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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. 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.

  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. 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)

  5. 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.

  6. 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...

  7. 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...

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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...

  13. 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

  14. 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 ...

  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. 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...

  17. 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 ...

  18. 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 ...

  19. 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…

  20. 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…

  1. 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...

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. 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.

  7. 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

  8. 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 ...

  9. 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

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. [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.

  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. American Indian Systems for Natural Resource Management.

    Science.gov (United States)

    Quintana, Jorge O.

    1992-01-01

    Outlines the philosophy and general principles of "primitive" indigenous production technologies and natural resource management systems in North and South America. Discusses indigenous practices that promote sustainable production in gathering, hunting and fishing, minerals extraction, and agriculture. (SV)

  3. 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.

  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. 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.

  7. [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.

  8. 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.

  9. 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

  10. 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...

  11. 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)

  12. 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.…

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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...

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. [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.

  8. 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...

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

    Science.gov (United States)

    Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

    2015-01-01

    Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value

  15. 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 ...

  16. 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...

  17. 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....

  18. 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

  19. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  20. 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

  1. 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.

  2. 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…

  3. The Experience of Intense Pain: Nursing Management and Interventions.

    Science.gov (United States)

    Kiser-Larson, Norma

    Personal stories of illness give depth to otherwise clinical descriptions of diagnoses. This article offers an autobiographical narrative of complications after total knee replacement surgery. Diagnosis and nursing management of acute compartment syndrome, nociceptive and neuropathic origins of pain, pharmacologic and nursing interventions for pain, the use of prayer in illness, and compassionate caring from a Christian perspective are discussed.

  4. 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

  5. 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...

  6. 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.

  7. 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.

  8. Root Zone Sensors for Irrigation Management in Intensive Agriculture

    Directory of Open Access Journals (Sweden)

    Jochen Hemming

    2009-04-01

    Full Text Available Crop irrigation uses more than 70% of the world’s water, and thus, improving irrigation efficiency is decisive to sustain the food demand from a fast-growing world population. This objective may be accomplished by cultivating more water-efficient crop species and/or through the application of efficient irrigation systems, which includes the implementation of a suitable method for precise scheduling. At the farm level, irrigation is generally scheduled based on the grower’s experience or on the determination of soil water balance (weather-based method. An alternative approach entails the measurement of soil water status. Expensive and sophisticated root zone sensors (RZS, such as neutron probes, are available for the use of soil and plant scientists, while cheap and practical devices are needed for irrigation management in commercial crops. The paper illustrates the main features of RZS’ (for both soil moisture and salinity marketed for the irrigation industry and discusses how such sensors may be integrated in a wireless network for computer-controlled irrigation and used for innovative irrigation strategies, such as deficit or dual-water irrigation. The paper also consider the main results of recent or current research works conducted by the authors in Tuscany (Italy on the irrigation management of container-grown ornamental plants, which is an important agricultural sector in Italy.

  9. 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.

  10. 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...

  11. 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.

  12. Modeling critical zone processes in intensively managed environments

    Science.gov (United States)

    Kumar, Praveen; Le, Phong; Woo, Dong; Yan, Qina

    2017-04-01

    Processes in the Critical Zone (CZ), which sustain terrestrial life, are tightly coupled across hydrological, physical, biochemical, and many other domains over both short and long timescales. In addition, vegetation acclimation resulting from elevated atmospheric CO2 concentration, along with response to increased temperature and altered rainfall pattern, is expected to result in emergent behaviors in ecologic and hydrologic functions, subsequently controlling CZ processes. We hypothesize that the interplay between micro-topographic variability and these emergent behaviors will shape complex responses of a range of ecosystem dynamics within the CZ. Here, we develop a modeling framework ('Dhara') that explicitly incorporates micro-topographic variability based on lidar topographic data with coupling of multi-layer modeling of the soil-vegetation continuum and 3-D surface-subsurface transport processes to study ecological and biogeochemical dynamics. We further couple a C-N model with a physically based hydro-geomorphologic model to quantify (i) how topographic variability controls the spatial distribution of soil moisture, temperature, and biogeochemical processes, and (ii) how farming activities modify the interaction between soil erosion and soil organic carbon (SOC) dynamics. To address the intensive computational demand from high-resolution modeling at lidar data scale, we use a hybrid CPU-GPU parallel computing architecture run over large supercomputing systems for simulations. Our findings indicate that rising CO2 concentration and air temperature have opposing effects on soil moisture, surface water and ponding in topographic depressions. Further, the relatively higher soil moisture and lower soil temperature contribute to decreased soil microbial activities in the low-lying areas due to anaerobic conditions and reduced temperatures. The decreased microbial relevant processes cause the reduction of nitrification rates, resulting in relatively lower nitrate

  13. 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...

  14. 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)

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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...

  20. 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,…

  1. 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.

  2. 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.

  3. 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.

  4. Assessing probabilistic predictions of ENSO phase and intensity from the North American Multimodel Ensemble

    Science.gov (United States)

    Tippett, Michael K.; Ranganathan, Meghana; L'Heureux, Michelle; Barnston, Anthony G.; DelSole, Timothy

    2017-05-01

    Here we examine the skill of three, five, and seven-category monthly ENSO probability forecasts (1982-2015) from single and multi-model ensemble integrations of the North American Multimodel Ensemble (NMME) project. Three-category forecasts are typical and provide probabilities for the ENSO phase (El Niño, La Niña or neutral). Additional forecast categories indicate the likelihood of ENSO conditions being weak, moderate or strong. The level of skill observed for differing numbers of forecast categories can help to determine the appropriate degree of forecast precision. However, the dependence of the skill score itself on the number of forecast categories must be taken into account. For reliable forecasts with same quality, the ranked probability skill score (RPSS) is fairly insensitive to the number of categories, while the logarithmic skill score (LSS) is an information measure and increases as categories are added. The ignorance skill score decreases to zero as forecast categories are added, regardless of skill level. For all models, forecast formats and skill scores, the northern spring predictability barrier explains much of the dependence of skill on target month and forecast lead. RPSS values for monthly ENSO forecasts show little dependence on the number of categories. However, the LSS of multimodel ensemble forecasts with five and seven categories show statistically significant advantages over the three-category forecasts for the targets and leads that are least affected by the spring predictability barrier. These findings indicate that current prediction systems are capable of providing more detailed probabilistic forecasts of ENSO phase and amplitude than are typically provided.

  5. 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.

    2017-01-01

    Background and Purpose Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods Stroke patients were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using two sample t-tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using chi-squared tests. Ethnic comparisons of rehabilitation services were compared using chi-squared tests, Fisher’s exact tests and logistic regression. Results 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 NIHSS 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). Conclusions In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs. PMID:28386042

  6. 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 ...

  7. 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.

  8. 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.

  9. 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...

  10. International Transfers of Managers in North American and European MNEs

    OpenAIRE

    Daniel Ondrack

    1985-01-01

    Global-scale MNEs require a network of managers to direct and control operations around the world. Managerial resources for these jobs can be managers from the headquarters country, host and third countries. International transfers can be for specific staffing needs, for management development and for organization development. The general hypothesis examined in this paper was the global scale MNEs would operate in a regio-or geocentric fashion with full integration of the world pool of manage...

  11. 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.

  12. 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...

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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...

  18. 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...

  19. 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...

  20. 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…

  1. 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

  2. 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

  3. 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...

  4. 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

  5. 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...

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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…

  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. 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.

  15. [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.

  16. 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.

  17. 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

  18. 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...

  19. Compare the Chinese and American Accounting Management System

    Institute of Scientific and Technical Information of China (English)

    刘晨

    2014-01-01

    Cultureplays an important role in the development of accounting. Dif erent culture environments foster dif erent accountants, andthen dif erent accounting subcultures, which wil have dif erent influence on the choice of accounting systems. Dif erent cultures in China and the United States influenced the two countries accounting system, which lead to dif erent management system.

  20. Majoring in Money: How American College Students Manage Their Finances

    Science.gov (United States)

    Sallie Mae Bank, 2016

    2016-01-01

    Sallie Mae, the nation's saving, planning, and paying for college company, along with Ipsos, one of the world's largest, independent market research companies, surveyed 800 college students to learn more about how they are managing their finances and using credit. The online survey, completed in December 2015, comprised a cross-section of key…

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. [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.

  6. 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...

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. [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.

  16. 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.

  17. 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.

  18. [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

  19. 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...

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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

  6. American cutaneous leishmaniasis: presentation and problems of patient management

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Chulay

    1988-12-01

    Full Text Available We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55, Brazil (4 or Colombia (I. Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days. Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient's delay in seeking medical attention (31 days, medical personnel's delay in considering the diagnosis (45 days, and the laboratory's delay in confirming the diagnosis (17 days. Forty-four patients (73% developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27% had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58% were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.Relatamos nossa experiência em 60 pacientes com leishmaniose tegumentar americana diagnosticada e tratada entre 1977 e 1982. Cinqüenta e cinco pacientes foram infectados no Panamá, 4 no Brasil, e 1 na Colômbia. Entre 35 pacientes com uma exposição de 3 semanas no Panamá, a média do período de incubação foi 33 dias (limite sobre 4 e 81 dias. O diagnóstico foi feito, em média, 93 dias depois do início das lesões de pele, devido a demora do paciente em procurar o serviço médico (31 dias, a demora do médico em considerar o diagnóstico (45 dias, e a demora do laboratório em confirmar o diagnóstico (17 dias. Quarenta e quatro pacientes (73% desenvolveram úlceras típicas de leishmaniose cutânea. Porém, 16 pacientes (27% tiveram lesões de pele at

  7. 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.

  8. 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...

  9. 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.

  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. 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…

  12. 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.

  13. 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

  14. 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

  15. 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

  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. 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

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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).

  3. 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...

  4. 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.

  5. 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].

  6. 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.

  7. [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.

  8. 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.

  9. 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…

  10. [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.

  11. 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...

  12. 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

  13. 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.

  14. 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

  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. 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. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. American Society for Pain Management Nursing (ASPMN) position statement: male infant circumcision pain management.

    Science.gov (United States)

    O'Conner-Von, Susan; Turner, Helen N

    2013-12-01

    The ASPMN strongly recommends that infants who are being circumcised must receive optimal pain management. ‘‘If a decision for circumcision is made, procedural analgesia should be provided’’ (AAP, 1999, p. 691). Therefore, it is the position of the ASPMN that optimal pain management must be provided throughout the circumcision process. Furthermore, parents must be prepared for the procedure and educated about infant pain assessment. They must also be informed of pharmacologic and integrative pain management therapies that are appropriate before, during, and after the procedure.

  10. 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.

  11. 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.

  12. 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.

  13. 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)

  14. 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.

  15. 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

  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. 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

  18. 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.

  19. 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

  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. 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)

  2. 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

  3. 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.

  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.

    2016-01-01

    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

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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).

  12. [Invasive candidiasis in non-neutropenic adults : Guideline-based management in the intensive care unit].

    Science.gov (United States)

    Glöckner, A; Cornely, O A

    2013-12-01

    Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in

  13. 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

  14. Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

    Science.gov (United States)

    Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

    2018-01-01

    The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

  15. 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.

  16. Biopotentiality of High Efficient Aerobic Denitrifier Bacillus megaterium S379 for Intensive Aquaculture Water Quality Management.

    Science.gov (United States)

    Gao, Junqian; Gao, Dan; Liu, Hao; Cai, Jiajai; Zhang, Junqi; Qi, Zhengliang

    2018-05-24

    Excessive nitrite accumulation is a very tough issue for intensive aquaculture. A high efficient aerobic denitrifier Bacillus megaterium S379 with 91.71±0.17% of NO 2 - -N (65 mg L -1 ) removal was successfully isolated for solving the problem. Denitrification of S379 showed excellent environment adaptation that it kept high nitrite removal ratio (more than 85%) when temperature ranged from 25°C to 40°C and pH varied between 7.0 and 9.0, and could endure as high as 560 mg L -1 of NO 2 - -N. Immobilization of S379 could enhance denitrification even when NO 2 - -N adding amount got to 340 mg L -1 . Immobilized cells also showed well pollutants removal performance in aquaculture wastewater treatment. Moreover, S379 possessed positive hydrolase activities for starch, casein, cellulose and fat and bore more than 60 ppt of salinity. Totally, all the results revealed significant potentiality of immobilized S379 applied in aquaculture water quality management. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. 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.

  18. 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.

  19. ANALYSIS OF AIR TRAFFIC CONTROL MANAGEMENT AT AIRPORTS WITH LOW FLIGHT INTENSITY IN FOREIGN COUNTRIES

    Directory of Open Access Journals (Sweden)

    Evgenii E. Nechaev

    2017-01-01

    Full Text Available This article discusses various options for air traffic management at low flight intensity airports and airports located remotely in the North, where air traffic control service is not necessary.There are some examples of already implemented concepts in foreign countries: such as remote control tower, which allows to control air traffic, being at a considerable distance from the airport. Such a remote control tower is already put into operation at the Örnsköldsvik airport (Sweden. The prospects of this system development in other countries are observed in this article. A remote control tower will also appear in the United States in the nearest future. Also the paper considers the pros and cons of this system and its effect on flight safety.Moreover, there are given the examples of using non-towered and uncontrolled airports, where air traffic control service is not provided. This kind of airports is partly used in the USA and in New Zealand. The article describes flight procedures in the area of uncontrolled airports, including visual flight rules and instrument flight rules.We also analyze the possibilities of remote control towers and uncontrolled airports adaptation in the Russian Federation. It is a very important problem for Russia because most airports do not provide more than 10 movements per day. But air traffic control service exists in all airports.

  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. 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

  2. Integration Of PanDA Workload Management System With Supercomputers for ATLAS and Data Intensive Science

    Science.gov (United States)

    Klimentov, A.; De, K.; Jha, S.; Maeno, T.; Nilsson, P.; Oleynik, D.; Panitkin, S.; Wells, J.; Wenaus, T.

    2016-10-01

    The.LHC, operating at CERN, is leading Big Data driven scientific explorations. Experiments at the LHC explore the fundamental nature of matter and the basic forces that shape our universe. ATLAS, one of the largest collaborations ever assembled in the sciences, is at the forefront of research at the LHC. To address an unprecedented multi-petabyte data processing challenge, the ATLAS experiment is relying on a heterogeneous distributed computational infrastructure. The ATLAS experiment uses PanDA (Production and Data Analysis) Workload Management System for managing the workflow for all data processing on over 150 data centers. Through PanDA, ATLAS physicists see a single computing facility that enables rapid scientific breakthroughs for the experiment, even though the data centers are physically scattered all over the world. While PanDA currently uses more than 250,000 cores with a peak performance of 0.3 petaFLOPS, LHC data taking runs require more resources than grid can possibly provide. To alleviate these challenges, LHC experiments are engaged in an ambitious program to expand the current computing model to include additional resources such as the opportunistic use of supercomputers. We will describe a project aimed at integration of PanDA WMS with supercomputers in United States, in particular with Titan supercomputer at Oak Ridge Leadership Computing Facility. Current approach utilizes modified PanDA pilot framework for job submission to the supercomputers batch queues and local data management, with light-weight MPI wrappers to run single threaded workloads in parallel on LCFs multi-core worker nodes. This implementation was tested with a variety of Monte-Carlo workloads on several supercomputing platforms for ALICE and ATLAS experiments and it is in full pro duction for the ATLAS since September 2015. We will present our current accomplishments with running PanDA at supercomputers and demonstrate our ability to use PanDA as a portal independent of the

  3. Integration Of PanDA Workload Management System With Supercomputers for ATLAS and Data Intensive Science

    Energy Technology Data Exchange (ETDEWEB)

    De, K [University of Texas at Arlington; Jha, S [Rutgers University; Klimentov, A [Brookhaven National Laboratory (BNL); Maeno, T [Brookhaven National Laboratory (BNL); Nilsson, P [Brookhaven National Laboratory (BNL); Oleynik, D [University of Texas at Arlington; Panitkin, S [Brookhaven National Laboratory (BNL); Wells, Jack C [ORNL; Wenaus, T [Brookhaven National Laboratory (BNL)

    2016-01-01

    The Large Hadron Collider (LHC), operating at the international CERN Laboratory in Geneva, Switzerland, is leading Big Data driven scientific explorations. Experiments at the LHC explore the fundamental nature of matter and the basic forces that shape our universe, and were recently credited for the discovery of a Higgs boson. ATLAS, one of the largest collaborations ever assembled in the sciences, is at the forefront of research at the LHC. To address an unprecedented multi-petabyte data processing challenge, the ATLAS experiment is relying on a heterogeneous distributed computational infrastructure. The ATLAS experiment uses PanDA (Production and Data Analysis) Workload Management System for managing the workflow for all data processing on over 150 data centers. Through PanDA, ATLAS physicists see a single computing facility that enables rapid scientific breakthroughs for the experiment, even though the data centers are physically scattered all over the world. While PanDA currently uses more than 250,000 cores with a peak performance of 0.3 petaFLOPS, LHC data taking runs require more resources than Grid computing can possibly provide. To alleviate these challenges, LHC experiments are engaged in an ambitious program to expand the current computing model to include additional resources such as the opportunistic use of supercomputers. We will describe a project aimed at integration of PanDA WMS with supercomputers in United States, Europe and Russia (in particular with Titan supercomputer at Oak Ridge Leadership Computing Facility (OLCF), MIRA supercomputer at Argonne Leadership Computing Facilities (ALCF), Supercomputer at the National Research Center Kurchatov Institute , IT4 in Ostrava and others). Current approach utilizes modified PanDA pilot framework for job submission to the supercomputers batch queues and local data management, with light-weight MPI wrappers to run single threaded workloads in parallel on LCFs multi-core worker nodes. This implementation

  4. Integration Of PanDA Workload Management System With Supercomputers for ATLAS and Data Intensive Science

    International Nuclear Information System (INIS)

    Klimentov, A; Maeno, T; Nilsson, P; Panitkin, S; Wenaus, T; De, K; Oleynik, D; Jha, S; Wells, J

    2016-01-01

    The.LHC, operating at CERN, is leading Big Data driven scientific explorations. Experiments at the LHC explore the fundamental nature of matter and the basic forces that shape our universe. ATLAS, one of the largest collaborations ever assembled in the sciences, is at the forefront of research at the LHC. To address an unprecedented multi-petabyte data processing challenge, the ATLAS experiment is relying on a heterogeneous distributed computational infrastructure. The ATLAS experiment uses PanDA (Production and Data Analysis) Workload Management System for managing the workflow for all data processing on over 150 data centers. Through PanDA, ATLAS physicists see a single computing facility that enables rapid scientific breakthroughs for the experiment, even though the data centers are physically scattered all over the world. While PanDA currently uses more than 250,000 cores with a peak performance of 0.3 petaFLOPS, LHC data taking runs require more resources than grid can possibly provide. To alleviate these challenges, LHC experiments are engaged in an ambitious program to expand the current computing model to include additional resources such as the opportunistic use of supercomputers. We will describe a project aimed at integration of PanDA WMS with supercomputers in United States, in particular with Titan supercomputer at Oak Ridge Leadership Computing Facility. Current approach utilizes modified PanDA pilot framework for job submission to the supercomputers batch queues and local data management, with light-weight MPI wrappers to run single threaded workloads in parallel on LCFs multi-core worker nodes. This implementation was tested with a variety of Monte-Carlo workloads on several supercomputing platforms for ALICE and ATLAS experiments and it is in full pro duction for the ATLAS since September 2015. We will present our current accomplishments with running PanDA at supercomputers and demonstrate our ability to use PanDA as a portal independent of the

  5. 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.

