WorldWideScience

Sample records for csu manager generally

  1. Impact of cloud microphysics on cloud-radiation interactions in the CSU general circulation model

    Energy Technology Data Exchange (ETDEWEB)

    Fowler, L.D.; Randall, D.A.

    1995-04-01

    Our ability to study and quantify the impact of cloud-radiation interactions in studying global scale climate variations strongly relies upon the ability of general circulation models (GCMs) to simulate the coupling between the spatial and temporal variations of the model-generated cloudiness and atmospheric moisture budget components. In particular, the ability of GCMs to reproduce the geographical distribution of the sources and sinks of the planetary radiation balance depends upon their representation of the formation and dissipation of cloudiness in conjunction with cloud microphysics processes, and the fractional amount and optical characteristics of cloudiness in conjunction with the mass of condensate stored in the atmosphere. A cloud microphysics package which encompasses five prognostic variables for the mass of water vapor, cloud water, cloud ice, rain, and snow has been implemented in the Colorado State University General Circulation Model (CSU GCM) to simulate large-scale condensation processes. Convection interacts with the large-scale environment through the detrainment of cloud water and cloud ice at the top of cumulus towers. The cloud infrared emissivity and cloud optical depth of the model-generated cloudiness are interactive and depend upon the mass of cloud water and cloud ice suspended in the atmosphere. The global atmospheric moisture budget and planetary radiation budget of the CSU GCM obtained from a perpetual January simulation are discussed. Geographical distributions of the atmospheric moisture species are presented. Global maps of the top-of-atmosphere outgoing longwave radiation and planetary albedo are compared against Earth Radiation Budget Experiment (ERBE) satellite data.

  2. CSU attention focuses on the Asian markets

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-15

    European coal terminal operators increasingly select grab cranes over continuous ship loader (CSU) technology, but does the Far East still offer the greatest potential for growth? Siewertell, part of the Cargotec group, has developed something of a niche market with its screw-type CSUs. The article reports recent business by Siwertell and ThyssenKrupp Foerdertechnik (TFK). 2 photos.

  3. The CSU Accelerator and FEL Facility

    NARCIS (Netherlands)

    Milton, S.V.; Biedron, S.G.; Burleson, T.; Carrico, C.; Edelenbos, J.; Hall, C.; Horovitz, K.; Morin, A.; Rand, L.; Sipahi, N.; Sipahi, T.; van der Slot, P.; Yehudah, H.; Dong, A.; Tanaka, T.; Schaa, V.R.W.

    2013-01-01

    The Colorado State University (CSU) Accelerator Facility will include a 6-MeV L-Band electron linear accelerator (linac) with a free-electron laser (FEL) system capable of producing Terahertz (THz) radiation, a laser laboratory, a microwave test stand, and a magnetic test stand. The photocathode

  4. Itch Management: General Principles.

    Science.gov (United States)

    Misery, Laurent

    2016-01-01

    Like pain, itch is a challenging condition that needs to be managed. Within this setting, the first principle of itch management is to get an appropriate diagnosis to perform an etiology-oriented therapy. In several cases it is not possible to treat the cause, the etiology is undetermined, there are several causes, or the etiological treatment is not effective enough to alleviate itch completely. This is also why there is need for symptomatic treatment. In all patients, psychological support and associated pragmatic measures might be helpful. General principles and guidelines are required, yet patient-centered individual care remains fundamental. © 2016 S. Karger AG, Basel.

  5. Colorado State University (CSU) accelerator and FEL facility

    NARCIS (Netherlands)

    Milton, S.; Biedron, S.; Harris, J.; Martinez, J.; D'Audney, A.; Edelen, J.; Einstein, J.; Hall, C.; Horovitz, K.; Morin, A.; Sipahi, N.; Sipahi, T.; Williams, J.; Carrico, C.; Van Der Slot, P. J M

    2014-01-01

    The Colorado State University (CSU) Accelerator Facility will include a 6-MeV L-Band (1.3 GHz) electron linear accelerator (linac) with a free-electron laser (FEL) system capable of producing Terahertz (THz) radiation, a laser laboratory, a microwave test laboratory, and a magnetic test laboratory.

  6. Beam Position Monitoring in the CSU Accelerator Facility

    Science.gov (United States)

    Einstein, Joshua; Vankeuren, Max; Watras, Stephen

    2014-03-01

    A Beam Position Monitoring (BPM) system is an integral part of an accelerator beamline, and modern accelerators can take advantage of newer technologies and designs when creating a BPM system. The Colorado State University (CSU) Accelerator Facility will include four stripline detectors mounted around the beamline, a low-noise analog front-end, and digitization and interface circuitry. The design will support a sampling rate greater than 10 Hz and sub-100 μm accuracy.

  7. Construction Manager or General Contractor?

    Science.gov (United States)

    McKinley, John

    1991-01-01

    Unlike the general contractor approach, the construction management firm acts on behalf of the school district in school construction. Examines the development and nature of construction management, and cites its advantages and disadvantages. (MLF)

  8. Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements.

    Science.gov (United States)

    Giménez-Arnau, A; Ferrer, M; Bartra, J; Jáuregui, I; Labrador-Horrillo, M; Frutos, J Ortiz de; Silvestre, J F; Sastre, J; Velasco, M; Valero, A

    Chronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge. To explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management. An online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus. The questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic tests should be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second-generation H1-antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1-antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children. This work offers consensus recommendations that may be useful in the management of CSU. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  9. BASE Temperature Data Record (TDR) from the SSM/I and SSMIS Sensors, CSU Version 1

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The BASE Temperature Data Record (TDR) dataset from Colorado State University (CSU) is a collection of the raw unprocessed antenna temperature data that has been...

  10. General survey of technology management

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Yong Ha; Jang Dong Hun; Lee, In Woo

    1999-02-15

    The content of this book are technology and management, conception of technology management, feature and model of technology management system, elements of technology management, performance measurement of technology management, connectivity between technology and business function, system management of technology, manpower management, readership and technology management, motivation and technology management, management of technical investment evaluation, new item development and marketing, product liability management, intellectual property rights and transfer of technology.

  11. General survey of technology management

    International Nuclear Information System (INIS)

    Shin, Yong Ha; Jang Dong Hun; Lee, In Woo

    1999-02-01

    The content of this book are technology and management, conception of technology management, feature and model of technology management system, elements of technology management, performance measurement of technology management, connectivity between technology and business function, system management of technology, manpower management, readership and technology management, motivation and technology management, management of technical investment evaluation, new item development and marketing, product liability management, intellectual property rights and transfer of technology.

  12. Implementing an Open Source Learning Management System: A Critical Analysis of Change Strategies

    Science.gov (United States)

    Uys, Philip M.

    2010-01-01

    This paper analyses the change and innovation strategies that Charles Sturt University (CSU) used from 2007 to 2009 during the implementation and mainstreaming of an open source learning management system (LMS), Sakai, named locally as "CSU Interact". CSU was in January 2008 the first Australian University to implement an open source…

  13. Biosorption of uranium by Pseudomonas aeruginosa strain CSU: Characterization and comparison studies

    International Nuclear Information System (INIS)

    Hu, M.Z.C.; Norman, J.M.; Faison, B.D.; Reeves, M.E.

    1996-01-01

    Pseudomonas aeruginosa strain CSU, a nongenetically engineered bacterial strain known to bind dissolved hexavalent uranium (as UO 2 2+ and/or its cationic hydroxo complexes) was characterized with respect to its sorptive activity. The uranium biosorption equilibrium could be described by the Langmuir isotherm. The rate of uranium adsorption increased following permeabilization of the outer and/or cytoplasmic membrane by organic solvents such as acetone. P. aeruginosa CSU biomass was significantly more sorptive toward uranium than certain novel, patented biosorbents derived from algal or fungal biomass sources. P. aeruginosa CSU biomass was also competitive with commercial cation-exchange resins, particularly in the presence of dissolved transition metals. Uranium binding by P. aeruginosa CSU was clearly pH dependent. Uranium loading capacity increased with increasing pH under acidic conditions, presumably as a function of uranium speciation and due to the H + competition at some binding sites. Nevertheless, preliminary evidence suggests that this microorganism is also capable of binding anionic hexavalent uranium complexes. Ferric iron was a strong inhibitor of uranium binding to P. aeruginosa CSU biomass, and the presence of uranium also decreased the Fe 3+ loading when the biomass was not saturated with Fe 3+ . Thus, a two-state process in which iron and uranium are removed in consecutive steps was proposed for efficient use of the biomass as a biosorbent in uranium removal from mine wastewater, especially acidic leachates

  14. Facile CO cleavage by a multimetallic CsU2 nitride complex

    International Nuclear Information System (INIS)

    Falcone, Marta; Scopelliti, Rosario; Mazzanti, Marinella; Kefalidis, Christos E.; Maron, Laurent

    2016-01-01

    Uranium nitrides are important materials with potential for application as fuels for nuclear power generation, and as highly active catalysts. Molecular nitride compounds could provide important insight into the nature of the uranium-nitride bond, but currently little is known about their reactivity. In this study, we found that a complex containing a nitride bridging two uranium centers and a cesium cation readily cleaved the C≡O bond (one of the strongest bonds in nature) under ambient conditions. The product formed has a [CsU 2 (μ-CN)(μ-O)] core, thus indicating that the three cations cooperate to cleave CO. Moreover, the addition of MeOTf to the nitride complex led to an exceptional valence disproportionation of the CsU IV -N-U IV core to yield CsU III (OTf) and [MeN=U V ] fragments. The important role of multimetallic cooperativity in both reactions is illustrated by the computed reaction mechanisms.

  15. General principles of the quality management

    International Nuclear Information System (INIS)

    Koutaniemi, P.

    2005-01-01

    The objective of the presentation is to outline some general infrastructure of nuclear industry with regard to the quality management; to emphasise significance of safety management as an integral part of the quality management; and to highlight different steps of the management process in a near-time working, at an annual level and as a strategic process

  16. Hotel Nikko Tianjin General Manager Interview

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Before the grand opening of Hotel Nikko Tianjin on April 11,Beijing Review conducted an interview with Mr.Hiroshi O’ishi,General Manager of the new hotel,in order to share the operational and management expertise of Nikko Hotels International with our readers.

  17. 75 FR 58330 - Minerals Management: General

    Science.gov (United States)

    2010-09-24

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management 43 CFR Part 3000 Minerals Management: General CFR Correction In Title 43 of the Code of Federal Regulations, Part 1000 to End, revised as of October 1, 2009, on page 331, in [[Page 58331

  18. NOAA Climate Data Record (CDR) of SSM/I and SSMIS Microwave Brightness Temperatures, CSU Version 1

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This NOAA Climate Data Record (CDR) from Colorado State University (CSU) contains brightness temperatures that have been improved and quality-controlled over the...

  19. LOGISTICS MANAGEMENT IN THE GENERAL STRUCTURE OF COMPANY MANAGEMENT

    OpenAIRE

    SERGIU PETROVICI; ALA GUDIMA

    2011-01-01

    The paper is dedicated to the place of logistics management in the general structure of an enterprise. It states some rules to improve the logistic system through development of logistic management as integral system and through a complex approach, development of a market-orientated logistic management with clear short-term and long-term purposes, development of information system in logistics. The course of Logistics Management is taught at the Cooperative-Commercial University of Moldova at...

  20. Opioid dependence - management in general practice.

    Science.gov (United States)

    Frei, Matthew

    2010-08-01

    Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain. To outline the management of opioid dependence using opioid pharmacotherapy as part of a comprehensive chronic illness management strategy. The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.

  1. The undergraduate physics tutorial program at CSU Los Angeles assessment of utility and areas of interest

    Science.gov (United States)

    Avetyan, Smbat

    The Physics Education Research (PER) group at the University of Washington have researched traditional teaching methods and found that students in introductory physics are lacking a conceptual understanding of the physics material. The solution they put forth is an interactive tutorial program designed to meet the lack of conceptual understanding. Since the tutorial programs inception at CSU Los Angeles in Fall 2006 no evaluation has been successfully undertaken therefore the effect of the tutorial program in the physics 200 series is deeply obscure to the department. The research has shed light on the tutorial program and brought into context its effectiveness on the overall physics 200 series courses at CSU Los Angeles. The researcher has addressed the following research questions, what overall effect does the tutorial program have on the Physics 200 series curriculum? What is the size and significance of gains attributable to the undergraduate calculus based Physics 200 series tutorial program at CSU Los Angeles? What can we learn from gains about individual weekly lessons from the Physics 200 series tutorial courses? What is the correlation of tutorial gains with student final course grades? Are the gains from the tutorial program different for genders? Is there a difference in gains based on the different students' colleges?

  2. Wireless Time Tracking Improves Productivity at CSU Long Beach.

    Science.gov (United States)

    Charmack, Scott; Walsh, Randy

    2002-01-01

    Describes California State University Long Beach's implementation of new maintenance management software, which integrated maintenance, inventory control, and key control and allows technicians to enter and receive information through handheld wireless devices for more accurate time accounting. The school estimates a 10 percent increase in…

  3. Preventing and managing awareness during general anesthesia

    Directory of Open Access Journals (Sweden)

    Jelena Berger

    2014-03-01

    Full Text Available Background: General anesthesia is a reversible state of a temporary loss of consciousness, analgesia, muscle paralysis, blunted autonomic responses and amnesia. To achieve this, an adequate depth of anesthesia should be maintained throughout the surgery. Awareness is a serious complication of general anesthesia, which occurs when the depth of anesthesia is not appropriate due to various causes.In this paper the underlying neurobiology of intraoperative awareness is presented, as well as risk factors for awareness and methods for assessing the depth of anesthesia. Possible psychological consequences of awareness and their management are also discussed. At the end, the recommendations for preventing intraoperative awareness are given.Conclusions: Awareness during general anesthesia may have adverse psychological sequelae in individual patients, therefore guidelines for preventing and managing of intraoperative awareness need to be adopted. In case of a possible awareness, the recommendations for offering a psychological support should also be followed.

  4. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

    ) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures...... of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...

  5. Generalized data management systems and scientific information

    International Nuclear Information System (INIS)

    Anon.

    1978-01-01

    This report aims to stimulate scientists of all disciplines to consider the advantages of using a generalized data management system (GDMS) for storage, manipulation and retrieval of the data they collect and often need to share. It should also be of interest to managers and programmers who need to make decisions on the management of scientific (numeric or non-numeric) data. Another goal of this report is to expose the features that a GDMS should have which are specifically necessary to support scientific data, such as data types and special manipulation functions. A GDMS is a system that provides generalized tools for the purpose of defining a database structure, for loading the data, for modification of the data, and for organizing the database for efficient retrieval and formatted output. A data management system is 'generalized' when it provides a user-oriented language for the different functions, so that it is possible to define any new database, its internal organization, and to retrieve and modify the data without the need to develop special purpose software (program) for each new database

  6. Biosorption of uranium by Pseudomonas aeruginosa strain CSU immobilized in a novel matrix

    International Nuclear Information System (INIS)

    Hu, M.C.Z.; Reeves, M.

    1997-01-01

    A number of polymeric materials, including calcium alginate, polyacrylamide, polysulfone, and polyurethane, were evaluated as possible immobilization matrices for lyophilized biomass of P. aeruginoso CSU. Polyurethane-based materials such as hydrogel were identified as superior candidates for biomass immobilization. A novel polyurethane gel-bead fabrication technique was developed and successfully demonstrated at pilot-plant scale for producing mass qualities of spherical, uniform-size beads. The immobilized bacterial biomass was evaluated via the measurement of sorption isotherms and dynamics within a batch, stirred-tank reactor; and loading and elution behavior within a continuous, upflow, packed-bed columnar reactor. Sorption equilibrium and dynamics in a batch stirred tank were modeled with a pore-diffusion mass transfer model, by which a pore-diffusion coefficient was determined to be approximately 2.0 x 10 -6 cm 2 /s for uranyl ion transport through the polyurethane gel matrix. The biosorbent beads were regenerable with dilute (0.01-0.1 M) sodium carbonate solutions. Preliminary column breakthrough-elution studies indicated that P. aeruginosa CSU biomass immobilized within polyurethane gel beads was effective for removal of uranium from low-concentration, acidic wastewater. 35 refs., 9 figs., 4 tabs

  7. Identifying management competencies of hotel owner-managers & general managers in the Republic of Ireland

    OpenAIRE

    O’Reilly, C

    2015-01-01

    The objective of this research was to investigate the concept of competencies, explore and identify the management competencies of hotel owner-managers and general managers in the hospitality industry in the Republic of Ireland. In other words, this research explored how hotel owner-managers and general managers identified, interpreted and made sense of their notion of managerial competencies in a complex work environment. The research was set within the context of the Irish hospitality and t...

  8. Transportation and General Traffic Management, Change 2

    Science.gov (United States)

    1979-01-01

    This Handbook sets forth those transportation and general traffic management responsibilities, guidelines, and procedures governing the use of commercial and Government transportation for NASA. Transportation is an integral function of the logistic process, involving all activities incident to the movement of persons and things. The fundamental and continuous objectives of transportation are to control and diminish the time-distance of lines of communication by the most suitable means. The function of transportation is accomplished through, and encompasses all, the planning, direction, supervision, and execution of the technical, operational, and administrative tasks required to procure or furnish efficient and economical conveyance of cargo and personnel by all modes of commercial and Government transportation. This Handbook is applicable to NASA Headquarters and Field Installations.

  9. Navigating the Institutional and Pedagogical Challenges of the Service-Learning Leadership Minor at CSU Monterey Bay

    Science.gov (United States)

    Burke, Deborah A.

    2012-01-01

    Despite solid foundations for service-learning at California State University Monterey Bay (CSUMB), the economic context of higher education in California, and in particular the CSU system, has created significant challenges for service-learning practitioners. This article provides an overview of the institutional foundations in place at CSUMB…

  10. CSU-CHILL Polarimetric Radar Measurements from a Severe Hail Storm in Eastern Colorado.

    Science.gov (United States)

    Hubbert, J.; Bringi, V. N.; Carey, L. D.; Bolen, S.

    1998-08-01

    Polarimetric radar measurements made by the recently upgraded CSU-CHILL radar system in a severe hailstorm are analyzed permitting for the first time the combined use of Zh, ZDR, linear depolarization ratio (LDR), KDP, and h to infer hydrometeor types. A chase van equipped for manual collection of hail, and instrumented with a rain gauge, intercepted the storm core for 50 min. The period of golfball-sized hail is easily distinguished by high LDR (greater than or equal to 18 dB), negative ZDR (less than or equal to 0.5 dB), and low h (less than or equal to 0.93) values near the surface. Rainfall accumulation over the entire event (about 40 mm) estimated using KDP is in excellent agreement with the rain gauge measurement. Limited dual-Doppler synthesis using the CSU-CHILL and Denver WSR-88D radars permit estimates of the horizontal convergence at altitudes less than 3 km above ground level (AGL) at 1747 and 1812 mountain daylight time (MDT). Locations of peak horizontal convergence at these times are centered on well-defined positive ZDR columns. Vertical sections of multiparameter radar data at 1812 MDT are interpreted in terms of hydrometeor type. In particular, an enhanced LDR `cap' area on top of the the positive ZDR column is interpreted as a region of mixed phase with large drops mixed with partially frozen and frozen hydrometeors. A positive KDP column on the the western fringe of the main updraft is inferred to be the result of drops (1-2 mm) shed by wet hailstones. Swaths of large hail at the surface (inferred from LDR signatures) and positive ZDR at 3.5 km AGL suggest that potential frozen drop embryos are favorably located for growth into large hailstones. Thin section analysis of a sample of the large hailstones shows that 30%-40% have frozen drop embryos.

  11. 7 CFR 1717.609 - RUS approval of general manager.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false RUS approval of general manager. 1717.609 Section... Operational Controls § 1717.609 RUS approval of general manager. (a) If a borrower's mortgage or loan contract... general manager of the borrower's system, such approval is hereby granted provided that the borrower is in...

  12. Waste management 86. Volume 1:General interest

    International Nuclear Information System (INIS)

    Post, R.G.

