 2009 International Association for Bear Research and Management.

  18. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  19. Diagnosis of state visits to patients held in intensive care units

    Directory of Open Access Journals (Sweden)

    Rosa Del Socorro Morales-Aguila

    2017-01-01

    Full Text Available The visit is the space where it is possible to relate the patient, family and health personnel. To diagnose the situation of the visits to patients imprisoned in units of intensive care of Institutions Prestadoras of Health (IPS. Study descriptive, cross; the population was five intensive care units, the intrinsic sample consisted of 34 participants. respondents agreed visiting hours morning and afternoon 53%; the residence time of family members during the half-hour visit was 30%; the number of people allowed is three relatives 70%; information about the patient's progress is provided by the medical specialist 65%; 18% weakness was evident in the application of informed consent procedures make. These results serve to generate changes in the future with the attention paid to the families of critically ill patients, based on the recommendations of the American Association of Intensive Care more flexible patient visits focused on family relationship, in order to minimize anxiety produced by the gravity of their situation and environment of the Unit of Intensive care.

  20. Topography and crop management are key factors for the development of american leaf spot epidemics on coffee in costa rica.

    Science.gov (United States)

    Avelino, Jacques; Cabut, Sandrine; Barboza, Bernardo; Barquero, Miguel; Alfaro, Ronny; Esquivel, César; Durand, Jean-François; Cilas, Christian

    2007-12-01

    ABSTRACT We monitored the development of American leaf spot of coffee, a disease caused by the gemmiferous fungus Mycena citricolor, in 57 plots in Costa Rica for 1 or 2 years in order to gain a clearer understanding of conditions conducive to the disease and improve its control. During the investigation, characteristics of the coffee trees, crop management, and the environment were recorded. For the analyses, we used partial least-squares regression via the spline functions (PLSS), which is a nonlinear extension to partial least-squares regression (PLS). The fungus developed well in areas located between approximately 1,100 and 1,550 m above sea level. Slopes were conducive to its development, but eastern-facing slopes were less affected than the others, probably because they were more exposed to sunlight, especially in the rainy season. The distance between planting rows, the shade percentage, coffee tree height, the type of shade, and the pruning system explained disease intensity due to their effects on coffee tree shading and, possibly, on the humidity conditions in the plot. Forest trees and fruit trees intercropped with coffee provided particularly propitious conditions. Apparently, fertilization was unfavorable for the disease, probably due to dilution phenomena associated with faster coffee tree growth. Finally, series of wet spells interspersed with dry spells, which were frequent in the middle of the rainy season, were critical for the disease, probably because they affected the production and release of gemmae and their viability. These results could be used to draw up a map of epidemic risks taking topographical factors into account. To reduce those risks and improve chemical control, our results suggested that farmers should space planting rows further apart, maintain light shading in the plantation, and prune their coffee trees.

  1. 75 FR 77869 - Notice of a Regional Waiver of Section 1605 (Buy American Requirement) of the American Recovery...

    Science.gov (United States)

    2010-12-14

    ... Office of Administration and Resources Management has concurred on this decision to make an exception to... ENVIRONMENTAL PROTECTION AGENCY [FRL-9238-8] Notice of a Regional Waiver of Section 1605 (Buy... Administrator of EPA Region 10 is hereby granting a waiver request from the Buy American requirements of ARRA...

  2. Perceptions of African American faculty in kinesiology-based programs at predominantly White American institutions of higher education.

    Science.gov (United States)

    Burden, Joe W; Harrison, Louis; Hodge, Samuel R

    2005-06-01

    The purpose of this study was to examine the perceptions of African American faculty on their organizational socialization in kinesiology-based (i.e., sport pedagogy, exercise physiology, motor behavior, sport management/history) programs at predominantly White American institutions of higher education (PW-IHE). Participants were 9 African American tenure-track faculty members from various kinesiology-based programs at PW-IHE. Data were gathered via interviewing and analyzed within the framework of critical race theory (Ladson-Billings, 2000). Findings are presented using storytelling and thematic narratives. Interviews with the participants revealed four major recurring themes with regard to: (a) resources, opportunities, and power structures; (b) programmatic neglects and faculty mentoring needs; (c) social isolation, disengagement, and intellectual inferiority issues; and (d) double standards, marginalization, and scholarship biases. This study suggests that faculty and administrators at PW-IHE should develop sensitivity toward organizational socialization issues relevant to faculty of color.