  6. 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...

  7. 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...

  8. 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

  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.; 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

  10. 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

  11. 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...

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. 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.

  20. Weed suppression greatly increased by plant diversity in intensively managed grasslands: A continental-scale experiment.

    Science.gov (United States)

    Connolly, John; Sebastià, Maria-Teresa; Kirwan, Laura; Finn, John Anthony; Llurba, Rosa; Suter, Matthias; Collins, Rosemary P; Porqueddu, Claudio; Helgadóttir, Áslaug; Baadshaug, Ole H; Bélanger, Gilles; Black, Alistair; Brophy, Caroline; Čop, Jure; Dalmannsdóttir, Sigridur; Delgado, Ignacio; Elgersma, Anjo; Fothergill, Michael; Frankow-Lindberg, Bodil E; Ghesquiere, An; Golinski, Piotr; Grieu, Philippe; Gustavsson, Anne-Maj; Höglind, Mats; Huguenin-Elie, Olivier; Jørgensen, Marit; Kadziuliene, Zydre; Lunnan, Tor; Nykanen-Kurki, Paivi; Ribas, Angela; Taube, Friedhelm; Thumm, Ulrich; De Vliegher, Alex; Lüscher, Andreas

    2018-03-01

    consistently strong across mixtures varying widely in species' proportions and over time. The level of weed biomass did not vary greatly across mixtures varying widely in proportions of sown species. These diversity benefits in intensively managed grasslands are relevant for the sustainable intensification of agriculture and, importantly, are achievable through practical farm-scale actions.

  1. Analysis of the nutritional management practices in intensive care: Identification of needs for improvement.

    Science.gov (United States)

    Lázaro-Martín, N I; Catalán-González, M; García-Fuentes, C; Terceros-Almanza, L; Montejo-González, J C

    2015-12-01

    To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions. Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation. ICU of a hospital of high complexity. Adult ICU forecast more than 48h of artificial nutrition. Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio. A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56). The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. 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.

  3. American Health Information Management Association. Position statement. Issue: managing health information in facility mergers and acquisitions.

    Science.gov (United States)

    1994-04-01

    Healthcare facility mergers and acquisitions are becoming more common as the industry consolidates. Many critical issues must be considered in mergers and acquisitions, including the management of patient health information. In addition to operational issues, licensure, regulatory, and accreditation requirements must be addressed. To ensure availability of health information to all legitimate users, patient records should be consolidated or linked in the master patient index. A record retention policy should be developed and implemented to meet user needs and assure compliance with legal, regulatory, and accreditation requirements. If health information from closed facilities will be stored for a period of time, its integrity and confidentiality must be preserved, and it must be readily accessible for patient care. The compatibility and functionality of existing information systems should be assessed, and a plan should be formulated for integration of the systems to the extent possible. Such integration may be essential for the organization to successfully meet the demands of integrated delivery systems. Existing databases should be maintained in an accessible form to meet anticipated future needs.

  4. 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.

  5. On-site wildland activity choices among African Americans and White Americans in the rural south: implications for management

    Science.gov (United States)

    Cassandra Y. Johnson; J. Michael Bowker

    1999-01-01

    Johnson and Bowker compare wildland activity choices for a sample of rural African Americans and Whites who visited wildland settings in and around the Apalachicola National Forest. The authors also look at intra-racial (same race, different gender) variations for activity participation. This research extends previous research focused on the visit/not visit wildland...

  6. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults.

    Science.gov (United States)

    Fan, Eddy; Cheek, Fern; Chlan, Linda; Gosselink, Rik; Hart, Nicholas; Herridge, Margaret S; Hopkins, Ramona O; Hough, Catherine L; Kress, John P; Latronico, Nicola; Moss, Marc; Needham, Dale M; Rich, Mark M; Stevens, Robert D; Wilson, Kevin C; Winkelman, Chris; Zochodne, Doug W; Ali, Naeem A

    2014-12-15

    Profound muscle weakness during and after critical illness is termed intensive care unit-acquired weakness (ICUAW). To develop diagnostic recommendations for ICUAW. A multidisciplinary expert committee generated diagnostic questions. A systematic review was performed, and recommendations were developed using the Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Severe sepsis, difficult ventilator liberation, and prolonged mechanical ventilation are associated with ICUAW. Physical rehabilitation improves outcomes in heterogeneous populations of ICU patients. Because it may not be feasible to provide universal physical rehabilitation, an alternative approach is to identify patients most likely to benefit. Patients with ICUAW may be such a group. Our review identified only one case series of patients with ICUAW who received physical therapy. When compared with a case series of patients with ICUAW who did not receive structured physical therapy, evidence suggested those who receive physical rehabilitation were more frequently discharged home rather than to a rehabilitative facility, although confidence intervals included no difference. Other interventions show promise, but fewer data proving patient benefit existed, thus precluding specific comment. Additionally, prior comorbidity was insufficiently defined to determine its influence on outcome, treatment response, or patient preferences for diagnostic efforts. We recommend controlled clinical trials in patients with ICUAW that compare physical rehabilitation with usual care and further research in understanding risk and patient preferences. Research that identifies treatments that benefit patients with ICUAW is necessary to determine whether the benefits of diagnostic testing for ICUAW outweigh its burdens.

  7. 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

  8. LTAR information management: Six examples of data intensive work at site and network levels

    Science.gov (United States)

    Information systems for managing research data from the Long-term Agroecosystem Research (LTAR) program are implemented at site and network levels. Different information management tools are necessary to manage a variety of data types. There is no one-size fits all solution for managing all LTAR dat...

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

    Directory of Open Access Journals (Sweden)

    V V Fadeyev

    2011-12-01

    Full Text Available В конце весны 2011 г. вышли новые рекомендации Американской тиреоидной ассоциации и Американской ассоциации клинических эндокринологов по диагностике и лечению тиреотоксикоза. Они озаглавлены “Гипертиреоз и другие причины тиреотоксикоза”. Bahn R.S., Burch H.B., Cooper D.S., Garber J.R., Greenlee M.C., Klein I., Laurberg P., McDougall I.R., Montori V.M., Rivkees S.A., Ross D.S., Sosa J.A., Stan M.N. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011:21. Рекомендации представляют собой достаточно большой документ, изданный на 54 журнальных страницах. Важно отметить, что в его создании участвовали не только американские, но и европейские эксперты, т.е. представленные рекомендации не узкоспецифичны для США, где, как известно, есть свои особенности организации медицинской помощи. В документе сформулировано собственно 100 пунктов рекомендаций, каждому из которых представлен уровень силы рекомендации и уровень доказательности. Большая же часть объема документа представлена обсуждением и аргументацией,на основании которой были сформулированы 100 рекомендаций. В этой статье хотелось бы

  14. 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.

  15. 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.

  16. 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.

  17. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Feingold, Brian; Mahle, William T; Auerbach, Scott; Clemens, Paula; Domenighetti, Andrea A; Jefferies, John L; Judge, Daniel P; Lal, Ashwin K; Markham, Larry W; Parks, W James; Tsuda, Takeshi; Wang, Paul J; Yoo, Shi-Joon

    2017-09-26

    For many neuromuscular diseases (NMDs), cardiac disease represents a major cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. © 2017 American Heart Association, Inc.

  18. Milk production, raw milk quality and fertility of dromedary camels (Camelus Dromedarius) under intensive management.

    Science.gov (United States)

    Nagy, Péter; Thomas, Sonia; Markó, Orsolya; Juhász, Jutka

    2013-03-01

    In many arid countries, dromedaries play an important role as a milk source in rural areas. However, the milk and meat production potential of this species is not well understood and documented. A large-scale camel dairy farm was established in 2006 in the United Arab Emirates. This study summarises the most important data on milk production, raw milk quality and reproductive efficiency collected on this farm during the first three years of operation. The average daily milk production, the mean length of lactation and the mean total milk production per lactation of 174 dromedaries were 6.0 ± 0.12 kg (± SEM), 586 ± 11.0 days (± SEM) and 3314 ± 98.5 kg (± SEM), respectively. The lactation curve reached its peak during the 4th month after parturition (mean ± SEM, 8.9 ± 0.04 kg), then it declined gradually, falling to 50% of the maximum by the 16th month postpartum (mean ± SEM, 4.3 ± 0.06 kg). Milking three times a day did not increase daily milk production compared to two times milking. Mean total viable bacterial count (TVC) and mean somatic cell count (SCC, ± SEM) of bulk raw camel milk were 4,403 ± 94 CFU/cm3 and 392,602 ± 5,999 cells/cm3 for a one-year period, respectively. There was a significant difference among months (P fat, protein, lactose, total solids (TS) and solid-non-fat (SNF) concentrations of individual milk samples were 2.51 ± 0.03%, 2.60 ± 0.01%, 4.03 ± 0.03%, 9.98 ± 0.03% and 7.56 ± 0.03%, respectively. Lactation period, average daily milk production and morning vs. evening milking significantly influenced milk chemical composition. For the 470 camels in the breeding programme, end-of-season pregnancy rate and birth rate were 87.0% and 82.6%, respectively, after natural mating. We have demonstrated that sustainable milk production is possible from a traditional species, the dromedary camel, under an intensive management system.

  19. Problems in knowledge management: a case study of a knowledge intensive company

    NARCIS (Netherlands)

    van Zolingen, S.J.; Streumer, Jan; Stooker, M.M.; Stooker, M.

    2001-01-01

    Knowledge management has become an important tool in staying ahead in the competition between companies. In this article five different phases of the knowledge management process are distinguished: acquiring knowledge, codifying knowledge, disseminating knowledge, developing knowledge and applying

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE.

    Science.gov (United States)

    Jellinger, Paul S; Handelsman, Yehuda; Rosenblit, Paul D; Bloomgarden, Zachary T; Fonseca, Vivian A; Garber, Alan J; Grunberger, George; Guerin, Chris K; Bell, David S H; Mechanick, Jeffrey I; Pessah-Pollack, Rachel; Wyne, Kathleen; Smith, Donald; Brinton, Eliot A; Fazio, Sergio; Davidson, Michael

    2017-04-01

    The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. The Executive Summary of this document contains 87 recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 203 (29.2 %) are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence). This CPG is a practical tool that endocrinologists, other health care professionals, health-related organizations, and regulatory bodies can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of individuals with various lipid disorders. The recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously endorsed and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to individuals with diabetes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. 4S

  9. 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.

  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. 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

  12. 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...

  13. 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.

  14. Service Level Agreements as Vehicles for Managing Acquisition of Software-Intensive Systems

    National Research Council Canada - National Science Library

    Gaines, Leonard T; Michael, James B

    2005-01-01

    ... to support quality and process control throughout the entire lifecycle of a software-intensive system. This article defines SLAs, discusses software quality and describes how SLAS can be utilized to incorporate requirements pertaining to product, process, project, and deployment quality throughout the software lifecycle.

  15. The Role of Leadership: The Challenge of Knowledge Management and Learning in Knowledge-Intensive Organizations

    Science.gov (United States)

    Mas-Machuca, Marta

    2014-01-01

    Knowledge and learning are important driving forces for business success and competitiveness, especially in the knowledge-intensive organizations (KIO's) whose core business is to create and sell knowledge (e.g. education, R&D units, and consultancy organizations, among others). Previous works suggested one of the Critical Success Factor (CSF)…

  16. Effectiviteit van een klassieke Crew Resource Management training in de Intensive Care: een gecontroleerde studie.

    NARCIS (Netherlands)

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

    2013-01-01

    Achtergrond: Er is een toenemende bewustwording dat onbedoelde zorg gerelateerde schade in de gezondheidszorg vaker voortvloeit uit problemen met niet-technische vaardigheden, dan door een gebrek in technische, of klinische, vaardigheden. Dit is vooral van belang in de Intensive Care (IC), waar

  17. 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...

  18. 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…

  19. 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…

  20. [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.

  1. 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…

  2. Implementation of crew resource management: a qualitative study in 3 intensive care units.

    NARCIS (Netherlands)

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

    2017-01-01

    Objectives: Classroom-based crew resource management (CRM) training has been increasingly applied in health care to improve safe patient care. Crew resource management aims to increase participants' understanding of how certain threats can develop as well as provides tools and skills to respond to

  3. The neutron beam intensity increase by in-core fuel management enhancement in multipurpose research reactors

    International Nuclear Information System (INIS)

    Martinc, R.; Vukadin, Z.; Konstantinovic, J.

    1986-01-01

    The exploitation characteristics of an existing multipurpose research reactor can be increased not only by great reconstruction, but also, to the considerable extent, by the in-core fuel management sophistication. The optimisation of the in-core fuel management procedure in such reactors is governed (among others) by the identified reactor utilisation goals, i.e. by weighting factors dedicated to different utilisation goals, which are often (regarding the in-core fuel management procedure) highly controversial. In this work the best solution for in-core fuel management is sought, with the highest weighting factor dedicated to the neutron beam usage, rather than sample irradiation in the reactor core. The term in-core fuel management includes: the core configuration, the locations of the fresh fuel inflow zone and spent fuel excite zone, and the fuel transfers between these two zones (author)

  4. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

  5. 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.

  6. Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit.

    Science.gov (United States)

    Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina

    2015-03-01

    Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  7. 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.

  8. Intensive care management of patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations

    International Nuclear Information System (INIS)

    Keller, E.; Yonekawa, Y.; Imhof, H.G.; Tanaka, M.; Valavanis, Anton

    2002-01-01

    We studied the impact of emergency neurosurgery and intensive care on the outcome for patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations (AVMs). We reviewed the case notes of 18 patients with severe haemorrhage after embolisation of a brain AVM between 1986 and 2001. During this period the treatment changed: before 1993, these patients were not surgically treated, and they died, while after 1994, all patients underwent emergency surgery. We established a standardised protocol for emergency treatment and intensive care in May 1998, and emergency surgery was performed as soon as possible after the onset of symptoms of haemorrhage. Postoperative intensive care was according to a standardised regime. During these 15 years, 24 out of 605 patients undergoing 1066 interventions had a haemorrhage during or after the procedure, of which 18 were severe (3% of patients, 1.7% of interventions). All patients had a severe clinical deficit (mean Glasgow coma scale 4.2); eight had uni- or bilateral mydriasis. From 1989 to April 1998 four (31%) of 13 patients died, one (7.5%) remained in a vegetative state and eight (61.5%) made a good recovery. All five patients treated between 1998 and 2001 had a favourable outcome. The mean time from onset of the symptoms of haemorrhage to reaching the operation room was 129 min between 1989 and 1998 and 24 min between 1998 and 2001. Standardised emergency treatment and intensive care with early resuscitation, minimal radiological exploration before rapid surgery improved the outcome. A short time between the onset of the symptoms of haemorrhage and evacuation of the haematoma may be the most important factor for a favourable outcome. (orig.)

