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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. American Values versus Low Intensity Conflict

    Science.gov (United States)

    1988-03-30

    revolutionary power, not to raffle off power, because the people (already) have power through their van- guard, the Sandanista Front of National Liberation...popular support. The U.S. Army’s new Joint Readiness Training Center, though advertising training in both low and mid intensity conflict, does not...history in our dealings with Nicaragua--as meddlesome big brother or greedy uncle--seems to argue for a wholly local initiative toward promoting peace

  4. Intensive Care Management in Pediatric Burn Patients

    Directory of Open Access Journals (Sweden)

    Ayşe Ebru Sakallıoğlu Abalı

    2011-07-01

    Full Text Available Burn injury is still a leading cause of morbidity and mortality in children. This article aimed to review the current principles of management from initial assessment to early management and intensive care for pediatric burn patients. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 62-9

  5. 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)

  6. 75 FR 23245 - American Lobster Fishery Management

    Science.gov (United States)

    2010-05-03

    ... Lobster Fishery Management AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and... management actions and alternatives for the American lobster fishery in Federal waters. The management... (Commission) as part of the Commission's Interstate Fishery Management Plan for American Lobster (ISFMP). Two...

  7. American Samoa ESI: MGT (Management Area Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains management area data for special management areas, marine parks, marine sanctuaries, national parks, and wildlife refuges in American Samoa....

  8. 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...

  9. Attitudes toward the American nutrition guidelines for the critically ill patients of Chinese intensive care physicians.

    Science.gov (United States)

    Xu, Xiao-ling; Zhou, Jian-cang; Pan, Kong-han; Zhao, Hong-chen; Ying, Ke-jing

    2015-01-01

    Nutrition therapy is essential for the management of critically ill patients. Some guidelines have been published to standardize and optimize the nutrition therapy. However, there are still many controversies in nutrition practice and there is a gap between guidelines and clinical nutrition therapy for patients in intensive care units (ICUs). This study aimed to assess attitudes and beliefs toward nutrition therapy of Chinese intensive care physicians by using the American guidelines as a surrogate. A questionnaire was sent to 45 adult ICUs in China, in which surveyed physicians were asked to rate their attitudes toward the American guidelines. A total of 162 physicians from 45 ICUs returned the questionnaires. Physicians were categorized into groups according to their professional seniority, hospital levels and whether they were members of Chinese Society for Parenteral and Enteral Nutrition (CSPEN). Overall, 94% of the respondents thought that nutrition therapy for critically ill patients was very important, and 80% mentioned that they used the American guidelines. There was diversity of opinion on the recommendations pertaining to nutrition assessment, supplemental parenteral nutrition and cutoff values for gastric residual volume, negative or neutral attitudes about these recommendations were 43%, 59% and 41%, respectively. Members of CSPEN were more likely to select a greater strength of recommendation than non-members. In conclusion, the overall attitudes of Chinese intensive care physicians toward the American guidelines were positive. Nevertheless, given the great guideline-practice gap, nutrition-focused education is warranted for many intensive care physicians in China.

  10. American Health Information Management Association

    Science.gov (United States)

    ... Government Corporate & Government Training Signature Partners Sponsorship Exhibitors Advertise With AHIMA Copyright & Permissions Privacy Policy RSS LinkedIn Facebook Twitter YouTube Copyright © 2017 by The American Health ...

  11. 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.

  12. 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...

  13. Strategically oriented management and controlling of resource intensive projects

    International Nuclear Information System (INIS)

    Kemmeter, Sascha

    2015-01-01

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

  14. Factors related to dimensions of grief intensity among African-American women after pregnancy loss.

    Science.gov (United States)

    Van, Paulina; Meleis, Afaf

    2010-12-01

    Grief is a normal response after pregnancy loss. Potentially, prolonged periods of grief can have a negative impact on physical or mental health. African-American women experience pregnancy loss at rates that are at least twice the rate of any other racial or ethnic group. However, the research literature on pregnancy loss has failed to include representative samples of African-American women or to explore and describe adequately their unique experiences after pregnancy loss. The purpose of this study was to examine the factors that are related to grief intensity after pregnancy loss (i.e., miscarriage, ectopic pregnancy, or fetal death) among African-American women. The results presented in this paper are components of a larger study in which the grief and coping experiences of African-American women following pregnancy loss were examined, using both quantitative and qualitative analysis. Eighty-six (N = 86) African-American women with a self-reported history ofinvoluntary pregnancy loss were recruited using a variety of culturally sensitive methods. The women completed three instruments: the Perinatal Grief Scale-Short Form (PGS-S), the Women's Role Integration Protocol (WRIP), and a personal profile tool designed specifically for the study. Pearson correlations were computed using pairwise deletion. Four models were tested using hierarchical multiple regression. Age and level of role integration were recurring predictors of the various dimensions of grief as measured by the PGS-S. Being older and reporting more major role satisfaction contributed to having less grief intensity after pregnancy loss. It is proposed that women with a history of pregnancy loss be assessed for residual grieving across their life span. Future explorations should address two main areas: specific interpersonal relations that facilitate grief management and the partners' experiences after pregnancy loss.

  15. African American Alumni Feelings of Attachment to a Predominately White Research Intensive University

    Science.gov (United States)

    Burley, Hansel; Butner, Bonita; Causey-Bush, Tonia; Bush, Lawson, V

    2007-01-01

    The authors examined African American alumni opinions of their experience at a predominately white research intensive university from the development office's perspective. Research on decades of African American alumni opinions of their alma mater is nonexistent. Gender, financial aid and matriculation period were the independent variables. The…

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

    African Journals Online (AJOL)

    groups, strongyloidiosis and coccidiosis induced eosinophilia in both management systems and lymphopenia in only semi-intensively managed sheep (P<0.05). As indicated in Table II, the leukocyte differential, especially eosinophils, of sheep in either age group of the extensively managed flock varied greatly from normal.

  17. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

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

    2016-01-01

    . Interventions: Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures: Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results: Standard management yielded 9.6 QALYs......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....... Objective: To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants: This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost...

  18. Intensive Care Management of Organophosphate Poisoned Patient ...

    African Journals Online (AJOL)

    challenging, more so in the setting of poor critical care facilities. The management requires the administration .... at the scene of the incident, signs and symptoms of organophosphate poisoning and improvement .... outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques. Crit.

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

    African Journals Online (AJOL)

    Background: The advent of intensive care management of severe tetanus patients is said to have reduced the mortality rate from the ailment. This study evaluated the experience at the University of Benin Teaching Hospital. Materials and Methods: Case files of severe tetanus patients referred to the intensive care unit (ICU) ...

  20. 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

  1. 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 ...

  2. 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…

  3. 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…

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

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

  6. 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...

  7. 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.

  8. 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

  9. haematological profiles of pigs raised under intensive management

    African Journals Online (AJOL)

    EZE J I

    SUMMARY. The haematological profile of pigs raised under intensive management system in South-. Eastern Nigeria was studied. A total of 114 pigs were sampled comprising of 48 males and 66 females. Thirty-seven pigs were sampled in Anambra State, 46 in Enugu State and 31 in Ebonyi State with 38 being piglets and ...

  10. Research strategies for increasing productivity of intensively managed forest plantations

    Science.gov (United States)

    E.D. Vance; D.A. Maguire; R.S. Zalesny

    2010-01-01

    Intensive management practices increase productivity of forest plantations by reducing site, stand, and biological limitations to dry matter production and by maximizing the allocation of production to harvestable tree components. The resulting increase allows greater fiber production from a smaller land base and provides market incentives to keep these lands under...

  11. Influence of Land use Intensity and Weed Management Practice on ...

    African Journals Online (AJOL)

    The effects of land use intensity and weed management practice on weed seedling emergence, growth and characterization of weed species were examined at Ilorin, in the southern Guinea savanna of Nigeria. The study was conducted on three pieces of land with known cropping history, laid out as randomized complete ...

  12. 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

  13. The Adolescent Intensive Management Team: an intensive outreach mental health service for high-risk adolescents.

    Science.gov (United States)

    Assan, Ben; Burchell, Peter; Chia, Andrew; Coffey, Catherine; Floreani, Sophie; Weir, Jennifer; Hammond, Sabine Wingenfeld; Woods, Barbara

    2008-12-01

    The aim of this paper was to describe the Adolescent Intensive Management (AIM) team at the Austin Child and Adolescent Mental Health Service (CAMHS), a unique model of intensive outreach service with high-risk and difficult-to-engage adolescents, and describe the profile of clients referred to it. This study used a retrospective review of clients' data, collected through file audit, over a 12-month period. The result of the study showed that a 100% retention rate of adolescents with complex social, emotional and mental health needs is possible in a flexible and multi-system approach to service provision. Clients referred to the CAMHS' AIM team displayed a pattern of multiple risk factors and comorbidities. Low caseload of 8-10 clients per clinician allowed flexibility and a level of intensity to make any necessary changes in service provision to better suit the client's needs. The majority of clients showed improvement in functioning following intervention by the team.

  14. 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...

  15. 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.

  16. 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.

  17. 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.

  18. Determinants of Working Capital Management in Latin American Companies

    Directory of Open Access Journals (Sweden)

    Samuel Mongrut

    2013-11-01

    Full Text Available The aim of this study is to determine the factors that affect working capital management in Latin American companies. Using an unbalanced panel data analysis for companies quoted in five Latin American capital markets it is shown that companies in Argentina, Brazil, Chile and Mexico are holding cash excesses, which could destroy firm value. Results show that the industry cash conversion cycle, the company market power, its future sales and country risk have an influence on the way Latin American companies manage their working capital with significant differences among countries in the region.

  19. [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.

  20. 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)

  1. 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

  2. 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

  3. 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

  4. 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)

  5. 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 Psychological stress and drug craving were inversely associated with drug-free days in bivariate testing (r = -.18, p associated with drug-free days in multivariate testing (B =.05, SE =.01, β =.39, t = 4.9, p psychological stress and drug cravings should be emphasized in intensive dual diagnosis group therapy.

  6. 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.

  7. 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.

  8. [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.

  9. Managing oncology neutropenia and sepsis in the intensive care unit.

    Science.gov (United States)

    Vioral, Anna N; Wentley, Dawn

    2015-01-01

    Neutropenic sepsis results as a post-cancer treatment complications and is considered an oncologic emergency. Neutropenic sepsis can result in mortality, especially if it is not identified at an early stage. Septic syndrome is the leading cause of nonrelapse mortality in patients with hematologic malignancies and solid tumors. Therefore, intensive care unit (ICU) nurses must possess a thorough understanding of cancer treatments, hematopoiesis, neutropenia, sepsis, risk factors, and the ability to perform a comprehensive assessment of the oncology patient. Each of these components plays a vital role in the patient's overall management following treatments with chemotherapy, radiation, and stem cell transplantation. The ICU nurse who encompasses this understanding will be able to identify neutropenic sepsis in a timely manner. The early identification of neutropenic sepsis will enable the ICU nurse to expeditiously implement preventive treatment and management to prevent mortality.

  10. 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.

  11. [Intercultural competence. Management of foreignness in intensive care medicine].

    Science.gov (United States)

    Bein, T

    2015-08-01

    Living in a multicultural society is characterized by different attitudes caused by a variety of religions and cultures. In intensive care medicine such a variety of cultural aspects with respect to pain, shame, bodiliness, dying and death is of importance in this scenario. To assess the importance of cultural and religious attitudes in the face of foreignness in intensive care medicine and nursing. Notification of misunderstandings and misinterpretations in communication and actions. An analysis of the scientific literature was carried out and typical intercultural conflict burden situations regarding the management of brain death, organ donation and end of life decisions are depicted. Specific attitudes are found in various religions or cultures regarding the change of a therapeutic target, the value of the patient's living will and the organization of rituals for dying. Intercultural conflicts are mostly due to misunderstandings, assessment differences, discrimination and differences in values. Intercultural competence is crucial in intensive care medicine and includes knowledge of social and cultural influences of different attitudes on health and illness, the abstraction from own attitudes and the acceptance of other or foreign attitudes.

  12. Additives in ensiling palisade grass managed under grazing intensities

    Directory of Open Access Journals (Sweden)

    Felipe Barros Macedo

    2015-10-01

    Full Text Available Conservation of summer forage excess represents a management strategy to meet animals' needs for dry matter in the shortage period, but has been poorly studied. Silage can be used for this purpose. This study analyzed the production of palisade grass silage from pasture subjected to different grazing intensities with and without additive, determining losses by gases and effluents and chemical composition of silage. The experiment was a 4 x 3 factorial completely randomized design, with four replications. The factors were: 1st – herbage allowance of 5% (5 kg dry matter 100 kg-1 of animal weight day-1, 10, 15 and 20%. The pasture was managed under rotational stocking with 35-day grazing cycles (7 days of occupation and 28 days of rest and 2nd - additives: a control; b citrus pulp pellets; c biological inoculant for grass silage. The forage of palisade grass harvested from pastures subjected to low-intensity grazing showed quantitative and qualitative characteristics for ensiling. However, high humidity and low fermentable carbohydrate require the use of additive, favor the fermentation process and increase the nutritional quality of silage.

  13. Pain management of neonatal intensive care units in Japan.

    Science.gov (United States)

    Ozawa, Mio; Yokoo, Kyoko

    2013-04-01

    To describe current neonatal pain management and individual and organizational factors that can improve neonatal pain practice from the viewpoints of both head nurses and head neonatologists in Japan. An anonymous questionnaire was sent to general perinatal maternal and child medical centres that had level 3 units across Japan. A total of 61 of 89 head nurses and 54 of 89 head neonatologists replied. The responses of head nurses and head neonatologists were almost the same. More than 60% of units (head nurses, 65%; head neonatologists, 61%) did not use pain scales, and about 63% units (both head nurses and head neonatologists) had no rules for health care professionals on the best methods for implementing pain relief for painful diagnostic and therapeutic procedures. Only 17% of head nurses and 24% of head neonatologists considered that nurses and physicians in their units collaborated in pain management, and units (both head nurses and head neonatologists) had written guidelines for their unit on neonatal pain management. This study suggested that Japanese neonatal intensive care units need national guidelines for pain management, and these might improve collaboration between nurses and physicians in minimizing neonatal pain. © 2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

  14. 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...

  15. IML-CZO: Critical Zone Observatory for Intensively Managed Landscapes

    Science.gov (United States)

    Kumar, Praveen; Papanicolaou, Thanos

    2014-05-01

    Intensively managed landscapes, regions of significant land use change, serve as a cradle for economic prosperity. However, the intensity of change is responsible for unintended deterioration of our land and water environments. By understanding present day dynamics in the context of long-term co-evolution of the Critical Zone comprising of the landscape, soil and biota, IML-CZO aims to support the assessment of short- and long-term resilience of the crucial ecological, hydrological and climatic services provided by the Critical Zone. An observational network of three sites in Illinois, Iowa, and Minnesota that capture the geological diversity of the low relief, glaciated, and tile-drained landscape will drive novel scientific and technological advances. IML-CZO will provide leadership in developing the next generation of scientists and practitioners, and informing management strategies aimed at reducing the vulnerability of the system to present and emerging trends in human activities. IML-CZO, one of the nine observatories funded by the United States National Science Foundation (NSF), consists of two core sites: the 3,690- sq. km. Upper Sangamon River Basin in Illinois and 270-sq. km. Clear Creek Watershed in Iowa, along with the 44,000- sq. km. Minnesota River Basin as third participating site. These sites together are characterized by low-relief landscapes with poorly drained soils and represent a broad range of physiographic variations found throughout the glaciated Midwest, and thereby provide an opportunity to advance understanding of the CZO in this important region. Through novel measurements, analysis and modeling, IML-CZO aims to address the following questions: • How do different time scales of geologic evolution and anthropogenic influence interact to determine the trajectory of CZ structure and function? • How is the co-evolution of biota, consisting of both vegetation and microbes, and soil affected due to intensive management? • How have

  16. Data-intensive management and analysis for scientifc simulations.

    Energy Technology Data Exchange (ETDEWEB)

    Hudson, R.; Norris, J.; Reid, L. B.; Cal Jordan IV, G.; Weide, K.; Papka, M. E. (CLS-CI); ( MCS); (Western Australian Geothemal Centre of Excellence, CSIRO); (School of Environmental Systems Engineering, University of Western Australia)

    2011-01-01

    Scientific simulations can produce enormous amounts of data, making the analysis of results and management of files a difficult task for scientists. The simulation management and analysis system (Smaash) described here is designed to allow scientists to easily capture, store, organize, monitor, and analyze simulation results. The system is automatic, standardized, and secure. Smaash was built using open-source tools and modularized to be independent of the scientific simulation. The web-based front-end allows the scientist to easily interact with the data, and has proved its usefulness in improving the efficiency of a scientific team's workflow. High performance parallel computing allows scientists to solve complex physical problems through computer simulation. However, the massive amounts of data generated and the complex computing environment can create additional complications. A recent review by Ludaescher et al.(2009) describes how scientific workflows can assist scientists in extracting knowledge from these data-intensive operations by automating components within pipelines. Within the fusion community, Klasky et al.(2008) and colleagues have developed a system that handles the storage management, data movement, metadata generation and management, and a means to analyze the results. In response to scientists needs, a simulation management and analysis system (Smaash) was developed at the University of Chicago and Argonne National Laboratory (USA). Smaash provides an integrated way to monitor simulations and analyze computational results; catalog, store, and retrieve simulations; and prepare output for publications. The system is independent of the particular simulation code, accessible from many HPC and browser-based platforms, and built around open-source software tools. Data security and provenance is considered throughout. The analysis components are hidden behind a web-based front end, enabling scientists to focus on their results and not get bogged

  17. Enrichment Ratio and Aggregate Stability Dynamics in Intensely Managed Landscapes

    Science.gov (United States)

    Wacha, K.; Papanicolaou, T.; Filley, T. R.; Hou, T.; Abban, B. K.; Wilson, C. G.; Boys, J.

    2015-12-01

    Challenges in understanding the soil carbon dynamics within intensely managed landscapes (IMLs), found throughout much the US Midwest, is highly complex due to the presence of heterogeneous landscape features and properties, as well as a mosaic of physical and biogeochemical processes occurring at different time scales. In addition, rainfall events exacerbate the effects of tillage by the impact of raindrops, which break down aggregates that encase carbon and dislodge and entrain soil particles and aggregates along the downslope. The redistribution of soil and carbon can have huge implications on biogeochemical cycling and overall carbon budgeting. In this study, we provide some rare field data on the mechanisms impacting aggregate stability, enrichment ratio values to estimate fluxes of carbon, as well as lignin chemistry to see influences on oxidation/mineralization rates. Rainfall simulation experiments were conducted within agricultural fields. Experiments were performed on the midslope (eroding) and toeslope (depositional) sections of representative hillslopes, under a variety of land managements, including row crop (conventional and conservation) and restored grasslands. Sensors were utilized to capture the evolution of soil moisture, temperature, microbial respiration pulses, and discharge rates to identify pseudo-steady state conditions. Samples collected at the weir outlet were tested for sediment concentrations and size fractions, as well as carbon and lignin fluxes. Preliminary findings show that conservation management practices have higher aggregate stability and decreased mass fluxes of carbon in the downslope than conventional tillage techniques.

  18. Severe ovarian hyperstimulation syndrome: Intensive care management of two cases

    Directory of Open Access Journals (Sweden)

    Praveen Talawar

    2011-01-01

    Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.

  19. 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.

  20. Part 2, Conflict management. Managing low-to-mid intensity conflict in the health care setting.

    Science.gov (United States)

    Aschenbrener, C A; Siders, C T

    1999-01-01

    Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations.

  1. 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

  2. Establishing a regional nitrogen management approach to mitigate greenhouse gas emission intensity from intensive smallholder maize production.

    Science.gov (United States)

    Wu, Liang; Chen, Xinping; Cui, Zhenling; Zhang, Weifeng; Zhang, Fusuo

    2014-01-01

    The overuse of Nitrogen (N) fertilizers on smallholder farms in rapidly developing countries has increased greenhouse gas (GHG) emissions and accelerated global N consumption over the past 20 years. In this study, a regional N management approach was developed based on the cost of the agricultural response to N application rates from 1,726 on-farm experiments to optimize N management across 12 agroecological subregions in the intensive Chinese smallholder maize belt. The grain yield and GHG emission intensity of this regional N management approach was investigated and compared to field-specific N management and farmers' practices. The regional N rate ranged from 150 to 219 kg N ha(-1) for the 12 agroecological subregions. Grain yields and GHG emission intensities were consistent with this regional N management approach compared to field-specific N management, which indicated that this regional N rate was close to the economically optimal N application. This regional N management approach, if widely adopted in China, could reduce N fertilizer use by more than 1.4 MT per year, increase maize production by 31.9 MT annually, and reduce annual GHG emissions by 18.6 MT. This regional N management approach can minimize net N losses and reduce GHG emission intensity from over- and underapplications, and therefore can also be used as a reference point for regional agricultural extension employees where soil and/or plant N monitoring is lacking.

  3. Admission, management and outcomes of acute pancreatitis in intensive care.

    Science.gov (United States)

    Russell, Peter S; Mittal, Anhubav; Brown, Lisa; McArthur, Colin; Phillips, Anthony J R; Petrov, Max; Windsor, John A

    2017-12-01

    A review of the management of acute pancreatitis (AP) at a tertiary intensive care unit (ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes. A retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001). Eighty-four patients (male 53, mean ± SD age = 56.9 ± 15 years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3 days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 ± 8.2 SD to 15.4 ± 7.3 (P < 0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) (P < 0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) (P = 0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P = 0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% (P = 0.198). There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved. © 2016 Royal Australasian College of Surgeons.

  4. Barriers to pain management in a community sample of Chinese American patients with cancer.

    Science.gov (United States)

    Edrington, Janet; Sun, Angela; Wong, Candice; Dodd, Marylin; Padilla, Geraldine; Paul, Steven; Miaskowski, Christine

    2009-04-01

    Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r=0.380) and the religious fatalism subscale and average pain (r=0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r=0.282, r=0.284, respectively; religious fatalism: r=0.358, r=0.353, respectively). The tolerance subscale was positively correlated with pain interference (r=0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management.

  5. The residence time of intensively managed agricultural landscapes

    Science.gov (United States)

    Bowling, Laura; Cherkauer, Keith; Chiu, Chun-mei; Rahman, Sanoar

    2015-04-01

    Much of the agricultural landscape across the Midwestern United States is intensively managed through numerous surface and subsurface drainage improvements, and the growing extraction of groundwater resources. The relatively recent glaciation of the North Central region means that the landscape is less dissected and hydrologically connected than older till areas. Low topographic gradients and underlying dense till which restricts vertical water movement, as well as kettle depressions, have led to poorly drained soils and extensive wetlands within the landscape. Large areas of this land could only be farmed once the excess water was removed through artificial surface and subsurface drainage. Conventional wisdom in the region maintains that subsurface tile drainage reduces the occurrence of peak flow events by increasing soil water storage capacity. At the watershed scale, this view does not take into account the coincident increase in surface drainage and reduction in residence time in surface depressions. This paper explores to what degree water management and irrigation has changed surface and subsurface water storage and residence time over the last century and how this has impacted flow duration throughout the Wabash River system in Indiana, USA. The effects of subsurface tile drains, wetlands and aquifer storage are explicitly represented within the Variable Infiltration Capacity (VIC) macroscale hydrology model. We maintain a focus on the entire Wabash River, a river system of historic importance that is also representative of many similar areas in the till plain region of the agricultural Midwest, which contribute to water quality and flood dynamics of the Mississippi river system. By lowering the water table, surface and subsurface drainage improvements have increased the subsurface storage capacity at the beginning of rain events, but this is overwhelmed by the decrease in surface storage capacity for intermediate to large events, decreasing the current

  6. More cultivation with lower intensity in the South American Chaco: A double hydrological challenge

    Science.gov (United States)

    Jobbagy, E. G.; Gimenez, R.; Mercau, J. L.; Houspanossian, J.; Baldi, G.; Kuppel, S.

    2014-12-01

    As in other semi-arid plains of the world, long-scale deforestation to establish croplands in the South American Chaco may disrupt the regional water balance. As annual crops use less water than the native perennial system, water in excess usually translates into serious degradation processes such as run-off driven erosion, or the onset of groundwater recharge which can develop flooding and dryland salinization. Agriculturally, water excess could be reduced by using more intensive crop systems which consume water exhaustively. We used MODIS imagery (2000-present) from Bandera, Argentina (28.8S 62.2W), a major agricultural cluster in the region, to assess deforestation, to identify the main crop systems, and to analyze the impact of crop expansion and phenological shifts on the regional water balance. Three cover classes (Dry Forest DF, Agriculture AG, and Pastures PA) and five AG crop types were distinguished (winter W, spring Sp,summer S, and late-summer LS single crops, winter/summer DCWS and spring/summer DCSpS double crops). Each season, water use (annual evapotranspiration, ET) for each cover/crop type (10 pixels/class) was computed with a daily water balance based on meteorological data and 2 remote sensing-derived indices: Normalized Difference Vegetation Index, to capture canopy conditions, and Dead Fuel Index to represent mulch cover conditions. Throughout 14 crop seasons AG expanded from 20 to 50% of the study area (1M ha) mostly replacing DF. Also, AG gradually evolved from a more intensive and diversified pattern dominated by DC (45-50%), S (28%) and Sp (16%) systems, to a more water-conservative system dominated by LS (60-80% in the last 3 seasons). Crop type differences in ET (DCWS≈DCSpS≈FG>S>Sp>LS≈W) were stronger in wet years (>1000mm) but nil in dry ones (250mm for the less intensive W and LS in wet years. Weighting each cover/crop class by their area, we found that the current expansion and reduced intensity of cultivation has cut regional

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

    DEFF Research Database (Denmark)

    Steinhueser, Melanie; Waizenegger, Lena; Vodanovich, Shahper

    2017-01-01

    study contributes to knowledge management research by showing how private IT use can change existing knowledge management practices. At the same time, we are able to give rich insights into the rise of Shadow IT in a manufacturing context which takes place in a selforganised way without knowledge......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...... of the management. This enables us to take a step towards a knowledge management strategy perspective on Shadow IT....

  8. 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.

  9. Behaviors and characteristics of African American and European American females that impact weight management.

    Science.gov (United States)

    Capers, Cynthia Flynn; Baughman, Kristin; Logue, Everett

    2011-06-01

    This report explores the extent to which sociodemographic and psychosocial factors could explain differences in obesity or dietary and exercise behaviors between middle-aged African American (AA) and European American (EA) women seen in primary care. We focus on "race × predictor" interactions that could explain how AA and EA women differ in ways that affect the prevalence of obesity. This comparative exploratory study uses data from the baseline examination of the Reasonable Eating and Activity to Change Health (REACH) trial, which included 173 AA women and 278 EA women. Inclusion criteria were membership in one of the study family medicine practices, an elevated body mass index (greater than 27 kg/m(2) ), age 40 to 69 years, and no contraindications to increased activity and dietary change. Secondary data analyses were employed. There was evidence of race differences in the level of multiple variables related to weight management but there were only three significant "race × predictor" interactions out of 48 comparisons: (a) race × physical health, with BMI as the dependent variable; (b) race × the percentage of dietary fat, with total dietary kilocalories as the dependent variable; and (c) race × median income, with exercise minutes per week as the dependent variable. The results support the proposition that the weight management experience of AA and EA primary care women is similar after different exposure levels are taken into account. The results contribute to the body of literature that addresses obesity management for AA and EA women in primary care settings. Findings illustrate the need for obesity prevention and management efforts from both multidisciplinary primary care providers and community-wide public health interventions. AA and EA women have different resources, but the same factors generally influence weight management, whether one is AA or EA. This suggests that clinical interventions and public health interventions for AA and EA women can

  10. Hallmarks of science missing from North American wildlife management.

    Science.gov (United States)

    Artelle, Kyle A; Reynolds, John D; Treves, Adrian; Walsh, Jessica C; Paquet, Paul C; Darimont, Chris T

    2018-03-01

    Resource management agencies commonly defend controversial policy by claiming adherence to science-based approaches. For example, proponents and practitioners of the "North American Model of Wildlife Conservation," which guides hunting policy across much of the United States and Canada, assert that science plays a central role in shaping policy. However, what that means is rarely defined. We propose a framework that identifies four fundamental hallmarks of science relevant to natural resource management (measurable objectives, evidence, transparency, and independent review) and test for their presence in hunt management plans created by 62 U.S. state and Canadian provincial and territorial agencies across 667 management systems (species-jurisdictions). We found that most (60%) systems contained fewer than half of the indicator criteria assessed, with more criteria detected in systems that were peer-reviewed, that pertained to "big game," and in jurisdictions at increasing latitudes. These results raise doubt about the purported scientific basis of hunt management across the United States and Canada. Our framework provides guidance for adopting a science-based approach to safeguard not only wildlife but also agencies from potential social, legal, and political conflict.

