Full Text Available Abstract Background A previous suicide attempt is a potent risk factor for suicide later on. Crisis intervention, psychiatric and psychosocial evaluation at emergency medical facilities, and follow-up care for suicide attempters are considered important components for suicide prevention. The Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP includes a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts (ACTION-J to address the continuing increase in suicides in Japan. The primary aim of ACTION-J is to examine the effectiveness of an extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention. This paper describes the rationale and protocol of the ACTION-J trial. Methods/Design In this clinical trial, case management intervention will be provided at 19 emergency medical facilities in Japan. After crisis intervention including psychiatric evaluation, psychosocial assessment, and psychological education, subjects will be randomly assigned to either a group receiving continuous case management or a control group receiving standard care. Suicidal ideation, depressive symptoms, and general health condition will be evaluated as secondary measures. The intervention was initiated in July 2006. By December, 2009, 842 subjects will be randomized. Subject follow-up will continue for 1.5 to 5 years. Discussion Suicide is a complex phenomenon that encompasses multiple factors. Case management by multi-sector collaboration is needed. ACTION-J may provide valuable information on suicide attempters and may develop effective case management to reduce future risk for suicide attempters. Trial registration UMIN Clinical Trials Registry number, UMIN000000444. ClinicalTrials.gov number, NCT00736918.
Chen, Wei-Jen; Ho, Chi-Kung; Shyu, Shi-Sen; Chen, Cheng-Chung; Lin, Guei-Ging; Chou, Li-Shiu; Fang, Yun-Ju; Yeh, Pin-Yang; Chung, Tieh-Chi; Chou, Frank Huang-Chih
Background Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period. Method A randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 partici...
Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk
Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.
Wang, Ying-Chuan; Hsieh, Ling-Yu; Wang, Ming-Yu; Chou, Cheng-Hsiang; Huang, Min-Wei; Ko, Huei-Chen
This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods.
Full Text Available Abstract Background Suicide attempts (SA constitute a serious clinical problem. People who attempt suicide are at high risk of further repetition. However, no interventions have been shown to be effective in reducing repetition in this group of patients. Methods/Design Multicentre randomized controlled trial. We examine the effectiveness of «ALGOS algorithm»: an intervention based in a decisional tree of contact type which aims at reducing the incidence of repeated suicide attempt during 6 months. This algorithm of case management comprises the two strategies of intervention that showed a significant reduction in the number of SA repeaters: systematic telephone contact (ineffective in first-attempters and «Crisis card» (effective only in first-attempters. Participants who are lost from contact and those refusing healthcare, can then benefit from «short letters» or «postcards». Discussion ALGOS algorithm is easily reproducible and inexpensive intervention that will supply the guidelines for assessment and management of a population sometimes in difficulties with healthcare compliance. Furthermore, it will target some of these subgroups of patients by providing specific interventions for optimizing the benefits of case management strategy. Trial Registration The study was registered with the ClinicalTrials.gov Registry; number: NCT01123174.
McDonald, H R; Abrams, G W; Irvine, A R; Sipperley, J O; Boyden, B S; Fiore, J V; Zegarra, H
Pneumatic retinopexy is a recently described procedure for treating retinal detachments with cryotherapy and intraocular gas injection, rather than scleral buckling. Prospective studies are underway to assess its safety and efficacy. One potential complication of this technique is persistent detachment due to subretinal gas. We report seven cases of subretinal gas following attempted pneumatic retinal reattachment. In all cases, multiple fish-egg gas bubbles were present following injection; some of these bubbles gained access to the subretinal space during the early postoperative period. The subretinal gas gave the detached retina a pearly, dome-shaped, refractive sheen. Three cases were managed by positioning the patients' heads to allow the subretinal gas to pass through the retinal break back into the vitreous cavity. One case underwent successful scleral buckling that closed the retinal break despite the presence of a small subretinal gas bubble. Three cases required vitrectomy, air-fluid exchange, and cryotherapy or endolaser treatment. In five of the seven eyes the retina was eventually reattached successfully.
Results: In Mr Green's case, the nurse chose to share the information of Mr Green's suicide attempt with other health care professionals. The nursing team followed the self-harm and suicide protocol of the hospital strictly, they maintained the effective communication with Mr Green, identified the factors which cause patient's suicide attempt, provided the appropriate nursing intervention to deal will these risk factors and collaborated with other health care professionals to prefect the further care. The patient transferred to a palliative care service with no sign of suicide attempt and other self-harm behaviors and passed away peacefully 76 days after discharged with his relatives and pastors accompany.
Katherine L. March
Full Text Available Treatment strategies for acute toxicity following massive ingestion of warfarin are not well described in the literature. Warfarin is the primary oral anticoagulation agent used in the treatment of thromboembolic disease, and patients with acute toxicity are at risk for life-threatening hemorrhages. Treatment options include phytonadione (vitamin K1, fresh frozen plasma (FFP, and prothrombin complex concentrates (PCCs used alone or in combination. FFP and PCC can be associated with volume complications, undesirable thromboembolic events, and increased costs. We describe the case of a 63-year-old female with acute warfarin toxicity following a massive ingestion of warfarin (420 mg–450 mg in an attempt to commit suicide. Upon arrival to the emergency department, serial INR checks were initiated to help guide dosing strategy and later adjusted based on INR response to treatment using only phytonadione.
Eszopiclone is a benzodiazepine-like hypnotic that is commonly prescribed to treat insomnia. However, eszopiclone’s efficacy has been questionable in several clinical trials, and its pharmacologic profile makes its effects on sleep and behavior difficult to predict. We report a case demonstrating an instance of eszopiclone-induced parasomnia involving paranoia and a suicide attempt in a patient taking eszopiclone. We explore possible biochemical explanations examining the pharmacologic profile of eszopiclone and its potential for drug-drug interactions, especially with concomitant administration of monoaminergic medications such as antidepressants. Caution should be exercised when prescribing these medications, and evidence-based treatments for insomnia (e.g., cognitive behavioral therapy, biofeedback, sedating antidepressants) should be considered prior to sedative-hypnotic administration. PMID:27974999
Rosenstein, A H; Propotnik, T
Providing cost-effective high quality healthcare services ranks as the number one concern for anyone involved with the healthcare delivery system. While quality of care should always be the number one priority, controlling healthcare costs receives most of the attention. With limited healthcare dollars and providers assuming more of the financial risk for services rendered, a whole assortment of cost-containment strategies are being introduced in an effort to maintain some semblance of financial viability. Healthcare providers can approach cost control from two different angles. On the fixed-cost operational overhead side, traditional cost-containment techniques have focused on downsizing, maximizing productivity, staffing redesign, improved purchasing contracts, standardization, inventory control, and other more individualized restructured service models. On the variable-cost clinical side, cost control has been approached by introducing a variety of cost-containment strategies designed to improve efficiency and effectiveness of provider performance. While many of these strategies, previously discussed in the Journal of Healthcare Resource Management have stressed the importance of education, guidelines, pathways, and other clinical "tools for improvement," the success of many of these tools resides in the ability to provide real-time intervention. Real-time intervention rather than the more passive retrospective variance analysis has the greatest potential for producing cost savings by actually making a recommendation that prevents the unwanted event from occurring. In many institutions, the case manager bears the responsibility for monitoring and managing these programs. This article describes various case management models currently used by different institutions.
The follow-up negotiations to the Convention on Biological Diversity formulated the Ecosystem Approach, inter alia. The principles of this holistic approach are also important for the forestry sector and its management of forest ecosystems. In the light of the national debate and international forest policy negotiations, there is a need for German and European forestry to switch to the perspective of the Ecosystem Approach. This should be based on the regulatory framework on sound and sustain...
Orchard, Ryan K.
In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…
Kerzner, Harold R
A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re
Full Text Available OBJECTIVE: Compared to other eating disorders, anorexia nervosa (AN has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN. Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED. METHOD: Case-control study in a cohort of suicide attempters (n = 1563. Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. RESULTS: AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9, with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5, and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6. BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. CONCLUSION: There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
U.S. Department of Health & Human Services — The Disaster Case Management Program (DCM) is a time-limited process that involves a partnership between a case manager and a disaster survivor (also known as a...
Mahon, Pamela B; Stütz, Adrian M; Seifuddin, Fayaz; Huo, Yuqing; Goes, Fernando S; Jancic, Dubravka; Judy, Jennifer T; Depaulo, J Raymond; Gershon, Elliot S; McMahon, Francis J; Zandi, Peter P; Potash, James B; Willour, Virginia L
Family, twin, and adoption studies provide convincing evidence for a genetic contribution to suicidal behavior. The heritability for suicidal behavior depends in part on the transmission of psychiatric disorders, such as mood disorders and substance use disorders, but is also partly independent of them. Three linkage studies using the attempted suicide phenotype in pedigrees with bipolar disorder, major depression, or alcoholism have provided consistent evidence that 2p11-12 harbors a susceptibility gene for attempted suicide. A microarray expression study using postmortem brain samples has implicated a gene from the 2p11-12 candidate region, the trans-Golgi network protein 2 (TGOLN2) gene, as being consistently up-regulated in suicide cases as compared to controls. Here, we present a TGOLN2 case-control association study using nine single nucleotide polymorphisms (SNPs). These nine SNPs, which include seven tag SNPs and two coding SNPs, have been genotyped in 517 mood disorder subjects with a history of attempted suicide and 515 normal controls. Allelic and genotypic analyses of the case-control sample did not provide evidence for association with the attempted suicide phenotype. Eight of the nine SNPs provided supportive evidence for association (P-values ranging from 0.008 to 0.03) when we compared the attempted suicide cases with a history of alcoholism to the attempted suicide cases without a history of alcoholism. However, this association finding was not replicated in an independent sample. Taken together, these analyses do not provide support for the hypothesis that common genetic variation in TGOLN2 contributes significantly to the risk for attempted suicide in subjects with major mood disorders.
Moret-Harman, M.; Reuzel, R.; Grin, J.; Kramers, C.; van der Wilt, G.J.
The quality of an evaluation largely depends on the quality of the underlying problem definition and the quality of the problem definition often improves as stakeholder involvement increases. By means of a study on the management of attempted suicides by drug overdose, we explored whether an interac
Benmohamed, Nadja; Abbassi, Ziad; Naiken, Surennaidoo P; Morel, Philippe; Platon, Alexandra; Poletti, Pierre-Alexandre; Toso, Christian
Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption.
van Heeringen, K
In order to study the distribution of attempted suicide among the population of Gent, exploratory and analytical case-control studies were carried out. The strength of the association between attempted suicide and marital and employment status was calculated taking into account the confounding and/or effect-modifying roles of age, gender, and the living situation. Unmarried individuals who were not living alone were at increased risk of attempted suicide compared to (cohabiting) married individuals. Young and middle-aged unemployed males and middle-aged unemployed females had significantly increased risks compared to employed individuals. In addition to a causal interpretation of the demonstrated associations, the roles of chance, reverse causality, and confounding or bias were considered. Selection and information biases may have accounted for the observed associations. For instance, in previous monitoring studies on attempted suicide, surprisingly little attention has been paid to the reliability of the information collected. The question of how one can reliably assess patients who may provide unreliable information remains unanswered. However, several findings support a role of causality in explaining the associations. The present studies therefore provide additional evidence for a detrimental affect of certain socio-demographic or -economic conditions on the occurrence of attempted suicide.
Barros, Alcina Juliana Soares; Rosa, Regis Goulart; Telles, Lisieux Elaine de Borba; Taborda, José Geraldo Vernet
Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.
Full Text Available Background. Glufosinate ammonium has a famous delayed complication as respiratory failure, however, delayed cardiogenic complication is not well known. Objectives. The aim of this study is to report a takotsubo cardiomyopathy as a delayed complication of glufosinate ammonium for suicide attempt. Case Report. A 75-year-old woman ingested about 90 mL of Basta, herbicide for suicide attempt at arousal during sleep. She came to our hospital at twelve hours after ingesting. She was admitted to our hospital for fear of delayed respiratory failure. Actually, she felt down to respiratory failure, needing a ventilator with intubation at 20 hours after ingesting. Procedure around respiratory management had smoothly done with no delay. Her vital status had been stable, however, she felt down to circulatory failure and diagnosed as Takotsubo cardiomyopathy at about 41 hours after ingestion. There was no trigger activities or events to evoke mental and physical stresses. Conclusion. We could successfully manage takotsubo cardiomyopathy resulted in circulatory failure in a patient with glufosinate poisoning for suicide attempt. Takotsubo cardiomyopathy should be taken into consideration if circulatory failure is observed for unexplained reasons.
Dunkel, Marion; Kramp, Melanie
The combination of medical and economical proceedings allows new perspectives in the illustration of medical workflows. Considering structural and developmental aspects multimodal therapy programs show similarities with typical subjects of economic process systems. By pointing out the strategic appearance of the multimodal pain therapy concept multimodal approaches can be described to some extent by using management approaches. E. g., an economic process landscape can be used to represent procedures of a multimodal pain therapy program.
Furfari, Kristin; Zehnder, Nichole; Abbott, Jean
A 62-year-old female with Huntington's disease presented after a suicide attempt. Her advance directive stated that she did not want intubation or resuscitation, which her family acknowledged and supported. Despite these directives, she was resuscitated in the emergency department and continued to state that she would attempt suicide again. Her suicidality in the face of a chronic and advancing illness, and her prolonged consistency in her desire to take her own life, left careproviders wondering how to provide ethical, respectful care to this patient. Tension between the ethical principles of autonomy and beneficence is central in this case. The patient's narrative demonstrated that her suicide was an autonomous decision, free from coercion or disordered thinking from mental illness. Beneficence then would seem to necessitate care aligned with the patient's desire to end her life, which created ethical uneasiness for her family and careproviders. The case highlights several end-of-life ethical considerations that have received much recent attention. With ongoing discussions about the legalization of aid in dying across the country, caregivers are challenged to understand what beneficence means in people with terminal illnesses who want a say in their death. This case also highlights the profound moral distress of families and careproviders that arises in such ethically challenging scenarios.
The definition of attempted accident is explained, the problems in attempted accidents management are analyzed, and the advices for attempted accidents management are proposed as well.%在阐释了未遂事件定义、做好未遂事件管理的基础上，分析了开展未遂事故管理中遇到的问题，从转变发展方式，提升RSE管理水平的高度，就如何做好未遂事件管理进行了探讨，提出了建议。
Full Text Available Game log data have great potential to provide actionable information about the in-game behavior of players. However, these low-level behavioral data are notoriously difficult to analyze due to the challenges associated with extracting meaning from sparse data stored at such a small grain size. This paper describes a three-step solution that uses cluster analysis to determine which strategies players use to solve levels in the game, sequence mining to identify changes in strategy across multiple attempts at the same level, and state transition diagrams to visualize the strategy sequences identified by the sequence mining. In the educational video game used in this case study, cluster analysis successfully identified 15 different in-game strategies. The sequence mining found an average of 40 different sequences of strategy use per level, which the state transition diagrams successfully displayed in an interpretable way.
Malec, Katarzyna; Gasiński, Mateusz; Kuchta, Krzysztof; Kozok, Andrzej
Gunshot injuries of the viscerocranium are rarely reported during times of peace in Europe. Penetrating wounds to the maxillofacial region pose a significant challenge for surgeons as they often comprise serious soft and bone tissue defects.We present a case report of 38-year-old male with gunshot wound to the viscerocranium after suicidal attempt. The patient's general condition was stable. The inlet wound was found in the submental region in the central line penetrating deep into the floor of the mouth, to the left, avoiding large vessels and hypoglossal nerve. No exit wound was identified. The ophthalmic examination revealed the limitation of motion in the left eyeball and diplopia in the whole field of vision. The revision was performed under general anesthesia. Control CT scan revealed the presence of one metallic fragment wedged in the hard palate. Second look of oral cavity with particular emphasis on the hard palate was performed. Shrapnel proved to be wedged in the bone of the hard palate very firmly and complete removal without damaging the function of the palate was impossible. The decision was made to withdraw from surgical removal of the remaining piece of the projectile. In most cases, it is recommended to remove all foreign material from human body. However, in the illustrated case we decided to leave small debris in the craniofacial skeleton. In our opinion, further surgical revision would result in greater tissue damage, disproportionate to the benefits of the removal of all fragments of the projectile.
Kralovec, Karl; Plöderl, Martin; Aistleiner, Ursula; Fartacek, Clemens; Fartacek, Reinhold
We describe a 59-year old patient who reported a near-death experience following attempted suicide. The near-death experience induced reduction of suicidality. Previous studies suggested a high prevalence of near-death experiences following attempted suicide and that near-death experiences may decrease rather than increase subsequent suicide risk. Implications for suicide risk assessment are discussed.
We are pleased to announce the recent launch of a new workshop on Project Management. This is designed for People with budgetary, scheduling and/or organizational responsibilities in a project or a sub-project. The objectives through a management case study specially suited to CERN are: to become familiar with modern management techniques in use for structuring, planning, scheduling, costing and progress monitoring of a project or a sub-project. to understand in-depth issues associated with Deliverable-oriented Project Management, Earned Value Management, Advanced Project Cost Engineering and Project Risk Management. The full description of this workshop can be found here. The next session will be held on 8 October 2004. If you are interested in this workshop, please contact Nathalie Dumeaux, email or 78144. Programme of Seminars October to December 2004 Situation : 21.09.2004 Séminaires bilingues Dates Jours Places disponibles Project Management Case study 8 October 1 oui Intr...
Kresnow, Marcie-jo; Ikeda, Robin M.; Mercy, James A.; Powell, Kenneth E.; Potter, Lloyd B.; Simon, Thomas R.; Lee, Roberta K.; Frankowski, Ralph F.
This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years. This study was designed to extend understanding of suicidal behavior and prevention activities beyond identification of mental illnesses. Overall strengths and…
Mahon, Pamela B.; Stütz, Adrian M.; Seifuddin, Fayaz; Huo, Yuqing; Goes, Fernando S.; Jancic, Dubravka; Judy, Jennifer T.; DePaulo, J. Raymond; Gershon, Elliot S.; McMahon, Francis J.; Zandi, Peter P.; Potash, James B; Willour, Virginia L.
Family, twin, and adoption studies provide convincing evidence for a genetic contribution to suicidal behavior. The heritability for suicidal behavior depends in part on the transmission of psychiatric disorders, such as mood disorders and substance use disorders, but is also partly independent of them. Three linkage studies using the attempted suicide phenotype in pedigrees with bipolar disorder, major depression, or alcoholism have provided consistent evidence that 2p11-12 harbors a suscept...
Mark, D D
The purpose of this article is to analyze the performance of and support for case management using a policy framework in order to increase case managers' awareness of policy making and facilitate successful planning for future policy initiatives. Feldstein's (1996) theory of opposing legislative outcomes indicates that legislation can be viewed on a continuum, ranging from legislation that meets the needs of the public to legislation considered to be in the self-interest of the participants and legislators. The current health care system requires that case managers working for publicly funded health care organizations balance the need for stewardship of U.S. tax dollars and the health care needs of consumers. It is apparent from the literature that case managers are successfully achieving this balance. However, certain conditions should exist that allow for case manager decision-making that promotes effective and efficient utilization of health care resources. Case managers must work within the context of the health care policy environment. Realizing that it is more likely that the conflicts between stewardship and the provision of health care services will continue, case managers' knowledge and influence regarding policy making becomes imperative in order to ensure that these conflicting goals do not become mutually exclusive.
McCall, Michael; Trombetta, Jessica; Gipe, Aimee
Prior research had suggested that individuals would estimate higher product values and even tip more in the presence of credit cues. In the absence of a clear theoretical interpretation of this credit card effect we propose that this tendency is an impression management strategy such that credit cue exposure influences perceptions of the self and focuses attention on individual wealth. Thus, in the presence of others, credit cues serve to enhance images of the self. Preliminary data in support of this alternative theoretical perspective are presented.
Full Text Available Background: Suicide is one of the ten major causes of death in India. Suicidal intent score has been found to be a good predictor of a subsequent completed suicide. The present study was conducted to find out the socio-demographic profile and the suicidal intent score of the cases of attempted suicide as well as to determine the association of suicidal intent score with various factors. Methodology: We conducted the present hospital based observational cross sectional study at a rural hospital of Eastern India. 156 admitted cases with history of self-poisoning were interviewed after obtaining the informed consent. Socio-demographic information and suicidal intent score were recorded and analyzed. Results: 55.1% patients were in the age group of below 20 years, 69.2% were females, 58.3% belonged to socioeconomic class V and 17.3% patients were illiterate. 43.6% were students and 28.8% housewives. 17.3% patients had history of suicidal attempts in the past and in 23.1 % cases stress factor was present in the family. Suicidal intent score was medium in 63.5% patients, 10.3% patients had low score and 26.2% had high score. Different factors like age of 20 years and above, male sex, married people, people having addiction habit, previous suicidal attempt, positive family history and stress factors in family increased the suicidal intent score whereas aged less than 20 years, female sex, unmarried people, people having no previous attempt of suicide, negative family history and absence of stress factor in the family decreased the suicidal intent score. Conclusion: The present study highlighted the influencing factors of suicidal intent score based on a hospital set up. A larger community based study with follow up of study subjects is required to get a detailed idea about the influencing factors of suicidal intent score. [Natl J Med Res 2013; 3(2.000: 122-125
E.J. Eshuis; K.M.M.Y. Magnin; P.C.F. Stokkers; W.A. Bemelman; J. Bartelsman
In the summary of product characteristics of infliximab (IFX), psychiatric side effects are reported to be rare, and in literature only limited data exist. This report presents a case of a patient with ulcerative colitis who developed a depression with psychotic symptoms during IFX therapy and made
Full Text Available Introduction. Overdose of potassium is not as frequently encountered in clinical practice as hyperkalaemia due to acute or chronic renal disease. However, potassium overdoses leading to serious consequences do occur. Case Presentation. A 20-year-old nurse student presented with a cardiac arrest with asystole rhythm. Beside the patient were found four 50-mL syringes and empty vials of potassium chloride (20 mL, 10%. After initial resuscitation with epinephrine, 125 mL of a 4.2% intravenous solution of sodium bicarbonate were injected which resulted in the recovery of an effective cardiac activity. The patient recovered without sequelae. Conclusion. The difficulty in this case was to recognize the potassium poisoning. The advanced resuscitation with the use of a specific treatment helped to resuscitate the patient.
Full Text Available Abstract A case of leptomeningeal carcinomatosis in a patient with known brain and lung metastases from renal cell cancer without previous systemic therapy is presented. Neoplastic meningitis (NM developed 31 months after first diagnosis of simultaneous extra- and intracranial recurrence of kidney cancer and surgical resection of a cerebellar metastasis. In spite of local radiotherapy to the macroscopic NM lesions in the cervical and lumbar spine followed by initiation of sunitinib, the patient succumbed to his disease 4 months after the diagnosis of NM. The untreated lung metastases progressed very slowly during almost 3 years of observation. This case illustrates important issues around both biological behaviour and treatment approaches in metastatic renal cell cancer.
Full Text Available Research studies of woodland caribou in west central Alberta began in 1979 in response to proposed timber harvesting on their winter ranges. Using results from initial studies, timber harvest guidelines were developed. A recent review of these guidelines, and the assumptions on which they were based, has resulted in a renegotiation by government and industry of timber harvesting on caribou range in west central Alberta. Caribou range in west central Alberta overlaps many jurisdictional boundaries: federal and provincial lands, four Forest Management Agreement Areas, three Alberta Land and Forest Service Regions and two Alberta Fish and Wildlife Service Regions. This jurisdictional complexity in combination with other factors such as total allocation of the timber resources, high levels of petroleum, natural gas and coal extraction activities, a high level of concern by public groups for caribou conservation and recent understanding of woodland caribou needs for abundant space has made resolution of caribou/timber harvest conflicts exceedingly slow and often relatively unproductive. This paper reviews 10 years of trying to resolve conflicts between timber harvesting and caribou conservation through meetings, committees, integrated resource planning, policy papers and public consultation. We describe what might be learned by other jurisdictions that are trying to resolve similar caribou/timber harvesting issues. We conclude with an overview of recent timber harvest planning initiatives on caribou range in west central Alberta.
Wolk, James L.; And Others
Contends that case managers engage in the practice of management. Employs Mintzberg's seminal research on chief executive behavior to argue that case managers' work is similarly characterized by brevity, variety, and fragmentation. Notes that case managers perform the 10 roles developed by Mintzberg. Describes roles and presents case managers'…
Bidell, M.; Furlong, M.; Dunn, D.; Koegler, J.
OBJECTIVE—To examine self service tobacco displays (SSTDs) and youth retail tobacco access by comparing longitudinal illegal tobacco sales rates in three communities in Santa Barbara County, California, that considered or implemented ordinances banning SSTDs. A confirmatory survey was also conducted to substantiate the longitudinal data. DESIGN—A longitudinal case study design was utilised. Five undercover tobacco buys were conducted between 1994 and 1997 (n = 332). In addition, one confirmatory survey was conducted in a geographically separated area, which had no ordinances banning SSTDs (n = 57). RESULTS—Decreases in youth buy rates were reported in all three communities. Most notably, the first city to enact a SSTD ban, Carpinteria, achieved a 0% sales rate, which was maintained throughout the study period. In contrast, Santa Barbara and Goleta experienced considerable drops in their illegal sales rates, but neither community obtained results as dramatic as those found in Carpinteria. The confirmatory survey showed that 32.1% of stores with SSTDs sold cigarettes to minors; this compares to a sales rate of 3.4% in stores without SSTDs (χ2 (1) = 8.11, p = 0.004). CONCLUSIONS—Efforts to enact self service bans are likely to meet with retail and tobacco industry opposition, as was the case in this study's three communities. The process of community debate, resultant publicity surrounding the issue, and enactment of SSTD ordinances may serve to not only increase merchant awareness of youth tobacco laws and their penalties but also may contribute to reduced youth cigarette sales rates. Implications and limitations of the findings are discussed. Keywords: self service tobacco displays; youth tobacco access; community tobacco control efforts PMID:10691760
Sweitzer, Maggie M.; Geier, Charles F.; Denlinger, Rachel; Forbes, Erika E.; Raiff, Bethany R.; Dallery, Jesse; McClernon, F.J.; Donny, Eric C.
Rationale Tobacco smoking is associated with dysregulated reward processing within the striatum, characterized by hypersensitivity to smoking rewards and hyposensitivity to non-smoking rewards. This bias toward smoking reward at the expense of alternative rewards is further exacerbated by deprivation from smoking, which may contribute to difficulty maintaining abstinence during a quit attempt. Objective We examined whether abstinence-induced changes in striatal processing of rewards predicted lapse likelihood during a quit attempt supported by contingency management (CM), in which abstinence from smoking was reinforced with money. Methods Thirty-six non-treatment seeking smokers participated in two fMRI sessions, one following 24-hr abstinence and one following smoking as usual. During each scan, participants completed a rewarded guessing task designed to elicit striatal activation in which they could earn smoking and monetary rewards delivered after the scan. Participants then engaged in a 3-week CM-supported quit attempt. Results As previously reported, 24-hr abstinence was associated with increased striatal activation in anticipation of smoking reward and decreased activation in anticipation of monetary reward. Individuals exhibiting greater decrements in right striatal activation to monetary reward during abstinence (controlling for activation during non-abstinence) were more likely to lapse during CM (p<.05), even when controlling for other predictors of lapse outcome (e.g., craving); no association was seen for smoking reward. Conclusions These results are consistent with a growing number of studies indicating the specific importance of disrupted striatal processing of non-drug reward in nicotine dependence, and highlight the importance of individual differences in abstinence-induced deficits in striatal function for smoking cessation. PMID:26660448
I'm going to close with some of my ideas about the characteristics that case managers exhibit. I have a great deal of professional respect for case managers. I think that you are a tenacious lot. One of the major things that case managers do is help create new alternatives to problems. You open doors; no ... you first build the door and then you open it. You're creative, persistent, and resourceful. You are sometimes asked to solve all of an organization's problems. I think that is a tremendous burden, and that you can get confused because of that role conflict and confusion. What model is best for my organization? Within that is my patient population. What is it that they need? What are the current issues that you are seeing? How is my case management role different from other roles? How large a scope of practice can I handle and be reasonably successful with the patients with whom I'm dealing? How many different kinds of approaches and models are needed within my organization? Look toward the future; think about the future in terms of your crystal balls. What trends do you see building in either the demographics or the health and social environments that are going to influence health care in the future? What effect will the aging of our population have on you and your case management practice? What issues are going to be related to those trends? How many more people do we have living in fragmented families? What's going to happens in terms of resources available for patients? How can case management influence those changes? I don't think we're going to see the pace of change in the health care industry slow down. We will continue to have health care organizations address social issues in addition to pathophysiologic ones. No matter what the role and how it evolves, case management will always be at the junction of change in health care. This will be difficult at times to deal with. It will also be a source of satisfaction for those in the role because of the
Saxton, S E
Humor is an effective tool to prevent and resolve burnout, a common problem associated with the practice of case management. Easily accessed by almost everyone, humor has many physiological and psychological benefits. The conscious use of humor in an organization requires a commitment at all levels in order for the organization to benefit as a whole. Offering formal seminars, using humor in company newsletters, and encouraging cartoon or joke sharing impacts on the physical and mental health of the employees. Techniques for bringing laughter to the workplace are outlined, as well as examples from the practice of case management.
Full Text Available Interest in Composite Content Applications has been climbing higher over the recent years due to the rising need around enabling business process improvements and addressing challenges around business process agility. Such applications can deliver substantial value by leveraging both content and process services for the better orchestration of people and processes and empower organizations to automate routine tasks and aggregate information from multiple sources in a collaborative work environment that enables rapid decision making. In this whitepaper, we have introduced Case Management and its relationship with ECM, the essential functionalities in a Case Management Product stack and expanded on leading vendors in this space along with the salient features of their case management offerings. Subsequently we have built on a sample case scenario of building a contracts management application using EMC Documentum xCelerated Composition Platform (xCP, the business needs and challenges that a well-designed Contracts Management application can address, a real-life application of xCP platform to build such a solution and the observations on the strengths and limitations of this platform, along with a few workarounds to address the limitations.
Rayburn; Lucas; Gittens; Goodwin; Baxi; Gall; Mostello; Heyl
Objective: To compare the clinical effectiveness and safety of outpatient administration of an intracervical prostaglandin (PG) E(2) gel with expectant management for women with an unfavorable cervix who wish to attempt a vaginal birth after cesarean section.Study Design: This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score cesarean section did not differ (P =.68) with use of the gel (61, 42%) or with expectant therapy (48, 45%). The onset of active labor, the duration of labor among those delivering vaginally, and the 1-minute and 5-minute Apgar scores were not different between the two groups. No uterine rupture was apparent, and adverse effects during labor were as likely to occur in the two groups.Conclusions: Although its safety was confirmed for outpatient use and for persons with a prior cesarean delivery, intracervical prostaglandin E(2) gel did not improve the chance of a vaginal birth after a cesarean delivery.
... From the Federal Register Online via the Government Publishing Office POSTAL REGULATORY COMMISSION Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It...
To strengthen teachers team construction in private schools and cultivate high quality skillful talents, this article takes the tourism management specialty in the Tourism College of Changchun University as an example, and discusses the reform of tourism management professional teachers team: to construct academic, double-role and skillful famous teacher team. Good results have been achieved.%为加强民办学校教师队伍建设，培养高素质技能应用型人才，本文以长春大学旅游学院旅游管理专业为例，探讨了旅游管理专业师资队伍改革的尝试---“学术型、双师型和技能名师型”相结合的教学队伍建设，并取得了良好的效果。
Full Text Available Nasal route of intubation is commonly used for surgical procedures involving Head and Neck, Patients with intra - oral pathology, structural abnormalities, trismus, cervical spine instability, cervical spine disease and OSA. The intubation may be aided by direct laryngoscopy, flexible fibreoptic laryngoscopy or by blind technique. The classical tec hnique of blind nasal intubation requires a spontaneously breathing patient and uses breath sounds to guide placement. Most common complication associated with this technique is epistaxis. Other rare complications include - Inferior turbinate avulsion, mid dle turbinate/nasal polyp/tumour avulsion, Bacteraemia, Retropharyngeal mucosa dissection/laceration. Here we present to you a case of fracture mandible posted for ORIF for which blind nasal intubation was planned. While attempting the intubation the endot racheal tube coursed behind the retropharyngeal mucosa for a short distance before entering the trachea. Post - operatively the patient was put on Ryle’s tube feeding for 3 days followed by orals. The track healed spontaneously and the recovery was uneventfu l.
Shafiee-Kandjani, Ali Reza; Amiri, Shahrokh; Arfaie, Asghar; Ahmadi, Azadeh; Farvareshi, Mahmoud
Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning.
Christiansen, Erik; Juul Larsen, Kim
Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk...... discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income....... Methods: A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total...
Che, Zhenghong; Che, Zhengmei
Case teaching is an efficient teaching method of management. It plays an important role to enhance the students' ability to practice the theory. However, case teaching of financial management has not achieved the expected results. The paper aims to study the importance, characteristics and corresponding methods of case teaching method of financial…
Issel, L M; Anderson, R A
Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.
Christiansen, Erik; Jensen, Børge
abuse with mental illness raised risk in an additive way. We found only small gender differences in risk. In order to lower the risk of suicide attempts, we need to improve after-care when discharging from psychiatric care. A differentiation between the possibilities of after-care for different mental...
Tahan, H A
Emotional intelligence is a skill necessary for case managers because of the diversity of their work, the multiple stakeholders they have to deal with on daily basis, and the increased potential for conflict. Managers and administrators need to be cognizant of the role emotional intelligence plays in employee performance and the importance of developing training programs to assist case managers in learning to deal with change and conflict. Case managers must assume responsibility for their actions and work to develop and improve their emotional intelligence skills set. Ultimately, patients and work associates will appreciate the case manager's efforts. Finally, case managers will find work an enjoyable experience and look forward to new opportunities the future holds.
Full Text Available Eiji Kirino, Masao GitohDepartment of Psychiatry, Juntendo University, School of Medicine, Shizuoka, JapanAbstract: Suicide is a serious social problem in many countries, including Japan. The majority of people who commit suicide suffer from depression. Suicide attempt patients suffering from serious physical injuries are initially treated in hospital emergency departments. The present post hoc analysis examined data from patients admitted to an emergency hospital for treatment of physical injuries, resulting from a suicide attempt, and initial psychiatric treatment for depression and prevention of future suicide attempts. The effects on depressive symptoms were studied in two groups of patients using the 17-item Hamilton depression scale (HAMD. One group (n = 6 had received intravenous tricyclic antidepressants (TCA (amitriptyline or clomipramine while the other group (n = 7 had been treated orally with milnacipran, a serotonin and norepinephrine reuptake inhibitor antidepressant. Prior to treatment the four highest scoring items on the HAMD scale were the same in both groups namely, item 1 (depressed mood, item 3 (suicidality, item 7 (interest in work and activities, and item 10 (psychic anxiety. After 1 week of treatment, mean global HAMD scores were significantly reduced in both groups. Treatment resulted in a significant reduction of five HAMD items in the TCA group, whereas in the milnacipran group 12 HAMD items were significantly reduced. Suicidality (item 3 was significantly improved by 1 week treatment with milnacipran, but not by TCAs. Milnacipran rapidly improved a wide range of depressive symptoms, including suicidality within the first week. The improvement with milnacipran would appear to be, at least, equivalent to that achieved with TCAs, possibly affecting a wider range of symptoms. Since milnacipran has been shown in comparative studies to be better tolerated than TCAs, this antidepressant offers an interesting option for the
White, Lori S.