  3. The American mink (Neovison vison) is a competent host for native European parasites.

    Science.gov (United States)

    Martínez-Rondán, F J; Ruiz de Ybáñez, M R; Tizzani, P; López-Beceiro, A M; Fidalgo, L E; Martínez-Carrasco, C

    2017-11-30

    The American mink (Neovison vison) is a mustelid native to North America that was introduced in Europe and the former USSR for fur farming. Throughout the last century, accidental or deliberate escapes of mink from farms caused the establishment of stable feral populations. In fact, the American mink is considered an invasive alien species in 28 European countries. The present study evaluates the gastrointestinal and cardiopulmonary helminth fauna of the American mink in Galicia (NW Spain) to understand its role as a potential reservoir for parasites affecting other autochthonous mustelids. In the period 2008-2014, fifty American mink (35 males and 15 females) of different ages (22 immature and 28 adults) from the provinces of Lugo, Ourense and Pontevedra were captured and sacrificed. Eight parasite species were found (6 nematodes and 2 trematodes) with the following prevalences: Molineus patens (68%), Aonchotheca putorii (54%), Crenosoma melesi (10%), Aonchotheca annulosa (8%), Angiostrongylus daskalovi (6%), Aelurostrongylus spp. (2%), Troglotrema acutum (2%) and an unidentified trematode (2%). Eighty-two per cent of the mink harboured helminths, including 15 animals (30%) infected by only one parasite species, 19 (38%) by two species, 5 (10%) by three species and 2 mink (4%) by four species. All helminth species identified are native to European mustelids. Statistical models were used to evaluate if animal characteristics (age, sex and weight), date and capture area influenced the prevalence, intensity or parasite richness. Statistical differences were detected only in models for intensity of M. patens, A. putorii and C. melesi. This is the first report of Angiostrongylus daskalovi, a cardiopulmonary nematode, and A. annulosa, a gastrointestinal nematode specific of rodents, in American mink. Moreover, although the fluke T. acutum has already been cited in American mink, to our knowledge, the present study represents the first report of this trematode in the

  4. Native Americans With Diabetes PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    This 60 second public service announcement is based on the January 2017 CDC Vital Signs report. Diabetes is the leading cause of kidney failure and Native Americans have a greater chance of having diabetes than any other racial group in the U.S. Learn how to manage your diabetes to delay or prevent kidney failure.

  5. Comparison of 3 airway access techniques during suspected spine injury management in American football.

    Science.gov (United States)

    Toler, Julianne D; Petschauer, Meredith A; Mihalik, Jason P; Oyama, Sakiko; Halverson, S Doug; Guskiewicz, Kevin M

    2010-03-01

    To determine how head movement and time to access airway were affected by 3 emergency airway access techniques used in American football. Prospective counterbalanced design. University research laboratory. Eighteen certified athletic trainers (ATCs) and 18 noncertified students (NCSs). Each participant performed 1 trial of each of the 3 after airway access techniques: quick release mechanism (QRM), cordless screwdriver (CSD), and pocket mask insertion (PMI). Time to task completion in seconds, head movement in each plane (sagittal, frontal, and transverse), maximum head movement in each plane, helmet movement in each plane, and maximum helmet movement in each plane. We observed a significant difference between all 3 techniques with respect to time required to achieve airway access (F(2,68) = 263.88; P football athlete experiencing respiratory arrest in the presence of a suspected cervical spine injury. In the event the athlete does not present with respiratory arrest, the facemask may be removed carefully with a pocket mask ready. Medical professionals must be familiar with differences in equipment and the effects these may have on the management of the spine-injured athlete.

  6. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine.

    Science.gov (United States)

    Trouillet, Jean-Louis; Collange, Olivier; Belafia, Fouad; Blot, François; Capellier, Gilles; Cesareo, Eric; Constantin, Jean-Michel; Demoule, Alexandre; Diehl, Jean-Luc; Guinot, Pierre-Grégoire; Jegoux, Franck; L'Her, Erwan; Luyt, Charles-Edouard; Mahjoub, Yazine; Mayaux, Julien; Quintard, Hervé; Ravat, François; Vergez, Sébastien; Amour, Julien; Guillot, Max

    2018-06-01

    Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  7. American Contact Dermatitis Society Contact Allergy Management Program: An Epidemiologic Tool to Quantify Ingredient Usage.