    1986-01-01

    This book presents the papers given at a symposium on radioactive waste management. Topics considered at the symposium included the status of radioactive waste disposal, the status of international nuclear waste management, waste management activities at the Idaho National Engineering Laboratory, legal and liability issues, risk perceptions and public involvement, waste transportation, waste processing, remedial action, decontamination, predisposal processing and treatment processes, low-level and mixed waste management, and mixed chemical and radioactive waste disposal

  13. The California State University Louis Stokes Alliance for Minority Participation (CSU-LSAMP): A Collaborative, Comprehensive Approach to Broadening Participation in STEM.

    Science.gov (United States)

    Hammersley, L. C.

    2016-12-01

    The National Science Foundation's Louis Stokes Alliances for Minority Participation (LSAMP) program supports alliances of institutions in their efforts to broaden participation in STEM and diversify the STEM workforce. There are currently 42 LSAMP alliances across the nation. Formed in 1993, the California State University LSAMP program (CSU-LSAMP) is an alliance of all 23 campuses of the CSU system and serves over 3,000 students per year. The primary goals of CSU-LSAMP are to increase persistence and graduation rates for URM participants, increase the number of STEM degrees awarded by the CSU to URM students, and increase the number of CSU-LSAMP students who advance to STEM graduate study. CSU-LSAMP activities are focused on four objectives - academic support (e.g. supplemental instruction & peer mentoring), support at transition points (e.g. first time freshmen & transfer students), research experiences (including international research experiences), and professional development (e.g. conference presentations & graduate school preparation activities). Financial support is offered in the form of textbook assistance, research stipends, and travel awards. We maintain a structure that allows campuses to tailor their programs to meet the needs of their own student populations but that also ties the Alliance together with a set of common activities, goals and policies. External evaluation of the program shows that our approach has been highly successful and can provide useful lessons for other programs focused on broadening participation. Since 1994, the number of URM students enrolled in STEM disciplines at CSU campuses has more than doubled and the number of STEM degrees to URM students has almost tripled. Persistence and graduation rates for URM students who participate in CSU-LSAMP are almost twice those of URM non-participants and equal to those of non-URM students. Of the students who participated in the past 15 years, 42 percent either earned a post

  14. The transition to general management in South Africa

    Directory of Open Access Journals (Sweden)

    Stephen J. Mallaby

    2017-05-01

    Full Text Available Orientation: Understanding the nature and challenges of making the transition from a functional role to a general management role in South African organisations. Research purpose: The objective of this study was to gain insight into the obstacles that affect the transition from functional to general management and identify steps that may be taken to overcome these challenges. Motivation for the study: One of the most difficult crossroads for a manager is making the shift from being a functional specialist to becoming a general manager. New competencies and behaviours are required, as well as a more strategic mind set. If the transition is not made successfully, the manager and the organisation suffer. Research design, approach and method: A qualitative design was used consisting of in-depth, semi-structured interviews, with 19 senior business leaders who had successfully made the transition. The interviews were used to gather insights into the challenges they faced during their transitions, and how these were overcome. Main findings: To make the transition successfully, functional managers need to gain relevant experience to prepare them for the broader scope of a general management role. They need to develop appropriate skills, attitudes and personal characteristics. Mentoring is an effective development process. Newly appointed general managers need to learn to let go of control while maintaining ownership, build relationships and strike the right balance between strategic thinking and execution. There are unique aspects of being a general manager in South Africa, such as dealing with Black Economic Empowerment and challenges of race and identity, given the country’s history. Practical and managerial implications: Specific interventions are suggested which are directed at both aspiring general managers and organisations seeking to assist middle managers to make the transition to general managers. Contribution: This study contributes to

  15. Facile CO Cleavage by a Multimetallic CsU2 Nitride Complex.

    Science.gov (United States)

    Falcone, Marta; Kefalidis, Christos E; Scopelliti, Rosario; Maron, Laurent; Mazzanti, Marinella

    2016-09-26

    Uranium nitrides are important materials with potential for application as fuels for nuclear power generation, and as highly active catalysts. Molecular nitride compounds could provide important insight into the nature of the uranium-nitride bond, but currently little is known about their reactivity. In this study, we found that a complex containing a nitride bridging two uranium centers and a cesium cation readily cleaved the C≡O bond (one of the strongest bonds in nature) under ambient conditions. The product formed has a [CsU2 (μ-CN)(μ-O)] core, thus indicating that the three cations cooperate to cleave CO. Moreover, the addition of MeOTf to the nitride complex led to an exceptional valence disproportionation of the CsU(IV) -N-U(IV) core to yield CsU(III) (OTf) and [MeN=U(V) ] fragments. The important role of multimetallic cooperativity in both reactions is illustrated by the computed reaction mechanisms. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  16. Tailoring Earned Value Management. General Guidelines

    National Research Council Canada - National Science Library

    2002-01-01

    Partial Contents: General Principles, A Spectrum of Implementation, OMB Guidance, A Special Note about DOD, Risk Factors to Consider, How can EVMS be tailored, Tailor EVMS to Inherent Risk, Application Thresholds-DoD...

  17. Tetralogy of Fallot: General Principles of Management.

    Science.gov (United States)

    Downing, Tacy E; Kim, Yuli Y

    2015-11-01

    Repaired tetralogy of Fallot (TOF) is one of the most common diagnoses encountered when caring for adults with congenital heart disease. Although long-term survival after childhood TOF repair is excellent, morbidity is common and most patients require reintervention in adulthood. This review provides an overview of key surveillance and management issues for adults with TOF, including residual right ventricular outflow tract disease and timing of pulmonary valve replacement, arrhythmias and risk stratification, left-sided heart disease and heart failure, and pregnancy management. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. General survey of solid-waste management

    Science.gov (United States)

    Reese, T. G.; Wadle, R. C.

    1974-01-01

    Potential ways of providing solid-waste management for a building complex serviced by a modular integrated utility system (MIUS) were explored. Literature surveys were conducted to investigate both conventional and unusual systems to serve this purpose. The advantages and disadvantages of the systems most compatible with MIUS are discussed.

  19. Role of Management Accounting in Accounting in General

    OpenAIRE

    Oleksandr Panadiy

    2015-01-01

    The article elucidates main scientific approaches to understanding of essence of management accounting. From scientific studies of domestic scientists it is concluded that most of them classify management accounting under competence of accounting in general. It is shown that the first institutional factors concomitant with division of general theory of accounting into financial and management components were development of forms of business and implementation of accounting standards and manua...

  20. Management in general practice: the challenge of the new General Medical Services contract.

    Science.gov (United States)

    Checkland, Kath

    2004-10-01

    Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the

  1. Head injury management guidelines for general practitioners

    Directory of Open Access Journals (Sweden)

    Jeremy C Ganz

    2011-01-01

    Full Text Available A complete examination of a head injured patient in the hospital requires a number of instruments. These include a stethoscope, sphygmomanometer, ophthalmoscope, otoscope, cotton wool, safety pin, tuning fork, reflex hammer and a small key to test the plantar response. Few of these are required at the accident scene. This is because, in the hospital, the aim is optimal definitive treatment. At the accident scene, the aim is prevention of secondary injury, rapid recording of the most important findings and safe efficient transport to the hospital. This short paper reviews how the local doctor should undertake a neurosurgical assessment of traumatic brain injury patients. Moreover, the primary management at accident scenes is described and the rationale behind the approach is outlined

  2. Place of Budget Management in the General System of Trade Enterprise Management

    OpenAIRE

    Kravchenko Olena S.; Brahina Olha S.

    2014-01-01

    The article grounds urgency of identification of the place of budget management in the general system of trade enterprise management. It analyses points of view of economists with respect to definitions of the “budgeting” and “budget management” terms. It considers main functions of budget management. It identifies the place of budget management in the general system of enterprise management. Pursuant to definition of the budget management as a managerial technology, which should meet a numbe...

  3. Interpretive Management: What General Managers Can Learn from Design.

    Science.gov (United States)

    Lester, Richard K.; Piore, Michael J.; Malek, Kamal M.

    1998-01-01

    An analytical management approach reflects a traditional perspective and an interpretive approach involves a perspective suited to rapidly changing, unpredictable markets. Both approaches are valid, but each serves different purposes and calls for different strategies and skills. (JOW)

  4. [Management of eyelid tumors: general considerations].

    Science.gov (United States)

    Lasudry, J

    2011-12-01

    Despite the fact that the majority of eyelid tumors are benign, proper management in daily practice requires detection of the malignant ones. Several clinical criteria are usually proposed to support or reject a hypothesis of malignancy; however, most are of limited reliability. In any case of doubt, outpatient biopsy is recommended, so as to establish the correct diagnosis and formulate the most appropriate treatment plan. In all facial malignancies, the first (and absolutely mandatory) consideration is control of the cancer. Then, restoration of eyelid function can be addressed, in the following order: protection of the globe by complete dynamic eyelid closure and opening, visual function (and prevention of possible deprivation amblyopia) by insuring a clear visual axis, correction of the tear film, efficient lachrymal drainage, and only then the role of the eyelids in facial expression and esthetics. For most malignant eyelid tumors, the best assurance of complete excision is obtained by extemporaneous examination of the resection margins by frozen section (by Mohs' micrographic surgery techniques, or a variation thereof). Currently, advancement and transposition flaps, possibly in combination with tarso-conjunctival or skin grafts, are the most utilised techniques. Despite the lack of histological verification, new treatment modalities, including topical chemotherapy, photodynamic therapy and cryotherapy, may provide interesting treatment options, particularly in collaboration with the dermatologist. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  5. Surgical management of generalized gingival enlargement - a case series

    International Nuclear Information System (INIS)

    Akhtar, M.U.; Nazir, A.; Montmorency College of Dentistry, Lahore; Kiran, S.; Montmorency College of Dentistry, Lahore

    2014-01-01

    Generalized gingival enlargement is characterized by massive and exuberant gingival overgrowth that poses social, aesthetic, phonetic and functional problems for the patient. Therefore, it requires meticulous management. Objective: To describe the surgical management of generalized gingival enlargement by electrosurgical excision of patients presenting to a tertiary care centre. Study Design: Case series. Materials and Methods: The study was conducted at the Department of Oral and Maxillofacial Surgery, de'Montmorency College of Dentistry, Lahore, from January 2010 to December 2012. A total of sixteen patients were operated by using electrosurgical approach under general anaesthesia for surgical excision of generalized gingival enlargement. Results: All of the sixteen patients, 11 males and 5 females, showed excellent healing postoperatively without any recurrent gingival overgrowth. Discussion: To the best of our knowledge, the current study presents the largest case series of generalized gingival enlargement. Most of these cases were with massive disease due to lack of information of the study population about their disease, delay in referral by the general dental practitioners, painless and innocent nature of the problem. Early referral of such patients to tertiary care centers can prevent the patients from social and psychological embarrassment. Conclusion: Electrosurgical excision is an excellent surgical technique for management of generalized gingival enlargement. Moreover, cross comparative studies are required to establish some diagnostic and therapeutic standards for such patients. (author)

  6. Dental management of hemophiliac child under general anesthesia.

    Science.gov (United States)

    Rayen, R; Hariharan, V S; Elavazhagan, N; Kamalendran, N; Varadarajan, R

    2011-01-01

    Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  7. Dental management of hemophiliac child under general anesthesia

    Directory of Open Access Journals (Sweden)

    R Rayen

    2011-01-01

    Full Text Available Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  8. Modification and Test of the CSU-13 B/P G-Suit for Use in the F/A-22

    National Research Council Canada - National Science Library

    Balldin, Ulf; O'Connor, Robert; Isdahl, Wayne; Werchan, Paul

    2005-01-01

    ...., burst leakage, and fill rate up to +9 G. Six human subjects were tested in the centrifuge with the CSU 13 B/P G-suit with hose inlet on the right or left side, and with COMBAT EDGE and Advanced Technology G Suit (CE-ATAGS...

  9. Generalized File Management System or Proto-DBMS?

    Science.gov (United States)

    Braniff, Tom

    1979-01-01

    The use of a data base management system (DBMS) as opposed to traditional data processing is discussed. The generalized file concept is viewed as an entry level step to the DBMS. The transition process from one system to the other is detailed. (SF)

  10. Municipal solid waste management problems: an applied general equilibrium analysis

    NARCIS (Netherlands)

    Bartelings, H.

    2003-01-01

    Keywords: Environmental policy; General equilibrium modeling; Negishi format; Waste management policies; Market distortions.

    About 40% of the entire budget spent on environmental problems in the

  11. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  12. Evaluation of general dentists’ knowledge regarding management of dental trauma

    Directory of Open Access Journals (Sweden)

    Nasim Seyfi

    2017-03-01

    Full Text Available Background and Aims: Traumatic dental injuries (TDIs are of the most common dental problems in children and adolescents, which usually occur in the anterior segment and have a significant role in patient’s physical and psychological health. Immediate intervention for damaged teeth can elevate the success rate of treatment in TDI. Thus, general dentists’ knowledge and their effective intervention in TDI are important factors in prognosis of traumatized teeth. The objective of this study was to assess the general dentists’ knowledge and awareness regarding the diagnosis and management of traumatic dental injuries. Materials and Methods: In this cross-sectional study, the questionnaire data were collected from 130 general dentists, including the demographic data and general dentists’ knowledge about TDIs. The data were analyzed using the Student t-test and Analysis of Variance (ANOVA, Spearman’s and Pearson’s correlation coefficient. Results: The mean score of general dentists’ knowledge was 8.5 ± 1.5 (total score:10 and it was the same between both males and females (P=0.083. Dentists’ work place does not have any influence in their knowledge (P=0.133. Also, there was no statically significant relationship between the age, job experience and dentists’ knowledge (P=0.805. The relationship between the frequency of TDI managed cases and dentists’ knowledge was not significant (P=0.507. Conclusion: Considering that the overall knowledge of general dentists regarding the management of TDI was sufficient, it could be a good opportunity in treating these injuries. As TDI is a developing science, it is important to motivate general dentists being up to date regarding this matter.

  13. Place of Budget Management in the General System of Trade Enterprise Management

    Directory of Open Access Journals (Sweden)

    Kravchenko Olena S.

    2014-01-01

    Full Text Available The article grounds urgency of identification of the place of budget management in the general system of trade enterprise management. It analyses points of view of economists with respect to definitions of the “budgeting” and “budget management” terms. It considers main functions of budget management. It identifies the place of budget management in the general system of enterprise management. Pursuant to definition of the budget management as a managerial technology, which should meet a number of requirements, which would be determined by specific features of enterprise practical activity, the article identifies its main principles. It groups principles of budget management in accordance with the functions it performs.

  14. Managing corneal foreign bodies in office-based general practice.

    Science.gov (United States)

    Fraenkel, Alison; Lee, Lawrence R; Lee, Graham A

    2017-03-01

    Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

  15. Stakeholders Involvement in Performance Management in Public General Schools

    Directory of Open Access Journals (Sweden)

    Kristi Ploom

    2013-01-01

    Full Text Available In response to increasing concerns with the legitimacy and efficiency of public spending, performance management as a part of world-wide public sector reform, called New Public Management (NPM has taken place. This is also the case of educational sector. In Estonian education system, legislation formally enables to design an integrated performance management system. But there is few research done to investigate how these policies and regulations ought to be put into force in order to gain the benefits considering the schools' and pupils' better performance. This study investigates how different stakeholders are involved into the performance management in Estonian general schools. The study is based on empirical survey data gathered from 303 schools providing secondary education in Estonia. The research findings have three main implications. Firstly, the paper contributes to the scarce knowledge about implementation of performance management issues in public schools. Our analysis revealed that compilation of school development plans in Estonian schools is rather a formal obligation. Therefore we propose that the analysis and discussion of the school development plans is needed to organize on regional level, involving all main stakeholders of a school. Secondly, we suggest that in the circumstances of a decentralised education system, like in Estonia, it is needed to implement, central practical performance assessment principles and guidance for the schools. Thirdly, it is highly necessary to improve schools’ cooperation with different stakeholder groups. Also the framework involving different stakeholder groups in the decentralized schools management system should be built up.

  16. Chinese hotel general managers' perspectives on energy-saving practices

    Science.gov (United States)

    Zhu, Yidan

    As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

  17. Leadership and management curriculum planning for Iranian general practitioners.

    Science.gov (United States)

    Khosravan, Shahla; Karimi Moonaghi, Hossein; Yazdani, Shahram; Ahmadi, Soleiman; Mansoorian, Mohammad Reza

    2015-10-01

    Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern's curriculum planning cycle. This study was conducted in 2011- 2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern's curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin's method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14. In the qualitatively stage of  this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3.59. Other results were shown in the paper

  18. Financial management challenges for general hospital psychiatry 2001.

    Science.gov (United States)

    Goldberg, R J

    2001-01-01

    Psychiatry programs are facing significant business and financial challenges. This paper provides an overview of these management challenges in five areas: departmental, hospital, payment system, general finance, and policy. Psychiatric leaders will require skills in a variety of business management areas to ensure their program success. Many programs will need to develop new compensation models with more of an emphasis on revenue collection and overhead management. Programs which cannot master these areas are likely to go out of business. For academic programs, incentive systems must address not only clinical productivity, but academic and teaching output as well. General hospital programs will need to develop increased sophistication in differential cost accounting in order to be able to advocate for their patients and program in the current management climate. Clinical leaders will need the skills (ranging from actuarial to negotiations) to be at the table with contract development, since those decisions are inseparable from clinical care issues. Strategic planning needs to consider the value of improving integration with primary care, along with the ability to understand the advantages and disadvantages of risk-sharing models. Psychiatry leaders need to define and develop useful reports shared with clinical division leadership to track progress and identify problems and opportunities. Leaders should be responsible for a strategy for developing appropriate information system architecture and infrastructure. Finally, it is hoped that some leaders will emerge who can further our needs to address inequities in mental health fee schedules and parity issues which affect our program viability.

  19. Smart Management in Effective Schools: Effective Management Configurations in General and Vocational Education in the Netherlands

    Science.gov (United States)

    Hofman, W. H. Adriaan; Hofman, Roelande H.

    2011-01-01

    Purpose: In this study the authors focus on different (configurations of) leadership or management styles in schools for general and vocational education. Findings: Using multilevel (students and schools) analyses, strong differences in effective management styles between schools with different student populations were observed. Conclusions: The…

  20. What's it worth? A general manager's guide to valuation.

    Science.gov (United States)

    Luehrman, T A

    1997-01-01

    Behind every major resource-allocation decision a company makes lies some calculation of what that move is worth. So it is not surprising that valuation is the financial analytical skill general managers want to learn more than any other. Managers whose formal training is more than a few years old, however, are likely to have learned approaches that are becoming obsolete. What do generalists need in an updated valuation tool kit? In the 1970s, discounted-cash-flow analysis (DCF) emerged as best practice for valuing corporate assets. And one version of DCF-using the weighted-average cost of capital (WACC)-became the standard. Over the years, WACC has been used by most companies as a one-size-fits-all valuation tool. Today the WACC standard is insufficient. Improvements in computers and new theoretical insights have given rise to tools that outperform WACC in the three basic types of valuation problems managers face. Timothy Luehrman presents an overview of the three tools, explaining how they work and when to use them. For valuing operations, the DCF methodology of adjusted present value allows managers to break a problem into pieces that make managerial sense. For valuing opportunities, option pricing captures the contingent nature of investments in areas such as R&D and marketing. And for valuing ownership claims, the tool of equity cash flows helps managers value their company's stake in a joint venture, a strategic alliance, or an investment that uses project financing.