  9. Barriers to Use of Non-pharmacological Pain Management Methods in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Y Zahedpasha

    2017-09-01

    CONCLUSION: According to the results of this study, inadequate nursing staff and insufficient knowledge about pain complications were the most important causes for lack of application of pain management methods for neonates

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. Development of Intensity-Duration-Frequency curves at ungauged sites: risk management under changing climate

    Science.gov (United States)

    Liew, San Chuin; Raghavan, Srivatsan V.; Liong, Shie-Yui

    2014-12-01

    The impact of a changing climate is already being felt on several hydrological systems both on a regional and sub-regional scale of the globe. Southeast Asia is one of the regions strongly affected by climate change. With climate change, one of the anticipated impacts is an increase in the intensity and frequency of extreme rainfall which further increase the region's flood catastrophes, human casualties and economic loss. Optimal mitigation measures can be undertaken only when stormwater systems are designed using rainfall Intensity-Duration-Frequency (IDF) curves derived from a long and good quality rainfall data. Developing IDF curves for the future climate can be even more challenging especially for ungauged sites. The current practice to derive current climate's IDF curves for ungauged sites is, for example, to `borrow' or `interpolate' data from regions of climatologically similar characteristics. Recent measures to derive IDF curves for present climate was performed by extracting rainfall data from a high spatial resolution Regional Climate Model driven by ERA-40 reanalysis dataset. This approach has been demonstrated on an ungauged site (Java, Indonesia) and the results were quite promising. In this paper, the authors extend the application of the approach to other ungauged sites particularly in Peninsular Malaysia. The results of the study undoubtedly have significance contribution in terms of local and regional hydrology (Malaysia and Southeast Asian countries). The anticipated impacts of climate change especially increase in rainfall intensity and its frequency appreciates the derivation of future IDF curves in this study. It also provides policy makers better information on the adequacy of storm drainage design, for the current climate at the ungauged sites, and the adequacy of the existing storm drainage to cope with the impacts of climate change.

  19. [The managment of serious pregnant disease in the intensive care unit].

    Science.gov (United States)

    Ali, Elhusseini; Bechir, Khemiri; Badis, Chennoufi Mohamed; Nabil, Mathlouthi; Hanene, Ellouze; Mourad, Bouchnak; Salah, Hendaoui Mohamed; Hayen, Maghrebi; Ezzeddine, Sfar; Hela, Chelli

    2005-02-01

    We report a retrospective study over a period of 4 years and half and bearing on 59 patients that require an intensive care. The number of childbirth during this period was 22237 with 8.97% of Caesareans. The main obstetrical diseases was: gravidic toxaemia 75.5%, uterine inertia 7%, cardiopathy 5% of the cases. The reasons for the transfer were: eclamptic state in 27% of the cases, hémostasis disorder 22% of the cases, and acute pulmonary oedema 18.6% of the cases. Average duration of hospitalization was 3.18 days. Five cases of death were noted.

  20. A Lightweight, High-performance I/O Management Package for Data-intensive Computing

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jun

    2011-06-22

    Our group has been working with ANL collaborators on the topic bridging the gap between parallel file system and local file system during the course of this project period. We visited Argonne National Lab -- Dr. Robert Ross's group for one week in the past summer 2007. We looked over our current project progress and planned the activities for the incoming years 2008-09. The PI met Dr. Robert Ross several times such as HEC FSIO workshop 08, SC08 and SC10. We explored the opportunities to develop a production system by leveraging our current prototype to (SOGP+PVFS) a new PVFS version. We delivered SOGP+PVFS codes to ANL PVFS2 group in 2008.We also talked about exploring a potential project on developing new parallel programming models and runtime systems for data-intensive scalable computing (DISC). The methodology is to evolve MPI towards DISC by incorporating some functions of Google MapReduce parallel programming model. More recently, we are together exploring how to leverage existing works to perform (1) coordination/aggregation of local I/O operations prior to movement over the WAN, (2) efficient bulk data movement over the WAN, (3) latency hiding techniques for latency-intensive operations. Since 2009, we start applying Hadoop/MapReduce to some HEC applications with LANL scientists John Bent and Salman Habib. Another on-going work is to improve checkpoint performance at I/O forwarding Layer for the Road Runner super computer with James Nuetz and Gary Gridder at LANL. Two senior undergraduates from our research group did summer internships about high-performance file and storage system projects in LANL since 2008 for consecutive three years. Both of them are now pursuing Ph.D. degree in our group and will be 4th year in the PhD program in Fall 2011 and go to LANL to advance two above-mentioned works during this winter break. Since 2009, we have been collaborating with several computer scientists (Gary Grider, John bent, Parks Fields, James Nunez, Hsing

  1. A Catchment Systems Engineering (CSE) approach to managing intensively farmed land

    Science.gov (United States)

    Jonczyk, Jennine; Quinn, Paul; Barber, Nicholas; Wilkinson, Mark; ODonnell, Greg

    2014-05-01

    Rural land management practices can have a significant impact on the hydrological and nutrient dynamics within a catchment which can dramatically alter the way it processes water, exacerbating nutrient losses from the system. A collaborative and holistic approach for managing potential conflicts between land management activity for food production alongside the aspiration to achieve good water quality and the need to make space for water can ensure the long-term sustainability of our agricultural catchments. Catchment System Engineering (CSE) is an interventionist approach to altering the catchment scale runoff regime through the manipulation of hydrological flow pathways throughout the catchment. By targeting hydrological flow pathways at source, such as overland flow, field drain and ditch function, a significant component of the runoff generation can be managed, greatly reducing erosive soil losses. Coupled with management of farm nutrients at source many runoff attenuation features or measures can be co-located to achieve benefits for water quality. Examples of community-led mitigation measures using the CSE approach will be presented from two catchments in Northumberland, Northern England, that demonstrate the generic framework for identification of multipurpose features that slow, store and filter runoff at strategic locations in the landscape. Measures include within-field barriers, edge of field traps and within-field sediment filters and sediment traps which demonstrate how sediment can be trapped locally (including silt and clay fractions) and be recovered for use back on the land. Deliverables from this CSE approach includes the reduction of downstream flood risk and capturing of sediment and associated nutrients. The CSE approach allows for a more natural flood and nutrient management approach which helps to restore vital catchment functions to re-establish a healthy catchment system.

  2. 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...

  3. Response of equatorial, low- and mid-latitude F-region in the American sector during the intense geomagnetic storm on 24-25 October 2011

    Science.gov (United States)

    de Jesus, R.; Sahai, Y.; Fagundes, P. R.; de Abreu, A. J.; Brunini, C.; Gende, M.; Bittencourt, J. A.; Abalde, J. R.; Pillat, V. G.

    2013-07-01

    In this paper, we present and discuss the response of the ionospheric F-region in the American sector during the intense geomagnetic storm which occurred on 24-25 October 2011. In this investigation ionospheric sounding data obtained of 23, 24, 25, and 26 October 2011 at Puerto Rico (United States), Jicamarca (Peru), Palmas, São José dos Campos (Brazil), and Port Stanley, are presented. Also, the GPS observations obtained at 12 stations in the equatorial, low-, mid- and high-mid-latitude regions in the American sector are presented. During the fast decrease of Dst (about ˜54 nT/h between 23:00 and 01:00 UT) on the night of 24-25 October (main phase), there is a prompt penetration of electric field of magnetospheric origin resulting an unusual uplifting of the F region at equatorial stations. On the night of 24-25 October 2011 (recovery phase) equatorial, low- and mid-latitude stations show h'F variations much larger than the average variations possibly associated with traveling ionospheric disturbances (TIDs) caused by Joule heating at high latitudes. The foF2 variations at mid-latitude stations and the GPS-VTEC observations at mid- and low-latitude stations show a positive ionospheric storm on the night of 24-25 October, possibly due to changes in the large-scale wind circulation. The foF2 observations at mid-latitude station and the GPS-VTEC observations at mid- and high-mid-latitude stations show a negative ionospheric storm on the night of 24-25 October, probably associated with an increase in the density of molecular nitrogen. During the daytime on 25 October, the variations in foF2 at mid-latitude stations show large negative ionospheric storm, possibly due to changes in the O/N2 ratio. On the night of 24-25, ionospheric plasma bubbles (equatorial irregularities that extended to the low- and mid-latitude regions) are observed at equatorial, low- and mid-latitude stations. Also, on the night of 25-26, ionospheric plasma bubbles are observed at equatorial

  4. Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

    Science.gov (United States)

    Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

    2005-06-01

    This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

  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. Management intensity at field and landscape levels affects the structure of generalist predator communities.

    Science.gov (United States)

    Rusch, Adrien; Birkhofer, Klaus; Bommarco, Riccardo; Smith, Henrik G; Ekbom, Barbara

    2014-07-01

    Agricultural intensification is recognised as a major driver of biodiversity loss in human-modified landscapes. Several agro-environmental measures at different spatial scales have been suggested to mitigate the negative impact of intensification on biodiversity and ecosystem services. The effect of these measures on the functional structure of service-providing communities remains, however, largely unexplored. Using two distinct landscape designs, we examined how the management options of organic farming at the field scale and crop diversification at the landscape level affect the taxonomic and functional structure of generalist predator communities and how these effects vary along a landscape complexity gradient. Organic farming as well as landscapes with longer and more diversified crop rotations enhanced the activity-density of spiders and rove beetles, but not the species richness or evenness. Our results indicate that the two management options affected the functional composition of communities, as they primarily enhanced the activity-density of functionally similar species. The two management options increased the functional similarity between spider species in regards to hunting mode and habitat preference. Organic farming enhanced the functional similarity of rove beetles. Management options at field and landscape levels were generally more important predictors of community structure when compared to landscape complexity. Our study highlights the importance of considering the functional composition of generalist predators in order to understand how agro-environmental measures at various scales shape community assemblages and ecosystem functioning in agricultural landscapes.

  7. Continuous EEG monitoring in the intensive care unit: beta scientific and management scientific aspects

    NARCIS (Netherlands)

    Sanders, P.M.H.; van Putten, Michel Johannes Antonius Maria; Jarm, T.; Kramar, P.; Zupanic, A.

    2007-01-01

    Due to various technological advances, it is now possible to continuously monitor critically ill patients using EEG, including the extraction of various quantitative features. In this study, several beta scientific and management scientific aspects of the implementation and use of cEEg on the ICU

  8. Characterizing European cultural landscapes: Accounting for structure, management intensity and value of agricultural and forest landscapes

    NARCIS (Netherlands)

    Tieskens, Koen F.; Schulp, Catharina J.E.; Levers, Christian; Lieskovský, Juraj; Kuemmerle, Tobias; Plieninger, Tobias; Verburg, Peter H.

    Abstract Almost all rural areas in Europe have been shaped or altered by humans and can be considered cultural landscapes, many of which now are considered to entail valuable cultural heritage. Current dynamics in land management have put cultural landscapes under a huge pressure of agricultural

  9. The development and current status of Intensive Care Unit management of prospective organ donors

    Directory of Open Access Journals (Sweden)

    Margaret Kathleen Menzel Ellis

    2016-01-01

    Conclusions: Management of deceased organ donors should focus first on maintaining adequate perfusion to all organ systems through adherence to standard critical care guidelines, early referral to OPOs, and family support. Furthermore, several specific DMGs and strategies have been recently shown to improve both the rates and outcomes of organ transplantation.

  10. Whole-tree bark and wood properties of loblolly pine from intensively managed plantations

    Science.gov (United States)

    Finto Antony; Laurence R. Schimleck; Richard F. Daniels; Alexander Clark; Bruce E. Borders; Michael B. Kane; Harold E. Burkhart

    2015-01-01

    A study was conducted to identify geographical variation in loblolly pine bark and wood properties at the whole-tree level and to quantify the responses in whole-tree bark and wood properties following contrasting silvicultural practices that included planting density, weed control, and fertilization. Trees were destructively sampled from both conventionally managed...

  11. Effects of high-intensity interval training on cardiometabolic risk in overweight and obese African-American women: a pilot study.

    Science.gov (United States)

    Hornbuckle, Lyndsey M; McKenzie, Michael J; Whitt-Glover, Melicia C

    2017-03-01

    Little is known about high-intensity interval training (HIIT) in African-American (AA) women. The purpose of this pilot study was to evaluate the effects of HIIT and steady-state (SS) exercise on cardiometabolic risk factors in young AA women. A 16-week exercise intervention was conducted 3x/week. Twenty-seven AA women were randomized to SS (n = 11; 32 continuous minutes of treadmill walking at 60-70% of maximum heart rate (HR max )), or HIIT (n = 16; 32 min of treadmill HIIT alternating 3 min at 60-70% of HR max with 1 min at 80-90% of HR max ). Two-way repeated measures ANOVA with intention-to-treat analysis was used to identify changes between groups. Significance was accepted at P ≤ 0.05. Of the 27 women who entered the study (age: 30.5 ± 6.8 years; BMI: 35.1 ± 5.1 kg/m 2 ; 5274 ± 1646 baseline steps/day), 14 completed the intervention. HIIT significantly decreased waist circumference (107.0 ± 11.3 to 105.1 ± 11.9 cm) compared to SS, which showed no change. There was a significant time effect for steps where HIIT increased steps/day (5334 ± 1586 to 7604 ± 1817 steps/day), and SS had no change. There were no significant changes in either group for any other measurements. HIIT was more effective at reducing waist circumference and increasing daily steps/day than SS treadmill exercise over 16 weeks. Further research in a larger sample is indicated to evaluate the effects of each protocol on cardiometabolic risk factors.

  12. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  13. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with >/=50 very low birth weight...... admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries...

  14. Bomb Blast and Its Consequences: Successful Intensive Care Management of Massive Pulmonary Embolsim.

    Science.gov (United States)

    Shamim, Faisal; Rizwan, Muhammad; Aziz, Adil

    2016-06-01

    A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic therapy with alteplase was started. The immediate improvement in hemodynamic status was evident following 2 hours of alteplase infusion. This case also highlights the aggressiveness of resuscitation, decision making in initiating thrombolytic therapy on clinical grounds, importance of deep venous thrombosis prophylaxis, and exhaustion of health resources due to blast related mass destruction.

  15. Does neonatal pain management in intensive care units differ between night and day? An observational study.

    Science.gov (United States)

    Guedj, Romain; Danan, Claude; Daoud, Patrick; Zupan, Véronique; Renolleau, Sylvain; Zana, Elodie; Aizenfisz, Sophie; Lapillonne, Alexandre; de Saint Blanquat, Laure; Granier, Michèle; Durand, Philippe; Castela, Florence; Coursol, Anne; Hubert, Philippe; Cimerman, Patricia; Anand, K J S; Khoshnood, Babak; Carbajal, Ricardo

    2014-02-20

    To determine whether analgesic use for painful procedures performed in neonates in the neonatal intensive care unit (NICU) differs during nights and days and during each of the 6 h period of the day. Conducted as part of the prospective observational Epidemiology of Painful Procedures in Neonates study which was designed to collect in real time and around-the-clock bedside data on all painful or stressful procedures. 13 NICUs and paediatric intensive care units in the Paris Region, France. All 430 neonates admitted to the participating units during a 6-week period between September 2005 and January 2006. During the first 14 days of admission, data were collected on all painful procedures and analgesic therapy. The five most frequent procedures representing 38 012 of all 42 413 (90%) painful procedures were analysed. Observational study. We compared the use of specific analgesic for procedures performed during each of the 6 h period of a day: morning (7:00 to 12:59), afternoon, early night and late night and during daytime (morning+afternoon) and night-time (early night+late night). 7724 of 38 012 (20.3%) painful procedures were carried out with a specific analgesic treatment. For morning, afternoon, early night and late night, respectively, the use of analgesic was 25.8%, 18.9%, 18.3% and 18%. The relative reduction of analgesia was 18.3%, pnight-time and 28.8%, pday. Parental presence, nurses on 8 h shifts and written protocols for analgesia were associated with a decrease in this difference. The substantial differences in the use of analgesics around-the-clock may be questioned on quality of care grounds.

  16. Sustaining the Productivity and Function of Intensively Managed Forests - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Burger, James A.; Xu, Yi-Jun

    2001-03-23

    The main goal of this study is to ensure sustainable management of wetland forests in the southeastern United States. The study is projected to measure soil, hydrology, and forest responses to several management scenarios across a complete forest cycle. From August 1997 to August 2000 the study has received funding as one of the Agenda 2020 projects, from the U.S. Department of Energy (Cooperative Agreement Number DE-FC07-97ID13551), the National Council of the Paper Industry for Air and Stream Improvement, and Westvac Corporation. Quarterly progress reports were submitted regularly to the Department and all project participants. This final report summarizes the project results and progress achieved during this 3-year period. Over the past three years all research objectives planned for this project were completed.

  17. The role of metrics and measurements in a software intensive total quality management environment

    Science.gov (United States)

    Daniels, Charles B.

    1992-01-01

    Paramax Space Systems began its mission as a member of the Rockwell Space Operations Company (RSOC) team which was the successful bidder on a massive operations consolidation contract for the Mission Operations Directorate (MOD) at JSC. The contract awarded to the team was the Space Transportation System Operations Contract (STSOC). Our initial challenge was to accept responsibility for a very large, highly complex and fragmented collection of software from eleven different contractors and transform it into a coherent, operational baseline. Concurrently, we had to integrate a diverse group of people from eleven different companies into a single, cohesive team. Paramax executives recognized the absolute necessity to develop a business culture based on the concept of employee involvement to execute and improve the complex process of our new environment. Our executives clearly understood that management needed to set the example and lead the way to quality improvement. The total quality management policy and the metrics used in this endeavor are presented.