  11. 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...

  12. Recent Responses of Western North American Forests and Hydroclimate to Pacific Storm Track Position and Intensity

    Science.gov (United States)

    Dannenberg, M. P.; Wise, E.

    2017-12-01

    Much of the precipitation delivered to western North America arrives during the October to March cool season via midlatitude Pacific storm tracks, which may shift in the future due to climate change. Using historical climate, tree-ring, and remote sensing data, we assessed the sensitivity of western North American hydroclimate and ecosystems to the position and intensity of cool-season Pacific storm tracks. From 1980-2014, mean annual cool-season storm tracks entered western North America between approximately 41°N to 53°N, with substantial interannual variability in both the position and intensity of the storm tracks. We examined relationships between storm tracks and two hydroclimatic variables: the cool-season standardized precipitation-evapotranspiration index and April snow water equivalent. We also assessed how historical storm track variability affected ecosystems using forest growth estimates from a large tree-ring network as well as land surface phenology and wildfire estimates from AVHRR and Landsat, respectively. Cool-season moisture supply and snowpack responded strongly to storm track position, with positive correlations to storm track latitude in eastern Alaska and northwestern Canada but negative correlations in the northwestern U.S. These hydroclimatic impacts were largely driven by the latitudinal position of storm tracks during the "shoulder" seasons (i.e., autumn and early spring). Ecosystems of the western U.S. tended to be greener and more productive following winters with south-shifted storm tracks, while Canadian ecosystems were greener in years when the cool-season storm track was shifted to the north. On average, larger areas of the northwestern U.S. were burned by moderate to high severity wildfires when storm tracks were displaced north, and the average burn area per fire also tended to be higher in years with north-shifted storm tracks. Assuming that these historical relationships continue to hold under future climate scenarios, our

  13. 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.

  14. 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.

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

    African Journals Online (AJOL)

    2015-02-25

    Feb 25, 2015 ... Subjects and Methods: This was a retrospective chart review of 62 patients, admitted to the Intensive Care Unit (ICU) with OP poisoning between .... were poisoned through more than one route with skin and gastrointestinal .... areas where the majority worked in the agricultural industry and therefore had.

  16. 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 ...

  17. 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.

  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. 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

  20. 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.

  1. Forages from intensively managed and semi-natural grasslands in the diet of dairy cows

    NARCIS (Netherlands)

    Bruinenberg, M.H.

    2003-01-01

    Keywords : Intensively managed grass, semi-natural grasslands, forage species, dairy cows, in vivo digestibility, feed degradation, energy metabolism, milk production, ruminant nutrition, rumen fermentation, rumen kinetics, voluntary intake, feed

  2. Evaluation and management of nosocomial sinusitis in Intensive ...

    African Journals Online (AJOL)

    Hence, an index of suspicion should be kept for nosocomial sinusitis in a case of pyrexia of unknown origin in ICU settings. Conclusion: Nosocomial sinusitis in ICU setting presenting with fever needs to be diagnosed early in patients having risk factors for this entity and should be managed aggressively to prevent life ...

  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. 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...

  5. Grazing intensity differentially regulates ANPP response to precipitation in North American semiarid grasslands.

    Science.gov (United States)

    Irisarri, J Gonzalo N; Derner, Justin D; Porensky, Lauren M; Augustine, David J; Reeves, Justin L; Mueller, Kevin E

    2016-07-01

    Grazing intensity elicits changes in the composition of plant functional groups in both shortgrass steppe (SGS) and northern mixed-grass prairie (NMP) in North America. How these grazing intensity-induced changes control aboveground net primary production (ANPP) responses to precipitation remains a central open question, especially in light of predicted climate changes. Here, we evaluated effects of four levels (none, light, moderate, and heavy) of long-term (>30 yr) grazing intensity in SGS and NMP on: (1) ANPP; (2) precipitation-use efficiency (PUE, ANPP : precipitation); and (3) precipitation marginal response (PMR; slope of a linear regression model between ANPP and precipitation). We advance prior work by examining: (1) the consequences of a range of grazing intensities (more grazed vs. ungrazed); and (2) how grazing-induced changes in ANPP and PUE are related both to shifts in functional group composition and physiological responses within each functional group. Spring (April-June) precipitation, the primary determinant of ANPP, was only 12% higher in NMP than in SGS, yet ANPP and PUE were 25% higher. Doubling grazing intensity in SGS and nearly doubling it in NMP reduced ANPP and PUE by only 24% and 33%, respectively. Increased grazing intensity reduced C 3 graminoid biomass and increased C 4 grass biomass in both grasslands. Functional group shifts affected PUE through biomass reductions, as PUE was positively associated with the relative abundance of C 3 species and negatively with C 4 species across both grasslands. At the community level, PMR was similar between grasslands and unaffected by grazing intensity. However, PMR of C 3 graminoids in SGS was eightfold higher in the ungrazed treatment than under any grazed level. In NMP, PMR of C 3 graminoids was only reduced under heavy grazing intensity. Knowing the ecological consequences of grazing intensity provides valuable information for mitigation and adaptation strategies in response to predicted

  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. Intensive Care Management of Pediatric Acute Liver Failure.

    Science.gov (United States)

    Lutfi, Riad; Abulebda, Kamal; Nitu, Mara E; Molleston, Jean P; Bozic, Molly A; Subbarao, Girish

    2017-05-01

    Pediatric acute liver failure is rare but life-threatening illness that occurs in children without preexisting liver disease. The rarity of the disease, along with its severity and heterogeneity, presents unique clinical challenges to the physicians providing care for pediatric patients with acute liver failure. In this review, practical clinical approaches to the care of critically ill children with acute liver failure are discussed with an organ system-specific approach. The underlying pathophysiological processes, major areas of uncertainty, and approaches to the critical care management of pediatric acute liver failure are also reviewed.

  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. Root zone sensors for irrigation management in intensive agriculture.

    Science.gov (United States)

    Pardossi, Alberto; Incrocci, Luca; Incrocci, Giorgio; Malorgio, Fernando; Battista, Piero; Bacci, Laura; Rapi, Bernardo; Marzialetti, Paolo; Hemming, Jochen; Balendonck, Jos

    2009-01-01

    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.

  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. 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

  12. 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.

  13. 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.

  14. Human Milk Management Redesign: Improving Quality and Safety and Reducing Neonatal Intensive Care Unit Nurse Stress.

    Science.gov (United States)

    Settle, Margaret Doyle; Coakley, Amanda Bulette; Annese, Christine Donahue

    2017-02-01

    Human milk provides superior nutritional value for infants in the neonatal intensive care unit and is the enteral feeding of choice. Our hospital used the system engineering initiative for patient safety model to evaluate the human milk management system in our neonatal intensive care unit. Nurses described the previous process in a negative way, fraught with opportunities for error, increased stress for nurses, and the need to be away from the bedside and their patients. The redesigned process improved the quality and safety of human milk management and created time for the nurses to spend with their patients.

  15. 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.

  16. 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,…

  17. 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.

  18. 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...

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Amrie Firmansyah

    2018-03-01

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

  1. Unilateral persistent hyperplastic primary vitreous: intensive management approach with excellent outcome beyond visual maturation.

    Science.gov (United States)

    Yusuf, Imran H; Patel, Chetan Kantibhai; Salmon, John F

    2015-01-06

    Persistent hyperplastic primary vitreous (PHPV) is an ocular developmental disorder resulting from incomplete apoptosis of the embryonic hyaloid vasculature. Unilateral PHPV is traditionally associated with a poor prognosis because of the challenges associated with managing progressive anisometropic amblyopia. We report a child with unilateral PHPV who underwent cataract extraction, primary posterior capsulotomy with anterior vitrectomy and intraocular lens implantation followed by combined trabeculectomy/trabeculotomy within the first 8 weeks of life. Intensive optometric and orthoptic input was required for many years to manage the increasing anisometropic amblyopia with final visual acuity of 20/40 unaided in the affected eye and without evidence of glaucomatous optic neuropathy. This case illustrates the excellent visual outcome possible in a child with complex, unilateral PHPV using an intensive management approach comprising: early surgical intervention for congenital cataract and secondary glaucoma, meticulous monitoring of refraction, visual acuity and intraocular pressure and motivated parents who engaged in the management. 2015 BMJ Publishing Group Ltd.

  2. 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.

  3. 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...

  4. 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...

  5. The critically ill patient with tuberculosis in intensive care: Clinical presentations, management and infection control.

    Science.gov (United States)

    Otu, Akaninyene; Hashmi, Madiha; Mukhtar, Ahmed M; Kwizera, Arthur; Tiberi, Simon; Macrae, Bruce; Zumla, Alimudin; Dünser, Martin W; Mer, Mervyn

    2018-03-13

    Tuberculosis (TB) is one of the top ten causes of death worldwide. In 2016, there were 490,000 cases of multi-drug resistant TB globally. Over 2 billion people have asymptomatic latent Mycobacterium tuberculosis infection. TB represents an important, but neglected management issue in patients presenting to intensive care units. Tuberculosis in intensive care settings may present as the primary diagnosis (active drug sensitive or resistant TB disease). In other patients TB may be an incidental co-morbid finding as previously undiagnosed sub-clinical or latent TB which may re-activate under conditions of stress and immunosuppression. In Sub-Saharan Africa, where co-infection with the human immunodeficiency virus and other communicable diseases is highly prevalent, TB is one of the most frequent clinical management issues in all healthcare settings. Acute respiratory failure, septic shock and multi-organ dysfunction are the most common reasons for intensive care unit admission of patients with pulmonary or extrapulmonary TB. Poor absorption of anti-TB drugs occurs in critically ill patients and worsens survival. The mortality of patients requiring intensive care is high. The majority of early TB deaths result from acute cardiorespiratory failure or septic shock. Important clinical presentations, management and infection control issues regarding TB in intensive care settings are reviewed. Copyright © 2018. Published by Elsevier Inc.

  6. 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...

  7. 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.

  8. Ultimate biochemical oxygen demand in semi-intensively managed shrimp pond waters

    Science.gov (United States)

    Three independent studies were conducted to quantified ultimate biochemical oxygen demand (UBOD) and the corresponding decomposition rate constant for production pond (average 21.5 ha each) waters and effluents on six semi-intensively managed marine shrimp (Litopenaeus vannamei) farms in Honduras. S...

  9. 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

  10. 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

  11. Modeling water, carbon, and nitrogen dynamics for two drained pine plantations under intensive management practices

    Science.gov (United States)

    Shiying Tian; Mohamed A. Youssef; R. Wayne Skaggs; Devendra Amatya; George M. Chescheir

    2012-01-01

    This paper reports results of a study to test the reliability of the DRAINMOD-FOREST model for predicting water, soil carbon (C) and nitrogen (N) dynamics in intensively managed forests. The study site, two adjacent loblolly pine (Pinus taeda L.) plantations (referred as D2 and D3), are located in the coastal plain of North Carolina, USA. Controlled drainage (with weir...

  12. Forages from intensively managed and semi-natural grasslands in the diet of dairy cows

    NARCIS (Netherlands)

    Bruinenberg, M.H.

    2003-01-01

    Keywords : Intensively managed grass, semi-natural grasslands, forage species, dairy cows, in vivo digestibility, feed degradation, energy metabolism, milk production, ruminant nutrition, rumen fermentation, rumen kinetics, voluntary

  13. Effect of drainage on CO2 exchange patterns in an intensively managed peat pasture

    NARCIS (Netherlands)

    Dirks, B.O.M.; Hensen, A.; Goudriaan, J.

    2000-01-01

    Eddy correlation measurements of CO2 exchange were made in intensively managed peat pastures at 2 different groundwater tables during most of a growing season. F was separated into a respiratory and an assimilatory CO2 flux. The fit of the Arrhenius temperature response to Fr showed that Fr was

  14. 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

  15. 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…

  16. Representing composition, spatial structure and management intensity of European agricultural landscapes: A new typology

    NARCIS (Netherlands)

    van der Zanden, E.H.; Levers, C.; Verburg, P.H.; Kuemmerle, T.

    2016-01-01

    Comprehensive maps that characterize the variation in agricultural landscapes across Europe are lacking. In this paper we present a new Europe-wide, spatially-explicit typology and inventory of the diversity in composition, spatial structure and management intensity of European agricultural

  17. A knowledge base for management of the capital-intensive fishery ...

    African Journals Online (AJOL)

    A knowledge base for management of the capital-intensive fishery for small pelagic fish off South Africa. TP Fairweather, M Hara, CD van der Lingen, J Raakjær, LJ Shannon, GG Louw, P Degnbol, RJM Crawford ...

  18. A Compatible Stem Taper-Volume-Weight System For Intensively Managed Fast Growing Loblolly Pine

    Science.gov (United States)

    Yugia Zhang; Bruce E. Borders; Robert L Bailey

    2002-01-01

    eometry-oriented methodology yielded a compatible taper-volume-weight system of models whose parameters were estimated using data from intensively managed loblolly pine (Pinus taeda L.) plantations in the lower coastal plain of Georgia. Data analysis showed that fertilization has significantly reduced taper (inside and outside bark) on the upper...

  19. Research on the Intensive Material Management System of Biomass Power Plant

    Science.gov (United States)

    Zhang, Ruosi; Hao, Tianyi; Li, Yunxiao; Zhang, Fangqing; Ding, Sheng

    2017-05-01

    In view of the universal problem which the material management is loose, and lack of standardization and interactive real-time in the biomass power plant, a system based on the method of intensive management is proposed in this paper to control the whole process of power plant material. By analysing the whole process of power plant material management and applying the Internet of Things, the method can simplify the management process. By making use of the resources to maximize and data mining, material utilization, circulation rate and quality control management can be improved. The system has been applied in Gaotang power plant, which raised the level of materials management and economic effectiveness greatly. It has an important significance for safe, cost-effective and highly efficient operation of the plant.

  20. Culture, organization, and management in intensive care: construction and validation of a multidimensional questionnaire.

    Science.gov (United States)

    Minvielle, Etienne; Dervaux, Benoît; Retbi, Aurélia; Aegerter, Philippe; Boumendil, Ariane; Jars-Guincestre, Marie Claude; Tenaillon, Alain; Guidet, Bertrand

    2005-06-01

    The objective of this study is to develop and validate a questionnaire designed to assess the culture, organization, and management of intensive care units. This is a prospective multicenter study. The study was conducted in 26 intensive care units located in Paris. All personnel were asked to complete the questionnaire. The questionnaire was developed in 2 steps: (1) development of a theoretical framework based on organizational theory and (2) testing of the reliability and validity of a comprehensive set of measures. The internal consistency of the items composing each scale was tested by using the Cronbach alpha. Convergent, and discriminant validity was assessed by factor analysis with varimax rotation. The overall completion rate was 74% with 1000 respondents (750 nurses, 26 head nurses, 168 physicians, and 56 medical secretaries). Starting with a 220-item questionnaire, we constructed a short version-conserving metrological characteristics with good reliability and validity. The short questionnaire, entitled Culture, Organization, and Management in Intensive Care, consists of 106 items distributed in 9 dimensions and 22 scales: culture (n = 3), coordination and adaptation to uncertainty (n = 3), communication (n = 3), problem solving and conflict management (n = 2), organizational learning and organizational change (n = 2), skills developed in a patient-caregiver relationship (n = 1), subjective unit performance (n = 3), burnout (n = 3), and job satisfaction and intention to quit (n = 2). All the scales showed good-to-high reliability, with Cronbach alpha scores higher than .7 (with the exception of coordination [.6]). Team satisfaction-oriented culture is positively correlated with good managerial practices and individual well-being. The Culture, Organization, and Management in Intensive Care questionnaire enables staff and managers to assess the organizational performance of their intensive care unit.

  1. Bench-to-bedside review: Leadership and conflict management in the intensive care unit

    Science.gov (United States)

    Strack van Schijndel, Rob JM; 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. PMID:18086322

  2. Evaluation of waterfowl conservation under the North American Waterfowl Management Plan

    Science.gov (United States)

    Williams, B.K.; Koneff, M.D.; Stith, David A.

    1999-01-01

    In 1986, the North American Waterfowl Management Plan (Plan) was signed by the U.S. Secretary of the Interior and the Canadian Minister of the Environment, with a goal of restoring waterfowl populations to levels of the 1970s via habitat conservation. Central to the Plan is a set of ambitious continental population goals and habitat objectives to be met through broad-based public-private partnerships. Inadequate attention has been paid to evaluation of the Plan, despite the fact that Plan delivery can be enhanced via improved understanding of the effects of habitat conservation on waterfowl population dynamics. Several factors confound the effort to evaluate the Plan at regional and continental levels, including difficulties in accounting for national land-use policies. To date, evaluation has proceeded along 2 avenues of investigation: (1) the study of conservation actions at local-regional levels, and (2) statistical assessment of Plan assumptions. Among other things, results thus far indicate duck production from the U.S. Northern Great Plains has increased in recent years, and intensive treatments such as planted cover have had positive effects on local reproductive success. Many duck species currently exceed Plan population goals; however, population levels of some species, most notably northern pintail (Anas acuta), remain below expectations based on historic relationships with precipitation. Management implications include the need for ongoing and more carefully prioritized conservation efforts, broader partnerships, and improved understanding of the linkages between habitats and biological processes. Delivery of the Plan must involve collaboration among the Continental Evaluation Team, joint Venture partners, the Adaptive Management and Assessment Team of the U.S. Fish and Wildlife Service, and other conservation groups. Although the challenges and projected costs of Plan conservation efforts are considerable, the long-term potential benefits to waterfowl

  3. Variation in pupil diameter in North American Gartersnakes (Thamnophis) is regulated by immersion in water, not by light intensity.

    Science.gov (United States)

    Fontenot, Clifford L

    2008-07-01

    A variable pupil generally regulates the amount of incoming light available for image formation on the retina. However, some of the semi-aquatic snakes (North American Gartersnakes, Thamnophis) that forage in relatively low light conditions reduce the pupil aperture in response to submergence underwater at the expense incoming light. Given that these snakes have all-cone retinas, reduction of incoming light because of pupillary constriction upon immersion seems counterintuitive. To test the effect of light and water on pupil aperture, three species of North American Gartersnakes (T. atratus, T. hammondii, and T. sirtalis) were exposed to nine light intensities in air and water. There was no effect of light on relative pupil aperture for any species. However, all three species showed a significant reduction in pupil aperture upon submergence underwater. The lack of a light response is surprising, and may be related to the method of accommodation in snakes. Snakes lack a ciliary muscle, and move the lens by constricting the pupil, which increases pressure in the posterior chamber and pushes the lens forward. Upon submergence, the snakes may be attempting to overcome the change in refractive index and defocus imposed by the water, by constricting the pupil. Thus, having the iris muscle involved in accommodation may preclude it from much of a light regulating function.

  4. 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.

  5. 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.

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

    Science.gov (United States)

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

    2017-12-01

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

  7. How does vineyard management intensity affect inter-row plant diversity and associated root parameters

    Science.gov (United States)

    Winter, Silvia; Labuda, Thomas; Probus, Sandra; Penke, Nicole; Himmelbauer, Margarita; Loiskandl, Willibald; Strauss, Peter; Bauer, Thomas; Popescu, Daniela; Comsa, Maria; Bunea, Claudiu-Ioan; Zaller, Johann G.; Kriechbaum, Monika

    2017-04-01

    Vineyard management has changed dramatically in the last 50 years. In many wine-growing regions, vineyard inter-rows are kept clean of vegetation by frequent tillage or use of herbicides to establish bare soil systems. In the last thirty years, policy-makers and several winegrowers have realized that temporary or permanent vegetation cover between the vine rows may increase ecosystem services like soil erosion mitigation, soil fertility and biodiversity conservation. The inter-row area of a vineyard can host a diverse flora providing habitat and food resources for pollinating insects and natural enemies of pests. The goal of this study was to analyze the influence of different soil management intensities on plant diversity and root parameters in the vineyard inter-rows. We investigated 15 vineyards in Romania and 14 in Austria to study the effects of three different management intensities on plant diversity, above and below-ground plant biomass, total root length and surface area of roots. Management intensity ranged from bare soil inter-rows to alternative soil tillage every second year to permanent vegetation cover for more than five years. In each vineyard inter-row, six soil samples (7 cm diameter and 10 cm height) of the upper soil layer were extracted for root analyses. Root were separated from the soil, stained and finally scanned and analyzed with the WinRHIZO software. Finally, roots were dried at 70°C to obtain dry matter of the root samples. Vegetation cover and vascular plant diversity was recorded in four 1 m2 plots within each vineyard inter-row two times a year. The most intensive bare soil management regime in Romania significantly reduced root biomass, total root length and surface area in comparison to the alternative and permanent vegetation cover management. Plant biodiversity was also reduced by intensive management, but differences were not significant. While alternative tillage every second year showed the highest values of plant species

  8. Management of Western North American Bark Beetles with Semiochemicals.

    Science.gov (United States)

    Seybold, Steven J; Bentz, Barbara J; Fettig, Christopher J; Lundquist, John E; Progar, Robert A; Gillette, Nancy E

    2018-01-07

    We summarize the status of semiochemical-based management of the major bark beetle species in western North America. The conifer forests of this region have a long history of profound impacts by phloem-feeding bark beetles, and species such as the mountain pine beetle (Dendroctonus ponderosae) and the spruce beetle (D. rufipennis) have recently undergone epic outbreaks linked to changing climate. At the same time, great strides are being made in the application of semiochemicals to the integrated pest management of bark beetles. In this review, we synthesize and interpret these recent advances in applied chemical ecology of bark beetles for scientists and land managers.

  9. 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…

  10. 50 CFR 665.817 - American Samoa pelagic fishery area management.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false American Samoa pelagic fishery area management. 665.817 Section 665.817 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN...

  11. 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.

  12. 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.

  13. Effects of management practices on grassland birds: American Bittern

    Science.gov (United States)

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

    1999-01-01

    Information on the habitat requirements and effects of habitat management on grassland birds were summarized from information in more than 5,500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. A special section on prey habitat is included for those predatory species that have more specific prey requirements. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The Brown-headed Cowbird (Molothrus ater) is an obligate brood parasite of many grassland birds. The section on cowbird brood parasitism summarizes rates

  14. Effects of management practices on wetland birds: American Avocet

    Science.gov (United States)

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

    2002-01-01

    Information on the habitat requirements and effects of habitat management on wetland birds were summarized from information in more than 500 published and unpublished papers. A range map is provided to indicate the relative densities of the species in North America, based on Breeding Bird Survey (BBS) data. Although the BBS may not capture the presence of elusive waterbird species, the BBS is a standardized survey and the range maps, in many cases, represent the most consistent information available on species’ distributions. Although birds frequently are observed outside the breeding range indicated, the maps are intended to show areas where managers might concentrate their attention. It may be ineffectual to manage habitat at a site for a species that rarely occurs in an area. The species account begins with a brief capsule statement, which provides the fundamental components or keys to management for the species. A section on breeding range outlines the current breeding distribution of the species in North America, including areas that could not be mapped using BBS data. The suitable habitat section describes the breeding habitat and occasionally microhabitat characteristics of the species, especially those habitats that occur in the Great Plains. Details on habitat and microhabitat requirements often provide clues to how a species will respond to a particular management practice. A table near the end of the account complements the section on suitable habitat, and lists the specific habitat characteristics for the species by individual studies. The area requirements section provides details on territory and home range sizes, minimum area requirements, and the effects of patch size, edges, and other landscape and habitat features on abundance and productivity. It may be futile to manage a small block of suitable habitat for a species that has minimum area requirements that are larger than the area being managed. The section on brood parasitism summarizes

  15. Environmental management and labour productivity: The moderating role of capital intensity.

    Science.gov (United States)

    Lannelongue, Gustavo; Gonzalez-Benito, Javier; Quiroz, Idaisa

    2017-04-01

    Recent years have seen firms improve their environmental practices, although the question still remains as to whether or not investing in such practices is or is not beneficial or simply a matter of image. This study focuses on labour productivity as a measure of performance, and we argue that the impact of greater environmental performance on that productivity is moderated by capital intensity. A sample of 2823 plants provides empirical evidence to support our approach. Specifically, the analyses, making use of estimates based on multiple regression models, reveal that environmental management has a positive impact on labour productivity in organisations with low capital intensity, although that impact becomes negative in cases of high capital intensity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. [Effects of intensive management on abundance and composition of soil N2-fixing bacteria in Phyllostachys heterocycla stands].

    Science.gov (United States)

    He, Dong-hua; Chen, Jun-hui; Xu, Qiu-fang; Shen, Qiu-lan; Li, Yong-chun; Mao, Xin-wei; Cheng, Min

    2015-10-01

    Denaturing gradient-gel electrophoresis and real-time quantitative PCR (qPCR) were employed to determine the effects of intensive management on soil N2-fixing bacteria in a moso bamboo (Phyllostachys heterocycla) plantation. Soil samples were collected from the moso bamboo stands receiving 0 (CK), 10, 15, 20, and 25 years of intensive management. It was found that intensive management caused a strong decrease in soil pH but a general increase in soil available nutrients. The structure of the N2-fixing bacterial communities in the soils having received 10 and 25 years of intensive management were quite similar to that from the CK; however, those from 15 and 20 years of intensification differed from the CK. With increasing time of intensive management, the abundance and diversity of the nifH gene at first decreased and then increased, with the minimum values being observed after 15 years of intensive management, indicating the eventual resiliency of N2-fixing bacteria to disturbance induced by intensive management. Redundancy analysis indicated that soil available potassium, available nitrogen, nitrite nitrogen, and ammonium nitrogen were more closely related to the changes of N2-fixing bacterial community structure compared with the other soil indices measured. In conclusion, the soil N2-fixing bacterial community was negatively affected by intensive management in the short term, but could recover in the long term.

  17. Implementing ACCM critical care guidelines for septic shock management in a Cuban pediatric intensive care unit.

    Science.gov (United States)

    Cartaya, José M; Rovira, Luis E; Segredo, Yamilet; Alvarez, Idalys; Acevedo, Yoandra; Moya, Ariel

    2014-01-01

    INTRODUCTION Sepsis is the most common direct cause of death worldwide and septic shock the syndrome's most serious complication. In 2002, the pediatric intensive care unit of the José Luis Miranda Pediatric University Hospital in Santa Clara (Villa Clara Province), Cuba, began implementing the recently published guidelines of the American College of Critical Care Medicine (ACCM) for management of pediatric and neonatal septic shock, observing a drop in case fatality from 34.6% to 19% between the years 2003 and 2007. ACCM updated these Guidelines in 2007. OBJECTIVE Describe experiences with the use of the 2007 ACCM updated Guidelines and discuss their possible impact in reducing case fatality. METHODS Between 2008 and 2010, a study was conducted of 280 children and adolescents, from newborns through 18 years, admitted to the pediatric intensive care unit with a diagnosis of septic shock. The diagnostic and therapeutic criteria used were those recommended in the ACCM's 2007 updated Guidelines. The dependent variable was case fatality. Independent variables were age, sex, comorbidity or prior chronic disease, origin and course of sepsis, hemodynamic state, blood glucose level, hyperglycemia, organ dysfunction, volume of fluid therapy administered, use of mechanical ventilation and therapeutic response. RESULTS In the 3-year period, 28-day case fatality was 11.1% (31/280). A total of 45 patients had comorbidities, with 14 deaths and a case fatality rate of 31.1% vs. 7.2% (17/235) in previously healthy patients. Cold shock with a hemodynamic state of low cardiac output and high systemic vascular resistance predominated (68.9%), with low cardiac output and low systemic vascular resistance the least common type (12.5%), but the one with highest case fatality (34.4%). Hyperglycemia was present in 39.6% of patients, with 15.3% case fatality; case fatality was higher (25.6%) when hyperglycemia was in the 10-15.9 mmol/L range. Fluid therapy of 40-100 mL/kg was administered

  18. 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......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......) and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients), respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarises considerations regarding clinical...

  19. [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.

  20. 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.

  1. 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...

  2. Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

    OpenAIRE

    Kweon, MeeRa; Ju, Dal Lae; Park, Misun; Choe, JiHyeong; Suh, Yun-Suhk; Seol, Eun-Mi; Lee, Hyuk-Joon

    2017-01-01

    Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due ...

  3. 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

  4. Lesions requiring wound management in a central tertiary neonatal intensive care unit.

    Science.gov (United States)

    Meszes, Angéla; Tálosi, Gyula; Máder, Krisztina; Orvos, Hajnalka; Kemény, Lajos; Csoma, Zsanett Renáta

    2017-04-01

    Most of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology. Data were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected. Among the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions. International guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.

  5. 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…

  6. 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.

  7. Chinese American Parents’ Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting

    OpenAIRE

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

    2014-01-01

    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 ...