  1. Management of osteoarthritis in general practice in Australia.

    Science.gov (United States)

    Brand, Caroline A; Harrison, Christopher; Tropea, Joanne; Hinman, Rana S; Britt, Helena; Bennell, Kim

    2014-04-01

    To describe management of osteoarthritis (OA) of the hip (OA-hip) and knee (OA-knee) by Australian general practitioners (GPs). We analyzed data from the Bettering the Evaluation and Care of Health program, from April 1, 2005 to March 31, 2010. Patient and GP characteristics and encounter management data were extracted. Data were classified by the International Classification of Primary Care, version 2, and summarized using descriptive statistics and 95% confidence intervals around point estimates. There were 489,900 GP encounters at which OA was managed (rate of 26.4 per 1,000 encounters). OA-hip was managed at a rate of 2.3 per 1,000 encounters (n = 1,106, 8.6% OA) and OA-knee at a rate of 6.2 per 1,000 (n = 3,058, 23.7% OA). The encounter management rate per 1,000 for OA-hip was higher among non-metropolitan dwellers (2.85 per 1,000 versus 1.97 per 1,000) and lower for non-English-speaking people (1.53 per 1,000 encounters versus 2.39 per 1,000). The rate for OA-knee was higher for non-English-speaking background (8.50 per 1,000 encounters versus 6.24 per 1,000) and lower among indigenous people (3.16 per 1,000 encounters versus 6.46 per 1,000). Referral to an orthopedic surgeon was the most frequently used nonpharmacologic management (OA-knee 17.4 per 100 contacts and OA-hip 17.7 per 100), followed by advice, education, and counselling. As first-line treatment, medication prescription rates (OA-knee 78.7 per 100 contacts and OA-hip 73.2 per 100) were substantially higher than rates of lifestyle management (OA-knee 20.7 per 100 contacts and OA-hip 14.8 per 100). OA-hip and OA-knee encounters and management differ. Nonpharmacologic treatments as first-line management were low compared with pharmacologic management rates, and surgical referral rates were high. However, lack of longitudinal data limits definitive assessment of appropriateness of care. Copyright © 2014 by the American College of Rheumatology.

  2. REGISTRO: Informatic application for a general file management

    International Nuclear Information System (INIS)

    Botija, L.

    1988-01-01

    It makes easier the mechanization of a 'General File' for a great Center as it allows the management, storage, maintenance and retrieval of all the circulating documents, involving any unit or section, to be considered officially or not. Shortly, it is a system which makes possible the inclusion, within the same Data Base, of references to official and unofficial documents of different classes, as well as document associated with them, under a number of registration correlative for each document and originated by the application. (Author)

  3. REGISTRO: Informatics application for a general file management

    International Nuclear Information System (INIS)

    Botija, L.

    1988-01-01

    It makes easier the mechanization of a General Fill for a great Center as it allows the management, storage, maintenance and retrieval of all the circulating documents, involving any unit or section, to be considered officially or not. Shortly, it is a system which makes possible the inclusion, within the same Data Base, of references to official and unofficial documents of different classes, as well as document associated with them, under a number of registration correlative for each document and originated by the application. (Author)

  4. Dental management of PHACE syndrome under general anesthesia

    Directory of Open Access Journals (Sweden)

    S Fernandes

    2011-01-01

    Full Text Available PHACE syndrome was first described by Dr. Ilonia Frieden and colleagues in 1996. It is an under-recognized rather than a very rare condition among patients with large facial hemangiomas. It is challenging as it has significant neurological, vascular and airway implications. Vascular malformations compromising cerebral blood flow predispose the patient to strokes and seizures. Subglottic hemangiomas, if present, could bleed during intubation. Meticulous neurological monitoring is mandatory in those undergoing repair of the great vessels. We describe the perioperative management of a child with PHACE syndrome subjected to dental treatment under general anesthesia.

  5. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  6. Informatics application for a general file management; Aplicacion informatica para la gestion de un registro general

    Energy Technology Data Exchange (ETDEWEB)

    Botija, L

    1988-07-01

    It makes easier the mechanization of a General Fill for a great Center as it allows the management, storage, maintenance and retrieval of all the circulating documents, involving any unit or section, to be considered officially or not. Shortly, it is a system which makes possible the inclusion, within the same Data Base, of references to official and unofficial documents of different classes, as well as document associated with them, under a number of registration correlative for each document and originated by the application. (Author)

  7. General Business Model Patterns for Local Energy Management Concepts

    Energy Technology Data Exchange (ETDEWEB)

    Facchinetti, Emanuele, E-mail: emanuele.facchinetti@hslu.ch; Sulzer, Sabine [Lucerne Competence Center for Energy Research, Lucerne University of Applied Science and Arts, Horw (Switzerland)

    2016-03-03

    The transition toward a more sustainable global energy system, significantly relying on renewable energies and decentralized energy systems, requires a deep reorganization of the energy sector. The way how energy services are generated, delivered, and traded is expected to be very different in the coming years. Business model innovation is recognized as a key driver for the successful implementation of the energy turnaround. This work contributes to this topic by introducing a heuristic methodology easing the identification of general business model patterns best suited for Local Energy Management concepts such as Energy Hubs. A conceptual framework characterizing the Local Energy Management business model solution space is developed. Three reference business model patterns providing orientation across the defined solution space are identified, analyzed, and compared. Through a market review, a number of successfully implemented innovative business models have been analyzed and allocated within the defined solution space. The outcomes of this work offer to potential stakeholders a starting point and guidelines for the business model innovation process, as well as insights for policy makers on challenges and opportunities related to Local Energy Management concepts.

  8. REJUVENATING CHRONIC DISEASE MANAGEMENT IN MALAYSIAN PRIVATE GENERAL PRACTICE

    Directory of Open Access Journals (Sweden)

    PITERMAN L

    2010-01-01

    Full Text Available Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden tothe patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary careglobally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT(strengths, weaknesses, opportunities and threats analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.

  9. General Business Model Patterns for Local Energy Management Concepts

    International Nuclear Information System (INIS)

    Facchinetti, Emanuele; Sulzer, Sabine

    2016-01-01

    The transition toward a more sustainable global energy system, significantly relying on renewable energies and decentralized energy systems, requires a deep reorganization of the energy sector. The way how energy services are generated, delivered, and traded is expected to be very different in the coming years. Business model innovation is recognized as a key driver for the successful implementation of the energy turnaround. This work contributes to this topic by introducing a heuristic methodology easing the identification of general business model patterns best suited for Local Energy Management concepts such as Energy Hubs. A conceptual framework characterizing the Local Energy Management business model solution space is developed. Three reference business model patterns providing orientation across the defined solution space are identified, analyzed, and compared. Through a market review, a number of successfully implemented innovative business models have been analyzed and allocated within the defined solution space. The outcomes of this work offer to potential stakeholders a starting point and guidelines for the business model innovation process, as well as insights for policy makers on challenges and opportunities related to Local Energy Management concepts.

  10. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  11. Improvement of the Model of Enterprise Management Process on the Basis of General Management Functions

    Directory of Open Access Journals (Sweden)

    Ruslan Skrynkovskyy

    2017-12-01

    Full Text Available The purpose of the article is to improve the model of the enterprise (institution, organization management process on the basis of general management functions. The graphic model of the process of management according to the process-structured management is presented. It has been established that in today's business environment, the model of the management process should include such general management functions as: 1 controlling the achievement of results; 2 planning based on the main goal; 3 coordination and corrective actions (in the system of organization of work and production; 4 action as a form of act (conscious, volitional, directed; 5 accounting system (accounting, statistical, operational-technical and managerial; 6 diagnosis (economic, legal with such subfunctions as: identification of the state and capabilities; analysis (economic, legal, systemic with argumentation; assessment of the state, trends and prospects of development. The prospect of further research in this direction is: 1 the formation of a system of interrelation of functions and management methods, taking into account the presented research results; 2 development of the model of effective and efficient communication business process of the enterprise.

  12. Management of perforated peptic ulcer in a district general hospital.

    Science.gov (United States)

    Critchley, A C; Phillips, A W; Bawa, S M; Gallagher, P V

    2011-11-01

    Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

  13. Relationship between harmonic analysis on SU(2) and on SL(2,C)/SU(2)

    International Nuclear Information System (INIS)

    Healy, D.M. Jr.

    1986-01-01

    A topic of interest in harmonic analysis is the comparison of Fourier transforms on compact and noncompact spaces. The Poisson summation formula provides a classical example of this idea by providing an explicit relationship between harmonic analysis on the real line R and on the circle S 1 . This dissertation provides a new geometric proof of this formula, and then generalizes this approach to obtain a relationship between Fourier transforms on Upsilon, the space of positive matrices in SL(2,C), and Fourier transforms on SU(2)

  14. Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals.

    Science.gov (United States)

    Hendel, Tova; Fish, Miri; Galon, Vered

    2005-03-01

    To identify conflict mode choices of head nurses in general hospitals and examine the relationship between leadership style, choice of strategy in handling conflicts and demographic characteristics. Nurse managers deal with conflicts daily. The choice of conflict management mode is associated with managerial effectiveness. The ability to creatively manage conflict situations, towards constructive outcomes is becoming a standard requirement. Head nurses (N = 60) in five general hospitals in central Israel were surveyed, using a 3-part questionnaire: The Thomas-Kilmann Conflict Mode Instrument, the Multi-factor Leadership Questionnaire, Form 5X-Short (MLQ 5X) and demographic data. Head nurses perceive themselves significantly more as transformational leaders than as transactional leaders. Compromise was found to be the most commonly used conflict management strategy. Approximately half of the nurses surveyed used only one mode in conflict management. Transformational leadership significantly affected the conflict strategy chosen. Head nurses tend to choose a conflict-handling mode which is concerned a form of a Lose-Lose approach. Preparation in conflict management should start from undergraduate education.

  15. Selected General Controls Over the Defense Business Management System

    National Research Council Canada - National Science Library

    1996-01-01

    .... The Defense Business Management System performs appropriation accounting, cost accounting, personnel, payroll, manpower, and management information functions for the Navy, the Air Force, five Defense...

  16. Monitoring Based Commissioning: Benchmarking Analysis of 24 UC/CSU/IOU Projects

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Evan; Mathew, Paul

    2009-04-01

    Buildings rarely perform as intended, resulting in energy use that is higher than anticipated. Building commissioning has emerged as a strategy for remedying this problem in non-residential buildings. Complementing traditional hardware-based energy savings strategies, commissioning is a 'soft' process of verifying performance and design intent and correcting deficiencies. Through an evaluation of a series of field projects, this report explores the efficacy of an emerging refinement of this practice, known as monitoring-based commissioning (MBCx). MBCx can also be thought of as monitoring-enhanced building operation that incorporates three components: (1) Permanent energy information systems (EIS) and diagnostic tools at the whole-building and sub-system level; (2) Retro-commissioning based on the information from these tools and savings accounting emphasizing measurement as opposed to estimation or assumptions; and (3) On-going commissioning to ensure efficient building operations and measurement-based savings accounting. MBCx is thus a measurement-based paradigm which affords improved risk-management by identifying problems and opportunities that are missed with periodic commissioning. The analysis presented in this report is based on in-depth benchmarking of a portfolio of MBCx energy savings for 24 buildings located throughout the University of California and California State University systems. In the course of the analysis, we developed a quality-control/quality-assurance process for gathering and evaluating raw data from project sites and then selected a number of metrics to use for project benchmarking and evaluation, including appropriate normalizations for weather and climate, accounting for variations in central plant performance, and consideration of differences in building types. We performed a cost-benefit analysis of the resulting dataset, and provided comparisons to projects from a larger commissioning 'Meta-analysis' database. A

  17. A generalization information management system applied to electrical distribution

    Energy Technology Data Exchange (ETDEWEB)

    Geisler, K.I.; Neumann, S.A.; Nielsen, T.D.; Bower, P.K. (Empros Systems International (US)); Hughes, B.A.

    1990-07-01

    This article presents a system solution approach that meets the requirements being imposed by industry trends and the electric utility customer. Specifically, the solution addresses electric distribution management systems. Electrical distribution management is a particularly well suited area of application because it involves a high diversity of tasks, which are currently supported by a proliferation of automated islands. Islands of automation which currently exist include (among others) distribution operations, load management, automated mapping, facility management, work order processing, and planning.

  18. Design management of general contractor under nuclear power project EPC mode

    International Nuclear Information System (INIS)

    Su Shaojian

    2013-01-01

    Design management has not yet formed a theoretical system recognized, general contractor design managers under nuclear power project EPC Mode lack the clear theory basis. This paper aims to discuss Design management from the angle of general contractor under nuclear power project EPC mode, Gives the concept of design management Clearly, by Combining the characteristics of nuclear power project, Gives the specific content and meaning of the design management of nuclear power project. (authors)

  19. Predisposal Management of Radioactive Waste. General Safety Requirements Pt. 5

    International Nuclear Information System (INIS)

    2010-01-01

    There are a large number of facilities and activities around the world in which radioactive material is produced, handled and stored. This Safety Requirements publication presents international consensus requirements for the management of radioactive waste prior to its disposal. It provides the safety imperatives on the basis of which facilities can be designed, operated and regulated. The publication is supported by a number of Safety Guides that provide up to date recommendations and guidance on best practices for management of particular types of radioactive waste, for storage of radioactive waste, for assuring safety by developing safety cases and supporting safety assessments, and for applying appropriate management systems. Contents: 1. Introduction; 2. Protection of human health and the environment; 3. Responsibilities associated with the predisposal management of radioactive waste; 4. Steps in the predisposal management of radioactive waste; 5. Development and operation of predisposal radioactive waste management facilities and activities; Annex: Predisposal management of radioactive waste and the fundamental safety principles.

  20. Predisposal Management of Radioactive Waste. General Safety Requirements Pt. 5

    International Nuclear Information System (INIS)

    2009-01-01

    There are a large number of facilities and activities around the world in which radioactive material is produced, handled and stored. This Safety Requirements publication presents international consensus requirements for the management of radioactive waste prior to its disposal. It provides the safety imperatives on the basis of which facilities can be designed, operated and regulated. The publication is supported by a number of Safety Guides that provide up to date recommendations and guidance on best practices for management of particular types of radioactive waste, for storage of radioactive waste, for assuring safety by developing safety cases and supporting safety assessments, and for applying appropriate management systems. Contents: 1. Introduction; 2. Protection of human health and the environment; 3. Responsibilities associated with the predisposal management of radioactive waste; 4. Steps in the predisposal management of radioactive waste; 5. Development and operation of predisposal radioactive waste management facilities and activities; Annex: Predisposal management of radioactive waste and the fundamental safety principles.

  1. 29 CFR 541.201 - Directly related to management or general business operations.

    Science.gov (United States)

    2010-07-01

    ... management or general business operations. (a) To qualify for the administrative exemption, an employee's... operations of the employer or the employer's customers. The phrase “directly related to the management or... 29 Labor 3 2010-07-01 2010-07-01 false Directly related to management or general business...

  2. 41 CFR 105-1.101 - General Services Administration Property Management Regulations.

    Science.gov (United States)

    2010-07-01

    ...-INTRODUCTION 1.1-Regulations System § 105-1.101 General Services Administration Property Management Regulations... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General Services Administration Property Management Regulations. 105-1.101 Section 105-1.101 Public Contracts and Property...

  3. 24 CFR 990.310 - Purpose-General policy on financial management, monitoring and reporting.

    Science.gov (United States)

    2010-04-01

    ... Management Systems, Monitoring, and Reporting § 990.310 Purpose—General policy on financial management, monitoring and reporting. All PHA financial management systems, reporting, and monitoring of program... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Purpose-General policy on financial...

  4. 75 FR 28055 - General Management Plan; Joshua Tree National Park; San Bernardino and Riverside Counties, CA...

    Science.gov (United States)

    2010-05-19

    ... kinds of resource management activities, visitor activities, and developments that would be appropriate... DEPARTMENT OF THE INTERIOR National Park Service General Management Plan; Joshua Tree National... National Park Service is updating the General Management Plan (GMP) for Joshua Tree National Park...

  5. 78 FR 13081 - Draft Environmental Impact Statement for General Management Plan, Everglades National Park, Florida

    Science.gov (United States)

    2013-02-26

    ... visitor use in the Park. The GMP will provide updated management direction for the entire park. The EEWS....YP0000] Draft Environmental Impact Statement for General Management Plan, Everglades National Park... the General Management Plan (GMP) and East Everglades Wilderness Study (EEWS) for Everglades National...

  6. 12 CFR 615.5180 - Interest rate risk management by banks-general.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Interest rate risk management by banks-general... FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Risk Assessment and Management § 615.5180 Interest rate risk management by banks—general. The board of directors of each Farm Credit Bank...

  7. Leadership and Management for Safety. General Safety Requirements (Spanish Edition)

    International Nuclear Information System (INIS)

    2017-01-01

    his Safety Requirements publication establishes requirements that support Principle 3 of the Fundamental Safety Principles in relation to establishing, sustaining and continuously improving leadership and management for safety and an integrated management system. It emphasizes that leadership for safety, management for safety, an effective management system and a systemic approach (i.e. an approach in which interactions between technical, human and organizational factors are duly considered) are all essential to the specification and application of adequate safety measures and to the fostering of a strong safety culture. Leadership and an effective management system will integrate safety, health, environmental, security, quality, human-and-organizational factors, societal and economic elements. The management system will ensure the fostering of a strong safety culture, regular assessment of performance and the application of lessons from experience. The publication is intended for use by regulatory bodies, operating organizations and other organizations concerned with facilities and activities that give rise to radiation risks.

  8. Leadership and Management for Safety. General Safety Requirements (French Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This Safety Requirements publication establishes requirements that support Principle 3 of the Fundamental Safety Principles in relation to establishing, sustaining and continuously improving leadership and management for safety and an integrated management system. It emphasizes that leadership for safety, management for safety, an effective management system and a systemic approach (i.e. an approach in which interactions between technical, human and organizational factors are duly considered) are all essential to the specification and application of adequate safety measures and to the fostering of a strong safety culture. Leadership and an effective management system will integrate safety, health, environmental, security, quality, human-and-organizational factors, societal and economic elements. The management system will ensure the fostering of a strong safety culture, regular assessment of performance and the application of lessons from experience. The publication is intended for use by regulatory bodies, operating organizations and other organizations concerned with facilities and activities that give rise to radiation risks.

  9. Leadership and Management for Safety. General Safety Requirements (Arabic Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This Safety Requirements publication establishes requirements that support Principle 3 of the Fundamental Safety Principles in relation to establishing, sustaining and continuously improving leadership and management for safety and an integrated management system. It emphasizes that leadership for safety, management for safety, an effective management system and a systemic approach (i.e. an approach in which interactions between technical, human and organizational factors are duly considered) are all essential to the specification and application of adequate safety measures and to the fostering of a strong safety culture. Leadership and an effective management system will integrate safety, health, environmental, security, quality, human-and-organizational factors, societal and economic elements. The management system will ensure the fostering of a strong safety culture, regular assessment of performance and the application of lessons from experience. The publication is intended for use by regulatory bodies, operating organizations and other organizations concerned with facilities and activities that give rise to radiation risks.

  10. Leadership and Management for Safety. General Safety Requirements (Chinese Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This Safety Requirements publication establishes requirements that support Principle 3 of the Fundamental Safety Principles in relation to establishing, sustaining and continuously improving leadership and management for safety and an integrated management system. It emphasizes that leadership for safety, management for safety, an effective management system and a systemic approach (i.e. an approach in which interactions between technical, human and organizational factors are duly considered) are all essential to the specification and application of adequate safety measures and to the fostering of a strong safety culture. Leadership and an effective management system will integrate safety, health, environmental, security, quality, human-and-organizational factors, societal and economic elements. The management system will ensure the fostering of a strong safety culture, regular assessment of performance and the application of lessons from experience. The publication is intended for use by regulatory bodies, operating organizations and other organizations concerned with facilities and activities that give rise to radiation risks.

  11. Leadership and Management for Safety. General Safety Requirements

    International Nuclear Information System (INIS)

    2016-01-01

    This Safety Requirements publication establishes requirements that support Principle 3 of the Fundamental Safety Principles in relation to establishing, sustaining and continuously improving leadership and management for safety and an integrated management system. It emphasizes that leadership for safety, management for safety, an effective management system and a systemic approach (i.e. an approach in which interactions between technical, human and organizational factors are duly considered) are all essential to the specification and application of adequate safety measures and to the fostering of a strong safety culture. Leadership and an effective management system will integrate safety, health, environmental, security, quality, human-and-organizational factor, societal and economic elements. The management system will ensure the fostering of a strong safety culture, regular assessment of performance and the application of lessons from experience. The publication is intended for use by regulatory bodies, operating organizations (registrants and licensees) and other organizations concerned with facilities and activities that give rise to radiation risks

  12. CLOUDCLOUD : general-purpose instrument monitoring and data managing software

    Science.gov (United States)

    Dias, António; Amorim, António; Tomé, António

    2016-04-01

    An effective experiment is dependent on the ability to store and deliver data and information to all participant parties regardless of their degree of involvement in the specific parts that make the experiment a whole. Having fast, efficient and ubiquitous access to data will increase visibility and discussion, such that the outcome will have already been reviewed several times, strengthening the conclusions. The CLOUD project aims at providing users with a general purpose data acquisition, management and instrument monitoring platform that is fast, easy to use, lightweight and accessible to all participants of an experiment. This work is now implemented in the CLOUD experiment at CERN and will be fully integrated with the experiment as of 2016. Despite being used in an experiment of the scale of CLOUD, this software can also be used in any size of experiment or monitoring station, from single computers to large networks of computers to monitor any sort of instrument output without influencing the individual instrument's DAQ. Instrument data and meta data is stored and accessed via a specially designed database architecture and any type of instrument output is accepted using our continuously growing parsing application. Multiple databases can be used to separate different data taking periods or a single database can be used if for instance an experiment is continuous. A simple web-based application gives the user total control over the monitored instruments and their data, allowing data visualization and download, upload of processed data and the ability to edit existing instruments or add new instruments to the experiment. When in a network, new computers are immediately recognized and added to the system and are able to monitor instruments connected to them. Automatic computer integration is achieved by a locally running python-based parsing agent that communicates with a main server application guaranteeing that all instruments assigned to that computer are

  13. Management of Clostridium difficile diarrhoea in District General ...

    African Journals Online (AJOL)

    ... four cases of Clostridium difficile in our hospital over duration of three months. We looked into the demographic features of the patient population and compliance with the Trust guidelines for the management of the diarrhoea. Keywords:Diarrhoea, Clostridium difficile, Management. Internet Journal of Medical Update Vol.