  18. 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.

  19. 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.

  20. 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.

  1. 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,…

  2. Diagnosis & Correction of Soil Nutrient Limitations in Intensively managed southern pine forests

    Energy Technology Data Exchange (ETDEWEB)

    University of Florida

    2002-10-25

    Forest productivity is one manner to sequester carbon and it is a renewable energy source. Likewise, efficient use of fertilization can be a significant energy savings. To date, site-specific use of fertilization for the purpose of maximizing forest productivity has not been well developed. Site evaluation of nutrient deficiencies is primarily based on empirical approaches to soil testing and plot fertilizer tests with little consideration for soil water regimes and contributing site factors. This project uses mass flow diffusion theory in a modeling context, combined with process level knowledge of soil chemistry, to evaluate nutrient bioavailability to fast-growing juvenile forest stands growing on coastal plain Spodosols of the southeastern U.S. The model is not soil or site specific and should be useful for a wide range of soil management/nutrient management conditions. In order to use the model, field data of fast-growing southern pine needed to be measured and used in the validation of the model. The field aspect of the study was mainly to provide data that could be used to verify the model. However, we learned much about the growth and development of fast growing loblolly. Carbon allocation patterns, root shoot relationships and leaf area root relationships proved to be new, important information. The Project Objectives were to: (1) Develop a mechanistic nutrient management model based on the COMP8 uptake model. (2) Collect field data that could be used to verify and test the model. (3) Model testing.

  3. Nitrous oxide emissions from an intensively managed greenhouse vegetable cropping system in Northern China

    International Nuclear Information System (INIS)

    He Feifei; Jiang Rongfeng; Chen Qing; Zhang Fusuo; Su Fang

    2009-01-01

    Nitrous oxide (N 2 O) emissions from a typical greenhouse vegetable system in Northern China were measured from February 2004 to January 2006 using a close chamber method. Four nitrogen management levels (NN, MN, CN, and SN) were used. N 2 O emissions occurred intermittently in the growing season, strongly correlating with N fertilization and irrigation. No peak emissions were observed after fertilization in the late Autumn season due to low soil temperature. 57-94% of the seasonal N 2 O emissions came from the initial growth stage, corresponding to the rewetting process in the soil. The annual N 2 O emissions ranged from 2.6 to 8.8 kg N ha -1 yr -1 , accounting for 0.27-0.30% of the annual nitrogen input. Compared with conventional N management, site-specific N management reduced N fertilization rate by 69% in 2004 and by 76% in 2005, and consequently reduced N 2 O emissions by 51% in 2004 and 27% in 2005, respectively. - High N 2 O emissions coming from the initial growth stage can be attributed to the rewetting process in the greenhouse soil.

  4. 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.

  5. 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.

  6. 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.

  7. Management of multidrug-resistant Pseudomonas aeruginosa in the intensive care unit: state of the art.

    Science.gov (United States)

    Maraolo, Alberto Enrico; Cascella, Marco; Corcione, Silvia; Cuomo, Arturo; Nappa, Salvatore; Borgia, Guglielmo; De Rosa, Francesco Giuseppe; Gentile, Ivan

    2017-09-01

    Pseudomonas aeruginosa (PA) is one of the most important causes of healthcare-related infections among Gram-negative bacteria. The best therapeutic approach is controversial, especially for multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains as well as in the setting of most severe patients, such as in the intensive care unit (ICU). Areas covered: This article addresses several points. First, the main microbiological aspects of PA, focusing on its wide array of resistance mechanisms. Second, risk factors and the worse outcome linked to MDR-PA infection. Third, the pharmacological peculiarity of ICU patients, that makes the choice of a proper antimicrobial therapy difficult. Eventually, the current therapeutic options against MDR-PA are reviewed, taking into account the main variables that drive antimicrobial optimization in critically ill patients. Literature search was carried out using Pubmed and Web of Science. Expert commentary: Methodologically rigorous studies are urgently needed to clarify crucial aspects of the treatment against MDR-PA, namely monotherapy versus combination therapy in empiric and targeted settings. In the meanwhile, useful options are represented by newly approved drugs, such as ceftolozane/tazobactam and ceftazidime/avibactam. In critically ill patients, at least as empirical approach, a combination therapy is a prudent choice when a MDR-PA strain is suspected.

  8. Intensive care management of severe hypernatraemia in the context of group A streptococcal septicaemia.

    Science.gov (United States)

    Davies, Bethan; Jesty, Robert; Uddin, Shahana; Metaxa, Victoria

    2018-04-26

    This case describes a 54-year-old woman with exudative eczema, who was admitted to the intensive care unit with a serum sodium concentration of 191 mmol/L, secondary to profound dehydration in the context of group A streptococcal septicaemia. Successful rehydration and electrolyte normalisation was achieved with continuous venovenous haemodiafiltration (CVVHDF), the replacement fluid of which was infused with hypertonic saline to limit the rate of sodium reduction. This case report comments on three areas of interest. First, hypernatraemia of this level is unusual. Second, the infusion of hypertonic saline into the replacement fluid of the CVVHDF filter is not common practice but successfully ensured a controlled reduction in serum sodium concentration while aggressively replacing a 9 L water deficit. Third, the notable physiological reserve demonstrated by the patient: despite an extraordinary serum sodium concentration in the context of overwhelming streptococcal septicaemia, she has made a full cognitive recovery. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Management of outbreaks of nosocomial pathogens in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    B. Ghirardi

    2013-12-01

    Full Text Available Outbreaks of nosocomial pathogens are one of the most relevant problems in Neonatal Intensive Care Unit (NICU. Many factors contribute to the onset of an epidemic, including virulence of the pathogen and vulnerability of the infants hospitalized in NICU. Outbreaks are often caused by multidrug-resistant organisms (MDROs. MDROs are defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. MDROs, including methicillin-resistant Staphylococcus aureus (MRSA, vancomycin-resistant enterococci (VRE and certain gram-negative bacilli (GNB, have important infection control implications. Once MDROs are introduced into a healthcare setting, transmission and persistence of the resistant strain is determined by the availability of vulnerable patients, selective pressure exerted by antimicrobial use, increased potential for transmission from larger numbers of infected or colonized patients (“colonization pressure”, and the impact of adherence to prevention efforts. Often, routine infection control measures are not enough to contain outbreaks, and additional control measures are needed, including implementation of hand hygiene, cohorting of infected/colonized infants, neonatal surveillance cultures, screening of healthcare workers and decolonization of neonates and/or healthcare workers in selected cases. In this review, we report the practices we developed in our NICU to contain an epidemic. These recommendations reflect the experience of the group, as well as the findings of the current literature.

  10. The SLICK hair locus derived from Senepol cattle confers thermotolerance to intensively managed lactating Holstein cows.

    Science.gov (United States)

    Dikmen, S; Khan, F A; Huson, H J; Sonstegard, T S; Moss, J I; Dahl, G E; Hansen, P J

    2014-09-01

    The SLICK haplotype (http://omia.angis.org.au/OMIA001372/9913/) in cattle confers animals with a short and sleek hair coat. Originally identified in Senepol cattle, the gene has been introduced into Holsteins. The objectives of the current study were to determine (1) whether lactating Holsteins with the slick hair phenotype have superior ability for thermoregulation compared with wild-type cows or relatives not inheriting the SLICK haplotype, and (2) whether seasonal depression in milk yield would be reduced in SLICK cows. In experiment 1, diurnal variation in vaginal temperature in the summer was monitored for cows housed in a freestall barn with fans and sprinklers. Vaginal temperatures were lower in slick-haired cows than in relatives and wild-type cows. In experiment 2, acute responses to heat stress were monitored after cows were moved to a dry lot in which the only heat abatement was shade cloth. The increases in rectal temperature and respiration rate caused by heat stress during the day were lower for slick cows than for relatives or wild-type cows. Moreover, sweating rate was higher for slick cows than for cows of the other 2 types. In experiment 3, effects of season of calving (summer vs. winter) on milk yield and composition were determined. Compared with milk yield of cows calving in winter, milk yield during the first 90 d in milk was lower for cows calving in the summer. However, this reduction was less pronounced for slick cows than for wild-type cows. In conclusion, Holsteins with slick hair have superior thermoregulatory ability compared with non-slick animals and experience a less drastic depression in milk yield during the summer. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  11. 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.

  12. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins.

    Science.gov (United States)

    Randhawa, Varinder K; Grunau, Brian E; Debicki, Derek B; Zhou, Jian; Hegazy, Ahmed F; McPherson, Terry; Nagpal, A Dave

    2018-02-01

    Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  13. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

    Science.gov (United States)

    Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

    2016-01-01

    To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  14. Failure mode and effect analysis: improving intensive care unit risk management processes.

    Science.gov (United States)

    Askari, Roohollah; Shafii, Milad; Rafiei, Sima; Abolhassani, Mohammad Sadegh; Salarikhah, Elaheh

    2017-04-18

    Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.

  15. THE KNOWLEDGE MANAGEMENT IN INTENSIVE ENVIRONMENTS OF KNOWLEDGE: THE SMALL INCUBATED SOFTWARES COMPANIES

    Directory of Open Access Journals (Sweden)

    Greyce Krambeck

    2009-07-01

    Full Text Available This article discusses the understanding and behavior of entrepreneurs incubated for software companies (development of information systems, provide services in information technology - hardware and software, and advise on the implementation of administrative management systems in relation to knowledge, in the obtaining and facilitating the use of knowledge and availability of media. Initially, it sought a fundamental concept for the study and is based contextualise the issue, making the connection with the knowledge of the views of academic and business. After an analysis was conducted based on applied research to executives on their understanding of the concept of knowledge regarding the way in which it operates (professional and personal, concluding with the importance of knowledge for business growth from the person.

  16. How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit?

    Science.gov (United States)

    Bhattacharjee, Anirban; Pradhan, Debasis; Bhattacharyya, Prithwis; Dey, Samarjit; Chhunthang, Daniala; Handique, Akash; Barman, Angkita; Yunus, Mohd

    2017-08-01

    The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. This prospective observational study included twenty mechanically ventilated critically ill patients with Acute Physiology and Chronic Health Evaluation score (APACHE II) >20. EVLWI and PVPI were measured using transpulmonary thermodilution, and simultaneously, PaO 2 :FiO 2 ratio, alveolar-arterial gradient of oxygen (AaDO 2 ), and chest radiograph scores from two radiologists were obtained. The correlation of EVLWI and PVPI with chest radiograph scores, PaO 2 :FiO 2 ratio, and AaDO 2 were calculated. The inter-observer agreement between the two radiologists was tested using kappa test. EVLWI and PVPI correlated modestly with PaO 2 :FiO 2 ( r = -0.32, P = 0.0004; r = -0.39, P = 0.0001). There was a better correlation of EVLWI and PVPI with PaO 2 :FiO 2 ratio ( r = -0.71, P < 0.0001; r = -0.58, P = 0.0001) in the acute respiratory distress syndrome (ARDS) subgroup. The EVLWI values correlated significantly with corresponding chest radiograph scores ( r = 0.71, P < 0.0001 for observer 1 and r = 0.68, P < 0.0001 for observer 2). EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.

  17. 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.

  18. 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.

  19. Gap formation in Danish beech (Fagus sylvatica) forests of low management intensity

    DEFF Research Database (Denmark)

    Ritter, Eva; Vesterdal, Lars

    2006-01-01

    -based managed forest, soil solution was collected for 5 years and soil moisture measured in the fourth year after gap formation. Average NO3-N concentrations were significantly higher in the gaps (9.9 and 8.1 mg NO3-N l(-1), respectively) than under closed canopy (0.2 mg l(-1)). In the semi-natural forest......, measurements were carried out up to 29 months after gap formation. Average NO3-N concentrations in the gap were 19.3 mg NO3-N l(-1). Gap formation alone did not account for this high level, as concentrations were high also under closed canopy (average 12.4 mg NO3-N l(-1)). However, the gap had significantly...... higher N concentrations when trees were in full leaf, and NO3-N drainage losses were significantly increased in the gap. No losses occurred under closed canopy in growing seasons. Soil moisture was close to field capacity in all three gaps, but decreased under closed canopy in growing seasons...

  20. Integration of quality assurance activities into a computerized patient data management system in an intensive care unit.

    Science.gov (United States)

    Weissman, C; Mossel, P; Haimet, S; King, T C

    1990-11-01

    A prototype computer-based patient data management system (PDMS) was developed for a surgery-anesthesiology intensive care unit (ICU) to reduce the time and staff needed to implement quality assurance (QA) functions. Goals of the system were to make QA functions routine and minimally intrusive to the daily operation of the ICU. PDMS collects general data (eg, admissions and discharges, lengths of stay, and bed utilization rates) and specialized data (eg, specific indicators) unique to the ICU and performs prospective monitoring for the occurrence of specific events (occurrence screening) and retrospective examinations of patient records (targeted reviews). Preliminary results suggest that PDMS facilitates the acquisition and analysis of QA data and reduces the time needed to acquire these data. Research to validate these claims and efforts to improve and expand the prototype system with a permanent production system are in progress.

  1. 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

  2. Assessment and Management of Acute Severe Mitral Regurgitation in the Intensive Care Unit.

    Science.gov (United States)

    Leitman, Marina; Tyomkin, Vladimir; Raanani, Ehud; Sharony, Ram; Tzatskin, Ludmila; Peleg, Eli; Blatt, Alex; Vered, Zvi

    2017-03-01

    Acute severe mitral regurgitation (MR) is a serious medical condition. Whilst clear guidelines exist regarding the management of chronic MR, acute severe MR is usually treated on an individual basis. Currently, few data exist regarding acute MR in the era of primary coronary interventions (PCI). The present study included patients admitted to the Department of Cardiology during recent years with acute severe MR of different etiologies, and an analysis of these data in the light of previous investigations. The digital database of the present authors' hospital was searched for patients diagnosed with severe MR between 2008 and 2015. From a total of 228 patients identified, 19 with primary MR and 17 with secondary (functional) MR were admitted to the Department of Cardiology. The clinical data and outcome of these patients were analyzed. Among patients with MR due to acute myocardial infarction (MI), 13 had functional MR and six had MR due to mechanical complications, namely rupture of the papillary muscle or chordae tendineae. Among patients with MR not in the setting of MI, 13 had primary MR and four had functional MR. Patients with MR due to acute MI were more often in cardiogenic shock or had pulmonary edema and had a higher mortality. The strongest predictor of mortality was the presence of shock, followed by female gender, hypertension, age ≥68 years; previous MI and pulmonary edema were also predictors of mortality. In patients with acute MI and secondary MR, PCI to the culprit coronary artery was associated with a lesser degree of MR on follow up. Patients with severe MR are at high risk of in-hospital death. Patients with functional MR are likely to benefit from prompt PCI to the culprit artery, and for those with primary MR urgent surgery is life-saving.

  3. Use of case-based reasoning to enhance intensive management of patients on insulin pump therapy.

    Science.gov (United States)

    Schwartz, Frank L; Shubrook, Jay H; Marling, Cynthia R

    2008-07-01

    This study was conducted to develop case-based decision support software to improve glucose control in patients with type 1 diabetes mellitus (T1DM) on insulin pump therapy. While the benefits of good glucose control are well known, achieving and maintaining good glucose control remains a difficult task. Case-based decision support software may assist by recalling past problems in glucose control and their associated therapeutic adjustments. Twenty patients with T1DM on insulin pumps were enrolled in a 6-week study. Subjects performed self-glucose monitoring and provided daily logs via the Internet, tracking insulin dosages, work, sleep, exercise, meals, stress, illness, menstrual cycles, infusion set changes, pump problems, hypoglycemic episodes, and other events. Subjects wore a continuous glucose monitoring system at weeks 1, 3, and 6. Clinical data were interpreted by physicians, who explained the relationship between life events and observed glucose patterns as well as treatment rationales to knowledge engineers. Knowledge engineers built a prototypical system that contained cases of problems in glucose control together with their associated solutions. Twelve patients completed the study. Fifty cases of clinical problems and solutions were developed and stored in a case base. The prototypical system detected 12 distinct types of clinical problems. It displayed the stored problems that are most similar to the problems detected, and offered learned solutions as decision support to the physician. This software can screen large volumes of clinical data and glucose levels from patients with T1DM, identify clinical problems, and offer solutions. It has potential application in managing all forms of diabetes.

  4. Effect of moderate versus high intensity interval exercise training on vascular function in inactive latin-american adults: a randomized clinical trial

    OpenAIRE

    Hernández Quiñonez, Paula Andrea

    2016-01-01

    Exercise training is effective for improving cardiometabolic health and physical fitness in inactive adults. However, limited research has been conducted on the optimal exercise training intensity for this population. We investigate the effect of moderate versus high intensity interval exercise training on vascular function and physical fitness in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate intensity training (MCT group) or high intens...