  8. Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

    Science.gov (United States)

    Fisher, Lawrence; Chesla, Catherine A; Chun, Kevin M; Skaff, Marilyn M; Mullan, Joseph T; Kanter, Richard A; Gardiner, Phillip S

    2004-06-01

    Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

  9. Grand challenges in the management and conservation of North American inland fishes and fisheries

    Science.gov (United States)

    Lynch, Abigail; Cooke, Steven J.; Beard, Douglas; Kao, Yu-Chun; Lorenzen, Kai; Song, Andrew M.; Allen, Micheal S.; Basher, Zeenatul; Bunnell, David B.; Camp, Edward V.; Cowx, Ian G.; Freedman, Jonathan A.; Nguyen, Vivian M.; Nohner, Joel K.; Rogers, Mark W.; Siders, Zachary A.; Taylor, William W.; Youn, So-Jung

    2017-01-01

    Even with long-standing management and extensive science support, North American inland fish and fisheries still face many conservation and management challenges. We used a grand challenges approach to identify critical roadblocks that if removed would help solve important problems in the management and long-term conservation of North American inland fish and fisheries. We identified seven grand challenges within three themes (valuation, governance, and externalities) and 34 research needs and management actions. The major themes identified are to (1) raise awareness of diverse values associated with inland fish and fisheries, (2) govern inland fish and fisheries to satisfy multiple use and conservation objectives, and (3) ensure productive inland fisheries given nonfishing sector externalities. Addressing these grand challenges will help the broader community understand the diverse values of inland fish and fisheries, promote open forums for engagement of diverse stakeholders in fisheries management, and better integrate the inland fish sector into the greater water and land use policy process.

  10. 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.

  11. 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.

  12. 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.

  13. Introducing Intensively Managed Spruce Plantations in Swedish Forest Landscapes will Impair Biodiversity Decline

    Directory of Open Access Journals (Sweden)

    Lena Gustafsson

    2011-08-01

    Full Text Available Due to pressure to raise forest productivity in Sweden, there are proposals to apply more intensive forestry methods, but they could have potentially large effects on biodiversity. Here we report a compilation and evaluation of the extent and significance of such effects. We evaluated potential effects on biodiversity by introducing intensively fertilized Norway spruce plantations as a management option in Swedish forests with low conservation values on insects, vascular plants, lichens, bryophytes, and red-listed species. Due to a lack of specific studies addressing this question, we based the evaluation on a combination of available and appropriate empiric and anecdotic knowledge; literature data, and expert judgments largely available in species data bases. Our evaluations suggest that such forests will only harbor species that are common and widespread in conventionally managed stands and that species of conservation interest will be lacking, due to the low heterogeneity and light intensity of even-aged monocultures with dense canopies, short rotation times and low availability of coarse woody debris. Effects at the landscape scale are more difficult to evaluate, but will be dependent on the area utilized and the conservation value of sites used. We conclude that negative effects on biodiversity can be reduced if: (1 only land with the lowest conservational value is utilized; (2 plantations are spatially arranged to minimize fragmentation of the landscape; (3 the quality and quantity of key structural elements (e.g., coarse woody debris, old living trees and snags are maintained at the landscape level; and (4 management intensity is relaxed on other land. For effective implementation of these measures, legislative frameworks and policy instruments need to be adjusted and new models for planning and monitoring need to be developed.

  14. The performance of intensive care units: does good management make a difference?

    Science.gov (United States)

    Shortell, S M; Zimmerman, J E; Rousseau, D M; Gillies, R R; Wagner, D P; Draper, E A; Knaus, W A; Duffy, J

    1994-05-01

    A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. Based on data collected from 17,440 patients across 42 ICUs, the present study examines the factors associated with risk-adjusted mortality, risk-adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs. Using the Apache III methodology for risk-adjustment, findings reveal that: 1) technological availability is significantly associated with lower risk-adjusted mortality (beta = -.42); 2) diagnostic diversity is significantly associated with greater risk-adjusted mortality (beta = .46); and 3) caregiver interaction comprising the culture, leadership, coordination, communication, and conflict management abilities of the unit is significantly associated with lower risk-adjusted length of stay (beta = .34), lower nurse turnover (beta = -.36), higher evaluated technical quality of care (beta = .81), and greater evaluated ability to meet family member needs (beta = .74). Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.

  15. Pharmacological approaches to the management of pain in the neonatal intensive care unit.

    Science.gov (United States)

    Anand, K J S

    2007-05-01

    Effective and consistent management of neonatal pain remains a controversial issue. Premature infants are repeatedly subjected to painful tests and procedures or suffer painful conditions when they are most vulnerable. With different mechanisms transducing various types of pain the practice of 'one-drug fits all' becomes questionable. Clinicians must use the latest non-pharmacologic and pharmacologic therapies for effective management of neonatal pain, distress, or agitation. Pharmacologic strategies for dealing with neonatal pain in the neonatal intensive care unit are described. Opioid therapy, once considered the mainstay for neonatal analgesia, may not be as effective as previously thought. Morphine infusions do not alter the neurological outcomes of preterm neonates and may not be effective against acute pain. Alternative approaches with methadone, ketamine, or local anesthetics should be considered. Clinicians must understand the contextual circumstances underlying pain in individual neonates and tailor therapy accordingly, using the most current evidence related to neonatal pain assessment and management.

  16. 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...

  17. Emergency management of children with acute severe asthma requiring transfer to intensive care.

    Science.gov (United States)

    Dehò, Anna; Lutman, Daniel; Montgomery, Mary; Petros, Andy; Ramnarayan, Padmanabhan

    2010-11-01

    Children presenting to emergency departments (ED) with acute severe asthma unresponsive to initial medical therapy may require endotracheal intubation and mechanical ventilation. There is little data on complications during the acute management of children with life-threatening asthma, particularly at hospitals where specialist paediatric staff are lacking. It was hypothesised that a better understanding of complications, particularly associated with intubation and mechanical ventilation, would improve acute management in ED, aid quality improvement initiatives at district general hospitals (DGH) and form the basis for educational interventions from regional paediatric critical care units. A retrospective case note review was performed for all children referred to a regional intensive care retrieval service with status asthmaticus over a 2-year period. Initial treatment, patient-related factors, indication for endotracheal intubation and the type and occurrence of adverse events during acute management at the DGH were studied. Bivariate and multivariate analyses were undertaken to identify factors associated with the occurrence of complications. 51 (85%) of the 60 children transferred to a paediatric intensive care unit for acute severe asthma required intubation. 36 (70.5%) experienced one or more complications during intubation and in the early phase of mechanical ventilation. The most common complications were hypotension (requiring fluid resuscitation and/or inotropic support) and severe bronchospasm with acute hypercarbia. The indication for intubation significantly affected the chances of a complication occurring during stabilisation. There is considerable morbidity in asthmatic children who are referred to paediatric intensive care. The majority of complications may be anticipated and prevented resulting in improved management at DGH.

  18. 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.

  19. 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

  20. Pain intensity influences the relationship between anger management style and depression.

    Science.gov (United States)

    Estlander, Ann-Mari; Knaster, Peter; Karlsson, Hasse; Kaprio, Jaakko; Kalso, Eija

    2008-11-30

    There is an abundance of studies concerning depression and pain, while the mechanisms and the relationships of anger expression and pain are less well known. The validity of commonly used depression questionnaires as measures of depression in pain patients has been questioned, as they include items which can be related to the pain problem as well as to signs of depression. The aim of this study was to investigate the relationships between pain severity, various signs of depression, and anger management style. Subjects were 100 consecutive patients referred to the Helsinki University Pain Clinic. Demographic data and pain intensity (VAS) were collected by a questionnaire. Two subscales (negative view and physical function) from the Beck Depression Inventory, and the Anger Expression Scales (Anger-in and Anger-out) from the Spielberg State Trait Anger Expression Inventory 2 were used to assess depression and anger expression, respectively. The results showed that pain severity modulates the relationship between anger expression and physical signs of depression. In patients with more severe pain, the relationships between anger management style, specifically, inhibition of anger and depression were strong, while no such relationships were found in the group of patients with less severe pain. No correlations were found between pain intensity and depression as measured by the sum score of the BDI. However, analysing separately the two subscales of the BDI, negative view and physical function, significant positive relationships between pain intensity and both subscales appeared.

  1. 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.

  2. How does vineyard management intensity affect ecosystem services and disservices - insights from a meta-analysis

    Science.gov (United States)

    Winter, Silvia; Zaller, Johann G.; Kratschmer, Sophie; Pachinger, Bärbel; Strauss, Peter; Bauer, Thomas; Paredes, Daniel; Gómez, José A.; Guzmán, Gema; Landa, Blanca; Nicolai, Annegret; Burel, Francoise; Cluzeau, Daniel; Popescu, Daniela; Bunea, Claudiu-Ioan; Potthoff, Martin; Guernion, Muriel; Batáry, Péter

    2016-04-01

    Viticultural agro-ecosystems provide a range of different ecosystem services which are affected by management decisions of winegrowers. At the global scale, vineyards are often high intensity agricultural systems with bare soil or inter-row vegetation consisting of only a few plant species. These systems primarily aim at optimizing wine production by reducing competition for water and nutrients between grapevines and weeds and by preventing the outbreak of pests and diseases. At the same time, this kind of management is often associated with ecosystem disservices such as high rates of soil erosion, degradation of soil structure and fertility, contamination of groundwater and decline of biodiversity. Recently, several initiatives across the world tried to overcome detrimental effects of that management style by creating biodiversity friendly vineyards. The consequences of establishing divers cover crop mixes or tolerating spontaneous vegetation in vineyards for ecosystem services (including yield) overstretching local case studies has not been investigated yet. This meta-analysis will provide an overview of all published studies comparing the effects of different vineyard management practices on a range of different ecosystem services like biodiversity, pest control, pollination, soil conservation and carbon sequestration. The aggregated effect size will point out which management measures can provide the best overall net sum of ecosystem services. This meta-analysis is part of the transdisciplinary BiodivERsA project VineDivers and will ultimately lead into management and policy recommendations for various stakeholder groups engaged in viticulture.

  3. International institutions for energy management: an American perspective

    Energy Technology Data Exchange (ETDEWEB)

    Kohl, W.L.

    1983-01-01

    International institutions need to continue preparing for sudden changes in oil prices and supply and to encourage long-term goals of energy conservation and the substitution of non-oil fuels. Because all governments interact with energy markets, international institutions can provide a framework for intergovernmental cooperation. The authors examine opportunities for such cooperation in oil crisis management, energy policy coordination, research and development cooperation and sharing, nuclear power and non-proliferation safeguards, and North-South stability. The effectiveness of international institutions is dependent upon politcial support from the separate nations. Following an introductory chapter on the nature of the energy problem and the role of institutions, later chapters examine their structures and meetings and evaluate their prospects for strengthening Western energy cooperation. 107 references, 2 figures, 5 tables.

  4. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions.

  5. 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.

  6. Severe pneumonia in intensive care: cause, diagnosis, treatment and management: a review of the literature.

    Science.gov (United States)

    De Pascale, Gennaro; Bello, Giuseppe; Tumbarello, Mario; Antonelli, Massimo

    2012-05-01

    Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure. Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections. New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia. Antimicrobials remain the mainstay of causative severe pneumonia treatment and the optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties. Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia; however, their extensive clinical application is limited by the need for well trained physicians and adequate hospital centers. Despite advancements in antibiotic and life-supportive treatments, severe pneumonia remains a leading cause of intensive care unit (ICU) admission and death. Prompt and appropriate antimicrobial therapy is essential. The use of new nonconventional strategies for ARF management might be effective in more severe patients.

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

    OpenAIRE

    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 dia...

  8. 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

  9. 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

  10. Factors that influence patient advocacy by pain management nurses: results of the American society for pain management nursing survey.

    Science.gov (United States)

    Ware, Laurie Jowers; Bruckenthal, Patricia; Davis, Gail C; O'Conner-Von, Susan K

    2011-03-01

    What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses. Copyright © 2011 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Simons, Theodore R.

    2017-01-01

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

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

    Science.gov (United States)

    Ellis, Margaret Kathleen Menzel; Sally, Mitchell Brett; Malinoski, Darren

    2016-01-01

    Introduction: Despite continuous advances in transplant medicine, there is a persistent worldwide shortage of organs available for donation. There is a growing body of research that supports that optimal management of deceased organ donors in Intensive Care Unit can substantially increase the availability of organs for transplant and improve outcomes in transplant recipients. Methods: A systematic literature review was performed, comprising a comprehensive search of the PubMed database for relevant terms, as well as individual assessment of references included in large original investigations, and comprehensive society guidelines. Results: In addition to overall adherence to catastrophic brain injury guidelines, optimization of physiologic state in accordance with established donor management goals (DMGs), and establishment of system-wide processes for ensuring early referral to organ procurement organizations (OPOs), several specific critical care management strategies have been associated with improved rates and outcomes of renal transplantation from deceased donors. These include vasoactive medication selection, maintenance of euvolemia, avoidance of hydroxyethyl starch, glycemic control, targeted temperature management, and blood transfusions if indicated. 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. PMID:27555674

  13. 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…

  14. Adherence to a multi-component weight management program for Mexican American adolescents

    Science.gov (United States)

    This study examined weight loss among Mexican American students in a weight management program. A total of 358 participants completed a 12-week intervention that incorporated four program components: nutrition education (NE), physical activity (PA), sedentary behavior (SB), and a snacking interventi...

  15. 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…

  16. 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.

  17. It Takes a Community To Create an American Indian Business and Management Course.

    Science.gov (United States)

    Muller, Helen Juliette

    2000-01-01

    Within the context of tribal economic development, a business management course was developed by faculty and American Indian students. The course integrates culture and business through case studies of organizations that developed their own culturally relevant business practices. Community involvement is an essential element. (SK)

  18. 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...

  19. Climate Change and Interacting Stressors: Implications for Coral Reef Management in American Samoa (Final Report)

    Science.gov (United States)

    EPA announced the release of the final document, Climate Change and Interacting Stressors: Implications for Coral Reef Management in American Samoa. This report provides a synthesis of information on the interactive effects of climate change and other stressors on the reef...

  20. The problem of information management in knowledge-intensive industry in Russia

    Directory of Open Access Journals (Sweden)

    Loginova Aleksandra Viktorovna

    2015-10-01

    Full Text Available The article deals with the problem of knowledge-intensive industries as a vital factor in enhancing their competitiveness and efficiency of the intellectual activity of scientific organizations in Russia. The aim of the work is to analyze the forms and methods of improving the effectiveness of information systems, storing the scientific and technical information. The problems, that will be solved in the research, are: analysis and evaluation of the cost-effectiveness of investing in mathematical and information support of research; evaluating the risk in information systems development and management; the development of a system concept for improving the effectiveness of information support of the scientific activity.

  1. 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...... and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance...

  2. 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.

  3. 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

  4. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Derdeyn, Colin P; Zipfel, Gregory J; Albuquerque, Felipe C; Cooke, Daniel L; Feldmann, Edward; Sheehan, Jason P; Torner, James C

    2017-08-01

    The aim of this statement is to review the current data and to make suggestions for the diagnosis and management of both ruptured and unruptured brain arteriovenous malformations. The writing group met in person and by teleconference to establish search terms and to discuss narrative text and suggestions. Authors performed their own literature searches of PubMed, Medline, or Embase, specific to their allocated section, through the end of January 2015. Prerelease review of the draft statement was performed by expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. The focus of the scientific statement was subdivided into epidemiology; diagnosis; natural history; treatment, including the roles of surgery, stereotactic radiosurgery, and embolization; and management of ruptured and unruptured brain arteriovenous malformations. Areas requiring more evidence were identified. Brain arteriovenous malformations are a relatively uncommon but important cause of hemorrhagic stroke, especially in young adults. This statement describes the current knowledge of the natural history and treatment of patients with ruptured and unruptured brain arteriovenous malformations, suggestions for management, and implications for future research. © 2017 American Heart Association, Inc.

  5. 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

    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......, 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...... 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...

  6. 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.

  7. 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.

  8. [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.

  9. Effect of fire season, fire frequency, rainfall and management on fire intensity in savanna vegetation in South Africa

    CSIR Research Space (South Africa)

    Govender, N

    2006-08-01

    Full Text Available and fire intensity in conjunction with the park's fire records to reconstruct broad fire intensity regimes. Changes in management from regular prescribed burning to 'natural' fires over the past four decades have resulted in a decrease in moderate...

  10. Outpatient management following intensive induction or salvage chemotherapy for acute myeloid leukemia.

    Science.gov (United States)

    Walter, Roland B; Taylor, Lenise R; Gardner, Kelda M; Dorcy, Kathleen Shannon; Vaughn, Jennifer E; Estey, Elihu H

    2013-01-01

    Adults with newly diagnosed or relapsed acute myeloid leukemia (AML) commonly receive intensive chemotherapy to achieve disease remission. In the United States and many other countries, it is standard practice that these patients remain hospitalized "preemptively" until blood count recovery, owing to the risk for overwhelming infections and bleeding during pancytopenia. This care policy requires hospitalization for an average of 3 to 4 weeks after completion of chemotherapy. However, highly effective oral prophylactic antimicrobials are now available, and transfusion support of outpatients has become routine in recent years. As a result, the care of patients with hematologic malignancies treated with intensive modalities is increasingly shifting from inpatient to outpatient settings. Benefits of this shift could include the reduced need for medical resources (eg, transfusions or intravenous antimicrobial therapy), improved quality of life (QOL), decreased rates of nosocomial infections, and lower costs. Increasing evidence indicates that select AML patients undergoing intensive remission induction or salvage chemotherapy can be discharged early after completion of chemotherapy and followed closely in a well-equipped outpatient facility in a safe and costeffective manner. Further demonstration that the current approach of preemptive hospitalization is medically unjustified, economically more burdensome, and adversely affects health-related QOL would very likely change the management of these patients throughout this country and elsewhere, resulting in the establishment of a new standard practice that improves cancer care.

  11. The role of acculturation in diabetes self-management among Chinese Americans with type 2 diabetes.

    Science.gov (United States)

    Xu, Y; Pan, W; Liu, H

    2011-09-01

    We sought to examine the acculturation level and its relationship with diabetes self-management among Chinese Americans with type 2 diabetes. We conducted a cross-sectional survey research study in a convenience sample of 211 Chinese Americans with type 2 diabetes. We measured acculturation and diabetes self-management and evaluated the association between acculturation and self-management behaviors after controlling participants' characteristics using structural equation modeling. The majority of the participants was born outside the U.S. and had a low level of acculturation. Women and older individuals were less acculturated, and those who had higher social economic status and lived in the U.S. for a longer period were more acculturated. The results of the structural equation modeling demonstrated that acculturation was significantly associated with DM self-management, and more-acculturated individuals were more likely to perform DM self-management than less-acculturated ones after controlling demographic characteristics. The results of this study indicated that Chinese Americans diagnosed with diabetes may benefit from acculturation to mainstream society probably because increased acculturation was associated with increased help seeking behaviors and increased use of professional services. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Effect of 26 years of intensively managed Carya cathayensis stands on soil organic carbon and fertility.

    Science.gov (United States)

    Wu, Jiasen; Huang, Jianqin; Liu, Dan; Li, Jianwu; Zhang, Jinchi; Wang, Hailong

    2014-01-01

    Chinese hickory (Carya cathayensis), a popular nut food tree species, is mainly distributed in southeastern China. A field study was carried out to investigate the effect of long-term intensive management on fertility of soils under a C. cathayensis forest. Results showed that after 26 years' intensive management, the soil organic carbon (SOC) content of the A and B horizons reduced by 19% and 14%, respectively. The reduced components of SOC are mainly the alkyl C and O-alkyl C, whereas the aromatic C and carbonyl C remain unchanged. The reduction of active organic matter could result in degradation of soil fertility. The pH value of soil in the A horizon had dropped by 0.7 units on average. The concentrations of the major nutrients also showed a decreasing trend. On average the concentrations of total nitrogen (N), phosphorus (P), and potassium (K) of tested soils dropped by 21.8%, 7.6%, and 13.6%, respectively, in the A horizon. To sustain the soil fertility and C. cathayensis production, it is recommended that more organic fertilizers (manures) should be used together with chemical fertilizers. Lime should also be applied to reduce soil acidity.

  13. Raccoon (Procyon lotor) diurnal den use within an intensively managed forest in central West Virginia

    Science.gov (United States)

    Owen, Sheldon F.; Berl, Jacob L.; Edwards, John W.; Ford, W. Mark; Wood, Petra Bohall

    2015-01-01

    Intensive forest management may influence the availability of suitable den sites for large den-seeking species, such as Procyon lotor (Raccoon). As part of a Raccoon ecology study on an industrial forest in the Allegheny Mountains of central West Virginia, we radio-tracked 32 Raccoons to 175 diurnal den sites to determine relative use of dens that included cavity trees, rock dens, log piles, slash piles, and exposed limbs. Patterns of den use significantly differed between sexes and among seasons. Overall, we recorded 58 cavity dens in 12 tree species with 7 maternal dens found in 5 tree species. Raccoons selected larger-diameter den trees than available cavity trees and non-cavity trees. Because the abundance of suitable tree cavities is known to influence Raccoon densities and recruitment at fine spatial scales and female Raccoons in this study used tree cavities as maternal den sites, the continued harvest of large-diameter trees (i.e., those capable of developing den cavities) without replacement may impact Raccoon recruitment within intensively managed forests throughout the central Appalachians.

  14. On-farm habitat restoration counters biotic homogenization in intensively managed agriculture.

    Science.gov (United States)

    Ponisio, Lauren C; M'Gonigle, Leithen K; Kremen, Claire

    2016-02-01

    To slow the rate of global species loss, it is imperative to understand how to restore and maintain native biodiversity in agricultural landscapes. Currently, agriculture is associated with lower spatial heterogeneity and turnover in community composition (β-diversity). While some techniques are known to enhance α-diversity, it is unclear whether habitat restoration can re-establish β-diversity. Using a long-term pollinator dataset, comprising ∼9,800 specimens collected from the intensively managed agricultural landscape of the Central Valley of California, we show that on-farm habitat restoration in the form of native plant 'hedgerows', when replicated across a landscape, can boost β-diversity by approximately 14% relative to unrestored field margins, to levels similar to some natural communities. Hedgerows restore β-diversity by promoting the assembly of phenotypically diverse communities. Intensively managed agriculture imposes a strong ecological filter that negatively affects several important dimensions of community trait diversity, distribution, and uniqueness. However, by helping to restore phenotypically diverse pollinator communities, small-scale restorations such as hedgerows provide a valuable tool for conserving biodiversity and promoting ecosystem services. © 2015 John Wiley & Sons Ltd.

  15. Ethical imperatives in staffing and managing a trauma intensive care unit.

    Science.gov (United States)

    Terry, Shawn; Kaplan, Lewis J

    2007-02-01

    As U.S. trauma surgery evolves to embrace the concept and practice of acute care surgery, the organization and management structure of the intensive care unit must also grow to reflect new challenges and imperatives faced by trauma surgeons. Key issues to be explored in light of acute care surgery include the role of the traumatologist/intensivist in the intensive care unit, as opposed to the traumatologist without specific critical care training, and a potentially expanded role for nonsurgical intensivists as the critical care time available for trauma/intensivists wanes due to increased surgical and non-critical care patient volume. Each of these changes to the practice of trauma/surgical critical care and acute care surgery are evaluated in light of the primacy of appropriately trained intensivists in the critical care unit. The ethics of providing the best care possible is interrogated in light of different service models in both the university and community settings. The roles of residents, fellows, and midlevel practitioners in supporting the goal of the intensivist and the critical care team is similarly explored. A recommendation for an ethical organizational and management structure is presented.

  16. [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.

  17. 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...

  18. 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).

  19. Lumbar puncture for suspected meningitis after intensive care unit admission is likely to change management.

    Science.gov (United States)

    Khasawneh, Faisal A; Smalligan, Roger D; Mohamad, Tammam N; Moughrabieh, Mohamad K; Soubani, Ayman O

    2011-02-01

    The aim of this study was to determine the outcome of lumbar punctures (LPs) in critically ill medical patients and how likely the results were to change case management. A retrospective review was conducted on the medical records of all 168 patients who underwent LP during their medical intensive care unit (MICU) admission at a university hospital during a 4.5-year period beginning in January 2000. Lumbar puncture was performed a mean of 2.8 days after MICU admission. The most common symptoms that prompted LP were changes in mental status and fever. Seventy-four percent of patients were on antibiotics at the time of LP, and 98% of patients had a computed tomography scan of the head performed before the procedure. Lumbar puncture confirmed meningitis in 47 (30%) patients and provided a specific bacteriologic diagnosis in 5 (3%) patients. The results of the procedure led to a change in management in 50 (30%) patients. The presence of meningeal signs and use of antibiotics at the time of the procedure were the factors that predicted change in management. Although the likelihood that LP will yield a specific bacteriologic diagnosis in critically ill patients is low, the procedure frequently provides important information that can lead to a change in case management, most commonly de-escalation of antibiotic therapy.

  20. 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

  1. 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.

  2. 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

    2014-01-01

    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. PMID:25678944

  3. 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…

  4. Effectiveness of a telemonitoring intensive strategy in early rheumatoid arthritis: comparison with the conventional management approach.

    Science.gov (United States)

    Salaffi, Fausto; Carotti, Marina; Ciapetti, Alessandro; Di Carlo, Marco; Gasparini, Stefania; Farah, Sonia; Gutierrez, Marwin

    2016-04-02

    The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in reaching remission and comprehensive disease control (CDC) after 1 year in early rheumatoid arthritis (ERA) patients. Forty-four ERA patients were randomly allocated into two groups: the telemonitoring intensive strategy (TIS) group (group 1) or the conventional strategy (CS) group (group 2). Three patients refused to participate. In group 1 (n = 21), a remote monitoring system of disease activity, in combination with protocolised treatment adjustments aiming for remission was applied. In group 2 (n = 20), patients were treated according to daily clinical practice, with regular evaluation of disease activity, but without protocolised treatment adjustments. A telemedical care called "REmote TElemonitoring for MAnaging Rheumatologic Condition and HEaltcare programmes" (RETE-MARCHE), was developed to perform the remote monitoring. A higher percentage of patients in the TIS group achieved CDAI remission vs patients in the CS group (38.1 % vs 25 % at year 1, p <0.01). Time to achieve remission was significantly shorter in the group 1 than in the group 2, with a median of 20 weeks vs a median over 36-weeks (p <0.001). Concordantly, the patients in group 1 showed a greater improvement (p <0.001), compared with group 2 in terms of functional impairment (71.4 % vs 35 %) and radiological damage progression (23.8 % vs 10 %), resulting in a greater rate of CDC (19.4 % vs 5 %). According to our results, an intensive treatment strategy by telemonitoring leads to more effective disease

  5. Diabetes self-management among Arab Americans: patient and provider perspectives.

    Science.gov (United States)

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

    2016-08-31

    Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. Qualitative content analysis was used to analyze five focus groups-two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

  6. Sedation scoring and managing abilities of intensive care nurses post educational intervention.

    Science.gov (United States)

    Ramoo, Vimala; Abdullah, Khatijah Lim; Tan, Patrick Sk; Wong, Li Ping; Chua, Yan Piaw; Tang, Li Yoong

    2017-05-01

    Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients. This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes. A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention. A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention. Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities. Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands

  7. 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

  8. Diabetes self-management in African Americans: an exploration of the role of fatalism.

    Science.gov (United States)

    Egede, Leonard E; Bonadonna, Ramita J

    2003-01-01

    This study was conducted to explore the concept of fatalism in relation to diabetes self-management behavior in African Americans with type 2 diabetes. Participants (n = 39) were recruited from a clinic sample of African Americans with type 2 diabetes. Seven focus groups were conducted; the sessions were recorded, transcribed, and analyzed to identify themes related to fatalism and diabetes self-management. The ISAS paradigm (individual, symbols, audience, situation), a social psychology theory, provided the theoretical framework for the study. Four dimensions of fatalism were identified: the meaning of diabetes, the illness experience, the individual's coping response, and the individual's religious and spiritual beliefs. For the participants in this study, fatalism seemed to characterize the nature of the interaction between the individual with diabetes and others, the meanings they attached to such interactions, and the decision to adopt an effective or ineffective diabetes self-management behavior. Fatalism was associated with diabetes self-management in African Americans with diabetes and was multidimensional in this population; the construct appeared to differ conceptually from the perspective of current measures.