    Science.gov (United States)

    Scheman, Andrew; Severson, David

    2016-01-01

    The usage prevalence of ingredients in topical products is important to dermatologists and industry. To determine the prevalence of methylisothiazolinone (MI) in various types of consumer products The Contact Allergy Management Program (CAMP) database was mapped and sorted in spreadsheet format to determine the prevalence of MI in various types of consumer products. Methylisothiazolinone was found in 13.2% of 4660 total products in CAMP. High usage of MI was seen in dishwashing products (64%), shampoos (53%), bathroom/kitchen/all-purpose cleaners (47%), hair conditioners (45%), hair dyes (43%), laundry additives/fresheners/softeners (30%), soaps/cleansers (29%), and surface cleaners/disinfectants (27%). Of the products containing MI, MI alone (without methylchloroisothiazolinone) was most common in makeup products (100%), cleaning/dish/laundry products (>99%), moisturizers (82%), shaving products (78%), sunscreens (71%), and antiaging products (67%). The American Contact Dermatitis Society's CAMP is a valuable tool to collect epidemiologic data on the incidence of specific ingredient usage in various types of topical products.

  8. Managing Workplace Conflict in the United States and Hong Kong.

    Science.gov (United States)

    Tinsley, Catherine H.; Brett, Jeanne M.

    2001-07-01

    We propose that managers have norms (standards of appropriate behavior) for resolving conflict, that these norms are culturally based, and that they explain cultural differences in conflict management outcomes. We confirm that the traditionally American norms of discussing parties' interests and synthesizing multiple issues were exhibited more strongly by American managers than by their Hong Kong Chinese counterparts. In addition, we confirm that the traditionally Chinese norms of concern for collective interests and concern for authority appeared more strongly among Hong Kong Chinese managers than among their American counterparts. American managers were more likely than Hong Kong Chinese managers, to resolve a greater number of issues and reach more integrative outcomes, while Hong Kong Chinese managers were more likely to involve higher management in conflict resolution. Culture had a significant effect on whether parties selected an integrative outcome rather than an outcome that involved distribution, compromise, higher management, or no resolution at all. Conflict norms explained the cultural differences that existed between reaching an integrative outcome and reaching an outcome involving distribution, compromise, or higher management; however, conflict norms did not fully explain the cultural differences that existed between reaching an integrative outcome and reaching no resolution. Copyright 2001 Academic Press.

  9. Adolescent work intensity, school performance, and substance use: links vary by race/ethnicity and socioeconomic status.

    Science.gov (United States)

    Bachman, Jerald G; Staff, Jeremy; O'Malley, Patrick M; Freedman-Doan, Peter

    2013-11-01

    High school students who spend long hours in paid employment during the school year are at increased risk of lower grades and higher substance use, although questions remain about whether these linkages reflect causation or prior differences (selection effects). Questions also remain about whether such associations vary by socioeconomic status (SES) and race/ethnicity. This study examines those questions using nationally representative data from two decades (1991-2010) of annual Monitoring the Future surveys involving about 600,000 students in 10th and 12th grades. White students are consistently more likely than minority students to hold paid employment during the school year. Among White and Asian American students, paid work intensity is negatively related to parental education and grade point averages (GPA) and is positively related to substance use. Also among Whites and Asian Americans, students with the most highly educated parents show the strongest negative relations between work intensity and GPA, whereas the links are weaker for those with less educated parents (i.e., lower SES levels). All of these relations are less evident for Hispanic students and still less evident for African American students. It thus appears that any costs possibly attributable to long hours of student work are most severe for those who are most advantaged--White or Asian American students with highly educated parents. Working long hours is linked with fewer disadvantages among Hispanic students and especially among African American students. Youth employment dropped in 2008-2010, but the relations described above have shown little change over two decades.

  10. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES - 2016 UPDATE

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R

    2016-01-01

    by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME). ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology AME = Associazione Medici Endocrinologi BEL = best...