  5. Control of Giardia infections with ronidazole and intensive hygiene management in a dog kennel.

    Science.gov (United States)

    Fiechter, Ruth; Deplazes, Peter; Schnyder, Manuela

    2012-06-08

    Infections with the intestinal protozoan parasite Giardia in dogs and cats are common. Clinical signs vary from asymptomatic to small bowel diarrhea and associated discomfort. The control of infections in dogs is frequently a frustrating issue for animal owners and veterinarians. Drugs with antiprotozoal activity such as fenbendazole and metronidazole are recommended, however, they do not show 100% efficacy and superinfections occur regularly. Ronidazole is currently the drug of choice for the treatment of Tritrichomonas foetus in cats and there is now limited information available about its efficacy against Giardia spp. In the kennel investigated, dogs regularly showed loose feces and the presence of Giardia (assemblage C, renamed as G. canis) cysts. An elimination strategy of this parasite involving strict hygiene management and disinfection of the enclosures with 4-chlorine-M-cresol, oral treatment with ronidazole (30-50mg/kg BW bid for 7 days) and two shampooings (containing chlorhexidine) at the beginning and the end of the treatments was implemented for a group of 6 dogs. As a control another group of 7 dogs was transferred to the disinfected enclosures and shampooed, but left untreated. Dog feces were tested for the presence of Giardia cysts (SAF concentration technique) or Giardia antigen with a commercial ELISA (NOVITEC(®)) and a quick immunochromatography-based test (SensPERT(®)) before and between 5 and 40 days after the last treatment. All ronidazole-treated dogs were negative for Giardia cysts and antigen up to 26 days after the last treatment, while between 1 and 5 of the control animals tested positive in each of the test series. At this point, also dogs of the control group were again moved into clean enclosures, shampooed twice and treated with ronidazole. Five, 12 and 19 days after the last treatment, the dogs in the control group tested negative for Giardia cysts and antigen. However, all animals had again positive results at later time points

  6. Greenhouse gas exchange in grasslands: impacts of climate, intensity of management and other factors

    Science.gov (United States)

    Smith, K. A.

    2003-04-01

    Grasslands occupy some 40% of the terrestrial land surface. They are generally categorised as natural (occurring mainly in those regions where the rainfall is too low to support forest ecosystems), semi-natural (where management, mainly by grazing, has changed the vegetation composition), and artificial (where forests have been cleared to create new pasture land). The soils of the natural and semi-natural grasslands constitute a large reservoir of carbon, and make a substantial contribution to the soil sink for atmospheric CH_4. The conversion of much of the natural temperate grassland to arable agriculture, e.g. in North America and Europe, resulted in a considerable decrease in soil organic carbon, and its release to the atmosphere as CO_2 has made a substantial contribution to the total atmospheric concentration of this gas. The associated increase in cycling of soil N (released from the organic matter) will have contributed to N_2O emissions, and land disturbance and fertilisation has resulted in a depletion of the soil CH_4 sink. Conversion of tropical forests to pastures has also been a major source of CO_2, and these pastures show elevated emissions of N_2O for some years after conversion. Seasonally flooded tropical grasslands are a significant source of CH_4 emissions. Consideration of grassland ecosystems in their entirety, in relation to GHG exchange, necessitates the inclusion of CH_4 production by fauna - domesticated livestock and wild herbivores, as well as some species of termites - in the overall assessment. Stocking rates on pasture land have increased, and the total CH_4 emissions likewise. The relationship between animal production and CH_4 emissions is dependent on the nutritional quality of the vegetation, as well as on animal numbers. In both temperate and tropical regions, increased N inputs as synthetic fertilisers and manures (and increased N deposition) are producing possibly a more-than-linear response in terms of emissions of N_2O. In

  7. 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.

  8. Nitrogen excess in North American ecosystems: Predisposing factors, ecosystem responses, and management strategies

    Science.gov (United States)

    Fenn, M.E.; Poth, M.A.; Aber, J.D.; Baron, Jill S.; Bormann, B.T.; Johnson, D.W.; Lemly, A.D.; McNulty, S.G.; Ryan, D.F.; Stottlemyer, R.

    1998-01-01

    , illustrating that ecosystems vary widely in the capacity to retain N inputs. Overly mature forests with high N deposition, high soil N stores, and low soil C:N ratios are prone to N saturation and NO3/- leaching. Additional characteristics favoring low N retention capacity include a short growing season (reduced plant N demand) and reduced contact time between drainage water and soil (i.e., porous coarse-textured soils, exposed bedrock or talus). Temporal patterns of hydrologic fluxes interact with biotic uptake and internal cycling patterns in determining ecosystem N retention. Soils are the largest storage pool for N inputs, although vegetation uptake is also important. Recent studies indicate that nitrification may be widespread in undisturbed ecosystems, and that microbial assimilation of NO3/- may be a significant N retention mechanism, contrary to previous assumptions. Further studies are needed to elucidate the sites, forms, and mechanisms of N retention and incorporation into soil organic matter, and to test potential management options for mitigating N losses from forests. Implementation of intensive management practices in N-saturated ecosystems may only be feasible in high-priority areas and on a limited scale. Reduction of N emissions would be a preferable solution, although major reductions in the near future are unlikely in many areas due to economic, energy-use, policy, and demographic considerations.

  9. 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...

  10. 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.

  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. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    Science.gov (United States)

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  13. Potential Carbon Transport: Linking Soil Aggregate Stability and Sediment Enrichment for Updating the Soil Active Layer within Intensely Managed Landscapes

    Science.gov (United States)

    Wacha, K.; Papanicolaou, T.; Abban, B. K.; Wilson, C. G.

    2014-12-01

    Currently, many biogeochemical models lack the mechanistic capacity to accurately simulate soil organic carbon (SOC) dynamics, especially within intensely managed landscapes (IMLs) such as those found in the U.S. Midwest. These modeling limitations originate by not accounting for downslope connectivity of flowpathways initiated and governed by landscape processes and hydrologic forcing, which induce dynamic updates to the soil active layer (generally top 20-30cm of soil) with various sediment size fractions and aggregates being transported and deposited along the downslope. These hydro-geomorphic processes, often amplified in IMLs by tillage events and seasonal canopy, can greatly impact biogeochemical cycles (e.g., enhanced mineralization during aggregate breakdown) and in turn, have huge implications/uncertainty when determining SOC budgets. In this study, some of these limitations were addressed through a new concept, Potential Carbon Transport (PCT), a term which quantifies a maximum amount of material available for transport at various positions of the landscape, which was used to further refine a coupled modeling framework focused on SOC redistribution through downslope/lateral connectivity. Specifically, the size fractions slaked from large and small aggregates during raindrop-induced aggregate stability tests were used in conjunction with rainfall-simulated sediment enrichment ratio (ER) experiments to quantify the PCT under various management practices, soil types and landscape positions. Field samples used in determining aggregate stability and the ER experiments were collected/performed within the historic Clear Creek Watershed, home of the IML Critical Zone Observatory, located in Southeastern Iowa.

  14. Epidemiology, Prognosis, and Evolution of Management of Septic Shock in a French Intensive Care Unit: A Five Years Survey

    Directory of Open Access Journals (Sweden)

    Nicolas Boussekey

    2010-01-01

    Full Text Available Purpose. To evaluate the epidemiology, prognosis, and management of septic shock patients hospitalized in our intensive care unit (ICU. Materiel and Methods. Five-year monocenter observational study including 320 patients. Results. ICU mortality was 54.4%. Independent mortality risk factors were mechanical ventilation (OR=4.97, Simplify Acute Physiology Score (SAPS II > 60 (OR=4.28, chronic alcoholism (OR=3.38, age >65 years (OR=2.65, prothrombin ratio <40% (OR=2.37, and PaO2/FiO2 ratio <150 (OR=1.91. These six mortality risk factors recovered allow screening immediately septic shock patients with a high mortality risk. Morbidity improved with time (diminution of septic shock complications, increase of the number of days alive free from mechanical ventilation and vasopressors on day 28, concomitant to an evolution of the management (earlier institution of all replacement and medical therapies and more initial volume expansion. There was no difference in mortality. Conclusion. Our study confirms a high mortality rate in septic shock patients despite a new approach of treatment.

  15. 76 FR 71501 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery

    Science.gov (United States)

    2011-11-18

    ... Lobster Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric... American lobster regulations that would limit entry into the lobster trap fishery in Lobster Conservation... to fish in Area 1 with up to 800 lobster traps. The proposed limited entry program responds to the...

  16. Managing Regional Collaboration in Higher Education: The Case of the North American Free Trade Agreement (NAFTA).

    Science.gov (United States)

    Crespo, Manuel

    2000-01-01

    Describes accomplishments in increasing collaboration in higher education within the North American Free Trade Agreement (NAFTA). Analyzes procedures for determining equivalencies of courses and degrees and for improving transnational mobility of students and professors. Also discusses the role of the private sector in research, education and…

  17. Response of the Ionospheric F-region in the Latin American Sector During the Intense Geomagnetic Storm of 21-22 January 2005

    Science.gov (United States)

    Sahai, Y.; Fagundes, P. R.; de Jesus, R.; de Abreu, A. J.; Crowley, G.; Pillat, V. G.; Guarnieri, F. L.; Abalde, J. R.; Bittencourt, J. A.

    2009-12-01

    Ionospheric storms are closely associated with geomagnetic storms and are an extreme example of space weather events. The response of the ionosphere to storms is rather complicated. In the present investigation, we have studied the response of the ionospheric F-region in the Latin American sector during the intense geomagnetic storm of 21-22 January 2005 (with storm sudden commencement (SSC) at 1712 UT on 21 January). This geomagnetic storm is anomalous (minimum Dst reached -105 nT at 0700 UT on 22 January) because the main phase occurred during the northward excursion of the Bz component of interplanetary magnetic fields (IMFs). The monthly mean F10.7 solar flux for the month of January 2005 was 99.0 sfu. The ionospheric F-region parameters observed at Ramey (18.5 N, 67.1 W; RAM), Puerto Rico, Jicamarca (12.0 S, 76.8 W; JIC), Peru, Manaus (2.9 S, 60.0 W; MAN), and São José dos Campos (23.2 S, 45.9 W; SJC), Brazil, during 21-22 January (geomagnetically disturbed) and 25 January (geomagnetically quiet) have been analyzed. Both JIC and MAN, the equatorial stations, show unusually rapid uplifting of the F-region peak heights(hpF2/hmF2) and a decrease in the NmF2 coincident with the time of SSC. At both RAM and SJC an uplifting of the F-region peak height is observed at about 2000 UT. The low-latitude station SJC shows a coincident decrease in NmF2 with the uplifting, whereas the mid-latitude station RAM shows a decrease in NmF2 earlier than the uplifting. Also, the observed variations in the F-region ionospheric parameters are compared with the TIMEGCM model run for 21-22 January and the model results show both similarities and differences from the observed results. Average GPS-TEC (21-22 and 25 January) and phase fluctuations (21, 22, 25, 26 January) observed at Belem (1.5 S, 48.5 W; BELE), Brasilia (15.9 S, 47.9 W; BRAZ), Presidente Prudente (22.3o S, 51.4 W; UEPP), and Porto Alegre (30.1 S, 51.1 W; POAL), Brazil, are also presented. These GPS stations belong to

  18. Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives.

    Science.gov (United States)

    Weeks, William B; Lazarus, Arthur; Wallace, Amy E

    2008-01-01

    In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.

  19. Does introduction of a Patient Data Management System (PDMS) improve the financial situation of an intensive care unit?

    Science.gov (United States)

    Castellanos, Ixchel; Schüttler, Jürgen; Prokosch, Hans-Ulrich; Bürkle, Thomas

    2013-09-16

    Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if such a major investment pays off. We tried to answer the following questions: How do costs and revenues of an intensive care unit develop before and after introduction of a PDMS? Can higher revenues be obtained with improved PDMS documentation? Can we present cost savings attributable to the PDMS? Retrospective analysis of cost and reimbursement data of a 25 bed Intensive Care Unit at a German University Hospital, three years before (2004-2006) and three years after (2007-2009) PDMS implementation. Costs and revenues increased continuously over the years. The profit of the investigated ICU was fluctuating over the years and seemingly depending on other factors as well. We found a small increase in profit in the year after the introduction of the PDMS, but not in the following years. Profit per case peaked at 1039 € in 2007, but dropped subsequently to 639 € per case. We found no clear evidence for cost savings after the PDMS introduction. Our cautious calculation did not consider additional labour costs for IT staff needed for system maintenance. The introduction of a PDMS has probably minimal or no effect on reimbursement. In our case the observed increase in profit was too small to amortize the total investment for PDMS implementation.This may add some counterweight to the literature, where expectations for tools such as the PDMS can be quite unreasonable.

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. Latin America’s Subtle Racism: Salient Managerial Implications For Non-Latin American Managers

    OpenAIRE

    Rutilio Martinez; Cris de la Torre

    2011-01-01

    Since the mid nineteen nineties most Latin American nations have implemented free market policies. The ensuing economic stability has attracted investment from non-Latin corporations, thereby causing the transfer of non-Latin executives to Latin nations. For many of these executives, their Latin assignments include an unexpected challenge: Dealing with Latin America’s subtle but pervasive racism. Such racism contributes to the mistreatment of labor and influences the promotion and hiring of e...

  6. American Indian Access to Department of Defense Facilities: Source Documents and Bibliography (Legacy Resource Management Program)

    Science.gov (United States)

    1993-09-01

    who under the terms of the Archeological and Historic Preservation Act must respond within 48 hours of notification. The DCA may render an immediate...1965 The Surviving Chumash. UCLA Archaeological Survey Annual Reports 65:277-302. Grant, Campbell 1973a Chuirash: Introduction. In R.F. Heizer , ed...Coastal Chumash. In R.F. Heizer , et., California. Volume 8, Handbook of North American"Indians, William C. Sturtevant, General Editor. Washington

  7. A Lesson for American Managers: Learning from Japanese Experiences in the U.S.

    Science.gov (United States)

    Nosow, Sigmund

    1984-01-01

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

  8. The Samurai or the Cowboy? Toward an American Model of Quality Management.

    Science.gov (United States)

    Beck, Mark W.

    1994-01-01

    The Japanese model of business management and Total Quality Management principles being applied to higher education as well as businesses are often ineffective because of the application of packaged ideas without consideration of the subtleties of individual organizations. The cowboy model of teamwork stresses the individual's role and better fits…

  9. 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.

  10. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

  11. Reproductive parameters in the critically endangered Blue-throated Macaw: limits to the recovery of a parrot under intensive management.

    Directory of Open Access Journals (Sweden)

    Igor Berkunsky

    Full Text Available Rediscovered in the wild twenty years ago, the breeding biology of wild Blue-throated Macaws remains largely unexplored, yet is essential to its effective conservation and recovery. Here, we analyse reproductive parameters in an intensively managed wild population of Blue-throated Macaws, providing the first data on the breeding biology of this critically endangered species. During the six-year study period, 2007-2012, the number of active breeding pairs either remained constant or decreased, depending on the site, and no new breeding pairs were discovered despite extensive searching. We documented nesting attempts in natural cavities in dead palms or live hardwoods, and artificial nest boxes. Egg-laying was concentrated during the end of dry season and the beginning of the wet season, August through December. Hatching failure was the greatest cause of egg losses. Half of the breeding attempts of Blue-throated Macaws produced at least one fledging, on average two, after a 85 days nestling period. An average of 4.3 nestlings per year fledged from all known wild nests combined. Each pair lost roughly 65% of its initial reproductive investment at each nesting attempt. In most successful nesting attempts of individualized pairs, a new nesting attempt was not detected the following year. All monitored breeding pairs showed high nest site fidelity, reusing hardwood-tree cavities and nest boxes. Our findings will aid conservation efforts by refining current actions and prompting new approaches towards the conservation and recovery of the Blue-throated Macaw.

  12. Linkage between N2O emission and functional gene abundance in an intensively managed calcareous fluvo-aquic soil

    Science.gov (United States)

    Yang, Liuqing; Zhang, Xiaojun; Ju, Xiaotang

    2017-02-01

    The linkage between N2O emissions and the abundance of nitrifier and denitrifier genes is unclear in the intensively managed calcareous fluvo-aquic soils of the North China Plain. We investigated the abundance of bacterial amoA for nitrification and narG, nirS, nirK, and nosZ for denitrification by in situ soil sampling to determine how the abundance of these genes changes instantly during N fertilization events and is related to high N2O emission peaks. We also investigated how long-term incorporated straw and/or manure affect(s) the abundance of these genes based on a seven-year field experiment. The overall results demonstrate that the long-term application of urea-based fertilizer and/or manure significantly enhanced the number of bacterial amoA gene copies leading to high N2O emission peaks after N fertilizer applications. These peaks contributed greatly to the annual N2O emissions in the crop rotation. A significant correlation between annual N2O emissions and narG, nirS, and nirK gene numbers indicates that the abundance of these genes is related to N2O emission under conditions for denitrification, thus partly contributing to the annual N2O emissions. These findings will help to draw up appropriate measures for mitigation of N2O emissions in this ‘hotspot’ region.

  13. 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…

  14. 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…

  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. 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…

  17. The importance of traditional fire use and management practices for contemporary land managers in the American Southwest

    Science.gov (United States)

    Carol Raish; Armando Gonzalez-Caban; Carol J. Condie

    2005-01-01

    Indigenous and traditional peoples worldwide have used fire to manipulate their environment for thousands of years. These longstanding practices still continue and have considerable relevance for today’s land managers. This discussion explores the value of documenting and understanding historic and contemporary fire use attitudes and practices of the varied cultural/...