  9. 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

  10. Perceptions on pain management among Korean nurses in neonatal intensive care units.

    Science.gov (United States)

    Jeong, Ihn Sook; Park, Soon Mi; Lee, Jeon Ma; Choi, Yoon Jin; Lee, Joohyun

    2014-12-01

    The present survey was conducted to investigate the perceptions among nurses of neonatal pain and the associated use of pharmacologic measures (PMs) and nonpharmacologic comfort measures (CMs) in neonatal intensive care units (NICUs). Pain perception, the necessity and actual use of PMs and CMs, and their relationships were investigated and compared according to nurses' positions, educational levels, the existence of guidelines, and prior education on neonatal pain management. Participants were 141 nurses from five NICUs at university hospitals. A questionnaire was developed by researchers based on previous studies of neonatal pain management and current practices in surveyed NICUs. Five-point Likert scales were used to assess nurses' perceptions of pain, the necessity of PMs and CMs, and their actual use in 29 painful procedures. The mean scores of perceived pain and the necessity of PMs and CMs were 3.68, 2.96, and 3.79 points, respectively. The actual use of PMs and CMs was 1.67 and 2.63 points, respectively. The perceived necessity of PMs correlated with the actual use of PMs (r = .316, p pain management resulted in a higher perception of the necessity of PMs. Korean nurses in NICUs often underestimate the necessity of pain relief measures and use few PMs or CMs. Therefore, systematic approaches to implement guidelines, such as adaptation of guidelines for each NICU, dissemination of guideline content to all NICU staff, and regular measurements of compliance with the guidelines, are recommended. Copyright © 2014. Published by Elsevier B.V.

  11. A Randomized Controlled Trial to Evaluate Outcomes of a Workplace Self-Management Intervention and an Intensive Monitoring Intervention

    Science.gov (United States)

    Schopp, Laura H.; Clark, Mary J.; Lamberson, William R.; Uhr, David J.; Minor, Marian A.

    2017-01-01

    The purpose of this study was to determine and compare outcomes of two voluntary workplace health management methods: an adapted worksite self-management (WSM) approach and an intensive health monitoring (IM) approach. Research participants were randomly assigned to either the WSM group or the IM group by a computer-generated list (n = 180; 92 WSM…

  12. Acculturation and Self-Management Perceptions Among Mexican American Adults With Type 2 Diabetes.

    Science.gov (United States)

    Plasencia, Julie; Hoerr, Sharon; Carolan, Marsha; Weatherspoon, Lorraine

    Because type 2 diabetes (T2DM) is disproportionately high among Mexican Americans in the United States, this study examined how acculturation influences T2DM self-management, a critical component for disease outcome. Qualitative interviews of 24 low-income Mexican American patients with T2DM were matched to their biomedical and dietary data and degree of acculturation. Greater acculturation to the United States was associated with less favorable diabetes control, fiber density, leisure-time physical activity, and more physical disability. Health care professionals can improve their cultural competence by learning culturally appropriate foods and fostering a warm, caring manner with Mexican Americans to enhance their sense of well-being and compliance with T2DM recommendations.

  13. Adaptive harvest management of North American waterfowl populations - recent successes and future prospects

    Science.gov (United States)

    Nichols, J.D.; Runge, M.C.; Johnson, F.A.; Williams, B.K.; Schodde, Richard; Hannon, Susan; Scheiffarth, Gregor; Bairlein, Franz

    2006-01-01

    The history of North American waterfowl harvest management has been characterized by attempts to use population monitoring data to make informed harvest management decisions. Early attempts can be characterized as intuitive decision processes, and later efforts were guided increasingly by population models and associated predictions. In 1995, a formal adaptive management process was implemented, and annual decisions about duck harvest regulations in the United States are still based on this process. This formal decision process is designed to deal appropriately with the various forms of uncertainty that characterize management decisions, environmental uncertainty, structural uncertainty, partial controllability and partial observability. The key components of the process are (1) objectives, (2) potential management actions, (3) model(s) of population response to management actions, (4) credibility measures for these models, and (5) a monitoring program. The operation of this iterative process is described, and a brief history of a decade of its use is presented. Future challenges range from social and political issues such as appropriate objectives and management actions, to technical issues such as multispecies management, geographic allocation of harvest, and incorporation of actions that include habitat acquisition and management.

  14. 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.

  15. 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.

  16. Successful management of 70% acetic acid ingestion on the intensive care unit: A case report.

    Science.gov (United States)

    Ratcliffe, Andrew; Baker, Andrew; Smith, Daniel

    2018-02-01

    Acetic acid is an organic acid available in concentrations from 2 to 80%. Whilst lower concentrations of 2-6% are more commonly used as the table top condiment, vinegar, much stronger solutions are regularly used in Eastern Europe as food preservatives and cleaning solutions. Oral ingestion of greater than 12% has been reported to cause haemolysis, renal failure, shock and death. Most reported cases of deliberate or accidental poisoning are from Russia and Eastern Europe in the 1980s, with very little currently in western publications. We present the case of a female patient who attempted suicide by drinking 250 ml of 70% acetic acid. Her widespread gastrointestinal injuries were managed conservatively, and despite suffering extensive upper airway and renal complications, she was successfully decannulated and discharged home after a prolonged intensive care and hospital stay.

  17. Habitat restoration promotes pollinator persistence and colonization in intensively managed agriculture.

    Science.gov (United States)

    M'Gonigle, Leithen K; Ponisio, Lauren C; Cutler, Kerry; Kremen, Claire

    2015-09-01

    Widespread evidence of pollinator declines has led to policies supporting habitat restoration including in agricultural landscapes. Yet, little is yet known about the effectiveness of these restoration techniques for promoting stable populations and communities of pollinators, especially in intensively managed agricultural landscapes. Introducing floral resources, such as flowering hedgerows, to enhance intensively cultivated agricultural landscapes is known to increase the abundances of native insect pollinators in and around restored areas. Whether this is a result of local short-term concentration at flowers or indicative of true increases in the persistence and species richness of these communities remains unclear. It is also unknown whether this practice supports species of conservation concern (e.g., those with more specialized dietary requirements). Analyzing occupancies of native bees and syrphid flies from 330 surveys across 15 sites over eight years, we found that hedgerow restoration promotes rates of between-season persistence and colonization as compared with unrestored field edges. Enhanced persistence and colonization, in turn, led to the formation of more species-rich communities. We also find that hedgerows benefit floral resource specialists more than generalists, emphasizing the value of this restoration technique for conservation in agricultural landscapes.

  18. 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.

  19. Adaptation of global land use and management intensity to changes in climate and atmospheric carbon dioxide.

    Science.gov (United States)

    Alexander, Peter; Rabin, Sam; Anthoni, Peter; Henry, Roslyn; Pugh, Thomas A M; Rounsevell, Mark D A; Arneth, Almut

    2018-02-27

    Land use contributes to environmental change, but is also influenced by such changes. Climate and atmospheric carbon dioxide (CO 2 ) levels' changes alter agricultural crop productivity, plant water requirements and irrigation water availability. The global food system needs to respond and adapt to these changes, for example, by altering agricultural practices, including the crop types or intensity of management, or shifting cultivated areas within and between countries. As impacts and associated adaptation responses are spatially specific, understanding the land use adaptation to environmental changes requires crop productivity representations that capture spatial variations. The impact of variation in management practices, including fertiliser and irrigation rates, also needs to be considered. To date, models of global land use have selected agricultural expansion or intensification levels using relatively aggregate spatial representations, typically at a regional level, that are not able to characterise the details of these spatially differentiated responses. Here, we show results from a novel global modelling approach using more detailed biophysically derived yield responses to inputs with greater spatial specificity than previously possible. The approach couples a dynamic global vegetative model (LPJ-GUESS) with a new land use and food system model (PLUMv2), with results benchmarked against historical land use change from 1970. Land use outcomes to 2100 were explored, suggesting that increased intensity of climate forcing reduces the inputs required for food production, due to the fertilisation and enhanced water use efficiency effects of elevated atmospheric CO 2 concentrations, but requiring substantial shifts in the global and local patterns of production. The results suggest that adaptation in the global agriculture and food system has substantial capacity to diminish the negative impacts and gain greater benefits from positive outcomes of climate change

  20. National survey on airway and difficult airway management in intensive care units.

    Science.gov (United States)

    Gómez-Prieto, M G; Míguez-Crespo, M R; Jiménez-Del-Valle, J R; González-Caro, M D; Marmesat-Ríos, I; Garnacho-Montero, J

    2018-02-18

    To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). Descriptive cross-sectional study and χ 2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. ICUs of public, private centers, and consortia. In total, 101 units responded (56.4%), corresponding to 1,827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% don't use routinely AW assessment scales, being the most frequently used the Cormack-Mallampati association (35.6%). There's not intubation (IOT) protocol in 77.2%, nor DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; P=.03), DAW (64.4% vs. 44.6%; P=.04), and more AW protocols (73.4% vs. 37.5%; P=.000). Having an specific guideline for DAW management in UCI is considered necessary in 99%. There is room for improvement in AW management. It's necessary to identify an expert in DAW in each Unit, and the development of an specific guideline for DAW management in critical care. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  1. [Changes in soil organic carbon and soil microbial functional diversity of Carya cathayensis plantations under intensive managements].

    Science.gov (United States)

    Wu, Jia-Sen; Qian, Jin-Fang; Tong, Zhi-Peng; Huang, Jian-Qin; Zhao, Ke-Li

    2014-09-01

    The change characteristics of soil organic carbon and microbial function diversity in Chinese hickory Carya cathayensis stands with different intensive-management durations (5, 10, 15 and 20 years) were studied. The results showed that soil total organic carbon (TOC), microbial biomass carbon (MBC), water-soluble organic carbon (WSOC) decreased significantly, while the stability of soil C pool increased significantly after the conversion from evergreen and deciduous broadleaf forest to intensively-managed forest (IMF). TOC, MBC and WSOC in the hickory forest soil decreased by 28.4%, 34.1% and 53.3% with 5-year intensive management, and by 38.6%, 48.9% and 64.1% with 20-year intensive management, respectively. The proportions of carboxyl C, phenolic C and aromatic C in the hickory forest soil all increased significantly, and the aromaticity of soil organic C increased by 23.0%. Soil microbial functional diversity decreased greatly af- ter intensive management of Chinese hickory forest. Significant differences in average well color development (AWCD) were found between the 0- and 5-year treatments and the 10-, 15- and 20- year treatments. The microbial diversity indexes (H) and evenness indexes (E) in the 0- and 5-year treatments were much greater than in the 10- and 20-year treatments. Correlation analysis showed that there were significant correlations among soil TOC, WSOC, MBC, AWCD, H and E.

  2. 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.

  3. 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.

  4. Congenital tuberculosis and management of exposure in neonatal and pediatric intensive care units.

    Science.gov (United States)

    Grisaru-Soen, G; Savyon, M; Sadot, E; Schechner, V; Sivan, Y; Schwartz, D; Tarabeia, J; Amitai, Z; Yoabov, I; Carmeli, Y

    2014-09-01

    This report describes the management and outcome of neonatal intensive care unit (NICU) and paediatric ICU (PICU) exposure to a 26-day-old premature infant with congenital tuberculosis (TB). The infant's mother underwent chest X-ray (CXR) and sputum culture. Contacts of the infant were identified. Tuberculin skin tests (TSTs) were performed on 97 infants and children, 156 NICU and PICU visitors and 115 health care workers. The mother's sputum culture was positive for Mycobacterium tuberculosis. No TST conversion occurred in the exposed NICU infants. All neonates received prophylactic isoniazid (INH). One exposed child in the PICU had TST conversion with normal CXR and completed 9 months of INH without developing active disease; 22 (14%) PICU and NICU visitors and 3 NICU personnel had TST conversion without evidence of disease. The sequence of events described here demonstrates the difficulty in diagnosis and management of TB in this age group. Transmission of TB in NICU and PICUs is unusual but can occur, and calls for a systematic approach to investigation of the exposed infants, family members and health care providers.

  5. 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)

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

    Science.gov (United States)

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

    2015-12-01

    We compiled all credible repeated lion surveys and present time series data for 47 lion (Panthera leo) populations. We used a Bayesian state space model to estimate growth rate-λ for each population and summed these into three regional sets to provide conservation-relevant estimates of trends since 1990. We found a striking geographical pattern: African lion populations are declining everywhere, except in four southern countries (Botswana, Namibia, South Africa, and Zimbabwe). Population models indicate a 67% chance that lions in West and Central Africa decline by one-half, while estimating a 37% chance that lions in East Africa also decline by one-half over two decades. We recommend separate regional assessments of the lion in the World Conservation Union (IUCN) Red List of Threatened Species: already recognized as critically endangered in West Africa, our analysis supports listing as regionally endangered in Central and East Africa and least concern in southern Africa. Almost all lion populations that historically exceeded ∼ 500 individuals are declining, but lion conservation is successful in southern Africa, in part because of the proliferation of reintroduced lions in small, fenced, intensively managed, and funded reserves. If management budgets for wild lands cannot keep pace with mounting levels of threat, the species may rely increasingly on these southern African areas and may no longer be a flagship species of the once vast natural ecosystems across the rest of the continent.

  7. Emergency department management of early sepsis: a national survey of emergency medicine and intensive care consultants.

    Science.gov (United States)

    Jiwaji, Zoeb; Brady, Shirin; McIntyre, Lauralyn A; Gray, Alasdair; Walsh, Timothy S

    2014-12-01

    Early goal-directed therapy (EGDT) is recommended for sepsis management in current guidelines, but the underpinning evidence is controversial. Clinician beliefs and the capacity to implement all recommended elements of EGDT in emergency departments (EDs) are uncertain. Our study aimed to explore self-reported management of early sepsis by Scottish emergency medicine (EM) and intensive care medicine (ICM) consultants, delineate important differences and determine the guideline recommendations rated most important and deliverable within the ED. A postal survey using a hypothetical patient with septic shock was sent to all EM and ICM consultants practising in Scotland. 67% (76/114) EM and 61% (96/157) ICM consultants responded. Normal saline was preferred by EM respondents ('always/often used': EM 86%, ICM 23%, pmanagement of sepsis exist between Scottish ICM and EM consultants. Transfusion practice is highly variable, suggesting clinical uncertainty. Lactate is considered more important than ScVO2 measurement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. 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

  9. 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

  10. An intensely sympathetic awareness: experiential similarity and cultural norms as means for gaining older African Americans' trust of scientific research.

    Science.gov (United States)

    Sabir, Myra G; Pillemer, Karl A

    2014-04-01

    Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group's hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans' participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders' worth and dignity, improved older African Americans' willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n=62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population's well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. 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)

  12. 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/

  13. 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.

  14. [Maternal complications in preeclamptic patients with hyperuricemia managed in Intensive Care Unit].

    Science.gov (United States)

    Vázquez-Rodríguez, J G; Rico-Trejo, E I

    2016-03-01

    Hyperuricemia is a factor related to a higher frequency of complications in patients with preeclampsia. To determine maternal complications in preeclamptic patients with hyperuricemia managed in the intensive care unit of a high-specialty hospital. Cross-sectional study. Clinical files of 127 preeclamptic patients with criteria of severe disease were reviewed. Maternal complications were studied only in patients with hyperuricemia defined as a serum uric acid (UA) level > 4 mg/dL upon admission. Descriptive statistics were used. Frequency of patients with hyperuricemia was 88.1% (112 cases). Median value of UA was 6.6 ± 1.5 mg/dL (range 4.6-12.4), maternal age 28.1 ± 5.98 years, parity 2 and gestational age 32.9 ± 3.7 weeks. Cesarean section was performed in 98.21%. Frequency of maternal complications was 50% (56 cases): HELLP syndrome 40.1% (45 cases), acute renal injury 6.2% (7 cases), abruptio placentae 1 .7% (2 cases), hemorrhage due to uterine atony 0.8% (1 case) and acute pulmonary edema 0.8% (1 case). There were no cases of multiorgan failure syndrome and maternal mortality was 0%. None of the patients experienced worsening of their condition. There was an elevated frequency of patients with hyperuricemia and maternal complications. Reported complications were different from those reported in previous studies. All patients were successfully intervened with the administered medical treatment and may be a reflection of the beneficial effect of intensive care treatment.

  15. 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

  16. 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

  17. 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

  18. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma

    Science.gov (United States)

    Asa, Sylvia L.; Dralle, Henning; Elisei, Rossella; Evans, Douglas B.; Gagel, Robert F.; Lee, Nancy; Machens, Andreas; Moley, Jeffrey F.; Pacini, Furio; Raue, Friedhelm; Frank-Raue, Karin; Robinson, Bruce; Rosenthal, M. Sara; Santoro, Massimo; Schlumberger, Martin; Shah, Manisha; Waguespack, Steven G.

    2015-01-01

    Introduction: The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. Methods: The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. Results: The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. Conclusions: The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice. PMID:25810047

  19. [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

  20. Implementation of Crew Resource Management: A Qualitative Study in 3 Intensive Care Units

    Science.gov (United States)

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

    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 such threats. Existing literature shows promising but inconclusive results that might be explained by the quality of the implementation. The present research systematically describes the implementation from the perspective of 3 trained intensive care units (ICUs). Methods The design of the study was built around 3 stages of implementation: (1) the preparation, (2) the actions after the CRM training, and (3) the plans for the future. To assess all stages in 3 Dutch ICUs, 12 semistructured interviews with implementation leaders were conducted, the End-of-Course Critique questionnaire was administered, and objective measurements consisting of the number and types of plans of action were reported. Results The results categorize initiatives that all 3 ICUs successfully launched, including the development of checklists, each using a different implementation strategy. All ICUs have taken several steps to sustain their approach for the foreseeable future. Three similarities between the units were seen at the start of the implementation: (1) acknowledgment of a performance gap in communication, (2) structural time allocated for CRM, and (3) a clear vision on how to implement CRM. Conclusions This study shows that CRM requires preparation and implementation, both of which require time and dedication. It is promising to note that all 3 ICUs have developed multiple quality improvement initiatives and aim to continue doing so. PMID:25420205

  1. Implementation of Crew Resource Management: A Qualitative Study in 3 Intensive Care Units.

    Science.gov (United States)

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

    2017-12-01

    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 such threats. Existing literature shows promising but inconclusive results that might be explained by the quality of the implementation. The present research systematically describes the implementation from the perspective of 3 trained intensive care units (ICUs). The design of the study was built around 3 stages of implementation: (1) the preparation, (2) the actions after the CRM training, and (3) the plans for the future. To assess all stages in 3 Dutch ICUs, 12 semistructured interviews with implementation leaders were conducted, the End-of-Course Critique questionnaire was administered, and objective measurements consisting of the number and types of plans of action were reported. The results categorize initiatives that all 3 ICUs successfully launched, including the development of checklists, each using a different implementation strategy. All ICUs have taken several steps to sustain their approach for the foreseeable future. Three similarities between the units were seen at the start of the implementation: (1) acknowledgment of a performance gap in communication, (2) structural time allocated for CRM, and (3) a clear vision on how to implement CRM. This study shows that CRM requires preparation and implementation, both of which require time and dedication. It is promising to note that all 3 ICUs have developed multiple quality improvement initiatives and aim to continue doing so.

  2. 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).

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  5. Using a Theory-Driven Approach to Manage the Relocation of an Intensive Care Unit: An Exemplar.

    Science.gov (United States)

    Lin, Frances; Marshall, Andrea; Hervey, Lucy; Foster, Michelle; Hancock, Jane; Chaboyer, Wendy

    2017-11-08

    Proactive planning and managing moving from old to newly built hospitals, and the relocation process of patients for complex specialized units such as intensive care units, are necessary for both patient safety and staff well-being. This article provides an exemplar for how theory can be used to facilitate a positive relocation experience. Using change management theory, a systematic approach to cocreate implementation strategy among researchers and clinicians was critical to the success of this project.

  6. High feeding intensity increases the severity of fatty liver in the American mink (Neovison vison) with potential ameliorating role for long-chain n-3 polyunsaturated fatty acids.

    Science.gov (United States)

    Dick, Morag F; Hurford, Jennifer; Lei, Sha; Mustonen, Anne-Mari; Nieminen, Petteri; Rouvinen-Watt, Kirsti

    2014-01-16

    Rapid body fat mobilization, obesity, and an inadequate supply of n-3 polyunsaturated fatty acids (PUFA) have been suggested to play roles in the etiology of fatty liver in the American mink (Neovison vison). This study examined the effects of feeding intensity and dietary fat source on fatty liver induced by fasting. In a multi-factorial design, 3 different fat sources (herring oil, rich in n-3 PUFA, soya oil, rich in n-6 PUFA, and canola oil, rich in n-9 monounsaturated fatty acids) were fed to mink at a low and high feeding intensity for 10 weeks, followed by an overnight or a 5-day fasting treatment to induce fatty liver. Fasting led to the development of fatty liver with increased severity in the mink fed at the high feeding intensity. The herring oil diet, high in long-chain n-3 PUFA, was found to decrease the severity of fatty liver in the mink at the high feeding intensity. Preventing excessive weight gain and increasing dietary intake of n-3 long-chain PUFA may help prevent excessive lipid accumulation during prolonged periods of fasting or inappetence by promoting hepatic fatty acid oxidation.

  7. Pain management in the neonatal intensive care unit: a national survey in Italy.

    Science.gov (United States)

    Lago, Paola; Guadagni, Annamaria; Merazzi, Daniele; Ancora, Gina; Bellieni, Carlo Valerio; Cavazza, Alessandra

    2005-11-01

    This study assessed current medical practice in preventative analgesia and sedation for invasive procedures in neonatal intensive care units (NICU) in Italy. A questionnaire was sent to level II and III Italian NICUs to investigate pain management, pharmacological treatment and the use of pain scores during invasive procedures. Main outcome measures were the extent to which analgesia and sedation are currently used for invasive procedures in Italian neonatal units. The rate of response to the questionnaire was 88%. Written guidelines were available on acute pain control in 25% of the NICUs, and on prolonged pain control in 50%. Routine use of preventative pharmacological and nonpharmacological measures for painful procedures ranged from 13% for elective tracheal intubation to 68% for chest tube insertion. Thirty-six percent of NICUs routinely use sedation with opioids for mechanical ventilation; 14% prevent distress and pain for tracheal suctioning, 44% for heel lancing, 50% for venepuncture and percutaneous venous catheter insertion; 58% use analgesia before lumbar puncture. Validated pain assessment scores were used by 19% of NICUs. The need for adequate analgesia is still underestimated. Further information on the safety of analgesics in neonatology is imperative, as is an adequate education of physicians and nurses on the use of pain control guidelines as part of the standard of care in the NICU.

  8. 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.

  9. Increase in carbon emissions from forest fires after intensive reforestation and forest management programs.

    Science.gov (United States)

    Choi, Sung-Deuk; Chang, Yoon-Seok; Park, Byung-Kwon

    2006-12-15

    This paper shows an example of substantial increase in carbon emissions from forest fires after reforestation on a national scale. It is the first estimation of historical carbon emissions from forest fires in Korea during the last 40 years. Investigation was focused on the recent increase in large forest fires and its closely related factors. A simple modeling approach to estimate carbon emission was applied. The direct carbon emission from forest fires in 2000, ranging from 115 to 300 Gg C, corresponds to 1-3% of the annual carbon uptake by forests. The influence of forest fires on the carbon cycle in Korea is not so significant, but Korean forests have a large potential for generating severe local fires due to increasing forest carbon density and a high forest area ratio (forest area/total land area) of 65%. The carbon emission per area burned (Mg C ha(-1)) clearly reflects the trend toward increases in the number of severe fires. Statistical analyses and the trends of annual temperature and precipitation show that the recent large increase in carbon emissions may be the negative consequences of intensive forest regrowth that is the product of successful reforestation and forest management programs rather than the effect of climate change. These results imply a need for further studies in other countries, where large-scale plantation has been conducted, to evaluate the role of plantation and forest fires on the global carbon cycle.

  10. 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.

  11. Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness.

    Science.gov (United States)

    De Rosa, Silvia; Samoni, Sara; Villa, Gianluca; Ronco, Claudio

    2017-01-01

    Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). 'Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD. © 2017 S. Karger AG, Basel.

  12. Parental influence on clinical management during neonatal intensive care: a survey of US neonatologists.

    Science.gov (United States)

    Bailey, Sean M; Hendricks-Muñoz, Karen D; Mally, Pradeep

    2013-08-01

    Family-centered care (FCC), which includes involving parents in conversations about medical management, is increasingly employed in the neonatal intensive care unit (NICU). Our aim was to determine which care decisions are discussed by neonatologists with families most frequently and the percentage of clinicians influenced by such conversations. Anonymous web-based survey provided to 2137 neonatologists assessing information sharing and parental involvement. Thousand and two neonatologists responded in which 893 fully completed the surveys. 88% practice FCC. Topics most frequently discussed with parents were blood transfusion, steroids for lung disease and patent ductus arteriosus (PDA) surgery, each being reported and discussed by more than 90% of respondents. Many therapies, including aminoglycoisdes, total parenteral nutrition, and phototherapy, were discussed with parents by far fewer clinicians. Additionally, parents had most influence on clinicians in two categories, blood transfusion and steroids, with more than 70% reporting that their practice was influenced by parental opinion if communicated. For some topics, such as PDA surgery and central line placement, conversations impacted few clinicians. FCC appears to have an impact on NICU clinical decision-making processes, some more than others. Further investigation in this area may provide information on how to best communicate with families and run effective, efficient FCC rounds.

  13. 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

  14. Comprehensiveness and humanization of nursing care management in the Intensive Care Unit.

    Science.gov (United States)

    Medeiros, Adriane Calvetti de; Siqueira, Hedi Crecencia Heckler de; Zamberlan, Claudia; Cecagno, Diana; Nunes, Simone Dos Santos; Thurow, Mara Regina Bergmann

    2016-01-01

    Identifying the elements that promote comprehensiveness and humanization of nursing care management in the Intensive Care Unit, with an ecosystemic approach. A documentary qualitative study. The method of documentary analysis was used for data analysis. Four pre-established categories were identified - Technical; Organizational; Technological; and Humanizing Dimensions. Data resulted in forming two sub-categories that integrate the humanizing dimension category, namely 'Comprehensiveness in healthcare actions' and 'Integrating processes and promoters of humanization,' bringing forth implications and challenges in forms of managing health work processes, enabling organizational, structural and managerial changes to the provided healthcare. It was considered that all structural elements in managing nursing care with a focus on the needs of users should be in line with public policies and the principles of comprehensiveness and humanization, thus possessing strong potential for transforming health practices. Identificar os elementos capazes de promover a integralidade e a humanização na gestão do cuidado de enfermagem na Unidade de Terapia Intensiva, com enfoque ecossistêmico. Pesquisa documental, de natureza qualitativa. Para a análise dos dados utilizou-se do método da análise documental. SForam identificadas quatro categorias preestabelecidas ‒ Dimensões: Técnica; Organizacional; Tecnológica e Humanizadora. Os dados resultantes das duas subcategorias que integraram a categoria Dimensão Humanizadora, Integralidade nas ações do cuidado e Processos integradores e promotores de humanização, trazem implicações e desafios nos modos de gerir os processos de trabalho em saúde, o que possibilita transformações organizacionais, estruturais e gerenciais na produção do cuidado. Considera-se que na gestão do cuidado de enfermagem todos os elementos estruturantes, com enfoque nas necessidades dos usuários, devem estar em consonância com as políticas p

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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...

  20. 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...

  1. 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...

  2. Biomass, Nitrogen, and Phosphorus Accumulation in 4-Year-Old Intensively Managed Loblolly Pine and Sweetgum Plantations

    Science.gov (United States)

    Charles A. Gresham; Thomas M. William

    2002-01-01

    Knowing the nutrient uptake potential of plantations of fast-growing species is essential to designing land-based tertiary water treatment facilities. This study was conducted to estimate the biomass of 4-year-old, intensively managed loblolly pine (Pinus taeda) and sweetgum (Liquidambar styraciflua) plantations and to estimate the...

  3. 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

  4. 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

  5. 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).

  6. Health issues in the Arab American community. Managing cardiovascular risk barriers to optimal health outcomes in the Arab American patient.

    Science.gov (United States)

    Harb, Walid A

    2007-01-01

    Heart disease accounts for 38% of all deaths in the United States. The American Heart Association identified cardiovascular disease (CVD) as the most common cause of hospitalization in 2002. Direct and indirect costs of CVD have reached a total of $393.5 billion in 2005. Despite great advances in the treatment of CVD, high mortality rates and poor clinical outcomes persist. It has been estimated that a 17-year gap exists for research to reach clinical practice. More than half a million Americans of Arab ancestry live in Michigan. Similar to other ethnic groups, Arab Americans face challenges within the US healthcare system that hinder optimal clinical outcomes. Evidence-based studies targeting the Arab American population do not exist. Small observational studies provide limited data of questionable value.

  7. 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.

  8. Spirituality, Religiosity, and Weight Management Among African American Adolescent Males: The Jackson Heart KIDS Pilot Study.