This chapter presents a series of supervision-related case studies of situations that midlevel managers might face. Individuals enrolled in a midlevel management professional development course recommended the topics selected for this chapter. Drawing upon her experience teaching the course, the author selected four case studies that individuals…
Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin
Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…
Full Text Available Mental capacity is a central determinant of patients’ ability to make autonomous decisions about their care and deal with bad news. Physicians should be cognizant of this when giving patients bad news in efforts to help them to cope with the illness and to avoid a deterioration of their mental well-being. To show the importance of this concept, a case of suicide attempt with lung cancer is exemplified. A 76-year-old woman attempted suicide after receiving a diagnosis of lung cancer. Her recent life had been emotionally turbulent and she did not have sufficient mental capacity to accept and cope with this truth. She developed depression before attempting suicide.
Case management is currently an important issue in France. Because neither service providers nor consumers pay for case management in this country, a cost-benefit analysis is often required by the organizations that do pay. Given the context of French social policy and the current focus on justifying case management through cost-benefit analysis, we have developed a way to evaluate its costs. This article presents the limitations of standard economic choice theory, provides a methodology based on the principles of limited rationality, and gives the results of an evaluation of four case management programs. The article provides a method to measure case management costs and efficiency, as well as the willingness of consumers to pay for services.
Full Text Available This unique colloquium of research for lecturers took place in an academic college of education focused on discussing and peer reviewing through an On-Line Forum and on participating in a conference. Both aimed at enhancing the level and quality of the research activity in the college by developing knowledge generation, communication and management. This study followed studies, which indicated that lecturers do not know and experience enough about generating, communicating and managing knowledge, especially with regards to the didactics of knowledge. Most of the studies carried out by the lecturers who participated in the colloquium focused on integrating disciplines with pedagogic-didactic applications. The method of the colloquium was based on virtual peer teaching, sharing their generated knowledge and experience, and then managing it. The findings indicated that the process was advanced very fast. The lecturers were able to integrate theory and practice while carrying out their research and instruction. This certainly affected the lecturers
Kim, Amy; Parker, Sareeta Singh
Coccidioidomycosis is a disease known for its endemicity to the Southwest United States. However, given the current trends of more frequent tourist and business travel, an increasing number of coccidioidomycosis infections are being seen in patients in other areas of the United States. Because the majority of patients with disseminated disease experience cutaneous manifestations, dermatologists can be of primary importance in the diagnosis of this disease. We report a case of coccidioidomycosis manifesting as granulomatous cutaneous nodules on the face of an otherwise healthy white man. We attempt to provide an update on the diagnosis, management, and treatment of patients who present with cutaneous lesions caused by coccidioidomycosis infection.
Dzimira, Stanislaw; Nizanski, Wojciech; Ochota, Malgorzata; Madej, Janusz A
Disturbances in sex differentiation (DSD - disorder of sexual development) may result from disturbances in sex chromosomes or a disturbed development of gonads, or from genotypic disturbances. The objective of this article is to describe the histological structure of gonads in dogs showing sexual disturbances and a case of a cancer resembling gonadoblastoma in one of the animals. Among the 10 examined dogs with disturbances of sex development only a single case of a gonadoblastoma was observed. In animals with sex disturbances, similarly to humans, there exists a potential tendency for neoplastic lesions in dysgenetic gonads. As a rule, its frequency in population is confined due to the early procedure of castration of non-breeding dogs. In the present study dogs demonstrated phenotypical traits of bitches with developmental anomalies such as hyperplastic clitoris with vestigial os penis (baculum), or abnormalities in the location and structure of the vulva. The material for the study included canine gonads of various breeds, sampled from phenotypical bitches, aged 7 months to 4 years - patients of the Department of Reproduction and Clinic of Farm Animals, Faculty of Veterinary Medicine, University of Environmental and Life Sciences in Wroclaw (Poland) in years 2006-2013. The organs were surgically removed from the abdomen and sent for histopathological examination for the purpose of determining their histological structure. The 10 examined cases of altered gonads included 6 bilateral cases of testes (60%), 2 cases of bilateral ovotestis (20%), one case of co-manifestation of testis and ovotestis (10%), and a single case of a testis and a neoplastically altered gonad (gonadoblastoma) (10%).
We present a case report of depression induced by IFN-α and ribavirin, leading to attempted suicide. Following the episode, antidepressant paroxetine (20 mg o.d. and zolpidem (10 mg h.s were added with psychotherapy. No significant improvement was observed. Patient was given a drug dechallenge (IFN-α and ribavirin. Dramatic improvement was seen over 1 month. Following rechallenge with combination, patient again experienced depressive symptoms with suicidal ideation. IFN-α and ribavirin were promptly stopped. Naranjo causality assessment scale revealed probable association with IFN-α and ribavirin. The report intends to improve awareness among clinicians to facilitate early diagnosis and intervention of similar cases.
Asaro, Frank; Michel, Helen V.; Alvarez, Luis W.; Alvarez, Walter
In Gubbio, Italy, a l em layer of clay between extensive limestone formations marks the boundary between the Cretaceous and Tertiary Periods. This clay layer was known to have been deposited about 65 million years ago when many life forms became extinct, but the length of time associated with the deposition was not known. In an attempt to measure this time with normally deposited meteoritic material as a clock, extensive measurements of iridium abundances (and those of many other elements) were made on the Gubbio rocks. Neutron activation analysis was the principal tool used in these studies. About 50 elements are searched for in materials like the earth's crust, about 40 are detected and about 30 are measured with useful precision. We were not able to determine exactly how long the clay deposition took. Instead the laboratory studies on the chemical and physical nature of the Cretaceous-Tertiary boundary led to the theory that an asteroid collision with the earth was responsible for the extinction of many forms of life including the dinosaurs.
Lim, Jerry; Laing, Christopher M; MacCallum, Niall S; Brealey, David A
We present a case of severe peripartum hyponatraemia that occurred following a major obstetric haemorrhage causing both an ischaemic stroke and Sheehan's syndrome and outline the investigations and management strategy required. PMID:27512448
Hall, James A; Sarrazin, Mary S Vaughan; Huber, Diane L; Vaughn, Thomas; Block, Robert I; Reedy, Amanda R; Jang, Mijin
OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.
Haber, S.B.; Barriere, M.T. (Brookhaven National Lab., Upton, NY (United States)); Roberts, K.H. (California Univ., Berkeley, CA (United States). Walter A. Haas School of Business)
Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission's (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.
Haber, S.B.; Barriere, M.T. [Brookhaven National Lab., Upton, NY (United States); Roberts, K.H. [California Univ., Berkeley, CA (United States). Walter A. Haas School of Business
Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission`s (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study.
Asif Qumer Gill
Full Text Available Emergency management agencies are progressively using social media for the sourcing and distribution of disaster information. Emergency management agencies are often unsure as to how to best identify and assess social media concerns (e.g. information security, trust which must be addressed to develop a social media-enabled disaster information management environment. This paper adopts the Social Architecture Viewpoint Assessment (SAVA framework for identifying and assessing social media concerns from four different viewpoints: IT, Value, Resource and Management. This paper demonstrates the use of the SAVA framework in the context of an in-depth empirical case study of an Australian emergency management agency. The results of this study indicate that the SAVA framework is useful for emergency information management managers in identifying and assessing social media concerns.
Management flows and methods for technological development are discussed in this paper according to the actual situations featuring various projects,tight schedules,heavy tasks,inadequate personnel as well as high intercrossing between scientific research and production.To guarantee successful implementation of the scientific research and fabrication of typical products and to stimulate the development of specialized techniques,the conventional mode of the technological development,which merely relies on advanced research projects,is broken through.For wider requirements and to involve more and more technologists to participate,the internal technological research projects with little investment but quick result are set up.By this means,varieties of technological work are promoted a lot.Moreover,some helpful experience is also obtained in the combination of task fulfillment and technological team training.%针对项目多、时间紧、任务重、人员少和科研生产高度交叉的实际情况,从充分保障型号产品科研生产顺利进行和促进专业技术发展的目的出发,突破以往单一依托预研课题进行工艺技术研究的模式,对工艺研究管理的流程和方法进行了探索。通过面向更广泛需求,调动更广泛工艺技术人员参与,开设短、平、快内部专项工艺研究项目,有力地促进了各项工作的开展,在完成任务和锻炼工艺队伍相结合方面取得了一些有益的经验。
Full Text Available OBJECTIVE: This study aimed to examine the association between negative life events (NLEs and attempted suicide in rural China. METHODS: Six rural counties were selected from disease surveillance points in Shandong province, China. A total of 409 suicide attempters in rural areas between October 1, 2009, and March 31, 2011, and an equal number of matched controls were interviewed. We compared negative life events experienced within 1 month, 1-3 months, 3-6 months, and 6-2 months prior to attempted suicide for cases and prior to interview for controls. We used multivariate logistic regression to examine the association between NLEs and attempted suicide. RESULTS: Suicide attempters experienced more NLEs within the last year prior to suicide attempt than controls prior to interview (83.1% vs. 33.5%. There was a significant dose-response relationship between NLEs experienced within the last year and increased risk of attempted suicide. Timing of NLEs analysis showed that NLEs experienced in the last month and 6-12 months prior to suicide attempt were significantly associated with elevated risk of attempted suicide, even after adjusting for mental disorders and demographic factors. Of NLEs, quarrelling with spouse, quarrelling with other family members, conflicting with friends or neighbors, family financial difficulty, and serious illness were independently related to attempted suicide. CONCLUSION: NLEs are significantly associated with increased risk for attempted suicide in rural China. Stress management and intervention may be important to prevent suicidal behavior in rural China.
Full Text Available International studies provide evidence that effective teachers are essential to students’ learning success. Research on teacher effectiveness in the United States began in the 1980’s, and valid and reliable methods for assessing teacher effectiveness have been developed in its context, research on this topic is still relatively new in German-speaking countries. While effective teaching is a highly complex construct which includes a whole repertoire of skills, there seems evidence that some of these skills play a particularly significant role for effective teaching. The present article will take a close look at these skills from the perspective of two mostly separate discourses: expertise research and the qualities of expert teachers, which are usually discussed in the Anglo-American context, and theories of teacher professionalism which is highly influential in the German speaking countries. The two concepts are explained and it is argued that–interestingly enough–research results of both discourses converge in the proposition that diagnostic and interpretative skills and an intuitive feel for situations –situation awareness–are decisive when it comes to successfully fostering students’ learning processes. These skills do not grow automatically with growing experience but need to be fostered by deliberate practice. Consequences for teacher education are drawn by suggesting that focusing on case study in teacher education as a particularly useful type of deliberate practice, is a promising approach to develop the above mentioned key skills.
Signorelli, Jason W; Osbun, Joshua W; Arias, Eric J; Reynolds, Lauren C; Chyatte, Douglas; Reynolds, Matthew R
Self-injection of household cleaning detergents (more specifically, commercial toilet bowl cleaner) into the reservoir of a ventriculoperitoneal shunt (VPS) has never been reported in the neurosurgical literature. A right-handed 41-year-old female with a past medical history significant for bipolar depression (with multiple prior hospital admissions for suicide attempts) and pseudotumor cerebri (status-post VPS placement from a right frontal approach) successfully injected ∼5 ml of toilet bowl cleaner into her ventricular shunt reservoir during a suicide attempt. She was found unresponsive by a family member 48 h after this event and presented to our hospital in moribund neurological condition (bilaterally fixed and dilated pupils with decerebrate posturing). Head computed tomography (CT) demonstrated marked ventriculomegaly. She was taken emergently to the operating room for placement of a left frontal ventriculostomy. Cerebrospinal fluid (CSF) sampled intraoperatively showed numerous Gram-positive cocci (later determined to be Staphylococcus epidermidis). For this reason, her right-sided shunt system was also removed in its entirety. She was treated with broad-spectrum intravenous and intraventricular antibiotics for her bacterial ventriculitis and her CSF was aggressively drained to treat her hydrocephalus. Once her infection had resolved, the shunt was replaced (using a right parietal approach) and she went on to make an excellent neurological recovery. Here, the authors present the case of a patient who self-injected household cleaning detergents into her VPS reservoir-and, likely, the ventricular system-during a suicide attempt and subsequently developed hydrocephalus and ventriculitis. Following this infrequent clinical scenario, consideration should be given to temporary ventriculostomy placement and shunt removal. Moreover, in patients with a known history of psychiatric co-morbidities-and particularly those patients with prior suicide attempts
LeCrom, Carrie; Rufer, Lisa; Slavich, Mark; Dwyer, Brendan; Greenhalgh, Gregory
The following case study attempted to assess what factors contribute to graduate school and early-career success among sport management graduate students. As faculty members charged with admitting the next generation of leaders in the sport industry, how should admissions decisions be made and what factors should be considered? The authors…
BOYACI, Reviewed By Dr. Adnan
161Case Studies in Knowledge ManagementEdited by Murray JennexHersley: PA: Idea Group, 2005, pp. 372, ISBN 1-59140-352-9Reviewed by Dr. Adnan BOYACIAnadolu UniversityEskişehir-TurkeyKnowledge management (KM) as a structured system and the way to the effectiveness isrelatively new field for the contemporary organizations functioning in different andcompetitive domain of public and private sectors in terms of getting optimal effectivenessunderlined by the concepts such as quality, productivity…...
Fay, Emily E; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa
Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.
Austin, Carol D; McClelland, Robert W; Gursansky, Di
Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.
Nursing Case Management as described here was developed in less than ideal conditions: a full census, a 30 per cent increase in patient volume over five years, a nursing shortage, no grants or outside funding, no clinical specialists or clinical ladder, and no computerized documentation system. No more staff or salary was added as we focused our attention on the new tools, roles, and structures necessary to achieve cost and quality outcomes. However, nursing case management has worked because of some very key elements: 1. A firm commitment to the belief that staff nurses must be accountable for the outcomes of the care that they have planned, given, managed, and continuously evaluated. 2. A combination of top-down organizational development strategies with excellent staff nurse involvement at each juncture. 3. Negotiation and collaboration with physicians and hospital administration at key turning points. This includes the relentless articulation of patient-centered care. 4. A willingness to learn and risk together as a whole department--across levels, across specialties. This includes a constant balance of moving from concrete examples and problems to reconceptualizing the issues. 5. Listening, responsiveness, humor, and acknowledging contributions of everyone. More than any other principal, the case manager must be a central caregiver to a patient to ensure cost/quality outcomes. Otherwise case management only adds to the cost of health care by adding another level of bureaucracy. Nurses have always managed the care of patients, but to stay effective and committed, they need to take increased authority in their patients' entire episode of care and develop formal collaborative practice groups. In other words: "Prospective payment has changed the health care product from a day of care (or a visit) to an entire case or episode of illness. More than just a new way of paying for care, it has changed our way of planning, managing, and thinking about health care
Jacky Siu-Lun Ting
Full Text Available Risk management is a decision-making process involving considerations of political, social, economic and engineering factors with relevant risk assessments relating to a potential hazard. In the last decade, a number of risk management tools are introduced and employed to manage and minimize the uncertainty and threats realization to the organizations. However, the focus of these methodologies are different; in which companies need to adopt various risk management principles to visualize a full picture of the organizational risk level. Regarding to this, this paper presents a new approach of risk management that integrates Hierarchical Holographic Modeling (HHM, Enterprise Risk Management (ERM and Business Recovery Planning (BCP for identifying and assessing risks as well as managing the consequences of realized residual risks. To illustrate the procedures of the proposed methodology, a logistic company ABC Limited is chosen to serve as a case study Through applying HHM and ERM to investigate and assess the risk, ABC Limited can be better evaluated the potential risks and then took the responsive actions (e.g. BCP to handle the risks and crisis in near future.
Thaís Sumie Nozu Imada
Full Text Available INTRODUCTION: Torus palatinus is a specific name to identify exostoses developed in the hard palate along the median palatine suture. Despite of not being a pathological condition, its presence requires attention and knowledge regarding its management. Surgical removal of exostoses is indicated when the patient frequently traumatizes the area of palatine torus during mastication and speech or when it is necessary for the rehabilitation of the upper arcade with complete dentures. OBJECTIVE: The aim of this article is to present three cases of Torus palatinus and to discuss the management of them. CASE REPORT: In the first case, a 57-year-old Caucasian man sought oral rehabilitation of his edentulous maxilla but presented a hard nodules in the hard palate; in the second case, a 40-year-old Caucasian woman was referred for frequent trauma of palatal mucosa during mastication, aesthetic complaint, and discomfort caused by the trauma of her tongue in this area; and in the third case, a 45-year-old Caucasian woman presented with a lesion on the palate that caused difficulty swallowing. When the Torus palatinus was impairing the basic physiological functions of the patients, all cases were surgically treated, improving the patients' quality of life. FINAL CONSIDERATION: The dentist should be properly prepared to choose the best from among the existing surgical approaches for each individual lesion in order to improve the results and avoid possible complications.
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.
Full Text Available Survival after nylon rope suicidal hanging is a rare occurance . We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully . Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery.
We have developed and implemented a large scale, centralized case management program to prevent healthcare consumption for frequent visitors to Emergency Departments. In a randomized trial of more than 12 000 patients we demonstrate sustained reductions of up to 20-40% in health care utilization. This session will focus on results and learnings gathered during a 5-year multicenter trial, growing from a small pilot to an international concept.The results have been published in several articles...
Full Text Available This case study serve as exemplar regarding what can go wrong with the implementation of an electronic document management system. Knowledge agility and knowledge as capital, is outlined against the backdrop of the information society and knowledge economy. The importance of electronic document management and control is sketched thereafter. The literature review is concluded with the impact of human resource management on knowledge agility, which includes references to the learning organisation and complexity theory. The intervention methodology, comprising three phases, follows next. The results of the three phases are presented thereafter. Partial success has been achieved with improving the human efficacy of electronic document management, however the client opted to discontinue the system in use. Opsomming Die gevalle studie dien as voorbeeld van wat kan verkeerd loop met die implementering van ’n elektroniese dokumentbestuur sisteem. Teen die agtergrond van die inligtingsgemeenskap en kennishuishouding word kennissoepelheid en kennis as kapitaal bespreek. Die literatuurstudie word afgesluit met die inpak van menslikehulpbronbestuur op kennissoepelheid, wat ook die verwysings na die leerorganisasie en kompleksietydsteorie insluit. Die metodologie van die intervensie, wat uit drie fases bestaan, volg daarna. Die resultate van die drie fases word vervolgens aangebied. Slegs gedeelte welslae is behaal met die verbetering van die menslike doeltreffendheid ten opsigte van elektroniese dokumentbestuur. Die klient besluit egter om nie voort te gaan om die huidige sisteem te gebruik nie.
Christiansen, Erik; Jensen, Børge Frank
The Register for Suicide Attempts (RSA) is a product of the WHO research project "WHO/Euro Multicentre Study on Parasuicide", which, among other things, had the purpose of collecting data on suicide attempts from 13 European countries. Data is collected in order to calculate trends and identify...
Day, Andrew; Hardcastle, Lesley; Birgden, Astrid
Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…
This case study deals with the argument of the Galenist author Gregor Horst (1578-1636), Medical Professor at Giessen University, Germany, and later town phyusician in Ulm, in the discussion on how purgatives act. Horst tried to reconcile a number of different opinions within a Galenist framework. His vast erudition enabled him to compare several classical as well as contemporary opinions. He takes into account Galen (129-c.200/216), Erasistratos (c. 330-255 BC), Asclepiades (fl. 1st century BC), the Hippocratic Corpus and the Problemata Aristotelis from antiquity, Mesue and Mundinus (c. 1270-1326) from the Middle Ages, and Jean Fernel (c. 1497-1558), Girolamo Cardano (1501-c. 1576), Johannes Costaeus (d. 1603), Laurent Joubert (1529-1583), Francisco Valles (1524-1592), Tobias Dorncreilius (1571-1605) and Gavriele Falloppio (1523-1562) from contemporary authors. Horst also integrated some Paracelsian ideas from Joseph Duchesne alias Quercetanus (1549-1609). In his attempt to preserve fundamentals of Galenic thought, Horst created a complicated theory nearly breaking under its own weight. He shows a rising divergence within traditional views as well as the fragmentation of Renaissance Galenism which took place already before the discovery of the blood circulation.
Christiansen, Erik; Larsen, Kim Juul
Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…
Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.
Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and
Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R
Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies.
Jacobus N. Cronjé
Full Text Available Background: Since logistics emerged as an applied discipline during the latter part of the 20th century, there has been an increased need for skills development in logistics and supply chain management. However, literature suggests a general shortage of educated and skilled logistics and supply chain managers worldwide.Objectives: The purpose of this article was to benchmark an in-house training programme in logistics management in the beverage industry of Zimbabwe with international best practice.Method: A case study approach was followed focusing on the programme curriculum, content and delivery. The article reports on the nature and effectiveness of the programme. The curriculum was benchmarked with skills requirements identified in literature. Relevance was evaluated based on participant perceptions over a period of 3 years using questionnaires with both closed- and open-ended questions.Results: Findings suggested that the programme offering is in line with international practice whilst it also addresses particular issues in Third World countries. Participants perceived the programme as being practical and valuable for enhancing their job performance and career development.Conclusion: The article provides a framework for evaluating logistics training programmes. Future research could include an evaluation that measures changes in on-the-job behaviour of participants.
Reviewed by Dr. Adnan BOYACI
Full Text Available 161Case Studies in Knowledge ManagementEdited by Murray JennexHersley: PA: Idea Group, 2005, pp. 372, ISBN 1-59140-352-9Reviewed by Dr. Adnan BOYACIAnadolu UniversityEskişehir-TurkeyKnowledge management (KM as a structured system and the way to the effectiveness isrelatively new field for the contemporary organizations functioning in different andcompetitive domain of public and private sectors in terms of getting optimal effectivenessunderlined by the concepts such as quality, productivity…etc. Because of the growingimportance and the popularity of the KM either as a research topic or specialized coursesubject, a crucial need for understanding, conceptualization and implementation of KM asa system has emerged since the mid 1990’s. In this sense, the book contributes criticallyto fill the gap between theory and implementation as a teaching material.This edited book is published by Idea Group Publishing. The book has twenty chaptersdivided into seven sections. In addition to a section of authors’ biography contributing thebook and an index, there is a preface that the basic terms and key concepts underliningthe cases discussed following chapters, which is explained in a schematized way.Besides the editor, total of 47 authors have contributed to the book. These authors arefrom different countries, academic backgrounds, and institutions. Although approximatelyone third of the authors are from USA, the rest of the authors are from Canada, England,Austria, Germany, Australia, New Zealand, Egypt, Bahrain and China. The authorsrepresent a variety of universities, private companies, and military institutions. Most ofthem have strong professional backgrounds, which help them address the issues bothfrom theoretical and practical perspectives. Contributions of authors having differentbackgrounds and institutions enable the book to have very comprehensive spectrum andthis makes the book attractive practically for those working different sectors
Jensen, Per Anker; Katchamart, Akarapong
on a case study of LEGO. Results: The study shows that the management model for FM creates a relevant starting point but also that stakeholder and relationship management is an essential aspect of Value Adding Management. The case study confirms the relevance of the basic concept and provides an important...
Wilmar M Wiersinga
Full Text Available Management of Graves′ ophthalmopathy (GO is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to discontinue smoking is straightforward, but just a small minority of smokers is able to quit smoking. Detailed information on how smoking adversely affects the outcome of Graves′ disease may convince patients they have to stop smoking right away. Controversy exists on the most appropriate treatment of Graves′ hyperthyroidism in the presence of GO. 131I therapy is associated with a risk of about 15% for worsening of GO; a preventive course of steroids is indicated in the presence of risk factors (smoking, biochemically severe hyperthyroidism, high level of TSH receptor antibodies, active GO. Alternatives are thyroidectomy or long-term treatment with antithyroid drugs, which apparently are rather neutral with respect to the course of GO. Mild GO is not always perceived as being mild by the patients themselves. Selenium improves mild GO. Moderate-to-severe GO is preferably treated with intravenous methylprednisolone pulses, but serious side effects and relapsing GO do occur. After steroid failure combination therapy with low-dose oral prednisone with either cyclosporine or retrobulbar irradiation can be effective. Dysthyroid optic neuropathy is best treated with IV pulses, followed by orbital decompression if visual functions do not improve. In resistant cases, rituximab might be considered, although failures of this drug are also described.
Na, Kyoung-Sae; Oh, Sei-Joong; Jung, Han-Yong; Irene Lee, Soyoung; Kim, Yong-Ku; Han, Changsu; Ko, Young-Hoon; Paik, Jong-Woo; Kim, Shin-Gyeom
Subpopulations of patients with adjustment disorder are at increased risk for suicide. The current study investigated whether personality traits, including alexithymia, temperament, and character, are associated with an increased risk of suicide in individuals with adjustment disorder. Age- and sex-matched patients meeting the diagnostic and statistical manual of mental disorders (DSM-IV) criteria for adjustment disorder with (n=92) and without (n=92) a history of suicide attempts were recruited for the present study. Ninety-two healthy individuals who did not meet diagnostic criteria for Axis I or II diagnoses were used as controls. The Toronto alexithymia scale-20 (TAS-20) and the temperament and character inventory (TCI) were used to assess personality traits. Significantly higher total and subscale scores on the TAS-20, including on the difficulty-identifying-feelings (DIF) and difficulty-describing-feelings (DDF) subscales, and lower scores on the TCI cooperativeness subscale were noted in adjustment-disorder patients with previous suicide attempts. In the multivariate regression analysis, high DDF and DIF and low cooperativeness increased the risk of suicide attempts in adjustment-disorder patients. A subsequent path analysis revealed that high DDF had a direct effect on suicide attempts, whereas high DIF had an indirect effect on suicide attempts via low cooperativeness.
Bechtel, Kristin; Lowenkamp, Christopher T.; Latessa, Edward
The purpose of the Youth Level of Service Case Management Inventory (YLS/CMI) is to assess, classify, and assist agencies with developing treatment and service plans according to the offender's criminogenic risk factors. Given the limited research in the predictive validity for this instrument, the current study attempts to examine this issue on a…
Miller, Mark S.
This qualitative multiple-case study was conducted to explore and understand how the implementation of required relationship-specific supply chain management system (SCMS) dictated by the network leader within a supplier network affects a supplier organization. The study, on a very broad sense, attempted to research the current validity of how the…
Roger E. Thomas
Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.
Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.
It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…
Javangula Kalyana C
Full Text Available Abstract Introduction Keloid scars following median sternotomy are rare and occur more frequently in pigmented skin. Different management strategies have been described with variable success. We present a case of keloid scar formation following cardiac surgery including our management and the final aesthetic result. Case description A 64 year old female of fair complexion underwent mitral valve replacement. The procedure and postoperative recovery were uncomplicated, however, during the following year, thick keloid scars formed over the incision sites. Initial non surgical measures failed to relieve pain and did not offer any tangible aesthetic benefit. Eventually surgical excision was attempted. She presented to our clinic for nine months follow up with significant improvement in pain and aesthetic result. Discussion and Evaluation Several theories have attempted to explore the pathophysiology of keloid scar formation. A number of predisposing factors have been documented however none existed in this case. A variety of invasive and non invasive approaches have been described but significant differences in success rates and methodology of investigations still precludes a standardized management protocol. Conclusions In this case study a rare presentation of keloid scar has been presented. The variety of methods used to improve pain and aesthetic result demonstrates the propensity of keloid scars to recur and the therapeutic challenges that surgeons have to face in their quest for a satisfactory patient outcome.
A case report of a pregnant woman with recalcitrant Trichomonas vaginalis is described. This case was managed with suppressive treatment with metronidazole during pregnancy and cleared with paromomycin vaginal treatment after delivery.
在建构主义理论指导下，考虑企业现实需求，在高职院校中进行质量管理的教学尝试。本文论述了质量管理课程的教学资料的选择，基于企业现实需求、基于建构主义理论进行的教学组织与展开、教学评价和结果分析。通过建构主义理论指导下的高职教学展开、教学评价，通过精选的质量管理内容体系，让学生在实践中获得成果，产生成就感，让学生在顶岗实习前能够对工业企业内部的质量体系有一定的认识。%Guided by constructivism teaching theory, and taking account of the real demands of some companies, it is necessary to carry out the teaching attempts of quality management in higher vocational colleges. This article discusses the selection of teach-ing materials for quality management course, the organization and implementation of the teaching based on the real needs of com-panies and constructivism theory, teaching evaluation and result analysis. The implementation of higher vocational teaching and teaching evaluation guided by constructivism theory, as well as the selected quality management content system, can make stu-dents achieve some good results and develop a sense of achieve-ment, and gain some understanding of the internal quality system of companies prior to their on-post practice.
... 34 Education 2 2010-07-01 2010-07-01 false Service coordination (case management). 303.23 Section... Service coordination (case management). (a) General. (1) As used in this part, except in § 303.12(d)(11), service coordination means the activities carried out by a service coordinator to assist and enable...
... case management providers; or (iii) The methodology under which case management providers will be paid..., including for foster care programs, services such as, but not limited to, the following: (1) Research... placements. (3) Recruiting or interviewing potential foster care parents. (4) Serving legal papers. (5)...
Ambrosini, Veronique; Bowman, Cliff; Collier, Nardine
Teaching case studies are widely deployed in business schools. They are contextually rich in detail, and students learn by applying and adapting theoretical concepts to specific business situations described in the case. This article proposes a new way to use teaching case studies, as research materials for academics. The article addresses three questions: (1) Can teaching cases be used as an alternative to field research? (2) When can teaching case studies be used as second...
Full Text Available Objective. The objective was to investigate factors that affect the efficient management of solid waste produced by commercial businesses operating in the city of Pretoria, South Africa. Methods. Data was gathered from 1,034 businesses. Efficiency in solid waste management was assessed by using a structural time-based model designed for evaluating efficiency as a function of the length of time required to manage waste. Data analysis was performed using statistical procedures such as frequency tables, Pearson’s chi-square tests of association, and binary logistic regression analysis. Odds ratios estimated from logistic regression analysis were used for identifying key factors that affect efficiency in the proper disposal of waste. Results. The study showed that 857 of the 1,034 businesses selected for the study (83% were found to be efficient enough with regards to the proper collection and disposal of solid waste. Based on odds ratios estimated from binary logistic regression analysis, efficiency in the proper management of solid waste was significantly influenced by 4 predictor variables. These 4 influential predictor variables are lack of adherence to waste management regulations, wrong perception, failure to provide customers with enough trash cans, and operation of businesses by employed managers, in a decreasing order of importance.
Purpose: To develop a management concept that can assist facilities managers in implementing value adding strategies and practices. The FM Value Map has been developed to analyse and demonstrate the different ways FM can add value. However, there is a need to develop management tools that can...... be used more directly and proactively by facilities managers to implement adding value strategies and practices. Methodology: The development of the concept of Value Adding Management is based on the management model for FM included in the European FM standards, recent theories on added value of FM...... and real estate and the related concept of Value Management from building projects. The chapter outlines a preliminary theoretical based management concept, which is investigated, tested and discussed based on a case study of LEGO. Findings: The case study provides a clear example of a company that actual...
Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana
There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…
Dzyacky, S C
It is rare for employers who self insure to have on-site case management. Generally, self-insured employers rely on the third-party-plan administrators to control health care costs, provide enrollees with health care benefit management services, and maintain customer satisfaction. In this article, the author discusses the internal workings of an employee case management program implemented in a self-insured hospital in Northwest Indiana. Information is presented on the goals and role of the case manager, scope of practice, barriers to the program, and resources involved to deliver health care services to its enrollees. Also presented is pertinent information to track and trend data for administrative reports. In addition, customer satisfaction and the value of an on-site case manager for self-insured organizations will be addressed. The results demonstrate a reduction in the volume of inpatient admissions, length of stay, and, therefore, an improved use of the health plan.
YANG Lan-rong; ZHANG Jin-long
This paper presents a Case-Based system for assisting construction project managers in identifying risk factors and the corresponding construction project risk. The construction project risk identification model captures the case, acquired from previous completed construction projects and experience. A prototype is developed based on the proposed Case-Based system to determine risk factors along with their risk effects.
Rajita S. Jani
Results: Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 96% cases. The classical triad of symptoms (amenorrhea, abdominal pain and vaginal bleeding was present in only 28% cases. PID contributed 24% cases and previous abortion contributed 28% cases indicating these two as the common risk factors. Ampulla was the commonest site for ectopic pregnancy, in 52% cases. Salpingostomy performed mainly at this site. In 6% cases ectopic pregnancy in infundibulum were treated with fimbrial expression and fimbriectomy. 22% patients were managed medically (methotraxte. These were the cases having unruptured ectopic pregnancy and ectopic mass <4 cm. Laparoscopy was done in 34% cases, in 2 cases it was converted to laparotomy. While open laparotomy was done in 40% cases. Conclusions: Ectopic pregnancy is a treatable problem. Ultrasonography plays central role in the diagnosis and management. Mode of therapy is determined by a combination of clinical symptoms, sonography findings and serum b-HCG values. Surgical management is still a cornerstone of management of ectopic pregnancy. But now scope of medical and laparoscopic management is also there. In recent years laparotomy has been replaced by laparoscopic surgery which is more conservative, minimally invasive and less time consuming which leads to quick recovery. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 374-379
National Aeronautics and Space Administration — Software Health Management (SWHM) is a new field that is concerned with the development of tools and technologies to enable automated detection, diagnosis,...
Full Text Available Suicide is a global phenomenon in all regions of the world affecting people of all age groups. It has detrimental consequences on patients, their families, and the community as a whole. There have been numerous risk factors described for suicide including mental illness, stressful life situations, loss of social support, and general despair. The association of suicide with Islam has not been extensively studied. The common impression from clinical practice is that being a practicing Muslim reduces the risk of suicide. Another factor associated with suicide is starting a patient on antidepressants. However, this has been questioned recently. This report describes a middle-aged man with depression and multiple social stressors who survived a serious suicide attempt. The discussion will focus on the factors that lead him to want to end his life and the impact of the assumed protective factors such as religious belief and family support on this act of self-harm. Such patients can be on the edge when there is an imbalance between risk factors (such as depression, insomnia, and psychosocial stressors and protective factors (like religious affiliation and family support. All physicians are advised to assess the suicide risk thoroughly in patients with depression regardless of any presumed protective factor.
Kopman, Aaron F; Sinha, Nidhi
We present a case of prolonged recovery from mivacurium. Neuromuscular monitoring using acceleromyography was extremely helpful following attempted reversal of residual block in determining when tracheal extubation could be safely performed. If a method of objective estimation of the TOF ratio had not been available, tracheal extubation would have taken place at a time when the train-of-four fade ratio was below 0.40.
This article attempts to apply the strategic management theory to the subsequent shaping up of a readjusted strategic development policy for Shanghai Library after its merger with the Institute of Scientific and Technological Information of Shanghai(ISTIS)in 1995.It also tries to analyze and explicate such an empirical implementation of institutional reintegration process through strategic management at Shanghai Metropolitan Library.By doing so,it aims to present an objective case study of activities based on the strategic management paradigm at a major Chinese metropolitan public library.
Conclusion: Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.
Graham, Andrew T.
This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…
Coulter, Christopher H
Employers' past solutions to rising health benefit costs--adopting managed care strategies, cost shifting to employees and reducing benefits-are no longer effectively controlling costs and are depressing the value of health benefits for employee recruitment and retention. An alternative strategy is to implement health management approaches that improve the health status of employees. These programs reduce medical costs and have a documented positive impact on workers' compensation, disability costs, absenteeism and productivity. Further, this approach is complementary to health care consumerism as a strategy for health improvement and benefit cost reduction and results in improved employee health, outlook and satisfaction.
Trombly, Robert M.; Comer, Robert W.; Villamil, Juanita E.