  14. 41 CFR 102-192.130 - What are your general responsibilities as an agency mail manager?

    Science.gov (United States)

    2010-07-01

    ... responsibilities as an agency mail manager? 102-192.130 Section 102-192.130 Public Contracts and Property... ADMINISTRATIVE PROGRAMS 192-MAIL MANAGEMENT Agency Mail Manager Requirements § 102-192.130 What are your general responsibilities as an agency mail manager? In addition to carrying out the responsibilities in Subparts B, C, D...

  15. How Agile Methods Conquers General Project Management - The Project Half Double Initiative

    DEFF Research Database (Denmark)

    Tordrup Heeager, Lise; Svejvig, Per; Schlichter, Bjarne Rerup

    2016-01-01

    Increased complexity in projects has forced new project management initiatives. In software development several agile methods have emerged and methods such as Scrum are today highly implemented in practice. General project management practice has been inspired by agile software development...

  16. 75 FR 71730 - General Management Plan/Wilderness Study/Off-Road Vehicle Management Plan, Final Environmental...

    Science.gov (United States)

    2010-11-24

    ... management under alternative B would be to enable visitor participation in a wide variety of outdoor... DEPARTMENT OF THE INTERIOR National Park Service [2031-A046-409] General Management Plan/Wilderness Study/Off-Road Vehicle Management Plan, Final Environmental Impact Statement, Big Cypress National...

  17. Financial Management: Ending Balance Adjustments to General Ledger Data for the Army General Fund

    National Research Council Canada - National Science Library

    2002-01-01

    The Chief Financial Officers Act of 1990, Public Law 101-576, November 15, 1990, as amended by the Federal Financial Management Act of 1994, Public Law 103-356, October 13, 1994, requires the annual...

  18. Predisposal management of radioactive waste. General safety requirements. Pt. 5

    International Nuclear Information System (INIS)

    2009-01-01

    The objective of this Safety Requirements publication is to establish, the requirements that must be satisfied in the predisposal management of radioactive waste. This publication sets out the objectives, criteria and requirements for the protection of human health and the environment that apply to the siting, design, construction, commissioning, operation and shutdown of facilities for the predisposal management of radioactive waste, and the requirements that must be met to ensure the safety of such facilities and activities. This Safety Requirements publication applies to the predisposal management of radioactive waste of all types and covers all the steps in its management from its generation up to its disposal, including its processing (pretreatment, treatment and conditioning), storage and transport. Such waste may arise from the commissioning, operation and decommissioning of nuclear facilities; the use of radionuclides in medicine, industry, agriculture, research and education; the processing of materials that contain naturally occurring radionuclides; and the remediation of contaminated areas. The introduction of the document (Section 1) informs about its objective, scope and structure. The protection of human health and the environment is considered in Section 2 of this publication. Section 3 establishes requirements for the responsibilities associated with the predisposal management of radioactive waste. Requirements for the principal approaches to and the elements of the predisposal management of radioactive waste are established in Section 4. Section 5 establishes requirements for the safe development and operation of predisposal radioactive waste management facilities and safe conduct of activities. The Annex presents a discussion of the consistency of the safety requirements established in this publication with the fundamental safety principles

  19. Management of needlestick injuries in general dental practice

    OpenAIRE

    Smith, A.J.; Cameron, S.O.; Bagg, J.; Kennedy, D.

    2001-01-01

    The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing con...

  20. Health Management Technology as a General Solution Framework

    Science.gov (United States)

    Nakajima, Hiroshi; Hasegawa, Yoshifumi; Tasaki, Hiroshi; Iwami, Taro; Tsuchiya, Naoki

    Health maintenance and improvement of humans, artifacts, and nature are pressing requirements considering the problems human beings have faced. In this article, the health management technology is proposed by centering cause-effect structure. The important aspect of the technology is evolvement through human-machine collaboration in response to changes of target systems. One of the reasons why the cause-effect structure is centered in the technology is its feature of transparency to humans by instinct point of view. The notion has been spreaded over wide application areas such as quality control, energy management, and healthcare. Some experiments were conducted to prove effectiveness of the technology in the article.

  1. Management and marketing for the general practice dental office.

    Science.gov (United States)

    Clarkson, Earl; Bhatia, Sanjeev

    2008-07-01

    This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

  2. GENERAL ASPECTS REGARDING THE MANAGEMENT ACTIVITY IN INTERNATIONAL BUSINESS

    Directory of Open Access Journals (Sweden)

    Mihaela Loredana LĂPĂDUŞI

    2010-09-01

    Full Text Available The strategy of penetrating and developing the external markets is an important objective of the international enterprises management. This involves a specific analysis of the business environment for illustrating the opportunities of business and risks and the business potential of a particular enterprise in order to establish the internalisation objectives and types. The international management is individualised by the environment where the enterprises develop their economical activity, supposing that the world market of international business involves the access to new markets and the enterprises must adapt to the specific needs and opportunities.

  3. Acitretin for the management of generalized cutaneous lichen planus.

    Science.gov (United States)

    Vazirnia, Aria; Cohen, Philip R

    2014-09-16

    Lichen planus is an inflammatory disease that affects the skin, the oral mucosa, or both. Generalized cutaneous lichen planus may pose a therapeutic challenge for clinicians if the condition persists or flares after topical or systemic corticosteroid therapy. Acitretin, a systemic retinoid, can be considered a potential second-line treatment for patients with generalized cutaneous lichen planus. Herein, we describe a postmenopausal woman with generalized cutaneous lichen planus who was successfully treated with acitretin. A 58-year-old woman presented with generalized cutaneous lichen planus involving her upper and lower extremities as well as her lower back. After failing corticosteroid therapy, she was started on acitretin 20 mg/day, which was later increased to 30 mg/day. To review the literature on the use of acitretin in cutaneous lichen planus, we used the PubMed search engine and searched for the terms "acitretin" and "cutaneous lichen planus." Our patient had complete resolution of pruritus within one week of initiating acitretin 20 mg/day. After an increase in dose to 30 mg/day, the cutaneous lesions completely resolved over a 3-month period. There was no recurrence of disease as acitretin was tapered and discontinued. Generalized cutaneous lichen planus may pose a therapeutic challenge for the symptomatic relief of skin lesions. Topical and systemic corticosteroids are first-line treatments. In patients who fail corticosteroids, relapse after corticosteroid therapy, or have contraindications to corticosteroids, acitretin may be considered a potential second-line therapy.

  4. Project management under uncertainty beyond beta: The generalized bicubic distribution

    Directory of Open Access Journals (Sweden)

    José García Pérez

    2016-01-01

    Full Text Available The beta distribution has traditionally been employed in the PERT methodology and generally used for modeling bounded continuous random variables based on expert’s judgment. The impossibility of estimating four parameters from the three values provided by the expert when the beta distribution is assumed to be the underlying distribution has been widely debated. This paper presents the generalized bicubic distribution as a good alternative to the beta distribution since, when the variance depends on the mode, the generalized bicubic distribution approximates the kurtosis of the Gaussian distribution better than the beta distribution. In addition, this distribution presents good properties in the PERT methodology in relation to moderation and conservatism criteria. Two empirical applications are presented to demonstrate the adequateness of this new distribution.

  5. Generalized Database Management System Support for Numeric Database Environments.

    Science.gov (United States)

    Dominick, Wayne D.; Weathers, Peggy G.

    1982-01-01

    This overview of potential for utilizing database management systems (DBMS) within numeric database environments highlights: (1) major features, functions, and characteristics of DBMS; (2) applicability to numeric database environment needs and user needs; (3) current applications of DBMS technology; and (4) research-oriented and…

  6. A methodology model for quality management in a general hospital.

    Science.gov (United States)

    Stern, Z; Naveh, E

    1997-01-01

    A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

  7. Management of generalized spasticity of lower limbs by selective ...

    African Journals Online (AJOL)

    Wael Fouad

    2011-08-09

    Aug 9, 2011 ... All cases underwent MDT that consisted of a longitudinal incision of the ... The methods of surgical management are classified accord- ... nerves, dorsal roots, dorsal root entry zone or spinal cord.7,8 ... bedridden and totally dependent patient). ... paraplegia of cerebral origin include cerebral palsy, cerebro-.

  8. Recurrent Pregnancy Loss: Generally Accepted Causes and Their Management.

    Science.gov (United States)

    Kaiser, Jennifer; Branch, D Ware

    2016-09-01

    Recurrent pregnancy loss (RPL), commonly defined as 3 consecutive losses causes include uterine malformation, antiphospholipid syndrome, and parental chromosomal abnormalities; however, the majority of RPL cases are idiopathic (up to 75%). This chapter covers these accepted causes of RPL and provides diagnosis and management strategies for patients falling within the above categories.

  9. Radioactive waste management at EDF plants: General overview and perspectives

    International Nuclear Information System (INIS)

    Debes, M.; Bordier, M.

    2001-01-01

    During the last fifteen years a significant decrease in solid radioactive waste generated by nuclear power plants of Electricite de France (EDF) has taken place. Technology used by EDF is described, with emphasis on innovative technologies. Experience and lessons learned are described showing how EDF has responded to meet increasingly stringent regulations for radioactive waste management. (author)

  10. General directions and practices for management of radioactive waste

    International Nuclear Information System (INIS)

    Fioroni, M.

    1990-12-01

    The present work underlines and synthesises the essential principles, directions and methodologies developed by Industrialized Nations and by the International Organizations for management of radioactive waste of high, intermediate and low levels. It fills a gap in scientific Italian literature and represents a valid introduction to the subject. (author)

  11. General RMP Guidance - Chapter 9: Risk Management Plan

    Science.gov (United States)

    You must submit one risk management plan (RMP) to EPA for all of your covered processes. The internet-based RMP*eSubmit allows you to submit your RMP in EPA's Central Data Exchange (CDX), where you can access and change/correct existing RMPs.

  12. The role of the General Practitioner in weight management in primary care – a cross sectional study in General Practice

    Directory of Open Access Journals (Sweden)

    Young Doris

    2008-12-01

    Full Text Available Abstract Background Obesity has become a global pandemic, considered the sixth leading cause of mortality by the WHO. As gatekeepers to the health system, General Practitioners are placed in an ideal position to manage obesity. Yet, very few consultations address weight management. This study aims to explore reasons why patients attending General Practice appointments are not engaging with their General Practitioner (GP for weight management and their perception of the role of the GP in managing their weight. Methods In February 2006, 367 participants aged between 17 and 64 were recruited from three General Practices in Melbourne to complete a waiting room self – administered questionnaire. Questions included basic demographics, the role of the GP in weight management, the likelihood of bringing up weight management with their GP and reasons why they would not, and their nominated ideal person to consult for weight management. Physical measurements to determine weight status were then completed. The statistical methods included means and standard deviations to summarise continuous variables such as weight and height. Sub groups of weight and questionnaire answers were analysed using the χ2 test of significant differences taking p as Results The population sample had similar obesity co-morbidity rates to the National Heart Foundation data. 74% of patients were not likely to bring up weight management when they visit their GP. Negative reasons were time limitation on both the patient's and doctor's part and the doctor lacking experience. The GP was the least likely person to tell a patient to lose weight after partner, family and friends. Of the 14% that had been told by their GP to lose weight, 90% had cardiovascular obesity related co-morbidities. GPs (15% were 4th in the list of ideal persons to manage weight after personal trainer Conclusion Patients do not have confidence in their GPs for weight management, preferring other health

  13. Fuel management optimization based on generalized perturbation theory

    International Nuclear Information System (INIS)

    White, J.R.; Chapman, D.M.; Biswas, D.

    1986-01-01

    A general methodology for optimization of assembly shuffling and burnable poison (BP) loadings for LWR reload design has been developed. The uniqueness of this approach lies in the coupling of Generalized Perturbation Theory (GPT) methods and standard Integer Programming (IP) techniques. An IP algorithm can simulate the discrete nature of the fuel shuffling and BP loading problems, and the use of GPT sensitivity data provides an efficient means for modeling the behavior of the important core performance parameters. The method is extremely flexible since the choice of objective function and the number and mix of constraints depend only on the ability of GPT to determine the appropriate sensitivity functions

  14. 76 FR 75557 - Draft Environmental Impact Statement for General Management Plan/Wilderness Study, Hawaii...

    Science.gov (United States)

    2011-12-02

    ... Environmental Impact Statement for General Management Plan/ Wilderness Study, Hawaii Volcanoes National Park, Hawaii AGENCY: National Park Service, Interior. ACTION: Notice of intent. SUMMARY: The National Park... updating the General Management Plan (GMP) for Hawaii Volcanoes National Park. As part of this conservation...

  15. Dutch general practitioners’ weight management policy for overweight and obese patients.

    NARCIS (Netherlands)

    Kloek, C.J.J.; Tol, J.; Veenhof, C.; Wulp, I. van der; Swinkels, I.C.S.

    2014-01-01

    Background: General practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy. Objective: To examine GPs’ current weight

  16. Medical Information Management System (MIMS): A generalized interactive information system

    Science.gov (United States)

    Alterescu, S.; Friedman, C. A.; Hipkins, K. R.

    1975-01-01

    An interactive information system is described. It is a general purpose, free format system which offers immediate assistance where manipulation of large data bases is required. The medical area is a prime area of application. Examples of the system's operation, commentary on the examples, and a complete listing of the system program are included.

  17. Managing RFID Sensors Networks with a General Purpose RFID Middleware

    Science.gov (United States)

    Abad, Ismael; Cerrada, Carlos; Cerrada, Jose A.; Heradio, Rubén; Valero, Enrique

    2012-01-01

    RFID middleware is anticipated to one of the main research areas in the field of RFID applications in the near future. The Data EPC Acquisition System (DEPCAS) is an original proposal designed by our group to transfer and apply fundamental ideas from System and Data Acquisition (SCADA) systems into the areas of RFID acquisition, processing and distribution systems. In this paper we focus on how to organize and manage generic RFID sensors (edge readers, readers, PLCs, etc…) inside the DEPCAS middleware. We denote by RFID Sensors Networks Management (RSNM) this part of DEPCAS, which is built on top of two new concepts introduced and developed in this work: MARC (Minimum Access Reader Command) and RRTL (RFID Reader Topology Language). MARC is an abstraction layer used to hide heterogeneous devices inside a homogeneous acquisition network. RRTL is a language to define RFID Reader networks and to describe the relationship between them (concentrator, peer to peer, master/submaster). PMID:22969370

  18. General considerations in fuel management for thermal reactors

    International Nuclear Information System (INIS)

    Tyror, J.G.; Fayers, F.J.

    1971-07-01

    By fuel management we mean the strategy for fuelling and refuelling a reactor together with any associated absorber movements. It incorporates (a) decisions made about the timing of fuel loading operations; (b) choice of enrichments to be loaded; (c) selection of sites at which reloading occurs; (d) programming of control rods and any other reactivity control facilities such as soluble or burnable poisons; and (e) evaluation of the resulting fuel element performance consequences. The topic of fuel management is thus a vast and vital one. It embraces most of the various aspects of core performance and determines many of a reactor's design characteristics. In this paper we review what to us appear to be some of the important issues in this important field

  19. Unicameral bone cysts: general characteristics and management controversies.

    Science.gov (United States)

    Pretell-Mazzini, Juan; Murphy, Robert Francis; Kushare, Indranil; Dormans, John P

    2014-05-01

    Unicameral bone cysts are benign bone lesions that are often asymptomatic and commonly develop in the proximal humerus and femur of skeletally immature patients. The etiology of these lesions remains unknown. Most patients present with a pathologic fracture, but these cysts can be discovered incidentally, as well. Radiographically, a unicameral bone cyst appears as a radiolucent lesion with cortical thinning and is centrally located within the metaphysis. Although diagnosis is frequently straightforward, management remains controversial. Because the results of various management methods are heterogeneous, no single method has emerged as the standard of care. New minimally invasive techniques involve cyst decompression with bone grafting and instrumentation. These techniques have yielded promising results, with low rates of complications and recurrence reported; however, prospective clinical trials are needed to compare these techniques with current evidence-based treatments.

  20. Managing Adverse and Reportable Information Regarding General and Flag Officers

    Science.gov (United States)

    2012-01-01

    require a complete reading. xvii Acknowledgments The authors appreciate the sponsor support provided by William Carr , Lernes Hebert, Cheryl Black, and...E7. 22 Managing Adverse and Reportable Information nel also review the promotion board statistics regarding race, gender , acquisition personnel... discrimination brought by service members are called “equal opportunity (EO)” complaints, or some- times “military equal opportunity (MEO)” complaints.1 In

  1. Leadership and management skills of general practice nurses: experience or education?

    Science.gov (United States)

    Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

    2014-12-01

    A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

  2. BRAND MANAGEMENT AT GENERAL MOTOR’S EUROPE

    Directory of Open Access Journals (Sweden)

    Liliana Adela ZIMA

    2013-06-01

    Full Text Available Brand is a trustworthy, relevant, and distinctive promise to the consumer. The Brand Manager must understand that he is responsible for the building of long term brand equity and he must keep the brand from both a Strategic and Tactical standpoint.The strategy of Adam Opel AG is focused on brand equity because it is important to add value for customer from products and services. The total sum of all the benefits, features, and associations, both functional and non-functional that make a brand competitive and distinctive in its market is the process of Brand Positioning. I made a study at Adam Opel AG in particularly at European Business In this study are observed the main tasks and responsibilities of each member of the team. The European Business Team has a lot of influence over the company which is a Marketing lead company. Brand Management is the management of the marketing value chain to consistently build brand equity, market share and profitability. In present, it is shifting our focus to brands, which include all the five “P”s of marketing: Product, Price, Place, Promotion and People. Our vehicles will always be a critical factor to our success. We are simply going to enhance our market potential by building on our brands at both the umbrella and vehicle line levels.

  3. 75 FR 1806 - Draft General Management Plan and Environmental Impact Statement, New River Gorge National River, WV

    Science.gov (United States)

    2010-01-13

    ... visitor experiences. Management actions would build upon the cultural resource, interpretive, and... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan and Environmental... Interior. ACTION: Notice of availability of the Draft General Management Plan and Environmental Impact...

  4. Bulk material management mode of general contractors in nuclear power project

    International Nuclear Information System (INIS)

    Zhang Jinyong; Zhao Xiaobo

    2011-01-01

    The paper introduces the characteristics of bulk material management mode in construction project, and the advantages and disadvantages of bulk material management mode of general contractors in nuclear power project. In combination with the bulk material management mode of China Nuclear Power Engineering Co., Ltd, some improvement measures have been put forward as well. (authors)

  5. Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews.

    Science.gov (United States)

    Wickramasinghe, Leelani K; Schattner, Peter; Hibbert, Marienne E; Enticott, Joanne C; Georgeff, Michael P; Russell, Grant M

    2013-08-19

    To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines. A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012. Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes). Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA(1c) level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05). There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.