    Science.gov (United States)

    Bruce, Marino A; Beech, Bettina M; Griffith, Derek M; Thorpe, Roland J

    2016-01-01

    Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12-19 year old African American males (N = 105) in the Jackson Heart KIDS Pilot Study. Key variables of interest are church attendance, prayer, daily spirituality, weight status, attempts to lose weight, nutrition, physical activity, and stress. Daily spirituality is associated with whether an individual attempts to lose weight. The results from logistic regression models suggest that daily spirituality increases the odds that African American male adolescents attempt to lose weight (OR = 1.22, CI: 1.07-1.41) and have a history of diet-focused weight management (OR = 1.13, CI: 1.02-1.26). Future studies are needed to further explore the association between religion, spirituality, and obesity-related behaviors.

  9. Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan.

    Science.gov (United States)

    Olufade, Temitope; Zhou, Siting; Anzalone, Deborah; Kern, David M; Tunceli, Ozgur; Cziraky, Mark J; Willey, Vincent J

    2017-05-04

    The purpose of this study was to characterize changes in statin utilization patterns in patients newly initiated on therapy in the 2 years following the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline in a large US health plan population. This retrospective, observational study used administrative medical and pharmacy claims data to identify patients newly initiated on statin therapy over 4 quarters prior to and 8 quarters following the release of the guideline (average N/quarter=3596). Patients were divided into the 4 statin benefit groups (SBGs) based on risk factors and laboratory lipid levels as defined in the guideline: SBG1 (with atherosclerotic cardiovascular disease [ASCVD]; N=1046/quarter), SBG2 (without ASCVD, with low-density lipoprotein cholesterol ≥190 mg/dL; N=454/quarter), SBG3 (without ASCVD, aged 40-75 years, with diabetes mellitus, low-density lipoprotein cholesterol 70-189 mg/dL; N=1391/quarter), SBG4 (no ASCVD or diabetes mellitus, age 40-75 years, low-density lipoprotein cholesterol 70-189 mg/dL, estimated 10-year ASCVD risk of ≥7.5%; N=705/quarter). Demographic variables, statin utilization patterns, lipid levels, and comorbidities were analyzed for pre- and postguideline periods. Postguideline, gradually increased high-intensity statin initiation occurred in SBG1, SBG2, and in SBG3 patients with 10-year ASCVD risk ≥7.5%. Moderate- to high-intensity statin initiation gradually increased among SBG4 patients. Recommended-intensity statin choice changed to a greater degree among patients treated by specialty care physicians. Regarding sex, target-intensity statin initiation was lower in women in all groups before and after guideline release. Prescriber implementation of the guideline recommendations has gradually increased, with the most marked change in the increased initiation of high-intensity statins in patients with ASCVD and in those treated by a specialist

  10. Effects of Coffee Management Intensity on Composition, Structure, and Regeneration Status of Ethiopian Moist Evergreen Afromontane Forests

    Science.gov (United States)

    Hundera, Kitessa; Aerts, Raf; Fontaine, Alexandre; Van Mechelen, Maarten; Gijbels, Pieter; Honnay, Olivier; Muys, Bart

    2013-03-01

    The effect of arabica coffee management intensity on composition, structure, and regeneration of moist evergreen Afromontane forests was studied in three traditional coffee-management systems of southwest Ethiopia: semiplantation coffee, semiforest coffee, and forest coffee. Vegetation and environmental data were collected in 84 plots from forests varying in intensity of coffee management. After controlling for environmental variation (altitude, aspect, slope, soil nutrient availability, and soil depth), differences in woody species composition, forest structure, and regeneration potential among management systems were compared using one way analysis of variance. The study showed that intensification of forest coffee cultivation to maximize coffee production negatively affects diversity and structure of Ethiopian moist evergreen Afromontane forests. Intensification of coffee productivity starts with the conversion of forest coffee to semiforest coffee, which has significant negative effects on tree seedling abundance. Further intensification leads to the conversion of semiforest to semiplantation coffee, causing significant diversity losses and the collapse of forest structure (decrease of stem density, basal area, crown closure, crown cover, and dominant tree height). Our study underlines the need for shade certification schemes to include variables other than canopy cover and that the loss of species diversity in intensively managed coffee systems may jeopardize the sustainability of coffee production itself through the decrease of ecosystem resilience and disruption of ecosystem services related to coffee yield, such as pollination and pest control.

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

    Science.gov (United States)

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

    2010-06-01

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

  12. Health literacy issues surrounding weight management among African American women: a mixed methods study.

    Science.gov (United States)

    James, D C S; Harville, C; Efunbumi, O; Martin, M Y

    2015-02-01

    Individuals with limited health literacy (LHL) have poorer health outcomes and have difficulty understanding and complying with recommendations to maintain a healthy lifestyle. The present study examined the association between health literacy (HL) and sources of dieting information, the weight-loss methods used and the information needed to manage weight among African American women. This mixed method study included seven focus groups and a survey of 413 African American women. Binary logistic regression analyses were performed to examine the association between HL category and sources of dieting information, weight-loss methods and information needed to lose weight. Thematic analysis was used to analyse focus group data. Women with LHL were significantly more likely to have a higher body mass index (BMI) than those with AHL (P health literacy (AHL) are more likely to rely on information obtained from the Internet (P physical activity to lose weight (P ≤ 0.002). In addition, women with AHL were significantly less likely to want information on portion control (P = 0.002). Major qualitative themes were the importance of television and the Internet as major sources of health information, the use of healthy and unhealthy weight-loss methods, and being overwhelmed by the plethora of dieting information. HL may affect BMI among AA women, where they access dieting information and the types of information needed to manage their weight. © 2014 The British Dietetic Association Ltd.

  13. Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes.

    Science.gov (United States)

    Chesla, Catherine A; Fisher, Lawrence; Skaff, Marilyn M; Mullan, Joseph T; Gilliss, Catherine L; Kanter, Richard

    2003-01-01

    Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.

  14. 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...

  15. 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.

  16. 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.

  17. Attention-deficit/hyperactivity disorder: presentation and management in the Haitian American child.

    Science.gov (United States)

    Prudent, Nicole; Johnson, Peggy; Carroll, Jennifer; Culpepper, Larry

    2005-01-01

    A case study of a young Haitian American is presented that is illustrative of cultural issues that influence care of those with attention-deficit/hyperactivity disorder (ADHD). Medications are the preferred treatment for ADHD and can be combined with psychological intervention. However, many Haitians and Haitian Americans see psychoactive medications as leading to substance abuse or mental illness. Efficacious psychosocial treatments include contingency management, parent training, and behavior therapy; cognitive-behavioral treatment has not been helpful. Complementary and alternative medicine might have appeal; primary care physicians can help families to assess such treatments and not to be enticed by expensive ones of little benefit. A determinant of the treatment a family pursues is their perception of the cause of the ADHD behaviors. While there is no term for ADHD in the Haitian-Creole language, in the Haitian culture the behaviors consistent with the diagnosis might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline, an intentionally bad child, or a psychically victimized child suffering from an "unnatural" condition. "Natural" ailments are attributed to natural forces (e.g., wind, temperature), while "unnatural" ones are attributed to bad spirits or punishment by God. Families may "lift their feet" (Leve pye nou: to see a Hougan or voodoo priest) to determine the unnatural cause. Haitian Americans often combine therapeutic foods that are considered cold in nature, natural sedatives and purgatives from herbal medicine, religious treatments, and Western medicine. Immigrants often lack support of extended families in an environment not supportive of their interpretation of child behaviors and traditionally accepted parental disciplinary style. Stigma, language, cultural conceptions, concerns about governmental agencies, and physician bias can all be barriers to care for immigrant families. Primary care

  18. 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.

  19. The Influence of Erosional Hotspots on Watershed-scale Phosphorus Dynamics in Intensively Managed Agricultural Landscapes

    Science.gov (United States)

    Baker, A.; Finlay, J. C.; Gran, K. B.; Karwan, D. L.; Engstrom, D. R.; Atkins, W.; Muramoto-Mathieu, M.

    2017-12-01

    The Minnesota River Basin is an intensively-managed agricultural watershed which contributes disproportionately to downstream sediment and nutrient loading. The Le Sueur River, an actively eroding tributary to the Minnesota River, has been identified as a disproportionate contributor of sediment and nutrients to this system. In an effort to identify best practices for reduction of phosphorus (P) in the context of intensifying agriculture and climate change pressure, we coupled investigation of source sediment P chemistry with an existing fine sediment budget to create a watershed mass balance for sediment-associated P. Sediments collected from primary source areas including agricultural fields, glacial till bluffs, alluvial streambanks, ravines, and agricultural ditches were analyzed for total- and extractable-P, and sorptive properties. Preliminary integration of these data into a mass-balance suggests that less than a quarter of the total-P exported from this watershed can be attributed directly to sediment inputs, likely due to the low P concentration of most sediment sources. While sediment may supply less than 25% of the total-P exiting the Le Sueur, a high proportion of total-P load ( 66% on average) is in particulate form. This finding indicates that sorption of dissolved-P from upstream sources onto fine sediment plays a major role in determining the form and reactivity of P in the watershed. Sorption processes convert dissolved-P into particulate-P, and may substantially alter the fate and reactivity of P in downstream channels and lakes. In highly erosive rivers, as the Le Sueur, where inputs of sediment from deep soil horizons are dominant, the dynamic relationship between sediment and dissolved-P must be evaluated and incorporated into models to forecast potential for P retention and export from the landscape. By incorporating results of this mass balance and analysis of sediment sorptive properties into existing models, we can develop strategies that

  20. A Survey of Self-Management and Intrusiveness of Illness in Native Americans with Diabetes Mellitus.

    Science.gov (United States)

    Chou, Ann F; Page, Evaren E; Norris, Ann I; Kim, Sue E; Thompson, David M; Roswell, Robert H

    2014-12-01

    Diabetes mellitus (DM) has emerged as an important focus of national public health efforts because of the rapid increase in the burden of this disease. In particular, DM disproportionately affects Native Americans. Adequate management of DM requires that patients participate as active partners in their own care and much of patient activation and empowerment can be attributed to their experience with DM and self-care. That is, the degree to which the patient feels the disease intrudes on his or her daily life would impact the motivation for self-care. We conducted a study in collaboration with 2 tribal nations in Oklahoma, collecting data on survey questions regarding intrusiveness of illness and self-management behaviors from a sample of 159 members of the Chickasaw and Choctaw Nations. Previously validated variables measuring intrusiveness of illness and self-care were included in the survey. Descriptive statistics and bivariate analyses illustrated the distribution of these variables and identified possible tribal and gender differences. Our findings showed that our sample adjusted well to DM and in general exhibited high compliance to self-care. However, our findings also revealed striking gender differences where female respondents were better adjusted to their disease, whereas male respondents reported higher adherence to self-management. Findings from our study, particularly those that describe tribal differences and gender disparities, can inform strategies for case management and patient interactions with providers and the health care system.

  1. 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.

  2. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Thompson, B Gregory; Brown, Robert D; Amin-Hanjani, Sepideh; Broderick, Joseph P; Cockroft, Kevin M; Connolly, E Sander; Duckwiler, Gary R; Harris, Catherine C; Howard, Virginia J; Johnston, S Claiborne Clay; Meyers, Philip M; Molyneux, Andrew; Ogilvy, Christopher S; Ringer, Andrew J; Torner, James

    2015-08-01

    The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. © 2015 American Heart Association, Inc.

  3. [Interhospital transport of intensive care patients in Lower Saxony : statewide need-based and effective management].

    Science.gov (United States)

    Roessler, M; Reinhardt, K; Lühmann, U; Bickel, A; Braun, J; Böhne, S; Gerberding, B; Hamann, A; Homann, M; Monnig, M; Panzer, W; Ruff, S; Flemming, A

    2011-08-01

    Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. A prospective follow-up study and evaluation of intensive care transport in Lower Saxony between April 1(st) 2008 and July 31(st) 2010 was carried out. A total of 6,779 data records were evaluated in this study of which 4,941 (72.9%) missions were located in Lower Saxony, 2,928 (43.2%) missions were carried out by helicopters and 3,851 (56.8%) by ground based mobile intensive care units. The mean duration of a mission was 3 h 59min±2 h 25 min, 4 h 39 min±2 h 23 min by ground based mobile intensive care units and 2 h 21 in±30 min by helicopter units. All systems proved to be feasible for intensive care transport. The degree of urgency was estimated correctly in 94.8% of the evaluated missions and 58.0% of the transfers could not be deployed. In 76.8% patients were transferred to hospitals with a higher level of medical care, 51.7% of patients were transferred for intensive care therapy and 40.4% for an operation/intervention. Of the patients 38.2% required mechanical ventilation and in 48.3% invasive monitoring was carried out. Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.

  4. Treatment intensity in everyday clinical management of speech sound disorders in Hong Kong.

    Science.gov (United States)

    To, Carol K S; Law, Thomas; Cheung, Pamela S P

    2012-10-01

    Much evidence supports the efficacy of different treatment approaches for speech sound disorders (SSD) in children. Minimal research in the field has been conducted using treatment intensity as a research variable. This study examined the current practice of speech-language pathologists (SLPs) in Hong Kong regarding the treatment intensity prescribed to children with SSD and potential factors that were associated with the intensity. Participants were 102 SLPs working in different settings in Hong Kong who completed an online questionnaire. SLPs who had a heavier caseload offered significantly less frequent and shorter treatment duration to clients with SSD. Public and private settings differed significantly in treatment duration. Treatment approaches and clinicians' consideration about a client's conditions did not affect treatment intensity. SLPs in Hong Kong do not plan treatment duration and frequency in an evidence-based direction because of their heavy workloads and the dearth of research evidence on treatment intensity to guide their clinical practice.

  5. 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.

  6. 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 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.

  7. Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India.

    Science.gov (United States)

    Kothari, Shikha Y; Dongara, Ashish R; Nimbalkar, Somashekhar M; Phatak, Ajay G; Nimbalkar, Archana S

    2016-01-01

    Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented. To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates. We conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics. A documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia. Stressful procedures are common in the NICU; mildly and moderately

  8. Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India

    Directory of Open Access Journals (Sweden)

    Shikha Yashwant Kothari

    2016-02-01

    Full Text Available Background:Neonates in the neonatal intensive care unit (NICU undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented.Objective:To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates.Methods:We conducted a cross-sectional study at a level III NICUlocated in a rural part of western India. A total of 69 neonates admitted for more than 24 hours were included.Twenty-nine neonates were directly observedfor a total of 24 hours each, and another 40 neonatal records were retrospectively reviewed for the neonate’s first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded.Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Averagenurse: patient ratio was also calculated. Data was analyzed using descriptive statistics.Results: A documentation deficit of 2.2% was observed. The average nurse: patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful and 2.2 moderately painful procedures per patient-day. Common stressful procedures were position changing (2501 and temperature recording (2208. Common mildly and moderately painful procedures were heel prick (757 and endotracheal suctioning (526 respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia.Conclusion: Stressful

  9. 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.

  10. 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.

  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. 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 work incapacity as compared to SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.

  13. Evaluation of the implementation of a bowel management protocol in intensive care: effect on clinician practices and patient outcomes.

    Science.gov (United States)

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

    2014-03-01

    To evaluate the effect of a multifaceted implementation of a bowel management protocol on outcomes for intensive care patients, in particular the incidence of constipation and diarrhoea, and on clinicians' bowel management practices. Complications associated with poor bowel management for critically ill patients result in adverse outcomes. Implementation of protocols requires strategies proven to change clinician behaviour. Before and after study. Our bowel management protocol was implemented using three evidence-based elements: education sessions, printed educational materials in the form of a fact sheet and reminders. We retrospectively collected data from patients' medical records admitted at two time points within three Sydney metropolitan intensive care units (preimplementation, n = 101; postimplementation, n = 107). No significant difference was found in the incidence of constipation and diarrhoea pre and postimplementation of the protocol. Seventy-two per cent (n = 73) of patients preimplementation and 70% (n = 75) of patients postimplementation experienced one or more episodes of constipation (bowels not open for 72 hours or greater), and 16% (n = 16) of patients preimplementation and 20% (n = 21) of patients postimplementation experienced one or more episodes of diarrhoea. There was a slight nonsignificant increase in bowel assessment on admission by medical officers postimplementation (pre, 47%, n = 48; post, 60%, n = 64). Targeted multifaceted implementation of a bowel management protocol did not have an impact on the incidence of constipation or diarrhoea for intensive care patients or on clinician practices. The lack of impact on patient outcomes may be due to clinicians' nonadherence to our bowel management protocol. Reasons clinicians' practices did not change may include the influences of clinical decision-making on behaviour. This study highlights difficulties inherent in changing clinician behaviour and practices to improve patient outcomes

  14. 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

  15. 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

    2017-04-05

    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 Information sharing was the only significant predictor (beta = .46, p information sharing is a potential health behavior to support intervention strategies for African American women with hypertension.

  16. 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.

  17. 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.

  18. 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.

  19. Latin American Immigration, Maternal Education, and Approaches to Managing Children's Schooling in the United States.

    Science.gov (United States)

    Crosnoe, Robert; Ansari, Arya; Purtell, Kelly M; Wu, Nina

    2016-02-01

    Concerted cultivation is the active parental management of children's educations that, because it differs by race/ethnicity, nativity, and socioeconomic status, plays a role in early educational disparities. Analyses of the Early Childhood Longitudinal Study-Kindergarten Cohort ( n = 10,913) revealed that foreign-born Latina mothers were generally less likely to engage in school-based activities, enroll children in extracurricular activities, or provide educational materials at home when children were at the start of elementary school than were U.S.-born White, African American, and Latina mothers, in part because of their lower educational attainment. Within the foreign-born Latina sample, the link between maternal education and the three concerted cultivation behaviors did not vary by whether the education was attained in the United States or Latin America. Higher maternal education appeared to matter somewhat more to parenting when children were girls and had higher achievement.

  20. Is there a role for stress management in reducing hypertension in African Americans?

    Science.gov (United States)

    Kondwani, K A; Lollis, C M

    2001-01-01

    When stress is considered as any demand placed on the body, the focus is shifted away from the stressor to how the body responds to the stress. There are psychological, physiological, and behavioral responses to excessive stress. Left unaddressed, cardiovascular or cerebrovascular diseases may occur. The goal of meditation is to decrease mental activity while simultaneously resting and rejuvenating the body. There are internal and external approaches to meditation. The most researched internal form of meditation is the Transcendental Meditation technique, which has been found to reduce stress, depression, anxiety, and blood pressure in hypertensive African Americans. Clinical use of stress management approaches, particularly Transcendental Meditation to reduce hypertension, is supported by randomized clinical trials. Studies with larger numbers of participants and more diverse ethnic groups should continue.

  1. 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.

  2. 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

  3. 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.

  4. 2018 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)

    Powers, William J; Rabinstein, Alejandro A; Ackerson, Teri; Adeoye, Opeolu M; Bambakidis, Nicholas C; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M; Hoh, Brian; Jauch, Edward C; Kidwell, Chelsea S; Leslie-Mazwi, Thabele M; Ovbiagele, Bruce; Scott, Phillip A; Sheth, Kevin N; Southerland, Andrew M; Summers, Deborah V; Tirschwell, David L

    2018-03-01

    The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke. © 2018 American Heart Association, Inc.

  5. An individualized intervention to improve asthma management among urban Latino and African-American families.

    Science.gov (United States)

    Bonner, Sebastian; Zimmerman, Barry J; Evans, David; Irigoyen, Matilde; Resnick, David; Mellins, Robert B

    2002-04-01

    We hypothesized that an educational intervention based on a readiness model would lead to improved health outcomes among patients with asthma. Within a randomized control design in an urban Latino and African-American community we conducted an intensive three-month pediatric intervention. A Family Coordinator provided patient education based on a readiness-to-learn model, and facilitated improved interactions between the patient and the doctor. Family education addressed the most basic learning needs of patients with asthma by improving their perception of asthma symptom persistence using asthma diaries and peak flown measures. The physician intervention focused cliniciancs' attention on patients' diary records and peak flow measures, and encouraged physicians to use stepped action plans. Patients were also tested for allergic sensitization and provided strategies to reduce contact with allergens and other asthma triggers. The results showed significant improvements by intervention group families on measures of knowledge, health belief, self-efficacy, self-regulatory skill, and adherence; decreases in symptom persistence and activity restriction; and increased prescription of anti-inflammatory medication by the physicians of the intervention group families.

  6. 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.

  7. 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.

  8. 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

  9. Clinical management issues of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit

    NARCIS (Netherlands)

    Hemels, M.A.C.

    2011-01-01

    Nosocomial sepsis is a major cause of morbidity in the neonatal intensive care unit (NICU), with coagulase-negative staphylococci (CONS) generally reported to be the most frequent causative micro-organisms. There is substantial evidence for the association between CONS sepsis and indwelling

  10. 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)…

  11. The influence of sampling intensity on vegetation classification and the implications for environmental management

    NARCIS (Netherlands)

    Cooper, A.; Mccan, T.; Bunce, R.G.H.

    2006-01-01

    As part of a programme of landscape-scale habitat surveillance in the United Kingdom (UK), the effect of grassland sampling intensity on the outcome of numerical classification was assessed. Sample quadrats from two regions of the UK were available for post priori analysis; a random sample from

  12. 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.

  13. 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

  14. 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

  15. “So We Adapt Step by Step”: Acculturation Experiences Affecting Diabetes Management and Perceived Health for Chinese American Immigrants

    OpenAIRE

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

    2010-01-01

    This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N=40) during group, couple and individual interviews conducted in 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N=19) meeting inclusion crit...

  16. 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.

  17. Disparities in lipid management for African Americans and Caucasians with coronary artery disease: A national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Carter-Edwards Lori

    2004-08-01

    Full Text Available Abstract Background Individuals with coronary artery disease are at high risk for adverse health outcomes. This risk can be diminished by aggressive lipid management, but adherence to lipid management guidelines is far from ideal and substantial racial disparities in care have been reported. Lipid treatment and goal attainment information is not readily available for large patient populations seen in the fee-for-service setting. As a result, national programs to improve lipid management in this setting may focus on lipid testing as an indicator of lipid management. We describe the detection, treatment, and control of dyslipdemia for African Americans and Caucasians with coronary artery disease to evaluate whether public health programs focusing on lipid testing can eliminate racial disparities in lipid management. Methods Physicians and medical practices with high numbers of prescriptions for coronary artery disease medications were invited to participate in the Quality Assurance Program. Medical records were reviewed from a random sample of patients with coronary artery disease seen from 1995 through 1998. Data related to the detection, treatment, and control of dyslipidemia were abstracted from the medical record and evaluated in cross-sectional stratified and logistic regression analyses using generalized estimation equations. Results Data from the medical records of 1,046 African Americans and 22,077 Caucasians seen in outpatient medical practices in 23 states were analyzed. African-American patients were younger, more likely to be women and to have diabetes, heart failure, and hypertension. The low density lipoprotein cholesterol (LDL-C testing rate for Caucasian men was over 1.4 times higher than that for African-American women and about 1.3 times higher than that for African-American men. Almost 60% of tested Caucasian men and less than half of tested African Americans were prescribed lipid-lowering drugs. Tested and treated Caucasian men

  18. 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.

  19. Weight management in African-Americans using church-based community interventions to prevent type 2 diabetes and cardiovascular disease.

    Science.gov (United States)

    Thompson, Elizabeth; Berry, Diane; Nasir, Laura

    2009-07-01

    The purpose of this literature review was to examine the utilization of church-based interventions designed for African-Americans in the community for the management of overweight and obesity and prevention of type 2 diabetes and cardiovascular disease. PubMed, CINAHL, and Google scholar were searched using the following key search terms: type 2 diabetes, cardiovascular disease, prevention, management, African-Americans, Blacks, weight loss, weight management, church-based interventions, community interventions, faith-based interventions, and prayer. Sixteen primary studies were located and six met inclusion criteria. The studies were separated into two categories: faith-placed interventions or collaborative interventions. The overall results demonstrated significant weight loss ranging from 2.3 (SD = 4.1) pounds to 10.1 (SD = 10.3) pounds post-intervention. Further research is needed to understand interventions that are church-based and culturally sensitive for African-Americans. Weight management is important in order to decrease the morbidity and mortality related to type 2 diabetes and cardiovascular disease in the African-American population.

  20. 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…

  1. 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…

  2. Coastal activities in American Samoa in 2012 for use in coastal management

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The American Samoa Coastal use Participatory Mapping Project was developed through a partnership between the American Samoa Government's Department of Commerce...

  3. [Delirium, analgesia, and sedation in intensive care medicine : Development of a protocol-based management approach].

    Science.gov (United States)

    Wolf, A; Mörgeli, R; Müller, A; Weiss, B; Spies, C

    2017-02-01

    Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental. Here, a treatment target is defined and continuously re-evaluated by validated monitoring methods. Evidence clearly supports a paradigm shift towards patients that are awake, attentive, and able to participate in their therapy. Individualized analgesia and (non)sedation approaches allow a Richmond Agitation-Sedation Scale (RASS) target value of 0/-1 for the majority of patients. Should sedation indeed be necessary, there must be a focus on avoiding oversedation, especially an early deep sedation.

  4. Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India

    OpenAIRE

    Kothari, Shikha Y.; Dongara, Ashish R.; Nimbalkar, Somashekhar M.; Phatak, Ajay G.; Nimbalkar, Archana S.

    2016-01-01

    Background Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented. Objective To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain ...

  5. Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia

    OpenAIRE

    Walter, Roland B.; Taylor, Lenise R.; Gardner, Kelda M.; Dorcy, Kathleen Shannon; Vaughn, Jennifer E.; Estey, Elihu H.

    2013-01-01

    Adults with newly diagnosed or relapsed acute myeloid leukemia (AML) commonly receive intensive chemotherapy to achieve disease remission. In the United States and many other countries, it is standard practice that these patients remain hospitalized “preemptively” until blood count recovery due to the risk for overwhelming infections and bleeding during pancytopenia. This care policy requires hospitalization for an average of 3–4 weeks after completion of chemotherapy. However, highly effecti...

  6. 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.)

  7. 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...

  8. 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.

  9. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses.

    Science.gov (United States)

    Byrd, Patricia J; Gonzales, Irene; Parsons, Virgil

    2009-12-01

    To explore barriers that NICU nurses face when attempting to optimally manage newborn pain. Ninety California NICU nurses with current membership in the National Association of Neonatal Nurses (NANN) voluntarily participated. A descriptive survey study. A researcher-developed survey consisting of 37 questions was mailed to 300 NICU nurses; 102 were returned and 90 were usable. Probability sampling from a listing of California registered nurses with current membership in the NANN was used to obtain the study's sampling frame. Less than half of the nurses felt that newborn pain is well managed within the NICUs where they are employed. Barriers identified related to physicians' pain management practices, lack of evidence-based pain management protocols, nurses' and physicians' resistance to change practice, infant pain assessment tools, and inadequate staff training regarding pain assessment and management. A knowledge-practice gap still exists within newborn pain management. Increased caregiver education remains a necessity, but strategies that address resistance to change practice within healthcare settings must also be considered.

  10. Interaction of Land Management Intensity and Micro-topography Controls on Geochemistry of Raindrop-Liberated/Mobilized Soil Particles

    Science.gov (United States)

    Hou, T.; Filley, T. R.; Berry, T.; Singh, S.; Hughes, M.; Tong, Y.; Papanicolaou, T.; Wacha, K.; Wilson, C. G.; Chaubey, I.

    2017-12-01

    The dynamics of raindrop-induced breakdown of soil aggregates, a critical factor in the initial process of surface erosion and lateral redistribution of soil, are strongly tied to land use intensity. What is unclear however is the relative control of rain and mechanical disturbance on the development of landscape-level heterogeneity in surface soil geochemistry. We used artificial rainfall simulated experiments including an aggregate stability test and time course rainfall-erosional test to evaluate the role of management intensity and micro-topography on the geochemistry of raindrop-liberated/mobilized particles from landscapes in southeastern Iowa. Comparing restored prairie, conservation tillage, and conventional tillage sites we found, and with a trend toward increasing tillage intensity, a decrease in aggregate stability and raindrop-liberated particles that were lower in organic carbon, nitrogen, and plant-derived biopolymers, while containing higher proportions of microbially-processed nitrogen than the raindrop stable aggregates. Time evolution of the geochemistry (e.g. elemental, stable isotope, and biopolymer composition) of transported soil particles exhibited distinct patterns based upon both position of the hillslope and oriented soil roughness. Additionally, in the restored prairie, raindrop liberated particles had identical geochemical composition to the raindrop stable aggregates. Our results demonstrate that agricultural sites under intensive tillage have not only a greater potential to liberate and mobilize soil particles during storms, but the mobilized particles will have a distinct chemical character based on tillage intensity, hillslope position and oriented roughness thus lead to a greater potential for landscape level heterogeneity in surface and buried soil chemistry upon mobilization and burial.

  11. 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.

  12. 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.

  13. Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease.