Explores techniques of conflict management as well as the positive and negative factors that may exert progressive or detrimental influences. Presents a case scenario, drawn from a faculty development workshop, involving a dental school faculty member, and highlights central issues of the case and relevant management concepts. (EV)
Full Text Available Anaesthesiologist plays a major role in Cerebrospinal Fluid (CSF rhinorrhea repair surgery as the prognosis of which is dependent on provision of clear bloodless surgical field and surgeons satisfaction. Anaesthesiologist also plays vital role in the management of CSF Lumbar drain. This case highlights the importance of hypotensive anaesthesia during endoscopic repair of a case of spontaneous CSF Rhinorrhea with successful perioperative management of Lumbar drainage of CSF
Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...
Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N
The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.
Full Text Available Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down′s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.
Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs
By trustworthy adaptive case management we mean that it should be possible to adapt processes and goals at runtime while guaranteeing that no deadlocks and livelocks are introduced. We propose to support this by applying a formal declarative process model, DCR Graphs, and exemplify its operational...... specified either as linear time logic (LTL) or DCR Graphs, extend the language with time and data and offer extended support for cross-organizational case management systems....
The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day!
workshop, and to reviewers of this paper, in particular, Sandy Brenner , Bill Curtis, Richard Martin, Joe Morin, Jock Rader, Dave Kitson, Anita ...Hart, Grace Downey, Wendy Gissendanner, Helen Joyce, Wendy Rossi, Tracy Lewis, Attilio Marini, Frank Authenreith, Jeff Herman, Ed Morris, Sandy Brenner ...CASE Tools/Environments OO-ALC/TISAC Bldg. 100 Hill AFB, UT 84056 (801)777-8045 FAX: (801) 777-8069 Sandy Brenner Secretary III, Case & SAE
Kopnina, H.; Haafkens, J.
Recent EU initiatives promote employability of the growing number of the chronically ill and disabled employees. While HRM professionals and managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, the chronically ill remain largely
McNamara, T G
Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.
Markowitz, V.M.; Lewis, S.; McCarthy, J.; Olken, F.; Zorn, M.
In this paper we describe a new approach to the construction of data management systems for genomic mapping applications in molecular biology, genetics, and plant breeding. We discuss the architecture of such systems and propose an incremental approach to the development of such systems. We illustrate the proposed approach and architecture with a case study of a prototype data management system for genomic maps.
McNamara, C M
This paper reviews the incidence, etiology and location of supernumerary teeth with emphasis on premolar supernumeraries and examines the management of supernumerary premolars of three patients undergoing orthodontics. These cases demonstrate that the management of premolars is assessed individually and treatments based on potential complications, which may occur during the orthodontic and surgical management of the dentition. Progress and posttreatment radiographs are recommended for the assessment of late forming supernumerary teeth.
Full Text Available This paper explores how a tutor engaged an individual student who was abusive to teachers and would not carry out coursework assessments which tutors had set him in the Lifelong Learning Sector. It offers strategies to overcome barriers to achievement, particularly where a student resists carrying out required assessment tasks. It is a self-reflexive, auto-ethnographic case study. The research is based on observation, interview and a narratology of the researcher’s own involvement in the situation. It is concerned with strategies that worked with this particular student. It argues a case for personal engagement, solution-focused and cognitive behavioural strategies in the teaching/learning situation and offers an overall humanist approach. It ultimately argues for the complexity of understanding the key relationship between teacher and student. It is also concerned with ‘improving practice’ which is the central agenda of this journal.
Ibon Tamayo Uria
Full Text Available Citizens’ reports of sightings of undesirable animals are a common component of pest control programmes in a city. For this reason, local authorities tend to develop procedures for the capture and analysis of the resulting data sets based on these reported sightings. These procedures in turn contribute to the development of other initiatives aimed at improving public health conditions. The study presented here focuses on the methodology designed and implemented by the Madrid City Council for controlling and managing the presence of urban pests.The long experience (over 100 years of the City Council and its commitment to the incorporation of new technologies have allowed a number of important lessons to be learnt in pest control and management, which may be useful as a guide and model for cities where public health services have not yet incorporated these methods.
Harrsi, Rachel; And Others
The relationship between substance abuse and suicide is indicated by high rate of attempted suicide among alcoholics and drug abusers, as well as increased likelihood of repeated attempts in these populations. This study reports on psychological characteristics of male drug suicide attempters who are in treatment for their addiction problem.…
Sorenson, Susan B.; Rutter, Carolyn M.
Using data from 2,304 community residents, found self-reports of suicide attempts were more common among persons with than without family history of suicide. Nearly one in four suicide attempters reported family history of suicide. Being female and unmarried, respondent mental disorder, parent mental disorder, and parent suicide attempt exerted…
Martínez, Henry; Espinoza, Miguel; Huaman, César; Monge, Eduardo; Salazar, Sonia; Tapia, Abel
This is a case report of a 19 year-old woman, with an acute recurrent pancreatitis diagnose, and pancreas divisum as anatomic alteration. An extensive evaluation including specialized labs, ERCP was done. The diagnosis is suspected during ERCP and confirmed by minor papilla injection. Treatment is directed towards relieving outflow obstruction at the level of the minor papilla, with successful results.
Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)
Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.
Rafeek, Reisha N; Paryag, Amit; Al-Bayaty, Haytham
Dentinogenesis imperfecta (DI) is an inherited disorder that affects dentin and often manifests as tooth discoloration; in addition, the dentition is also extremely susceptible to wear. Treatment of DI focuses primarily on protecting affected dentin, reducing sensitivity, and improving esthetics. Routine restorative materials, such as amalgams and composites, may be used. In more severe cases, the treatment of choice is full coverage crowns, while bonding of veneers may be used to improve the esthetics of the anterior teeth. This study presents two cases of Type II DI in the same family and the management of each case. Restorative management included amalgams, composite veneers, crowns, bridges, and overdentures.
Full Text Available Introduction: Conservative management is the first option for patients with stress urinary incontinence (SUI. However, successful management of women diagnosed with SUI is dependent on a proper assessment and a tailored treatment plan. This case report aims to show the effectiveness of physiotherapy management in a 42-year-old patient diagnosed with SUI.Patient presentation: The patient’s main complaints were involuntary loss of urine on coughing, sneezing and lifting of heavy objects, which started following the birth of her third child.Management and outcome: The patient was taught the ‘Knack’ manoeuvre and provided with a tailored pelvic floor exercise programme. Improvement was noted at the third visit and the patient no longer had involuntary episodes.Conclusion: This case report shows the successful outcome of conservative management in a patient with stress urinary incontinence.
Morrison, G.; Greening, H.S.; Yates, K.K.
Tampa Bay, Florida,USA, is a shallow,subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of sea grasses and other selected habitat types, to support estuarine-dependent faunal guilds.
published in a book of essays on cyber analogies that he commissioned (Axelrod, 2014). The third phase of the project developed a mathematical ...phase analyzed how historical analogies are used to make sense of novel events, comparing historical analogies invoked in three events in newspapers...from five countries. Case-based reasoning was found to be very common, with almost one historical analogy per article (963/1061). The second phase
Astor Eugênio Hexsel
Full Text Available The Cordilheira de Santana case, from now on referred to simply as Cordilheira, was conducted and reported with the main purpose of contributing to the understanding of the process of strategy formulation in the winery sector. It presents the case of a recently created small firm aiming to compete in the market by offering high quality based on reduced premium line products, with prices established in accordance. Even so, it has not achieved the expected results. The wine industry with its basis in the wineries of the extreme south of Brazil, which is the most productive sector in the whole country, is also discussed. The case study began in 2008, when Rosana, owner and director of the company, travelled from São Paulo to Porto Alegre and highly concerned that the expected results had not been achieved. Data included as a technical note on the wine industry provides information on the industry as a whole, enabling students to reconsider the firm´s positioning in the market. The teaching note that follows provides the professor with information that will allow him to explore several perspectives that will have to be faced by Rosana further. She may choose to strengthen the present strategy or to take it in a new direction.
Full Text Available A conservation project was implemented at a commercial limestone quarry site in Sri Lanka managed by Holcim Lanka (Pvt. Ltd. The project intended to assess the biodiversity of a proposed excavation site and to translocate fauna that will be affected by quarry operations such as forest clearance and blasting. The biodiversity of the area was surveyed using a rapid assessment technique, prior to the initiation of forest clearance and blasting. A total of 41 floral species and 220 faunal species were recorded from the project site. Around 90 % of the fauna were amphibians, reptiles and butterflies. Among these species, one endemic tree, a theraposid spider and 20 endemic vertebrates. Among the vertebrates documented, 9 species are categorized as nationally threatened. A total of 141 vertebrates and 85 arthropods and mollusks including endemics threatened species were captured and translocated to Sethtavilluwa area. This project is the first ever initiative in Sri Lanka aimed at reducing impacts of quarry operation on biota through rehabilitation and rescue operations. Such projects are invaluable as they will, at least in part assist in safeguarding biota that will be vulnerable to local extinction as a result of developmental projects.
Pinninti, Narsimha R; Schmidt, Lisa T; Snyder, Richard P
Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses.
Strong, T H; Vega, J S; O'Shaughnessy, M J; Feldman, D B; Koemptgen, J G
Eighteen of 901 women (2%) attempting vaginal birth after cesarean delivery (VBAC) received amnioinfusion. No untoward effects occurred in the subjects or their fetuses. We conclude that, though amnioinfusion in the setting of a VBAC attempt is needed only infrequently, it appears to be a reasonable intrapartum management option. The usual safeguards for a VBAC attempt should be followed.
Cangemi, C F; Miller, R J
Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depression, and apathy leads to cachexia. Factors of considerable concern to the anesthesiologist who treats patients with Huntington's disease may include how to treat frail elderly people incapable of cooperation, how to treat patients suffering from malnourishment, and how to treat patients with an increased risk for aspiration or exaggerated responses to sodium thiopental and succinylcholine. The successful anesthetic management of a 65-yr-old woman with Huntington's disease who presented for full-mouth extractions is described.
In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show how case managers use this assemblage in their everyday routines, but also how it undercuts key elements of the original ACT mission. Reflecting its roots in the deinstitutionalization movement, the ACT model gives case managers limitless responsibilities for clients' lives, but then narrowly defines their role as the prosthetic extension of psychiatric authority. To produce compliance, case managers depend on the medication cassette, analyzed here as a human/non-human hybrid woven into their ordinary work. The medication cassette has pre-scripted uses that enlist clinicians in biopsychiatric thinking and also silently impose compliant behavior on clients. The elements in the assemblage of compliance depend on each other, but they do not form a seamless whole, as evidenced by the dilemmas and micropolitics of the clinical front-line. Theoretical notions of assemblages and technologies of compliance, drawn from science and technology studies, illuminate a core conundrum of practice in psychiatric case management.
Redford, L J; Parkins, L G
The purpose of this article is to stir the imagination and incite the creative energies of case managers in finding ways to capitalize on communication and information technologies to improve access to care as well as the quality of care in rural communities. Today, the general dearth of services and logistics of providing services in rural areas challenges even the most seasoned case managers. Given the current economic and political climate, it is unlikely that these challenges will lessen, particularly if we continue to pursue our more traditional approaches to case management and service delivery. Telecommunications technologies are opening exciting opportunities for changing this trajectory and expanding the role and reach of case managers, while improving access to many services. This article highlights the new and the potential applications of interactive televideo in health and human services, as well as the vast opportunities offered by the Internet. There are, however, also pitfalls we must overcome to realize the full potential of these technologies. Case managers, in their roles as advocates, coordinators, and facilitators, are ideally positioned to be on the cutting edge of these technological applications and play a catalytic role in moving rural communities into the "information age."
Full Text Available International trade plays a special role in all countries due the influence exerted in the economic and social field. At the same time, subjects such as planning and implementing the operation of export and import becomes very important, with particular relevance among entrepreneurs and academics. When it comes to this issue, the aim of this teaching case is to provide discussions about the subjects of entrepreneurship, business planning and the learning of strategists. It describes the experience of company SK, started in July of 1997, which began its businesses through exporting and importing leather and its artifacts. Later, the enterprise redirected its focus and began importing chocolates for the Brazilian market. The entrepreneur found, during the process of the business construction, a series of challenges that obliged him to make decisions and make choices. Having an amount of capital and willingness to undertake, he had to decide which path to follow and how to decide. Were there right and wrong choices? How would he plan and operationalize a start-up business? How would he evaluate opportunities and estimate the risk of an enterprise? These are some of many questions that the reader will be challenged to answer after analyzing this case.
John Ross Williams
Full Text Available Penetrating cranial injury by mechanisms other than are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here we present a case of penetrating brain injury by the low velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of lower-velocity penetrating brain injury (LVPBI, including benefit in delaying foreign body removal to allow for tamponade; the importance of history taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using DECT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher velocity forms of intracranial injury.
Full Text Available A multi-lateral horizontal well is one of the main well types employed in the coal bed methane (CBM development. In a traditional CBM multi-lateral horizontal well, either a major hole or laterals will go crossing through coal beds to the largest extent, which may eventually result in bed collapse, footage failing to meet the design requirement, and the major hole unable to be monitored, re-entered and flushed. Therefore, this paper puts forward a design idea of a tree-like horizontal well composed of a major hole (for dredging passage, laterals (for controlling drainage area and sub-laterals (for enhancing production. The major hole is usually drilled on the stable roof or floor of a coal bed, laterals are drilled from the major hole into coal beds, and several sub-laterals are drilled from laterals. The major hole, laterals and sub-laterals constitute a tree-like drainage and recovery system, whose major hole remains stable for a long period and can be monitored and maintained. The technique has been successfully applied in Well ZS 1P-5H in the Qinshui Basin, Shanxi. The well included one major hole, 13 laterals, and 26 sub-laterals, with a total drilling footage of 12288 m, a total coal bed footage of 9512 m, and a total pure coal footage of 9408 m. Its major hole was fully placed in the mudstone of the coal bed roof. This well records a successful case of incident-free single well drilling with a footage of more than 10,000 m and serves as a new well type for efficient CBM development in China.
Vijay M Ravindra
Conclusions:Pregnancy presents a challenge for any patient requiring neurosurgical intervention. We present an interesting case example with a rare central nervous system neoplasm and discuss the management of intracranial pathology in pregnant patients.
Simmons, Florence M
Hospital overcrowding is primarily a shortage of inpatient beds, not a lack of emergency department capacity, as initially assumed. According to Asplin et al., many factors contribute to overcrowding, including inadequate or inflexible nurse-to-patient staffing ratios, isolation precautions, or delays in cleaning rooms after patient discharge; an overreliance on intensive care or telemetry beds; inefficient diagnostic and ancillary services on inpatient units; and delays in discharging hospitalized patients to postacute-care facilities. Hospital overcrowding presents a challenge for hospital employees and clients, often leading to frustration and dissatisfaction. Overcrowding also has a direct effect on patient care, including compromised patient safety, increased costs, increased length of stay, and increased mortality and morbidity rates. The emergency department is changed from a temporary holding area to an extended patient care unit, decreasing its ability to handle new admissions and to manage a mass casualty. Beds in the critical care units become filled with inappropriate patients if floor beds are not available, making placement of seriously ill patients difficult. Trauma patients may have to be diverted to other hospitals to receive the appropriate level of care. Patients who require specialty services may have to wait for extended periods to obtain a bed in a referral center.
Fushimi, Masahito; Sugawara, Junya; Saito, Seiji
To determine the factors underlying suicide in Akita prefecture, a questionnaire survey was conducted among members of the Akita Prefectural Medical Association (APMA), regarding suicide cases they attended. During the investigation period (1 July 2001-30 June 2002), the total number of suicide cases was 243 (138 completed, 105 attempted). Significant differences were identified between completed and attempted suicide groups in terms of gender, age distribution, and suicidal methods. Specifically, in the completed suicide group, the number of male completers exceeded that of female completers, the number of middle-aged or elderly completers was high, and the majority of completed suicide cases involved hanging as the suicide method. Conversely, in the attempted suicide group, the number of female attempters exceeded that of male attempters, younger attempters were frequent, hanging was rare, and drug overdose or cutting was common. In addition, the number of cases involving a history of previous suicide attempts was significantly higher in the attempted suicide group than in the completed suicide group. The results of the present study support the concept that the completed and attempted suicide groups are essentially of a different nature. Furthermore, the number of cases involving a history of previous suicide attempts was found to be significantly lower in the completed suicide group than in the attempted suicide group. This result indicates the difficulty in decreasing the number of completed suicides by simply providing intervention and care for individuals who have attempted suicide.
Sánchez Ruiz, Lidia; Blanco Rojo, Beatriz; Simón, Rosa María
Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process managemen...
The purpose of this study was to identify the aspects affecting customer satisfaction and to find out how the management can improve customer service. The purpose was to give guidelines to the case company of how to improve customer service and thus gain competitive advantage over competitors. The data to this study was gathered from various online sources and literature. The core theories and concepts were CRM, creating customer satisfaction, managing employees and complaint handling pro...
Vallejos, Rolando,; Oliveira Gomes, Jefferson,; Lima, Celson; Nesello, Priscila
Part 19: Knowledge Management in Networks; International audience; This work describes a practical case combining collaborative networks and knowledge management, at SENAI environment. SENAI was founded in 1942 to support the Brazilian industry through professional and technological education, and services. In 2011 SENAI started implementing a national program targeting the industrial competitiveness all over the country. Such an ambitious program relies upon several key elements and this wor...
Rudagi B M
Full Text Available Ameloblastoma, first recognized by Cusack in 1827, is a neoplasm of odontogenic epithelium, especially of enamel organ-type tissue that has not undergone differentiation to the point of hard tissue formation. It accounts for about 1% of all oral tumors and about 9-11% of odontogenic tumors. Ameloblastoma in the mandible can progress to a great size and cause facial asymmetry, displacement of teeth, malocclusion, and pathologic fractures. A case of large ameloblastoma of mandible in a 39 year old male patient is being reported. Patient had large swelling on left lower side of the jaw since 2 years. Swelling was approximately 15 X 10cm in size. Intraorally the swelling involved buccal and lingual cortical plates and was obliterating the vestibular space. Patient did not seek medical attention because swelling was painless. The patient was investigated and treated with surgical excision and was providedwith prosthesis to correct the post operative sequale. The patient showed uneventful recovery with no recurrence after a follow up of one year.
Robert William Campos-Guzmán
Full Text Available We report a case of male patient of 32 years old; with a history of thoracic surgery for hydatid cyst at 9 years of age; admission was at the general surgery Service of the Hospital II Lima Norte Callao Luis Negreiros Vega, with a history of illness of 1 year, referring abdominal pain oppressive predominance of the upper abdomen, especially on right upper quadrant. Refers concomitantly history of previous surgery in thoracic region and positive epidemiological history. After clinical evaluation by the staff of surgery, outpatient clinic and the observation and reporting of CT in which well-defined lesions in segment IV and V multicystic appearance and lesser sac showing peripheral enhancement it is observed after administration contrast; associated with positive Western Blot, surgical treatment is decided. Laparoscopic Surgery was performed consisting of cyst aspiration drainage and washing the interior with hipersodio (20% ClNa and placement of laminar drain was done. Presented a postoperative biliary fistula that was resolved in five weeks, beginning of oral tolerance on the first postoperative day and liver function controls within normal ranges discharge was performed four days after surgery.
Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L
Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.
Madsen, Arne Stjernholm; Ulhøi, John Parm
This case addresses the Home Communication Concept (HCC) and represents the response of a major ICT manufacturer to the reshaping of the telecom market, paved by Internet technology. The project is described from its start in summer 1997 to the end of 2001. This is a unique case study in more than...... of management during disruptive technological development, but also illustrates the internal problem of allowing a creative BDD to become "sectarian," i.e. blindly believing in itself and suspicious of the rest of the world. Using the framework presented in this paper, several fundamental concerns regarding...... existing research are identified and discussed. In closing, implications for research and management are addressed....
Hesse, Morten; Vanderplasschen, Wouter; Rapp, Richard;
). Reference searching; personal communication; conference abstracts; book chapters on case management. Selection criteria Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol...... or drug related problem. Data collection & analysis Two groups of reviewers extracted the data independently . Standardized mean difference was estimated. Main results In total, we could extract results from 15 studies. Outcome on illicit drug use was reported from 7 studies with 2391 patients. The effect...
Full Text Available This paper aims to highlight a link between publishing business innovation and how editors manage creativity in the digital era. Examining the changing industrial and historical business context for the U.K. magazine publishing industry, two case studies are analyzed as representatives of different ends of the publishing company spectrum (one a newly launched magazine published by a major, the other an independent ‘magazine’ website start-up. Qualitative data analysis on publishing innovation and managing creativity is presented as a springboard for further research on magazine media management.
Purpose: To investigate how Risk Management (RM) is perceived and practiced in Facilities Management (FM) and corporate management and to evaluate the potential benefits of an increased application. Theory: RM is a generic management discipline, but apparently it has not achieved the attention...... it deserves in FM. Application of RM in FM could help to increase the strategic importance and awareness of FM among corporate managers. Approach: A preliminary study with expert interviews was initially conducted followed by a main study with an interview survey in two Danish case companies - a real estate...... company and a consulting engineering company. Findings: The research showed that RM was applied in both companies to a higher degree than initially expected, but often using other terminology. The real estate company had a much stronger focus on RM in relation to the technical aspects of real estate...
Kshirod Kumar Mishra
Full Text Available Background: Suicides, attempted suicides and different form of suicidal behaviors are on the rise in most part of the world. It is generally assumed that official suicidal rate are underestimated from the true rate by 20-100 % due to prevailing socio-cultural issues, religious attitude, stigma attached, and legal process involved. Attempted suicides occur 8-20 times more frequently than complete suicide. Statistics on attempted suicide or deliberate self harm are not usually available officially. Materials and Methods: All the cases of attempted suicide who were admitted and referred for psychiatric evaluation and management to a rural medical college of central India during a period of one Year (April 13-March-14, following initial recovery they were evaluated on a semi-structured performa on socio demographic profile, mode of attempt and reason for attempt. Data collected was analyzed using suitable statistical methods. Results: Total 68 cases were evaluated during the study period. 43% of the cases were involved in farming. Among 85% of the study population pesticide consumption was the common mode of attempt, which is easily available among the agrarian community of rural India. Interpersonal conflict in the family due to indebtedness, financial loss due to crop failure was the commonest reason for attempt. Conclusion: Though there is reduced reporting in the incidents of suicide cases in media from this region, still quite a number of people attempt suicide due to financial constraint from crop failure, ongoing indebtedness, and poor socioeconomic condition culminating into poor mental health among the rural agrarian community of central Maharashtra.
Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce
Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…
Wright, J T
Epidermolysis bullosa (EB) is a group of rare genetic disorders which are of dental interest because of their specific oral manifestations and management difficulties. Two cases of recessive EB which may be classified clinically as the atrophicans-gravis Herlitz type are described. Dental therapy consisted of extractions and stainless steel crown restorations, with inhalation general anesthesia. The need for and advantages of early preventive and restorative dental care are illustrated by the cases presented.
Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta
The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.
Salem Bilal A
Full Text Available Abstract The possible increase of suicidal ideation with some antidepressants is still a matter of debate. We are reporting two cases of suicidal attempt that occurred concomitantly with the use of Duloxetine. To our knowledge there is no prior publication about a possible Duloxetine related increase in the risk of suicidality.
Marmet, C; Shell, E; Aldana, S
Based on this more thorough assessment, the lactation consultant may be able to identify all of the factors contributing to this complex case. In some situations, her skilled interventions will suffice once the underlying problem is addressed. Occasionally, she will identify a factor that falls outside of her area of expertise; when this happens, she must make the appropriate referrals. For example, a referral to a physician for a frenotomy or suspected neurological or other medical problem is appropriate. It is clear that because Baby E's problems were not resolved after 6 weeks of concerned effort, something was missed. It would certainly be appropriate for the lactation consultant to refer the dyad to another lactation consultant who has more expertise in handling clinically challenging breastfeeding problems. If possible, the referring lactation consultant should accompany the dyad so that she can improve her clinical skills. Assuming Baby E does not have underlying medical problems, the most likely causes of Baby E's difficulties are anatomical variation and/or sucking dysfunction. Because the baby is so fussy, it also would be wise to consider the possibility of allergies or food tolerance. Our first rule is " Feed the baby." The second rule is " Correct or work on correcting the problem or problems." Our goal is to achieve exclusive breastfeeding or as close an approximation as possible. We almost never give up on this goal, but we do educate the mother and work professionally with her choices. Until the baby is breastfeeding well, the lactation consultant will probably need to instruct the mother to continue using a pump ( preferably a hospital-grade, electric, bilateral pump). The mother should use the pump physiologically, pumping as many times a day as the baby would breastfeed. As soon as the situation improves, the mother should be instructed to wean gradually from the pump and any other breastfeeding equipment she is using. The goal should always be
Stenager, Elsebeth Nylev; Jensen, Børge; Stenager, Maria
The purposes of the study were (1) to estimate the risk of suicide attempts in multiple sclerosis (MS) patients in Denmark and compare the risk to the background population in the County of Funen, Denmark; (2) to estimate the risk of suicide attempts in MS patients receiving immunomodulating...
Molly B Kraus
Full Text Available Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.
Molly B Kraus; Spitznagel, Rachel A; Kugler, Jane A
Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.
Full Text Available Swedish moose (Alces alces management has over the years transformed from a situation similar to what Hardin (1968 defined as a tragedy of the commons – i.e. where open access and unrestricted demands lead to over-exploitation – into a situation characterized by an abundance of moose. While high numbers of moose are preferred by hunters, they damage forests through grazing, causing conflicts between hunters and forest owners. In an attempt to resolve these disputes, the Swedish government is introducing a new local ecosystem-based management system. This paper analyzes this shift from managing a single resource to the broader perspective of ecosystem management and discusses to what extent it will contribute to conflict resolution. The results suggest that some of the problems highlighted may be solved through the implementation of an ecosystem management system. However, several challenges remain to be tackled, such as how to establish robust partnerships between forest owners and hunters for managing moose on land with a fragmented property rights structure. This can lead to different and conflicting objectives and, consequently, difficulties in reaching collective action.
Shelesky, Kristin; Weatherford, Ryan D.; Silbert, Janelle
The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center…
Glickman, Gerald N.; Comer, Robert W.; Filler, Steven J.; Fine, James Burke
Presents an overview of some critical theories in human relations management. Offers a hypothetical case, drawn from a faculty development workshop, involving a dental school faculty member and her dean, for discussion and application of principles. Finally, presents the central issues of the case along with a review of relevant management…
Trombly, Robert M; Comer, Robert W; Villamil, Juanita E
The need for administrative faculty members to have superior leadership and management skills to handle their increasingly complex responsibilities is well established. As a part of the 2000-01 ADEA Leadership Institute curriculum, fellows were responsible for developing situational case studies for a faculty development workshop to develop participants' leadership and management skills. The case presented here involved managing conflicts in the dental academic setting. The foundation of conflict management centers on communication techniques including transparent communication, open discussion, open confrontation, and active listening. Management options such as avoidance, accommodation, competition, negotiation, and collaboration are potential strategies for the faculty leader. This case study involves a fictitious public dental school, New Horizons University, which has embarked on solutions to address limited resources, but unwittingly has created conflicts between individuals and groups of faculty members. The case discussion analyzes the cause of conflicts, presents the positive and negative potential of the conflicts, reviews techniques of conflict management, and discusses specific management concepts regarding resource allocation and equity theory.
Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…
Lena M. O'Keefe
Full Text Available Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus (SV is extremely rare. Herein we report a case of SV, review the literature and provide a suggested algorithm for diagnosis and management.
Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.
Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…
Smith, Pernille; Carugati, Andrea; Giangreco, Antonio
the integration process of the merger. The main issue is how a middle manager constitutes an obstacle to this organisational change by re-inforcing the 'old' ways of working in his group. To solve this case satisfactorily students should be able to see the organisation from several different layers (employee...
Purpose: The purpose of this paper is to understand how social networks can help to produce the "magic" of extraordinary results for organizations. Design/methodology/approach: In this exploratory study four cases (from published reports) are compared in order to illustrate different management approaches to utilizing the power of networks.…
This report describes the content of a case-study, which was carried out in a Scandinavian company. The purpose of the study is to identify and indicate the current company approach to portfolio management (tools, methods, and processes) for new products combined with suggestions for improvement...
Full Text Available In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF. However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice. We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France. These cases highlight the heterogeneity in the presentation, history and clinical course of IPF, together with expert insights regarding the diagnosis and management of IPF in the real-life setting.
Milosevic, Dragan Z; Srivannaboon, Sabin
The ever expanding market need for information on how to apply project management principles and the PMBOK contents to day-to-day business situations has been met by our case studies book by Harold Kerzner. That book was a spin-off from and ancillary to his best selling text but has gained a life of its own beyond adopters of that textbook. All indications are that the market is hungry for more cases while our own need to expand the content we control, both in-print and online woudl benefit from such an expansion of project management "case content".
Siddiqui, Fraz Anwar; Kabeer, Jamal; Shahabuddin, Syed
Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully- equipped centres. Such injuries can cause ventricular septal defect (VSD) or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography (CT) to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass (CPB) along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart.
Full Text Available Knowledge is the new strategic imperative of organizations. The ability to manage knowledge is a crucial part of any organizations operational processes. The creation and diffusion of knowledge have become ever more important factors in competitiveness. This paper investigates the Knowledge Management and flow information and in small design firms. It is divided into three main parts. The first part of this paper describes the importance of Knowledge Management for organizations are described together with responsibilities needed to ensure successful Knowledge Management implementations and the Spiral of Organizational Knowledge Creation conception. The second part approaches literature available about process and organizational structure and information flow related to Brazilian design firms. Finally, this paper presents a case study of small design office of Civil Engineering identifying organizational process, verifying the types of communication practices and identifying the types of dynamic process of The Spiral of Organizational Knowledge Creation, KM strategy and dynamic through Knowledge Transfer.
Jadea S. Alshammari
industries. The optimization model is developed based on the goal programming technique that attempts to minimize the set of deviations from pre-specified multiple goals, which are considered simultaneously but are weighted according to their relative importance. A set of data from local petroleum refining industries is obtained and is analyzed using the unique presently developed multi-objective optimization model based on goal programming technique with all treatment options and economic constraints. The successful application of this model has provided the most economically viable solution to be applied for the specified objectives to be accomplished for the management of solid waste generated from petroleum industries.
A clinical case reported to SENSAR is presented (www.sensar.org). A patient came to the operating room for surgery for parathyroidectomy. She had several predictors of difficult airway management, including a story of difficulties in previous intubations in other hospitals, as the patient reported. Therefore, after evaluation in preoperative consultation, fibreoptic bronchoscopy intubation was recommended. The day of surgery after induction of general anesthesia direct laryngoscopy was performed, without recognizing any glottic structure (Cormack-Lehane grade iv). Conventional laryngoscope was changed to a videolaryngoscope (Airtraq(®)) to try to improve the laryngoscopic view, but there were difficulties with handling and insertion of it, causing minor injuries to the lingual mucosa. Finally, tracheal intubation was achieved after several attempts. Analysis of the incident revealed the active error due to lack of experience of the professional who performed intubation maneuvers, favored by latent factors or contributors as were the complex pathology of the patient and the absence of protocols to difficult airway management in the hospital. Communication and analysis of this incident served to highlight the importance of the security protocols in Anesthesia, and as a result a working group that conducted the current algorithm approach to a difficult airway management was formed, established guidelines for further information patient and deals since clinical training and professional practice for the management of airway devices availables in the hospital.
Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal
Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.
Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd [School of Technology Management and Logistics, Universiti Utara Malaysia, 06010 Sintok, Kedah (Malaysia); Baharum, Mohd Faizal [School of Building, Housing and Planning, Universiti Sains Malaysia, 11800 Penang (Malaysia)
Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.
Kwon, Ahye; Song, Jungeun; Yook, Ki-Hwan; Jon, Duk-In; Jung, Myung Hun; Hong, Narei; Hong, Hyun Ju
We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents. PMID:27776392
Full Text Available In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM, for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment. Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500. When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of
Nielsen, A S; Stenager, E; Brahe, U B
The purpose of the present study was to relate suicidal intent to the suicide method chosen and the medical lethality of the suicidal act, and to discuss how ingestion of alcohol impacts these three factors. The study was based upon interviews with 139 suicidal patients admitted to the Department of Psychiatry of Odense University Hospital. The results indicated a tendency for suicide attempters using wrist-cutting to score low on the Suicidal Intent Scale. Patients using kinds of self-injury other than self-poisoning or wrist-cutting scored high. In the case of self-poisoning, suicidal intent did not influence the choice of toxic agent, nor was the choice of method and/or choice of toxic agent affected by alcohol ingestion. A correlation between suicidal intent and the lethality of the suicide attempt was seen only among patients without a diagnosis of alcohol dependence. Alcohol-dependent patients who made highly lethal attempts scored relatively low on the Suicidal Intent Scale. The results indicate that the lethality of the suicidal act is only an incomplete guide to a patient's suicidal intent. However, it should be stressed that, despite the fact that alcohol-dependent suicide attempters may not strongly wish to die, they are nonetheless at high risk for making fatal suicide attempts.
Thomas, Bejoy J.; Nishad, A.; Paulaian, Benin; Sam, Jonathan Emil
Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management. PMID:27829770
Full Text Available Anaesthetic management for caesarean section of a patient with peripartum cardiomyopathy (PPCM can be challenging. These patients require analgesia/anaesthesia for normal delivery or caesarean section. In this case report we describe the anaesthetic management of a 20-year-old patient at 37 weeks of gestation, with peripartum cardiomyopathy, heart failure and pulmonary oedema. She was scheduled for emergency caesarean section because of a threat to mother’s life and fetal distress. GA was induced with Etomidate and fentanyl safely. No adverse outcome on mother or new born was observed.
Full Text Available Gender identity disorder (GID is a complex disorder and can be defined as a group of disorders whose common feature is a strong and persistent preference for living as a person of the other sex. It is associated with significant impairment in social, occupational, interpersonal, and other areas of functioning. We describe the case of an adolescent, biologically male who was brought to our outpatient department primarily with symptoms of adjustment disorder with GID and the management provided. The role of a psychiatrist in the management, ethical and legal issues involved is also discussed.
Full Text Available In France, for a long time, flood risk management has only oriented to controlling flood hazard with structural measures such as dikes. But since 1990’s many events have proved they have not totally efficient measures. So, institutions decided it’s necessary to manage flood risk with others ways like prevention. Risk management is so organize about holistic policies with different stakeholders and societies exposed at risk. Our study have the aim to demonstrate through several examples how flood risk is manage in French Mediterranean area. Post event feedback permit us to evaluate damage and crisis management. This method is use for show if this strategies is efficient or not. This study demonstrate how is risk management in France. Regulations are they efficient, so have they an influence about the reduction of deaths and damages? Individual measures are they more important than collective action? Finally, what policies and strategies are used and effective? The main results about cases studies show that natural event has most important that publics policies and it determines preventive policies.
... Operations Casing Pressure Management § 250.518 What are the requirements for casing pressure management? Once you install your wellhead, you must meet the casing pressure management requirements of API RP 90... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are the requirements for casing...
Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.
This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.
Magaly Álvarez Bárzaga
Full Text Available The anesthesiologist plays a unique role in the health care of all patients who will undergo a surgical procedure. In this sense, he is a key factor in the appropriate and timely management of the airway. There are special situations that condition a difficult airway and can have a profound impact on anesthetic morbidity and mortality. These risks increases in the case of children, that is why the case of a pediatric patient with a difficult airway caused by limitation of mouth opening, scheduled for elective surgery in order to treat this condition in the Pediatric University Hospital ¨Paquito González Cueto " in Cienfuegos, is presented.
Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this
Forchuk, Cheryl; Ouwerkerk, Alice; Yamashita, Mineko; Martin, Mary-Lou
The purpose of this study was to examine case managers' (CM) job position descriptions through content analysis. There were 29 case manager job position descriptions examined. The job descriptions could be grouped into four categories: (1) what the individuals should bring to the position, (2) what they did as CM, (3) to whom they were accountable, and (4) what was valued. Themes included focus on client as individual, focus on the external/system, or outer-directed work, and the articulation point between the individual and broader system. The CM works directly and indirectly in the system and community through education, organizing, planning, and networking, as well as through provision of direct care to the individual client. The expectations of the positions are extensive.
Disease-related malnutrition is usually caused by the joint action of the underlying disease itself and dietary deficiency. The consequences of malnutrition, if left untreated, are serious, causing a marked decline in physical and psychological health and function, and an increased rate of complications and decreased effectiveness of the medical treatments. In case a functional gastrointestinal tract is present, the recommended form of nutritional management is the use of oral nutritional supplements. However, just like to any other therapy, compliance to oral nutritional supplements is highly influenced by the consistency, taste, smell, volume consumed, and side effects. The aim of the present case report is to illustrate that nutritional management is a successful and effective treatment option of disease-related malnutrition when the selection of the oral nutritional supplement takes into consideration patient's preferences as well.
Ølholm, Anne Mette; Christensen, Janne B; Kamionka, Stine Lundstrøm
to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity...... of both their health needs and the skills needed to meet these. However, categorical care is generally considered to be stigmatizing and to decrease care quality. The evidence base for both arguments is unclear. The aim of this review was therefore to investigate the effectiveness of specialized hospital...... - b ased case management for ethnic minority patients. Methods: This review used a health technology assessment model, including a systematic search of literature in the PubMed, Embase, the Cochrane Library, Sociological Abstracts, the Cumulative Index to Nursing and Allied Health Literature databases...
Full Text Available Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.
00C Ca~aegie ej=)n ’C= 4P -jý A Case for Customizable Resource Management in Networks Peter Steenkiste Allan Fisher Hui Zhang October 21, 1998 CMU-CS-98...167 School of Computer Science Carnegie Mellon University Pittsburgh, PA 15213 Abstract We envision the deployment of an electronic services market ...that will deliver a wide range of electronic ser- vices over networks. This market will allow applications to combine resources at endpoints with
Mikkiliineni, Venkata Rama Rao; Panidapu, Nagarjuna; Parasa, Mrunalini; Shaik, Mastan Saheb
Antiphospholipid antibody (APLA) syndrome is one of the most common thrombocytophilias but, unfortunately, goes unrecognized most often. It is an auto-immune disorder in which thrombotic events and a recurrent fetal loss occur in the presence of antibodies to phospholipids. It is the most common acquired hyper-coagulable state. There is a limited literature on peroperative management of patients with this syndrome. We report a case of APLA syndrome in a parturient due to its rarity and complexity.
Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs
We describe how the declarative Dynamic Condition Response (DCR) Graphs process model can be used for trustworthy adaptive case management by leveraging the flexible execution, dynamic composition and adaptation supported by DCR Graphs. The dynamically composed and adapted graphs are verified...... for deadlock freedom and liveness in the SPIN model checker by utilizing a mapping from DCR Graphs to PROMELA code. We exemplify the approach by a small workflow extracted from a field study at a danish hospital....
Full Text Available Anorectal abscesses are commonly encountered in clinical surgical practice. These abscesses require surgical management. Supralevator abscesses are thought to originate either from an ischiorectal or intersphincteric abscess extension or from an intraperitoneal source. These abscesses are quite uncommon and present a difficult surgical problem. We present a case here of a 42-year-old female with a recurrent supralevator abscess requiring multiple surgical procedures for adequate drainage and care of her abscess.
Full Text Available Fusion is a rare occurrence and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic and esthetic management of fused maxillary right lateral incisor. Root canal treatment was performed on the fused tooth. Nickel Chromium with ceramic crown was fabricated in the shape of lateral incisor. The patient remained asymptomatic and there was a reduction in the size of periapical radiolucency after six months.
Laleng M Darlong
Full Text Available Ascaris lumbricoides is a common intestinal parasite in tropical and temperate regions. Although usually asymptomatic, infection can lead to biliary or intestinal obstruction and very rarely obstruction of the main pancreatic duct due to its smaller lumen. We report two cases of ascariasis in the main pancreatic duct, which is not a common site, presenting as acute pancreatitis and recovering uneventfully with conservative management.
Cardiac involvement is common in Friedreich\\'s Ataxia and is a common cause of premature death. Evidence regarding treatment of congestive heart failure in patients with Friedreich\\'s Ataxia is lacking. The case of a 31-year-old male with advanced Friedreich\\'s Ataxia who presented with an acute diarrhoeal illness and features of acute heart failure is discussed. We then review the reported cardiac manifestations of Friedreich\\'s Ataxia and discuss management options.
Full Text Available Due to the known difficulties on managing the design process of built environments, researchers and entrepreneurs have continuously developed and implemented best practices from areas such as Project Management (PM. However, there are still gaps to be filled, such as difficulties on monitoring the stakeholder’s requirements and their dynamics. In attempt to eliminate this gap, this paper aims to analyze if requirements management (RM can be integrated to PM and which are the main advantages and disadvantages of this integration. The research includes a literature review which presents PM and RM concepts, the last one based on software engineering approach. Moreover, a case study was performed in a construction company, using semi-structured interviews. The research showed that the use of RM is advantageous, even not solving all the projects difficulties, and that the proper structuring of the projects is a condition for the success of RM implementation. The main contribution is a generic and systematic proposal for integrating the stages of the RM to the projects.
Full Text Available To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios’s theoretical frame of Communication Privacy Management (CPM. Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient’s family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors.
Full Text Available Bangladesh is the biggest delta of the world. Construction of numbers of polders is one of the flood resilient approach. But the presence of coastal polders de-linked the flood plain. The siltation in river causes riverbeds to become higher than the adjacent crop lands, and vast area under the polders became permanently water logged rendering large tract of land uncultivable. The current practice is temporarily de-poldering by cutting embankment. This is a natural water management process with very little human interventions but it needs strong participation and consensus with a great deal of sacrifice by the stakeholders for a specific period (3 to 5 years or even more. An attempt has been made to study the phenomena of tidal basin management reviewing some secondary data and processes involved in successfully operated tidal basins of Bangladesh. And preliminary laboratory experiments are carried out to precisely look into the suspended sediment transport. With varying outflow discharge and sediment supply, the transport processes are investigated. 3D sediment transport model developed using openFOAM has good agreement with experimental result and can be used to better understand effectiveness of tidal basin management.
Employing the language management framework, this paper reports on multilingual use among the staff of a major metropolitan university in Melbourne and covers both simple and organised management. It describes a top-down attempt to survey staffs' (academic and general) background in Languages other than English (LOTE), LOTE usage and…
Nilda Maria de Clodoaldo Pinto Guerra Leone
Full Text Available Small family businesses present a series of peculiarities and challenges, especially when it comes to the management of human resources. This case describes the true situation of an enterprise, Restaurante Sabor de Casa, and portrays the relationship between the founder and successor and its consequences on the practice and policy of human resources. The story is told from the point of view of the successor, who thinks about the situation of the company and his deep involvement in the dynamic and complex stage of working with his mother, the founder of the company, whose performance is that of an entrepreneur, albeit a traditional one. It shows his reflections on the directions the company has taken, the opinions of employees, based on research conducted in 2006 by university students and their questions about the way the contributions of the employees are managed, mainly by recognizing their importance for both the present and the future of the company. This case deals with the complexity of the management of human resources in a family organizational environment.
Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.
BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the
Kelly, Peter J.; Deane, Frank P.; Kazantzis, Nikolaos; Crowe, Trevor P.
The study examined mental health case managers' attitudes toward the use of homework and explored the relationship between clinician attitudes and systematic homework administration practices. A survey examining attitudes toward the use of homework was completed by 122 Australian mental health case managers. Case managers who held more positive…
Full Text Available Knowledge management (KM was a well-founded management approach that held significant benefits for public sector organisations. KM as a management philosophy had an impact on various components of an organisation and it could therefore significantly advance organisational efficiency. The successful implementation of KM initiatives had to be ensured because, different organisational processes and departments had to collaborate and functional silos had to be eliminated. KM required long-term commitment and dedication from all organisational members. Furthermore, there were certain knowledge management enablers in an organisation that needed to be developed and that were necessary for the achievement of organisational effectiveness. These enablers were the organisational culture, human resources, information technology, organisational structure and, the organisation’s strategy and leadership. This article assessed each of these enablers and how they impacted on an organisation’s KM efforts. Stellenbosch Municipality was used as a case in point. The article further examined how local governments were able to effectively implement KM practices as strategic tools used to achieve service delivery and operational goals. The article concluded with a number of recommended strategies, (1 to develop the KM enablers that were present in organisations and (2 to aid the implementation of successful organisational KM initiatives.
Full Text Available The scenario of quality is expanding exponentially. In the present-day world, quality is now in the driver's seat. With this globalisation of industrial products, many problems and opportunities have risen, primarily due to inconsistent standards existing in the market. The International Standards Organisation has tried (and seem to be very successful in doing so to standardise a minimum level of quality norms. These norms act as the foundation to implements total quality management (TQM. TQM has been identified as a philosophy of interdependent characteristics, such as customer focus, commitment, measurement, systematic support, and continuous improvement. This paper presents a case study on the implementation of ISO 9002: 1994 at Kerala Hitech Industries (KELTEC, with the benefits, hurdles faced, and shortcomings. Upgradation of KELTEC's quality management system to the requirements of ISO 9001: 2000 is currently under progress.
Full Text Available Pneumatosis intestinalis (PI, defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007, Morris et al. (2008, and Peter et al. (2003. Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.
Full Text Available Aim: In this paper we describe the physical therapy management of a 64-year-old female following a bilateral hip arthroplasty. Method: The patient featured in this study, after the surgical intervention had undergone specific recovery treatment consisting of: posture techniques, static (isometric contractions and dynamic kinetic techniques (passive motion, passive-actives, actives, actives with resistance, massage, respiratory gymnastics and reeducation of walking. Results: At the end of the rehabilitation program, hip muscular strength and joint range of motion were improved significantly. The Harris hip score was significantly improved, in comparison to the preoperative one. Conclusion: This case illustrates the importance of the rehabilitation management after bilateral hip replacement.
Nowadays as Chinese economy is rapidly integrated with the global economy,business English writing has become an important link in business activities and consequently,business English writing skills has become one of the core skills that business English major students should grasp.With the help of multimedia courseware and internet,the author attempts to introduce the case teaching method into the business English writing course,so that the students can improve their initiative and creativity to study English writing and upgrade their bushiness English writing skills.%随着中国经济日益融入全球经济一体化的格局,商务英语写作已经成为商务活动中的重要一环,商务英语写作技能也成为商务英语专业学生需要掌握的核心技能之一。作者在商务英语写作教学中尝试引入案例教学法,结合多媒体课件和互联网等现代化教学手段,提高学生学习英语写作的主动性和创造性,培养了学生的商务英语写作技能。
Klavž, Janez; Gorenjak, Maksimiljan; Marinšek, Martin
We report on a case of intoxication with a mix of new psychoactive substances. A 38-year-old male was brought to the emergency department (ED) following the ingestion of an unknown drug in a suicide attempt. During the transport, he became progressively more somnolent and unresponsive to painful stimuli. Urine and stomach content were collected on admission to be screened for drugs of abuse and medicinal drugs. After admission, the patient's next of kin presented five small grip seal plastic bags containing different powders/crystals, and they were sent for analysis along with urine and stomach content to the toxicology laboratory. An easy and rapid sample preparation technique was applied for the extraction of urine and stomach content. Samples were extracted with liquid-liquid extraction (LLE) technique and analysed using gas chromatography-mass spectrometry (GC-MS). A small amount of powder material from the bags was diluted in methanol and injected directly into the GC-MS instrument. Obtained spectra (EI) were evaluated against SWGDRUG library. Five different designer drugs were identified in the powder material, including synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA) and synthetic cathinones (alpha-PHP, alpha-PVP and 4-CMC). With the exception of 4-CMC, all of these substances were also detected in the stomach content along with the prescription drugs. This is the first time that a positive identification of these five drugs has been made by a clinical laboratory in Slovenia.
Goswami, D; Kashyap, L; Batra, RK; Bhagat, C
Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance. PMID:26955320
Full Text Available Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance.
Prabhakar, A R; Tauro, David P; Shubha, A B
The purpose of this case report was to describe the management of a trauma-induced maxillary dentoalveolar fracture of the right maxilla in an 8-year-old boy. The child presented with swelling of the right maxillary region, difficulty in chewing and closing the mouth, and a sutured laceration on the cheek. Complete palatal displacement of the fractured fragment involving the deciduous canine and molars was observed clinically and confirmed by radiological examination. The fracture was reduced and stabilized using a custom-fabricated, open-cap acrylic splint with modified interdental wiring under general anesthesia.
Full Text Available Intratonsillar abscess is a rare complication of acute tonsillitis. It is a rarely diagnosed infection occurring in both children and adults. Herein, we present a case of intratonsillar abscess in a 25-year-old female patient, who was managed by needle aspiration which is a minimally invasive procedure and it is low cost, safe and effective along with antibiotic therapy. The aspiration of the pus from the tonsil confirms the diagnosis of intratonsillar abscess. So intratonsillar abscesses are uncommon, but should be considered in the differential diagnosis of peritonsillar abscess and tonsillitis.
Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E
Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.
Petronio, Sandra; Helft, Paul R; Child, Jeffrey T
To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios's theoretical frame of Communication Privacy Management (CPM). Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient's family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors. Significance for public healthMuch of the mission central to public health sits squarely on the ability to communicate effectively. This case analysis offers an in-depth assessment of how error disclosure is complicated by misunderstandings, assuming ownership and control over information
Full Text Available ABSTRACT: Title – Aesthetic management of fractured endodonti cally treated teeth- Case report Healthy oral cavity is primary requisite for beautif ul looks. Aesthetic requirement of severely mutilated teeth has been a challenge to de ntist. This paper presents endodontic treatment of grossly decayed tooth followed by the placement of a fibre-reinforced composite resin post. The crown reconstruction was done with f ull ceramic crown. Resin fibre post has best properties in elasticity, translucency, adaptabil ity and resistance to traction
Sheet, Jagabandhu; Mandal, Anamitra; Sengupta, Swapnadeep; Jana, Debaleena; Mukherji, Sudakshina; Swaika, Sarbari
Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula. PMID:25886120
Strickler, David Charles
In this Open Forum a psychiatric health care consumer recounts his experience with his state's requirement to hold case management meetings outside of the clinic. Over time, the author found that meeting elsewhere amounted to being put on public display, and he felt embarrassed and powerless to change the situation. Requiring people with psychiatric disorders to meet outside a clinical setting may violate the Health Insurance Portability and Accountability Act and human rights. This New Hampshire state policy needs to be changed because it undermines treatment and reinforces the stigma that many consumers already feel because of their disability.
Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.
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.
Full Text Available Aim of study: This paper aims to test a participatory methodology to draw parallels and paradoxes as to how some forest sector-related entities and local communities view the Montemuro Mountain forest, namely in terms of its characteristics, the offered opportunities, its problems and the likely solutions for its management as well as the role played by stakeholders, which can be replicated in other case studies and can also facilitate the forest policy making process.Area of study: The Natura 2000 Network “Montemuro Mountain” Site in Portugal.Material and methods: This study combined several consultation and citizen participation techniques.Main results: The perceptions shared by the stakeholders are some similar, others not similar and others still quite paradoxical regarding forest characteristics and the opportunities they offer. The study has shown that it is possible to implement and improve citizen participation methodologies. This can be a viable way towards more effective forest management and fire prevention as this may help blunt conflicts of interest in forest space management. However, for participation to be truly effective and representative, a policy regarding training and awareness of the importance of information is necessary.Research highlights: The stakeholder perceptions on forests and forest management are assessed; forest fires and agrarian abandonment are central for territory’s development; depopulation, old age and absenteeism emphasize degradation of forest areas; Conscious citizen participation benefit policymaking and forest management.Abbreviations used: ZIF: Forest Intervention Zones; GAL: Local Follow-up Group; GTFs: Technical Bureaus of Forestry.
Project management education programmes are often proposed in higher education to give students competences in project planning (Gantt's chart), project organizing, human and technical resource management, quality control and also social competences (collaboration, communication), emotional ones (empathy, consideration of the other, humour, ethics), and organizational ones (leadership, political vision, and so on). This training is often given according a training-by-project type of learning with case studies. This article presents one course characterized by a pedagogical organization based upon Knowledge Management (KM) concepts: knowledge transfer and construction throughout a learning circle and social interactions. The course is supported by a rich and complex tutor organization. We have observed this course by using another KM method inspired from KADS with various return of experience formalized into cards and charts. Our intention is, according to the model of Argyris and Sch\\"on (Smith, 2001), to gai...
Moise, Imelda K; Mulhall, Peter F
Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded
Imelda K Moise
Full Text Available Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1 the structural challenges faced in implementing case management for program participants, and 2 possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty; contractual requirements (predefined catchment neighborhoods, caseload; limited support (client incentives, tailored training, and a high staff turnover rate; and logistic difficulties (organizational issues. Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1 the structural challenges faced in implementing case management for program participants, and 2 possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were
Apriani Kurnia Suci
Full Text Available Production Management is the act of designing, operating, and improving the productive systems – a system for getting the work done. Along the process, the synergy in between machineries, facilities and people could empower the sustainable of the production. In fact, for some cases, the implementation of unique system is needed for the production process. The example for this transformation production management is in the case of CV Wiracana, a handmade manufacturing company for folding hand fans from Bali. CV Wiracana's products are very unique, combined from mass production for the speed and an art for the custom made product. At one side, the market forces them to speed up the production and for this purpose, they must set up the new system on their production line. On the other side, the masterpiece also needs to be produced without jeopardizing mass production line schedule. The transformation production system needs to be done no later than 2015 as the urgency to fulfill the customer demand, business growth, compete in the industry and sustainability. The changes are expected to improve the production at least about 20% or doubled from the current production.
Full Text Available The purpose of this paper is to provide a background to and guide for mainstreaming Disaster Risk Management (DRM into higher education and training institutions in Small Island Developing States (SIDS, with the aim of increasing awareness and understanding of the complexity of DRM issues in business and management, based on their general and specific vulnerabilities. SIDS are considered a special category within the discussion on DRM, given a number of vulnerabilities generally and specifically. Furthermore, little attention has been paid to the business impact of disasters in such settings. It is proposed that one major route to improving this situation is through the educational and training institutions, which play a major role in shaping thinking and practices in such settings.
This case report describes the chiropractic management of a 30-year-old female patient with severe postpartum pelvic pain secondary to pubic symphysis diastasis. No literature was found on the chiropractic management of postpartum symphysis pubis diastasis. The existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited and indicates a potential benefit. Separation of the pubic symphysis may include ligamentous injury to the sacroiliac joints and may lead to chronic pain. Pubic symphysis separation of 17 millimeters was present on digital radiograph. Management consisted of chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt, and specific stabilizing exercises. The patient's pain improved immediately following treatment on the initial visit. Pain was reduced from 8/10 VAS at the first visit to 2/10 at the fourth visit. She was able to resume normal activities and reached a final pain level of 1/10. The diastasis was reduced by 7 millimeters at 14-weeks post radiograph for a final separation of just under 10 millimeters. Collaboration between obstetricians, midwives and chiropractors may be warranted.
Full Text Available Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.
Full Text Available Successful implementing andmanaging of change is urgently necessary for each adult educational organization. During the process, leading of the staff is becoming a key condition and the most significant factor. Beside certain personal traits of the leader, change management demands also certain leadership knowledges, skills, versatilities and behaviour which may even border on changing the organizational culture. The paper finds the significance of certain values and of organizational climate and above all the significance of leadership style which a leader will adjust to the staff and to the circumstances. The author presents a multiple qualitative case study of managing change in three adult educational organizations. The paper finds that factors of successful leading of change exist which represent an adequate approach to leading the staff during the introduction of changes in educational organizations. Its originality/value is in providing information on the important relationship between culture, leadership styles and leader’s behaviour as preconditions for successful implementing and managing of strategic change.
Araujo, Juliano; Lima, Marcelo; Leitao, Gustavo; Guedes, Luiz Affonso [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil); Branco, Nicolau; Coelho, Robson; Elias, Gustavo Passos; Nunes, Marcelo [Transportadora Brasileira Gasoduto Bolivia-Brasil (TBG), Rio de Janeiro, RJ (Brazil)
In order to improve the requirements of industrial processes, many decision support systems have been introduced in recent years. In this context, the alarm management systems have great relevance. On the other hand, the informatics revolution allowed a great increase of information concerning the operation of the industrial processes. Currently, process operators handle an excessive number of about 1.500 alarms per day. Thus, this overdose of information implies in the discredit of alarms. Then, in order to improve the operation activities of industrial processes, it is mandatory to incorporate procedures to evaluate and rationalize alarms. Since the EMMUA191 Standard is the reference guide to alarm management, but it does not specify how to execute an alarm management procedure, in this paper, a systematic procedure to evaluate alarms configurations in industrial processes is proposed. This procedure is in line with EMMUA191 and is composed by the following steps: to use statistics analyses to identify problematic alarms, such as occurrence, intermittency, correlation, and flooding calculation; to indicate problematic alarm group; and to propose a set of actions to be implemented. To validate our proposal, we present a case study in a gas pipeline plant using the BR-AlarmExpert software. (author)
Full Text Available Abstract Background It has been established that careful diabetes self-management is essential in avoiding chronic complications that compromise health. Disciplined diet control and regular exercise are the keys for the type 2 diabetes self-management. An ability to maintain one's blood glucose at a relatively flat level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. Hemoglobin A1c (HbA1c or simply A1c is a measure of a long-term blood plasma glucose average, a reliable index to reflect one's diabetic condition. A simple regimen that could reduce the elevated A1c levels without altering much of type 2 diabetic patients' daily routine denotes a successful self-management strategy. Methods A relatively simple model that relates the food impact on blood glucose excursions for type 2 diabetes was studied. Meal is treated as a bolus injection of glucose. Medical intervention of hypoglycaemic drug or injection, if any, is lumped with secreted insulin as a damping factor. Lunch was used for test meals. The recovery period of a blood glucose excursion returning to the pre-prandial level, the maximal reach, and the area under the excursion curve were used to characterize one's ability to regulate glucose metabolism. A case study is presented here to illustrate the possibility of devising an individual-based self-management regimen. Results Results of the lunch study for a type 2 diabetic subject indicate that the recovery time of the post-prandial blood glucose level can be adjusted to 4 hours, which is comparable to the typical time interval for non-diabetics: 3 to 4 hours. A moderate lifestyle adjustment of light supper coupled with morning swimming of 20 laps in a 25 m pool for 40 minutes enabled the subject to reduce his A1c level from 6.7 to 6.0 in six months and to maintain this level for the subsequent six months. Conclusions The preliminary result of this case study is encouraging
Full Text Available Zika virus is an RNA virus belonging to the Flaviviridae family, and is primarily transmitted by Aedes mosquitoes. Only a small number of cases had been described until 2007 when the first major Zika virus outbreak occurred on Yap Island, Micronesia. Approximately 80% of people infected with Zika virus do not exhibit any symptoms. Symptomatic infections are generally moderate and characterized by acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. The virus has recently attracted a broad interest due to the emerging cases of microcephaly that are possibly associated with mothers infected by the Zika virus during pregnancy, and the regional increases in the incidence of Guillain-Barre syndrome during the epidemic periods. Although the relationship between Zika virus infection and these abnormalities is not obviously understood yet, Zika virus testing is recommended for infants with microcephaly or intracranial calcifications whose mothers were potentially infected with the Zika virus during pregnancy. Every day, new reports are being published about the outbreaks associated with this virus; nevertheless, no new cases of this virus have been reported in Turkey. Despite this, we cannot currently exclude the possibility of the encounter with the virus because of the presence of Aedes mosquitoes, which are responsible for the spread of the virus, are prevalent in Turkey, and an increasing number of travel-related cases are being reported from different countries. In the light of the current knowledge on this virus, this review aims to discuss the course of Zika virus infections in detail, especially congenital infection, and presenting current information about the case management and preventive measures. [Cukurova Med J 2016; 41(1.000: 143-151
J. B. Strydom
Full Text Available To establish the perception of employees regarding diversity management at South Africa's largest residential university, the questionnaires of Gardenswartz & Rowe (1993 was adapted and a case study approach with a sample of 25 employees was used. The diversity audit measured the sample's perceptions on symptoms of diversity related problems; openness to change of the university; the status quo regarding diversity management; organisational barriers to diversity; the valuing of diversity; and the management of diversity by managers or supervisors. It was found that a high number of symptoms of diversity-related problems are perceived and that respondents believed that the university is relatively unresponsive to the need to change. The university was believed to be in a mono cultural stage of development and barriers to developing into a multicultural organisation were identified. Respondents did report a very positive attitude towards diversity but perceived that certain procedures are not supportive.
Die vraelyste van Gardenswartz en Rowe (1993 en 'n gevalstudiebenadering is benut om die persepsies van 'n steekproef van 25 personeellede aangaande die bestuur van diversiteit in 'n Suid Afrikaanse universiteit te ondersoek. Die diversiteitsaudit meet die steekproef se waameming van simptome van diversiteitsverwante probleme, die bereidwilligheid van die universiteit om te verander, die huidige stand van diversiteitsbestuur, organisatoriese hindemisse, die waarde wat aan diversiteitsbestuur geheg word, en die bestuur van diversiteit deur bestuurders en toesighouers. Die resultate toon dat 'n beduidende aantal simptome van diversiteitsverwante probleme gei'dentinseer word en dat die respondente meen dat die universiteit relatief min bewustheid vir die nodigheid van verandering toon. Respondente meen dat die universiteit in 'n monokulturele fase van onfrwikkeling is en hindemisse in die ontplooїng na 'n multikulturele organisasie
Raul, Jean-Sébastien; Berthelon, Laurent; Geraut, Annie; Tracqui, Antoine; Ludes, Bertrand
The use of Japanese swords for homicidal attempts is rare. A Japanese samurai sword is a sharp and cutting object. When faced with the use of this weapon, one must distinguish between stabs and incised wounds. Incised wounds can rarely lead to death, but because of the size of the weapon, stabs usually cause much more serious injuries. Stabs also imply a penetrating movement, whereas incised wounds can be the consequence of protective circular blows. Therefore, it is important to distinguish clinically between these two kinds of wounds. We report a case where the perpetrator argued he had given a circular blow, unfortunately hitting the victim. The pieces of evidence are discussed.
All the health care facilities examined in the case studies addressed several important organizational issues before and during the installation of their systems. All the facilities examined employee commitment. The prudent managers considered how easily their employees adapt to changes in their jobs and work environment. They considered how enthusiastic cooperation can be fostered in the creation of a liberated and reengineered office. This was determined not only by each individual's reaction to change, but also by the health care facility's track record with other system installations. For example, document image, diagnostic image, and coded data processing systems allow the integration of divergent health care information systems within complex institutions. Unfortunately, many institutions are currently struggling with how to create an information management architecture that will integrate their mature systems, such as their patient care and financial systems. Information managers must realize that if optical storage technology-based systems are used in a strategic and planned fashion, these systems can act as focal points for systems integration, not as promises to further confuse the issue. Another issue that needed attention in all the examples was the work environment. The managers considered how the work environment was going to affect the ability to integrate optical image and data systems into the institution. For example, many of these medical centers have created alliances with clinics, HMOs, and large corporate users of medical services. This created a demand for all or part of the health information outside the confines of the original institution. Since the work environment is composed of a handful of factors such as merged medical services, as many work environment factors as possible were addressed before application of the optical storage technology solution in the institutions. And finally, the third critical issue was the organization of work
Eduardo Barbin Zuccolotto
Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.
姜春玲; 李献云; 费立鹏; 许永臣
Background:Suicide rates in rural China are two-fold to three-fold those in urban China but the reasons for this large difference remain unclear. Aim:Assess the characteristics and risk factors of medically serious suicide attempts in rural China. Methods:A comprehensive 2 to 3 hour structured interview was administered by psychiatrists to 297 medically serious suicide attempters (defined as those who remained in hospital for 6 hours or longer) treated in the emergency room of the People’s Hospital of Yuncheng County in Shandong Province and, separately, to their accompanying co-resident family members. A parallel interview was administered to control subjects matched for age and gender from the same village who had never made a suicide attempt and to their co-resident family members. Risk factors for attempted suicide were identified using Cox regression models. Results:Among the 297 suicide attempters, 74%were female, 78%were farmers, their mean (sd) age was 33.2 (14.6) years, their mean length of formal schooling was 4.8 (3.1) years, 80%had attempted suicide by ingesting pesticides, 57%reported considering suicide for five minutes or less before acting, 76%had a score of less than 50 (range, 0 to 100) on the planning subscale of the Suicide Intent Scale, 11%had made prior attempts, and only 38%met DSM-IV criteria for a current mental disorder. After controlling for gender, age, location of residence and prior suicide attempt (in the matched analysis), risk factors identified in the multivariate analysis included a low level of education, having relatives or associates with prior suicidal behavior, experiencing four or more negative life events in the prior year, a low quality of life and low family cohesion over the prior month, high depressive symptom scores over the prior two weeks, and (only assessed in a subsample) high impulsivity and aggression. Conclusion:Many of the medically treated suicide attempts in rural China are low-intent attempts by the
Silverman, Enid; Ebright, Linda; Kwiatkowski, Marianne; Cullina, Joanne
Bronchiectasis is the abnormal, irreversible dilatation of diseased bronchi. Permanently dilated airways, usually in the medium-sized bronchi, are inflamed and often obstructed with thick, purulent secretions. Known causative factors include postinfection bronchial damage, postinhalation injury, hypersensitivity reactions, and congenital airway obstructive disorders. Typical symptoms include sputum overproduction, fever, pleurisy, dyspnea, and chronic cough. Diagnosis involves radiographic studies and pulmonary function testing. Treatment includes oral, aerosolized, or intravenous antibiotic therapy according to the severity of the exacerbation, and mucus clearance by means of bronchial hygiene assistive devices, chest physiotherapy, postural drainage, and high-frequency chest compression. We present a review of bronchiectasis and offer 3 case studies illustrating current management of different presentations, including use of aerosolized antibiotics for patients infected with Pseudomonas aeruginosa. Although an adjunctive program of pulmonary rehabilitation may be useful for patients with bronchiectasis, no confirming studies have been performed to date, and additional research in this area is warranted.
frustration and inefficiency because they do not allow workers to use their expert experience to make the best judgements on how to solve the unique challenges they are faced with. However some structuring of their work is still required to ensure that laws and business rules are being followed. IT Systems...... for process control have a large role to play in structuring and organizing such processes, however most of these systems have been developed with a focus on production work and fail to support the more flexible processes required by knowledge workers. The problem arises at the core of these systems...... of the process and techniques for runtime adaptation. This dissertation reports on the results of the Technologies for Flexible Cross-organizational Case Management Systems (FLExCMS) research project which was started in cooperation between ITU and the company Exformatics A/S. The goals of the project were...
Goals of hemorrhage management involve promoting coagulation and reducing fibrinolysis to enhance clot formation and stability, and minimizing hemorrhagic expansion to reduce the likelihood of adverse outcomes. The optimal hemostatic regimen to obtain these goals will differ according to the clinical scenario. Two hypothetical cases of patients with hemorrhage are presented that are typical of those encountered by clinical pharmacists who practice in centers that treat trauma or surgical patients or patients in need of emergency or critical care because of serious bleeding. To maximize therapy, the clinician must be aware of how best to clinically apply hemostatic agents, their comparative benefits and disadvantages, and the optimal methods for monitoring their effectiveness and toxicities.
Full Text Available Epidermolysis bullosa (EB is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.
Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza
Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.
Lee, Pei-Yi; Chang, Tsue-Rung
Cancer case management provides consecutive care during the entire process through diagnosis to treatment and follow-up. We established an integrative information system with integration of the health information system. This integrative information system shortened the time spent on case screening, follow-up data management, and monthly data summarization of case managers. It also promoted the case follow-up rate. This integrative information system may improve the quality and effectiveness for cancer case management, one important part of cancer nursing. PMID:26089680
Full Text Available Among the inherited bone marrow failure disorders, dyskeratosis congenita is an X-linked inherited disorder arising as a consequence of short telomere and mutations in telomere biology. Production of the altered protein dyskerin, leads to vulnerable skin, nails, and teeth which lead to higher permeability for noxious agents which can induce carcinogenesis accounting for the classical triad of skin pigmentation, nail dystrophy and oral leukoplakia. This condition is fatal and patients succumb to aplastic anemia, malignancy or immunocompromised state. We present a young male with the classic clinical triad and avascular necrosis of both femoral heads, with no evidence of hematologic anomaly or any malignancy. He was managed for osteonecrosis with uncemented total hip arthroplasty for the symptomatic left hip. Our case represents a benign form of such a fatal and rare condition, which if detected and managed early can result in improved quality of life for the patient suffering from this disorder. This patient is under our meticulous follow-up for the last 2 years in order to determine any late development of complications before being labelled as a variant of this syndrome.
The role of the nurse in hospital is varied and some are choosing to incorporate more managerial and administrative skills into their clinical role. One such role is that of the nurse case manager (NCM). This particular role concentrates on involving the family and the patient in his or her own care, facilitation of the care plan, and open discussions between the patient, medics and nursing staff. NCMs in the author's hospital have made a remarkable contribution to patient care. It is a challenging and exceedingly demanding role in both developing and developed countries, but one that is increasingly important. The NCMs are involved in coordination, facilitation of core process and mobilization of resources, not only in hospital but at the patient's home. In this short introductory article the role of NCM is highlighted and the author discusses how this diverse role is concerned with patient care. NCMs work with multidisciplinary teams to enhance the patient's care process. Their attention is also given to cost reduction and clinical pathway management.
Walsh, Anne; Bearden, Eithne
Despite the plethora of methods and tools available to support strategic management, the challenge for health executives in the next century will relate to their ability to access and interpret data from multiple and intricate communication networks. Integrated digital networks and satellite systems will expand the scope and ease of sharing information between business divisions, and networked systems will facilitate the use of virtual case discussions across universities. While the internet is frequently used to support clinical decisions in the healthcare industry, few executives rely upon the internetfor strategic analysis. Although electronic technologies can easily synthesize data from multiple information channels, research as well as technical issues may deter their application in strategic analysis. As digital models transform access to information, online models may become increasingly relevant in designing strategic solutions. While there are various pedagogical models available to support the strategic management process, this framework was designed to enhance strategic analysis through the application of technology and electronic research. A strategic analysis framework, which incorporated internet research and case analysis in a strategic managementcourse, is described alongwith design and application issues that emerged during the case analysis process.
Uddin, Md Akther
Islamic banking industry has been growing rapidly for last three decades. As risk is inherent in banking business it is necessary to develop a comprehensive risk management framework and process. In this paper, a humble attempt has been made to study and analyze risk management practices of Islami Bank Bangladesh Limited (IBBL), one of the leading Islamic banks in Bangaladesh. Annual reports of IBBL and 7 other full-fledged Islamic banks, Bangladesh Bank, the central bank of Bangladesh, publi...