  6. GENERAL RISKS AND UNCERTAINTIES OF REPORTING AND MANAGEMENT REPORTING RISKS

    Directory of Open Access Journals (Sweden)

    CAMELIA I. LUNGU

    2011-04-01

    Full Text Available Purpose: Highlighting risks and uncertainties reporting based on a literature review research. Objectives: The delimitation of risk management models and uncertainties in fundamental research. Research method: Fundamental research study directed to identify the relevant risks’ models presented in entities’ financial statements. Uncertainty is one of the fundamental coordinates of our world. As showed J.K. Galbraith (1978, the world now lives under the age of uncertainty. Moreover, we can say that contemporary society development could be achieved by taking decisions under uncertainty, though, risks. Growing concern for the study of uncertainty, its effects and precautions led to the rather recent emergence of a new science, science of hazards (les cindyniques - l.fr. (Kenvern, 1991. Current analysis of risk are dominated by Beck’s (1992 notion that a risk society now exists whereby we have become more concerned about our impact upon nature than the impact of nature upon us. Clearly, risk permeates most aspects of corporate but also of regular life decision-making and few can predict with any precision the future. The risk is almost always a major variable in real-world corporate decision-making, and managers that ignore it are in a real peril. In these circumstances, a possible answer is assuming financial discipline with an appropriate system of incentives.

  7. Managing RFID Sensors Networks with a General Purpose RFID Middleware

    Directory of Open Access Journals (Sweden)

    Enrique Valero

    2012-06-01

    Full Text Available RFID middleware is anticipated to one of the main research areas in the field of RFID applications in the near future. The Data EPC Acquisition System (DEPCAS is an original proposal designed by our group to transfer and apply fundamental ideas from System and Data Acquisition (SCADA systems into the areas of RFID acquisition, processing and distribution systems. In this paper we focus on how to organize and manage generic RFID sensors (edge readers, readers, PLCs, etc… inside the DEPCAS middleware. We denote by RFID Sensors Networks Management (RSNM this part of DEPCAS, which is built on top of two new concepts introduced and developed in this work: MARC (Minimum Access Reader Command and RRTL (RFID Reader Topology Language. MARC is an abstraction layer used to hide heterogeneous devices inside a homogeneous acquisition network. RRTL is a language to define RFID Reader networks and to describe the relationship between them (concentrator, peer to peer, master/submaster.

  8. GENERAL REQUIREMENTS FOR SIMULATION MODELS IN WASTE MANAGEMENT

    International Nuclear Information System (INIS)

    Miller, Ian; Kossik, Rick; Voss, Charlie

    2003-01-01

    Most waste management activities are decided upon and carried out in a public or semi-public arena, typically involving the waste management organization, one or more regulators, and often other stakeholders and members of the public. In these environments, simulation modeling can be a powerful tool in reaching a consensus on the best path forward, but only if the models that are developed are understood and accepted by all of the parties involved. These requirements for understanding and acceptance of the models constrain the appropriate software and model development procedures that are employed. This paper discusses requirements for both simulation software and for the models that are developed using the software. Requirements for the software include transparency, accessibility, flexibility, extensibility, quality assurance, ability to do discrete and/or continuous simulation, and efficiency. Requirements for the models that are developed include traceability, transparency, credibility/validity, and quality control. The paper discusses these requirements with specific reference to the requirements for performance assessment models that are used for predicting the long-term safety of waste disposal facilities, such as the proposed Yucca Mountain repository

  9. General Motors' R&D: Managing Innovation Globally

    Science.gov (United States)

    Taub, Alan

    2006-03-01

    The rapid pace of technology development and the globalization of the automobile industry are major forces driving General Motors to devise new ways to innovate faster and more efficiently. In response, GM has developed a global R&D network that has transformed GM's research and development organization from a U.S.-based enterprise to one that is over 30 percent leveraged with collaboration in 16 countries. This talk will focus on the challenges faced as well as the lessons learned and best practices developed in building this network.

  10. Surgical management of gynecomastia: experience of a general surgery center.

    Science.gov (United States)

    Longheu, A; Medas, F; Corrias, F; Farris, S; Tatti, A; Pisano, G; Erdas, E; Calò, P G

    2016-01-01

    Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results.

  11. Obesity, periodontal and general health: Relationship and management

    Directory of Open Access Journals (Sweden)

    Parveen Dahiya

    2012-01-01

    Full Text Available Obesity is a multifaceted subject. It has increased at an alarming rate in recent years. Being overweight increases the likelihood of a patient having associated health and social problems which may affect dental services and dental management. A review of the literature on obesity and periodontal disease suggested that they both confound each other and obesity itself has been recognized as a major risk factor for periodontal disease. It has been found that adverse effects of obesity on the periodontium may be mediated through pro-inflammatory cytokines and various other bioactive substances. This article tries to focus on the possible role of obesity and obesity-related diseases like diabetes and coronary heart diseases (CHD, as a potential contributor to periodontal disease and vice versa. The meanings of these associations can be useful for various diagnostic and treatment planning purposes.

  12. Nanoparticle risk management and cost evaluation: a general framework

    Science.gov (United States)

    Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

    2011-07-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  13. Nanoparticle risk management and cost evaluation: a general framework

    International Nuclear Information System (INIS)

    Fleury, Dominique; Metz, Sebastien; Bouillard, Jacques X; Brignon, Jean-Marc; Bomfim, Joao A S

    2011-01-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  14. 78 FR 18960 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; General Provisions for Domestic...

    Science.gov (United States)

    2013-03-28

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC586 Atlantic Coastal Fisheries Cooperative Management Act Provisions; General Provisions for Domestic Fisheries; Application for Exempted Fishing Permits AGENCY: National Marine Fisheries Service (NMFS), National Oceanic...

  15. An Object-oriented Knowledge Link Model for General Knowledge Management

    OpenAIRE

    Xiao-hong, CHEN; Bang-chuan, LAI

    2005-01-01

    The knowledge link is the basic on knowledge share and the indispensable part in knowledge standardization management. In this paper, a object-oriented knowledge link model is proposed for general knowledge management by using objectoriented representation based on knowledge levels system. In the model, knowledge link is divided into general knowledge link and integrated knowledge with corresponding link properties and methods. What’s more, its BNF syntax is described and designed.

  16. Practical and effective management of libraries integrating case studies, general management theory and self-understanding

    CERN Document Server

    Moniz, Jr, Richard

    2010-01-01

    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

  17. 76 FR 70483 - Environmental Impact Statement and General Management Plan, Paterson Great Falls National...

    Science.gov (United States)

    2011-11-14

    ... planning process and will remain actively involved throughout the development of the plan. Prepared by... the long-term management of Paterson Great Falls NHP early in the process through public meetings and... Impact Statement and General Management Plan, Paterson Great Falls National Historical Park, NJ AGENCY...

  18. 77 FR 16558 - General Management Plan/Final Environmental Impact Statement, Hampton National Historic Site...

    Science.gov (United States)

    2012-03-21

    ... Management Plan/Final Environmental Impact Statement, Hampton National Historic Site, Maryland AGENCY...) announces the availability of the Final Environmental Impact Statement for the General Management Plan.../Baltimore County Library, 320 York Avenue, Towson, Maryland 21204. Baltimore County Tourism Office and...

  19. Using Self-Management Interventions to Address General Education Behavioral Needs: Assessment of Effectiveness and Feasibility

    Science.gov (United States)

    Briesch, Amy M.; Daniels, Brian

    2013-01-01

    A comprehensive self-management intervention was utilized to increase the on-task behavior of three African American students within an urban middle-school setting. The intervention was designed to necessitate minimal management on the part of the general education classroom teacher by utilizing an electronic prompting device, as well as a…

  20. Implementation of a Self-Management System for Students with Disabilities in General Education Settings

    Science.gov (United States)

    Schulze, Margaret A.

    2016-01-01

    Despite the fact that self-management procedures have a robust literature base attesting to their efficacy with students with disabilities, the use of these strategies in general education settings remains limited. This mixed methods study examined the implementation of self-management procedures using both quantitative and qualitative methods.…

  1. 78 FR 29245 - U.S. General Services Administration Federal Property Management Regulations; Administrative Wage...

    Science.gov (United States)

    2013-05-20

    ... Federal Property Management Regulations; Administrative Wage Garnishment AGENCY: Office of the Chief... the U.S. General Services Administration Property Management Regulation (GSPMR) to remove information... Administrative Wage Garnishment Code of Federal Regulations (CFR) Parts affected are as follows: 41 CFR part 105...

  2. Discussion on the operation of quality management system in general agent of nuclear pants

    International Nuclear Information System (INIS)

    Ji Cunxing; Ran Muzi; Shi Lei; Cui Hannan; Wang Gang; Hou Yanli; Li Qilong

    2010-01-01

    In view of some questions encountered in operation process of quality management system in general agent of nuclear plants of CNNC China Nuclear Power Engineering Co., Ltd. Discussion is made on the questions from four aspect, which should be paid attentions in operation and improvement in order to perfect enterprise management system, increase management level, competitive power to ensurereliable and stable incomes for enterprises. (authors)

  3. 76 FR 70166 - Electrical Standards for Construction and General Industry; Extension of the Office of Management...

    Science.gov (United States)

    2011-11-10

    ...] Electrical Standards for Construction and General Industry; Extension of the Office of Management and Budget... contained in the Electrical Standards for Construction (29 CFR part 1926, Subpart K) and for General... maintenance of electric utilization equipment that prevent death and serious injuries among construction and...

  4. Developing a framework of, and quality indicators for, general practice management in Europe.

    NARCIS (Netherlands)

    Engels, Y.M.P.; Campbell, S.M.; Dautzenberg, M.G.H.; Hombergh, P. van den; Brinkmann, H.; Szecsenyi, J.; Falcoff, H.; Seuntjens, L.; Kuenzi, B.; Grol, R.P.T.M.

    2005-01-01

    OBJECTIVES: To develop a framework for general practice management made up of quality indicators shared by six European countries. METHODS: Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six

  5. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice

    DEFF Research Database (Denmark)

    Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm

    2014-01-01

    BACKGROUND: The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and...

  6. Management of arterial hypertension in Cotonou city, Benin: general practitioners' knowledge, attitudes and practice.

    Science.gov (United States)

    Houenassi, Martin Dèdonougbo; Codjo, Léopold Houétondji; Dokoui, David; Dohou, Serge Hugues Mahougnon; Wanvoegbe, Armand; Agbodande, Anthelme; Attinsounon, Angelo Cossi; Alassani, Adebayo; Ahoui, Séraphin; Dovonou, Albert Comlan; Adoukonou, Thierry Armel

    2016-08-23

    We aimed to assess the management of hypertensive patients by general practitioners in Cotonou city. This was a cross-sectional study based on a multicentre survey conducted from 1 May to 31 July 2011. We recruited all consenting general practitioners who worked in public and private centres in Cotonou city. We used the 7th report of the Joint National Committee to assess the management of hypertension by general practitioners. A tested and validated self-questionnaire was used to collect the data on hypertension management by general practitioners. In eight centres that approved the study, 41 general practitioners were included. The definition of hypertension was known by 20 (48.8%) practitioners. Only 25 (61.0%) could describe the conditions for blood pressure measurement. Ten of them were unable to list half of the minimum recommended tests for hypertension, and the majority (92.7%) did not have any idea of global cardiovascular risk. The blood pressure goal was known by only 18 (43.9%) practitioners. Lifestyle (82.9%) and monotherapy (70.7%) were the therapeutic modalities most prescribed. Antihypertensive agents commonly used by practitioners were calcium channel blockers (82.9%), angiotensin converting enzyme inhibitors (53.7%) and diuretics (36.6%). The general practitioners referred their patients to cardiologists mainly for uncontrolled hypertension (63.4%) and the onset of acute complications (56.1%). The general practitioners' knowledge of hypertension was insufficient and their management did not reflect international guidelines.

  7. Treatment management between orthodontists and general practitioners performing clear aligner therapy.

    Science.gov (United States)

    Best, Alexandra D; Shroff, Bhavna; Carrico, Caroline K; Lindauer, Steven J

    2017-05-01

    To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners. A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment. Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction. There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.

  8. A Generalized Decision Framework Using Multi-objective Optimization for Water Resources Planning

    Science.gov (United States)

    Basdekas, L.; Stewart, N.; Triana, E.

    2013-12-01

    Colorado Springs Utilities (CSU) is currently engaged in an Integrated Water Resource Plan (IWRP) to address the complex planning scenarios, across multiple time scales, currently faced by CSU. The modeling framework developed for the IWRP uses a flexible data-centered Decision Support System (DSS) with a MODSIM-based modeling system to represent the operation of the current CSU raw water system coupled with a state-of-the-art multi-objective optimization algorithm. Three basic components are required for the framework, which can be implemented for planning horizons ranging from seasonal to interdecadal. First, a water resources system model is required that is capable of reasonable system simulation to resolve performance metrics at the appropriate temporal and spatial scales of interest. The system model should be an existing simulation model, or one developed during the planning process with stakeholders, so that 'buy-in' has already been achieved. Second, a hydrologic scenario tool(s) capable of generating a range of plausible inflows for the planning period of interest is required. This may include paleo informed or climate change informed sequences. Third, a multi-objective optimization model that can be wrapped around the system simulation model is required. The new generation of multi-objective optimization models do not require parameterization which greatly reduces problem complexity. Bridging the gap between research and practice will be evident as we use a case study from CSU's planning process to demonstrate this framework with specific competing water management objectives. Careful formulation of objective functions, choice of decision variables, and system constraints will be discussed. Rather than treating results as theoretically Pareto optimal in a planning process, we use the powerful multi-objective optimization models as tools to more efficiently and effectively move out of the inferior decision space. The use of this framework will help CSU

  9. Evaluation and Management of Patch Test-Negative Patients With Generalized Dermatitis.

    Science.gov (United States)

    Spiker, Alison; Mowad, Christen M

    Patients with generalized dermatitis are common in dermatology practices. Allergic contact dermatitis is often suspected, and patients frequently undergo patch testing. When the patch testing result is negative, further evaluation and management of these patients are challenging. The purpose of this study was to survey members of the American Contact Dermatitis Society regarding the evaluation and management of patch test-negative patients with generalized dermatitis. Generalized dermatitis was the most common term identified for patch test-negative patients with diffuse dermatitis. After having negative expanded patch testing results, most physicians proceeded with additional testing including skin biopsy, complete blood cell count with differential, and liver and renal function tests. The most commonly used systemic treatment is prednisone, followed by methotrexate. Narrow-band ultraviolet B (UVB) is the most commonly used light source. Antihistamines are frequently prescribed. Food allergy is not felt to be causative. This cohort of patients experiences significant impairment in quality of life, stress on personal relationships, and time off work. The management of patch test-negative patients with generalized dermatitis is challenging. This study provides insight into management of these complex patients. It also demonstrates practice gaps in the management of these patients, indicating a need for further studies to direct the evaluation and management of this patient population.

  10. Management of venous leg ulcers in general practice - a practical guideline.

    Science.gov (United States)

    Sinha, Sankar; Sreedharan, Sadhishaan

    2014-09-01

    Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.

  11. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  12. 41 CFR 102-192.140 - What are your general responsibilities as a Federal mail center manager?

    Science.gov (United States)

    2010-07-01

    ... responsibilities as a Federal mail center manager? 102-192.140 Section 102-192.140 Public Contracts and Property... ADMINISTRATIVE PROGRAMS 192-MAIL MANAGEMENT Mail Center Manager Requirements § 102-192.140 What are your general responsibilities as a Federal mail center manager? A Federal mail center manager should— (a) Implement policies and...

  13. How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners

    Directory of Open Access Journals (Sweden)

    Magda Vytrisalova

    2017-05-01

    Full Text Available Introduction: General practitioners (GPs are key participants in osteoporosis (OP management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention.Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources.Results: The overall questionnaire return rate was 37% (551 respondents; mean age of the respondents was 53 year (37% men. The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012. The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61% and financial limits set by health insurance company (44% were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29% and patient's reluctance to go to a specialist (18%.Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and

  14. Development of CSA N1600-14: general requirements for nuclear emergency management programs

    Energy Technology Data Exchange (ETDEWEB)

    Sellar, C. [Canadian Standards Association Group, Mississauga, ON (Canada); Coles, J. [Ontario Power Generation, Darlington, ON (Canada)

    2014-07-01

    CSA Group has published a new standard on General requirements for nuclear emergency management programs (CSA N1600-14). The standard establishes criteria for the emergency management programs of on- and off-site organizations to address nuclear emergencies at Canadian nuclear power plants (NPPs). It provides the requirements to develop, implement, evaluate, maintain, and continuously improve a nuclear emergency management program for prevention and mitigation, preparedness, response, and recovery from a nuclear emergency at a NPP. This paper discusses the development of the standard, and provides the key drivers, structure, scope, and outline of the standard, while highlighting key features, impacts, and benefits. (author)

  15. A preliminary study for the implementation of general accident management strategies

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Soo Hyung; Kim, Soo Hyung; Jeong, Young Hoon; Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1997-12-31

    To enhance the safety of nuclear power plants, implementation of accident management has been suggested as one of most important programs. Specially, accident management strategies are suggested as one of key elements considered in development of the accident management program. In this study, generally applicable accident management strategies to domestic nuclear power plants are identified through reviewing several accident management programs for the other countries and considering domestic conditions. Identified strategies are as follows; 1) Injection into the Reactor Coolant System, 2) Depressurize the Reactor Coolant System, 3) Depressurize the Steam Generator, 4) Injection into the Steam Generator, 5) Injection into the Containment, 6) Spray into the Containment, 7) Control Hydrogen in the Containment. In addition, the systems and instrumentation necessary for the implementation of each strategy are also investigated. 11 refs., 3 figs., 3 tabs. (Author)

  16. A preliminary study for the implementation of general accident management strategies

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Soo Hyung; Kim, Soo Hyung; Jeong, Young Hoon; Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1998-12-31

    To enhance the safety of nuclear power plants, implementation of accident management has been suggested as one of most important programs. Specially, accident management strategies are suggested as one of key elements considered in development of the accident management program. In this study, generally applicable accident management strategies to domestic nuclear power plants are identified through reviewing several accident management programs for the other countries and considering domestic conditions. Identified strategies are as follows; 1) Injection into the Reactor Coolant System, 2) Depressurize the Reactor Coolant System, 3) Depressurize the Steam Generator, 4) Injection into the Steam Generator, 5) Injection into the Containment, 6) Spray into the Containment, 7) Control Hydrogen in the Containment. In addition, the systems and instrumentation necessary for the implementation of each strategy are also investigated. 11 refs., 3 figs., 3 tabs. (Author)

  17. A preliminary study for the implementation of general accident management strategies

    International Nuclear Information System (INIS)

    Yang, Soo Hyung; Kim, Soo Hyung; Jeong, Young Hoon; Chang, Soon Heung

    1997-01-01

    To enhance the safety of nuclear power plants, implementation of accident management has been suggested as one of most important programs. Specially, accident management strategies are suggested as one of key elements considered in development of the accident management program. In this study, generally applicable accident management strategies to domestic nuclear power plants are identified through reviewing several accident management programs for the other countries and considering domestic conditions. Identified strategies are as follows; 1) Injection into the Reactor Coolant System, 2) Depressurize the Reactor Coolant System, 3) Depressurize the Steam Generator, 4) Injection into the Steam Generator, 5) Injection into the Containment, 6) Spray into the Containment, 7) Control Hydrogen in the Containment. In addition, the systems and instrumentation necessary for the implementation of each strategy are also investigated

  18. Basic concepts in the management of heart failure in general clinical ...

    African Journals Online (AJOL)

    Basic concepts in the management of heart failure in general clinical practice. KO Ogunyankin. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors ...

  19. Achieving Competitive Advantage in Human Resource Management in General School District of Riyadh in Saudi Arabia

    Science.gov (United States)

    Al dakeel, Taghreed M.; Almannie, Mohamed A.

    2015-01-01

    The general school district of Riyadh is one of largest in the country of (45) school districts in Saudi Arabia. The school districts play an important roles in the development of education, therefore the objective of the study is to examine the roles of the management in the school districts to see if it is achieving competitive advantage. After…

  20. A Management Information System Design for a General Museum. Museum Data Bank Research Report No. 12.

    Science.gov (United States)

    Scholtz, Sandra

    A management information system (MIS) is applied to a medium sized general museum to reflect the actual curatorial/registration functions. The recordkeeping functions of loan and conservation activities are examined since they too can be effectively handled by computer and constitute a complementary data base to the accession/catalog information.…

  1. 34 CFR 76.565 - General management costs-restricted rate.