  11. Precipitation Intensity Effects on Groundwater Recharge in the Southwestern United States

    Directory of Open Access Journals (Sweden)

    Brian F. Thomas

    2016-03-01

    Full Text Available Episodic recharge as a result of infrequent, high intensity precipitation events comprises the bulk of groundwater recharge in arid environments. Climate change and shifts in precipitation intensity will affect groundwater continuity, thus altering groundwater recharge. This study aims to identify changes in the ratio of groundwater recharge and precipitation, the R:P ratio, in the arid southwestern United States to characterize observed changes in groundwater recharge attributed to variations in precipitation intensity. Our precipitation metric, precipitation intensity magnification, was used to investigate the relationship between the R:P ratio and precipitation intensity. Our analysis identified significant changes in the R:P ratio concurrent with decreases in precipitation intensity. The results illustrate the importance of precipitation intensity in relation to groundwater recharge in arid regions and provide further insights for groundwater management in nonrenewable groundwater systems and in a changing climate.

  12. Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease.

    Science.gov (United States)

    Rosenson, Robert S; Kent, Shia T; Brown, Todd M; Farkouh, Michael E; Levitan, Emily B; Yun, Huifeng; Sharma, Pradeep; Safford, Monika M; Kilgore, Meredith; Muntner, Paul; Bittner, Vera

    2015-01-27

    National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events. This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge. We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg. Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge. The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Parameters of Carcass Cuts and Measurements of Martinik Lambs Managed under Intensive Conditions

    Directory of Open Access Journals (Sweden)

    G. Alexandre

    2008-02-01

    Full Text Available The Martinik sheep is selected for its good adaptive and reproductive traits. The production sector reproaches it with low carcass conformation, although its carcasses have been little described. Two intensive fattening experiments were conducted, whereby lambs were slaughtered for linear measurements and cuts. The variables were analyzed and allometric equations were determined. The database (n = 43 was adjusted for feeding levels and slaughter weight groups (SW: 28, 32 and 36 kg. Mean cold carcass (CC weights varied (P 0.05. The weights of all carcass cuts significantly (P < 0.01 increased with CC increase. Shoulders and legs represented 18 and 34% of CC, respectively. Various measurements taken on the carcass and pelvis width significantly increased (P < 0.05 with CC increase (near 9% difference between extreme weights. Indices of carcass and leg compactness (0.32 and 0.45, respectively did not vary with SW, whereas weight indices did. Allometric coefficients of the shoulder (0.915 and leg (0.891 were in line with those of the literature. This preliminary description of Martinik sheep carcasses could be made available to the sector actors in order to pursue the work and help to better select breeds and management systems.

  14. Carbon fluxes on North American rangelands

    Science.gov (United States)

    Tony Svejcar; Raymond Angell; James A. Bradford; William Dugas; William Emmerich; Albert B. Frank; Tagir Gilmanov; Marshall Haferkamp; Douglas A. Johnson; Herman Mayeux; Pat Mielnick; Jack Morgan; Nicanor Z. Saliendra; Gerald E. Schuman; Phillip L. Sims; Kereith Snyder

    2008-01-01

    Rangelands account for almost half of the earth's land surface and may play an important role in the global carbon (C) cycle. We studied net ecosystem exchange (NEE) of C on eight North American rangeland sites over a 6-yr period. Management practices and disturbance regimes can influence NEE; for consistency, we compared ungrazed and undisturbed rangelands...

  15. Self-Care Behaviors of African Americans Living with Heart Failure.

    Science.gov (United States)

    Woda, Aimee; Haglund, Kristin; Belknap, Ruth Ann; Sebern, Margaret

    2015-01-01

    African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.

  16. Are we meeting the American Diabetes Association goals for HIV-infected patients with diabetes mellitus?

    Science.gov (United States)

    Adeyemi, Oluwatoyin; Vibhakar, Sonia; Max, Blake

    2009-09-01

    We determined rates of achieving the American Diabetes Association goals among human immunodeficiency virus (HIV)-infected diabetic patients. American Diabetes Association goals (for hemoglobin A1c, blood pressure, and lipid levels) were defined by 2008 American Diabetes Association guidelines. HIV-infected diabetic patients achieved American Diabetes Association goals at rates similar to those in general medicine clinic patients. A multidisciplinary approach is needed to improve diabetes management in HIV clinics.