    Science.gov (United States)

    Toobert, D J; Glasgow, R E; Nettekoven, L A; Brown, J E

    1998-11-01

    Females, especially older women, historically have been excluded from coronary heart disease (CHD) studies. The PrimeTime program was a randomized clinical trial designed to study the effects of a comprehensive lifestyle management program (very low-fat vegetarian diet, smoking cessation, stress-management training, moderate exercise, and group support) on changes in behavioral risk factors among postmenopausal women with CHD. The study also explored program effects on four psychosocial clusters: coping with stress, distress, social support, and self-efficacy. The program produced significant behavioral improvements in 4- and 12-months adherence to diet, physical activity, and stress-management in the PrimeTime women compared to the Usual Care (UC) group. In addition, the PrimeTime participants demonstrated improvements relative to UC on psychosocial measures of self-efficacy, perceived social support, and ability to cope with stress. Strengths and weaknesses of the study, and implications for future research are discussed.

  14. Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women.

    Science.gov (United States)

    Franklin, Nina C; Arena, Ross

    2016-01-01

    Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Rodrigues G.S

    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.

  16. 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.

  17. Nitrate and fluoride contamination in groundwater of an intensively managed agroecosystem: a functional relationship.

    Science.gov (United States)

    Kundu, Manik Chandra; Mandal, Biswapati; Hazra, Gora Chand

    2009-04-01

    A study was conducted to assess the potential of nitrate-nitrogen (NO(3)-N) and fluoride (F) contamination in drinking groundwater as a function of lithology, soil characteristics and agricultural activities in an intensively cultivated district in India. Two hundred and fifty two groundwater samples were collected at different depths from various types of wells and analyzed for pH, electrical conductivity (EC), NO(3)-N load and F content. Database on lithology, soil properties, predominant cropping systems, fertilizer and pesticide uses were also recorded for the district. The NO(3)-N load in groundwater samples were low ranging from 0.12 to 6.58 microg mL(-1) with only 8.7% of them contained greater than 3.0 microg mL(-1) well below the 10 microg mL(-1), the threshold limit fixed by WHO for drinking purpose. Samples from the habitational areas showed higher NO3-N content over the agricultural fields. The content decreased with increasing depth of wells (r=-0.25, Pgeology of the district. The content showed a significant positive correlation (r=0.234, P=< or =0.01) with the amount of phosphatic fertilizer (single super phosphate) used for agriculture. Results thus indicated that the groundwater of the study area is presently safe for drinking purpose but some anthropogenic activities associated with intensive cultivation had a positive influence on its loading with NO(3)-N and F.

  18. High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer.

    Science.gov (United States)

    Dababou, Susan; Marrocchio, Cristina; Scipione, Roberto; Erasmus, Hans-Peter; Ghanouni, Pejman; Anzidei, Michele; Catalano, Carlo; Napoli, Alessandro

    2018-01-01

    Cancer-related pain affects up to 80% of patients with malignancies. Pain is an important distressing symptom that diminishes the quality of life and negatively affects the survival of patients. Opioid analgesics are generally the primary therapy for cancer-related pain, with surgery, radiation therapy, chemotherapy, and other interventions used in cases of treatment-resistant pain. These treatments, which can be associated with substantial side effects and systemic toxicity, may not be effective. High-intensity focused ultrasound is an entirely noninvasive technique that is approved for treatment of uterine fibroids, bone metastases, and essential tremors. With magnetic resonance imaging or ultrasonographic guidance, high-intensity ultrasound waves are focused on a small well-demarcated region to result in precise localized ablation. This treatment may represent a multimodality approach to treating patients with malignant diseases-facilitating pain palliation, enhanced local drug delivery and radiation therapy effects, and stimulation of anticancer specific immune responses, and potentially facilitating local tumor control. Focused ultrasound can be used to achieve pain palliation by producing several effects, including tissue denervation, tumor mass reduction, and neuromodulation, that can influence different pathways at the origin of the pain. This technology has several key advantages compared with other analgesic therapies: It is completely noninvasive, might be used to achieve rapid pain control, can be safely repeated, and can be used in combination with chemotherapy and radiation therapy to enhance their effects. Online supplemental material is available for this article. © RSNA, 2018.

  19. Understanding and Managing Shock: A Core Curriculum for an Intensive Care Unit.

    Science.gov (United States)

    Polson, Alasdair

    This paper describes a 2-week curriculum designed to give graduate level physicians an understanding of the pathophysiology of shock and to enable them to diagnose and manage deranged oxygen metabolism in critically ill patients. The curriculum is predicated on an extensive needs assessment and addresses the unique characteristics and learning…

  20. 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.

  1. Management of Endometrial Cancer at Mayo Clinic: Intensive Surgical Staging and Disease-based Postoperative Treatment

    NARCIS (Netherlands)

    Mariani, A.

    2006-01-01

    Chapter 1 is a general introduction, while chapter 8 is the final discussion and conclusions. The remaining chapters (from 2 to 7) are composed by a brief introduction, followed by the published article(s) that form(s) the structure of the chapter. Management of Endometrial Cancer at Mayo

  2. IBM, CERN join to create a data-intensive management system

    CERN Multimedia

    2003-01-01

    "IBM, White Plains, N.Y., has agreed to collaborate with the European Organization for Nuclear Research's (CERN), Geneva, Switzerland, openlab for a DataGrid project. The aim is to develop a vast data-management system based on Grid computing to investigate the origins of the universe (1/2 page).

  3. 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...

  4. 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

  5. Effect of improved nitrogen management on greenhouse gas emissions from intensive dairy systems in the Netherlands

    NARCIS (Netherlands)

    Schils, R.L.M.; Verhagen, A.; Aarts, H.F.M.; Kuikman, P.J.; Sebek, L.B.J.

    2006-01-01

    Dairy systems in Europe contribute to the emissions of the greenhouse gases (GHGs) nitrous oxide (N2O), methane (CH4) and carbon dioxide (CO2). In this paper, the effects of improved nitrogen (N) management on GHG emissions from Dutch dairy farms are determined. The GHG emissions are calculated

  6. Environmental change and disease dynamics: effects of intensive forest management on Puumala hantavirus infection in boreal bank vole populations.

    Science.gov (United States)

    Voutilainen, Liina; Savola, Sakeri; Kallio, Eva Riikka; Laakkonen, Juha; Vaheri, Antti; Vapalahti, Olli; Henttonen, Heikki

    2012-01-01

    Intensive management of Fennoscandian forests has led to a mosaic of woodlands in different stages of maturity. The main rodent host of the zoonotic Puumala hantavirus (PUUV) is the bank vole (Myodes glareolus), a species that can be found in all woodlands and especially mature forests. We investigated the influence of forest age structure on PUUV infection dynamics in bank voles. Over four years, we trapped small mammals twice a year in a forest network of different succession stages in Northern Finland. Our study sites represented four forest age classes from young (4 to 30 years) to mature (over 100 years) forests. We show that PUUV-infected bank voles occurred commonly in all forest age classes, but peaked in mature forests. The probability of an individual bank vole to be PUUV infected was positively related to concurrent host population density. However, when population density was controlled for, a relatively higher infection rate was observed in voles trapped in younger forests. Furthermore, we found evidence of a "dilution effect" in that the infection probability was negatively associated with the simultaneous density of other small mammals during the breeding season. Our results suggest that younger forests created by intensive management can reduce hantaviral load in the environment, but PUUV is common in woodlands of all ages. As such, the Fennoscandian forest landscape represents a significant reservoir and source of hantaviral infection in humans.

  7. Environmental change and disease dynamics: effects of intensive forest management on Puumala hantavirus infection in boreal bank vole populations.

    Directory of Open Access Journals (Sweden)

    Liina Voutilainen

    Full Text Available Intensive management of Fennoscandian forests has led to a mosaic of woodlands in different stages of maturity. The main rodent host of the zoonotic Puumala hantavirus (PUUV is the bank vole (Myodes glareolus, a species that can be found in all woodlands and especially mature forests. We investigated the influence of forest age structure on PUUV infection dynamics in bank voles. Over four years, we trapped small mammals twice a year in a forest network of different succession stages in Northern Finland. Our study sites represented four forest age classes from young (4 to 30 years to mature (over 100 years forests. We show that PUUV-infected bank voles occurred commonly in all forest age classes, but peaked in mature forests. The probability of an individual bank vole to be PUUV infected was positively related to concurrent host population density. However, when population density was controlled for, a relatively higher infection rate was observed in voles trapped in younger forests. Furthermore, we found evidence of a "dilution effect" in that the infection probability was negatively associated with the simultaneous density of other small mammals during the breeding season. Our results suggest that younger forests created by intensive management can reduce hantaviral load in the environment, but PUUV is common in woodlands of all ages. As such, the Fennoscandian forest landscape represents a significant reservoir and source of hantaviral infection in humans.

  8. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.

    Science.gov (United States)

    Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

    2012-03-01

    Patients in the intensive care unit (ICU) 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 ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations.

  9. 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.

  10. Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management: A Comparative Focus Group Study.

    Science.gov (United States)

    Axelin, Anna; Anderzén-Carlsson, Agneta; Eriksson, Mats; Pölkki, Tarja; Korhonen, Anne; Franck, Linda S

    2015-01-01

    This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.

  11. Evaluation of detemir in diabetic cats managed with a protocol for intensive blood glucose control.

    Science.gov (United States)

    Roomp, Kirsten; Rand, Jacquie

    2012-08-01

    The aim of this study was to report outcomes using detemir and a protocol aimed at intensive blood glucose control with home monitoring in diabetic cats, and to compare the results with a previous study using the same protocol with glargine. Eighteen cats diagnosed with diabetes and previously treated with other insulins were included in the study. Data was provided by owners who joined the online German Diabetes-Katzen Forum. The overall remission rate was 67%. For cats that began the protocol before or after 6 months of diagnosis, remission rates were 81% and 42%, respectively (P = 0.14). No significant differences were identified between the outcomes for the glargine and detemir studies, with the exception of three possibly interrelated factors: a slightly older median age of the detemir cohort at diabetes diagnosis, a higher rate of chronic renal disease in the detemir cohort and lower maximal dose for insulin detemir.

  12. High diversity stabilizes the thermal resilience of pollinator communities in intensively managed grasslands.

    Science.gov (United States)

    Kühsel, Sara; Blüthgen, Nico

    2015-08-10

    The resilience of ecosystems depends on the diversity of species and their specific responses to environmental variation. Here we show that the diversity of climatic responses across species contributes to a higher projected resilience of species-rich pollinator communities in real-world ecosystems despite land-use intensification. We determined the thermal niche of 511 pollinator species (flies, bees, beetles and butterflies) in 40 grasslands. Species in intensively used grasslands have broader thermal niches and are also more complementary in their thermal optima. The observed increase in thermal resilience with land-use intensification is mainly driven by the dominant flies that prefer cooler temperatures and compensate for losses of other taxa. Temperature explained 84% of the variation in pollinator activity across species and sites. Given the key role of temperature, quantifying the diversity of thermal responses within functional groups is a promising approach to assess the vulnerability of ecosystems to land-use intensification and climate change.

  13. Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care.

    Science.gov (United States)

    Gibson-Scipio, Wanda; Gourdin, Dustin; Krouse, Helene J

    2015-01-01

    Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. 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%, p<0.01, between daytime and night-time and 28.8%, p<0.001, between morning and the rest of the day. 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.

  15. 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.

  16. 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.

  17. 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...

  18. Influence of dry period length on reproductive performance and productivity of Lacaune dairy sheep under an intensive management system.

    Science.gov (United States)

    Hernandez, Fernando; Elvira, Laura; Gonzalez-Martin, Juan-Vicente; Astiz, Susana

    2012-08-01

    Intensive management is almost the only way to ensure dairy farm profitability. The dry period length (DPL) is a key factor in the productivity and health of dairy cows, but whether the same is true of dairy sheep is unclear. This study investigated the effects of DPL on the performance of Lacaune sheep under intensive management. We recorded 8136 lactations from 4220 ewes on one farm for the period 2005-2010, and data from a total of 6762 complete lactations 1-4 were included in the study. The length of the dry period following the current lactation was studied. The larger the total milk yield (MY) and daily milk yield (DMY), the shorter was the DPL before the next lactation. DPL correlated with MY (r=-0·384), DMY (r=-0·277) and the lambing-to-conception interval (LC; r=0·201, PDPL (P-DPL), or the length of the period prior to the start of the next lactation, was studied for 4318 lactations. P-DPL was classified into five intervals: very short (P-DPL-XS), 1-30 d; short (P-DPL-S), 31-60 d; medium (P-DPL-M), 61-90 d; long (P-DPL-L), 91-120 d; and very long (P-DPL-XL), >120 d. P-DPL positively correlated with lambing-to-next conception interval (LNC; r=0·095, PDPL-XL, 161·5±62·9 d; P-DPL-M, 169·0±74·8 d; PDPL-S, 432±187 l; P-DPL-M, 436±191 l; PDPL. Hence, 30-60 d should be the optimal dry period length for Lacaune sheep under intensive conditions.

  19. Dilemma of fossil water management within Southern Tunisia oases: vulnerability to salt under intensive use context

    OpenAIRE

    Omrani , Nizar

    2009-01-01

    International audience; In southern Tunisia oases, water is the most important natural resource. The survival of those ecosystems is conditioned by the availability of such resource. Under an arid climate, oases inhabitants acquired secular traditions in water management. These oases observed a lightening development. The improvement in drilling techniques reinforced their capabilities to provide for the expansion of urban water needs and irrigation requirements. Despite being fossils, underg...

  20. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    He Feifei [Key Laboratory of Plant-soil Interactions of Ministry of Education, Key Laboratory of Plant Nutrition of Minstry of Agriculture, College of Resources and Environmental Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Haidian District, Beijing 100193 (China); College of Bioscience and Biotechnology, Hunan Agricultural University, Furong District, Changsha 410128 (China); Jiang Rongfeng; Chen Qing; Zhang Fusuo [Key Laboratory of Plant-soil Interactions of Ministry of Education, Key Laboratory of Plant Nutrition of Minstry of Agriculture, College of Resources and Environmental Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Haidian District, Beijing 100193 (China); Su Fang, E-mail: sufang@cau.edu.c [Key Laboratory of Plant-soil Interactions of Ministry of Education, Key Laboratory of Plant Nutrition of Minstry of Agriculture, College of Resources and Environmental Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Haidian District, Beijing 100193 (China)

    2009-05-15

    Nitrous oxide (N{sub 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{sub 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{sub 2}O emissions came from the initial growth stage, corresponding to the rewetting process in the soil. The annual N{sub 2}O emissions ranged from 2.6 to 8.8 kg N ha{sup -1} yr{sup -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{sub 2}O emissions by 51% in 2004 and 27% in 2005, respectively. - High N{sub 2}O emissions coming from the initial growth stage can be attributed to the rewetting process in the greenhouse soil.

  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. 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.

  4. 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.

  5. 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,…

  6. The management of severe community acquired pneumonia in the intensive care unit.

    Science.gov (United States)

    Liapikou, Adamantia; Rosales-Mayor, Edmundo; Torres, Antoni

    2014-06-01

    Severe CAP (SCAP), accounting for 6% of admissions to intensive care units (ICUs) needs early diagnosis and aggressive interventions at the most proximal point of disease presentation. The prognostic scores as the ATS/IDSA rule, the systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH or SCAP system are appropriate in early identification of eligible patients requiring admission to ICU. Then the recommended initial resuscitation in SCAP in the ICU consists of fluid volume intake titrated to specific goals after a fluid challenge and hemodynamic optimization. The first selection of antimicrobial therapy should be started in the first hour and would be broad enough to cover all likely pathogens. Combination therapy may be useful in patients with non refractory septic shock and severe sepsis pneumococcal bacteremia as well. After 6 hours the patient would be reevaluated in terms of hemodynamic stability and antibiotic and therapy. Future developments will focus on sepsis biomarkers, molecular diagnostic techniques and the development of novel therapeutic immunomodulaty agents.

  7. THE PERFORMANCE OF JAVA AND ONGOLE CROSSBRED BULL UNDER INTENSIVE FEEDING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    C.M.S. Lestari

    2011-06-01

    Full Text Available This study was set up to evaluate the performance of Java and Ongole Crossbred (OC bulls fed concentrate and rice straw. A total of four Java bulls and four OC bulls were used in this experiment. The bulls were fed concentrates (50% of the total dry matter feed requirement and rice straw (ad libitum. The concentrates were consisted of rice bran, beer waste product, copra meal, minerals, with crude protein (CP and total digestible nutrients (TDN contents of 15.32% and 73.09%, respectively. The average daily gain (ADG, dry matter intake (DMI, protein and energy intake, and feed conversion ratio (FCR were observed. The results of this study showed that the ADG, DMI, CP and TDN intake, and FCR were not significantly different (p> 0.05. The ADG of Java and OC bulls were 0.58 kg and 0.78 kg, respectively. The averages of DMI, CP and TDN intake were 6.59 kg (2.09% of BW, 0.81 kg and 4.34 kg for Java bulls whereas for OC bulls were 6.42 kg (2.11% of BW, 0.78 kg, and 4.20 kg, respectively. The FCR of Java bulls was 11.49 and those of OC bulls was 9.21. It can be concluded that Java and OC bulls raised intensively and fed concentrate and rice straw had the similar performance.

  8. THE PERFORMANCE OF JAVA AND ONGOLE CROSSBRED BULL UNDER INTENSIVE FEEDING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    C.M.S. Lestari

    2014-10-01

    Full Text Available This study was set up to evaluate the performance of Java and Ongole Crossbred (OC bulls fedconcentrate and rice straw. A total of four Java bulls and four OC bulls were used in this experiment. Thebulls were fed concentrates (50% of the total dry matter feed requirement and rice straw (ad libitum.The concentrates were consisted of rice bran, beer waste product, copra meal, minerals, with crudeprotein (CP and total digestible nutrients (TDN contents of 15.32% and 73.09%, respectively. Theaverage daily gain (ADG, dry matter intake (DMI, protein and energy intake, and feed conversion ratio(FCR were observed. The results of this study showed that the ADG, DMI, CP and TDN intake, andFCR were not significantly different (p> 0.05. The ADG of Java and OC bulls were 0.58 kg and 0.78kg, respectively. The averages of DMI, CP and TDN intake were 6.59 kg (2.09% of BW, 0.81 kg and4.34 kg for Java bulls whereas for OC bulls were 6.42 kg (2.11% of BW, 0.78 kg, and 4.20 kg,respectively. The FCR of Java bulls was 11.49 and those of OC bulls was 9.21. It can be concluded thatJava and OC bulls raised intensively and fed concentrate and rice straw had the similar performance.

  9. 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.

  10. 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.

  11. [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.

  12. 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.

  13. Shock in the first 24 h of intensive care unit stay: observational study of protocol-based fluid management.

    Science.gov (United States)

    See, Kay Choong; Mukhopadhyay, Amartya; Lau, Samuel Chuan-Xian; Tan, Sandra Ming-Yien; Lim, Tow Keang; Phua, Jason

    2015-05-01

    Precision in fluid management for shock could lead to better clinical outcomes. We evaluated the association of protocol-based fluid management with intensive care unit (ICU) and hospital mortality. We performed an observational study of mechanically ventilated patients admitted directly from our emergency department to the ICU from August 2011 to December 2013, who had circulatory shock in the first 24 h of ICU stay (systolic blood pressure 4 mmol/L). Patients with onset of shock beyond 24 h of ICU stay were excluded. Protocol-based fluid management required close physician-nurse cooperation and computerized documentation, checking for fluid response (≥10% arterial pulse pressure or stroke volume increase after two consecutive 250-mL crystalloid boluses), and fluid loading with repeated 500-mL boluses until fluid response became negative. Six hundred twelve mechanically ventilated patients with shock (mean [±SD] age, 63.0 years [16.5]; 252 or 41.2% females; mean Acute Physiology and Chronic Health Evaluation II score, 30.2 [8.8]) were studied. The fluid management protocol was used 455 times for 242 patients (39.5% of 612 patients) within the first 24 h of ICU stay, with 244 (53.6% of 455) positive responses. Adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II score, comorbidity, and admission year, protocol use was associated with reduced ICU mortality (odds ratio, 0.60; 95% confidence interval, 0.39-0.94; P = 0.025) but not hospital mortality (odds ratio, 0.82; 95% confidence interval, 0.54-1.23; P = 0.369). Among mechanically ventilated patients with shock within the first 24 h of ICU stay, about half had positive fluid responses. Adherence to protocol-based fluid management was associated with improved ICU survival.

  14. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version.

    Science.gov (United States)

    Neal, Joseph M; Woodward, Crystal M; Harrison, T Kyle

    2018-02-01

    The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically revises and updates its checklist for the management of local anesthetic systemic toxicity. The 2017 update replaces the 2012 version and reflects new information contained in the third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Electronic copies of the ASRA checklist can be downloaded from the ASRA Web site (www.asra.com) for inclusion in local anesthetic toxicity rescue kits or perioperative checklist repositories.

  15. 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.

  16. Phylogeography of the American woodcock (Scolopax minor): Are management units based on band recovery data reflected in genetically based management units?

    Science.gov (United States)

    Rhymer, J.M.; McAuley, D.G.; Ziel, H.L.

    2005-01-01

    Information on population connectivity throughout the annual cycle has become more crucial, because populations of many migratory birds are in decline. One such species is the American Woodcock (Scolopax minor), which inhabits early-successional forests in eastern North America. Although band recoveries have proved useful for dividing populations of this game bird species into an Eastern Region and Central Region for management purposes, these data do not provide enough detail to determine the breeding population of origin of birds recovered on stopover and wintering areas. To obtain more fine-scale data, we undertook a phylogeographic study of American Woodcock populations throughout their primary breeding range in the eastern United States and Canada using mitochondrial DNA (mtDNA) sequences from the hypervariable control region I (CRI) and ND6 gene. Despite high haplotype diversity, nucleotide diversity was low and there was no phylogeographic structure among American Woodcock populations across the species range, with birds from many states and provinces in both management regions sharing identical haplotypes. Results suggest recent or ongoing gene flow among populations, with asymmetric movement of birds between migration flyways. As has been demonstrated for several other avian species in North America, American Woodcock appear to have undergone a rapid population expansion following the late Pleistocene glacial retreat. Thus, a combination of historical demographic factors and recent or ongoing gene flow mask any population structure based on mtDNA that might accrue from philopatry to breeding areas observed in studies of marked birds.

  17. Adaptive harvest management of North American waterfowl populations: a brief history and future prospects

    Science.gov (United States)

    Nichols, J.D.; Runge, M.C.; Johnson, F.A.; Williams, B.K.

    2007-01-01

    Since 1995, the US Fish and Wildlife Service has used an adaptive approach to the management of sport harvest of mid-continent Mallard ducks (Anas platyrhynchos) in North America. This approach differs from many current approaches to conservation and management in requiring close collaboration between managers and scientists. Key elements of this process are objectives, alternative management actions, models permitting prediction of system responses, and a monitoring program. The iterative process produces optimal management decisions and leads to reduction in uncertainty about response of populations to management. This general approach to management has a number of desirable features and is recommended for use in many other programs of management and conservation.

  18. 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.

  19. 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.

  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. Aetiology, diagnosis and management of infective causes of severe haemoptysis in intensive care units.

    Science.gov (United States)

    Fartoukh, Muriel; Parrot, Antoine; Khalil, Antoine

    2008-05-01

    Infective causes of severe haemoptysis have progressively shifted to causes related to chronic inflammatory lung diseases. Physicians should, however, recognize the most common of them, for example necrotizing parenchymal infections, tuberculosis and mycetoma. The recent increase in the incidence of a devastating Panton-Valentine leukocidin-associated staphylococcal pneumonia has reminded us of the crucial role of prompt diagnosis and management. General supportive care should be administered to prevent asphyxiation in addition to starting appropriate antibiotics as soon as possible. Once the bleeding has been controlled, the diagnostic strategy should integrate a detailed medical history, physical examination, Gram stain of the respiratory specimens and chest radiograph. Computed tomography scan has dramatically improved the diagnosis and the treatment of infective causes of severe haemoptysis by assessing the cause and mechanism(s) of haemoptysis. Although bronchial arteries are the major source of bleeding, nonbronchial systemic and pulmonary arteries' involvement should be feared, especially in haemoptysis related to tuberculosis and mycetoma. Endovascular therapy should be first attempted to control the bleeding and then elective surgery performed in case of localized lesion and adequate pulmonary function. Fibreoptic bronchoscopy with broncho-alveolar lavage remains the cornerstone of diagnosis in immunocompromised hosts with haemoptysis and in the rare cases of alveolar haemorrhage related to infectious diseases.

  2. 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....... In the semi-natural forest, advanced regeneration and lateral closure of the gap affected soil moisture levels in the gap in the last year of the study. Author Keywords: gaps; drainage fluxes; Fagus sylvatica L.; nitrate; soil moisture; soil solution; unmanaged forest ecosystems; WATBAL......Soil moisture content (0-90 cm depth) and nitrate-nitrogen (NO3-N) concentrations in soil solution (90 cm depth) were monitored after gap formation (diameter 15-18 m) in three Danish beech-dominated forests on nutrient-rich till soils. NO3-N drainage losses were estimated by the water balance model...

  3. Impact of armillaria root rot in intensively managed white spruce/aspen stands

    Energy Technology Data Exchange (ETDEWEB)

    Blenis, P.V.; Mallet, K.I.; Titus, S.J.

    1995-12-31

    The Western Boreal Growth and Yield (WESBOGY) experiment was initiated to determine the growth and yield of aspen and white spruce when the two species occur in mixtures at different densities. Armillaria root rot may play an important role in mixedwood management because the fungus can attack both spruce and aspen, and the spatial distribution of trees influences the spread of these pathogens. The ultimate objective of WESBOGY is to determine the effect of the different densities on the impact of Armillaria root rot. However, as Armillaria may be distributed irregularly across the landscape, it is necessary to know the initial pathogen population so that it can be used as a covariate to adjust estimated treatment effects to account for different starting levels of Armillaria. This paper reports on a project to determine the distribution of Armillaria in two replicates of the WESBOGY trial. Armillaria distribution was determined by inserting trap logs into the soil between the planted spruces in July 1993 and examining the logs a year later for the distinctive white mycelium typical of Armillaria.

  4. [Survey on the management of acute renal failure and renal replacement techniques in Spanish intensive care units].

    Science.gov (United States)

    Úbeda-Iglesias, A; Herrera-Rojas, D; Gómez-González, C

    2015-03-01

    To analyze knowledge and experience in the diagnosis and management of acute renal failure (ARF) and the use of renal replacement therapy (RRT) in different Spanish Intensive Care Units (ICUs). A case series with a survey conducted by the Nephro-Intensive Care Working Group of the SEMICYUC was compiled between January and November 2011. Spanish national ICUs. A survey of 28 questions with multiple and open responses. The survey was sent to 99 ICUs. Volunteers consisting of the medical staff belonging to the 51 ICUs that responded. Main variables of interest General characteristics of hospitals and ICUs, definitions of ARF and RRT (indications and management). RIFLE/AKIN scales to define ARF (47%). ARF diagnosis: plasma creatinine (80.4%), creatinine clearance (52.9%). Protocols for RRT: 72.5%. RRT in non-renal indications: 70.6%. Indications for initiation of RRT: oliguria, increased creatinine and urea. End of RRT: increased diuresis. RRT dose: 21-35 ml/kg/h (41.2%), 36-45ml/kg/h (33.3%). There is great variability in the ARF detection methods, and adequate incorporation of the RIFLE/AKIN systems to daily clinical practice in the ICU is still lacking. Written protocols aimed at establishing an early diagnosis of ARF are needed, based on these systems. On the other hand, there is growing interest in RRT, despite the fact that there are no definitive indications or guidelines on the use and handling of such techniques. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  5. Ten-year follow-up of early intensive self-management guidance in newly diagnosed patients with asthma.

    Science.gov (United States)

    Kauppinen, Ritva Sirkka; Vilkka, Vesa; Hedman, Jouni; Sintonen, Harri

    2011-11-01

    We assessed the 10-year effectiveness of self-management guidance in a prospective follow-up study of patients with asthma when inhaled corticosteroids were used from the beginning in the treatment. Consecutive newly diagnosed asthmatics (n = 162) were randomized: 80 to an intervention group (IG) and 82 to a control group (CG). Lung function (LF), airway hyperresponsiveness (AHR), and health-related quality of life (HRQoL) were examined at 10 years. The advantages of intensive education with regards to LF measured by forced expiratory volume in 1 second and forced vital capacity were seen only after the first year. Later, there were no statistically significant differences in any parameters between the groups. However, during 10-year follow-up, peak expiratory flow, AHR, and HRQoL improved significantly in both groups (no differences as regards gender, smoking, or atopy). At 10 years, 68% of the IG and 75% of the CG patients still showed AHR after histamine challenge. Generic HRQoL scores in both groups equaled that of the age-standardized group a general population but only 50% in the IG and 55% in the CG had normal disease-specific HRQoL scores. According to Global Initiative for Asthma (GINA) criteria 23% of patients in the IG and 25% in the CG had asthma under control. The effectiveness of intensive self-management education could be shown only in the short term. The groups did not differ significantly in any of the parameters investigated, and showed nearly normal LF and HRQoL. AHR improved only partly and only a minority of the patients had asthma under good control according to GINA criteria. This study showed that evaluation of asthma using LF alone does not show the whole truth about asthma treatment results. HRQoL should be used in conjunction with GINA criteria, to assess asthma treatment outcomes. The value and importance of AHR for the evaluation of treatment remains obscure.