    Science.gov (United States)

    2010-07-01

    ... that are for the direction and control of the grantee's affairs that are organization-wide. An activity...) Components of the grantee are those organizational units supervised directly or indirectly by the chief executive officer. These organizational units generally exist one management level below the executive...

  2. Bernie's Odyssey: Denver Nuggets' General Manager Bernie Bickerstaff's Basketball Roots in Harlan County, Ky.

    Science.gov (United States)

    Nelson, Glenn

    1992-01-01

    Bernie Bickerstaff discusses how growing up as an African-American athlete in rural Kentucky prepared him to become the general manager of the Denver Nuggets. Triumphing over the area's racial segregation, poverty, and mining perils gave him a sense of strength that enabled him to overcome barriers in advancing his career. (LP)

  3. Teaching Management Information Systems as a General Education Requirement (GER) Capstone

    Science.gov (United States)

    Hoanca, Bogdan

    2012-01-01

    Although many IS programs nationwide use capstone courses in the major, this paper reports on the use of an upper division Management Information Systems (MIS) class as a general education requirements (GER) capstone. The class is a core requirement for all majors in the Bachelor of Business Administration (BBA) program at the University of Alaska…

  4. Periodontal instrumentation for the general dental practitioner: Pt. 2. Management maintenance and sterilization

    Energy Technology Data Exchange (ETDEWEB)

    Touyz, L.Z.G. (University of the Witwatersrand, Johannesburg (South Africa). Dept. of Oral Medicine and Periodontology); De Waal, J.

    1983-03-01

    The purpose of this article is to describe the management, maintenance and sterilization of periodontal instrumentation used by the general dental practitioner. The pre-sterilization, decontamination and cleaning, the sharpening of instrumentation and the packaging, identification and grouping for sterilization are discussed. Attention is also given to various techniques of sterilization, including gamma radiation.

  5. An Executive Appraisal of Courses which Best Prepare One for General Management.

    Science.gov (United States)

    Hildebrandt, H. W.; And Others

    1982-01-01

    Summarizes 1980-81 data from 1,158 newly promoted executives who rated business administration courses that best prepare a young person for a general management career. Business communication--oral and written--was the course selected as "very important" more often than any of 13 courses. (PD)

  6. Management of patients with epistaxis by general practitioners: impact of otolaryngology experience on their practice

    NARCIS (Netherlands)

    Tassone, Peter; Georgalas, Christos; Appleby, Esther; Kotecha, Bhik

    2006-01-01

    This study aims to assess the management of patients with epistaxis by general practitioners (GPs) and to show whether previous experience as a junior doctor in ear, nose and throat (ENT) surgery influences their practice. A questionnaire was sent together with self-addressed reply envelopes to a

  7. Effectiveness of post-discharge case management in general-medical outpatients: a randomized, controlled trial

    NARCIS (Netherlands)

    Latour, Corine H. M.; de Vos, Rien; Huyse, Frits J.; de Jonge, Peter; van Gemert, Liesbeth A. M.; Stalman, Wim A. B.

    2006-01-01

    This study was initiated to determine the impact of post-discharge, nurse-led, home-based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N=147) were

  8. Effectiveness of post-discharge case management in general-medical outpatients: A randomized, controlled trial

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; Vos, R.; Huyse, F.J.; de Jonge, P.; van Gemert, L.A.M.; Stalman, W.A.B.

    2006-01-01

    This study was initiated to determine the impact of post-discharge, nurse-led, home-based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N=147) were

  9. Nurse-led case management for ambulatory complex patients in general health care: A systematic review

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.

    2007-01-01

    Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized

  10. Effectiveness of post-discharge case management in general-medical outpatients: A randomized, controlled trial

    NARCIS (Netherlands)

    Latour, C.H.M.; de Vos, R.; Huyse, F.J.; De Jonge, P.; van Gemert, L.A.M.; Stalman, W.A.B.

    2006-01-01

    This study was initiated to determine the impact of post- discharge, nurse- led, home- based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N = 147)

  11. Effectiveness of post-discharge case management in general-medical outpatients : A randomized, controlled trial

    NARCIS (Netherlands)

    Latour, Corine H. M.; de Vos, Rien; Huyse, Frits J.; de Jonge, Peter; van Gemert, Liesbeth A. M.; Stalman, Wim A. B.

    2006-01-01

    This study was initiated to determine the impact of post- discharge, nurse- led, home- based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N = 147)

  12. Self-Management of Social Initiations by Kindergarten Students with Disabilities in the General Education Classroom

    Science.gov (United States)

    Reynolds, Brooke M.; Gast, David L.; Luscre, Deanna

    2014-01-01

    The effectiveness of a self-management intervention on social interaction behaviors was evaluated for students with disabilities and social deficits. Four students enrolled in a general education kindergarten classroom were taught to self-monitor social initiations during nonstructured social time via a digital wrist counter. The number of social…

  13. 76 FR 31359 - Notice of Intent To Prepare an Environmental Impact Statement on a General Management Plan...

    Science.gov (United States)

    2011-05-31

    ... management activities, visitor activities, and developments that would be appropriate in the park in the future. In addition, the plan will generally address visitor-use related issues and provide management... Environmental Impact Statement on a General Management Plan Amendment/Wilderness Study for Lake Clark National...

  14. GENERAL MILITARY HUMAN RESOURCE MANAGEMENT AND SPECIAL FORCES HUMAN RESOURCE MANAGEMENT. A COMPARATIVE OUTLOOK

    Directory of Open Access Journals (Sweden)

    Marius Emil PATRICHI

    2015-10-01

    Full Text Available The switch from conscript’s army to an all volunteer force military brought new challenges for the military organization. This is more obvious in the human resource domain than in any other area. In the competition to recruit and retain quality personnel, the military organizations should strategically align the human resource management to the overall strategy. The challenges are greater for the Special Forces because the need for a rigorous selection process to recruit from within the military. The rift already in place between the conventional military and the Special Forces need to be overcome to transform the strain relationship into a positive sum game..

  15. Optimization of power plants management structure based on the generalized criteria of the efficiency

    Directory of Open Access Journals (Sweden)

    Salov Aleksey

    2017-01-01

    Full Text Available In the article, the analysis of the operation of power plants in the conditions of economic restructuring to ensure successful entry into the market is carried out. The analysis of the five management structures, including current, typical structure and re-designed by the authors is presented. There are developed the partial efficiency criteria of the management structures that characterize the most important properties - the balance, integrity, controllability and stability. Local criteria of the analyzed structures do not allow to make a definite conclusion about the effectiveness of one of the structures analyzed, formulated global efficiency criterion. There is developed the global criterion of the comparative effectiveness of the management systems based on the DEA method (Data envelopment analysis, taking into account the complex of the proposed local criteria. The considered management structures are ranked based on the generalized criterion of efficiency.

  16. Tracking the evolution of the disaster management cycle: A general system theory approach

    Directory of Open Access Journals (Sweden)

    Christo Coetzee

    2012-12-01

    Full Text Available Officials and scholars have used the disaster management cycle for the past 30 years to explain and manage impacts. Although very little understanding and agreement exist in terms of where the concept originated it is the purpose of this article to address the origins of the disaster management cycle. To achieve this, general system theory concepts of isomorphisms, equifinality, open systems and feedback arrangements were applied to linear disaster phase research (which emerged in the 1920s and disaster management cycles. This was done in order to determine whether they are related concepts with procedures such as emergency, relief, recovery and rehabilitation.

  17. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  18. 41 CFR 102-192.150 - What are your general responsibilities as a program level mail manager?

    Science.gov (United States)

    2010-07-01

    ... responsibilities as a program level mail manager? 102-192.150 Section 102-192.150 Public Contracts and Property... general responsibilities as a program level mail manager? Your responsibilities at the program level include— (a) Working closely with the agency mail manager and mail center managers who handle significant...

  19. Promoting leadership and management in Australian general practice nursing: what will it take?

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Patterson, Elizabeth

    2008-10-01

    This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

  20. Practice nurse and health visitor management of acute minor illness in a general practice.

    Science.gov (United States)

    Pritchard, A; Kendrick, D

    2001-11-01

    To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

  1. Why the general dentist needs to know how to manage oral lichen planus.

    Science.gov (United States)

    Price, Stephanie M; Murrah, Valerie A

    2015-01-01

    Oral lichen planus (OLP) is a frequently mismanaged chronic disease that requires care throughout a patient's life, and therefore a condition the general dentist must know how to manage. Patients with OLP often suffer considerable physical discomfort and an inability to perform proper oral hygiene, eventually resulting in poor periodontal health. In addition, these patients are confronted with the psychological stress of knowing that OLP is not curable. This is accompanied by a fear of other negative health developments, particularly oral cancer. The objective of this study was to identify major issues surrounding the management of OLP by the general dentist. A literature review of over 1100 articles was performed. An eclectic compilation of the issues revealed 12 major areas of concern. This article reviews those concerns and presents strategies for coping with the myriad signs, symptoms, and complications associated with this disease, as well as educational approaches and legal considerations. A rationale is provided to place the responsibility for the management of these patients under the person best positioned to coordinate care for this condition--the general dentist. A general dentist can contribute to the overall oral health of an OLP patient with timely diagnosis, effective treatment, thorough patient education, and the orchestration of efforts by a team of health care providers.

  2. DEFINING ASPECTS OF HUMAN RESOURCE MANAGEMENT STRATEGY WITHIN THE GENERAL STRATEGY OF THE MODERN ORGANIZATION

    Directory of Open Access Journals (Sweden)

    Emanoil MUSCALU

    2013-07-01

    Full Text Available The field of human resources requires the presence and action of several categories of persons and managerial structures interested in the quality of human resources and the activities developed by them. Besides managers and employees there are also the shareholders, the unions, the customers, the different national or local agencies, the local community, etc., with major interests regarding decisions in the human resources area. In order to harmonize their activities and achieve an optimal perspective within the evolution of Human Resource Management, special attention is paid to the strategy of human resources management. According to many specialists, strategies in the field of Human Resource Management show, in the first place, that personnel function adopts a broader perspective and a more dynamic view of human resources, which enables its full integration within the other functions of the organization. In the second place, strategies in the field of Human Resource Management designate the assembly of long term objectives concerning human resources, the main modalities of achieving them and the necessary resources which guarantee that the organization’s structure, value and culture as well as the utilization of its personnel contribute to fulfilling the general objectives of the organization. Therefore, we approached in this paper the problems of grounding and elaborating the Human Resource Management strategy, and we outlined their specific traits, as these are necessary aspects in order to emphasise at the end of our paper the correlation between the strategy in the field of Human Resource Management and the general strategy of the organization. Taking into account specialists and practitioners’ increased interest in knowing, substantiating and implementing strategies in the area of Human Resource Management, we consider that the aspects presented in this paper are modern issues and a starting pointing in solving the great problems of

  3. Comparing stream-specific to generalized temperature models to guide salmonid management in a changing climate

    Science.gov (United States)

    Andrew K. Carlson,; William W. Taylor,; Hartikainen, Kelsey M.; Dana M. Infante,; Beard, Douglas; Lynch, Abigail

    2017-01-01

    Global climate change is predicted to increase air and stream temperatures and alter thermal habitat suitability for growth and survival of coldwater fishes, including brook charr (Salvelinus fontinalis), brown trout (Salmo trutta), and rainbow trout (Oncorhynchus mykiss). In a changing climate, accurate stream temperature modeling is increasingly important for sustainable salmonid management throughout the world. However, finite resource availability (e.g. funding, personnel) drives a tradeoff between thermal model accuracy and efficiency (i.e. cost-effective applicability at management-relevant spatial extents). Using different projected climate change scenarios, we compared the accuracy and efficiency of stream-specific and generalized (i.e. region-specific) temperature models for coldwater salmonids within and outside the State of Michigan, USA, a region with long-term stream temperature data and productive coldwater fisheries. Projected stream temperature warming between 2016 and 2056 ranged from 0.1 to 3.8 °C in groundwater-dominated streams and 0.2–6.8 °C in surface-runoff dominated systems in the State of Michigan. Despite their generally lower accuracy in predicting exact stream temperatures, generalized models accurately projected salmonid thermal habitat suitability in 82% of groundwater-dominated streams, including those with brook charr (80% accuracy), brown trout (89% accuracy), and rainbow trout (75% accuracy). In contrast, generalized models predicted thermal habitat suitability in runoff-dominated streams with much lower accuracy (54%). These results suggest that, amidst climate change and constraints in resource availability, generalized models are appropriate to forecast thermal conditions in groundwater-dominated streams within and outside Michigan and inform regional-level salmonid management strategies that are practical for coldwater fisheries managers, policy makers, and the public. We recommend fisheries professionals reserve resource

  4. Views of the Scottish general public on community pharmacy weight management services: international implications.

    Science.gov (United States)

    Weidmann, Anita Elaine; Cunningham, Scott; Gray, Gwen; Hansford, Denise; Bermano, Giovanna; Stewart, Derek

    2012-04-01

    Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. General public in Scotland. A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18 years and over. Views on community pharmacy led weight management services. Questionnaires were returned by 20.6% (n = 1,236). Over half 60.1% (n = 751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n = 438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n = 162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n = 320). Concerns over privacy (47.3%; n = 592) and perceived lack of pharmacists' specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists' skill level and of public health services available to

  5. Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?

    OpenAIRE

    Mammucari, M; Maggiori, E; Lazzari, M; Natoli, S

    2016-01-01

    Wide variations in the types of pain and response to analgesic pharmacotherapy mean that a variety of treatment strategies are needed. One approach is mesotherapy (intradermal therapy). This consists of microinjections into the skin and is ideally suited to the management of localized pain. Advantages include increasing the duration of drug activity, reduced risk of adverse events and interactions, and possible synergy with other therapies. Mesotherapy provides general practitioners with anot...

  6. Financial Management: DOD Needs to Clarify Its General Gift Fund Policies to Provide for Effective Oversight

    Science.gov (United States)

    2009-05-27

    Representatives Subject: Financial Management: DOD Needs to Clarify Its General Gift Fund Policies to Provide for Effective Oversight From fiscal...year 2005 through fiscal year 2008, the military services received about $295 million in monetary and nonmonetary gifts from individuals and...organizations wishing to donate gifts to the Department of Defense (DOD).1 Section 2601(a) of Title 10, U.S. Code is a long-standing authority under which

  7. Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

    Science.gov (United States)

    Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

    2015-01-01

    This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

  8. Developing a framework of, and quality indicators for, general practice management in Europe.

    Science.gov (United States)

    Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

    2005-04-01

    To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

  9. Current contraceptive management in Australian general practice: an analysis of BEACH data.

    Science.gov (United States)

    Mazza, Danielle; Harrison, Christopher; Taft, Angela; Brijnath, Bianca; Britt, Helena; Hobbs, Melissa; Stewart, Kay; Hussainy, Safeera

    2012-07-16

    To determine current contraceptive management by general practitioners in Australia. Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed. GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception. Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.

  10. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder.

    Science.gov (United States)

    McMain, Shelley F; Links, Paul S; Gnam, William H; Guimond, Tim; Cardish, Robert J; Korman, Lorne; Streiner, David L

    2009-12-01

    The authors sought to evaluate the clinical efficacy of dialectical behavior therapy compared with general psychiatric management, including a combination of psychodynamically informed therapy and symptom-targeted medication management derived from specific recommendations in APA guidelines for borderline personality disorder. This was a single-blind trial in which 180 patients diagnosed with borderline personality disorder who had at least two suicidal or nonsuicidal self-injurious episodes in the past 5 years were randomly assigned to receive 1 year of dialectical behavior therapy or general psychiatric management. The primary outcome measures, assessed at baseline and every 4 months over the treatment period, were frequency and severity of suicidal and nonsuicidal self-harm episodes. Both groups showed improvement on the majority of clinical outcome measures after 1 year of treatment, including significant reductions in the frequency and severity of suicidal and nonsuicidal self-injurious episodes and significant improvements in most secondary clinical outcomes. Both groups had a reduction in general health care utilization, including emergency visits and psychiatric hospital days, as well as significant improvements in borderline personality disorder symptoms, symptom distress, depression, anger, and interpersonal functioning. No significant differences across any outcomes were found between groups. These results suggest that individuals with borderline personality disorder benefited equally from dialectical behavior therapy and a well-specified treatment delivered by psychiatrists with expertise in the treatment of borderline personality disorder.

  11. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  12. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study.

    Science.gov (United States)

    Garg, Rakesh; Khanna, Puneet; Sinha, Renu

    2011-05-01

    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  13. General Managers' and building managers' different evaluation of building value and quality - as built and over time

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    2007-01-01

    building. Furthermore, the respondents were asked to prioritize the quality factors. In the analysis the quality factors were grouped into cultural value and use value and into quality as built and over time. The paper presents the general results of the survey with focus on the differences between......This paper is one of the results of a research project on real estate strategies and building values based on a case study of the corporate buildings of DR (Danish Broadcasting Corporation). The paper presents some of the results from a questionnaire survey among select groups of managers in DR...... concerning their evaluation of 5 buildings. The overall purpose of the survey was to evaluate the different buildings’ values and quality, both as built and over time. A second purpose was to develop and test a methodology to describe the values and quality of buildings at a general but still differentiated...

  14. A Reinforcement Model of the Relationships of Supervisors' General Communication Styles and Conflict Management Styles to Task Attraction.

    Science.gov (United States)

    Wheeless, Lawrence R.; Reichel, Lisa S.

    1990-01-01

    Investigates the relationship between general styles of communicating and more situation-specific conflict management styles. Finds substantial relationships between general communication styles and conflict management styles, as well as very substantial relationships between the style constructs and task attraction of supervisors. (SR)

  15. 78 FR 63974 - Student Assistance General Provisions-Subpart K-Cash Management; Extension of Public Comment...

    Science.gov (United States)

    2013-10-25

    ... DEPARTMENT OF EDUCATION Student Assistance General Provisions--Subpart K--Cash Management... an information collection entitled, ``Student Assistance General Provisions--Subpart K--Cash Management''. ED is extending the comment period to November 18, 2013 due to the public's inability to access...

  16. How general dentists could manage a patient with oral lichen planus

    Science.gov (United States)

    Robledo-Sierra, Jairo

    2018-01-01

    Background The literature hardly contains information on how patients suffering from oral lichen planus could be managed by dentists. Material and Methods Based on the limited available literature and particularly on the long-term clinical and histopathological experience of one of the authors, suggestions on how dentists could manage patients with oral lichen planus have been put forward. Results: In most cases, the dentist should be able to establish a correct diagnosis. Results In most cases, the dentist should be able to establish a correct diagnosis. Occasionally, the dentist may call upon a specialist, usually an oral medicine specialist or an oral and maxillofacial surgeon for confirmation of the diagnosis, possibly a biopsy procedure, and management of the patient in case of severe symptoms. Proper patient information is of utmost importance in the management. Conclusions General dentists can be expected to manage the majority of patients with oral lichen planus. Some patients may need to be referred for diagnostic purposes to a specialist; this is also the case for the rare patient with severe symptoms, possibly requiring systemic treatment. Key words:Oral mucosal disease, oral lichen planus. PMID:29476684

  17. Virginia Space Grant Consortium Management of National General Aviation Design Competition

    Science.gov (United States)

    2002-01-01

    This report summarizes the management of the National General Aviation Design Competition on behalf of NASA, the FAA and the Air Force by the Virginia Space Grant Consortium (VSGC) for the time period October 1, 2000 through September 30, 2001. This was the VSGC's seventh and final year of managing the Competition, which the Consortium originally designed, developed and implemented for NASA and the FAA. The competition is now being managed in-house by NASA. Awards to winning university teams were presented at a ceremony held at AirVenture 2001, the Experimental Aircraft Association's Annual Convention and Fly-In at Oshkosh, Wis. by NASA and FAA officials. The competition called for individuals or teams of undergraduate and graduate students from U.S. engineering schools to participate in a major national effort to rebuild the U.S. general aviation sector. Participants were challenged to meet the engineering goals of the Advanced General Aviation Transport Experiment (AGATE) project. For the purpose of the contest, general aviation aircraft are typically defined as single or twin engine (turbine or piston), single-pilot, fixed-wing aircraft for 2 - 6 passengers. The competition seeks to raise student awareness of the importance of general aviation by having students address design challenges for a small aircraft transportation system. NASA, AFRL and the FAA hope to stimulate breakthroughs in technology and their application in the general aviation marketplace. National goals for revitalizing the industry offer excellent, open-ended design challenges with real world applications for the Innovative Design Category. Both individual and team submissions were encouraged. University faculty advisors and students consistently cite the value of this kind of educational experience for their engineering students. Eight proposals were submitted for the 2001 Competition for the Innovative Design Category. Eleven faculty members and 124 students participated. Since inception

  18. Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice.