Alexandra Troy, OD
Full Text Available Background: Infantile nystagmus is a common cause of visual impairment. It can occur in isolation, but it is often found in association with other conditions, such as albinism. The condition results in varying levels of vision impairments ranging from mild to severe. Characteristics include early onset, bilateral involvement, pendular and jerk waveforms, the presence of a null point, and the lack of optokinetic nystagmus and oscillopsia (environment moving. This article provides a review of pathogenesis, epidemiology, and treatment of infantile nystagmus. A case study highlights low vision strategies and management for the condition. Case Report: A 12-year-old male with infantile nystagmus presented to the satellite low vision pediatric clinic for initial evaluation. He reported difficulty with different tasks at school secondary to his visual impairment. Low vision intervention utilized various devices and strategies to meet his distance and near goals. Discussion: With no known cure, low vision rehabilitation is important for individuals with nystagmus to allow them to reach their highest potential. Rehabilitation techniques can easily be applied by a primary care optometrist.
Full Text Available Congenital lobar emphysema (CLE is a congenital anomaly of the lower respiratory tract characterized by over inflation of alveoli of the one or more lobes of the lung. CLE is potentially reversible, though possibly life threatening cause of respiratory distress in the neonate. We are presenting a 2 week old baby who presented with sudden onset of respiratory distress related to CLE affecting the upper lobe of left lung. Lobectomy was performed under general anesthesia with one lung ventilation. The anesthetic challenges and management of this case are discussed here.
Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang
To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.
Full Text Available Background. Attempted suicides and suicides are becoming pertinent social phenomena in Albania, with increasing trend in the last years, exceeding the road traffic accident numbers. Our objective was to examine suicide attempts trends among Albanian children and adolescents. Methods. We conducted a retrospective analysis of standardized suicide attempts rates in Statistic Department at University Hospital Center “Mother Theresa”; epidemiology data for the period spanning from 2006 to 2012. We analyzed the data by age, sex and by suicide attempts method over time for two age groups: 10–14 year old (children and 15–19 year old (adolescents. Results. We found an average annual increase of the suicide attempts rate for children and adolescents (p<0.001, but stratification by age and sex showed significant variation. By comparing the two age groups it came out that the suicidal phenomena is more present at adolescence age (p<0.001. According to the statistic data and by analyzing the cases on yearly bases it resulted that female gender is more attempt to commit suicide that male gender, with a significant statistical variation of (p<0.001. From the study it was noted that the suicidal attempt methods, in the most of cases, were drug overdose (97.6% and 2.4% hang themselves (suffocation or cut their vein. Conclusions. The increasing cases of suicidal tendency among children and adolescents necessitate further studies to identify the causes and risk factors, and to develop suitable preventive programs .
This paper describes a methodology for estimating the true internal costs of construction waste, aimed at promoting environmentally friendly waste management. The study employs cost-benefit analysis, contribution margin analysis, the polluter-pays principle and a mathematical model: the model for Efficient Use of Resources for Optimal Production Economy (EUROPE), which has been introduced previously by the author for assigning industrial costs to waste. The calculations are performed on construction waste created in a case study of a building project. Moreover, waste is regarded as, in a business sense, having the same basic status as any normal industrial product, namely the 'equality principle'. Application of the methodology is suggested to create incentives for environmental and profitability improvement in construction companies and other types of industrial sectors. The results of the case study show the generation of construction waste to substantially decrease the final operating income, due to the internal shadow price cost it creates. This paper is intended to reduce the gap between the choice of waste management procedures and their economic impact, the overall objective being to accomplish an improved industrial environmental situation.
Kilic, Elife Dogan; Serin, Huseyin; Karakus, Ozge; Ergene, Ozkan; Corbaci, E. Cihat; Kilic, Nayil
As a result of globalization, talented employees have been needed in the workplace anymore. With being hired of talented employees, new understanding of management has appeared and talent management has gained importance due to this new understanding. Talent management is a kind of management understanding according to which employees feel…
Huang, I-Yueh; Chen, Chao-Ming; Chang, Sung-Wen; Yang, Chia-Fu; Chen, Chung-Ho; Chen, Chun-Min
Surgical removal of the mandibular third molar is a regular surgical procedure in dental clinics, and like all operations, it may have some complications, such as infection, bleeding, nerve injuries, trismus and so on. An accidentally displaced lower third molar is a relatively rare complication, but may cause severe tissue injury and medicolegal problems. As few papers and cases have been published on this topic, we report this case to remind dentists on ways to prevent and manage this complication. The patient, a 28-year-old male, had his right lower mandibular third molar extraction in January 2006. The dentist resected the crown and attempted to remove the root but found that it had suddenly disappeared from the socket. Assuming that the root had been suctioned out he closed the wound. The patient was not followed up regularly because he studied abroad. About 3 months later, the patient felt a foreign body sensation over his right throat, and visited a local hospital in Australia. He was told after a computed tomography (CT) scan that there was a root-like radio-opaque image in the pterygomandibular space. The patient came to our hospital for further examination and management in June 2006. We rechecked with both Panorex and CT and confirmed the location of the displaced root. Surgery for retrieving the displaced root was performed under general anesthesia by conventional method without difficulty, and the wound healed uneventfully except for a temporary numbness of the right tongue. This case reminds us that the best way to prevent a displaced mandibular third molar is to evaluate the condition of the tooth carefully preoperatively, select adequate instruments and technique, and take good care during extraction. If an accident does occur, dentists should decide whether to retrieve it immediately by themselves or refer the case to an oral and maxillofacial surgeon, and should not try to remove the displaced root without proper assurance. Localization with
In project management and particularly software project management, there has been a shift from traditional plan based project management to the agile event driven project management style. Agile project management has for some time been viewed as the new big change that will revolutionize the software industry. The concept of agile has been around for some time, and although knowledge and usage are increasing, agile is not always the answer. Understanding when to use agile and which succ...
Full Text Available The strategic importance of knowledge in today’s organisation has been discussed extensively and research has looked at various issues in developing knowledge management systems. Both the characterisation of knowledge and alternate models for understanding the acquisition and use of such knowledge have taken on significant prominence. This is due to the complexities associated with acquiring and representing knowledge, and the varied nature of its use in knowledge work. However, the role of the knowledge workers and the processes that guide their knowledge work as they meet the knowledge goals of an organisation have received little attention. This paper proposes a knowledge audit (an assessment of the way knowledge processes meet an organisation’s knowledge goals methodology to understand the “gaps” in the needs of a knowledge worker before one develops KM systems. The methodology also uses “process change” research to help build a socio-technical environment critical for knowledge work. The audit methodology is applied to a particular case and the implementation of the audit recommendations is discussed. Future implications of such an audit are also discussed.
Das, U M; Viswanath, D; Subramanian, V; Agarwal, M
Children aged 6-15 years old experience more injuries to their teeth and the injuries sustained are more serious as evidenced by a higher percentage of luxations, avulsions, fractures and dislocations. The mandible is the most frequently fractured facial bone and mandibular alveolar injuries have been reported to range between 8.1-50.6%. Those with mandibular or midface fractures have a higher incidence of associated chest, extremity, abdomen and cervical spine injuries. The growing patient with facial injuries presents the clinician with a series of thought-provoking circumstances. Dentoalveolar and mandibular injuries are especially important to understand because of the potential complications related to tooth eruption, alveolar development, occlusion and facial growth. However, the principles involved in the treatment for children need to be modified by certain anatomical, physiological and psychological factors specifically related to childhood. This case report documents the trauma, management and follow-up care of an 11-year-old boy who sustained undisplaced infraorbital, nasal fractures and mandibular dentoalveolar fracture along with other associated injuries of the extremities.
Maruschke, M; Hakenberg, O W
Gunshot wounds to the kidney occur with different regional incidence. They are commonly combined with thoracic and abdominal injuries. Gunshot wounds may be caused by low-velocity or high-velocity bullets. The latter are usually used with military weapons and cause a higher degree of tissue damage. The therapeutic management of renal gunshot wounds has changed in recent decades resulting in more organ-preserving strategies. An imperative indication for surgical exploration of the kidney is critical renal bleeding with symptoms of hypovolaemic shock. We report the case of a 23-year-old male admitted to the hospital with combined gunshot wounds from a small-bore weapon with damage of the liver, stomach and the left kidney. There were no signs of thoracic injuries. The patient underwent transabdominal exploration with treatment of the liver and stomach lesions, removal of the bullet and preservation of the left kidney. A percutaneous nephrostomy and drainage of the retroperitoneal region were inserted; antibiotic prophylaxis was given. A 4-week postoperative intravenous pyelogram showed complete integrity of the upper left tract and good renal function.
Full Text Available Children aged 6-15 years old experience more injuries to their teeth and the injuries sustained are more serious as evidenced by a higher percentage of luxations, avulsions, fractures and dislocations. The mandible is the most frequently fractured facial bone and mandibular alveolar injuries have been reported to range between 8.1-50.6%. Those with mandibular or midface fractures have a higher incidence of associated chest, extremity, abdomen and cervical spine injuries. The growing patient with facial injuries presents the clinician with a series of thought-provoking circumstances. Dentoalveolar and mandibular injuries are especially important to understand because of the potential complications related to tooth eruption, alveolar development, occlusion and facial growth. However, the principles involved in the treatment for children need to be modified by certain anatomical, physiological and psychological factors specifically related to childhood. This case report documents the trauma, management and follow-up care of an 11-year-old boy who sustained undisplaced infraorbital, nasal fractures and mandibular dentoalveolar fracture along with other associated injuries of the extremities.
Chun-yan Li; Hong-qing Wang; Hai-yuan Liu; Jing-he Lang
Objective To investigate the clinical features and management ofureteral endometriosis.Methods Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed.Results Ten patients were diagnosed as ureteral endometriosis among 7561 cases with surgically and histologically proved diagnosis of endometriosis,with an incidence of 0.132%.Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis,and the other was intrinsic ureteral endometriosis.Hormone therapy failed in 2 patients with urinary tract obstruction.Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients.One ease of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy.No relapse was observed in the other 9 patients.Conclusions Ureteral endometriosis is a rare entity.The upper urinary tract should be evaluated in patients with severe endometriosis,even in postmenopausal women.The treatment of ureteral endometriosis usually requires surgery,while ureterolysis should not be performed in patients with extensive disease.As a form of adjuvant therapy of surgery,hormonal therapy is an appropriate option.
Fire ants, Solenopsis richteri and Solenopsis invicta, entered the United States before the mid 1930’s and have spread within the country to over 129.5 million ha. The rapid and extensive spread of these stinging ants resulted in drastic attempts to eliminate or control the problem quickly. Initia...
Sudhir M Naik
Full Text Available Background: Foreign bodies (FB are the commonest emergencies in otorhino-laryngology. The most common incidences are in the nasal cavity, ears and oropharynx. FB in the nose, ears and oropharynx have characteristic symptoms and their removal does not represent a great difficulty to the otorhino-laryngologist unless 2 the FB is in the tracheo-bronchial tree. The FB inoculation may be voluntary or accidental.Design: A retrospective study of 860 cases managed in 57 months period between January 2007 to July 2011.Setting: Department of ENT, Head and Neck Surgery, KVG Medical College, Sullia.Materials and method: 860 cases of foreign bodies were managed successfully in the OPD under topical anaesthesia and also under general anaesthesia. There were 471 males & 389 females in the study, the youngest was 4 year old girl and the oldest was 69 year old female.Result: In our study we managed 860 cases of FBs which included 505 ear cases, 118 nasal cases, 118 pharyngeal cases, 100 esophageal cases and 19 FBs in the trachea, bronchus. 429 cases were managed in the OPD under topical anaesthesia and 431 cases were managed under general anaesthesia.Conclusion: Most of the foreign bodies in the nose and ear can be managed in the outpatients itself. All the foreign bodies of the esophagus and trachea bronchus were managed under general anaesthesia after admission. Complication rates are very low when managed prudently by a trained otorhino-laryngologist.
Dillen, van S.; Hiddink, G.J.
Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 19
Dejean, Alain; Corbara, Bruno; Azémar, Frédéric; Carpenter, James M
Because group-hunting arboreal ants spread-eagle insect prey for a long time before retrieving them, these prey can be coveted by predatory flying insects. Yet, attempting to rob these prey is risky if the ant species is also an effective predator. Here, we show that trying to rob prey from Azteca andreae workers is a fatal error as 268 out of 276 potential cleptobionts (97.1 %) were captured in turn. The ant workers hunt in a group and use the "Velcro®" principle to cling firmly to the leaves of their host tree, permitting them to capture very large prey. Exceptions were one social wasp, plus some Trigona spp. workers and flies that landed directly on the prey and were able to take off immediately when attacked. We conclude that in this situation, previously captured prey attract potential cleptobionts that are captured in turn in most of the cases.
The paper has a twofold structure and focus. The first part is an examination of the funding challenges facing African universities resulting mainly from public finance difficulties, and the second part is a case study of how some Kenyan and South African public universities have attempted to mitigate resource dependence difficulties through…
Khan, Aliya A; Hodsman, Anthony B.; Papaioannou, Alexandra; Kendler, David; Brown, Jacques P.; Olszynski, Wojciech P.
In 2002, Osteoporosis Canada published clinical practice guidelines for the diagnosis and management of osteoporosis. The current paper supplements that guideline and provides a review and synthesis of the current literature on the diagnosis and management of osteoporosis in men.
Work of a kindergarten or school headmaster can be defined as school management, comprising both administrative and pedagogical management. An individual in the role of a headmaster has difficulties in performing numerous position-related tasks with the same desired quality, so it would be sensible to develop teamwork in the field of kindergarten management as well. Team management in kindergartens is a current issue, which needs to be explored in depth. In the school year 2011/12 we form...
Central core myopatyhy is a rarely seen hereditary neuromuscular disorder that is involved in congenitally myopathies group. The disease is characterized by muscular weakness, skeleton system deformities, increased malign hyperthermia sensitivity and anesthesia management is critically important. In these patients, prolonged muscular weakness and malign hyperthermia that can complicate the perioperative management are the most critical risks. In this case report, anesthesia management of an e...
Samar K Biswas
Full Text Available Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker′s classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after
Yu, Holly, Ed.
Using database-driven web pages or web content management (WCM) systems to manage increasingly diverse web content and to streamline workflows is a commonly practiced solution recognized in libraries today. However, limited library web content management models and funding constraints prevent many libraries from purchasing commercially available…
pastoral and spiritual care for patients, their relatives, and other medical personnel. Approximately 50 chaplains work in different Toronto hospitals, of whom 21 individuals were selected using purpose f ul sampling : a non-random method o f sampling in which the researcher selects “in f ormation-rich” cases f or in-depth interview. The author tried to collect data as records of action-in-process from a variety of people. Because the in-depth responses obtained by qualitative studies cannot be easily categorized, analysis must rely less on counting and correlating and more on interpretation, summary and integration. Therefore, more than anything else, the findings of this study are supported by quotations and case descriptions. The method of data analysis is qualitative description, with a phenomenological inclination: that is, the goal is to describe emotion management experiences as they are lived and felt by chaplains. Discussion of Results & Conclusions Chaplains who participated in this study are between the ages of 33 and 65. The average age is approximately 52. Also, 11 chaplains work part-time and 10 chaplains work full-time. 18 of the 21 chaplains in the sample are women. Recruiting more than 3 male chaplains was not possible due to the fact that hospital chaplaincy is a job predominantly occupied by women. In terms of ethnicity, the majority of the respondents are white, with European and Anglo-Saxon backgrounds. However, the sample also includes two Asian chaplains (with Chinese and Indian backgrounds and one from the Caribbean Islands. Moreover, the sample includes chaplains from five different religions and faith traditions. The majority of the chaplains are Christian, including five chaplains belonging to the Anglican Church, three to the Roman Catholic Church, two to the United Church of Canada, and one to the Baptist Church. The remaining four Christian chaplains did not specify their Church. Several of the chaplains are church ministers. Also
Verkade, P.J.; Meijel, B. van; Brink, C.; Os-Medendorp, H. van; Koekkoek, B.; Francke, A.L.
Background: Case management programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of case management for people with dementia as well as the preconditions for an effective deli
Ronnau, John; And Others
This training manual for social work practitioners is based on the Family Advocacy Model of Case Management, which states that case management with adolescents contains two important elements: work with the adolescent and work with those responsible for his/her care. This manual deals with the first of two elements and is designed to be used in…
Smith, Michael D.; Seal, David Wyatt; Hartley, Shannon
An HIV knowledge survey and qualitative interview were administered to 20 case managers in community-based programs for troubled youth to assess HIV knowledge and their perception of client HIV risk behaviors. Participants had good HIV knowledge. Case managers perceived client youth to be at high risk for HIV infection due to unsafe sexual…
该文从病案档案管理现状出发,对病案档案如何管理,从七个方面提出了具体措施与方法。%From the current situation of medical case archives management, it advanced measures and methods on how to manage medical case archives from seven aspects.
Lindahl, Marianne Larsson; Berglund, Mats; Tönnesen, Hanne
Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined...
... 25 Indians 1 2010-04-01 2010-04-01 false What case management responsibilities does the social... HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Direct Assistance Employment Requirements § 20.318 What case management responsibilities does the social services worker have? In...
Rendtorff, Jacob Dahl
Case studies can be an important methodology for ethics and philosophy in humanistic management and liberal education as well as in the social sciences because they integrate a deeper, reflective, philosophical, and ethical understanding of the organization. A case study approach based on philosophy of management contributes to putting into…
Sarchiapone, Marco; Carli, Vladimir; Di Giannantonio, Massimo; Roy, Alec
We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history…
The paper is concerned with a case of local management of eco certification. With outset in a case study, the paper explores the relation of eco certification to economy, society and culture. The paper emphasizes the multidimensional quality of local eco management of global organic agrifood...... systems. It takes a postmodern stance and discusses the case from the perspective of trust, responsible management, cosmopolitanization, the ‘transparent society’ and ‘green growth’ strategies. In the concluding section, the implications for the further development of a concept ‘responsible management...
Full Text Available Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail.
Singh, Anju; Agarwal, Neelam; Chopra, Seema; Sikka, Pooja; Suri, Vanita; Kumar, Bhupesh; Dutta, Pinaki
Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail.
Full Text Available Purpose: The purpose of this paper is to analyse and draw a correlation between service science theory and practice as it relates to the complexity of engendering a services orientated paradigm of management within a traditionally manufacturing enterprise. It is suggested that the traditional manufacturing paradigm is founded on scientific management principles whereas that of service science is far more multidisciplinary and complex in nature. It would seem that the service science paradigm is directed at co-creational value in contrast to a transactional paradigm of management that form the foundation of the manufacturing era. Problem investigated: With the emergence of an essentially services orientated global economy, manufacturing enterprises are increasing adding a range of services to the value offerings they make available to clients. The first part of this paper constitutes a literature study directed at gaining a theoretical understanding and insight into the underlying principles of management involved in moving from an essentially manufacturing management setting to one that incorporates services and in some instances where services assume the dominant paradigm of management. The second part of the paper attempts to correlate the theoretical insights gain from the literature study with relation to that of practice by means of a case study undertaken at a South African manufacturing enterprise that has implemented a servitization strategy. Methodology: A multidisciplinary literature review and analysis is undertaken to gain an insight of contemporary management theory and practice, as it relates to servitization or the transition from an essentially manufacturing to a services inclusive operational setting. With the insights gained from the literature research serving as a source of information and reference a case study was undertaken at a South African enterprise to determine if a correlation exists between theory as expressed in
The health and social care service system in the Netherlands is fragmented and poorly organized. Facing an increase in the number of elderly citizens, a more consumer-oriented and vocal citizenry, and rising competition at least in part in response to government concerns over runaway costs, Dutch government officials and social researchers have been experimenting with various forms of case management since the mid-1980s. For some types of clients, such as the mentally handicapped, case management seems to be well accepted. Many issues remain to be resolved, however, including (a) the level of clinical expertise needed by case managers for clients with complex medical problems; (b) whether case management tasks are more appropriately carried out by service providers or as a separate function; and (c) how much autonomy service providers will be expected to relinquish under the control of a case manager.
Schulte, Amanda; Musolf, Jeanne; Meurer, John R; Cohn, Jennifer H; Kelly, Kevin J
Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.
Focseneanu, B E; Marian, G
Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge.
Ardito, M; Botuck, S; Freeman, S E; Levy, J M
To meet the needs of individuals with mental retardation and developmental disabilities (MR/DD) and their families living in urban setting, a noncenter-based model of case management was implemented. In contrast to traditional case management in which families and consumers come to the case manager and most service coordination is done by telephone or in meetings at the case manager/social worker's worksite, the case manager in a noncenter-based model is mobile and able to meet the consumer and family in their domains. In this model, case management is provided in conjunction with in-home residential habilitation and funded by Medicaid under the Home and Community Based Services Waiver. This funding stream provides monies for nontraditional services delivered in noncertified settings. Case managers used the Family Resource Scale to get an immediate indication of the resources and needs of each family. The scale highlights the adequacy of a person's basic and caregiving resources, as well as financial needs. The findings from this study suggest that an understanding of both disability and entitlements is essential for case managers who may have to help advocate for consumers around services and benefits. Moreover, to build and maintain an egalitarian and supportive relationship with families, the importance of caregiver-specified resources and needs must be recognized by case managers. Access to resource information and the ability to engage the family in problem-solving depends on a well-trained staff with the ability to respond to individuals with different needs and from a variety of circumstances. These essential skills prepare a case manager to assist families with their immediate requirements as well as to mobilize them to plan for future needs.
Doan, AnHai; Baid, Akanksha; Chai, Xiaoyong; Chen, Fei; Chen, Ting; Chu, Eric; DeRose, Pedro; Gao, Byron; Gokhale, Chaitanya; Huang, Jiansheng; Shen, Warren; Vuong, Ba-Quy
The challenge of managing unstructured data represents perhaps the largest data management opportunity for our community since managing relational data. And yet we are risking letting this opportunity go by, ceding the playing field to other players, ranging from communities such as AI, KDD, IR, Web, and Semantic Web, to industrial players such as Google, Yahoo, and Microsoft. In this essay we explore what we can do to improve upon this situation. Drawing on the lessons learned while managing relational data, we outline a structured approach to managing unstructured data. We conclude by discussing the potential implications of this approach to managing other kinds of non-relational data, and to the identify of our field.
Full Text Available Quality assurance has become very important to the majority of production or service companies with international activity. Maritime transport companies were also required to take measures to implement a quality management system. Because of navigation accidents that had a significant impact on shipping, there was designed a ship safety management code. To put into practice the quality management system, each company adopts specific quality strategies according to their activity.
Peggie Rothe; Christopher Heywood
Corporate short-distance relocation is a significant event in the course of an organization’s lifetime. While these kinds of relocations happen frequently, they are an infrequent event from the perspective of a single organization. Therefore, few organizations have experience and knowledge on relocation management, which can result in improvised ways of managing the process. The aim of this paper is to describe different short-distance relocation management approaches applied by organizations...
M.Comm. The limited availability of South African case studies created the opportunity to compile an authentic South African business case study to be presented in a usable manner. The goal of the case study is to explore the challenges of the implementation and management of an integrated computer system. This dissertation gives a brief review on the characteristics of a business case study and the associated benefits of the case method. It also looks at the properties needed to create a ...
Karoline Doro Alves Carneiro; Cristina Dai Prá Martens
This study explores the implementation of project portfolio management in the organizational context. The objective is to analyze the methodology of project portfolio management adopted by an organization based in the project portfolio management maturity model proposed by Rad and Levin (2006). We developed an exploratory case study in a small financial institution that experienced problems with the implementation of its methodology in project portfolio management. As a result of study, we fo...
Boxelaar, Lucia; Paine, Mark; Beilin, Ruth
Post-modern theorists have challenged the totalizing and unifying ambitions of change management practices. This paper explores how a narrative action research approach may be used to combine our modernist commitment to facilitate change and collaboration in the land management context with a post-modern sensitivity to complexity and difference.…
Hoof, van L.J.W.; Hoefnagel, E.W.J.; Schans, van der J.W.; Nielsen, J.R.; Christensen, A.; Sverdrup-Jensen, S.; Delaney, A.; Jentoft, S.; Mikalsen, K.; Karlsen, G.R.; Bodiguel, C.; Catanzano, J.; Suarez de Vivero, J.L.; Alba, I.M.; Dominquez, S.F.; Rommel, D.
This report focuses on the evaluation of the process of devolution of responsibilities in the current institutional landscape in European fisheries management. In particular the analysis focuses on how the present management systems contribute to good governance. We follow the criteria as suggested
Pandey, Krishna Nath
This book has been written by studying the knowledge management implementation at POWERGRID India, one of the largest power distribution companies in the world. The patterns which have led to models, both hypothesized and data-enabled, have been provided. The book suggests ways and means to follow for knowledge management implementation, especially for organizations with multiple business verticals to follow. The book underlines that knowledge is both an entity and organizational asset which can be managed. A holistic view of knowledge management implementation has been provided. It also emphasizes the phenomenological importance of human resource parameters as compared to that of technological parameters. Various hypotheses have been tested to validate the significant models hypothesized. This work will prove useful to corporations, researchers, and independent professionals working to study or implement knowledge management paradigms.
Recently, mobile health care has been applied to manage diabetes requiring self-management. Health care by mobile applications (apps) has a great advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be improved through mobile apps. The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes since 2010. However, mobile apps may not be effective for all patients. We here report the effect of use of mobile-based diabetes care app (Healthy-note app) for 2 patients with diabetes, and discuss issues and strategies for effective mobile intervention. Further study is needed on improving patient's participation to increase the effect of management via a mobile app. PMID:28168183
Tomida, Takashi; Yano, Takashi; Hidaka, Naoaki; Okada, Yoshikatsu; Iwasaki, Makoto; Goshima, Hiromichi
Ten cases of delayed radiation injuries of the gastrointestinal tracts (consisting of 2 with peptic ulcer, 4 with intestinal obstruction, and 4 with rectal bleeding) are reported. Although conservative therapy or artificial colostomy was undertaken in all cases, satisfactory results were not obtained. In four cases in which subsequent resection of the gastrointestinal tracts was performed, the prognosis was favorable, but various symptoms still continued in the other non-resected cases. Delayed radiation injuries are progressive lesions involving the vasculo-connective tissue, so that cure can not be achieved. Resection of the damaged gastrointestinal tract is recommended, however, this is difficult to do in many cases. (Namekawa, K.).
César Medeiros Cupertino
Full Text Available Este artigo promove um estudo de caso de uma das maiores instituições financeiras brasileiras da década de 90: o Banco Nacional S.A. (BNSA. O BNSA teve sua intervenção decretada pelo Banco Central do Brasil em 1995, após ser identificada a existência de ativos insolventes, originados por gerenciamento fraudulento dos lucros da entidade. O estudo visa investigar a gestão fraudulenta de lucros do Banco Nacional S.A., tanto nos seus aspectos motivadores, quanto em relação aos seus efeitos na composição patrimonial da entidade. A abordagem metodológica contempla: (i pesquisa explicativa, quanto aos objetivos do estudo; (ii estudo de caso, quanto aos procedimentos aplicados e (iii pesquisa qualitativa, quanto à abordagem do problema. Constatou-se que pode haver interesses inconciliáveis entre o agente e o principal, conforme disciplinado pela teoria da agência. O artigo, ainda, ressalta a importância do conhecimento dos dados financeiros na identificação dos fatos de interesse, dos ajustes pertinentes e da correta evidenciação da situação patrimonial da entidade.This paper features a case study of one of the main Brazilian banks of the 90's: Banco Nacional S/A (BNSA. The bank had its intervention decreed by Central Bank of Brazil in 1995, after the existence of insolvent assets, originated by fraudulent earnings management, were identified. The study aims to investigate the fraudulent earnings management of BNSA, both in motivational aspects and in relation of the effects in its balance sheet structure. The methodological approach of the study encompasses: (i an explanatory research, regarding the intended aim of the study; (ii case study, regarding the applied procedures; and (iii a qualitative research, regarding the approach to the problem. It was concluded that irreconcilable conflicts of interest might occur between the agent and the principal, according to the Agency Theory. The paper also emphasizes the importance of
Full Text Available Suicide attempts in North India are generally underreported but have been considered to be rising. The number of admissions due to attempted suicide at Duncan Hospital, North Bihar, rose from 82 in 2007 to 419 in 2011.A structured interview and the WHO (World Health Organization Major (ICD-10 Depression Inventory were completed by 157 suicide-attempt survivors. Immediate relatives were also interviewed. Only 23% of patients came from India; 77% of patients came from Nepal. The highest incidence was in the age group 16-20 years. Females have higher rates in the 21-30 year age group (p=0.012, but after 30 years of age, the number of males becomes higher than the females (p=0.048; 81.5% of the respondents were below the age of 30 years.Pesticide poisoning was the major mode of attempted suicide (94.3%. Using the WHO Major (ICD-10 Depression Inventory, 28 of the participants suffered from depression (17.7%. Ninety people (56.9% admitted to previous thoughts of suicide, and nine (5.7% people had attempted suicide previously.Hindus made up 84.0% of the respondents. Almost 50% of respondents only carried out their religious rituals on an occasional basis or not at all. 70.2% had not completed education beyond primary school, and 49.7% earned less than Rs10,000 per month (US$200. Eighty percent of the participants stated conflicts with family members led to the attempted suicide. Relatives did not expect the attempted suicide in 97.4% of cases. Knowledge of the suicide of a neighbour, friends, or relative influenced 77.0% of the participants to attempt suicide.Efforts to prevent suicide attempts and deaths need to be multifaceted. Banning the most poisonous pesticides and improving poison storage in the community must be encouraged. Prevention, early intervention and treatment all are required in a suicide prevention plan. The lack of psychiatrists necessitates that other professionals and trained non-professionals be utilised in the mental health team
Bennani Othmani, M; Diouny, S; Boumalif, O
This study is a contribution to the ongoing debate on the application of informatics in medicine. It attempts to outline a theoretical framework supported by a software application of a telemedicine management system. The proposed model is based on a detailed benchmarking of Telecom environments, hardware environments, and content management systems. This approach, which uses open source technologies, helps to create an interface with two entities: web and medical care USB. In sum, for the proposed telemedicine model to be successful, health professionals, telecom operators and research medical informatics laboratories must play an active role in the conception and implementation of telemedicine applications.
K Nagaraja Rao
Full Text Available Background: Attempted suicide is a common clinical problem in a general hospital setting. It has a serious clinical and socio-economical impact too. Aims: To study the psychosocial, psychiatric, and personality profile of the first suicide attempters in a general hospital. Settings and Design: Cross-sectional, hospital-based, descriptive study. Materials and Methods: All the consecutive cases of first suicide attempt ( n=100 treated in a general hospital were studied to know the clinical profile. Variables related to socio-demographic characteristics, family background, suicide characteristics, psychiatric morbidity, and comorbidity were analyzed. Risk-Rescue rating was applied to know the medical seriousness of the suicide attempt. Presumptive stressful life event scale was utilized to calculate life events score. Structured clinical interview (MINI Plus and semi-structured clinical interview (IPDE were used for axis-I and axis-II (personality diagnoses. The results were analyzed using appropriate statistical measures. Results: Family history of psychiatric illnesses (31% and suicide (11% were noted. Insecticides and pesticides were the most common agents (71% employed to attempt suicide. Interpersonal difficulties (46% were the most frequent stressor. Overall medical seriousness of the suicide attempt was of moderate lethality. 93% of the suicide attempters had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders, and substance-related disorders, with axis-I disorders (89%, personality disorders (52%, and comorbidity of psychiatric disorders (51.6%. Conclusion: Individuals who made first suicide attempt were young adults, had lower educational achievement; overall seriousness of the suicide attempt was of moderate lethality, high prevalence of psychiatric morbidity, personality disorders, and comorbidity, and had sought medical help from general practitioners.
Full Text Available Increasing competition among companies, constantly growingproduct and service quality requirements, rapidly changing consumerbehavior, technology advancements and changes enablescustomer to make decisions which product or service to buy. Inthis context, customer relationship management is becoming animportant tool creating preconditions to maintain loyal customersand improve company’s performance. The paper analyzespeculiarities of customer relationship management in Lithuaniancompanies. In order to reveal motives and problems of customerrelationship management implementation the survey was carriedout. 82 companies participated in the survey. At the end of thepaper conclusions are presented.
Full Text Available The paper describes how Lean Management may be applied in the university setting to improve the management processes. The correlation of didactic, educational and research activities with the stakeholders needs is one of the main objectives of the university. In this respect, an indicator used to analyse a university, for the purposes of fulfilling its mission, respectively for the purposes of streamlining its didactic and scientific activity, is related to the number of graduates on the labour market, acting in their area of specialization. This work presents a best practice of Lean Management at Transilvania University of Brasov, Romania.
Full Text Available Oral submucous fibrosis is a progressive oral disease first described by Pindborg and Sirsat 3 decades ago. It is a premalignant condition. The signs and symptoms depend on the involvement of the different sites in the oral cavity. The patient feels burning sensation for normal diet and trismus which may be so severe. If not properly treated the risk of malignant change in advanced cases of OSMF is relatively high. Wide ranges of treatment such as medical management, surgical therapy and physiotherapy have been attempted in the past, but none of them has proved to be a cure for this chronic fibrotic disease.Histopathologically as the disease progresses, (i change in the morphology of collagen, (ii increased accumulation of amorphous collagen, and (iii decreased collagen degradation results in decrease in number of blood vessels are observed in the affected area compared to the normal area. With an aim of bringing more blood supply to the affected area which is expected to bring ?more nutrients and help in collagen degradation, earlier application of vasodilators and studies with curcumin have been done, but still with - no significant outcome.As an alternative approach to improve the blood circulation, we have tried Autologous bone marrow stem cells which have been earlier applied in several diseases such as ischemic peripheral vascular diseases, ischemic heart diseases etc with proven improvement in angiogenesis. A 38 year old patient with oral submucosal fibrosis, proven by histopathology, and endothelial markers was injected 175 million BMMNCs into the area affected. The paramaters such as blanching, fibrous band have significantly improved, 4 weeks after the injection. We could observe positive changes clinically to prove the improvement. The mouth opening has improved to 35 mm from the previous 30.0 mm. Further histopathology and SEM studies with larger samples are done for establishing stem cell therapy’s safety and efficacy.
Robinson, Monica; Fisher, Thomas F; Broussard, Kim
Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.
Dillen, van, J.; Hiddink, G.J.
Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. Results - Especially in the last three years, man...
Maughan, E; Pankhania, M; Shah, K; Gurr, P
Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.
HAKSÖZ, Çağrı; Haksoz, Cagri; Arslan, Özgür; Arslan, Ozgur
We present the current procurement risk management practice of Enerjisa, a major energy company in Turkey. We provide results of a managerial survey and interview conducted at Enerjisa, which illuminates the current perception of the critical procurement risks and how they are being managed effectively. Especially, we shed light on the procurement risk awareness and perception, critical drivers of procurement risks, risk assessment strategies, operational and financial hedging of procurement ...
Nowadays, sustainable management seems more likely to be a guarantee of competitiveness for companies, regardless of their size. Besides offering those strategic opportunities, sustainable management practices also play a significant role in gaining acceptance and legitimacy in the marketplace. Moreover, SMEs are continually researching ways to improve their performance. The relationship between sustainability and company performance has interested researchers for twenty years, even if the ac...
Jørs, Erik; Christoffersen, Mette; Veirum, Nikoline Høgsgaard
prevalent among young adults aged 20-29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate...... suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010-2011. Data on age was stratified into three age groups: adolescents aged 10-19 years, young...... adults aged 20-29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21...