  6. Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

    Directory of Open Access Journals (Sweden)

    Keith Killu

    2014-01-01

    Full Text Available Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC ultrasound curriculum into an intensive care unit (ICU fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720. Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435. Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

  7. Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

    Science.gov (United States)

    Killu, Keith; Coba, Victor; Mendez, Michael; Reddy, Subhash; Adrzejewski, Tanja; Huang, Yung; Ede, Jessica; Horst, Mathilda

    2014-01-01

    Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied. PMID:25478217

  8. Spirituality, Religiosity, and Weight Management among African American Adolescent Males: The Jackson Heart KIDS Pilot Study

    OpenAIRE

    Bruce, Marino A.; Beech, Bettina M.; Griffith, Derek M.; Thorpe, Roland J.

    2016-01-01

    Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12–19 year old African American males (N=105) in the Jackson Heart Kids Pilot Study. Key variables of interest are church atte...

  9. 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.

  10. 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.

  11. 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.

  12. Managing wetlands for waterbirds: How managers can make a difference in improving habitat to support a North American Bird Conservation Plan

    Science.gov (United States)

    Erwin, R.M.; Laubhan, M.K.; Cornely, J.E.; Bradshaw, D.M.; Bonney, Rick; Pashley, David N.; Cooper, Robert; Niles, Larry

    2000-01-01

    Wetlands are the most productive ecosystems in the world, yet they have suffered more loss and degradation than any other ecosystem. Not surprisingly, 50% (29 of 58) of all the bird species in the U. S. (excluding Hawaii and territories) that are listed either as federally threatened or endangered, or are on the U. S. Fish & Wildlife Service 1995 List of Migratory Nongame Birds of Management Concern, occupy wetland or aquatic habitats even though many remaining wetlands across the North American landscape already are managed primarily for waterbirds. Some of these wetlands are administered by federal and state entities (e.g., national wildlife refuges, national and state parks, state wetland management areas) or are maintained on private lands through federally supported restoration and enhancement programs (e.g., Conservation Reserve Program, Wetland Reserve Program, Waterfowl Production Areas, and Partners for Wildlife). Private organizations, such as the National Audubon Society, The Nature Conservancy, and private hunting clubs, also own wetland areas that are managed specifically to benefit wildlife. If management philosophies are altered to consider the entire complex of wetlands, many wetlands can provide benefits to a broad array of waterbirds, as opposed to just one or a few species. However, challenges for natural resource managers are in forming partnerships with owners-managers of wetlands where the objectives are not primarily wildlife oriented. These owners or managers need to be included in wetland training workshops in an attempt to educate them about wetland values and secondary wildlife benefits that may be derived in flooded agricultural lands, aquaculture ponds, altered coastal marshes (mosquito control), and salt evaporation ponds. In some cases, compensation for crop damages by wildlife may be a necessary part of any cooperative agreements. In the development of a North American Bird Conservation Plan we propose a four-step approach and

  13. Adolescents with severe obesity: outcomes of participation in an intensive obesity management programme.

    Science.gov (United States)

    Luca, P; Dettmer, E; Khoury, M; Grewal, P; Manlhiot, C; McCrindle, B W; Birken, C S; Hamilton, J K

    2015-08-01

    Most interventions for childhood obesity are randomized controlled studies. Less is known about the effectiveness of clinical obesity programmes. To assess outcomes in adolescents participating in the SickKids Team Obesity Management Program (STOMP) vs. a comparison group of obese adolescents. Severely obese adolescents (n = 75) in STOMP (15.1 ± 1.8 years, body mass index [BMI] 44.8 ± 7.8 kg m(-2) ) were compared with adolescents (n = 41) not in the programme (14.9 ± 2.0 years, BMI 34.5 ± 8.0 kg m(-2) ). Outcomes were change in BMI, cardiometabolic, psychological and health behaviour measures. At 6 months, STOMP patients' BMI was unchanged (0.08 ± 0.3; P = 0.79) and they reported improvements in quality of life and depression (-3.6 ± 1.4; P = 0.009), and increases in measures of readiness to change (RTC). Between-group differences in change between 0 and 6 months, in favour of STOMP patients, were observed for homeostatic measurement assessment-insulin resistance (HOMA-IR; -2.7 ± 1.0; P = 0.007), depression scores (-3.5 ± 1.7; P = 0.04), diet-RTC (0.6 ± 0.2; P change between 0 and 12 months, in favour of STOMP patients, were observed for waist circumference (-5.9 ± 2.4 cm; P = 0.01), HOMA-IR (-2.9 ± 0.7; P participants did not experience a significant reduction in BMI but did have improvements in cardiometabolic, psychological and health behaviour outcomes. Evaluation of paediatric clinical obesity programmes using multiple measures is essential to understanding real-world outcomes. © 2014 World Obesity.

  14. Takotsubo cardiomyopathy: real life management in the intensive coronary care unit.

    Science.gov (United States)

    Pullara, A; Chinaglia, A; Giammaria, M; Bequaraj, F; Orlando, F; Coda, L; Lucciola, M T; Forno, D; Ravera, L; Cecchi, E; Gaita, F; Belli, R

    2013-10-01

    Takotsubo cardiomyopathy is a cardiac syndrome characterized by reversible left ventricular dysfunction, ischemic changes on electrocardiogram, elevation of cardiac biomarkers, absence of obstructive coronary artery disease in the setting of various stressing conditions. To date, little is known on best clinical management of this syndrome in coronary care units. Whe thus aimed to present our experience in a real life takotsubo population. We identified all patients with Takotsubo cardiomyopathy at our center Maria Vittoria Hospital, Turin, between October 2006 and February 2012. Patients where considered to have Takotsubo syndrome if they presented chest pain on admission, new elettrocardiographic changes suggestive of myocardial ischemia, evidence of apical balloning with hyperkinesis of basal segments on echocardiography, rise in troponin I and, after coronary angiography, no coronary artery disease. We adjudicated the following clinical events: death and recurrence of ischemic events; we also made a detailed analysis of the stressing conditions leading to clinical syndrome. A total of 26 patients were included, 4 (15%) males and 22 (85%) females; mean age was 71±13. After more than 1 year median follow-up the incidence of death was 7.7% (2 deaths), with all deaths, due to cardiogenic shock, occurring in the first 10 days of hospitalization; 2 patients (8%) experienced recurrence of ischemic event. Leading cause of Takostubo was major depressive episode (16%), followed by mourning (12%), falling down with difficulties in standing up (12%), vomiting (8%) and pulmonary infection (8%). In the coronary care unit major complications of patients with Takotsubo syndrome were acute hearth failure (62%), cardiogenic shock (27%), sepsis (31%), pulmonary aedema (27%) and anemia (12%). Two patients needed non-invasive ventilation support and one intra-aortic balloon conterpulasation. In addition one patient developed rabdomyolysis and one left heart thrombus. Cornerstone

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. Using the health belief model to develop culturally appropriate weight-management materials for African-American women.

    Science.gov (United States)

    James, Delores C S; Pobee, Joseph W; Oxidine, D'lauren; Brown, Latonya; Joshi, Gungeet

    2012-05-01

    African-American women have the highest prevalence of adult obesity in the United States. They are less likely to participate in weight-loss programs and tend to have a low success rate when they do so. The goal of this project was to explore the use of the Health Belief Model in developing culturally appropriate weight-management programs for African-American women. Seven focus groups were conducted with 50 African-American women. The Health Belief Model was used as the study's theoretical framework. Participants made a clear delineation between the terms healthy weight, overweight, and obese. Sexy, flirtatious words, such as thick, stacked, and curvy were often used to describe their extra weight. Participants accurately described the health risks of obesity. Most believed that culture and genetics made them more susceptible to obesity. The perceived benefits of losing weight included reduced risk for health problems, improved physical appearance, and living life to the fullest. Perceived barriers included a lack of motivation, reliable dieting information, and social support. Motivators to lose weight included being diagnosed with a health problem, physical appearance, and saving money on clothes. Self-efficacy was primarily affected by a frustrated history of dieting. The data themes suggest areas that should be addressed when developing culturally appropriate weight-loss messages, programs, and materials for African-American women. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. Ionospheric F region effects observed in the American and African sectors during the intense geomagnetic storm of September-October 2012

    Science.gov (United States)

    De Jesus, Rodolfo; Gende, Mauricio; Fagundes, Paulo Roberto; Coster, Anthea; Bolaji, Segun; Kavutarapu, Venkatesh; De Abreu, Alessandro; Sobral, J. H. A.; Pillat, Valdir Gil; Batista, Inez S.

    This study presents an investigation of geomagnetic disturbance effects on the equatorial, low- and mid-latitude ionospheric F region over the American and African sectors during the intense geomagnetic storm (maximum Kp index of 6.7) that occurred on 30th September, 2012 and 1st October, 2012. In this study digital ionosonde and Global Positioning System (GPS) data are simultaneously utilized from 30th September to 3rd October 2012. The diurnal variability over this four day period observed from both the digital ionosonde and from ground based GPS units can be characterized as quiet, slightly disturbed, and strongly disturbed periods. This time period includes the sudden commencement of the storm (SCS), the main phase (MPS), and the recovery phase of the storm (RPS). During the period of investigation, ionospheric parameters F-region critical frequency (foF2) and minimum F-region virtual height ('hF) were obtained at Jicamarca, São Luís, Fortaleza, Palmas and Port Stanley at the following geographical coordinates, respectively: 12.0ºS 76.8ºW, 2.6ºS 44.2ºW, 3.8ºS 38ºW, 10.2ºS 48.8ºW and 51.6ºS 57.9ºW. In this study, we also used observations of 20 GPS stations located at Greenbelt (39.0ºN, 76.8ºW), Cambridge (38.6ºN, 76.1ºW), Virgin Islands (17.6ºN, 64.6ºW), Eusebio (03.9ºS, 38.4ºW), Iquitos (03.8ºS, 73.3 ºW), Arequipa (16.5ºS, 71.5ºW), Cachoeira Paulista (22.7ºS, 45.0ºW), Copiapo (27.4ºS, 70.4ºW), La Plata (34.9ºS, 57.9ºW), Concepcion (36.8ºS, 73.0ºW), Rio Grande (53.8ºS, 67.8ºW), Dakar (14.7ºN, 17.4ºW), Addis (09.0ºN, 38.8ºE), Cotonou (06.4ºN, 02.5ºE), Libreville (00.4ºN, 09.7ºE), Mbarara (00.6ºS, 30.7ºE), Lusaka (15.4ºS, 28.3ºE), Windhoek (22.6ºS, 17.1ºE), Springbok (29.7ºS, 17.9ºE) and Sutherland (32.4ºS, 20.8ºE). Vertical Total Electron Content (VTEC) and TEC fluctuations (ROT, rate of change of TEC) are calculated from GPS data using the measured Slant Total Electron Content (STEC) records from the 20 GPS

  2. 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.

  3. 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...

  4. 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.

  5. Spatial distribution of soils determines export of nitrogen and dissolved organic carbon from an intensively managed agricultural landscape

    Directory of Open Access Journals (Sweden)

    T. Wohlfart

    2012-11-01

    Full Text Available The surrounding landscape of a stream has crucial impacts on the aquatic environment. This study pictures the hydro-biogeochemical situation of the Tyrebækken creek catchment in central Jutland, Denmark. The intensively managed agricultural landscape is dominated by rotational croplands. The small catchment mainly consist of sandy soil types besides organic soils along the streams. The aim of the study was to characterise the relative influence of soil type and land use on stream water quality. Nine snapshot sampling campaigns were undertaken during the growing season of 2009. Total dissolved nitrogen (TDN, nitrate (NO3, ammonium nitrogen and dissolved organic carbon (DOC concentrations were measured, and dissolved organic nitrogen (DON was calculated for each grabbed sample. Electrical conductivity, pH and flow velocity were measured during sampling. Statistical analyses showed significant differences between the northern, southern and converged stream parts, especially for NO3 concentrations with average values between 1.4 mg N l−1 and 9.6 mg N l−1. Furthermore, throughout the sampling period DON concentrations increased to 2.8 mg N l−1 in the northern stream contributing up to 81% to TDN. Multiple-linear regression analyses performed between chemical data and landscape characteristics showed a significant negative influence of organic soils on instream N concentrations and corresponding losses in spite of their overall minor share of the agricultural land (12.9%. On the other hand, organic soil frequency was positively correlated to the corresponding DOC concentrations. Croplands also had a significant influence but with weaker correlations. For our case study we conclude that the fractions of coarse textured and organic soils have a major influence on N and DOC export in this intensively used landscape. Meanwhile, the contribution of DON to the total N

  6. 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.

  7. 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.

  8. [Severe Reye syndrome: report of 14 cases managed in a pediatric intensive care unit over 11 years].

    Science.gov (United States)

    Thabet, F; Durand, P; Chevret, L; Fabre, M; Debray, D; Brivet, M; Devictor, D

    2002-06-01

    Idiopathic Reye syndrome is a rare disease revealed by unexplained encephalopathy and microvesicular liver steatosis. Some clinical and epidemiological studies mainly performed in English speaking countries questioned the reality of Reye syndrome because numerous know inherited metabolic diseases, and some of them unrecognized, could mimick this disorder. We focused in our study on severe forms of Reye syndrome admitted to a pediatric intensive care unit. Retrospective study over the last eleven years (1991-2001) included all the pediatric patients admitted to our tertiary referral center with the classical American Reye syndrome criteria (e.g. CDC). Extensive metabolic screening was performed in all cases, except for the ultimately dead patients. Fourteen patients (mean age 52 months) were included. Fever always occurred before their admission and aspirin (n = 12) or acetaminophen (n = 7) was prescribed. Median Glasgow scale was 7 on admission. Mean amoniac plasma level was 320 mumol/L and alanine-aminotransferase peak plasma level 1475 +/- 1387 IU/L. Mechanical ventilation was started in ten children and six of them underwent continuous venovenous hemofiltration. Three patients ultimately died and 11 survived with a mean five years follow-up without relapses or neurological impairment. Any of them demonstrated inherited metabolic disease except for one infant with hereditary fructose intolerance. Unlike widespread opinion, severe Reye syndrome without identified metabolic disorders seems to not disappear in our country. Reye syndrome remains a potentially life threatening disease and raises for aggressive treatment of brain edema. If aspirin and Reye syndrome association are not formally documented in France, cautiousness must be kept in mind and all the aspirin adverse effects notifications should be addressed to the public drugs survey network.

  9. 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…

  10. 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.

  11. 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

  12. 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.

  13. Providing intensive addiction/housing case management to homeless veterans enrolled in addictions treatment: A randomized controlled trial.

    Science.gov (United States)

    Malte, Carol A; Cox, Koriann; Saxon, Andrew J

    2017-05-01

    This study sought to determine whether homeless veterans entering Veterans Affairs (VA) substance use treatment randomized to intensive addiction/housing case management (AHCM) had improved housing, substance use, mental health, and functional outcomes and lower acute health care utilization, compared to a housing support group (HSG) control. Homeless veterans (n = 181) entering outpatient VA substance use treatment were randomized to AHCM and HSG and received treatment for 12 months. AHCM provided individualized housing, substance use and mental health case management, life skills training, and community outreach. The control condition was a weekly drop-in housing support group. Adjusted longitudinal analyses compared groups on baseline to month 12 change in percentage of days housed and functional status, substance use, and mental health outcomes (36-Item Short-Form Health Survey; Addiction Severity Index [ASI]). Negative binomial regression models compared groups on health care utilization. Both conditions significantly increased percentage of days housed, with no differences detected between conditions. In total, 74 (81.3%) AHCM and 64 (71.1%) HSG participants entered long-term housing (odds ratio = 1.9, 95% confidence interval [0.9, 4.0], p = .088). HSG participants experienced a greater decrease in emergency department visits than AHCM (p = .037), whereas AHCM participants remained in substance use treatment 52.7 days longer (p = .005) and had greater study treatment participation (p housing and substance use care. For those veterans not entering or losing long-term housing, different approaches to outreach and ongoing intervention are required. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. 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)

  15. Prediction of Job Performance for Black, Mexican-American, and Caucasian Inventory Management Specialists.

    Science.gov (United States)

    Crooks, Lois A.; Mahoney, Margaret H.

    This report is a description of the instrumentation, methodology, and sample obtained for the final phase of the study concerned with the Occupational Inventory Management Specialist. Inventory managers were asked to keep a Daily Activity Log for five days and to record the range of activities and interaction with others in the process of…

  16. Reproductive Parameters in the Critically Endangered Blue-Throated Macaw: Limits to the Recovery of a Parrot under Intensive Management

    Science.gov (United States)

    Berkunsky, Igor; Daniele, Gonzalo; Kacoliris, Federico P.; Díaz-Luque, José A.; Silva Frias, Carmen P.; Aramburu, Rosana M.; Gilardi, James D.

    2014-01-01

    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. PMID:24941317

  17. 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.

  18. 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.

  19. 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.

  20. Using Religious Songs as an Integrative and Complementary Therapy for the Management of Psychological Symptoms Among African American Cancer Survivors.

    Science.gov (United States)

    Hamilton, Jill B; Worthy, Valarie C; Kurtz, Melissa J; Cudjoe, Joycelyn; Johnstone, Peter A

    Acupuncture, acupressure, yoga, meditation, cognitive-behavioral techniques, and, to a lesser extent, music are among those integrative and complementary therapies with known beneficial effects on psychological symptoms. However, noticeably absent from this research is the use of religious song as a type of integrative and complementary therapy. The aim of this study was to explore how religious songs were used to alleviate psychological symptoms associated with a cancer diagnosis among a sample of older African American cancer survivors. Thirty-one older African American cancer survivors residing in the Southeastern US participated in a qualitative descriptive study involving criterion sampling, open-ended semistructured interviews, and qualitative content analysis. Participants used religious songs in response to feeling depressed, low, or sad; feeling weak and seeking strength to endure treatment; and feeling worried, anxious, or fearful. Religious songs were also a source of support and hope. Types of religious songs included instructive, thanksgiving and praise, memory of forefathers, communication with God, and life after death. Religious songs appear to be an important form of religious expression in this population and used to manage psychological symptoms. Integrative and complementary oncology therapy has generally focused on yoga, meditation, acupuncture, and cognitive-behavioral techniques. However, religious songs are an important strategy used among older African American cancer patients. Religious songs can be readily integrated into cancer care. The incorporation of religious songs into spiritually based support groups and other integrative and complementary therapies might enhance health outcomes among this medically underserved cancer population.

  1. 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

  2. Diabetes management with a care coordinator improves glucose control in African Americans and Hispanics

    OpenAIRE

    Rawlins, Wayne S.; Toscano-Garand, Michele A.; Graham, Garth

    2017-01-01

    BACKGROUND: The purpose of this study was to evaluate diabetes control, as measured by hemoglobin A1c (HbA1c) improvements among African American and Hispanic patients receiving conventional clinical treatment combined with a bilingual diabetes educator using culturally and linguistically appropriate educational materials. This study also sought to estimate the healthcare cost savings resulting from any A1c improvements and assess the cost-effectiveness of this approach. MATERIALS AND METHODS...

  3. 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...

  4. Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans.

    Science.gov (United States)

    Vincent, Deborah; Clark, Lauren; Zimmer, Lorena Marquez; Sanchez, Jessica

    2006-01-01

    The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.

  5. 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/...

  6. Effects of intensive management practices on 10-year Douglas-fir growth, soil nutrient pools, and vegetation communities in the Pacific Northwest, USA

    Science.gov (United States)

    Robert A. Slesak; Timothy B. Harrington; Dave Peter; Daniel G. DeBruler; Stephen H. Schoenholtz; Brian D. Strahm

    2016-01-01

    Intensive management practices are commonly used to increase fiber production from forests, but potential tradeoffs with maintenance of long-term productivity and early successional biodiversity have yet to be quantified. We assessed soil and vegetation responses in replicated manipulations of logging debris (LD; either retained or removed) and competing vegetation...

  7. 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…

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

    Science.gov (United States)

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

    2009-01-01

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

  9. Impact of Goal Setting and Goal Attainment Methods on Asthma Outcomes: Findings From an Asthma Self-Management Intervention for African American Women

    Science.gov (United States)

    Aaron, Micah; Nelson, Belinda W.; Kaltsas, Elena; Brown, Randall W.; Thomas, Lara J.; Patel, Minal R.

    2017-01-01

    Optimal use of goal-setting strategies in self-management efforts with high-risk individuals with asthma is not well understood. This study aimed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to…

  10. Evaluating the placement and performance of nature based measures for managing flood runoff in intensively farmed landscapes

    Science.gov (United States)

    Wilkinson, Mark; Quinn, Paul; Hewett, Caspar; Stutter, Marc

    2017-04-01

    Over the past decade economic losses from fluvial floods have greatly increased and it is becoming less viable to use traditional measures for managing flooding solely. This has given rise to increasing interest in alternative, nature based solutions (NBS) for reducing flood risk that aim to manage runoff at the catchment source and deliver multiple benefits. In many cases these measures need to work with current agricultural practices. Intensive agriculture often results in increases in local runoff rates, water quality issues, soil erosion/loss and local flooding problems. However, there is potential for agriculture to play a part in reducing flood risk. This requires knowledge on the effectiveness of NBS at varying scales and tools to communicate the risk of runoff associated with farming. This paper assesses the placement, management and effectiveness of a selection of nature-based measures in the rural landscape. Measures which disconnect overland flow pathways and improve soil infiltration are discussed. Case study examples are presented from the UK where a large number of nature-based measures have been constructed as part of flood protection schemes in catchment scales varying from 50 ha to 25 km2. Practical tools to help locate measures in agricultural landscapes are highlighted including the Floods and Agriculture Risk Matrix (FARM), an interactive communication/visualization tool and FARMPLOT, a GIS mapping tool. These have been used to promote such measures, by showing how and where temporary ponded areas can be located to reduce flood and erosion risk whilst minimising disruption to farming practices. In most cases land managers prefer small ( 100-1000m3) temporary ponding areas which fill during moderate to large storm events since they incur minimal loss of land. They also provide greater resillience to multi-day storm events, as they are designed to drain over 1-2 days and therefore allow for storage capacity for proceeding events. However, the

  11. 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

  12. 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.

  13. 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.

  14. Effects of fire management on the richness and abundance of central North American grassland land snail faunas

    Directory of Open Access Journals (Sweden)

    Nekola, J. C.

    2002-01-01

    Full Text Available The land snail faunas from 72 upland and lowland grassland sites from central North America were analyzed. Sixteen of these had been exposed to fire management within the last 15 years, while the remainder had not. A total of 91,074 individuals in 72 different species were observed. Richness was reduced by approximately 30% on burned sites, while abundance was reduced by 50-90%. One-way ANOVA of all sites (using management type as the independent variable, a full 2-way ANOVA (using management and grassland type of all sites, and a 2-way ANOVA limited to 26 sites paired according to their habitat type and geographic location, demonstrated in all cases a highly significant (up to p < 0.0005 reduction in richness and abundance on fire managed sites. Contingency table analysis of individual species demonstrated that 44% experienced a significant reduction in abundance on fire-managed sites. Only six species positively responded to fire. Comparisons of fire response to the general ecological preferences of these species demonstrated that fully 72% of turf-specialists were negatively impacted by fire, while 67% of duff-specialists demonstrated no significant response. These differences were highly significant (p = 0.0006. Thus, frequent use of fire management represents a significant threat to the health and diversity of North American grassland land snail communities. Protecting this fauna will require the preservation of site organic litter layers, which will require the increase of fire return intervals to 15+ years in conjunction with use of more diversified methods to remove woody and invasive plants.

  15. 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.

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

    OpenAIRE

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

    2016-01-01

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

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

    Science.gov (United States)

    Di Maria, Francesco; Micale, Caterina

    2014-11-01

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

  18. 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

  19. 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

  20. 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

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

    Science.gov (United States)

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

    2011-11-10

    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. 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. 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. Netherlands Trial Register (NTR): NTR1976.

  2. Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997-2012.

    Science.gov (United States)

    Puymirat, Etienne; Fagon, Jean Yves; Aegerter, Philippe; Diehl, Jean Luc; Monnier, Alexandra; Hauw-Berlemont, Caroline; Boissier, Florence; Chatellier, Gilles; Guidet, Bertrand; Danchin, Nicolas; Aissaoui, Nadia

    2017-02-01

    To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years. From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P patients decreased by 2.7 years [95% confidence interval (CI), -2.0 to -3.4] and SAPS-II increased by 5.8% (95% CI 4.8-6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction. Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  3. 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.

  4. Challenges and lessons learned in establishing a critical zone observatory in an intensively managed rural landscape of India

    Science.gov (United States)

    Paul, D.; Tripathi, S.; Harsha, K. S.; Adla, S.; Dash, S. K.; Chander, Y.; Mahajan, P.; Tripathi, S. N.; Sen, I. S.; Sinha, R.

    2016-12-01

    The study of critical earth system processes, particularly in densely populated regions in the developing world, entails the additional challenges of incorporating anthropogenic forcing and the economic constraints of low-cost technology. The criteria for site selection of Critical Zone Observatory (CZO) networks (crucial for the advancement of hydrological research in data scarce regions) generally give weightage to pristine, undisturbed regions to study isolated critical zone processes. This study details the factors involved and challenges faced in establishing a CZO in the Pandu River basin (Uttar Pradesh, India). This region is representative of the fertile Ganga River Basin which produces 50% of India's food grain annually and is critical for the food security of about 40% of the Indian population. Moreover, Uttar Pradesh has the highest absolute population and population density among all Indian states, amongst the lowest GDP/capita, an average landholding size of 0.76 ha with 92% of operational farm-holdings categorized as small or marginal. The significant proportion of Indians disgruntled with the state of public sector corruption may transform into scepticism towards government projects such as ours, thereby constraining our options for secure site selection. Within the framework of hypothesis-experiment-learning feedback loops, this paper chronicles iterative field trials and their outcomes in establishing an intensively managed rural landscape CZO. The work includes a conscious effort to combine the strengths of low-cost sensor, data logging and data-transfer technology and citizen science approaches through participatory data collection guided by scientific, socio-economic, cultural, political and administrative considerations.

  5. 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

  6. THE ISSUE AND IMPORTANCE OF CREDIT RISK MANAGEMENT EXEMPLIFIELD BY THE COLLAPSE OF AMERICAN MORTGAGE MARKET

    OpenAIRE

    Karolina Przenajkowska

    2008-01-01

    The risk is connected to all types of economic activities. It is especially important for the functioning of banks, which are institutions based on the trust of the society. The most common risk banks have to face is the credit risk. The first part of the paper refers to the reasons, classification and consequences of its appearance. Serious negative effects of credit risk existence force banks to design programs of this type of risk management. The credit risk management is founded on the ba...

  7. Whole Watershed Management to Maximize Total Water Storage: Case Study of the American-Cosumnes River Basin

    Science.gov (United States)

    Goharian, E.; Gailey, R.; Medellin-Azuara, J.; Maples, S.; Adams, L. E.; Sandoval Solis, S.; Fogg, G. E.; Dahlke, H. E.; Harter, T.; Lund, J. R.

    2016-12-01

    Drought and unrelenting water demands by urban, agricultural and ecological entities present a need to manage and perhaps maximize all the major stores of water, including mountain snowpack and soil moisture, surface reservoirs, and groundwater reservoirs for the future. During drought, the over-exploitations of groundwater, which supplies up to 60% of California's agricultural water demand, has caused serious overdraft in many areas. Moreover, owing to climate change, faster and earlier snowmelt in Mediterranean climate systems such as California dictates that less water can be stored in reservoirs. If we are to substantially compensate for this loss of stored water without drastically cutting back water supply, a new era of radically increased groundwater recharge will be needed. Managed aquifer recharge (MAR) has become a common and fast-growing management option, especially in areas with high water availability variation intra- and inter-annually. Enhancing the recharge by the use of peak runoff requires integrated river basin management to improve prospects to downstream users and ecology. This study implements a quantitative approach to assess the physical and economic feasibility of MAR for American-Cosumnes River basin, CA. For this purpose, two scenarios are considered, the pre-development condition which is represented by unimpaired flows, and the other one in which available peak flow releases from Folsom reservoir derived from the CalSim II hydrologic simulation model will be employed to estimated available water for recharge. Preliminary results show peak flows during winter (Dec-Feb) and extended winter (Nov-Mar) from the American River flow can be captured within a range of 64,000 to 198,000 af/month through the Folsom South Canal for recharge. Changes in groundwater storage are estimated by using California Central Valley Groundwater-Surface Water Simulation Model (C2VSim). Results show increasing groundwater recharge benefits not only the regional

  8. 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…

  9. Ecological foundations for fire management in North American forest and shrubland ecosystems

    Science.gov (United States)

    J.E. Keeley; G.H. Aplet; N.L. Christensen; S.G. Conard; E.A. Johnson; P.N. Omi; D.L. Peterson; T.W. Swetnam

    2009-01-01

    This synthesis provides an ecological foundation for management of the diverse ecosystems and fire regimes of North America based on scientific principles of fire interactions with vegetation, fuels, and biophysical processes. Although a large amount of scientific data on fire exists, most of those data have been collected at small spatial and temporal scales. Thus, it...