  18. 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

  19. Management of Type II Odontoid Fractures: Experience from Latin American Spine Centers.

    Science.gov (United States)

    Falavigna, Asdrubal; Righesso, Orlando; da Silva, Pedro Guarise; Siri, Carlos Rocca; Daniel, Jefferson W; Esteves Veiga, José Carlos; de Azevedo, Gustavo Borges Laurindo; Carelli, Luis Eduardo; Yurac, Ratko; Sanchez Chavez, Felix Adolfo; Sfreddo, Ericson; Cecchini, Andre; do Reis, Marcelo Martins; Jiménez Avila, Jose Maria; Riew, K Daniel

    2017-02-01

    To analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic factors, that influence surgical planning in 8 Latin American centers. Retrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from 8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2) clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement, displacement of odontoid relative to C2 body, anatomy of fracture line, distance between fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed tomography. Mean patient age was 45.33 years ± 23.54; 78.4% of patients were male. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was chosen when distance between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid screw treatment in a symptomatic patient. The treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when distance between bone fragments was >2 mm and in symptomatic patients with nonunion. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Analysis of the Environmental Management System based on ISO 14001 on the American continent.

    Science.gov (United States)

    Neves, Fábio de Oliveira; Salgado, Eduardo G; Beijo, Luiz A

    2017-09-01

    The American continent is in broad economic and industrial development. Consequently, a more detailed discussion of the impacts generated by such development is needed. Moreover, there is an increase in the number of ISO 14001 certificates issued to this continent. Given the above, no studies were found that bridge the gap to identify the influence of different factors on ISO 14001 in the Americas. Thus, this article has as its main aim to check which economic, environmental and cultural factors have influence on ISO 14001 Certification in the American Continent. The data were collected in the ISO Survey, World Bank, United Nations Development Programme and International Energy Agency. Among the countries of that continent, thirteen were analyzed and only two did not show the economic factors as the influence factor in the multiple regression models fitted with Brazil and the United State. In these models, all presented environmental factors as influencing factors. Only in Brazil the index HDI presented as cultural factor in multiple regression model fitted. The economic factors: Gross Domestic Product and exports of goods and services and environmental: Carbon Dioxide (CO 2 ) and fossil fuel consumption were the most influential in ISO 14001 certification. Venezuela, Uruguay, Colombia and the United States were countries that had factors dependent on each other, featuring the environmental marketing. Briefly, this study brings up several implications: to the academy, with the proposal of new concepts and guidance on the factors that assist in ISO 14001 certification in the American Continent. Additionally, taking into account the industry, the factors serve as efficiency parameters for the implementation of ISO 14001 standard, and for the Government to improve through factors that do not fit in multiple regression models. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    van Diepen, Sean; Katz, Jason N; Albert, Nancy M; Henry, Timothy D; Jacobs, Alice K; Kapur, Navin K; Kilic, Ahmet; Menon, Venu; Ohman, E Magnus; Sweitzer, Nancy K; Thiele, Holger; Washam, Jeffrey B; Cohen, Mauricio G

    2017-10-17

    Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. © 2017 American Heart Association, Inc.

  2. 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...

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Brian J Greco

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

  5. 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

  6. New perspectives in fire management in South American savannas: The importance of intercultural governance.

    Science.gov (United States)

    Mistry, Jayalaxshmi; Schmidt, Isabel Belloni; Eloy, Ludivine; Bilbao, Bibiana

    2018-05-11

    Wildfires continue to cause damage to property, livelihoods and environments around the world. Acknowledging that dealing with wildfires has to go beyond fire-fighting, governments in countries with fire-prone ecosystems have begun to recognize the multiple perspectives of landscape burning and the need to engage with local communities and their practices. In this perspective, we outline the experiences of Brazil and Venezuela, two countries where fire management has been highly contested, but where there have been recent advances in fire management approaches. Success of these new initiatives have been measured by the reduction in wildfire extent through prescribed burning, and the opening of a dialogue on fire management between government agencies and local communities. Yet, it is clear that further developments in community participation need to take place in order to avoid the appropriation of local knowledge systems by institutions, and to better reflect more equitable fire governance.

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

    Science.gov (United States)

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

    2016-01-01

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

  8. 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.

  9. Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.

    Science.gov (United States)

    Fusco, Matthew R; Fisher, Winfield S; McGrew, Benjamin M; Walters, Beverly C

    2014-12-01

    Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada

  10. Foundations of data-intensive science: Technology and practice for high throughput, widely distributed, data management and analysis systems

    Science.gov (United States)

    Johnston, William; Ernst, M.; Dart, E.; Tierney, B.

    2014-04-01

    Today's large-scale science projects involve world-wide collaborations depend on moving massive amounts of data from an instrument to potentially thousands of computing and storage systems at hundreds of collaborating institutions to accomplish their science. This is true for ATLAS and CMS at the LHC, and it is true for the climate sciences, Belle-II at the KEK collider, genome sciences, the SKA radio telescope, and ITER, the international fusion energy experiment. DOE's Office of Science has been collecting science discipline and instrument requirements for network based data management and analysis for more than a decade. As a result of this certain key issues are seen across essentially all science disciplines that rely on the network for significant data transfer, even if the data quantities are modest compared to projects like the LHC experiments. These issues are what this talk will address; to wit: 1. Optical signal transport advances enabling 100 Gb/s circuits that span the globe on optical fiber with each carrying 100 such channels; 2. Network router and switch requirements to support high-speed international data transfer; 3. Data transport (TCP is still the norm) requirements to support high-speed international data transfer (e.g. error-free transmission); 4. Network monitoring and testing techniques and infrastructure to maintain the required error-free operation of the many R&E networks involved in international collaborations; 5. Operating system evolution to support very high-speed network I/O; 6. New network architectures and services in the LAN (campus) and WAN networks to support data-intensive science; 7. Data movement and management techniques and software that can maximize the throughput on the network connections between distributed data handling systems, and; 8. New approaches to widely distributed workflow systems that can support the data movement and analysis required by the science. All of these areas must be addressed to enable large

  11. Role of Micro-Topographic Variability on the Distribution of Inorganic Soil-Nitrogen Age in Intensively Managed Landscape

    Science.gov (United States)

    Woo, Dong K.; Kumar, Praveen

    2017-10-01

    How does the variability of topography structure the spatial heterogeneity of nutrient dynamics? In particular, what role does micro-topographic depression play in the spatial and temporal dynamics of nitrate, ammonia, and ammonium? We explore these questions using the 3-D simulation of their joint dynamics of concentration and age. To explicitly resolve micro-topographic variability and its control on moisture, vegetation, and carbon-nitrogen dynamics, we use a high-resolution LiDAR data over an agricultural site under a corn-soybean rotation in the Intensively Managed landscapes Critical Zone Observatory in the U.S. Midwest. We utilize a hybrid CPU-GPU parallel computing architecture to reduce the computational cost associated with such high-resolution simulations. Our results show that in areas that present closed topographic depressions, relatively lower nitrate concentration and age are observed compared to elsewhere. The periodic ponding in depressions increases the downward flux of water that carries more dissolved nitrate to the deeper soil layer. However, the variability in the depressions is relatively higher as a result of the episodic ponding pattern. When aggregate efflux from the soil domain at the bottom of the soil is considered, we find a gradual decrease in the age on the rising limb of nitrate efflux and a gradual increase on the falling limb. In addition, the age of the nitrate efflux ranges from 4 to 7 years. These are significantly higher as compared to the ages associated with a nonreactive tracer indicating that they provide an inaccurate estimate of residence time of a reactive constituent through the soil column.

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

    Science.gov (United States)

    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 organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail. Methods/Design Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training). Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation) were assessed using questionnaires, direct observations, interviews and routine ICU administration data. Discussion It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM. Trial registration Netherlands Trial Register (NTR): NTR1976 PMID:22073981

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

    Directory of Open Access Journals (Sweden)

    Kemper Peter F

    2011-11-01

    Full Text Available Abstract 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 organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail. Methods/Design Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training. Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation were assessed using questionnaires, direct observations, interviews and routine ICU administration data. Discussion It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM. Trial registration Netherlands Trial Register (NTR: NTR1976

  14. American college of gastroenterology monograph on the management of irritable bowel syndrome.

    Science.gov (United States)

    Camilleri, Michael

    2015-04-01

    This editorial reviews a recently published guideline on management of irritable bowel syndrome. The guideline illustrates problems arising from the quality of clinical trials used in systematic reviews and the potential impact of the inherent weaknesses of those trials on rating the strength of evidence and the resulting recommendations.

  15. Selling Out (In) Sport Management: Practically Evaluating the State of the American (Sporting) Union

    Science.gov (United States)

    Wiest, Amber; King-White, Ryan

    2013-01-01

    When teaching in Sport Management programs professors are often forced to respond to the actions and teachings of professionals in the field. According to the study by Kincheloe & Steinberg many of these normalized and, indeed celebrated, behaviors are actions that are part and parcel of the "recovery movement" which (re)inscribe new…

  16. Taking Care of Business: Walter Carpenter and the Management of American Enterprise.

    Science.gov (United States)

    Cheape, Charles W.

    1996-01-01

    Evaluates the life and career of DuPont corporate executive, Walter Carpenter, and uses it to illustrate the rise of the managerial class. Neither owners nor entrepreneurs, managers like Carpenter used their intelligence and skill to reorganize and expand the companies the companies where they worked. (MJP)

  17. 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

    2018-06-01

    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. This study examined smartphone usage, social media engagement, and willingness to participate in mHealth weight management among AAW in north-central Florida, United States. A self-administered survey was completed by a convenience sample of 425 smartphone owners in north-central Florida. Mean age was 34.84 ± 13.74, with age distribution of 18 to 29 (45%), 30 to 50 (39%), and 51+ years (17%). Mean body mass index was 29.52 ± 8.18. Most used smartphones to access the Internet daily and were engaged with eight social media sites, such as Facebook (85%), YouTube (75%), and Google+ (57%). Compared to those 51+, those 18 to 29 were more likely to use YouTube (odds ratio [OR] = 2.52, p = .017) and Instagram (OR = 10.90, p smartphone apps (68%). Compared to those 51+, women 18 to 29 were more likely to report willingness to use a smartphone app (OR = 5.45, p smartphones, use of mHealth apps and tools, and willingness to participate in mHealth research has the potential to curb the obesity epidemic by participating in mHealth weight management programs and research.

  18. 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.

  19. 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.

  20. 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

  1. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants.

    Science.gov (United States)

    Almadhoob, Abdulraoof; Ohlsson, Arne

    2015-01-30

    Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing auditory signals that frequently challenge preterm infants, staff and parents. The sound levels in NICUs often exceed the maximum acceptable level of 45 decibels (dB), recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general paediatric population. Noise may cause apnoea, hypoxaemia, alternation in oxygen saturation, and increased oxygen consumption secondary to elevated heart and respiratory rates and may, therefore, decrease the amount of calories available for growth. Elevated levels of speech are needed to overcome the noisy environment in the NICU, thereby increasing the negative impacts on staff, newborns, and their families. High noise levels are associated with an increased rate of errors and accidents, leading to decreased performance among staff. The aim of interventions included in this review is to reduce sound levels to 45 dB or less. This can be achieved by lowering the sound levels in an entire unit, treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled, or reducing the sound levels that reaches the individual infant by using earmuffs or earplugs. By lowering the sound levels that reach the neonate, the resulting stress on the cardiovascular, respiratory, neurological, and endocrine systems can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. Primary objectiveTo determine the effects of sound reduction on growth and long-term neurodevelopmental outcomes of neonates. Secondary objectives1. To evaluate the effects of sound reduction on short-term medical outcomes (bronchopulmonary

  2. Effect of Intensive Forest Management Practices on Wood Properties and Pulp Yield of Young, Fast Growing Southern Pine

    Science.gov (United States)

    Timothy D. Faust; Alexander Clark; Charles E. Courchene; Barry D. Shiver; Monique L. Belli

    1999-01-01

    The demand for southern pine fiber is increasing. However, the land resources to produce wood fiber are decreasing. The wood industry is now using intensive cultural treatments, such as competition control, fertilization, and short rotations, to increase fiber production. The impact of these intensive environmental treatments on increased growth is positive and...

  3. An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units

    NARCIS (Netherlands)

    Peterson-Carmichael, Stacey; Seddon, Paul C.; Cheifetz, Ira M.; Frerichs, Inéz; Hall, Graham L.; Hammer, Jürg; Hantos, Zoltán; van Kaam, Anton H.; McEvoy, Cindy T.; Newth, Christopher J. L.; Pillow, J. Jane; Rafferty, Gerrard F.; Rosenfeld, Margaret; Stocks, Janet; Ranganathan, Sarath C.

    2016-01-01

    Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory

  4. Radiotherapy Technical Considerations in the Management of Locally Advanced Pancreatic Cancer: American-French Consensus Recommendations

    International Nuclear Information System (INIS)

    Huguet, Florence; Goodman, Karyn A.; Azria, David; Racadot, Severine; Abrams, Ross A.

    2012-01-01

    Summary: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose

  5. Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations.

    Science.gov (United States)

    Huguet, Florence; Goodman, Karyn A; Azria, David; Racadot, Severine; Abrams, Ross A

    2012-08-01

    Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity

  6. The North American Bats and Mines Project: a cooperative approach for integrating wildlife, ecosystem management, and mine land reclamation

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, D.A.R. [Bat Conservation International, Austin, TX (United States)

    1995-06-01

    Abandoned underground mines in North America provide a habitat for bats. Closure of mines without conducting biological surveys can endanger bat species that are abundant. The North American Bats and Mines Project (NABMP) has been created by the U.S. Bureau of Land Management and Bat Conservation International to provide coordination among government and conservation organizations and the mining industry in order to minimize the loss of bats living in mines. NABMP provides coordination through education on the importance of mines for bat populations by providing training on mine assessment and closure methods, by assisting with protection and improvement of abandoned mine roosts, and by developing methods for creating new bat habitat. 1 tab.

  7. Increasing physical activity for veterans in the Mental Health Intensive Case Management Program: A community-based intervention.

    Science.gov (United States)

    Harrold, S Akeya; Libet, Julian; Pope, Charlene; Lauerer, Joy A; Johnson, Emily; Edlund, Barbara J

    2018-04-01

    Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and

  8. Role of 3D PET-FDG in the Management of Lymphomas. The Latin American Experience

    International Nuclear Information System (INIS)

    Guirao, M.A.; Garcia, A.; Binia, S.; Arribas, L.C.; Spigatin, F.

    2002-01-01

    Aim: To assess the role that 3D PET and FDG played in the management of patients referred to our institution (last two years) for either initial staging (IS), intra-treatment evaluation (IT), or post treatment (PT) evaluation of patients with Hodgkin (HL) or Non Hodgkin lymphomas (NHL). Material and Methods: Fifty-four studies were performed to 42 patients (15 HL; 27 NHL) for IS (9), IT (12) or PT (33). Most patients had previously performed conventional imaging procedures (CT, Gallium-SPECT, MRI) during staging or clinical follow up (median 18 months.) Biopsy was done when relevant. At least 6-hour fasting and glucose serum level ≤ 1.2 g/l was required before IV injection of 50 to 60 microCi /Kg of [18F]-Fluorodeoxiglucose (FDG.) After a 60 to 90-minute uptake period, a whole body PET scan was performed, 5-minute acquisition and 2-minute transmission per bed, 5 to 7 beds, with an average scanning time of 1 hour. Localized images (15 minutes) were done when deemed relevant. Results: FDG PET showed: 1) IS: 9 unsuspected sites in 4 patients, upstaging 2 of them (22.2%) -1 HL from II to III and 1 NHL from III to IV-. 2) IT: it helped to change the management previously decided by conventional imaging in 41.6% of patients (either stop or continue therapy.) 3) PT (Chemotherapy or EBRT): it helped to change the management of patients based on conventional imagining to a more aggressive (21.9%) or conservative one (20.6%.) Overall, either biopsy or follow up confirmed two false negative and 3 false positive PET studies. Conclusions: This ongoing clinical study of HL and NHL patients showed that 3D PET-FDG was as good as 2D PET in the management of Lymphoma. Besides being more accurate than conventional imaging for initial staging, it had a major impact in assessing treatment (IT or PT), and it helped to improve the management in more than 40% of patients. Besides, additional advantages were reported by patients and referrals when compared PET to Gallium-SPECT: mainly

  9. Provider Adherence to National Guidelines for Managing Hypertension in African Americans

    Directory of Open Access Journals (Sweden)

    Jeanette Sessoms

    2015-01-01

    Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

  10. Managing realities of the new market uncertainty : standards development in the North American electricity industry

    International Nuclear Information System (INIS)

    Green, B.

    2003-01-01

    Standards for the electricity industry are developed to ensure quality and serve as a basis to which utilities should conform. Standards specify agreed upon properties for a manufactured product. They should be used for equipment specifications as well as operational procedures. Standardization is performed by regulators, transmission owners/operators, and organizations such as the National Electric Reliability Council (NERC), the Northeast Power Coordinating Council (NPCC), the North American Energy Standards Board (NAESB), and the Committee of Chief Risk Officers (CCRO). Before markets were opened to competition, operational standards were dictated by transmission owners and reliability issues were dealt with by NERC and NPCC. This presentation explained the process of standardization in the electric power industry in Canada, the derivation of standards, moving beyond NERC, and the transmission owners. Issues for Ontario Power Generation were highlighted. In contrast to the situation in the United States, there is no federal government backstop for developing Standards in Canada. There is no federal initiative toward open access. Canadian utilities participated in NERC, but compliance was voluntary. It is still questionable if Canadian utilities will implement NERC and NAESB Standards if they are codified

  11. 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

  12. 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.