Glenn R. Gaudette
Full Text Available In a biomedical engineering lab at Worcester Polytechnic Institute, co-author Dr. Glenn R. Gaudette and his research team are investigating the effects of stem cell therapy on the regeneration of function in damaged cardiac tissue in laboratory rats. Each instance of stem cell experimentation on a rat yields hundreds of data sets that must be carefully captured, documented and securely stored so that the data will be easily accessed and retrieved for papers, reports, further research, and validation of findings, while meeting NIH guidelines for data sharing. After a brief introduction to the bioengineering field and stem cell research, this paper focuses on the experimental workflow and the data generated in one instance of stem cell experimentation; the lab’s data management practices; and how Dr. Gaudette teaches data management to the lab’s incoming graduate students each semester. The co-authors discuss the haphazard manner by which engineering and science students typically learn data management practices, and advocate for the integration of formal data management instruction in higher education STEM curricula. The paper concludes with a discussion of the Frameworks for a Data Management Curriculum developed collaboratively by the co-authors’ institutions -- the University of Massachusetts Medical School and Worcester Polytechnic Institute -- to teach data management best practices to students in the sciences, health sciences, and engineering.
Tahan, Hussein A; Huber, Diane L
Defining the roles and functions of case managers is crucial in today's healthcare environment and necessary for the case management field. One way to address this issue is through the examination of case managers' job descriptions used in various healthcare organizations. The study reported herein used qualitative analysis procedures and the latent class cluster analysis method to examine a national sample of 1028 job descriptions of case managers. The study identified the activities, role relationships, knowledge, skills, and abilities of case managers working in varied settings. It also described the changes that occurred in the practice of case management, based on these job descriptions, over 5 years: from the mid-1990s until the early 2000s. One benefit of this study was a change in one eligibility criterion of the CCM credential. Another was the development of a taxonomy of case managers' roles and functions that can be used as a step toward standardization of case managers' job descriptions.
Full Text Available Introduction. Filicide is the killing of a son or daughter by a parent. The paper examines interaction between stress and maternal psychopathology that led to the killing. Case Outline. After prolonged conflict with her ex-husband and father of her only child, the respondent committed filicide. Two years before committing filicide, after she had divorced the father of the child, the respondent attempted suicide and had to be hospitalized. On that occasion, she was diagnosed with depressive disorder, which was not treated after hospitalization. Having killed her daughter by cutting her throat, she tried to commit suicide in the same manner, by slitting her throat. During further observation, the respondent was found to suffer from acute psychotic disorder, depressive disorder and histrionic personality disorder. These disorders in interaction with stress do not provide us with an explanation for an unusual and psychopathological motivation analysis of killing the child. Conclusion. Filicide is a violent act, most frequently multifactorial in its nature. Histrionic personality disorder in mother cannot explain the filicide act. Only interactive and dynamic evaluation of this psychiatric disorder in its longitudinal, development aspects and its potentiality to enable the expression of some other psychiatric disorders, especially dissociative states, as well as the importance of prolonged and acute stress and its subjective importance for the individual can shed some more light on the mental state of the mother at the time of filicide.
Jagadeesan Madras Sundararajan
Full Text Available BACKGROUND Schizophrenia is a major mental illness whose sufferers have been found to have lesser longevity than general population. The most common cause for premature death in schizophrenia is suicide. There are very few Indian studies on suicide in persons suffering from schizophrenia. OBJECTIVES The objectives were to study the frequency of suicide attempt in schizophrenia to compare and study the clinical and sociodemographic profile of suicide attempters and non-attempters in schizophrenia and to analyse and study the various risk factors of suicide attempts in persons suffering from schizophrenia. METHODS A sample of 100 consecutive patients attending review OPD of a government tertiary care hospital in Chennai were selected. Those who had a diagnosis of schizophrenia were screened for past suicide attempts. They were divided into two groups as suicide attempters and non-attempters and analysed using the SAPS (Scale for Assessment of Positive Symptoms, SANS (Scale for Assessment of Negative Symptoms, Calgary depression scale, and Beck’s suicide intent scale. RESULTS People suffering from schizophrenia are at a high risk for making suicidal attempts (27% especially when the illness is acute and severe in early stages when accompanied by depressive symptoms. Demographic profile such as age, sex, education, occupation, socio-economic status, marital status, and family type were not significantly related to suicide attempts. Family history of suicide was a significant factor in patients with suicide attempts. Majority of the attempts were of medium-to-high intent, hanging being the commonest method, and were attributed to most commonly delusions and depressive symptoms.
Undergoing nearly 60 years＇ development,Gtes de France has accumulated abundant experience in the development and management of rural travel holiday accommodation product.On the basis of studying about Gtes de France management mode,this paper has analyzed and thought the realistic significance that its management mode is introduced to Huizhou（Huangshan City） and the problem it will face,so that it can offer a reference for the development of the rural hotel in our country.%法国乡村旅馆联合会经过近60年的发展,在乡村旅游度假住宿产品的开发和经营方面积累了十分丰富的经验。在对法国乡村旅馆联合会经营模式研究的基础上,分析、思考了将其经营模式引入徽州（黄山市）的现实意义以及要面临的问题,希望为我国乡村旅游住宿产品的发展提供借鉴。
Morales-Asencio, José Miguel
Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services.
Moniz, Jr, Richard
Aimed at library science students and librarians with newly assigned administrative duties the book is about improving one's thinking and decision making in a role as a library manager. Most librarians get very little exposure to management issues prior to finding themselves in a management role. Furthermore, most library science students do not expect that they will need to understand management yet they quickly find that there is a need to understand this perspective to be effective at almost any library job. Effective library management is about having some tools to make decisions (such as
Cooper, Kristy S.; Stanulis, Randi N.; Brondyk, Susan K.; Hamilton, Erica R.; Macaluso, Michael; Meier, Jessica A.
This embedded case study examines the leadership practices of eleven teacher leaders in three urban schools to identify how these teacher leaders attempt to change the teaching practice of their colleagues while working as professional learning community leaders and as mentors for new teachers. Using a theoretical framework integrating complex…
Parellada, Mara; Saiz, Pilar; Moreno, Dolores; Vidal, Jorge; Llorente, Cloe; Alvarez, Mar; García-Portilla, Paz; Ruiz-Sancho, Ana; Arango, Celso; Bobes, Julio
Attempted suicide may be a different phenomenon in adolescents than in adults. To our knowledge, direct comparisons between these two populations are very scarce. The aim of this study is to analyze the differences between adolescents and adults in methods of attempted suicide, accompanying certainty of death, and intentionality. All cases admitted to one adult (n=173) and one adolescent (n=104) inpatient unit who attempted suicide in the period from January 2003 through October 2005 were included in a prospective, common, national register, with data on methods, circumstances, and intentionality. The methodology followed that of the WHO/Euro Multicenter Study on Parasuicide. A stratified analysis was performed using the Mantel-Haenszel procedure in order to control for the effects of gender and diagnosis. Adolescents used significantly more over-the-counter medicines. Adults were significantly more certain of the possible fatal outcome of their attempt and had a significantly more severe intention when harming themselves. Individuals appear to use the methods that are available to them to attempt suicide. Adolescents may display more impulsive and less lethal directed behavior than adults or, alternatively, they are more frequently admitted for less severe attempts.
Nelson Oly Ndubisi
Full Text Available This paper critically examines the term "knowledge management" (KM, its components, and the initiatives of a number of organizations that parade as knowledge management pioneers and catalysts, as well as the concept of tacit knowledge. The concept of knowledge management is examined in the web sites of consultancy firms, information practitioners, and other firms that claim to have benefited immensely by implementing knowledge management solutions. In addition a pool of experienced academicians was interviewed to get their views on knowledge management and to furnish information on the knowledge management initiatives in their department/unit etc. The observation made is that the firms are either managing information under the knowledge management nomenclature or managing work practices by instituting an information sharing culture. It is concluded that information management (IM has been searched and replaced with KM. There is no value added to warrant KM to be an emerging field of management, even the ontology and epistemology of KM at best is ill-defined. In fact KM has no intrinsic meaning.
Full Text Available Abstract Introduction Placenta percreta is an obstetric emergency often associated with massive hemorrhage and emergency hysterectomy. Case presentation We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left in situ, methotrexate was administered, and a delayed hysterectomy was successfully performed. Conclusions Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.
Full Text Available Central core myopatyhy is a rarely seen hereditary neuromuscular disorder that is involved in congenitally myopathies group. The disease is characterized by muscular weakness, skeleton system deformities, increased malign hyperthermia sensitivity and anesthesia management is critically important. In these patients, prolonged muscular weakness and malign hyperthermia that can complicate the perioperative management are the most critical risks. In this case report, anesthesia management of an electively planned caesarean section patient, taken into emergency surgery that is also previously known to have central core myopathy diagnosis will be shared. [Cukurova Med J 2013; 38(4.000: 770-773
Jarusuraisin, Ngamwong; Kesornsukon, Kanch
On December 26, 2004, tsunamis hit Southeast Asia and caused serious damage and loss of lives. In Thailand, six provinces (Ranong, Phang-Nga, Phuket, Krabi, Trang, and Satun) were impacted. The present study reports the psychiatric assessments such as Thai GHQ-60 and IES. It also reports management techniques of both cognitive behavior therapy and medication. Those were provided to a Thai female patient who was 54 years old. The patient responded to treatment quickly because of early management. The tsunami victim with Posttraumatic Stress Disorder (PTSD) is not an individual. A mass of people who faced or witnessed the tsunami are vulnerable to get PTSD any time during 6 months after trauma. These early management techniques are useful and practical for a mass of victims and survivors.
Harvey, Carol P
For undergraduate and graduate courses in human resources. A diverse approach to understanding and managing diversity. Understanding and Managing Diversity uses applications to clarify the complexity of a diverse workforce, and explains how it can be used as an organizational asset. This text also provides students with a wide range of expertise—from the perspective of experienced interdisciplinary instructors (business, psychology, economics, theology, law, politics, history, etc.) to practitioners (diversity trainers, corporate managers, etc.). Teaching and Learning Experience This program will provide a better teaching and learning experience–for you and your students. Here’s how: Provide Students with an Accessible Format: Information is presented in a logical succession to help students learn that is in a way accessible to them. Present New and Timely Diversity Topics: Topics include Racial Identity, Work-Life Balance, Diversity Leadership, and Workplace Communication. Stimulat...
Full Text Available The present study aims to discuss issues related to the degree of implementation of national waste managementstrategy by emphasizing progress in waste management at national level in three years after its development. In 2004,Romania has developed national policy documents as Waste Management Strategy and National Waste ManagementPlan (WMS, WMSP based on the ”waste hierarchy”. In the four years after the initiation of this process resultsdemonstrate the advantages of using this system in ensuring a sustainable solution to eliminate pollution from waste.Also, the amount of waste recovered at the start of the period - 2004, occupies a proportion of 5.08% of total while inthe end of 2007, the degree of recovery reached 7%. Concerning waste disposal, this was achieved by storage. Thereason is the lack of incinerators for thermal treatment of waste. Traditional collection of household and similar waste inthe mixture, is the most common, accounting for a share of about 97%.
Bille Brahe, U.; Egebo, H.; Crepet, P.; Kerkhof, A.J.F.M.
Abstract In order to measure social support among suicide attempters, an instrument was especially designed to be included in the follow-up interview study being part of the WHO/Euro Multicentre Study on Parasuicide which is carried out in cooperation with EC Concerted Action on Attempted Suicide. I
Crane-Ross, Dushka; Lutz, Wilma J; Roth, Dee
This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.
Hedeland, Rikke; Jørgensen, Marianne H; Teilmann, Grete;
Aims: To explore: (1) The relationship between children admitted to our paediatric department as a result of suicide attempts with acetaminophen and their parents and friends. (2) The extent to which the children had attempted to speak to their parents about their problems before their suicide...... Hospital, Denmark, 2006-2011. Study group: 107 children, 11 to 15 years old. Control group: 59 age- and gender-matched children. Results: 43.5% experienced a dissociated parental relationship characterized by the inability to speak to their parents about any problems, compared with 2% in the control group.......02). Prior to their suicide attempts, 41.5% of the children had attempted to speak to their parents about their problems but felt that they were not heard. There was a significant association among 'the feeling of not being heard' and the purpose of the suicide attempt (p = 0.002) and self-mutilation (p = 0...
Syre, Peter; Bohman, Leif-Erik; Baltuch, Gordon; Roux, Peter Le; Welch, William C
: Study Design. Retrospective chart review and literature review.Objective. To identify cases where a CSF leak occurred during an ACDF and to create a management algorithm based on the findings.Summary of Background Data. Anterior cervical discectomy and fusion (ACDF) is a commonly performed spinal operation. It is effective with very low complication rates. One rare complication of ACDF is a CSF leak. There is limited information on the management of CSF leaks following ACDF and management is on a surgeon-by-surgeon basis.Methods. We reviewed 3 surgeons' case logs and identified cases where a CSF leak was encountered during ACDF and reviewed the patients' medical records, operative reports and imaging to determine how these leaks were managed. We also performed a PubMed search for articles about the presentation and management of CSF leaks following ACDF.Results. Thirteen CSF leaks were identified in 1223 ACDFs, corresponding to a CSF leak rate of 1%. Of these, 9 were successfully treated with intraoperative repair. Postoperative lumbar drainage was used in the remaining 4 patients and was successful in 1 patient. Three patients underwent neck re-exploration and attempted delayed repair. Three patients, including one who was found to have hydrocephalus, ultimately required continuous CSF diversion via shunting. We identified 7 case reports of CSF leak in ADCF in the literature and 1 article that reviewed the prevalence and management of this complication.Conclusion. CSF leak following ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF.
Raslan, M.; Hiew, K.; Hoyle, A.; Ross, D.G.; Betts, C.D.; Maddineni, S.B.
Stuttering priapism is an extremely rare and poorly understood entity. We present a rare case of a 47-year-old Afro-Caribbean gentleman who required proximal shunt procedure to treat his ischemic stuttering priapism after he had failed medical management. We provided a concise review of the literature on the surgical management of ischemic priapism. This case highlighted the importance of prompt surgical intervention in prolonged stuttering priapism to avoid serious psychological and functional complications. PMID:26977408
Lerbæk, Birgitte; Aagaard, Jørgen; Andersen, Mette Braendstrup;
The context of care in assertive community treatment (ACT) can be precarious and generate ethical issues involving the principles of autonomy and paternalism. This focus group study examined case managers' situated accounts of moral reasoning. Our findings show how they expressed strong moral...... obligation towards helping the clients. Their moral reasoning reflected a paternalistic position where, on different occasions, the potential benefits of their interventions would be prioritised at the expense of protecting the clients' personal autonomy. The case managers' reasoning emphasised situational...
Stavrianakos, K; Kontaxakis, V; Moussas, G; Paplos, K; Papaslanis, T; Havaki-Kontaxaki, B; Papadimitriou, Gn
) and 95 in 2011, during the financial crisis (mean age 41.0 years, women 65%). There is an increase of suicide attempts by 35.71%. There were no statistically significant differences between the two periods regarding the gender and age of attempters. There was a statistically significant increase of unemployed (p=0.004), as well as of married/widowed/divorced (p=0.02) suicide attempters during the crisis. There was not statistically significant difference in the severity of suicide attempts before and during the economic crisis or the severity of psychopathology of the attempters. The financial crisis is probably associated with upward trend in attempted suicide of the Athens population. Most affected are those who are unemployed, married, widowed, divorced. Suicide prevention programs are essential for the accurate and timely identification and the immediate and effective management of this special high risk group of attempters during the financial crisis.
Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan
Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed a...
Full Text Available Javad Zarei,1 Farahnaz Sadoughi2 1Health Information Management, Health Management and Economics Research Center, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran, 2Health Information Management Department, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran Background: In recent years, hospitals in Iran – similar to those in other countries – have experienced growing use of computerized health information systems (CHISs, which play a significant role in the operations of hospitals. But, the major challenge of CHIS use is information security. This study attempts to evaluate CHIS information security risk management at hospitals of Iran.Materials and methods: This applied study is a descriptive and cross-sectional research that has been conducted in 2015. The data were collected from 551 hospitals of Iran. Based on literature review, experts’ opinion, and observations at five hospitals, our intensive questionnaire was designed to assess security risk management for CHISs at the concerned hospitals, which was then sent to all hospitals in Iran by the Ministry of Health.Results: Sixty-nine percent of the studied hospitals pursue information security policies and procedures in conformity with Iran Hospitals Accreditation Standards. At some hospitals, risk identification, risk evaluation, and risk estimation, as well as risk treatment, are unstructured without any specified approach or methodology. There is no significant structured approach to risk management at the studied hospitals.Conclusion: Information security risk management is not followed by Iran’s hospitals and their information security policies. This problem can cause a large number of challenges for their CHIS security in future. Therefore, Iran’s Ministry of Health should develop practical policies to improve information security
This article contends that the strategic thinking process is composed of two joint, but paradigmatically distinct, activities--analysis and synthesis. Analysis represents the scientific paradigm, whereas synthesis represents the artistic paradigm. Nevertheless, the Strategic Management course is dominated by the scientific paradigm, even though…
Balali, M.R.; Keulartz, F.W.J.; Korthals, M.
To illuminate the problems and perspectives of water management in Iran and comparable (semi-) arid Middle East and North Africa (MENA) countries, three paradigms can be distinguished: the traditional, the industrial and the reflexive paradigm. Each paradigm is characterised by its key technical sys
Roth, Kevin J.; Smith, Chad
The selection of an appropriate and effective pedagogy has been a central theme in management education for decades. There currently exists a wide range of pedagogical options designed to match course content with the most appropriate technique(s) for effective learning outcomes. Most recently, a variety of experiential learning methods have been…
Choong, Andrew; Alagaratnam, Swethan; Suliman, Samir; Gikas, Panagiotis; Briggs, Timothy; Loh, Alexander; Lotzof, Kevin
We describe the management of a 30-year-old male with type I neurofibromatosis who required an above-knee amputation for bleeding, infection, swelling, and multiple severe joint instability. Postoperatively, he continued to bleed from the stump site. Angiography revealed multiple small distal bleeding aneurysms. Hemostasis was eventually achieved with standard microcoil embolization.
Full Text Available With its origins in logistics, Supply Chain Management (SCM concept is covering all managerial aspects of the flow of materials and information from source to customer, across the entire range of materials handling and movement functions, and throughout an organization and its supply channels. In tourism, these issues relate to the whole process of providing tourism services from sourcing of raw materials, products or different services to supply and distribution, and SCM performance can ultimately be measured by customer satisfaction. Thus, an important component of tourism SCM is the demand management. Therefore, this study aims to highlight the features of the concept of SCM and demand management in tourism, with an emphasis on a hotel chain in Romania, based on research and analysis of tourist traffic indicators as well as assessment of customers satisfaction. The sources of information are the internal company statistics, as well as various hotels booking websites that offer customers’ feedback. The results of the study provide a snapshot of how the hotel demand management can influence SCM performance in tourism.
In today's heterogeneous classrooms, one-method-fits-all-students behavior management approaches are ineffective and often harmful. To succeed with all of their students, teachers should determine whether students have emotional disorders, conduct/behavior disorders, robust male-typical behavior patterns, culturally influenced behavior, learning…
Johnson, David W.; Bartholomew, Kimberly W.; Miller, Duane
Stakeholders, such as future employers, parents, and educators, have raised their expectations of college graduates in the area of computer literacy. Computer skills and understanding are especially critical for business management graduates, who are expected to use computer technology as a tool in every aspect of their career. Business students…
Full Text Available Purpose: The purpose of this article is to characterize the process of knowledge management in business clusters in terms of the benefi ts for the cluster members. The paper examines which mechanisms within the clusters promote knowledge creation between companies and other institutions. Methodology: The literature review is based on databases of books and scientifi c articles, such as EBSCO, Elsevier, JSTOR, Springer, and the Oxford Library and Kingston University London Library. The analysis of the literaturę is focused around the concepts of business clusters, knowledge management in organizations, knowledge management in clusters. Findings: The literature presented in this paper shows that network forms of organization such as clusters are conducive to inter-fi rm knowledge and skill development. Clusters as a type of network turn out to be a highly structured model of knowledge development, transfer and diffusion, produced by the interaction of social and economic relations within cluster institutions. Research implications: The article constitutes a combination of two theoretical aspects – knowledge management and business clusters. The theoretical conclusions of the literature review, mostly foreign literature, provide a basis for research in that area. Practical implications: In the Polish literature on the subject the aspect of knowledge management in business clusters has not yet been discussed. The conclusions of the presented literature analysis provide a basis for research and the development of practical recommendations for cluster managers. Knowledge-based clusters can serve as an example for developing clusters in the world. They are often clustered around research centers, making it possible to improve the exchange of knowledge between the cluster members and also providing the opportunity to better connect the world of science and business. Originality: The author has presented a unique mix of theory, knowledge management
grids share basic characteristics with Supply Chain Management. This thesis presents a linear programming model to assess power grid resilience as a...particular case of Supply Chain Management. Since resilient behavior is not an individual or specific system’s attribute but a holistic phenomenon based
Kuo, Eddie C. Y.; Jernudd, Bjorn H.
Shows how both macro- and microsociolinguistic perspectives are necessary to explain national language management. Macrolevel language planning is motivated by tasks of national consolidation by the state, notably in Singapore's case tasks of socio-ethnic integration and economic development. Microlevel language management pertains to individuals'…
Koutsoukos, Marios; Mouratidis, Antonios
The aim of the present study is to investigate the teaching techniques applied, as well as the difficulties, with which educators in teaching Natural Resource Management are confronted. For research purposes, a case study was conducted on teaching Natural Resource Management in the Third Grade of Vocational Lyceum (EPAL) in Northern Greece. It was…
Rusk, Robert Brian
This qualitative case study explored how the classroom management practices of sampled teachers in a private school in central Oregon influenced classroom disruptions. Through the study, the researcher was able to provide insight on the differences in specific classroom management processes between teachers who had a high number of Positive…
Persson, John Stouby; Schlichter, Bjarne Rerup
. Against this backdrop, we present an interpretive case study of how managers perceive and mitigate the risk areas in software development offshoring with a mature CMMI level 5 (Capability Maturity Model, Integrated) software company as the client. We find that managers perceive and mitigate most...
Villamagna, Amy M.; Murphy, Brian R.
Water resources have become an increasingly important topic of discussion in natural resources and environmental management courses. To address the need for more critical thinking in the classroom and to provide an active learning experience for undergraduate students, we present a case study based on water competition and management in the…
Latha, S Jothi; Velmurugan, N; Kavitha, M; Kumar, A R Pradeep
Variations in dental anatomy and root canal systems are often reported in the dental literature. Among them, Radix entomolaris (RE) is the presence of an additional lingual root in mandibular molars. Though RE appears relatively infrequently, knowledge of the condition will aid in its management. This article presents 2 case reports of RE and clinical guidelines for endodontic management.
Fakih, Souhiela; Marriott, Jennifer L.; Hussainy, Safeera Y.
With the increase in the overweight and obese population, it is critical that pharmacy staff are able to provide weight management advice to women at different stages of their life. This study utilized case vignettes to identify pharmacists' and pharmacy assistants' current weight management recommendations to women of different ages,…
The present book focuses on platforms for (natural) resource management. It analyses various case studies in Benin and Burkina Faso. Conditions for collective resource management in conflict and interdependent situations are the most critical issues. The present study raises the importance of socio-
Financial institutions are the protagonists of the ongoing economic crisis. Recent financial scandals and dubious management have emerged while an intense debate on the responsibility of business has risen. In academia, the stakeholder management school has earned acceptance; and one question arises: is orderly, coherent management possible when executives embrace the demands of customers and other stakeholders? A case study from the banking sector would be of interest, in order to ascertain ...
The main objective of this thesis is to determine the effect of time management on high organizational performance using LASACO ASSURANCE Plc. as a case company. In this thesis, the employees working with the company were sent questionnaires. Their responses were critically analyzed and thus related to the theories. A quantitative approach was used as the methodology. According to the theory, time management is a method for managers to increase work performance effectiveness. Time man...
ZOU Yong-gui; CHENG Ke-fei; ZHANG Cong
Vehicle management is a very important application area of GPS/GIS. Each customer has its special requirements on GIS system when he installs it. We discuss a common structure of our GPS/GIS implementation, and present a case study on bulk concrete trucks management for bulk concrete producers. With GPS/GIS system, bulk concrete producers can improve their performance in scheduling and management.
This paper aims to explore how well green facility management has performed in Shanghai office building and finds the possible way to improve the situation. Together with two interviews, questionnaire based on benchmarking approach is conducted in a case study of the Asia Building, which lead to the conclusion that green facility management has done a fair work in Asia Building, and suggestions that laws and regulations related to green facility management should be established; governmental ...
Wang, Yun-Tung; Lin, Yi-Jiun
Purpose The aim of this study is to explore whether/which vocational rehabilitation case manager (VRCMer) factors were significantly associated with the vocational rehabilitation service (VRS) program outcomes in Taiwan. Method This study used the 2011 VRS Program for People with Disabilities Database in a metropolitan city in Taiwan (N = 466) to do a secondary data analysis using hierarchical logistic regression. Results This study found that the employment rate and stable employment rate created by the 2011 VRS program in a metropolitan city in Taiwan were 48.7% and 42.1%, respectively. For the predictors of employment/stable employment, "occurrences of the services provided by the VRCMer" variable was definitely dominant. In addition, "level of the disability" was the second-ranking predictor, and was significantly negatively correlated with both employment and stable employment outcomes. Conclusions Vocational rehabilitation case manager factors in this study were significantly correlated with VRS program outcomes for people with disabilities in Taiwan after controlling for the clients' socio-demographic variables. The results indicate that greater input by VRCMers for people with disabilities equates to better employment outcomes in metropolitan Taiwan. Implications for Rehabilitation This is the first study to build an inferential statistical model in attempt to explain and predict the association between vocational rehabilitation case manager factors and vocational rehabilitation service program outcomes for people with disabilities in Taiwan. In cases of severe disability, a vocational rehabilitation case manager should seek out more in-kind and in-cash resources, and choose a suitable job coach to cooperate in assisting the client to become employed. Based on the findings, government has to continue implementing opportunities for people with disabilities to attain higher and better quality educational levels, for increasing their employment rate
Full Text Available As part of its public sector modernization effort, a North African government has put a lot of effort and allocated significant budgets since 1997 to modernize one of its main public sector companies. Consequently, this company, that mainly offers postal services, initiated many IT-based projects to computerize all paper-based ongoing services offered through its branches and to present new products to customers. This company was aiming to improve service quality and to diversify the range of its services. However, some of these IT-based projects inevitably faced problems. Some projects were either not completed successfully, cancelled, over-budget or taking more time than scheduled. As a result, many employees and customers of this company were dissatisfied and complained about bad planning, slowness and significant disruptions in these projects, an event that affected adversely the quality of service. This study aims at determining the causes of these project disruptions, failures or delays. To achieve this aim, 30 experienced project developers and engineers working in that company’s IT department volunteered to respond to a detailed questionnaire specifically developed for this purpose. The questionnaire included questions about project vision clarity, time/cost management, project quality assurance, risk management and human resources management. Results show that the main reasons for disruptions, failure or delays in IT projects are lack of business plan and poor documentation during and after finishing projects, lack of clear quality assurance criteria, standards and reviews, and poor project risk management practices. Ramifications of such results in terms of improving IT project management practices in the public service sector are finally presented.
Full Text Available BACKGROUND: Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions. METHODS: This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. RESULTS: FOUR RECURRENT THEMES EMERGED: (1 Participants described profound social isolation prior to case management program enrollment; (2 Participants perceived that caring personal relationships with case managers were key to the program; (3 Participants valued assistance with navigating medical and social systems; and (4 Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. CONCLUSIONS: Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.
Full Text Available This paper offers an alternative approach to defining the management concept. The proposed methodology relies on the identification of tools supporting the given concept. The author assumed that the identification of tools’ evolution gives clearer insights into circumstances of constant development of—by its nature—a more general concept. The tools’ classification resembles a phylogenic tree and is based on the idea of an affinity diagram. To provide the proof for such reasoning, the total quality management (TQM concept was chosen. This proposition can be useful for better understanding origins and the development of management thought. It clarifies relationships among methods constituting frameworks of quality management.
Full Text Available BACKGROUND: Temporomandibular joint (TMJ ankylosis is associated with partial or complete restriction of mouth opening and poses a significant problem to the anesthesiologist making the airway management very challenging. Alternative methods of securing the airway should be kept ready because conventional laryngoscopy and intubation are impossible. Thoracic epidural anesthesia (TEA is one of the options to avoid general anesthesia in this case. We aimed to manage a case of bilateral modified radical mastectomy with TMJ ankylosis solely under thoracic epidural anesthesia. METHODOLOGY: Female patient of 32 years of age, with bilateral TMJ ankylosis with no mouth opening was posted for bilateral breast surgery. Thoracic epidural was instituted at T4-T5 interspace and 18G epidural catheters was secured. Alternative airway management strategies were included in our plan if thoracic epidural fails. OBSERVATION: Adequate preparation of the patient, counseling about anesthetic plan of management, placement of epidural catheter by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Regional anesthesia techniques are safer alternatives to provide intraoperative anesthesia with difficult airway for bilateral breast surgeries.
Nagendra Gouda M
Full Text Available Research Question: What are the factors responsible for suicidal attempts? Objectives: To study the socio-demographic factors, methods and reasons for suicidal attempts. Type of Study: Cross-sectional study. Setting: Bapuji and C.G. Hospitals attached to J.J.M. Medical College, Davanagere. Participants: A total of 540 suicidal attempters admitted to emergency wards. Methodology: A pretested proforma was administered to the subjects relating the factors responsible for the attempt. The data thus obtained was compiled and analyzed. Statistical Analysis: Proportions, Z -test and Chi-square test. Results: In this study, 61.3% were males and 38.7% were females. Peak occurrence of suicidal attempts was found in the second and third decades (15-29 years. Hindus constituted about 94.6% of the total suicidal attempters. Almost half (52.2% of the subjects had education below or up to matriculation and 83% of them were from the lower (classes IV and V socio-economic groups. Agriculturists, housewives and unskilled workers represented 75% of the total subjects. Fifty-five percent of the subjects were from nuclear families and most (62.4% of them were married; frequent mode of attempting suicides was by organo-phosphorus compounds (66.3% followed by overdosage of tablets (17.8%. Common cause was family problem (27.2% followed by illness (27%.
Hisham Y. El Batawi
Full Text Available Sanjad-Sakati syndrome (SSS is a rare genetic disorder with autosomal recessive pattern of inheritance characterized by hypoparathyroidism, sever growth failure, mental retardation, susceptibility to chest infection, and dentofacial anomalies. A child with SSS was referred to the dental departmentseeking dental help for sever dental caries which was attributed to his dietary habits and quality of dental tissues. Full restorative rehabilitation was done under general anesthesia. Two years later, the child presented with recurrent caries affecting uncrowned teeth. High carries recurrence rate was blamed for the nutritional habits endorsed by the parents. Only steel crowned teeth survived such hostile oral environment which suggested shifting of treatment strategy towards full coverage restorations instead of classical cavity preparations and fillings during a second attempt for dental treatment under general anesthesia and for the dental treatment of two cousins of the same child. The author recommends effective health education for parents including the nature of their child’s genetic disorder, nutritional needs, and dental health education to improve the life style of such children.
Wise, Meg; Gustafson, David H; Sorkness, Christine A; Molfenter, Todd; Staresinic, Anthony; Meis, Tracy; Hawkins, Robert P; Shanovich, Kathleen Kelly; Walker, Nola P
This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.
Khatami, Ameneh; Sparks, Rebecca T; Marais, Ben J
Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.
Taylor, J D
In this case, a medical center learns how to evaluate each of its services along a Product Life Cycle curve. Each stage of the cycle has characteristics that suggest appropriate strategic growth and action orientations. When services were plotted along the Product Life Cycle curve, many of the services were found to be mature or making the transition from growth to maturity. At the time of the case, Memorial Medical Center's competitors were entering many of its traditional markets creating a strong competition for market share. Greater competitive emphasis on performance and price reduced profits in the medical center's mature services. The case reports the medical center's approach to modifying its action orientation in light of a better understanding of organizational competence.
Meena N. Satia
Full Text Available Functioning of health systems with respect to maternal health were previously audited using indicators like maternal mortality ratio. However, maternal morbidity as a consequence of pregnancy-related complications is not accounted for in these indicators. Thus, the World Health Organization (WHO has formulated a maternal near-miss approach to pregnancy complications for a more thorough evaluation of health care systems across the world. In practical terms, women are said to be maternal near-miss cases when they survive lethal conditions during pregnancy or in the postpartum period. We report one such case of traumatic variety of postpartum haemorrhage subsequent to a lower segment caesarean section with immediate post-operative removal of cervical cerclage threads that resulted in a maternal near-miss case.
Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.
Che Azhar, N. A.; Mansor, M. A.
In large plant industry, it is not easy to maintain machine performance without using any method such as checklist system. Manual checklist is a common maintenance checklist used in industry. All machine, equipment and parts that need to be checked will be written down for the employee to do maintenance checks. Converting the manual checklist to the Plant Maintenance Management System (PMMS) can improve the way of employees work and make plant management easier. Therefore, a new system was designed to maintain the equipment so that the activities are more efficient and cost effective. The system consists of three frames that connect to each other. The frames divide to section, equipment and checklist. This system also builds to prevent data from arbitrarily changes. Only certain officers or staffs are permitted to make modifications to data. Using this system, a company can make the office environment a paperless environment.
Full Text Available Recognizing the asset value dynamics volatility of the financial institutions and the importance of its recognition both for financial reporting purposes and risk management effect, this paper aims to provide a practical model for the assets and financial institutions evaluation especially banks. It also aims to present a model to measure the value of banking assets for the purposes of risk management as an opportunity to identify in an early moment the banking risks. The paper develops the bank assets assessment forms and the basis of mathematical modeling of this assessment in general. He identifies also the evaluation factors as for example time to maturity, interest rate market for the assets (YTM, the interest rate agreed, the early repayment of the loan, interest ceilings and floors, off-balance sheet treatment, etc..
Full Text Available Treatment of large soft tissue vascular lesions remains one of the greatest challenges in modern plastic surgery. The extent of the disease and the involved structures, but also the expectations of the patients are important in determining the way of treatment. The effective management of hemangiomas and vascular malformations of the head and neck requires a team approach, in order to understand the biologic behavior of the lesion, complete the diagnostic studies necessary to define the area of involvement, and understand the benefits and limitations of interventional radiologic and surgical procedures. The synthesis of this knowledge can help determine the best treatment. The strategic plan and subsequent management of a 34-year-old Maori man with an extensive arteriovenous intraparotid malformation is presented.
Raúl Comas Rodríguez
Full Text Available The objective of this article is to design and to implement a procedure that integrates management control tools focusing on process, to improve the efficiency and the efficacy. It was carried out an experimental study where is defined a procedure, based in the Balanced Scorecard, which integrates the process management into the strategic planning and their evaluation. As results of this work, we define the key factors of success associated with the four perspectives of the Balanced Scorecard that are linked through the cause-effect relations obtaining the strategic map that allows visualizing and communicating the enterprise strategy. The indicators evaluate the key factor of success, integrating the process with the assistance of a software. The implementation of the procedure in a commercialization enterprise contributed to integrate the process definition into the strategic planning. The alignment was evaluated and the efficiency and efficacy indicators improved the company´s performance.
Full Text Available This paper describes a model of supply chain management (SCM. It explains overall supply chain issues, strategic importance of SCM, supply chain strategies and an example of mathematical formulation. A supply chain is a global network of organizations that cooperate to improve the flows of material and information between suppliers and customers at the lowest cost and the highest speed. The objective of a supply chain is customer satisfaction. At the strategic level, a supply chain can be considered as being composed of five activities: buy, make, move, store and sell. Each activity is a module. The set of modules, along with its links, constitutes a model of the supply chain. Our paper presents some insights into the supply chain strategies of companies in Croatia. The major goal of this paper is to show a model for supply chain management in mathematical terms, with an example of mathematical formulation.