  10. University-Industry Entrepreneurship: The Organization and Management of American University Technology Transfer Units.

    Science.gov (United States)

    Dill, David D.

    1995-01-01

    A survey of 289 university technology transfer units investigated their organization, management, and perceived performance effectiveness. Unit types studied included licensing and patent offices, small business development centers, research and technology centers, business facility incubators, and entrepreneurial investment/endowment offices.…

  11. 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...

  12. 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

    2017-08-01

    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

  13. 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.

  14. 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.

  15. Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension.

    Science.gov (United States)

    Bartolome, Rowena E; Chen, Agnes; Handler, Joel; Platt, Sharon Takeda; Gould, Bernice

    2016-01-01

    At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity. These strategies were implemented through: 1) physician-led educational programs on treatment intensification, medication adherence, and consistent use of clinical practice guidelines; 2) building strong care teams by defining individual roles and responsibilities in hypertension management; 3) redesign of the care delivery system to expand access; and 4) programs on culturally tailored communication tools and self-management. At a physician practice level where 65% of patients with hypertension were black, BP control rates (team-based approach closed the gap for blacks with hypertension.

  16. Women Weigh In: Obese African-American and White Women’s Perspectives on Physicians’ Roles in Weight Management

    Science.gov (United States)

    Chugh, M.; Friedman, A. M.; Clemow, L. P.; Ferrante, J. M.

    2013-01-01

    Background There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race. Methods This qualitative study used semi-structured in-depth interviews of 33 moderately to severely obese white and African-American (AA) women to elucidate and compare their perceptions regarding their primary care physician’s approach to weight loss counseling. Data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. Results White and AA women appeared to internalize weight stigma differently. AA participants spoke about their pride and positive body image, while white women more frequently expressed self-deprecation and feelings of depression. Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including: (1) giving specific weight loss advice and individualized plans for weight management; (2) addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and (3) providing encouragement to foster self-motivation for weight loss. Conclusion While both AA and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression and low self-esteem before attempting weight loss. PMID:23833157

  17. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

    Science.gov (United States)

    2015-11-01

    To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are

  18. Effect of genetic and nongenetic factors on chemical composition of individual milk samples from dromedary camels (Camelus dromedarius) under intensive management.

    Science.gov (United States)

    Nagy, P; Fábri, Zs N; Varga, L; Reiczigel, J; Juhász, J

    2017-11-01

    The aims of the present study were to monitor the changes in gross chemical composition of individual dromedary camel milk over a 5-yr period, to provide reference values, and to determine the effect of genetic and nongenetic factors influencing camel milk composition under intensive management. A total of 1,528 lactating dromedary camels were included in the study. Animals were fed a constant diet and were milked twice a day in a herringbone parlor. Milk samples were collected at monthly intervals using a sampling device and then fat, protein, lactose, total solids (TS), and solids-nonfat (SNF) concentrations of raw camel milk were determined with an automatic milk analyzer. For each milk sample, production parameters were recorded and quantities (grams) of milk constituents were calculated. The overall mean quantity and fat, protein, lactose, SNF, and TS concentrations of the morning milk were 4.0 kg, 2.58%, 2.95%, 4.19%, 8.08%, and 10.46%, respectively. Milk quantity showed a positive correlation with lactose and a negative correlation with all other components. Parity exerted a strong effect on all milk parameters. Primiparous dromedaries (n = 60) produced less milk with higher concentrations of components than did multiparous animals (n = 1,468). Milk composition varied among the 7 breeds tested, but none of the genotypes was found to be superior to the others in this respect. We detected a significant, yet small calf sex-biased difference in milk yield and composition. Stage of lactation and season strongly influenced milk yield and all milk components. We also found a significant interaction between month postpartum (mPP) and month of the year. The concentration of all milk components decreased from 1 to 5 mPP. Later, lactose concentration and quantity continued to decrease parallel with decreasing milk production. The concentration of other components showed a temporary increase in mid lactation, from 6 to 11 mPP, and in late lactation, from 18 to 23 m

  19. 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

  20. 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

  1. The role of population monitoring in the management of North American waterfowl

    Science.gov (United States)

    Nichols, J.D.; Williams, B.K.; Johnson, F.A.

    2000-01-01

    Despite the effort and expense devoted to large-scale monitoring programs, few existing programs have been designed with specific objectives in mind and few permit strong inferences about the dynamics of monitored systems. The waterfowl population monitoring programs of the U.S. Fish and Wildlife Service, Canadian Wildlife Service and state and provincial agencies provide a nice example with respect to program objectives, design and implementation. The May Breeding Grounds Survey provides an estimate of system state (population size) that serves two primary purposes in the adaptive management process: identifying the appropriate time-specific management actions and updating the information state (model weights) by providing a basis for evaluating predictions of competing models. Other waterfowl monitoring programs (e.g., banding program, hunter questionnaire survey, parts collection survey, winter survey) provide estimates of vital rates (rates of survival, reproduction and movement) associated with system dynamics and variables associated with management objectives (e.g., harvest). The reliability of estimates resulting from monitoring programs depends strongly on whether considerations about spatial variation and detection probability have been adequately incorporated into program design and implementation. Certain waterfowl surveys again provide nice examples of monitoring programs that incorporate these considerations.

  2. Lessons Learned from 20 Years of Diabetes Self-Management Research With Mexican Americans in Starr County, Texas.

    Science.gov (United States)

    Brown, Sharon A; Hanis, Craig L

    2014-07-01

    The purpose is to provide an overview of a 20-year research program aimed at testing diabetes self-management education interventions culturally tailored for Mexican Americans residing in an impoverished rural community on the Texas-Mexico border. The research program involved focus group interviews to obtain community input, pilot testing to refine instruments and interventions, and community-based randomized controlled trials to examine intervention effects. Here the authors summarize lessons learned related to the (1) overall effects of culturally tailored diabetes self-management education; (2) impact of culture on study design, intervention development, health outcomes, and community acceptance; (3) benefits of and findings from multiple focus groups held over time in the community; and (4) personal and cultural motivators for behavioral change that were evident among study participants. Postintervention reductions in A1C ranged from 1.4 to 1.7 percentage points. Individuals who attended ≥ 50% of intervention sessions achieved a 6-percentage point reduction in A1C. Intervention teams included bilingual Mexican American nurses, dietitians, and promotoras, all recruited from the local community. Focus group interviews indicated that a traditional promotora model was not acceptable to the participants who wanted knowledgeable health professionals, or perceived authority figures, to lead intervention sessions while promotoras provided logistical support. Free glucometers and strips, family participation, and interpersonal dynamics within intervention groups motivated individuals to make healthier lifestyle choices. Culturally tailored diabetes interventions are effective in improving the health of socially disadvantaged minorities who bear a disproportional burden of type 2 diabetes, and these interventions are cost-effective. © 2014 The Author(s).

  3. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples.

    Science.gov (United States)

    Jimenez, Nathalia; Garroutte, Eva; Kundu, Anjana; Morales, Leo; Buchwald, Dedra

    2011-05-01

    Substantial literature suggests that diverse biological, psychological, and sociocultural mechanisms account for differences by race and ethnicity in the experience, epidemiology, and management of pain. Many studies have examined differences between Whites and minority populations, but American Indians (AIs), Alaska Natives (ANs), and Aboriginal peoples of Canada have been neglected both in studies of pain and in efforts to understand its biopsychosocial and cultural determinants. This article reviews the epidemiology of pain and identifies factors that may affect clinical assessment and treatment in these populations. We searched for peer-reviewed articles focused on pain in these populations, using PubMed, CINAHL, Cochrane, and the University of New Mexico Native Health Database. We identified 28 articles published 1990 to 2009 in 3 topic areas: epidemiology of pain, pain assessment and treatment, and healthcare utilization. A key finding is that AI/ANs have a higher prevalence of pain symptoms and painful conditions than the U.S. general population. We also found evidence for problems in provider-patient interactions that affect clinical assessment of pain, as well as indications that AI/AN patients frequently use alternative modalities to manage pain. Future research should focus on pain and comorbid conditions and develop conceptual frameworks for understanding and treating pain in these populations. We reviewed the literature on pain in AI/ANs and found a high prevalence of pain and painful conditions, along with evidence of poor patient-provider communication. We recommend further investigation of pain and comorbid conditions and development of conceptual frameworks for understanding and treating pain in this population. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. Epidemiology and neonatal pain management of heelsticks in intensive care units: EPIPPAIN 2, a prospective observational study.

    Science.gov (United States)

    Courtois, Emilie; Droutman, Stéphanie; Magny, Jean-François; Merchaoui, Zied; Durrmeyer, Xavier; Roussel, Camille; Biran, Valérie; Eleni, Sergio; Vottier, Gaëlle; Renolleau, Sylvain; Desfrere, Luc; Castela, Florence; Boimond, Nicolas; Mellah, Djamel; Bolot, Pascal; Coursol, Anne; Brault, Dominique; Chappuy, Hélène; Cimerman, Patricia; Anand, Kanwaljeet J S; Carbajal, Ricardo

    2016-07-01

    Heelstick is the most frequently performed skin-breaking procedure in the neonatal intensive care units (NICUs). There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs. To describe the frequency of heelsticks and their analgesic management in newborns in the NICU. To determine the factors associated with the lack of specific preprocedural analgesia for this procedure. EPIPPAIN 2 (Epidemiology of Procedural PAin In Neonates) is a descriptive prospective epidemiologic study. All 16 NICUs in the Paris region in France. All newborns in the NICU with a maximum corrected age of 44 weeks +6 days of gestation on admission who had at least one heelstick during the study period were eligible for the study. The study included 562 newborns. Data on all heelsticks and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011 to July 12, 2011. Newborns were followed from their admission to the 14th day of their NICU stay or discharge, whichever occurred first. The mean (SD) gestational age was 33.3 (4.4) weeks and duration of participation was 7.5 (4.4) days. The mean (SD; range) of heelsticks per neonate was 16.0 (14.4; 1-86) during the study period. Of the 8995 heelsticks studied, 2379 (26.4%) were performed with continuous analgesia, 5236 (58.2%) with specific preprocedural analgesia. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific). In a multivariate model, the increased lack of preprocedural analgesia was associated with female sex, term birth, high illness severity, tracheal or noninvasive ventilation, parental absence and use of continuous sedation/analgesia. Heelstick was very frequently performed in NICUs. Although, most heelsticks were performed with analgesia, this was not systematic. The high frequency of this procedure and the known adverse effects of repetitive pain in neonates

  6. 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.

  7. Sociodemographic Factors, Acculturation, and Nutrition Management among Hispanic American Adults with Self-reported Diabetes.

    Science.gov (United States)

    Yoshida, Yilin Xu; Simonsen, Neal; Chen, Liwei; Zhang, L U; Scribner, Richard; Tseng, Tung-Sung

    2016-01-01

    This study aimed to examine whether sociodemographic factors and acculturation affect achievement of selected American Diabetes Association (ADA) nutrition therapy recommendations among Hispanics with diabetes. Cross-sectional data for Hispanics with diabetes in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were used. Achievements of the ADA recommendation for five nutrition components were examined (i.e., daily intake of saturated fat, cholesterol, sodium, and fiber, and daily servings of alcohol). Acculturation measurement derived from language use, country of birth, and length of residence in the U.S. Logistic regressions were performed. Only 49% of Hispanics with diabetes met three or more recommended criteria. Male gender and younger age (≤45) predicted poor recommendation adherence. More acculturated individuals had around 50% lower odds to achieve saturated fat [OR 0.5, CI 0.2-0.7], fiber [OR 0.5, CI 0.2-0.9], sodium [OR 0.5, CI 0.3-0.9] and cholesterol intake [OR 0.5, CI 0.3-0.8] recommendations than their less acculturated counterparts.

  8. 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.

  9. Effects of silvicultural management intensity on fluxes of dissolved and particulate organic matter in 27 forest sites of the Biodiversity Exploratories

    Science.gov (United States)

    Michalzik, Beate; Bischoff, Sebastian; Levia, Delphis; Schwarz, Martin; Escher, Peter; Wilcke, Wolfgang; Thieme, Lisa; Kerber, Katja; Kaupenjohann, Martin; Siemens, Jan

    2017-04-01

    In forested ecosystems, throughfall and stemflow function as key components in the cycling of water and associated biogeochemistry. Analysing annual flux data collected from 27 intensively monitored forest sites of the Biodiversity Exploratories, we found throughfall fluxes of DOC (dissolved organic carbon) linearly related (R2 = 0.40, p losses of DOC and POC from the litter layer of forests increased significantly with increasing forest management intensity. The observed relationships revealed by intensive flux monitoring are important because they allow us to link organic matter fluxes to forest metrics of larger forested areas (e.g. derived from LiDAR imagery), and hence to model and up-scale water-bound OC dynamics to the landscape level.

  10. 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

  11. 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

  12. 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

  13. Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

    Directory of Open Access Journals (Sweden)

    Paulo Lisboa Bittencourt

    Full Text Available ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

  14. North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome.

    Science.gov (United States)

    Emery, Stephen P; Hasley, Steve K; Catov, Janet M; Miller, Russell S; Moon-Grady, Anita J; Baschat, Ahmet A; Johnson, Anthony; Lim, Foong-Yen; Gagnon, Alain L; O'Shaughnessy, Richard W; Ozcan, Tulin; Luks, Francois I

    2016-09-01

    Stage I twin-twin transfusion syndrome presents a management dilemma. Intervention may lead to procedure-related complications while expectant management risks deterioration. Insufficient data exist to inform decision-making. The aim of this retrospective observational study was to describe the natural history of stage I twin-twin transfusion syndrome, to assess for predictors of disease behavior, and to compare pregnancy outcomes after intervention at stage I vs expectant management. Ten North American Fetal Therapy Network centers submitted well-documented cases of stage I twin-twin transfusion syndrome for analysis. Cases were retrospectively divided into 3 management strategies: those managed expectantly, those who underwent amnioreduction at stage I, and those who underwent laser therapy at stage I. Outcomes were categorized as no survivors, 1 survivor, 2 survivors, or at least 1 survivor to live birth, and good (twin live birth ≥30.0 weeks), mixed (single fetal demise or delivery between 26.0-29.9 weeks), and poor (double fetal demise or delivery <26.0 weeks) pregnancy outcomes. Outcomes were analyzed by initial management strategy. A total of 124 cases of stage I twin-twin transfusion syndrome were studied. In all, 49 (40%) cases were managed expectantly while 30 (24%) underwent amnioreduction and 45 (36%) underwent laser therapy at stage I. The overall fetal mortality rate was 20.2% (50 of 248 fetuses). Of those managed expectantly, 11 patients regressed (22%), 4 remained stage I (8%), 29 advanced in stage (60%), and 5 experienced spontaneous previable preterm birth (10%) during observation. The mean number of days from diagnosis of stage I to a change in status (progression, regression, loss, or delivery) was 11.1 (SD 14.3) days. Intervention by amniocentesis or laser therapy was associated with a lower risk of fetal loss (P = .01) than expectant management. The unadjusted odds of poor outcome were 0.33 (95% confidence interval, 0.09-01.20), for

  15. "So We Adapt Step by Step": Acculturation experiences affecting diabetes management and perceived health for Chinese American immigrants.

    Science.gov (United States)

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

    2011-01-01

    This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N = 40) during group, couple and individual interviews conducted from 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N = 19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients' and spouses' acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants' varied family relations and pre-migration family support levels and diverse cultural and linguistic

  16. “So We Adapt Step by Step”: Acculturation Experiences Affecting Diabetes Management and Perceived Health for Chinese American Immigrants

    Science.gov (United States)

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

    2011-01-01

    This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N=40) during group, couple and individual interviews conducted in 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N=19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients’ and spouses’ acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants’ varied family relations and pre-migration family support levels and diverse cultural and linguistic

  17. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.

    Science.gov (United States)

    Hernández-Tejedor, A; Peñuelas, O; Sirgo Rodríguez, G; Llompart-Pou, J A; Palencia Herrejón, E; Estella, A; Fuset Cabanes, M P; Alcalá-Llorente, M A; Ramírez Galleymore, P; Obón Azuara, B; Lorente Balanza, J A; Vaquerizo Alonso, C; Ballesteros Sanz, M A; García García, M; Caballero López, J; Socias Mir, A; Serrano Lázaro, A; Pérez Villares, J M; Herrera-Gutiérrez, M E

    The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  18. Evaluation of the shaking technique for the economic management of American foulbrood disease of honey bees (Hymenoptera: Apidae).

    Science.gov (United States)

    Pernal, Stephen F; Albright, Robert L; Melathopoulos, Andony P

    2008-08-01

    Shaking is a nonantibiotic management technique for the bacterial disease American foulbrood (AFB) (Paenibacillus larvae sensu Genersch et al.), in which infected nesting comb is destroyed and the adult honey bees, Apis mellifera L. (Hymenoptera: Apidae), are transferred onto uncontaminated nesting material. We hypothesized that colonies shaken onto frames of uninfected drawn comb would have similar reductions in AFB symptoms and bacterial spore loads than those shaken onto frames of foundation, but they would attain higher levels of production. We observed that colonies shaken onto drawn comb, or a combination of foundation and drawn comb, exhibited light transitory AFB infections, whereas colonies shaken onto frames containing only foundation failed to exhibit clinical symptoms. Furthermore, concentrations of P. larvae spores in honey and adult worker bees sampled from colonies shaken onto all comb and foundation treatments declined over time and were undetectable in adult bee samples 3 mo after shaking. In contrast, colonies that were reestablished on the original infected comb remained heavily infected resulting in consistently high levels of spores, and eventually, their death. In a subsequent experiment, production of colonies shaken onto foundation was compared with that of colonies established from package (bulk) bees or that of overwintered colonies. Economic analysis proved shaking to be 24% more profitable than using package bees. These results suggest that shaking bees onto frames of foundation in the spring is a feasible option for managing AFB in commercial beekeeping operations where antibiotic use is undesirable or prohibited.

  19. A survey of members of the American Academy of Pediatric Dentistry on their use of behavior management techniques.

    Science.gov (United States)

    Adair, Steven M; Waller, Jennifer L; Schafer, Tara E; Rockman, Roy A

    2004-01-01

    The objective of this study was to survey members of the American Academy of Pediatric Dentistry (AAPD) regarding their use of behavior management techniques. Surveys were mailed to 4,180 members, with a follow-up mailing to nonrespondents 2 months later. The survey contained items on demographic variables and use (current, past, and future) of communicative and pharmacologic techniques. Information was also obtained on informed consent, parental presence in the operatory, and parenting styles. Survey response was 66%. Communicative techniques are widely used, with the exception of the hand-over-mouth exercise (HOME). Immobilization for sedated and nonsedated children and pharmacologic techniques are used by a majority or near majority of respondents. Little change was reported in technique use over time, except that 50% of respondents indicated they use HOME less now than 5 years ago, and 24% plan to use it less over the next 2 to 3 years. Parental presence in the operatory appeared to be a common practice for some procedures and for children with special health care needs. The majority of respondents believed that parenting styles had changed in ways that adversely impacted children's behavior in the dental setting. Most practitioners have not changed their use of behavior management techniques in recent years, nor do they plan to change their use of them in the near future. HOME was the exception to these trends.

  20. 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

    2017-06-01

    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 Instagram (β = 1.28, OR = 3.61, p = .014) and Facebook (β = 1.04, OR = 2.84, p < .006). Most were willing to participate in research that used text messages (73%), smartwatches/fitness trackers (69%), and 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 < .0001) as were those 30 to 50 (OR = 3.14, p < .0001). AAW's high ownership of 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.

  1. The Effect of Intensive Phototherapy on Management of Hyperbilirubinemia in Neonates with the Gestational Age of 34 Weeks and More

    Directory of Open Access Journals (Sweden)

    Maryam Saboute

    2017-12-01

    Results: According to the results of this study, nonhemolytic jaundice was the most frequent cause of hyperbilirubinemia (82.19%. The mean bilirubin levels after 6 and 24 hours of intensive phototherapy were 4 and 6.2 mg/dl, respectively. Intensive phototherapy after 6 hours led to more significant reduction in the total bilirubin level of the neonates with total bilirubin level of higher than 14 mg/dl in comparison to those with the total bilirubin level of 14 mg/dl or less. The total bilirubin level was significantly decreased in all the groups after 6 and 24 hours of intensive phototherapy. Comparison of the rate of decrement of the total bilirubin level among the groups demonstrated that the neonates with ABO incompatibility showed the greatest decline after 6 and 24 hours of treatment (the rate of bilirubin decline: -5.16; P

  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. A summary of the update on cardiovascular implantable electronic device infections and their management A scientific statement from the American Heart Association

    NARCIS (Netherlands)

    Baddour, Larry M.; Epstein, Andrew E.; Erickson, Christopher C.; Knight, Bradley P.; Levison, Matthew E.; Lockhart, Peter B.; Masoudi, Frederick A.; Okum, Eric J.; Wilson, Walter R.; Beerman, Lee B.; Bolger, Ann F.; Estes, N. A. Mark; Gewitz, Michael; Newburger, Jane W.; Schron, Eleanor B.; Taubert, Kathryn A.

    Background. The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for cardiovascular implantable electronic device (CIED) infections and their management, which were last published in 2003. Methods and Results. The AHA commissioned this scientific

  4. 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...

  5. Regional summer cooling from agricultural management practices that conserve soil carbon in the northern North American Great Plains

    Science.gov (United States)

    Stoy, Paul; Bromley, Gabriel; Gerken, Tobias; Tang, Angela; Morgan, Mallory; Wood, David; Ahmed, Selena; Bauer, Brad; Brookshire, Jack; Haggerty, Julia; Jarchow, Meghann; Miller, Perry; Peyton, Brent; Rashford, Ben; Spangler, Lee; Swanson, David; Taylor, Suzi; Poulter, Ben

    2017-04-01

    Conserving soil carbon resources while transitioning to a C negative economy is imperative for meeting global climate targets, and can also have critical but under-investigated regional effects. Parts of the North American northern Great Plains have experienced a remarkable 6 W m-2 decrease in summertime radiative forcing since the 1970s. Extreme temperature events now occur less frequently, maximum temperatures have decreased by some 2 ˚ C, and precipitation has increased by 10 mm per decade in some areas. This regional trend toward a cooler and wetter summer climate has coincided with changes in agricultural management. Namely, the practice of keeping fields fallow during summer (hereafter 'summerfallow') has declined by some 23 Mha from the 1970s until the present in the Canadian Prairie Provinces and across the U.S., an area of similar size to the United Kingdom. In addition to potential climate impacts, replacing summerfallow with no-till cropping systems results in lesser soil carbon losses - or even gains - and usually confers economic benefits. In other words, replacing summerfallow with no-till cropping may have resulted in a 'win-win-win' scenario for regional climate, soil carbon conservation, and farm-scale economics. The interaction between carbon, climate, and the economy in this region - and the precise domain that has experienced cooling - are still unknown, which limits our ability to forecast coupled carbon, climate, and human dynamics. Here, we use eddy covariance measurements to demonstrate that summerfallow results in carbon losses during the growing season of the same magnitude as carbon uptake by winter and spring wheat, on the order of 100 - 200 g C m-2 per growing season. We use eddy covariance energy flux measurements to model atmospheric boundary layer and lifted condensation level heights to demonstrate that observed regional changes in near-surface humidity (of up to 7%) are necessary to simulate observed increases in convective

  6. 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...

  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. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study.

    Science.gov (United States)

    Drawz, Paul E; Pajewski, Nicholas M; Bates, Jeffrey T; Bello, Natalie A; Cushman, William C; Dwyer, Jamie P; Fine, Lawrence J; Goff, David C; Haley, William E; Krousel-Wood, Marie; McWilliams, Andrew; Rifkin, Dena E; Slinin, Yelena; Taylor, Addison; Townsend, Raymond; Wall, Barry; Wright, Jackson T; Rahman, Mahboob

    2017-01-01

    The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249. © 2016 American Heart Association, Inc.

  9. Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program.

    Science.gov (United States)

    Logan, Deirdre E; Conroy, Caitlin; Sieberg, Christine B; Simons, Laura E

    2012-09-01

    The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. A total of 157 children ages 10 to 18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pretreatment, posttreatment, and short-term follow-up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children's readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents' readiness to adopt a pain self-management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pretreatment willingness to self-manage pain and posttreatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B

  10. A Review of the Experience, Epidemiology, and Management of Pain among American Indian, Alaska Native, and Aboriginal Canadian Peoples

    Science.gov (United States)

    Jimenez, Nathalia; Garroutte, Eva; Kundu, Anjana; Morales, Leo; Buchwald, Dedra

    2011-01-01

    Substantial literature suggests that diverse biological, psychological, and sociocultural mechanisms account for differences by race and ethnicity in the experience, epidemiology, and management of pain. Many studies have examined differences between Whites and minority populations, but American Indians (AIs), Alaska Natives (ANs), and Aboriginal peoples of Canada have been neglected both in studies of pain and in efforts to understand its bio-psychosocial and cultural determinants. This article reviews the epidemiology of pain and identifies factors that may affect clinical assessment and treatment in these populations. We searched for peer-reviewed articles focused on pain in these populations, using PubMed, CINAHL, Cochrane, and the University of New Mexico Native Health Database. We identified 28 articles published 1990-2009 in 3 topic areas: epidemiology of pain, pain assessment and treatment, and healthcare utilization. A key finding is that AI/ANs have a higher prevalence of pain symptoms and painful conditions than the U.S. general population. We also found evidence for problems in provider-patient interactions that affect clinical assessment of pain, as well as indications that AI/AN patients frequently use alternative modalities to manage pain. Future research should focus on pain and comorbid conditions and develop conceptual frameworks for understanding and treating pain in these populations. Perspective We reviewed the literature on pain in AI/ANs and found a high prevalence of pain and painful conditions, along with evidence of poor patient-provider communication. We recommend further investigation of pain and comorbid conditions and development of conceptual frameworks for understanding and treating pain in this population. PMID:21330217

  11. Emerging resistance among bacterial pathogens in the intensive care unit – a European and North American Surveillance study (2000–2002

    Directory of Open Access Journals (Sweden)

    Thornsberry Clyde

    2004-07-01

    Full Text Available Abstract Background Globally ICUs are encountering emergence and spread of antibiotic-resistant pathogens and for some pathogens there are few therapeutic options available. Methods Antibiotic in vitro susceptibility data of predominant ICU pathogens during 2000–2 were analyzed using data from The Surveillance Network (TSN Databases in Europe (France, Germany and Italy, Canada, and the United States (US. Results Oxacillin resistance rates among Staphylococcus aureus isolates ranged from 19.7% to 59.4%. Penicillin resistance rates among Streptococcus pneumoniae varied from 2.0% in Germany to as high as 20.2% in the US; however, ceftriaxone resistance rates were comparably lower, ranging from 0% in Germany to 3.4% in Italy. Vancomycin resistance rates among Enterococcus faecalis were ≤ 4.5%; however, among Enterococcus faecium vancomycin resistance rates were more frequent ranging from 0.8% in France to 76.3% in the United States. Putative rates of extended-spectrum β-lactamase (ESBL production among Enterobacteriaceae were low, Escherichia coli in the five countries studied. Ceftriaxone resistance rates were generally lower than or similar to piperacillin-tazobactam for most of the Enterobacteriaceae species examined. Fluoroquinolone resistance rates were generally higher for E. coli (6.5% – 13.9%, Proteus mirabilis (0–34.7%, and Morganella morganii (1.6–20.7% than other Enterobacteriaceae spp (1.5–21.3%. P. aeruginosa demonstrated marked variation in β-lactam resistance rates among countries. Imipenem was the most active compound tested against Acinetobacter spp., based on resistance rates. Conclusion There was a wide distribution in resistance patterns among the five countries. Compared with other countries, Italy showed the highest resistance rates to all the organisms with the exception of Enterococcus spp., which were highest in the US. This data highlights the differences in resistance encountered in intensive care units in