  13. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    Science.gov (United States)

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly

  14. Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel.

    Science.gov (United States)

    Wirrell, Elaine C; Laux, Linda; Donner, Elizabeth; Jette, Nathalie; Knupp, Kelly; Meskis, Mary Anne; Miller, Ian; Sullivan, Joseph; Welborn, Michelle; Berg, Anne T

    2017-03-01

    To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process. An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies

  15. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration for Management of Organophosphorus Pesticide Poisoning: a Case Series

    Directory of Open Access Journals (Sweden)

    Abu Saleh Ahmed

    2014-03-01

    , Basher A, Amin MR, Faiz MA. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration for Management of Organophosphorus Pesticide Poisoning: a Case Series. Asia Pac J Med Toxicol 2014;3:23-6.

  16. American Contact Dermatitis Society Contact Allergy Management Program: An Epidemiologic Tool to Determine Relative Prevalence of Contact Allergens.

    Science.gov (United States)

    Scheman, Andrew; Severson, David

    2016-01-01

    Data on the prevalence of contact allergy in North America are currently reported by groups of academic contact allergy specialists at select academic centers. Sampling of data from numerous centers across North America, including practices performing more limited patch testing, would provide a broader perspective of contact allergen prevalence in North America. The American Contact Dermatitis Society Contact Allergy Management Program is an ideal tool for collection of epidemiologic data regarding contact allergy prevalence in North America. The aim of the study was to identify the relative prevalence of contact allergy to common contact allergens in North America. Mapping of Contact Allergy Management Program (CAMP) data was performed to allow analysis of how frequently searches were performed for various contact allergens. The number of searches performed for specific allergens provides a measure of the relative prevalence of contact allergy to these allergens. The top 35 allergens for the period from November 18, 2012 to November 18, 2013 are reported. Although these data are useful, specific recommendations for minor alterations to CAMP are discussed, which will allow future CAMP data to be stratified and more powerful. With minor modifications, CAMP can provide a quantum leap in the reporting of contact allergy epidemiologic data in North America.

  17. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM--2015 EXECUTIVE SUMMARY.

    Science.gov (United States)

    Garber, Alan J; Abrahamson, Martin Julian; Barzilay, Joshua I; Blonde, Lawrence; Bloomgarden, Zachary T; Bush, Michael A; Dagogo-Jack, Samuel; Davidson, Michael B; Einhorn, Daniel; Garber, Jeffrey R; Garvey, W Timothy; Grunberger, George; Handelsman, Yehuda; Hirsch, Irl B; Jellinger, Paul S; McGill, Janet B; Mechanick, Jeffrey I; Rosenblit, Paul David; Umpierrez, Guillermo E

    2015-12-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  18. 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...

  19. 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.

  20. Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

    Directory of Open Access Journals (Sweden)

    Tatiana M. Davidson

    2015-11-01

    Full Text Available African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH compared to Non-Hispanic Whites. Medication non-adherence (MNA is the leading modifiable behavior to improved blood pressure (BP control. The Smartphone Medication Adherence Stops Hypertension (SMASH program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18 and Hispanic (20 uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM revealed statistically significant time-by-treatment interactions (p < 0.0001 indicating significant reductions in resting systolic blood pressure (SBP and diastolic blood pressure (DBP for the SMASH group vs. the standard care (SC control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH at month 1 (p < 0.001. At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003. Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

  1. Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers.

    Science.gov (United States)

    Lehrer, H Matthew; Dubois, Susan K; Brown, Sharon A; Steinhardt, Mary A

    2017-08-01

    Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.

  2. Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

    Science.gov (United States)

    Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

    2017-10-01

    We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

  3. 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

  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. Spatial genetic structure within populations and management implications of the South American species Acacia aroma (Fabaceae).

    Science.gov (United States)

    Pometti, Carolina; Bessega, Cecilia; Cialdella, Ana; Ewens, Mauricio; Saidman, Beatriz; Vilardi, Juan

    2018-01-01

    The identification of factors that structure intraspecific diversity is of particular interest for biological conservation and restoration ecology. All rangelands in Argentina are currently experiencing some form of deterioration or desertification. Acacia aroma is a multipurpose species widely distributed throughout this country. In this study, we used the AFLP technique to study genetic diversity, population genetic structure, and fine-scale spatial genetic structure in 170 individuals belonging to 6 natural Argentinean populations. With 401 loci, the mean heterozygosity (HE = 0.2) and the mean percentage of polymorphic loci (PPL = 62.1%) coefficients indicated that the genetic variation is relatively high in A. aroma. The analysis with STRUCTURE showed that the number of clusters (K) was 3. With Geneland analysis, the number of clusters was K = 4, sharing the same grouping as STRUCTURE but dividing one population into two groups. When studying SGS, significant structure was detected in 3 of 6 populations. The neighbourhood size in these populations ranged from 15.2 to 64.3 individuals. The estimated gene dispersal distance depended on the effective population density and disturbance level and ranged from 45 to 864 m. The combined results suggest that a sampling strategy, which aims to maintain a considerable part of the variability contained in natural populations sampled here, would include at least 3 units defined by the clusters analyses that exhibit particular genetic properties. Moreover, the current SGS analysis suggests that within the wider management units/provinces, seed collection from A. aroma should target trees separated by a minimum distance of 50 m but preferably 150 m to reduce genetic relatedness among seeds from different trees.

  6. 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

  7. AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE

    Science.gov (United States)

    Rubio-Tapia, Alberto; Hill, Ivor D; Kelly, Ciarán P; Calderwood, Audrey H; Murray, Joseph A

    2013-01-01

    This guideline presents recommendations for the diagnosis and management of patients with celiac disease. Celiac disease is an immune-based reaction to dietary gluten (storage protein for wheat, barley and rye) that primarily affects the small intestine in those with a genetic predisposition and resolves with exclusion of gluten from the diet. There has been a substantial increase in the prevalence of celiac disease over the last 50 years and an increase in the rate of diagnosis in the last 10 years. Celiac disease can present with many symptoms, including typical gastrointestinal symptoms (e.g. diarrhea, steatorrhea, weight loss, bloating, flatulence, abdominal pain) and also non-gastrointestinal abnormalities (e.g. abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and many other protean manifestations). Indeed, many individuals with celiac disease may have no symptoms at all. Celiac disease is usually detected by serologic testing of celiac-specific antibodies. The diagnosis is confirmed by duodenal mucosal biopsies. Both serology and biopsy should be performed on a gluten-containing diet. The treatment for celiac disease is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Non-responsive celiac disease occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms should lead to a review of the patient’s original diagnosis to exclude alternative diagnoses, a review of the GFD to ensure there is no obvious gluten contamination, and serologic testing to confirm adherence with the GFD. In addition, evaluation for disorders associated with celiac disease that could cause persistent symptoms, such as microscopic colitis, pancreatic exocrine dysfunction, and complications of celiac disease, such as enteropathy-associated lymphoma or refractory celiac disease, should be entertained. Newer therapeutic modalities are being studied in clinical

  8. 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.

  9. Soil carbon and nitrogen content and stabilization in mid-rotation, intensively managed sweetgum and loblolly stands

    Science.gov (United States)

    Kurt H. Johnsen; Lisa J. Samuelson; Felipe G. Sanchez; Bob Eaton

    2013-01-01

    Intensive forestry has resulted in considerable increases in aboveground stand productivity including foliar and belowground biomass which are the primary sources of soil organic matter. Soil organic matter is important for the maintenance of soil physical, chemical and biological quality. Additionally, sequestering carbon (C) in soils may provide a means of mitigating...

  10. Climate policy and energy-intensive manufacturing: A comprehensive analysis of the effectiveness of cost mitigation provisions in the American Energy and Security Act of 2009

    International Nuclear Information System (INIS)

    Bassi, Andrea M.; Yudken, Joel S.

    2011-01-01

    In response to the ongoing climate policy debates, this study examines the cost impacts of carbon-pricing legislation on selected US energy-intensive manufacturing industries. Specifically, it evaluates output-based rebate measures and the border adjustment provision specified in the bill, and tests the effectiveness of cost containment features of the policy, such as the international offsets, under various market assumptions. Results of the examination confirm that in all policy cases or industries, the output-based rebates would effectively mitigate the manufacturers' carbon-pricing costs in the short-to-medium term. However as the rebates decline after 2020, especially in a case where low-carbon electricity generation or international offsets are not readily available or implemented, these industries would suffer greater declines in profitability. At the same time, the study's findings were mixed concerning the effectiveness of the border adjustment measure in reducing cost impacts after 2020. While border adjustments could reduce costs to US manufacturing sectors, at least temporarily, they could create problems for domestic downstream producers and exports, under cost pass-along conditions. However at best, the output-based rebates, international offset, and border adjustment and measures primarily buy time for manufacturers. The only long-term solution is for EITE industries to invest in energy-saving and next-generation low-carbon technologies. - Highlights: → The output-based rebates would effectively mitigate the costs of carbon-pricing for EITE industries. → After 2021 economic impacts on the EITE industries would escalate. → The BA measure would support US firms passing through their emissions costs to their US customers. → The BA measure would not alleviate the higher production costs of US. EITE exports. → In the medium term the only true solution is for US. EITE manufacturers to invest in energy-saving technologies.

  11. 3-PG simulations of young ponderosa pine plantations under varied management intensity: why do they grow so differently?

    Science.gov (United States)

    Liang Wei; Marshall John; Jianwei Zhang; Hang Zhou; Robert Powers

    2014-01-01

    Models can be powerful tools for estimating forest productivity and guiding forest management, but their credibility and complexity are often an issue for forest managers. We parameterized a process-based forest growth model, 3-PG (Physiological Principles Predicting Growth), to simulate growth of ponderosa pine (Pinus ponderosa) plantations in...

  12. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists.

    Science.gov (United States)

    Cannesson, Maxime; Pestel, Gunther; Ricks, Cameron; Hoeft, Andreas; Perel, Azriel

    2011-08-15

    Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States. A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members. Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P < 0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P < 0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved. In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.

  13. [Optimizing the managment of patients with diabetes mellitus: selected clinical trials from the 2004 Congress of the American Diabetes Association].

    Science.gov (United States)

    Scheen, A J; Radermecker, R P; Philips, J C

    2004-06-01

    The 64th scientific congress of the American Diabetes Association had a special session devoted to the presentation of the results from three clinical trials: 1) the first multicentre international trial of pancreatic islet transplantation according to the so-called Edmonton protocol with the primary endpoint of restoring insulin independence in type 1 diabetic patients; 2) three pivotal studies of 30 weeks testing both the efficacy and safety of exenatide (exendin-4), a new insulin secretagogue that is a long-acting analogue of glucagon-like peptide-1, in patients with type 2 diabetes treated with either metformin, or a sulfonylurea, or a metformin-sulfonylurea combination; and 3) the "Collaborative AtoRvastatin Diabetes Study" (CARDS), a placebo-controlled primary prevention trial of cardiovascular complications using atorvastatin 10 mg in 2 838 at risk patients with type 2 diabetes. The main results and conclusions of these trials are briefly presented as they open new perspectives in the management of patients with type 1 or type 2 diabetes mellitus.

  14. A comparison of the nesting success of mourning doves and American robins in conventionally managed and organic orchards

    Science.gov (United States)

    Fluetsch, K.M.

    1992-01-01

    A comparative study was undertaken to document more closely the effects of operational pesticide use on non-target avian species. Mourning Dove (Zenaida macroura) and American Robin (Turdus migratorius) nesting activity was monitored in three organic and three conventional orchards during two breeding seasons. Surveys were conducted to characterize the avian community within orchards under both management practices. Organophosphorus (OP) and carbamate pesticides, known to be extremely toxic to birds, were repeatedly sprayed during the peaks in dove and robin breeding activity. Spray card tests revealed that OP pesticides were deposited on 85.5% of the nests tested during routine spray operations. The threat of direct pesticide exposure to eggs, nestlings, and adult birds was considerable. Nest daily survival rates (DSRs) for both doves and robins, were significantly higher in the organic orchards than in the conventional orchards in 1991 and years combined (P < 0.05). Species diversity was significantly greater in the organic orchards (H = 2.43) than in the conventional orchards (H = 1.79). Results suggest that repeated applications of pesticides, within the conventional orchards, directly or indirectly, affected the reproductive success of doves and robins, as well as influenced species diversity within the treated orchards. Organic orchards appear to provide more favorable nesting and foraging habitat for birds than conventional orchards.

  15. 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.

  16. Managing the double burden: Effects of pregnancy on labor-intensive time use in rural China, Mexico and Tanzania

    Science.gov (United States)

    Peterman, Amber; Ng, Shu Wen; Palermo, Tia; Lee, I-Heng Emma

    2014-01-01

    Labor-intensive work is often a way of life for women in rural areas of developing countries. However, physical exertion may result in poor health outcomes for mother and infant if continued through pregnancy. Using longitudinal data from China, Mexico and Tanzania, we examine the relationship between pregnancy and four time use outcomes, measured as hours spent in the last week on: 1) housework, 2) care giving, 3) agricultural work, and 4) self-employed or non-agricultural work outside the home. An individual fixed effects approach is adopted to overcome potential time invariant woman-level endogeneity of pregnancy status. With a few exceptions, we do not find significantly different time use patterns between pregnant and non-pregnant women. The assumption that women decrease labor intensive work in developing countries during pregnancy needs revisiting, and may have implications for both women’s livelihood programming and assistance during childbearing periods. PMID:24323660

  17. Managing the double burden: pregnancy and labor-intensive time use in rural China, Mexico, and Tanzania.

    Science.gov (United States)

    Peterman, Amber; Ng, Shu Wen; Palermo, Tia; Lee, I-Heng Emma

    2013-12-01

    Labor-intensive work is often a way of life for women living in rural areas of developing countries. The physical exertion involved in such work may result in poor health outcomes for mothers and infants when continued through pregnancy. Using longitudinal data from China, Mexico, and Tanzania, we examine the relationship between pregnancy and four time-use outcomes, measured as hours spent in the past week on: (1) housework, (2) caregiving, (3) agricultural work, and (4) self-employment or nonagricultural work outside the home. An individual fixed-effects approach is adopted to overcome the potential time-invariant woman-level endogeneity of pregnancy status. With few exceptions, we do not find significantly different time-use patterns between pregnant and nonpregnant women. The assumption that women decrease labor-intensive work in developing countries during pregnancy needs revisiting and may have implications for both women's livelihood programming and assistance during childbearing periods. © 2013 The Population Council, Inc.

  18. Spatiotemporal Pattern and Driving Forces of Arable Land-Use Intensity in China: Toward Sustainable Land Management Using Emergy Analysis

    Directory of Open Access Journals (Sweden)

    Hualin Xie

    2014-05-01

    Full Text Available The level of arable land-use intensity has important impacts on food security and rural sustainable development. Using the emergy method, we investigate the spatial disparities and driving forces of arable land-use intensity in China from 1999 to 2008 at the national, regional and provincial levels. The empirical results show that chemical fertilizer was the largest component of agricultural inputs and that agricultural diesel oil recorded the highest growth rate. The degree of heterogeneities in arable land-use intensity in China showed a decreasing trend, which resulted mainly from the differences among the eastern, northeastern, central and western regions. The regional disparities in labor, pesticides and plastic sheeting decreased from 1999 to 2008. The per capita annual net incomes of household operations and the agricultural policies had a significant positive correlation with total inputs, fertilizer inputs, pesticide inputs and agricultural plastic sheeting. In addition, the nonagricultural population had a greater impact on agricultural plastic sheeting. Finally, we suggest that there is an urgent need to focus on the effects of chemical fertilizer and pesticide inputs on the ecological environment. Agricultural support policies should be introduced for the poor agricultural production provinces.

  19. 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.

  20. The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

    Science.gov (United States)

    Galanter, M; Keller, D S; Dermatis, H; Egelko, S

    2000-01-01

    This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

  1. 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.

  2. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline.

    Science.gov (United States)

    Carey, Robert M; Whelton, Paul K

    2018-03-06

    In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The committee reviewed literature and commissioned systematic reviews and meta-analyses on out-of-office BP monitoring, the optimal target for BP lowering, the comparative benefits and harms of different classes of antihypertensive agents, and the comparative benefits and harms of initiating therapy with a single antihypertensive agent or a combination of 2 agents. This article summarizes key recommendations in the following areas: BP classification, BP measurement, screening for secondary hypertension, nonpharmacologic therapy, BP thresholds and cardiac risk estimation to guide drug treatment, treatment goals (general and for patients with diabetes mellitus, chronic kidney disease, and advanced age), choice of initial drug therapy, resistant hypertension, and strategies to improve hypertension control.

  3. 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

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

    Science.gov (United States)

    Warren, Diane

    2011-06-01

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

  5. 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

  6. The Cost of Health Service Waste Management of (HSWM: A Case Study of Intensive Care Unit of Infectious Diseases at a Public Hospital in São Paulo.