Full Text Available Abstract Background The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers and trainers. This process was also intended to develop the capacity of the National Public Health Management Centre in Tabriz, Iran, to enable it to organize relevant short courses in health management on a continuing basis. A total of seven short training courses were implemented, three in the United Kingdom and four in Tabriz, with 35 participants. A detailed evaluation of the courses was undertaken to guide future development of the training programmes. Methods The Kirkpatrick framework for evaluation of training was used to measure participants' reactions, learning, application to the job, and to a lesser extent, organizational impact. Particular emphasis was put on application of learning to the participants' job. A structured questionnaire was administered to 23 participants, out of 35, between one and 13 months after they had attended the courses. Respondents, like the training course participants, were predominantly from provincial universities, with both health system and academic responsibilities. Interviews with key informants and ex-trainees provided supplemental information, especially on organizational impact. Results Participants' preferred interactive methods for learning about health planning and management. They found the course content to be relevant, but with an overemphasis on theory compared to practical, locally-specific information. In terms of application of learning to their jobs, participants found specific information and skills to be most useful, such as health systems research and group work/problem solving. The least
Full Text Available This paper attempted to analyze and understand the management of capital allocation for sustainable municipal solid waste management system at Bang Saen, Thailand. Financial, manufactured, human, social and natural capital was the focus of this study. Capital allocation to five capitals, activities of the stakeholders related to municipal solid waste management, and the output of these activities were analyzed. The investigation was carried out by reviewing documents, conducting in-depth interviews with various stakeholders including the Saensuk municipality officials, locals and tourists, and carrying out field observations. Results showed that total output from five capitals is influenced by activity performance of stakeholders, which is dependent on input to five capitals. However, input was made without assessments of output produced by the activities of the stakeholders, which stemmed from the absence of a policy goal on municipal solid waste management and action plans to achieve its goal. Capital was mostly allocated to financial and manufactured capitals in terms of support of municipal solid waste collection, transportation and disposal. Findings suggest that capital should be allocated to activities related to human, social and natural capitals that can help improve activity performance of the stakeholders, and therefore improve total output and sustainability of the system. Well-designed activities could generate improved output, which is made by readjusting input based on assessments of output and by reflecting feedback in decision making on capital allocation. For this reason, the municipality has to set a clear policy goal of municipal solid waste management, short-term, and long-term action plans. Finally, recommendation is given to municipality.
Gabriela Ţigu; Bogdan Călăreţu
With its origins in logistics, Supply Chain Management (SCM) concept is covering all managerial aspects of the flow of materials and information from source to customer, across the entire range of materials handling and movement functions, and throughout an organization and its supply channels. In tourism, these issues relate to the whole process of providing tourism services from sourcing of raw materials, products or different services) to supply and distribution, and SCM performance can ul...
The purpose of this study was to increase the amount of new likes of Diamo Oy in the social media network site Facebook, eventually aiming for the creation of new customer relationships, increased visibility of the company and into strictly increasing purchasing of their products. The theoretical part of the study consists of the role of content production in the social media field and customer relationship management, of which particularly customer acquisition and retention are discussed mor...
Chau Thi Tra, Mi
In response to changes imposed by the Finnish government on the Univer-sities of Applied Sciences system in the near future, HAMK has proactive-ly adopted several programmes to prepare for future challenges and rein-force the organization’s competitiveness. However, organizational change has never been an easy, straightforward issue and how to manage change effectively has become an interest to the organization. The study aims at providing suggestions for a more successful change im-pleme...
Reifer, Donald J
This book provides readers with practical advice on how to handle the many issues that can arise as a software project unfolds. The book uses twelve case studies to communicate lessons learned addressing such issues as they occur in government, industrial and academic settings. These cases focus on addressing the things that can be done to establish and meet reasonable expectations. Such corrective actions often involve more than just dealing with project issues. For example, software practitioners may have to address obstacles placed in their way by procurement, organizational procedures an
Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan
Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population.
Levy, S R; Jurkovic, G L; Spirito, A
The present study tested an ecologically based model, which predicted that hopelessness (individual level) mediates the effects of family dysfunction (interpersonal level) and socioeconomic status (sociocultural level) on both suicidal intent and suicidal ideation, within a sample of attempters. Subjects included adolescent males and females presenting at a general hospital emergency room following suicide attempts. Baron and Kenny's (1986) criteria for testing mediation models through multiple-regression analyses were employed. Little evidence of mediation was found. Hopelessness proved to be the best predictor of suicidal intent and ideation within a sample of attempters.
Sumithra, S; Sunitha, V; Nagaraju, G
Solid waste management (SWM) is a worldwide phenomenon. It is a big challenge all over the world for human beings. The problem of municipal solid waste management (MSWM) is also prevailing in the environment of Kadapa town in India. Therefore, the present study was undertaken to find out the problems and prospects of municipal solid waste in Kadapa town. A detailed investigation was made regarding the methods of practices associated with sources, quantity generated, collection, transportation, storage, treatment and disposal of municipal solid waste in the study area. The data related to SWM in the study area was obtained through questionnaire, individual field visits, interaction with people and authentic record of municipal corporation. Status of the MSW in Kadapa town was studied. The results indicated that the major constituents of municipal solid waste were organic in nature and approximately one fourth of municipal solid waste was recyclable. Detailed data on solid waste management practices, including collection, recovery and disposal method, has been presented in this paper.
Abdur-Raouf; Kalim, Rukhsana; Siddiqi, Ahmed F.
This paper aims to identify the gaps in management education highlighted by 3 primary stakeholders: students, faculty and alumni. The study tries to address the issue of relevance and compatibility of management education and investigates areas of improvement perceived by respondents. The paper assumes that business departments of universities…
Rendtorff, Jacob Dahl
Case studies can be an important methodology for ethics and philosophy in humanistic management and liberal education as well as in the social sciences because they integrate a deeper, reflective, philosophical, and ethical understanding of the organization. A case study approach based...... in business schools following the Harvard method, wherein students are supposed to get knowledge through the reading of a case prepared by the teacher or from a business textbook. The aim of the case study is to analyze a concrete case and get general knowledge through the integrated analysis of the different...... ethical, philosophical, and economic dimensions of the case. This article presents an argument for case studies that highlight ethics and philosophy in the following parts: (1) Introduction, (2) Historical and Philosophical Definitions of Case Studies, (3) The Quality and Structure of the Case Study, (4...
QIN Xiang; WANG Dong-xin; WU Xin-min
@@ Stiff-person syndrome (SPS, also called stiff-man syndrome) is a rare neurological disease with autoimmune features. It is characterized by fluctuating and progressive muscle rigidity, and episodic spasm that prominently involve axial and limb musculature.1,2 Herein we report a case of anesthetic management of a patient with SPS for thymectomy and review several other cases.
Kawulich, Barbara B.
This manuscript shares lessons learned from conducting an action evaluation of the use of multimedia case studies in Management Information Systems (MIS) courses. Three undergraduate MIS classes took part in the study. The purpose for using case studies in these classes was to teach students about the role of MIS in business. An action evaluation…
Cevik, Yasemin Demiraslan; Andre, Thomas
This study was aimed at comparing the impact of three types of case-based approaches (worked example, faded work example, and case-based reasoning) on preservice teachers' decision making and reasoning skills related to realistic classroom management situations. Participants in this study received a short-term implementation of one of these three…
Leong, A.K. [Woodward-Clyde International, Kuala Lumpur (Malaysia)
Brownfields are turning back to green. This paper presents a case study of a former dump site for hazardous waste that has been remediated and will be developed into an enhanced wildlife management habitat. This successful remediation case combined various investigations, remedial designs, risk assessments, ecological studies, and engineering practices. 3 refs., 1 fig., 1 tab.
Full Text Available Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.
Yakup Alsancak; Burak Sezenoz; Sedat Turkoglu; Adnan Abacı
Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.
Alsancak, Yakup; Sezenoz, Burak; Turkoglu, Sedat; Abacı, Adnan
Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.
Balachandran Nair, L.; Gibbert, Michael
Cases inconsistent with theoretical expectations are by default indicators for a lack of theory-data fit, and as such are prime candidates for theory building. However, the conventional tendency is to ignore inconsistent cases in Management research. The current article focuses on the theory-buildin
Maxwell, James R.; Gilberti, Anthony F.; Mupinga, Davison M.
This paper will study some of the problems associated with case studies and make recommendations using standard and innovative methodologies effectively. Human resource management (HRM) and resource development cases provide context for analysis and decision-making designs in different industries. In most HRM development and training courses…
Maile, Michael D; Patel, Rajesh A; Blum, James M; Tremper, Kevin K
Many cases of malignant hyperthermia triggered by volatile anesthetic agents have been described. However, to our knowledge, there has not been a report describing the precise changes in physiologic data of a human suffering from this process. Here we describe a case of malignant hyperthermia in which monitoring information was frequently and accurately captured by an anesthesia information management system.
Michelle Alexandra Gomes Alves
Full Text Available This study sought to verify the records on file and the number of cases of attempted suicide among children and adolescents who were attended by Emergency Care health professionals in the municipality of Matozinhos, Minas Gerais, Brazil. Documentary and descriptive research was conducted, the data for which was collected by means of an investigation of Outpatient Records from 2008 to 2010. Of the 73,000 files evaluated, those dealing with cases of attempted suicide among children and adolescents between the age of 3 and 18 years were selected. It was revealed that the health professionals, particularly physicians and nurses, fail to register the cases appropriately, invalidating information about the problem and potential prevention measures. The conclusion reached was that underreporting and the discrepancy of the diagnoses which were not duly referred to the competent agencies require rethinking and reviewing medical practices, and taking a systematic and careful look to address the individual as a complex whole.
Prats-Guardiola, Marta; López-Pisa, Rosa María
We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care.
Full Text Available Porphyrio porphyrio (Fulica porphyrio Linnaeus was reported to the South Florida Water Management District in a Water Conservation Area and in constructed wetlands in the Everglades in 2006. A rapid assessment, including casual observations and surveys of land managers, indicated a limited number of P. porphyrio (~300 birds was present, and an eradication attempt was initiated. From 2006 – 2008, more than 3100 P. porphyrio were killed by shotgun from airboats during 73 hunts, suggesting the initial population assessment was severely underestimated. After removing nearly 1500 P. porphyrio in 2008, we concluded that eradication was not possible. Failure of this eradication attempt is attributed to P. porphyrio’s affinity with dense emergent vegetation, which greatly limited shooting effectiveness. Further, the failed eradication underscores the importance of a reporting network to improve early detection and the chance to eliminate naturalized or feral populations of non‐native species.
Full Text Available Tuberous sclerosis complex is a multi-system disorder with autosomal dominant inheritance, which can affect the brain, heart, skin, kidneys, lungs, and retina. We hereby report therapeutic challenges faced in a case of an adolescent male suffering from tuberous sclerosis.
This article offers an introduction to case-based modeling (CBM) and a demonstration of the efficacy of this instructional model. CBM is grounded primarily in the concepts and theory of experiential learning, augmented by concepts of script creation. Although it is labor intensive, the model is one that has value for instruction in various…
Full Text Available We present a case of 50 year old female with a diagnosis of intraabdominal mass suffering from pemphigus vulgaris, myasthenia gravis, hypothyroidism, diabetes mellitus. Extra care to protect skin and mucus membranes from trauma during procedures is essential. Adrenocortical suppression following prolonged steroid therapy is another hazard to be tackled in the perioperative period.
Gentilucci, James L.
Crisis communication training of school principals is problematic because it overemphasizes media relations and underemphasizes the critical importance of immediate and personal communication with students, staff, and parents--those most affected by school crises. A case study involving the death of a student in a small rural school explains why…
Casarin Santina Nunes Alves
Full Text Available Case Management is a term that is present in almost every American health care situation. It is mostly used to coordinate community services with satisfactory results for the patient within a certain period of time, with limited resources. Through time, it has been used for different purposes. The goal of this study was to show the historical evolution of case management as expressed by the American nursing literature, in the 80's and 90's, according to its use, meaning, and application, and following a theoretical framework for concept analysis. The data was extracted from two journals: "Nursing Management" and "Journal of Nursing Administration". The publications showed case management portrayed as a process that serves a common goal; where quality and cost of care were the prevalent and influential elements along time, and its practice focusing in a given population defined as of high risk and high cost for health care.
Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.
Full Text Available ABSTRACT In this study the researcher attempted to understand and explain to explore the social development dimension of the nurse professions in managing HIV cases. Specifically the study sought to answer the following questions 1 what is the profile of the key informants with regards to HIV Patients age gender education and socio economics status Nurses age gender no of years of work experiences specific to HIV social workers age gender and no of years of work experiences specific to HIV. 2 What are lived experiences of key informants on social development dimension of the helping process HIV patients Nurses and Social Workers 3 What social development model can be designed in managing HIV cases 4 What policy recommendations can be developed pertaining to development dimension in managing HIV cases. This study utilized qualitative approach. The phenomenology was used to explore and describe HIV patients through their lived experiences in a selected rehabilitation center in Sukabumi West Java Indonesia the nurses and social workers. The approach developed an understanding of the experiences as perceived by the key informants. Qualitative research aims to collect a deep understanding of human behavior. Survey checklists In-depth interviews repertory grid and dendogram were utilized in the data gathering procedure data presentations and data analyses. The informants of this study were focused on nurses social workers and HIV Patients in the rehabilitation center the Directorate General for Social Rehabilitation Social Ministries of the Republic of Indonesia the school nurses Ministry of Health Community Health Centers that carry out community health care program-specific examination of VCT. Generally the findings of the research conducted by qualitative research methods in a statement obtained significant categories and themes that emerged is significant for the statement is feeling sad angry when patients get HIV diagnosis the process of
Ramberg, Maria; Stanley, Barbara; Ystgaard, Mette; Mehlum, Lars
Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behavior. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure, and suicidal behavior. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm, and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.
Jarodzka, H. (2012, 27 April). Visual expertise: characteristics and instructional attempts. Presentation during the ‘Symposium 4C-ID: Hoe implementer je de blauwdruk?’, Studiecentrum Open Universiteit, Utrecht, The Netherlands.
Tentativas de transmissão da lepra ao homem, por meio de Triatomídeos infectados em doentes lepromatosos: (nota prévia Attempts to transmit Leprosy to man by means of Triatomidae infected in lepromatous cases
H. C. de Souza-Araújo
Full Text Available The A.A. started a new series of experiments upon the transmission of Leprosy to man by means of one of the more widespread hematophagi of the hinterland of Brazil, the Triatomidae. Two species of these insects were found naturally infected with Hansen's bacillus in huts of lepers in the interior of the State of Minas Gerais and one of the writers (S.A. upon feeding the same insects on lepromatous cases could obtain two strains of acid-fast bacilli cultures smearing Lowenstein medium with the intestinal contains of the same. The first phase of the experiments lasted five months and the results, partially positive, are here describe. More than one hundred Triatomidae (Triatoma infestans and Panstrongylus megistus bred in the Institute Oswaldo Cruz and fed in normal pigeons until convenient growth were put on lepromatous lesions, which they sucked many times, and them after one or more days they were put to be fed on selected regions of the skin of four negativated cases of leprosy. The arguments in favour and against the possibility of obtaining new lesions of leprosy in such burnet out patients were discussed. The A.A. are not authorized to draw any definite conclusions, but the few facts registered are worth of divulgation, in orther that other workers send their suggestions. Three out of the four volunteers showed moderate local reactions between 1 to 4 days after being sucked by the infected insectes. After five months experiments subcutanous lymph were obtained from the points where the insects have bitten. A very few acid-fast bacilli were found in such material. The patients, being kept in separation from infectious cases, will be followed up during months or a year in order to be detected any suspicious experimental lesions of leprosy.
Turner, Ryan C; Dodson, Sean C; Rosen, Charles L
A large abscess of the posterior fossa often warrants surgical intervention. We report a case of a 50-year-old male presenting with a cerebellar abscess measuring 2.8 cm x 1.6 cm located in the left cerebellar hemisphere at the level of the middle cerebellar peduncle that was treated conservatively and successfully with antibiotics. Therapeutic management options are discussed in regards to this case specifically as well as a review of the literature. This case illustrates the successful medical management of a cerebellar abscess of otogenic origin in an adult, a unique result in terms of abscess size and age of the patient.
Stroke is a leading cause of death and disability worldwide. The elderly, in whom atrial fibrillation (AF) is most prevalent, carry the greatest risk, undergoing more recurrent, deadlier strokes, with bigger deficits, slower recoveries, and more comorbidities. Evidence-based data on advanced age stroke management are scarce. Age-related cerebral changes might undermine the benefit of established stroke treatments. Nevertheless, the elderly should probably also undergo thrombolysis for ischemic stroke: they do not bleed more, and die not because of hemorrhage but of concomitant illnesses. Beyond natural bleeding risks, AF in advanced age has a high embolic potential if not anticoagulated. Standard or lower intensity warfarin anticoagulation prevents embolic stroke in the elderly with a hemorrhage risk even lower than aspirin. In fact, adverse effects seem to occur more often with aspirin. Excess anticoagulation hazards are prevented with lower starting doses, stricter corrections, more frequent International Normalized Ratio monitoring, and longer adjustment intervals. Validated prognostic scores such as CHADS(2) help minimize bleeds. Direct inhibitors have recently shown a benefit similar to warfarin with fewer hemorrhages. Carefully tailoring antithrombotics to this age group is therefore useful. Antihypertensives probably help 80-plus stroke patients as well, but the risk/benefit of lowering blood pressure in secondary stroke prevention at that age is uncertain. Evidence-based data on diabetes management and use of lipid-lowering drugs are still lacking in this age group. In summary, emerging data suggest that stroke management should be specifically targeted to the elderly to better prevent its devastating consequences in the population at the highest risk.
Gimenes, Celso Huerta; Barroso, Antonio Carlos de Oliveira; Imakuma, Kengo [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)], e-mail: firstname.lastname@example.org, e-mail: email@example.com, e-mail: firstname.lastname@example.org
To guide human resources selection and development, organizations usually have a list of the competencies they consider crucial for the various segments of their endeavor. At IPEN, a R and D institute with graduate teaching (within USP framework) and some production facilities, the elaboration of a list of the highly appraised competencies for IPEN's managers become a research theme in itself. This work has produced: a methodology to generate, validate and recycle periodically the list and descriptions of managers' competencies; and the first version of the list. Delphi questionnaires were applied via web using 'Lime Survey', a freeware that enables import and export the data as csv files and has a simple and workable language for database access. The consistency of the numerical results, as well as the consensus preferences manifested by the sample is discussed in the paper. Also a segmentation and multivariate statistical analysis to reveal differences and similarities among the various subgroups of the sample is presented providing a lot of insightful information. The merit of structuring the pertinence of the competencies according to seven BNQA's criteria is discussed. Combining the manifested preference of the sample with a factor analysis to check the most significant loads in each construct a reduced set of competencies is proposed. This reduced set can be the base for IPEN's directors to select the crucial set of managers' competence. The methodology here explained can be used each two years to co-validate and update this reduced set. (author)
Full Text Available Context: Different risk factors associated with adolescent suicide attempts have been identified including those of socio-demographic and clinical variables. Relatively, little research has been done in the area of their stressors and coping patterns. Aims: To study the recent psychosocial stressors and patterns of coping associated with adolescent suicide attempts. Settings and Design: Tertiary care hospital, case-control study. Materials and Methods: One hundred consecutive cases of adolescent attempted suicide admitted to the hospital and an equal number of controls, matched individually for age and sex, from the relatives and friends of other patients in the ward, were studied. Assessment included details regarding socio-demographic data, psychiatric and physical morbidity, their recent stressors, and patterns of coping. Stressors were assessed using Presumptive Stressful Life Event Scale and coping strategies by Ways of Coping Questionnaire (revised. Statistical Analysis: Chi-square test and multivariate logistic regression analysis. Results: The number of stressful life events and mean stress scores in the preceding 1 month and certain coping strategies such as confronting, distancing, and escape-avoidance were found to be significant risk factors associated with adolescent suicide attempts. Strategies such as self-control, seeking social support, accepting responsibilities, problem solving, and positive appraisal act as protective factors. Conclusions: Recent stressors and strategies such as confronting, distancing, and escape-avoidance are significant risk factors associated with adolescent suicide attempts, whereas certain coping strategies act as protective factors. Teaching adolescents these protective coping patterns may be a promising strategy for prevention of adolescent suicide attempts.
Safari, Narges; Safari, Fariba; Olesen, Karin; Shahmehr, Fatemeh
This research paper investigates the influence of industry on electronic customer relationship management (e-CRM) performance. A case study approach with two cases was applied to evaluate the influence of e-CRM on customer behavioral and attitudinal loyalty along with customer pyramid. The cases covered two industries consisting of computer and automotive industries. For investigating customer behavioral loyalty and customer pyramid companies database were computed while for examining custome...
Crandall, Karen S.; Auping, Judith V.; Megargle, Robert G.
In the late 70's, a refurbishment of the analytical laboratories serving the Materials Division at NASA Lewis Research Center was undertaken. As part of the modernization efforts, a Laboratory Information Management System (LIMS) was to be included. Preliminary studies indicated a custom-designed system as the best choice in order to satisfy all of the requirements. A scaled down version of the original design has been in operation since 1984. The LIMS, a combination of computer hardware, provides the chemical characterization laboratory with an information data base, a report generator, a user interface, and networking capabilities. This paper is an account of the processes involved in designing and implementing that LIMS.
A N Sulabha
Full Text Available A post traumatic parotid sialocele is an acquired lesion that arises from extravasation of saliva into glandular or periglandular tissues secondary to disruption of the parotid duct or parenchyma. Facial trauma and surgery in the parotid region are the most common causes of this rare condition. This paper presents an unusual incidence of post traumatic parotid sialocele after Le-Fort II fracture reduction and its management by relatively simple and cost-effective technique which can be carried out in routine dental surgery suite. The results achieved justify our recommendation of scalp vein cannula for the treatment of sialocele in clinical practice.
This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH.\\r\
services are a set of support services. They are meant to ensure that the employees of an organisation can carry out the tasks and activities related to the core business, without having to worry about, for example, the management of the workplace, catering and cleaning, security and safety. Facilities...... data and passive observation, and the data analysis was carried out through a systematic approach to coding supported by the qualitative data analysis software Atlas.ti (v.6). Overall, this dissertation offers several contributions to theory and practice. First of all, this work stresses the role...
Lowry, Roy K.
Since the mid 1980s, much of the marine science research effort in the United Kingdom has been focused into large scale collaborative projects involving public sector laboratories and university departments, termed Community Research Projects. Two of these, the Biogeochemical Ocean Flux Study (BOFS) and the North Sea Project incorporated large scale data collection to underpin multidisciplinary modeling efforts. The challenge of providing project data sets to support the science was met by a small team within the British Oceanographic Data Centre (BODC) operating as a topical data center. The role of the data center was to both work up the data from the ship's sensors and to combine these data with sample measurements into online databases. The working up of the data was achieved by a unique symbiosis between data center staff and project scientists. The project management, programming and data processing skills of the data center were combined with the oceanographic experience of the project communities to develop a system which has produced quality controlled, calibrated data sets from 49 research cruises in 3.5 years of operation. The data center resources required to achieve this were modest and far outweighed by the time liberated in the scientific community by the removal of the data processing burden. Two online project databases have been assembled containing a very high proportion of the data collected. As these are under the control of BODC their long term availability as part of the UK national data archive is assured. The success of the topical data center model for UK Community Research Project data management has been founded upon the strong working relationships forged between the data center and project scientists. These can only be established by frequent personal contact and hence the relatively small size of the UK has been a critical factor. However, projects covering a larger, even international scale could be successfully supported by a
Iuga, Anca N.
Applying the principles of sustainable development in Romania involves a new approach to ecological waste using basic concepts of circular economy to weigh accurately the proposed projects in this area taking into account existing environmental resources and zero waste objectives. The paper is focused on: quantitative and qualitative measures of waste prevention in Romania, the changing status of the waste by selling it as product, the mechanisms for paying for treatment and / or disposal which discourage waste generation and the use of financial resources obtained from secondary raw materials for the efficiency of waste management.
Trudel-Ferrari, C.C. [Kinectrics Inc., Toronto, ON (Canada)
This paper discussed the development of effective training and knowledge management systems for recently hired personnel in electric utilities. Case studies of best practices from electric utilities in Ontario, consultants, and universities were used to develop an overview of current training practices. Methods of identifying, attracting, and recruiting personnel were presented and knowledge management and mentoring programs were discussed. The use of training programs in developing knowledge databases was also evaluated. Knowledge management formats included qualification training; simulation training; knowledge transfer; and curriculum development. Human resources, revenue, and management issues currently challenging electric utilities were discussed along with various new training practices. 2 refs., 3 tabs., 2 figs.
Full Text Available ABSTRACT: We report successful anaesthetic management of a pat ient with hereditary spherocytosis who underwent laproscopic splenectomy, ch olecystectomy and appendioectomy. Hereditary spherocytosis is a familial hemolytic di sorder with marked heterogeneity of clinical features, ranging from asymptomatic condition to a f ulminant hemolytic anaemia. Commonly recommended perioperative management in these patien ts includes preemptive erythrocyte transfusion, aggressive hydration and avoidance of hypoxia, aplastic crisis, hypothermia and acidosis. The management of such a case is challeng ing from anaesthetic point of view because of sickling oriented anaesthetic approach. Key words: Hereditary spherocytosis, splenectomy, cholecystectomy, perioperative management.
Hala M Al-Shamlan
Full Text Available Top management usually faces an unexpected attitude from potential users during implementing an enterprise resource planning (ERP system. For one reason or another, they resist the implementation process and may cause the failure of ERP system. Therefore, top management should be deal with this problem using effective change management strategies and processes. In this paper, we discuss the successful change management strategies and processes in literature. A case study of MADAR has been presented to discover the strategies and processes used for the successful enterprise system.
Full Text Available Introduction: For decades, acetabular fractures were treated conservatively. Judet et al. in 1960s established the operative treatment of these fractures by continuous improvement of pre-operative evaluation and classification of fractures. Several studies demonstrated that accurate fracture reduction decreases the incidence of post-traumatic arthritis and improves functional outcome.Case Series: We report 67 consecutive patients who underwent surgical treatment for acetabular fracture; 44 patients were available for follow-up. In 35 (79.5% cases, congruent reductions were achieved. The final mean Harris hip score was 81.8 (53-95. Functional outcomes according to Harris score were excellent and good in 31 patients (70.5%.Conclusions: The results of internal fixation of displaced acetabular fractures in our series were satisfactory.
Full Text Available Laugier's fractures are rare because they are located deep in the elbow joint and are thus protected from any direct trauma. Laugier's fractures have been insufficiently described in the literature. Surgical treatment does not have an alternative, and timely diagnosis and surgical and physical therapy. We presented a case report of a 23 years' old man, sustained a Laugier's fracture in June 2012 after falling from motocycle (low energy trauma and hit with his flexed elbow against the street.
Full Text Available Oligodontia or severe hypodontia is a rare developmental dental anomaly which is described as congenital absence of 6 or more teeth excluding the third molars. In this case report, the treatment of a 31-yearold woman with congenital absence of 9 permanent teeth is described. The treatment with occlusal appliance and fixed a partial dentures ended up in functional and aesthetic results.
Fergus, Todd; Pacanowski, John P; Fasseas, Panayotis; Nanjundappa, A; Habeeb Ahmed, M; Dieter, Robert S
Subclavian stenosis is a highly prevalent and underrecognized clinical entity. In patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery, subclavian artery stenosis can cause coronary-subclavian steal, leading to myocardial ischemia. Traditionally, this has been treated surgically with a vascular bypass operation. Two cases of coronary-subclavian steal syndrome are presented, 1 treated percutaneously with angioplasty and stent, and 1 treated with a combined endovascular-surgical procedure.
De Rossi, Moara; De Rossi, Andiara; Queiroz, Alexandra Mussolino de; Nelson Filho, Paulo
This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.
Full Text Available Objectives: To assess the incidence, clinical features, diagnosis and treatm ent of complications of cholesteatomatous chronic otitis media (CCOM seen in the ENT/Head and Neck Surgery Clinic, University Clinical Center of Kosova, Prishtina. Materials and Methods: This is a retrospective study of the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period time of 1994 to 2011. Results: From a total of 2765 patients suffering from COM, 502 (18.08% had cholesteatoma. From this group, in 145 patients had complications. The mean age was 30 years. Eighty-two (56.55% cases had extracranial complications (ECC and 49 patients (33.79% intracranial complications (ICC. For the ECC cases, we found that subperiostal mastoid abscess occurred in 25%, facial nerve palsy was seen in 13% and labyrinthine fistula in 9.6 %. For the ICC cases, meningitis (12% and perisinusal abscess (11% were the most common complications. The most frequent radiological diagnostic procedures were mastoid X-rays, which were performed in 70% of the patients, and computed tomography in 20%. Patients with ECC were treated in the ENT Clinic, whereas patients with ICC, after otologgic surgical procedures, were transferred to the Neurosurgery Clinic. In this series, 5 patients (3.4% died as a result of complications. Conclusions: The incidence of cholesteatoma and its complications in our country still poses a challenge that requires higher dedication. Application of sophisticated diagnostic methods, CT and MRI is going to assist in choosing the adequate surgical approach, especially in cases with intracranial complications
Full Text Available Aesthetics of the teeth is of great importance to patients , including tooth color. Of the various causes of tooth discoloration fluorosis , enamel hypoplasia , medication staining etc. is commonly encountered. The treatment options for discoloration are varied depending on individual case basis. The purpose of this article is to report the advanced treatment options for generalized intrinsic discoloration encompassing power bleaching to veneers to full mouth rehabilitation w ith porcelain laminates and ceramic crowns
Dax Abraham; Nikhil Bahuguna; Rishi Manan
The purpose of this article is to emphasize the use of Cone Beam Computed Tomography (CBCT) for root canal treatment. Two case reports are presented where CBCT has been used to locate and eventually treat extra canals in maxillary first molars. Dental clinicians should be aware of the anatomical variations in maxillary molars. CBCT should be an essential part of the diagnosis prior to initiating root canal treatment.
Fernanda Chagas Borelli
Full Text Available This case describes the story of Kenner, a company that traditionally focused only on its product and is now realizing that its target market has changed drastically: from young higher-income consumers they are now lower-income consumers. Because of the excessive care with product quality, part of the company did not accept this new consumer, believing that the original consumer of the product should be their target market. As part of the restructuring of the company, in 2007 a marketing department was created, concerned with getting to know its consumers and their preferences better. In 2009, the year the case is set, the image of the company still appeared to be defined by its consumers, being associated with criminals, guns, drugs and violence. It was necessary to take control of the situation and decide on the market positioning the company would adopt. But before this, it was necessary to decide what the company’s target market would be. The case invites the reader to analyze the company’s situation and present and evaluate different alternatives in order to debate concepts of market segmentation, target market decisions and market positioning, as well as decisions related to the marketing mix.
Hasan Emre Aydın
Full Text Available These days, as a consequence of the improvement in technology and increase in the use of motor vehicles, spine injuries have become common. Spine traumas, which often occur after motor vehicle accidents, are observed mostly in cervical regions, particularly in the subaxial cervical region, which is also known as the subcervical region, and neurological damage occurs in 70% of the patients. Despite still being controversial, the common ranging for neurological evaluation is the American Spinal Injury Association ranging, which includes the motor and sensory loss and accordingly, the impairment rate. In subaxial cervical traumas, acute neurological deterioration is an indication and therefore requires urgent surgical treatment. The choice of anterior or posterior approach substantially depends on the traumatization mechanism, affected tissues, and neurological deterioration occurring after. The state of patient and instability are the most two important factors affecting the treatment decision. Although the anterior approach is accepted as a routinely available and easily applicable surgical technique, it lacks in the burst fractures involving the three colons, which shows a stabilization disorder. The anterior plate screw technique and posterior lateral mass screw application applied in our clinic are reviewed in literature and are discussed in two cases. Although the best clinical results are achieved in cases where only anterior surgery is performed and in cases where instability is excessive, in unstable compression and blow-out fractures, even if neurological deficit and three colon involvement are not observed in the patient, the requirement of posterior fusion is observed.
Full Text Available Abstract Introduction A number of vision defects have been reported in association with albinism, such as photophobia, nystagmus and astigmatism. In many cases only prescription sunglasses are prescribed. In this report, the effectiveness of low-vision rehabilitation in albinism, which included prescription of multiple visual aids, is discussed. Case presentation We present the case of a 21-year-old Asian woman with albinism and associated vision defects. Her problems were blurring of distant vision, glare and her dissatisfaction with her current auto-focus spectacle-mounted telescope device, which she reported as being heavy as well as cosmetically unacceptable. We describe how low-vision rehabilitation using multiple visual aids, namely spectacles, special iris-tinted contact lenses with clear pupils, and bi-level telemicroscopic apparatus devices improved her quality of life. Subsequent to rehabilitation our patient is happier and continues to use the visual aids. Conclusions Contact lenses with a special iris tint and clear pupil area are useful aids to reduce the glare experienced by albinos. Bi-level telemicroscopic apparatus telemicroscopes fitted onto our patient’s prescription spectacles were cosmetically acceptable and able to improve her distance vision. As a result these low-vision rehabilitation approaches improved the quality of life of our albino patient.
Kasnazani Kalandar A
Full Text Available Abstract Introduction Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. Case presentation A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. Conclusion Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.
Full Text Available A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.
CHANG Luh-maan; CHEN Po-han
One of the key elements in real estate management is streamlining the construction process. Thus,the facilities can be built on a faster, cheaper, and higher quality base. Consequently, it will enhance the owner's competitiveness. Due to the high cost and lengthy duration of mega-construction projects in recent years,Build-Operate-Transfer (BOT) contracts are getting popular in delivering constructed projects in the public sector. With BOT, the public owners are able to focus on the effectiveness of fair resource allocation as well as bring the efficiency of private enterprise into governmental operations.This paper uses Taiwan High Speed Rail project to exemplify the BOT method in executing the constructed projects in the chain of real estate management processes. The paper explains the reasons for building HSR and adopting BOT approach.The detail of the HSR project and the feasibility analysis of the project will be presented in this paper. The feasibility analysis comprises the comparisons of different transportation means, the financial analysis, and other benefits from HSR. Finally, conclusions will be drawn.