  17. Intensive Versus Distributed Aphasia Therapy: A Nonrandomized, Parallel-Group, Dosage-Controlled Study.

    Science.gov (United States)

    Dignam, Jade; Copland, David; McKinnon, Eril; Burfein, Penni; O'Brien, Kate; Farrell, Anna; Rodriguez, Amy D

    2015-08-01

    Most studies comparing different levels of aphasia treatment intensity have not controlled the dosage of therapy provided. Consequently, the true effect of treatment intensity in aphasia rehabilitation remains unknown. Aphasia Language Impairment and Functioning Therapy is an intensive, comprehensive aphasia program. We investigated the efficacy of a dosage-controlled trial of Aphasia Language Impairment and Functioning Therapy, when delivered in an intensive versus distributed therapy schedule, on communication outcomes in participants with chronic aphasia. Thirty-four adults with chronic, poststroke aphasia were recruited to participate in an intensive (n=16; 16 hours per week; 3 weeks) versus distributed (n=18; 6 hours per week; 8 weeks) therapy program. Treatment included 48 hours of impairment, functional, computer, and group-based aphasia therapy. Distributed therapy resulted in significantly greater improvements on the Boston Naming Test when compared with intensive therapy immediately post therapy (P=0.04) and at 1-month follow-up (P=0.002). We found comparable gains on measures of participants' communicative effectiveness, communication confidence, and communication-related quality of life for the intensive and distributed treatment conditions at post-therapy and 1-month follow-up. Aphasia Language Impairment and Functioning Therapy resulted in superior clinical outcomes on measures of language impairment when delivered in a distributed versus intensive schedule. The therapy progam had a positive effect on participants' functional communication and communication-related quality of life, regardless of treatment intensity. These findings contribute to our understanding of the effect of treatment intensity in aphasia rehabilitation and have important clinical implications for service delivery models. © 2015 American Heart Association, Inc.

  18. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Konstam, Marvin A; Kiernan, Michael S; Bernstein, Daniel; Bozkurt, Biykem; Jacob, Miriam; Kapur, Navin K; Kociol, Robb D; Lewis, Eldrin F; Mehra, Mandeep R; Pagani, Francis D; Raval, Amish N; Ward, Carey

    2018-05-15

    The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF. The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations. Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple

  19. The situation-specific theory of pain experience for Asian American cancer patients.

    Science.gov (United States)

    Im, Eun-Ok

    2008-01-01

    Studies have indicated the need for theories that explain and target ethnic-specific cancer pain experiences, including those of Asian Americans. In this article, I present a situation-specific theory that explains the unique cancer pain experience of Asian Americans. Unlike other existing theories, this situation-specific theory was developed on the basis of evidence, including a systematic literature review and research findings, making it comprehensive and highly applicable to research and practice with Asian American patients with cancer. Thus, this theory would strengthen the interconnections among theory, evidence, and practice in pain management for Asian American cancer patients.

  20. ADIPOSITY-BASED CHRONIC DISEASE AS A NEW DIAGNOSTIC TERM: THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT.

    Science.gov (United States)

    Mechanick, Jeffrey I; Hurley, Daniel L; Garvey, W Timothy

    2017-03-01

    The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) have created a chronic care model, advanced diagnostic framework, clinical practice guidelines, and clinical practice algorithm for the comprehensive management of obesity. This coordinated effort is not solely based on body mass index as in previous models, but emphasizes a complications-centric approach that primarily determines therapeutic decisions and desired outcomes. Adiposity-Based Chronic Disease (ABCD) is a new diagnostic term for obesity that explicitly identifies a chronic disease, alludes to a precise pathophysiologic basis, and avoids the stigmata and confusion related to the differential use and multiple meanings of the term "obesity." Key elements to further the care of patients using this new ABCD term are: (1) positioning lifestyle medicine in the promotion of overall health, not only as the first algorithmic step, but as the central, pervasive action; (2) standardizing protocols that comprehensively and durably address weight loss and management of adiposity-based complications; (3) approaching patient care through contextualization (e.g., primordial prevention to decrease obesogenic environmental risk factors and transculturalization to adapt evidence-based recommendations for different ethnicities, cultures, and socio-economics); and lastly, (4) developing evidence-based strategies for successful implementation, monitoring, and optimization of patient care over time. This AACE/ACE blueprint extends current work and aspires to meaningfully improve both individual and population health by presenting a new ABCD term for medical diagnostic purposes, use in a complications-centric management and staging strategy, and precise reference to the obesity chronic disease state, divested from counterproductive stigmata and ambiguities found in the general public sphere. AACE = American Association of Clinical Endocrinologists ABCD = Adiposity