    Science.gov (United States)

    Mahomed, Rosemary; St John, Winsome; Patterson, Elizabeth

    2012-11-01

      To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice.   Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses.   A grounded theory study underpinned by a relativist ontological position and a relativist epistemology.   Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods.   Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care.   Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction. © 2012 Blackwell Publishing Ltd.

  19. General practitioners' management of mental disorders: A rewarding practice with considerable obstacles

    Directory of Open Access Journals (Sweden)

    Fleury Marie-Josée

    2012-03-01

    Full Text Available Abstract Background Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs, even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. Methods This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS and qualitative (NVivo analyses were performed. Results At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks, and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one

  20. 75 FR 4413 - Notice of Intent to Prepare an Environmental Impact Statement for a General Management Plan...

    Science.gov (United States)

    2010-01-27

    ... also will outline the kinds of resource management activities, visitor activities, and developments... visitor-use related issues and provide management direction for the six designated wild rivers within the... Impact Statement for a General Management Plan Amendment/Wilderness Study, for Gates of the Arctic...

  1. Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.

    Science.gov (United States)

    Eley, Diann S; Patterson, Elizabeth; Young, Jacqui; Fahey, Paul P; Del Mar, Chris B; Hegney, Desley G; Synnott, Robyn L; Mahomed, Rosemary; Baker, Peter G; Scuffham, Paul A

    2013-01-01

    The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

  2. Generalized Information Architecture for Managing Requirements in IBM?s Rational DOORS(r) Application.

    Energy Technology Data Exchange (ETDEWEB)

    Aragon, Kathryn M.; Eaton, Shelley M.; McCornack, Marjorie Turner; Shannon, Sharon A.

    2014-12-01

    When a requirements engineering effort fails to meet expectations, often times the requirements management tool is blamed. Working with numerous project teams at Sandia National Laboratories over the last fifteen years has shown us that the tool is rarely the culprit; usually it is the lack of a viable information architecture with well- designed processes to support requirements engineering. This document illustrates design concepts with rationale, as well as a proven information architecture to structure and manage information in support of requirements engineering activities for any size or type of project. This generalized information architecture is specific to IBM's Rational DOORS (Dynamic Object Oriented Requirements System) software application, which is the requirements management tool in Sandia's CEE (Common Engineering Environment). This generalized information architecture can be used as presented or as a foundation for designing a tailored information architecture for project-specific needs. It may also be tailored for another software tool. Version 1.0 4 November 201

  3. Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.

    Science.gov (United States)

    Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

    2017-02-01

    Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder. METHODS: Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES. RESULTS: Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+\\/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services. CONCLUSIONS: PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.

  5. Self-reported confidence and skills of general practitioners in management of mental health disorders.

    Science.gov (United States)

    Oakley Browne, Mark; Lee, Adeline; Prabhu, Radha

    2007-10-01

    To identify the predictors of self-reported confidence and skills of GPs in management of patients with mental health problems. Cross-sectional survey, with questionnaire presented to 246 GPs working in 62 practices throughout Gippsland. Rural general practices in Gippsland. One hundred and thirty-four GPs across Gippsland. GPs completed a questionnaire assessing self-perception of knowledge and skills in recognition and management of common mental health problems. Of 134 GPs, 45% reported that they have a specific interest in mental health, and 39% of GPs reported that they had previous mental health training. Only 22% of GPs describe having both an interest and prior training in mental health care. Age and years since graduation are not significantly related to self-reported confidence and skills. The results of this study highlight that self-professed interest and prior training in mental health are associated. Self-professed interest in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health disorders. Similarly, prior training in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health problems. Self-professed interest in mental health issues is also associated with hours of participation in continuing medical education related to mental health care. Unfortunately, only a minority described having both interest and prior training in mental health care.

  6. A Business Process Management System based on a General Optimium Criterion

    Directory of Open Access Journals (Sweden)

    Vasile MAZILESCU

    2009-01-01

    Full Text Available Business Process Management Systems (BPMS provide a broadrange of facilities to manage operational business processes. These systemsshould provide support for the complete Business Process Management (BPMlife-cycle [16]: (redesign, configuration, execution, control, and diagnosis ofprocesses. BPMS can be seen as successors of Workflow Management (WFMsystems. However, already in the seventies people were working on officeautomation systems which are comparable with today’s WFM systems.Recently, WFM vendors started to position their systems as BPMS. Our paper’sgoal is a proposal for a Tasks-to-Workstations Assignment Algorithm (TWAAfor assembly lines which is a special implementation of a stochastic descenttechnique, in the context of BPMS, especially at the control level. Both cases,single and mixed-model, are treated. For a family of product models having thesame generic structure, the mixed-model assignment problem can be formulatedthrough an equivalent single-model problem. A general optimum criterion isconsidered. As the assembly line balancing, this kind of optimisation problemleads to a graph partitioning problem meeting precedence and feasibilityconstraints. The proposed definition for the "neighbourhood" function involvesan efficient way for treating the partition and precedence constraints. Moreover,the Stochastic Descent Technique (SDT allows an implicit treatment of thefeasibility constraint. The proposed algorithm converges with probability 1 toan optimal solution.

  7. Surveillance Monitoring Management for General Care Units: Strategy, Design, and Implementation.

    Science.gov (United States)

    McGrath, Susan P; Taenzer, Andreas H; Karon, Nancy; Blike, George

    2016-07-01

    The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring). In late 2007, a patient surveillance monitoring system was piloted on the basis of a structured design and implementation approach in a 36-bed orthopedics unit. Beginning in early 2009, it was expanded to cover more than 200 inpatient beds in all medicine and surgical units, except for psychiatry and labor and delivery. Improvements in clinical outcomes (reduction of unplanned transfers by 50% and reduction of rescue events by more than 60% in 2008) and approximately two alarms per patient per 12-hour nursing shift in the original pilot unit have been sustained across most D-H general care units in spite of increasing patient acuity and unit occupancy. Sample analysis of pager notifications indicates that more than 85% of all alarm conditions are resolved within 30 seconds and that more than 99% are resolved before escalation is triggered. The D-H surveillance monitoring system employs several important, generalizable features to manage alarms in a general care setting: alarm delays, static thresholds set appropriately for the prevalence of events in this setting, directed alarm annunciation, and policy-driven customization of thresholds to allow clinicians to respond to needs of individual patients. The systematic approach to design, implementation, and performance management has been key to the success of the system.

  8. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2011-01-01

    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  9. Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?

    Science.gov (United States)

    Mammucari, Massimo; Maggiori, Enrica; Lazzari, Marzia; Natoli, Silvia

    2016-06-01

    Wide variations in the types of pain and response to analgesic pharmacotherapy mean that a variety of treatment strategies are needed. One approach is mesotherapy (intradermal therapy). This consists of microinjections into the skin and is ideally suited to the management of localized pain. Advantages include increasing the duration of drug activity, reduced risk of adverse events and interactions, and possible synergy with other therapies. Mesotherapy provides general practitioners with another tool for the treatment of local pain. However, it is important to provide patients with full details of the pros and cons of this approach and obtain informed patient consent.

  10. Generalized data management systems and scientific information. Report of a specialist study

    Energy Technology Data Exchange (ETDEWEB)

    1978-06-01

    Separate abstracts were prepared for 19 of the papers in this volume. Four additional papers have already been cited in ERA; these can be found by referring to CONF-771062-- in the Report Number Index. Five other papers were not in the scope of coverage of ERA; these dealt with an introduction to generalized data management systems and capabilities required of them in handling data, a programming language for data bases, and specialized applications of data bases to laboratory animals (environmental husbandry, hematology, clinical chemistry) and environmental chemicals. (RWR)

  11. Optimization of Candu fuel management with gradient methods using generalized perturbation theory

    International Nuclear Information System (INIS)

    Chambon, R.; Varin, E.; Rozon, D.

    2005-01-01

    CANDU fuel management problems are solved using time-average representation of the core. Optimization problems based on this representation have been defined in the early nineties. The mathematical programming using the generalized perturbation theory (GPT) that was developed has been implemented in the reactor code DONJON. The use of the augmented Lagrangian (AL) method is presented and evaluated in this paper. This approach is mandatory for new constraint problems. Combined with the classical Lemke method, it proves to be very efficient to reach optimal solution in a very limited number of iterations. (authors)

  12. Airway management by the general practitioner in trauma patients. Technical and non-technical skills

    Directory of Open Access Journals (Sweden)

    Juan David Dominguez-Sánchez

    2016-07-01

    Full Text Available General practitioners must constantly face challenges imposed by their profession when performing interventions that are necessary for their patients. Many of these interventions not only require proper use of theoretical knowledge, but also putting into practice non-technical and psychomotor skills developed through professional training. Given the specific characteristics of each patient, the clinical setting in the which procedure takes place and the limited skills of the professional, the management of the airway of a patient with trauma injuries in the emergency room represents a major challenge for physicians.

  13. Managing patient demand: a qualitative study of appointment making in general practice.

    Science.gov (United States)

    Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

    2001-04-01

    Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

  14. Knowledge Management Systems as an Interdisciplinary Communication and Personalized General-Purpose Technology

    Directory of Open Access Journals (Sweden)

    Ulrich Schmitt

    2015-10-01

    Full Text Available As drivers of human civilization, Knowledge Management (KM processes have co-evolved in line with General-Purpose-Technologies (GPT, such as writing, printing, and information and communication systems. As evidenced by the recent shift from information scarcity to abundance, GPTs are capable of drastically altering societies due to their game-changing impact on our spheres of work and personal development. This paper looks at the prospect of whether a novel Personal Knowledge Management (PKM concept supported by a prototype system has got what it takes to grow into a transformative General-Purpose-Technology. Following up on a series of papers, the KM scenario of a decentralizing revolution where individuals and self-organized groups yield more power and autonomy is examined according to a GPT's essential characteristics, including a wide scope for improvement and elaboration (in people's private, professional and societal life, applicability across a broad range of uses in a wide variety of products and processes (in multi-disciplinary educational and work contexts, and strong complementarities with existing or potential new technologies (like organizational KM Systems and a proposed World Heritage of Memes Repository. The result portrays the PKM concept as a strong candidate due to its personal, autonomous, bottom-up, collaborative, interdisciplinary, and creativity-supporting approach destined to advance the availability, quantity, and quality of the world extelligence and to allow for a wider sharing and faster diffusion of ideas across current disciplinary and opportunity divides.

  15. INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Jovanović Dušan

    2015-03-01

    Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

  16. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review

    Directory of Open Access Journals (Sweden)

    Hutton Catherine

    2007-05-01

    Full Text Available Abstract Background Psychological problems present a huge burden of illness in our community and GPs are the main providers of care. There is evidence that longer consultations in general practice are associated with improved quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer consultations may lead to reduced access to health care. The aim of this research was to conduct a systematic literature review to determine whether management of psychological problems in general practice is associated with an increased consultation length and to explore whether longer consultations are associated with better health outcomes for patients with psychological problems. Methods A search was conducted on Medline (Ovid databases up to7 June 2006. The following search terms, were used: general practice or primary health care (free text or family practice (MeSH AND consultation length or duration (free text or time factors (MeSH AND depression or psychological problems or depressed (free text. A similar search was done in Web of Science, Pubmed, Google Scholar, and Cochrane Library and no other papers were found. Studies were included if they contained data comparing consultation length and management or detection of psychological problems in a general practice or primary health care setting. The studies were read and categories developed to enable systematic data extraction and synthesis. Results 29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to treating depression. There was some evidence that increased consultation length is associated with more accurate diagnosis of psychological problems. Conclusion Further research is needed to

  17. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

    Directory of Open Access Journals (Sweden)

    Marie Ludlow

    2017-06-01

    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  18. General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study.

    Science.gov (United States)

    van Dipten, Carola; van Berkel, Saskia; de Grauw, Wim J C; Scherpbier-de Haan, Nynke D; Brongers, Bouke; van Spaendonck, Karel; Wetzels, Jack F M; Assendelft, Willem J J; Dees, Marianne K

    2018-06-06

    Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care. Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation. Five themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document. CKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs' understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes. Not applicable.

  19. THE USE OF ICT IN THE MANAGEMENT OF SCHOOLS OF GENERAL EDUCATION IN THE FORMING OF CIVIL SOCIETY

    Directory of Open Access Journals (Sweden)

    Sergiy I. Netyosov

    2013-03-01

    Full Text Available The status and character of the use of ICT in the management of schools of general education and related utilization of information technology in the organization of management of educational institutions with the requirements of the formation of civil society is considered in the article. The author proves that the management of general education institutions involves a significant amount of social information, and the use of ICT in these activities contributes to the inclusion of the public in the mission of education. But the actual state of realization of ICTs in management of secondary schools is mainly directed at the use of technocratic information technology capabilities and the realization of social component in the management of institutions of general education is involved partially, that is an indicator of the rather slow progress of Ukraine toward the establishment of a civil society.

  20. Management of dental trauma in primary care: a postal survey of general dental practitioners.

    Science.gov (United States)

    Jackson, N G; Waterhouse, P J; Maguire, A

    2005-03-12

    To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to

  1. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

    Directory of Open Access Journals (Sweden)

    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  2. Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

    Science.gov (United States)

    Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

    2009-08-26

    With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of

  3. Attitudes, norms and controls influencing lifestyle risk factor management in general practice

    Directory of Open Access Journals (Sweden)

    McKenzie Suzanne H

    2009-08-01

    Full Text Available Abstract Background With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP. This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45–49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. Methods A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. Results GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the

  4. 77 FR 49011 - Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management...

    Science.gov (United States)

    2012-08-15

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5613-N-06-A] Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management System--Change in Final Effective... the OGC E-Discovery Management System until after the opportunity for further comment is provided to...

  5. 78 FR 67187 - Notice of Availability of the Draft General Management Plan/Wilderness Study/Environmental Impact...

    Science.gov (United States)

    2013-11-08

    ... focus on protecting natural resources and systems. Under this alternative, most of the Big Spring... Availability of the Draft General Management Plan/ Wilderness Study/Environmental Impact Statement for the... Management Plan/Wilderness Study/Environmental Impact Statement (GMP/WS/EIS) for the Ozark National Scenic...

  6. Generic functional requirements for a NASA general-purpose data base management system

    Science.gov (United States)

    Lohman, G. M.

    1981-01-01

    Generic functional requirements for a general-purpose, multi-mission data base management system (DBMS) for application to remotely sensed scientific data bases are detailed. The motivation for utilizing DBMS technology in this environment is explained. The major requirements include: (1) a DBMS for scientific observational data; (2) a multi-mission capability; (3) user-friendly; (4) extensive and integrated information about data; (5) robust languages for defining data structures and formats; (6) scientific data types and structures; (7) flexible physical access mechanisms; (8) ways of representing spatial relationships; (9) a high level nonprocedural interactive query and data manipulation language; (10) data base maintenance utilities; (11) high rate input/output and large data volume storage; and adaptability to a distributed data base and/or data base machine configuration. Detailed functions are specified in a top-down hierarchic fashion. Implementation, performance, and support requirements are also given.

  7. 78 FR 37846 - Resource Management Plan/General Plan and Environmental Impact Statement/Environmental Impact...

    Science.gov (United States)

    2013-06-24

    ...The Bureau of Reclamation and the California Department of Parks and Recreation (CDPR) have prepared a Final Environmental Impact Statement/Environmental Impact Report (EIS/EIR) for the San Luis Reservoir State Recreation Area Resource Management Plan/General Plan (RMP/GP). The Final EIS/EIR describes and presents the environmental effects of the No Action/No Project Alternative and three Action Alternatives for implementing the RMP/GP. A Notice of Availability of the Draft EIS/EIR was published in the Federal Register on August 3, 2012 (77 FR 46518). The comment period on the Draft EIS/EIR ended on October 2, 2012. The Final EIS/EIR contains responses to all comments received and reflects comments and any additional information received during the review period.

  8. Chronic disease management in general practice: results from a national study.

    Science.gov (United States)

    Darker, C; Martin, C; O'Dowd, T; O'Kelly, F; O'Shea, B

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380; 71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380; 76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future changes in CDM.

  9. Chronic disease management in general practice: results from a national study.

    LENUS (Irish Health Repository)

    Darker, C

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380\\/527).The majority of GPs (240\\/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95\\/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267\\/380; 71%), asthma \\/ COPD (279\\/380; 74%) and hypertension (297\\/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379\\/380; 99%), lack of appropriate funding (286\\/380; 76%), with GPs interested in targeted payments (244\\/380; 68%). This study provides baseline data to assess future changes in CDM.

  10. General principles of nuclear safety management related to research reactor decommissioning

    International Nuclear Information System (INIS)

    Banciu, Ortenzia; Vladescu, Gabriela

    2003-01-01

    The paper contents the general principles applicable to the decommissioning of research reactors to ensure a proper nuclear safety management, during both decommissioning activities and post decommissioning period. The main objective of decommissioning is to ensure the protection of workers, population and environment against all radiological and non-radiological hazards that could result after a reactor shutdown and dismantling. In the same time, it is necessary, by some proper provisions, to limit the effect of decommissioning for the future generation, according to the new Romanian, IAEA and EU Norms and Regulations. Assurance of nuclear safety during decommissioning process involves, in the first step, to establish of some safety principles and requirements to be taken into account during whole process. In the same time, it is necessary to perform a series of analyses to ensure that the whole process is conducted in a planned and safe manner. The general principles proposed for a proper management of safety during research reactor decommissioning are as follows: - Set-up of all operations included in a Decommissioning Plan; - Set-up and qualitative evaluation of safety problems, which could appear during normal decommissioning process, both radiological and nonradiological risks for workers and public; - Set-up of accident list related to decommissioning process the events that could appear both due to some abnormal working conditions and to some on-site and off-site events like fires, explosions, flooding, earthquake, etc.); - Development and qualitative/ quantitative evaluation of scenarios for each incidents; - Development (and evaluation) of safety indicator system. The safety indicators are the most important tools used to assess the level of nuclear safety during decommissioning process, to discover the weak points and to establish safety measures. The paper contains also, a safety case evaluation (description of facility according to the decommissioning

  11. General Practitioner's Attitudes and Confidence in Managing Patients with Dementia in Singapore.

    Science.gov (United States)

    Subramaniam, Mythily; Ong, Hui Lin; Abdin, Edimansyah; Chua, Boon Yiang; Shafie, Saleha; Siva Kumar, Fiona Devi; Foo, Sophia; Ng, Li Ling; Lum, Alvin; Vaingankar, Janhavi A; Chong, Siow Ann

    2018-03-01

    The number of people living with dementia is increasing globally as a result of an ageing population. General practitioners (GPs), as the front-line care providers in communities, are important stakeholders in the system of care for people with dementia. This commentary describes a study conducted to understand GPs' attitudes and self-perceived competencies when dealing with patients with dementia and their caregivers in Singapore. A set of study information sheet and survey questionnaires were mailed to selected GP clinics in Singapore. The survey, comprising the "GP Attitudes and Competencies Towards Dementia" questionnaire, was administered. A total of 400 GPs returned the survey, giving the study a response rate of 52.3%. About 74% of the GPs (n=296) were seeing dementia patients in their clinics. Almost all the GPs strongly agreed that early recognition of dementia served the welfare of the patients (n=385; 96%) and their relatives (n=387; 97%). About half (51.5%) of the respondents strongly agreed or agreed that they felt confident carrying out an early diagnosis of dementia. Factor analysis of questionnaire revealed 4 factors representing "benefits of early diagnosis and treatment of patients with dementia", "confidence in dealing with patients and caregiver of dementia", "negative perceptions towards dementia care" and "training needs". GPs in Singapore held a generally positive attitude towards the need for early dementia diagnosis but were not equally confident or comfortable about making the diagnosis themselves and communicating with and managing patients with dementia in the primary care setting. Dementia education and training should therefore be a critical step in equipping GPs for dementia care in Singapore. Shared care teams could further help build up GPs' knowledge, confidence and comfort in managing patients with dementia.