Full Text Available Problem statement: This case study presented students with a situation based in the healthcare industry, highlighting the importance of contract review, clear communications and interestbased negotiations in order to avoid the costly consequences that could be associated with contract related disputes. The case allowed students to understand how clearly written contracts play a deciding role in the success of business partnerships. Students practiced negotiation skills while discussing the performance clauses of the contract and considering effective amendments to that contract with the purpose of extending a business relationship. Approach: The author interviewed a project manager working for a preferred implementation vendor which had a contract with a large hospital provider in Colorado and California. The purpose of the interview and the case study focused on contract law, contract management, enterprise risk management and negotiation skills. The case study is based on class room use with practical, real-life contract management scenarios. Results: The team projects submitted for this case study in case management highlighted the receptivity of students in understanding the benefit of preserving business relationships, avoiding litigation and carefully wording the specifics of complex contracts. The students excelled in practicing interest-based bargaining skills and writing contract amendments that reflected the specifics of the complex contract problem presented. Conclusion/Recommendations: Case studies focused on real business situations resonate well with upper division students in business law classes; the complexities of the situations and of the contract language did not deter students from brainstorming solutions to the problems presented and in writing amendments to the contract such that the business relationship was preserved. The results of the students work on this case study problem were presented to the
Richards, N T; Darby, S; Howie, A J; Adu, D; Michael, J
There is great debate as to whether the benefit gained from the knowledge of renal histology outweighs the risk to the patient from the biopsy procedure. We conducted a prospective study of 276 native renal biopsies performed on 266 patients from a single centre in 1991 to assess the effect of the knowledge of renal histology on patient management. Biopsies were performed under ultrasound guidance using the Trucut biopsy needle. The indications for biopsy were: non-nephrotic proteinuria alone (25), haematuria and proteinuria (28), nephrotic range proteinuria (28), acute renal failure (31), haematuria alone (36), and chronic renal failure (128). Two hundred and sixty-three biopsies were successful. The mean number of glomeruli obtained was 23, range 0-115. Eight patients developed macroscopic haematuria of which two required blood transfusion. The result of the biopsy altered management in 24/28 (86%) of cases of nephrotic range proteinuria, 22/31 (71%) of cases of acute renal failure, 58/128 (45%) of cases of chronic renal failure, 9/28 (32%) of cases with haematuria and proteinuria, 3/25 (12%) of cases with non-nephrotic proteinuria alone, and 1/36 (3%) of cases with haematuria alone. management was altered in 42% of cases overall. These data suggest that knowledge of renal histology is essential in the management of patients with renal disease.
Estrella, Jenny Lynn D C; Soriano-Estrella, Agnes L
Cases of gestational trophoblastic neoplasia (GTN) with uterine rupture are often catastrophic owing to profuse bleeding, which could be potentially lethal. Management often entails removal of the uterus. Among patients in the reproductive age who have not completed their desired family size, such a procedure could be unacceptable. To address this, uterine resection of localized disease has been performed to preserve fertility. However, in some cases, resection would not leave much of the uterus for future fertility. Hence, primary repair of the rupture could be done. Two cases of uterine rupture in low-risk GTN conservatively managed with primary uterine rupture repair using hemostatic stitches and postoperative single-agent chemotherapy are presented. Both patients were in their early reproductive years and with a great desire to preserve future fertility. The extent of the disease was evaluated in both cases intraoperatively before considering this conservative approach. Such management proved to be effective for both cases. The 2 cases presented are the first reported successful cases in literature on which primary repair of uterine tumor rupture by oversewing with figure-of-eight stitches were done. One should then consider this as a new option in the management of patients who have GTN with uterine rupture, highly desirous of pregnancy, with large uterine tumors but relatively small areas of rupture for which simple stitches would suffice in providing adequate hemostasis.
Lily A. Ray
Full Text Available Sustainability science promotes place-based resource management because natural processes vary among ecosystems. When local science is limited, land managers may be forced to generalize from other ecosystems that function differently. One proposed solution is to draw upon the traditional ecological knowledge that indigenous groups have accumulated through resource use. Integrating traditional ecological knowledge with conventional resource management is difficult, especially when the two offer competing explanations of local environments. Although resource managers may discount traditional ecological knowledge that contradicts conventional resource management, we investigate the possibility that these disagreements can arise when nonlocal resource management generalizations displace place-based science. Specifically, we compare claims about wildfires made by Athabascan forest users residing in or near the Koyukuk National Wildlife Refuge and in the U.S. Fish and Wildlife Service fire management plan for that refuge. We focus on two aspects of fire ecology and management: the drivers of landscape flammability and the feasibility of using wildfires and prescribed burns to achieve resource management objectives. The results indicated that some disagreements came from reliance of the federal fire management plan on generalized national narratives at the expense of place-based science. We propose that in some cases, conflicts between traditional ecological knowledge and conventional resource management, rather than indicating a dead end, can identify topics requiring in-depth, place-based research.
Full Text Available Quetiapine is an atypical antipsychotic approved for the treatment of patients with psychotic disorders. Since approvement several case reports about intoxication with quetiapine were linked mainly with tachycardia, QTc-prolongation, somnolence, and hyperglycemia. Here, we present the first case report of an intoxication with an extreme overdose of quetiapine (36 g, ingested by a 32-year-old female (62 kg bodyweight to attempt suicide. Symptoms associated with intoxication were coma without arterial hypotension, persistent tachycardia, hyperglycemia, and transient hypothyreoidism. QTc-interval was moderately extended. Management consisted of intubation for airway protection, gastric lavage, the use of activated charcoal, i.v. saline, and observation for 17 hours on an intensive care unit. Despite the extremely high dose of quetiapine, the patient recovered completely without residual symptoms.
Full Text Available Objective: The suicidal rate among epileptic patients is up to 5 times more than general population and depression is the most common mood disturbance among them while usually under noticed. This study was performed to determine possible symptoms of psychiatric disorders for suicidal behavior in pediatric patients with epilepsy that had attempted suicide.Methods: Among medical records of 1169 patients under 17 years of age being admitted to the exclusive university hospital for poisoning in Tehran since April 2006 to Feb 2008 due to attempt to suicide, 31 cases(13 male and 18 female with mean age 15.8±1.3 years had concomitant epilepsy. Mental status and epilepsydata sheet of these patients were analyzed.Findings: The psychological evaluation of these 31 cases revealed long lasting symptoms of psychological disorder in 21 (91.4% cases before their attempt to suicide while only 5(16% cases had been noticed for psychiatric care and merely 3 of them had been under treatment.Conclusion: Despite strong correlation between affective disorders and epilepsy it is unfortunately underdiagnosed or undertreated. Since overdose of antiepileptic drugs used for treatment of epilepsy may be lethal,dismissing suicidal behavior can be life threatening.
Pregnancy with Rh isoimmunization is a grave situation. Two women with indirect Coombs test (ICT) positive were managed conservatively with a favorable outcome. Peak systolic velocity (PSV) of middle cerebral artery (MCA) was measured every 2 weeks, and pregnancy continued till the value remained <1.5 mean of median. In one woman, the pregnancy could be prolonged to 37 weeks when delivery was induced and the neonate did not develop hyperbilirubinemia. In the second woman with bad obstetric history, when a highly positive ICT was reported, intravenous immunoglobulin (IVIG) was given in a single dose of 5 g every 2 weeks starting at 27 weeks, for a total of three doses, along with measurement of PSV of MCA. Labor could be prolonged to 34 weeks when preterm spontaneous delivery occurred. The neonate could be salvaged with exchange transfusion and IVIG. The neonate is healthy with normal tone and no evidence of kernicterus.
Shubhangi Nigwekar P, Chaitanya Gupte P, Prajakta Kharche M, Akshay Beedkar U, Neeta Misra S, ParagTupe N
Full Text Available ABSTRACT Dermoids are congenital lesions representing normal tissue in abnormal location. Orbital dermoid cysts are divided into superficial and deep dermoids. Depending on type and location, superficial ocular dermoid cysts are divided into limbal, dermoid cyst and epibulbar dermoid cyst or dermolipoma. The most common location for the epibulbar dermoid cyst is inferotemporal region of eye. They are usually asymptomatic or may present with inflammatory response due to leakage of cyst contents or may cause local irritation due to protruding hair and do cause cosmetic blemish to a school going child. For local irritation and cosmetic reasons, complete surgical excision with intact capsule of epibulbar dermoid cyst is mandatory to prevent acute inflammatory response and its recurrence. In this article we are presenting the clinical features and surgical management of an inferotemporal epibulbar dermoid in a male patient.
Pregnancy with Rh isoimmunization is a grave situation. Two women with indirect Coombs test (ICT) positive were managed conservatively with a favorable outcome. Peak systolic velocity (PSV) of middle cerebral artery (MCA) was measured every 2 weeks, and pregnancy continued till the value remained <1.5 mean of median. In one woman, the pregnancy could be prolonged to 37 weeks when delivery was induced and the neonate did not develop hyperbilirubinemia. In the second woman with bad obstetric history, when a highly positive ICT was reported, intravenous immunoglobulin (IVIG) was given in a single dose of 5 g every 2 weeks starting at 27 weeks, for a total of three doses, along with measurement of PSV of MCA. Labor could be prolonged to 34 weeks when preterm spontaneous delivery occurred. The neonate could be salvaged with exchange transfusion and IVIG. The neonate is healthy with normal tone and no evidence of kernicterus.
Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C
Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation.
Full Text Available Supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e. molars, premolars or anterior teeth, or it may bear little resemblancein size or shape to which it is associated. Many complications can be associated with supernumeraries, like impaction, delayed eruption or ectopic eruption of adjacent teeth, crowding, development of median diastema and eruption into floor of the nasal cavity. This may also cause the formation of follicular cysts with significant bone destruction. Early intervention to remove it is usually required to obtain reasonable alignment and occlusal relationship. This article will present the clinical management of an (i impacted supernumerary tooth impeding the eruption of maxillary central incisor and (ii erupted supernumerary tooth with midline diastema.
Full Text Available A 34 year old lady was found to be in acute pain due to metastatic phaeochromocytoma following involvement of L5 , S1 & S2 vertebrae. She was treated with series of MIBG scanning and ablation and surgical option was refused by the patient. She was suffering from rapidly increasing radicular pain of the lower limbs which was being managed with oral and injectable opioids. The team of doctors treating her decided to give epidural opioids and bupivacaine initi ally but the total dose of the drug and frequency was found to be gradually increased. Therefore , continous administration of intathecal opiods and bupivacaine was given but the same problem occured after a few weeks and pain relief was minimal. Ultimately intrathecal absolute alcohol was given as there were no more options left. The patient had dramatic pain relief till her death.
Lazarevic, Aleksandar; Prnjat, Ognjen
The Grid technology is evolving into a global, service-orientated architecture, a universal platform for delivering future high demand computational services. Strong adoption of the Grid and the utility computing concept is leading to an increasing number of Grid installations running a wide range of applications of different size and complexity. In this paper we address the problem of elivering deadline/economy based scheduling in a heterogeneous application environment using statistical properties of job historical executions and its associated meta-data. This approach is motivated by a study of six-month computational load generated by Grid applications in a multi-purpose Grid cluster serving a community of twenty e-Science projects. The observed job statistics, resource utilisation and user behaviour is discussed in the context of management approaches and models most suitable for supporting a probabilistic and autonomous scheduling architecture.
Baranauskaitė-Fedorova, Inga; Dvarionienė, Jolanta; Nikiforov, Vladimir A
Investigation on the sources, discharges and related risks for the environment of the pharmaceutical substance (PhS) diclofenac (DCF) was performed in Lithuania, a country of the Baltic Sea region, for the first time. The investigation only refers to DCF as a PhS for human use; emissions from animal husbandry were not considered. In the first stage of the research, the main sources and pathways of DCF via substance flow analysis were identified within the country. During the second stage, DCF flows along the wastewater treatment plants (WWTPs) in two different cities were measured in order to assess the current levels of pharmaceutical residues in the environment. Furthermore, environmental risk assessment was carried out by taking into account the parameters of consumption data and elimination rate in WWTPs. Then, the assessment of different technical and managerial removal approaches was accomplished in an environmental management model of wastewater containing PhS, based on the framework of environmental systems theory.
Sawalha, Ihab H; Anchor, John R
Despite their considerable growth in last few decades, emerging markets (EM) face numerous risks that have the potential to slow down or obstruct their development. Three main issues are discussed in this paper: first, the risks facing organisations operating in emerging markets and Jordan in particular; secondly, the role of business continuity management (BCM) in emerging markets; and thirdly, potential factors that underpin the role of BCM in emerging markets. These issues are significant, as they represent the role of BCM in highly dynamic and fast changing business environments. The paper provides a discussion of the significance of BCM in reducing or preventing risks facing organisations operating in emerging markets, especially those in Jordan.
Full Text Available Glanzmann's thrombasthenia (GT is a rare, genetically inherited platelet disorder in which the platelet glycoprotein IIb/IIIa (GP IIb/IIIa complex is either deficient or, dysfunctional. The incidence is about 1 in 1,000,000. This case report deals with a 4 year-old girl diagnosed with GT presenting with dental caries and periapical lesions in the primary mandibular first molars. To provide the best care, an interdisciplinary approach was followed by a team consisting of pediatric dentists, pediatricians and anesthesiologists. Complete oral rehabilitation was planned under general anesthesia which included extractions, multiple esthetic restorations and space maintainers with the utmost care to prevent unwarranted bleeding.
Varkey, Indu; Rai, Kavita; Hegde, Amitha M; Vijaya, Mangalpady Shenoy; Oommen, Vinod Idicula
Glanzmann's thrombasthenia (GT) is a rare, genetically inherited platelet disorder in which the platelet glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either deficient or, dysfunctional. The incidence is about 1 in 1,000,000. This case report deals with a 4 year-old girl diagnosed with GT presenting with dental caries and periapical lesions in the primary mandibular first molars. To provide the best care, an interdisciplinary approach was followed by a team consisting of pediatric dentists, pediatricians and anesthesiologists. Complete oral rehabilitation was planned under general anesthesia which included extractions, multiple esthetic restorations and space maintainers with the utmost care to prevent unwarranted bleeding.
Full Text Available Staphylococcal toxic shock syndrome (TSS is most frequently produced by TSS toxin-1 (TSST-1 and Staphylococcal enterotoxin B (SEB, and only rarely by enterotoxins A, C, D, E, and H. Various clinical pictures can occur depending on severity, patient age and immune status of the host. Severe forms, complicated by sepsis, are associated with a death rate of 50-60%. The case of a Caucasian female infant, aged seven weeks, hospitalized with a diffuse skin rash, characterized as allergodermia, who initially developed TSS with axillary intertrigo, is reported.
Full Text Available Ankylosis is a condition frequently associated with primary molars, wherein the ankylosed primary teeth remain in a fixed position, while the adjacent teeth continue to erupt, moving occlusally. In this case report, a five-year-old boy, who had a retained and submerged left lower second primary molar, was presented. Luxation of ankylosed primary molar was considered as a treatment approach. After four months, the tooth erupted to the occlusal level, and there was evidence of further development of a permanent successor in radiographic evaluation. After one year, tooth mobility, bone formation, and development of a permanent successor were in good condition.
relationship management is proposed – the concept of Customer Attractiveness. Customer Attractiveness is founded on the revised understanding of the supplier relationship management task and focuses on influencing suppliers by being an attractive customer, hereby motivating the necessary commitment to long......Companies are increasingly relying on suppliers when developing and manufacturing industrial products. Therefore the supplier relationships of the company need to be managed. This dissertation looks at existing theoretical approaches to supplier relationship management. By studying a number...... of supplier relationships of the company Danfoss Drives, an alternative understanding of the supplier relationship management task is proposed. The case study methodology forms the basis for the applied research design. The alternative understanding sees the management task as one of influencing suppliers...
The discipline of diversity management has reached high popularity in the private and public sectors of the Nordic countries. In spite of the common use, the term diversity management contains an embedded complexity and equivocality leaving it diverse in itself. Thereby the management of diverse...... human resources becomes a highly complex task imbedded in an ongoing debate on political, scientific and business oriented arguments. Based on this confusing blend of concepts, statements, claims, and arguments, organizations strive to build their strategy for diversity management. This paper set out...... to deconstruct the concept of diversity management and relate the findings to the common application of the term. In the process of analysis, two distinct approaches to or discourses within diversity management emerge in the rhetoric: 'the argument of social responsibility' and 'the business case argument...
Fitzner, Karen; Greenwood, Deborah; Payne, Hildegarde; Thomson, John; Vukovljak, Lana; McCulloch, Amber; Specker, James E
Diabetes affects 7.8% of Americans, nearly 24 million people, and costs $174 billion yearly. People with diabetes benefit from self-management; disease management (DM) programs are effective in managing populations with diabetes. Little has been published on the intersection of diabetes education and DM. Our hypothesis was that diabetes educators and their interventions integrate well with DM and effectively support providers' care delivery. A literature review was conducted for papers published within the past 3 years and identified using the search terms "diabetes educator" and "disease management." Those that primarily addressed community health workers or the primary care/community setting were excluded. Two case studies were conducted to augment the literature. Ten of 30 manuscripts identified in the literature review were applicable and indicate that techniques and interventions based on cognitive theories and behavioral change can be effective when coupled with diabetes DM. Better diabetes self-management through diabetes education encourages participation in DM programs and adherence to recommended care in programs offered by DM organizations or those that are provider based. Improved health outcomes and reduced cost can be achieved by blending diabetes education and DM. Diabetes educators are a critical part of the management team and, with their arsenal of goal setting and behavior change techniques, are an essential component for the success of diabetes DM programs. Additional research needs to be undertaken to identify effective ways to integrate diabetes educators and education into DM and to assess clinical, behavioral, and economic outcomes arising from such programs.
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ENGLISH ABSTRACT: Value engineering (VE has been effectively applied in many different areas. The results have been very encouraging, and many companies accept VE not only as a tool to reduce costs, but also to improve the quality of their produce and streamline their systems. This paper attempts to highlight the application of VE in agriculture, as in pistachio tree farms in Iran. It is found that by implementing VE, unnecessary cultivation costs are lowered. Many of the other factors that lead to the inefficient use of resources could be resolved. In this study, the province of Yazd Iran was studied. Unfortunately there are cases of mismanagement and problems in agriculture management; and the problems must be resolved to make the system of pistachio growing more efficient. The prime objective of this paper is to introduce the concept of value engineering and highlight its application in pistachio farms. The results suggest that it is essential to use Indian Neem pesticide, because it is economically feasible and environmentally friendly to pistachio trees.
AFRIKAANSE OPSOMMING: Waarde-Ingenieurswese (WI word reeds doeltreffend toegepas op verskeie gebiede. Die resultate is sodanig bemoedigend dat maatskappye WI aanvaar as ‘n hulpmiddel vir kosteverlaging sowel as vir die verbetering van kwaliteit van opbrengs en stroombelyning van prosesse. Die artikel poog om die toepassing van WI op die landbou van Iran na vore te bring. Dit toon dat onnodige verbouingskoste verlaag word met die implementering van WI. Talle ander faktore wat ook bydra tot ondoeltreffende gebruik van hulpbronne word ook deur WI aangespreek. Die Yazd-provinsie van Iran word in die artikel bestudeer. Ten einde die verbouingsproses van pistasieneute meer doeltreffend te maak moet wanbestuur en probleme van landboubestuur aangespreek word. Die hoofdoelwit van die artikel is om die konsep van WI bekend te stel en die toepassing daarvan op pistasieboerderye uit te lig
Somme, Dominique; Corvol, Aline; Couturier, Yves; Pimouguet, Clément; Moreau, Olivier; Perivier, Samuel; Balard, Frédéric; de Stampa, Matthieu
Case management is a relatively new career field in France. It was first introduced on an experimental basis in 2007-2008, and was then developedfollowing the National Alzheimer Plan and finally enshrined in legislation in 2012. This careerfield is based on a set of tasks widely described internationally: identifying the right level of intervention, standardized multidimensional assessment, planning all aid (care and social services), implementation of the plan, monitoring and reassessment and periodic reassessment of all needs in a continuous and long-term process. The specific, systematic and dedicated nature of these tasks to these tasks makes training essential. Regulations also stipulate that the professional must acquire additional training by a dedicated inter-university degree. This requirement is a French specificity The authors present the history of case management and training in France and analyze the various international training frameworks identified by an Internet search. Moreover, based on the opinions expressed by case managers at different times of the scientific assessment and a review ofseveral studies conducted by inter-university case management program students, this article highlights the specific training needs of case managers and how the proposed training can meet these needs.
Goh Bee See
Full Text Available Objective: This is a series of five cases of branchial anomalies which were diagnosed and treated in a span of six years in the Department of Otorhinolaryngology, Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC. The main objective of this article is to highlight the use of endoscopic electrocautery in the management of branchial fistula. Case report: five cases were reported of the age group between 11 months old to 16 years who presented with an intermittent mucoid discharge from an external opening in the neck since birth and three cases were on the left side and the other two cases were bilateral fistula. Direct laryngoscopy under general anaesthesia was done as part of diagnostic and therapeutic management for the patients. Conclusion: Endoscopic electrocautery is a safe method and appears to be an effective alternative to open excision for branchial fistula.
Employers, who pay for much of the healthcare in this country, are not waiting for government to restructure the healthcare system. In this cover story, PROFILES examines how two firms formed their own managed care networks to control healthcare cost and quality, and what hospitals did to become players. By understanding the employer' point of view, hospital marketers can better anticipate their needs and develop a marketing strategy to form closer relationships with employers, provide quality care at a lower cost, and increase their market share.
Song, X; Ravesteijn, W; Frostell, B; Wennersten, R
The emerging water crisis in China shows that the current institutional frameworks and policies with regard to water resources management are incapable of achieving an effective and satisfactory situation that includes Integrated River Basin Management (IRBM). This paper analyses this framework and related policies, examines their deficiencies in relation to all water stress problems and explores alternatives focusing on river basins. Water resources management reforms in modern China are reviewed and the main problems involved in transforming the current river management system into an IRBM-based system are analysed. The Huai River basin is used as an example of current river basin management, with quantitative data serving to show the scale and scope of the problems in the country as a whole. The institutional reforms required are discussed and a conceptual institutional framework is proposed to facilitate the implementation of IRBM in China. In particular, the roles, power and responsibilities of River Basin Commissions (RBCs) should be legally strengthened; the functions of supervising, decision-making and execution should be separated; and cross-sectoral legislation, institutional coordination and public participation at all levels should be promoted.
Mad Nasir Shamsudin
Full Text Available Environmental protection is a basic element of sustainable agricultural development. Agricultural production practices, however, can cause negative externalities. One main concern of the externality is the negative effects of pesticide use. This has motivated the application of Integrated Pest Management (IPM program. This study attempts to evaluate the economic benefits of IPM to address the widespread misuse of pesticides in cabbage production. IPM application in cabbage production includes initiatives on the optimal use of pesticides, complementary weed control strategies, and alternative cultural and biological controls. Results of this study showed that the programme would generate economic benefits which include improvements in water quality, food safety, pesticide application safety, and long term sustainability of pest management systems. Thus there is justification for public investment of resources in training and educational programs to increase awareness about IPM and promote IPM adoption.
Lim, K I; Dy, C; Pugash, D; Williams, K P
Monoamniotic twin pregnancy discordant for anencephaly (MATDA) is a rare occurrence with only seven prior reported cases. Selective termination has been advocated in managing discordant monoamniotic twins. We report two cases managed expectantly with good outcomes and review other previously reported cases. The first case was a primigravid woman diagnosed with MATDA at 18 weeks. She was managed expectantly until 32 + 5 weeks when a Cesarean section was performed for preterm labor. The surviving female infant weighed 1610 g. The second case was a multigravid woman who was diagnosed with MATDA at 17 + 5 weeks and was managed as an outpatient. An emergency Cesarean section was performed at 31 weeks for non-reassuring monitoring and the surviving male infant weighed 1790 g. In both cases, the survivors were discharged home in good condition. A review of these two cases and those in the literature suggests that expectant management should be considered among management options for this rare condition.
Mansor, Azlin Norhaini; Eng, Wong Kim; Rasul, Mohamad Sattar; Hamzah, Mohd Izham Mohd; Hamid, Aida Hanim A.
This paper attempts to explore and identify the characteristics of an effective teacher who teaches English as a second language to 10 year old students from different ethnics, various social economic background and multi-level language ability, at a private primary school in Malaysia. The study focused on classroom management using a case study…
Full Text Available This case presents a crisis in an organization after the news of a nationwide political scandal involving the institution broke. It presents the organization's scenario of growth and prosperity before the crisis and its goals for the future. It also describes how the institution was affected by the corruption scheme and its reflections on the organization's business. It reveals the measures taken to reverse the situation that threatened its image and reputation, including reviewed strategic planning and the need to restructure the company. Finally, it encourages the reader to evaluate the measures taken by the organization and propose alternatives, as well as reflecting on the steps to resume growth in the context that this type of political involvement is dealt with in Brazil.
Full Text Available Children are uniquely susceptible to cranio facial trauma because of their greater cranial mass to body ratio. Below the age of 5, the incidence of pediatric facial fractures in relation to the total is very low ranging from 0.6-1.2%. Maxillo-facial injuries may be quite dramatic causing parents to panic and the child to cry uncontrollably with blood, tooth and soft tissue debris in the mouth. The facial disfigurement caused by trauma can have a deep psychological impact on the tender minds of young children and their parents. This case report documents the trauma and follow up care of a 4-year-old patient with maxillofacial injuries.
Full Text Available When a patient receiving new oral anticoagulants (NOACs requires an invasive procedure, the consequences of bleeding if anticoagulation is continued and the risk of thrombosis if it is omitted need to be carefully considered. In addition to the bleeding risk of the procedure, it is of paramount importance to evaluate the renal function, especially for dabigatran that is eliminated predominantly via the renal pathway. NOAC therapy should be stopped for at least 24 h before the intervention, and a longer interruption should be considered in cases of high bleeding risk procedures and/or renal failure. A base-line assessment of coagulation should be performed and intervention should be postponed (if possible if high levels of anticoagulation parameters are found. In the post-surgical period, if oral anticoagulant therapy cannot be re-started, patients should temporarily receive low molecular weight heparins and re-start NOACs as soon as possible.
Full Text Available Pain due to cancer is one of the most distressing symptoms experienced by the patients at some or the other time during the course of treatment or disease progression. The multidimensional nature of cancer pain is characterized by various dimensions including physical, social, psychological, and spiritual; which together constitute the term "total pain". Young cancer patients illustrate their unique psychological and developmental needs. This case report highlights the concept of "total cancer pain" in a young adult and demonstrates his distinctive social, spiritual, and psychological sufferings. The report emphasizes that addressing all these concerns is considerably significant in order to provide optimal pain relief to the patient. In the present scenario, it has been done by a skillful multiprofessional team communicating effectively with both the patient and the carer.
Varkey, Indu; Rai, Kavita; Hegde, Amitha M.; Vijaya, Mangalpady Shenoy; Oommen, Vinod Idicula
Glanzmann’s thrombasthenia (GT) is a rare, genetically inherited platelet disorder in which the platelet glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either deficient or, dysfunctional. The incidence is about 1 in 1,000,000. This case report deals with a 4 year-old girl diagnosed with GT presenting with dental caries and periapical lesions in the primary mandibular first molars. To provide the best care, an interdisciplinary approach was followed by a team consisting of pediatric dentists, pediatricians and anesthesiologists. Complete oral rehabilitation was planned under general anesthesia which included extractions, multiple esthetic restorations and space maintainers with the utmost care to prevent unwarranted bleeding. PMID:24910701
Singh, Virendra; Verma, Ajay; Attresh, Gyanander; Batra, Jitender
Condylar hyperplasia of the mandible is a clinical condition of over-development and growth because of excessive cellular growth of one condylar part of the mandible leading to facial asymmetry, mandibular deviation and enlargement of condyle. The elongation of the condylar neck in turn leads to malocclusion and articular dysfunction. In the past the interceptive and corrective procedures of growth and deformity in condylar hyperplasia were either condylectomy or high condylotomy. However, the deformity ceases after growth is completed. Therefore, other surgical procedures have to be undertaken to correct the manifested deformity of condylar hyperplasia. Further it has to be stressed that no single procedure can completely correct the deformity. So in addition to condylectomy, other orthognathic surgical procedures both on body and ramus and also on maxilla can be undertaken to correct the canting of occlusion. Two rare cases of unilateral hyperplasia encountered in our hospital are presented which required different lines of treatment.
Satyarthee Guru Dutta
Full Text Available Combined fracture involving atlas together associated with axis (CAAF accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5, commonest mode of injury was fall (n=3, time interval since injury was within 24 hours in (n=4, however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3, neurological deficit (n=2, neck tenderness and swelling tenderness (n=3 Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5, one case had multiple site fracture of both arches, odontoid fracture (n=2, lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3, transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study.
Nicoleta- Luminiţa STRÂMBEANU RISTEA
Full Text Available The paper aimed to present the benefits of implementing HACCP (Hazard Analysis and Critical Control Points to company S.C. "DOBRE AND SONS" S.R.L. Constanta, Romania. The data have been provided by the above mentioned manufacturer. The objectives of S.C. "DOBRE AND SONS" S.R.L. are protecting the health of the consumers of the products and their satisfaction regarding the consumption of products that are nutritional, tasty, fresh, free from microbiological, chemical and physical hazard, as well as possessing stable properties during the validity for consumption. In this respect, there has been implemented and maintained an integrated management system of food quality and safety according to SR EN ISO 9001:2008, SR EN ISO 22000:2005 and according to IFS standard, version 5/2007, which consists of determining the potential biological, chemical and physical hazards that might affect the safety of bread and bakery products, or the health of the consumer. HACCP team is analyzing hazard using one of the recommended techniques: brainstorming or the cause - effect diagram. In conclusion, the company S.C. "DOBRE AND SONS" S.R.L. Constanta, Romania provides awareness and employee involvement at all levels in achieving the appointed objectives.
Ramón Garrote Jurado
Full Text Available In this article the use of Learning Management Systems (LMS at the School of Engineering, University of Borås, in the year 2004 and the academic year 2009-2010 is investigated. The tools in the LMS were classified into four groups (tools for distribution, tools for communication, tools for interaction and tools for course administration and the pattern of use was analyzed. The preliminary interpretation of the results was discussed with a group of teachers from the School of Engineering with long experience of using LMS. High expectations about LMS as a tool to facilitate flexible education, student centered methods and the creation of an effective learning environment is abundant in the literature. This study, however, shows that in most of the surveyed courses the available LMS is predominantly used to distribute documents to students. The authors argue that a more elaborate use of LMS and a transformation of pedagogical practices towards social constructivist, learner centered procedures should be treated as an integrated process of professional development.
Călin Emilian HINȚEA
Full Text Available Strategic planning is an excellent tool that local governments can (and should use in order to deal effi ciently with change, which means that planning is an important aspect of public sector reform, arguably one of the defi ning elements of the public policy landscape for the past three decades (Pollitt and Bouckaert, 2011. Our main objective with this research is twofold: to analyze why and how local public administration uses strategic planning as a managerial tool for managing change (reform, and to identify whether the planning efforts display a specifi c reform pattern. We employed a quantitative methodology – online survey – to collect data on the strategic planning process at the local level in Romania, with a specifi c framework for the strategic profi le (Hinţea, 2015 and another three dimension model – NPM, NWS, NPG1 – for the reform component (Pollitt and Bouckaert, 2011. Our analysis indicates that over 70% of strategic planning efforts are done because it is a mandatory condition for accessing EU funds. Major issues concern implementation, monitoring and evaluation with only around a third of organizations having a formal body responsible for this. Although the process has mixed characteristics, NWS type elements are more common/preferred, while NPM seem least common/preferred by local authorities
Full Text Available The elderly, in whom atrial fibrillation is most prevalent, carry the greatest risk, undergoing more recurrent, deadlier strokes, with bigger deficits, slower recoveries, and more comorbidities. Age-related cerebral changes might undermine the benefit of established stroke treatments. Nevertheless, the elderly should probably also undergo thrombolysis for ischemic stroke: they do not bleed more, and die not because of hemorrhage but of concomitant illnesses. Beyond natural bleeding risks, atrial fibrillation in advanced age has a high embolic potential if not anticoagulated. Standard or lower intensity warfarin anticoagulation prevents embolic stroke in the elderly with a hemorrhage risk even lower than aspirin. Excess anticoagulation hazards are prevented with lower starting doses, stricter corrections, more frequent INR monitoring. Direct thrombin inhibitors have recently shown a benefit similar to warfarin with fewer hemorrhages. Antihypertensives probably help 80-plus stroke patients as well, but the risk/benefit of lowering blood pressure in secondary stroke prevention at that age is uncertain. In summary, emerging data suggest that stroke management should be specifically targeted to the elderly.
Lafreniere, Katherine C; Deshpande, Sameer; Bjornlund, Henning; Hunter, M Gordon
Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations.
This article from three aspects of the classroom teaching, learning lessons and appraisal system attempted to introduce a health management operational research teaching reform , and focuses on the cases in classroom teaching are divided into three levels processing are introduced, and points out some problems and suggestions existing in the case teaching.%文章从课堂教学、课后学习和考核体系三个方面介绍了卫生管理运筹学教学改革的尝试，并着重对课堂教学中所用的案例分成三个级别处理进行了介绍，同时指出案例教学中存在的一些问题及处理意见。
Full Text Available Problem statement: Predicting customer's future orders has an essential role in planning appropriate strategy in a Supply Chain Management (SCM implementation. Purpose of this study is to identify how predicting future orders can facilitate managing activities across companies. Approach: A case study conducted in four Iranian automotive organisations to understand the actual results of order prediction in managing organisational processes. Results: Results of case study highlighted that more than 86% of activities completed before actual orders were received in these organisations. Conclusion: The findings show the high level of order management in these organisations which are the results of accessing to the right and timely information. This study would give invaluable information to all researchers who investigate the impact of order prediction in fulfilling organisational activities.
Full Text Available Sustainable resources management requires a major transformation of existing resource governance and management systems. These have evolved over a long time under an unsustainable management paradigm, e.g., the transformation from the traditionally prevailing technocratic flood protection toward the holistic integrated flood management approach. We analyzed such transformative changes using three case studies in Europe with a long history of severe flooding: the Hungarian Tisza and the German and Dutch Rhine. A framework based on societal learning and on an evolutionary understanding of societal change was applied to identify drivers and barriers for change. Results confirmed the importance of informal learning and actor networks and their connection to formal policy processes. Enhancing a society's capacity to adapt is a long-term process that evolves over decades, and in this case, was punctuated by disastrous flood events that promoted windows of opportunity for change.
From time to time in my responsibilities as a medical social worker, I become involved with a "complicated" case. Translation: a case was referred to the social worker to intervene and "fix" the problem because no one else knew what to do with the client or the issues surrounding the client. Necessity is the mother of invention, so when all else failed, that was my cue to be creative.
María Victoria Flores Trujillo
Full Text Available An efficient management of education in the 21st century requires that educational institutions not only promote the use of Information and Communication Technologies (ICT, but also manage strategic changes in the organization that facilitate the adaptation of this to the educational demands of the century XXI. In this context, this article tries to formulate, from the findings of a fieldwork, some considerations of educational management for the integration of policies in favor of the use of ICT in the Simón Bolívar University. As theoretical references is taken into account the model TPACK, formulated by XXX and the "connectivist" system formulated by Siemens, which gives account of a "new way of learning" with the use of technologies. From a holistic point of view, it takes into account the study by competences in the curricula.
Presidential Helicopter Acquisition: Program Established Knowledge -Based Business Case and Entered System Development with Plans for Managing Challenges...Presidential Helicopter Acquisition: Program Established Knowledge -Based Business Case and Entered System Development with Plans for Managing...progress by establishing a knowledge - based business case for entry into system development that included an approved cost, schedule and performance
Purpose: The purpose of this paper is to discuss the role of principals in light of public management reforms taking place in the German educational system and in reference to the empirical patterns uncovered by the papers contained in the Special Issue. Policy makers have created new expectations and new technologies that seem to suggest to…
De Mari, G
Displays the results of a handful of graduates of the postgraduate Master of IT Management at TU Delft. This title presents summaries of eight these written between 2003 and 2008, selected to provide a picture of a range of graduation projects
Stenager, E N; Stenager, Egon; Jensen, Knud
. Statistically, the risk of repetition of parasuicide for patients with a somatic disease but without depression was significantly less. The 7 patients committing suicide were older and a tendency was found towards painful somatic diseases and depression as risk factors for suicide....... on analgesics for pain. Patients that suffered from a somatic disease differed from other suicide attempters in depression score, age, pain and the presence of psychosis. Fewer of the somatically ill suicide attempters had a psychosis. Patients complaining of pain were more often depressed and abused medicine...