    Directory of Open Access Journals (Sweden)

    Chennyfer Dobbins Paes da Rosa

    2015-08-01

    Full Text Available The Health Service Waste Management is a set of technical and legal procedures for waste management in any type of health facilities. It is known about the limited resources, so reducing environmental costs can contribute to the management of hospital costs. The objective was to estimate the cost of the phases of HSWM to the Intensive Care Unit for public service. Data collecting was done through a script of questions and observations on site at the Emilio Ribas Infectious Diseases Institute in Sao Paulo. The ABC costing method was used. The most costly step was wrapping (40.68%, followed by segregation (40.17%, which is justified by both being associated with health workers’ salaries. The daily cost of the management of health care waste from segregation to final disposal in the ICU was R$ 4,288.81 a day, being R$ 314.80/bed-patient/day. To know the cost of an activity allows for the analysis of strategies for price negotiation. Health care waste is little remembered when pricing a daily ICU, many managers believe this value to be irrelevant; but< if not measured, it may bring losses to the institution.

  7. A hybrid simulated annealing approach to handle energy resource management considering an intensive use of electric vehicles

    DEFF Research Database (Denmark)

    Sousa, Tiago; Vale, Zita; Carvalho, Joao Paulo

    2014-01-01

    The massification of electric vehicles (EVs) can have a significant impact on the power system, requiring a new approach for the energy resource management. The energy resource management has the objective to obtain the optimal scheduling of the available resources considering distributed...... to determine the best solution in a reasonable amount of time. This paper presents a hybrid artificial intelligence technique to solve a complex energy resource management problem with a large number of resources, including EVs, connected to the electric network. The hybrid approach combines simulated...... annealing (SA) and ant colony optimization (ACO) techniques. The case study concerns different EVs penetration levels. Comparisons with a previous SA approach and a deterministic technique are also presented. For 2000 EVs scenario, the proposed hybrid approach found a solution better than the previous SA...

  8. Adolescent Secretive Behavior: African American and Hmong Adolescents' Strategies and Justifications for Managing Parents' Knowledge about Peers

    Science.gov (United States)

    Bakken, Jeremy P.; Brown, B. Bradford

    2010-01-01

    Drawing upon the expectancy violation-realignment theory of autonomy development, this qualitative study examined African American and Hmong adolescent autonomy-seeking behaviors and parent-child communication about activities and relationships with peers. Twenty-two African American and 11 Hmong adolescents in grades 6-12 and 14 African American…

  9. Site characterization and performance assessment for a low-level radioactive waste management site in the American Southwest

    International Nuclear Information System (INIS)

    Shott, G.J.; Sully, M.J.; Muller, C.J.; Hammermeister, D.P.; Ginanni, J.M.

    1995-01-01

    The Area 5 Radioactive Waste Management Site located in southern Nevada, has been used for the disposal of low-level radioactive waste since 1961. The site is located in the Mohave Desert of the American Southwest, an extremely arid region receiving as little as 0.1 m/yr of precipitation. Site characterization studies have measured the physical, hydrologic, and geochemical properties of core samples collected from 10 shallow boreholes and 3 deep boreholes that extend through the unsaturated zone to the uppermost aquifer. Results indicate that the unsaturated zone consists of 240 m of dry alluvial sediments and is remarkably uniform with respect to most physical parameters. Measurements of saturated hydraulic conductivity with depth showed no evidence of trends, layering, or anisotropy. Parameters for hydraulic functions were not highly variable and exhibited little trend with depth. Water potential profiles indicate that water movement in the upper alluvium is upward, except immediately following a precipitation event. Below the evaporative zone, the liquid flux was downward and of the same order of magnitude as the upward thermal vapor flux induced by the geothermal gradient. The extreme climatic conditions at the site reduce or eliminate many radionuclide release and transport mechanisms. Downward transport of radionuclides to the uppermost aquifer appears unlikely under current climatic conditions. Important radionuclide transport pathways appear to be limited to upward diffusion and advection of gases and biologically-mediated transport. Conceptual models of disposal site performance have been developed based on site characterization studies. The limited transport pathways and limited land use potential of the site provide reasonable assurance that regulatory performance objectives can be met

  10. Productivity of Veterans Health Administration laboratories: a College of American Pathologists Laboratory Management Index Program (LMIP) study.

    Science.gov (United States)

    Valenstein, Paul N; Wang, Edward; O'Donohue, Tom

    2003-12-01

    The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P benefits; P depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.

  11. Implementation of the American College of Cardiology/American Heart Association 2008 Guidelines for the Management of Adults With Congenital Heart Disease.

    Science.gov (United States)

    Goossens, Eva; Fernandes, Susan M; Landzberg, Michael J; Moons, Philip

    2015-08-01

    Although different guidelines on adult congenital heart disease (ACHD) care advocate for lifetime cardiac follow-up, a critical appraisal of the guideline implementation is lacking. We investigated the implementation of the American College of Cardiology/American Heart Association 2008 guidelines for ACHD follow-up by investigating the type of health care professional, care setting, and frequency of outpatient visits in young adults with CHD. Furthermore, correlates for care in line with the recommendations or untraceability were investigated. A cross-sectional observational study was conducted, including 306 patients with CHD who had a documented outpatient visit at pediatric cardiology before age 18 years. In all, 210 patients (68.6%) were in cardiac follow-up; 20 (6.5%) withdrew from follow-up and 76 (24.9%) were untraceable. Overall, 198 patients were followed up in tertiary care, 1/4 (n = 52) of which were seen at a formalized ACHD care program and 3/4 (n = 146) remained at pediatric cardiology. Of those followed in formalized ACHD and pediatric cardiology care, the recommended frequency was implemented in 94.2% and 89%, respectively (p = 0.412). No predictors for the implementation of the guidelines were identified. Risk factors for becoming untraceable were none or lower number of heart surgeries, health insurance issues, and nonwhite ethnicity. In conclusion, a significant number of adults continue to be cared for by pediatric cardiologists, indicating that transfer to adult-oriented care was not standard practice. Frequency of follow-up for most patients was in line with the ACC/AHA 2008 guidelines. A considerable proportion of young adults were untraceable in the system, which makes them vulnerable for discontinuation of care. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Assessing Sediment Yield and the Effect of Best Management Practices on Sediment Yield Reduction for Tutuila Island, American Samoa

    Science.gov (United States)

    Leta, O. T.; Dulai, H.; El-Kadi, A. I.

    2017-12-01

    Upland soil erosion and sedimentation are the main threats for riparian and coastal reef ecosystems in Pacific islands. Here, due to small size of the watersheds and steep slope, the residence time of rainfall runoff and its suspended load is short. Fagaalu bay, located on the island of Tutuila (American Samoa) has been identified as a priority watershed, due to degraded coral reef condition and reduction of stream water quality from heavy anthropogenic activity yielding high nutrients and sediment loads to the receiving water bodies. This study aimed to estimate the sediment yield to the Fagaalu stream and assess the impact of Best Management Practices (BMP) on sediment yield reduction. For this, the Soil and Water Assessment Tool (SWAT) model was applied, calibrated, and validated for both daily streamflow and sediment load simulation. The model also estimated the sediment yield contributions from existing land use types of Fagaalu and identified soil erosion prone areas for introducing BMP scenarios in the watershed. Then, three BMP scenarios, such as stone bund, retention pond, and filter strip were treated on bare (quarry area), agricultural, and shrub land use types. It was found that the bare land with quarry activity yielded the highest annual average sediment yield of 133 ton per hectare (t ha-1) followed by agriculture (26.1 t ha-1) while the lowest sediment yield of 0.2 t ha-1 was estimated for the forested part of the watershed. Additionally, the bare land area (2 ha) contributed approximately 65% (207 ha) of the watershed's sediment yield, which is 4.0 t ha-1. The latter signifies the high impact as well as contribution of anthropogenic activity on sediment yield. The use of different BMP scenarios generally reduced the sediment yield to the coastal reef of Fagaalu watershed. However, treating the quarry activity area with stone bund showed the highest sediment yield reduction as compared to the other two BMP scenarios. This study provides an estimate

  13. Influence of thinning intensity and canopy type on Scots pine stand and growth dynamics in a mixed managed forest

    Energy Technology Data Exchange (ETDEWEB)

    Primicia, I.; Artázcoz, R.; Imbert, J.B.; Puertas, F.; Traver, M.C.; Castillo, F.J.

    2016-07-01

    Aim of the study: We analysed the effects of thinning intensity and canopy type on Scots pine growth and stand dynamics in a mixed Scots pine-beech forest. Area of the study: Western Pyrenees. Material and methods: Three thinning intensities were applied in 1999 (0, 20 and 30% basal area removed) and 2009 (0, 20 and 40%) on 9 plots. Within each plot, pure pine and mixed pine-beech patches are distinguished. All pine trees were inventoried in 1999, 2009 and 2014. The effects of treatments on the tree and stand structure variables (density, basal area, stand and tree volume), on the periodic annual increment in basal area and stand and tree volume, and on mortality rates, were analysed using linear mixed effects models. Main Results: The enhancement of tree growth was mainly noticeable after the second thinning. Growth rates following thinning were similar or higher in the moderate than in the severe thinning. Periodic stand volume annual increments were higher in the thinned than in the unthinned plots, but no differences were observed between the thinned treatments. We observed an increase in the differences of the Tree volume annual increment between canopy types (mixed < pure) over time in the unthinned plots, as beech crowns developed. Research highlights: Moderate thinning is suggested as an appropriate forest practice at early pine age in these mixed forests, since it produced higher tree growth rates than the severe thinning and it counteracted the negative effect of beech on pine growth observed in the unthinned plots. (Author)

  14. 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

  15. The Swiss agri-environment scheme enhances pollinator diversity and plant reproductive succes in nearby intensively managed farmland

    NARCIS (Netherlands)

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

    2007-01-01

    1. Agri-environment schemes attempt to counteract the loss of biodiversity and associated ecosystem services such as pollination and natural pest control in agro-ecosystems. However, only a few studies have evaluated whether these attempts are successful. 2. We studied the effects of managing

  16. Neuroprotective Anesthesia Regimen and Intensive Management for Pediatric Cardiac Surgery with Cardiopulmonary Bypass: a Review and Initial Experience

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    Full Text Available Abstract This article describes our proposal for routine anesthesia, intraoperative medical management, cerebral and physiological monitoring during pediatric cardiac surgery with cardiopulmonary bypass that intend to provide appropriate anesthesia (analgesia, hypnosis, neuroprotection, adequate cerebral and systemic oxygen supply, and preventing against drugs neurotoxicity. A concise retrospective data is presented.

  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. 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.

  19. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management.

    Science.gov (United States)

    Savel, Richard H; Cohen, Wess; Borgia, Dena; Simon, Ronald J

    2018-01-01

    The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care.

  20. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

    Directory of Open Access Journals (Sweden)

    Richard H Savel

    2018-01-01

    Full Text Available The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1 leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2 preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3 intensivist staffing changes; (4 roles for and training of advanced practice practitioners; (5 graduate medical education issues; (6 optimizing interactions with closely related services; (7 nursing, staffing, and training issues; (8 bed allocation issues; and (9 reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care.

  1. Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.

    Science.gov (United States)

    Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

    2010-01-01

    The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches.

  2. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach.

    Science.gov (United States)

    Molter, G; Seifert, H; Mandraka, F; Kasper, G; Weidmann, B; Hornei, B; Öhler, M; Schwimmbeck, P; Kröschel, P; Higgins, P G; Reuter, S

    2016-02-01

    An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAb) occurred in an interdisciplinary intensive care unit, affecting 10 patients. Within hours of recognition of the spread of CRAb an intervention team was instituted for collection of available data, decision-making, communication and monitoring of all interventions performed, including cohorting, temporary stop of admissions, staff education, and enforcement of infection control measures. An area was defined for cohortation of patients colonized with CRAb, with a separate nursing team and a second set of mobile equipment. New transmissions were no longer observed after only four days into the institution of enhanced infection control measures. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  3. Peritoneal dialysis in the neonatal intensive care unit. Management of acute renal failure after a severe subgaleal hemorrhage.

    Science.gov (United States)

    Coe, Kristi; Lail, Candace

    2007-08-01

    Acute renal failure is common in the neonatal intensive care unit but is often not recognized in its early phases, when it is potentially reversible. The typical patient with acute renal failure is premature, but many term infants are also at risk. One such group is those with severe bleeding, such as a subgaleal hemorrhage. In these cases, hypovolemia can quickly progress to ischemia, which affects many organs but has profound effects on the kidney. In term infants, acute renal failure is most commonly diagnosed in those with perinatal depression. This article presents a unique case of an infant with subgaleal and intracranial bleeding that resulted in acute renal failure requiring peritoneal dialysis in the hopes of the eventual restoration of kidney function.

  4. 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

  5. Profit and loss analysis for an intensive care unit (ICU in Japan: a tool for strategic management

    Directory of Open Access Journals (Sweden)

    Abe Toshikazu

    2006-01-01

    Full Text Available Abstract Background Accurate cost estimate and a profit and loss analysis are necessary for health care practice. We performed an actual financial analysis for an intensive care unit (ICU of a university hospital in Japan, and tried to discuss the health care policy and resource allocation decisions that have an impact on critical intensive care. Methods The costs were estimated by a department level activity based costing method, and the profit and loss analysis was based on a break-even point analysis. The data used included the monthly number of patients, the revenue, and the direct and indirect costs of the ICU in 2003. Results The results of this analysis showed that the total costs of US$ 2,678,052 of the ICU were mainly incurred due to direct costs of 88.8%. On the other hand, the actual annual total patient days in the ICU were 1,549 which resulted in revenues of US$ 2,295,044. However, it was determined that the ICU required at least 1,986 patient days within one fiscal year based on a break-even point analysis. As a result, an annual deficit of US$ 383,008 has occurred in the ICU. Conclusion These methods are useful for determining the profits or losses for the ICU practice, and how to evaluate and to improve it. In this study, the results indicate that most ICUs in Japanese hospitals may not be profitable at the present time. As a result, in order to increase the income to make up for this deficit, an increase of 437 patient days in the ICU in one fiscal year is needed, and the number of patients admitted to the ICU should thus be increased without increasing the number of beds or staff members. Increasing the number of patients referred from cooperating hospitals and clinics therefore appears to be the best strategy for achieving these goals.

  6. 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.

  7. A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils

    Science.gov (United States)

    Sainju, Upendra M.

    2016-01-01

    Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management

  8. A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

    Science.gov (United States)

    Sainju, Upendra M

    2016-01-01

    Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management

  9. Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team.

    Science.gov (United States)

    Cohen, I L; Bari, N; Strosberg, M A; Weinberg, P F; Wacksman, R M; Millstein, B H; Fein, I A

    1991-10-01

    To test the hypothesis that a formal interdisciplinary team approach to managing ICU patients requiring mechanical ventilation enhances ICU efficiency. Retrospective review with cost-effectiveness analysis. A 20-bed medical-surgical ICU in a 450-bed community referral teaching hospital with a critical care fellowship training program. All patients requiring mechanical ventilation in the ICU were included, comparing patients admitted 1 yr before the inception of the ventilatory management team (group 1) with those patients admitted for 1 yr after the inception of the team (group 2). Group 1 included 198 patients with 206 episodes of mechanical ventilation and group 2 included 165 patients with 183 episodes of mechanical ventilation. A team consisting of an ICU attending physician, nurse, and respiratory therapist was formed to conduct rounds regularly and supervise the ventilatory management of ICU patients who were referred to the critical care service. The two study groups were demographically comparable. However, there were significant reductions in resource use in group 2. The number of days on mechanical ventilation decreased (3.9 days per episode of mechanical ventilation [95% confidence interval 0.3 to 7.5 days]), as did days in the ICU (3.3 days per episode of mechanical ventilation [90% confidence interval 0.3 to 6.3 days]), numbers of arterial blood gases (23.2 per episode of mechanical ventilation; p less than .001), and number of indwelling arterial catheters (1 per episode of mechanical ventilation; p less than .001). The estimated cost savings from these reductions was $1,303 per episode of mechanical ventilation. We conclude that a ventilatory management team, or some component thereof, can significantly and safely expedite the process of "weaning" patients from mechanical ventilatory support in the ICU.

  10. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2018 EXECUTIVE SUMMARY.

    Science.gov (United States)

    Garber, Alan J; Abrahamson, Martin J; Barzilay, Joshua I; Blonde, Lawrence; Bloomgarden, Zachary T; Bush, Michael A; Dagogo-Jack, Samuel; DeFronzo, Ralph A; Einhorn, Daniel; Fonseca, Vivian A; Garber, Jeffrey R; Garvey, W Timothy; Grunberger, George; Handelsman, Yehuda; Hirsch, Irl B; Jellinger, Paul S; McGill, Janet B; Mechanick, Jeffrey I; Rosenblit, Paul D; Umpierrez, Guillermo E

    2018-01-01

    A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACEI = angiotensin-converting enzyme inhibitor; ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BCR-QR = bromocriptine quick release; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CHD = coronary heart disease; CKD = chronic kidney disease; CVD = cardiovascular disease; DASH = Dietary Approaches to Stop Hypertension; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density lipoprotein cholesterol; IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial; LDL-C = low-density lipoprotein cholesterol; LDL-P = low-density lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium glucose cotransporter-2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione; VADT = Veterans Affairs Diabetes Trial.

  11. Effectiveness of intensive healthcare waste management training model among health professionals at teaching hospitals of Pakistan: a quasi-experimental study.

    Science.gov (United States)

    Kumar, Ramesh; Somrongthong, Ratana; Shaikh, Babar Tasneem

    2015-02-28

    I