  12. Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice

    NARCIS (Netherlands)

    de Vries, Corlien J. H.; Wieringa-de Waard, Margreet; Vervoort, Cléo-Lotte A. G.; Ankum, Willem M.; Bindels, Patrick J. E.

    2008-01-01

    BACKGROUND: Abnormal vaginal bleeding (AVB) in women of reproductive age is a common reason for consulting a general practitioner. Nevertheless, how general practitioners (GPs) choose to initially manage AVB is largely unknown, as is the prevalence of underlying pathology of AVB in primary care.

  13. Mobile task management tool that improves workflow of an acute general surgical service.

    Science.gov (United States)

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  14. How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia.

    Science.gov (United States)

    Mahendradhata, Yodi; Lestari, Trisasi; Probandari, Ari; Indriarini, Lucia Evi; Burhan, Erlina; Mustikawati, Dyah; Utarini, Adi

    2015-10-14

    Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia. A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented. Of 608 eligible GPs invited to participate during the study period, 547 (89.9%) consented and completed the interview. A low proportion of GPs (24.6-74.3%) had heard of the International Standards for TB care (ISTC) and only 41.2-68.9% of these GPs had participated in ISTC training. As few as 47.3% (90% CI: 37.6-57.0%) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0-5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6%. In all cities, a substantial proportion of GPs (12.0-45.5%) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8-52.0%). The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions.

  15. The complexity of managing COPD exacerbations: a grounded theory study of European general practice

    Science.gov (United States)

    Risør, Mette Bech; Spigt, Mark; Iversen, R; Godycki-Cwirko, M; Francis, N; Altiner, A; Andreeva, E; Kung, K; Melbye, H

    2013-01-01

    Objectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs. Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong). Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians. Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition. Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations

  16. Economic evaluation of an implementation strategy for the management of low back pain in general practice.

    Science.gov (United States)

    Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

    2017-05-01

    In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

  17. Chronic care management in Danish general practice - a cross‒sectional study of workload and multimorbidity

    Directory of Open Access Journals (Sweden)

    Moth Grete

    2012-06-01

    Full Text Available Abstract Background About 30% of the Danish population has one or more chronic conditions, and general practitioners (GPs play a key role in effective chronic care management. However, little is known about these encounters in general practice. The aim was to describe the frequency of patients with one or more chronic conditions in general practice and how these consultations were experienced by the GPs. Methods All GPs in the Central Denmark Region were invited to register all contacts during one day in the 12‒month study period from December; 404 (46% accepted. For each patient contact, the GPs were asked to fill in a one‒page registration form covering information on chronic disease, reason for encounter, diagnosis, number of additional psychosocial problems raised by the patient during the consultation, time consumption, experienced burden of the consultation, referral to specialized care, and whether a nurse could have substituted the GP. Patients were categorized according to the number of chronic conditions (none, one, two, three or more and the categories compared with regard to the GP‒experienced burden of the contacts. Moreover, we examined which chronic conditions posed the the greatest challenge to the GPs. Results Patients aged 40 years or more had a total of 8,236 contacts. Among these patients 2,849 (34.6%; 95% CI 33.6‒35.6 had one and 2,596 (31.5%; CI 30.5‒32.5 had more than one chronic disease. The time consumption and the burden of their contacts tended to rise with the number of chronic conditions. Being present in 22.9% (CI 21.6‒24.3 of all face‒to‒face contacts, hypertension was the most common chronic condition. The burden of the contacts was experienced as particularly heavy for patients with depression and dementia due to more additional psychosocial problems and the time consumption. Conclusion General practitioners considered consultations with multimorbid patients demanding and not easily delegated to

  18. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  19. Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

    Science.gov (United States)

    Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

    2017-12-01

    Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

  20. Computer templates in chronic disease management: ethnographic case study in general practice.

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

    2012-01-01

    To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography. Two general practices in England. Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients' stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient-as 'individual' or as 'one of a population'. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work

  1. Case-specific colleague guidance for general practitioners' management of sickness absence.

    Science.gov (United States)

    Nordhagen, H P; Harvey, S B; Rosvold, E O; Bruusgaard, D; Blonk, R; Mykletun, A

    2017-12-02

    General practitioners (GPs) report sickness absence certification as challenging. They express need for support with functional assessment beyond guidelines and reforms. Case-specific collegial one-to-one guidance for other clinical topics has proved popular with GPs and may be an acceptable and effective way to improve GPs skills and competence in sickness absence certification. To present a new model of case-specific colleague guidance focusing on the management of long-term sickness absence and to describe its feasibility in terms of application and reception among GPs, and also GPs' self-reports of effects on their practice. Randomly selected GPs received case-specific collegial guidance over a 12-month period, in two Norwegian trials, delivered by former GPs employed by the social security administration. We measured reception and perceived effects by GPs' self-report and registered participation and withdrawal rates. The participation rate (n = 165) was 94%, and no GPs withdrew during training. Among the 116 GPs responding to the survey (70%), 112 (97%; 95% CI 92-99) stated they would recommend it to their colleagues. Considerable benefit from the guidance was reported by 68 (59%; 95% CI 50-68). The GPs self-reported other effects on their sickness absence certification, specifically an increased use of part-time sickness absence (Fit-Note equivalent). This model of case-specific colleague guidance to aid GPs' management of long-term sickness absence is feasible and was popular. This type of guidance was perceived by GPs to be somewhat beneficial and to alter their sickness absence certification behaviour, though the true impact requires further testing in controlled trials. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  2. Attitudes to diagnosis and management in dementia care: views of future general practitioners.

    Science.gov (United States)

    Tang, Eugene Yee Hing; Birdi, Ratika; Robinson, Louise

    2018-03-01

    ABSTRACTConsiderable international governmental support is focused on the timely diagnosis of dementia and post-diagnostic care of people with dementia. Identifying those at high risk of dementia is one approach to timely diagnosis. General practitioners (GPs) are well-placed clinicians in the community to provide both pre- and post-diagnostic dementia care. However, GPs have in the past consistently demonstrated low confidence in both diagnosing dementia and providing care for these complex patients particularly for patients in the post-diagnostic phase. It is currently unclear how future GPs view dementia care. We aimed to evaluate the current attitudes and experiences of future GPs in dementia care and their views on targeting high risk groups. All (n = 513) GP trainees were approached by email to participate in a cross-sectional web and paper-based survey in the North of England. A further reminder was sent out two months after the initial invitation. We received 153 responses (29.8% response rate, 66.7% female, average age 31 (range 25-55 years old). The main difficulties encountered included coordinating supporting services for carers and the person with dementia and responding to co-existing behavioral and psychiatric symptoms. Further education in dementia management was considered to be important by respondents. GP trainees were generally very positive about their future role in caring for people with dementia, particularly in the area of earlier diagnosis via identification of high-risk individuals. Future GPs in one area of England are very positive about their key role in dementia care. In order to facilitate the delivery of high quality, community-based care, work is required to establish core post-diagnostic dementia support services. Further research is needed to identify effective systems to enable accurate assessment and to ensure earlier diagnosis in high-risk groups.

  3. Several factors influenced general practitioner participation in the implementation of a disease management programme.

    Science.gov (United States)

    Ribe, Anette Riisgaard; Fenger-Grøn, Morten; Vedsted, Peter; Bro, Flemming; Kærsvang, Lone; Vestergaard, Mogens

    2014-09-01

    Disease management programmes (DMPs) require a high degree of participation from general practitioners (GPs) in order to succeed. We aimed to describe the participation among Danish GPs in a DMP. A quality improvement project entitled the Chronic Care Compass (CCC) was introduced in 2010 by the Central Denmark Region. The project was based on DMPs targeting persons suffering from three chronic diseases (diabetes, chronic obstructive pulmonary disease and acute coronary syndrome). All GPs in the region were invited to participate. We obtained data from administrative registries and studied the participation and its association with characteristics of practices and patients. Differences in participation were assessed using binomial regression models. A total of 271 (69.1%) practices participated in the CCC. The participation was 28.9 percentage points (pp) (confidence interval (CI): 14.3; 43.6) lower among GPs who were older than 60 years versus younger than 50 years, 32.2 pp (CI: 19.1; 45.2) lower among GPs who provided few versus many chronic care consultations, 13.7 pp (CI: 1.7; 25.6) lower among GPs with lower versus medium practice gross income, and 16.9 pp (CI:6.1; 27.8) lower among GPs with a patient population with medium versus low degree of socio-economic deprivation. Participation in the CCC was lower among GPs who provided less chronic care, had a lower practice gross income and had a patient population with a higher degree of deprivation. The project was supported by the Research Unit for General Practice, Aarhus University, and the Lundbeck Foundation. not relevant.

  4. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  5. [The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management].

    Science.gov (United States)

    Grundmann, R T; Petersen, M; Lippert, H; Meyer, F

    2010-06-01

    This review comments on epidemiology, diagnosis and general principles of surgical management in patients with acute abdomen. DEFINITION AND EPIDEMIOLOGY: The most common cause of acute abdominal pain is non-specific abdominal pain (24 - 44.3 % of the study populations), followed by acute appendicitis (15.9 - 28.1 %), acute biliary disease (2.9 - 9.7 %) and bowel obstruction or diverticulitits in elderly patients. Acute appendicitis represents the cause of surgical intervention in two-thirds of the children with acute abdomen. A standardised physical examination combined with ultrasonography (US) represents the initial investigation in patients with acute abdominal pain. Due to the risk associated with radiation and due to the costs, a selective use of CT imaging is recommended. The work-flow given in this paper restricts the use of CT imaging to less than 50 % of patients with acute abdominal pain. Diagnostic laparoscopy should be considered in patients without a specific diagnosis after appropriate imaging and as an alternative to active clinical observation which is the current practice in patients with non-specific abdominal pain. Acute small bowel obstruction has previously been considered as a relative contraindication for laparoscopic management, but it has been shown in the meantime that laparoscopic treatment is an elegant tool for the management of simple band small bowel obstruction. Bedside diagnostic laparoscopy is recommended in intensive care unit (ICU) patients with acute abdomen or sepsis of unknown origin, in suspicion of acute cholecystitis, diffuse gut hypoperfusion and mesenteric ischaemia or in refractory lactic acidosis, especially after cardiac surgery. Early administration of analgesia to patients with acute abdominal pain in the emergency department will reduce the patient's discomfort without impairing clinically important diagnostic accuracy and is recommended on the basis of some prospective randomised trials. However, the impact on

  6. Crew Factors in Flight Operations XV: Alertness Management in General Aviation Education Module

    Science.gov (United States)

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.; Cannon, Mary M. (Technical Monitor)

    2002-01-01

    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  7. Nuclear safety philosophy and its general application to fuel management and handling - a regulator's viewpoint

    International Nuclear Information System (INIS)

    Petty, I.C.

    1995-01-01

    The Nuclear Safety Division (NSD) of the Health and Safety Executive (HSE) informs the UK Nuclear Industry of the principles that it applies in assessing whether licensees have demonstrated that their nuclear plants are as safe as is reasonably practicable. The paper commences with a discussion of the non-prescriptive approach to health and safety regulation which is the basis of the regulatory activities of NSD's operating arm -the Nuclear Installations Inspectorate (NII). It then describes in broad terms the overall approach used by NII for analysing the safety of nuclear plant, including fuel, which will cover both deterministic and probabilistic methodologies. The paper then introduces the sections of the Safety Assessment Principles which apply to nuclear fuel safety (both fuel handling and management). Most of these principles are of a general nature and do not just apply to fuel. The paper explains how safety cases might relate to the SAPs and offers some views on how a licensee might interpret them in developing his safety case. Particular emphasis is placed on the importance of submitting a high quality safety case and the type of information that should be in it. The advantages of the approach proposed, to the licensee as well as to the regulator, are identified. (author)

  8. Management of mediastinal syndromes in pediatrics: a new challenge of ultrasound guidance to avoid high-risk general anesthesia.

    Science.gov (United States)

    Sola, Chrystelle; Choquet, Olivier; Prodhomme, Olivier; Capdevila, Xavier; Dadure, Christophe

    2014-05-01

    Adverse events associated with anesthetic management of anterior mediastinal masses in pediatrics are common. To avoid an extremely hazardous general anesthesia, the use of real-time ultrasonography offers an effective alternative in high-risk cases. We report the anesthetic management including a light sedation and ultrasound guidance for regional anesthesia, surgical node biopsy, and placement of a central venous line in two children with an anterior symptomatic mediastinal mass. For pediatric patients with clinical and/or radiologic signs of airway compression, ultrasound guidance provides safety technical assistance to avoid general anesthesia and should be performed for the initial diagnostic and therapeutic procedures. © 2013 John Wiley & Sons Ltd.

  9. Non-Hodgkin's lymphoma - Part II: Management of primary extranodal lymphomas, generalized disease and salvage treatment

    International Nuclear Information System (INIS)

    Gospodarowicz, Mary K.; Sutcliffe, Simon B.

    1996-01-01

    Objective: To review the approach to the diagnosis, classification, assessment, treatment and continuing management of patients with primary extranodal non-Hodgkin's lymphoma, and the management of generalized disease with the emphasis on the current role of salvage treatment with high dose chemotherapy and stem cell/bone marrow support strategies. Non-Hodgkin's lymphoma may involve any part of the body. Many lymphomas, such as MALT, angiocentric T-cell, etc., commonly present in extranodal sites. Lymphomas presenting in the GI tract, and head and neck, are most common with the single most common site being the stomach. Gastric lymphoma is associated with Helicobacter pylorii and is most common in areas endemic for Helicobacter pylorii infection. Recent advances in the understanding of the etiology of gastric MALT, thyroid, and intestinal lymphomas present new opportunities for the application of novel therapeutic approaches e.g. antibiotic therapy for Helicobacter pylori and early stage IPSID. Lymphomas presenting in the orbit, thyroid, breast, bone, extradural and skin are of interest because of the importance of expert RT in securing local control. Primary brain lymphomas present a particular challenge to the radiation oncologist. Although localized, primary brain lymphomas are extremely difficult to control. Rare sites of extranodal lymphoma include testis, female genital tract, and lung. Extranodal lymphomas are often localized and cure with RT or CMT is possible. They represent a assorted group of diseases with diverse presentations, prognosis, sensitivity to RT and expected outcome. They are of particular importance to radiation oncologists as they require special attention to patterns of spread and treatment planning. The principles of management of primary extranodal lymphoma, however, follow those applicable to localized nodal presentations. Although primary extranodal lymphomas are highly curable, a proportion of patients will fail with disseminated

  10. Management of Overweight during Childhood: A Focus Group Study on Health Professionals’ Experiences in General Practice,”

    DEFF Research Database (Denmark)

    Larsen, Lone Marie; Ledderer, Loni; Jarbol, Dorte E

    2015-01-01

    Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised...... controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health...... to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised...

  11. 77 FR 71711 - Commission's Rules Regarding the Office of Managing Director and the Office of Inspector General

    Science.gov (United States)

    2012-12-04

    ...In this document, the Federal Communications Commission (Commission) amends its rules to reassign to the Office of Managing Director (OMD) certain audit activities formerly assigned to the Office of Inspector General (OIG). The activities concern oversight of the annual audit of the Universal Service Administrative Corporation (USAC) required by the Commission's rules. In addition, the Commission delegates of authority to OMD, in consultation with the Office of General Counsel, to issue subpoenas concerning matters within its jurisdiction.

  12. 78 FR 68469 - Draft General Management Plan/Wilderness Study/Environmental Impact Statement, Channel Islands...

    Science.gov (United States)

    2013-11-14

    ... decision making, which will allow managers to effectively address future opportunities and problems, such... will serve as the basis for future detailed management documents, such as five-year strategic plans and...

  13. Computer templates in chronic disease management: ethnographic case study in general practice

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

    2012-01-01

    Objective To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Design Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography. Setting Two general practices in England. Participants and methods Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Results Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Conclusions Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the

  14. 78 FR 26067 - General Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas

    Science.gov (United States)

    2013-05-03

    .... Alternative 2, the NPS preferred alternative, would support a broad ecosystem approach for preserve management... management of cross-boundary resource issues and the importance of encouraging partnerships to address and... Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas AGENCY: National...

  15. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

    Directory of Open Access Journals (Sweden)

    James Yates

    2016-08-01

    Full Text Available Background: Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Design and setting: A prospective observational study of 80 patients aged over 50 years and who had not received echocardiography or chest CT within 12 months presenting to a general practice. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Results and conclusion: Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20% patients, including aortic stenosis in 9 (11% and cardiac failure in 7 (9%, which were missed by clinical examination in 10 (62.5% of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease including referral for diagnostic echocardiography in 8 (10%, commencement of heart failure treatment in 3 (4% and referral to a cardiologist in 1 patient (1%. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice.

  16. Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon.

    Science.gov (United States)

    Fernández, Luis G

    2016-09-01

    Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  17. Nurse managers: Determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study.

    Science.gov (United States)

    Heckemann, Birgit; Peter, Karin A; Halfens, Ruud Jg; Schols, Jos Mga; Kok, Gerjo; Hahn, Sabine

    2017-12-01

    To explore nurse managers' behaviours, attitudes, perceived social norms, and behavioural control in the prevention and management of patient and visitor aggression in general hospitals. Patient and visitor aggression in general hospitals is a global problem that incurs substantial human suffering and organizational cost. Managers are key persons for creating low-aggression environments, yet their role and behaviours in reducing patient and visitor aggression remains unexplored. A qualitative descriptive study underpinned by the Reasoned Action Approach. Between October 2015-January 2016, we conducted five focus groups and 13 individual interviews with nurse leaders in Switzerland. The semi-structured interviews and focus groups were recorded, transcribed, and analysed in a qualitative content analysis. We identified three main themes: (i) Background factors: "Patient and visitor aggression is perceived through different lenses"; (ii) Determinants and intention: "Good intentions competing with harsh organizational reality"; (iii) Behaviours: "Preventing and managing aggressive behaviour and relentlessly striving to create low-aggression work environments". Addressing patient and visitor aggression is difficult for nurse managers due to a lack of effective communication, organizational feedback loops, protocols, and procedures that connect the situational and organizational management of aggressive incidents. Furthermore, tackling aggression at an organizational level is a major challenge for nurse managers due to scant financial resources and lack of interest. Treating patient and visitor aggression as a business case may increase organizational awareness and interest. Furthermore, clear communication of expectations, needs and resources could optimize support provision for staff. © 2017 John Wiley & Sons Ltd.

  18. Routine general practice care for panic disorder within the lifestyle approach to managing panic study

    Directory of Open Access Journals (Sweden)

    Rodney A. Lambert

    2012-07-01

    Full Text Available Routine general practice (GP care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts. Participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PD with/without agoraphobia. Follow-up measures recorded at 20 weeks/10 months following randomisation. Control arm, unrestricted routine GP care (practice appointments, referrals and prescriptions. Trial arm, occupational therapyled lifestyle treatment comprising lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine. Primary outcome measure: beck anxiety inventory. At baseline, participants attended 2-3 times more GP appointments than population average, reducing at 10 months to 1.6 times population average for routine GP care and 0.97 population average for lifestyle arm. At 10 months, 33% fewer referrals (6 referrals; 0 mental health than at baseline (9 referrals; 2 mental health were made for lifestyle arm patients compared with 42% increase (from 12 referrals; 8 mental health at baseline to 17 referrals; 7 mental health in GP care arm. Selective serotonin reuptake inhibitors were prescribed most often. Benzodiazepines and beta-blockers were prescribed more often than tricyclic against current clinical guidelines. In conclusion, we found that PD patients at baseline were high healthcare resource users. Treatment in both study arms reduced resource use. Routine GP care requires further review for this patient group.

  19. The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice

    Directory of Open Access Journals (Sweden)

    Bakare Tony MO

    2010-07-01

    Full Text Available Abstract Background Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat. Methods Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to Main outcome measures: 1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat. 2. Patients' trust in the scorecard. Results The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity. There was a high level of patient trust in the scorecard was (85.8% agreement. Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement. Conclusions As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.

  20. Training and validation of standardized patients for evaluation of general practitioners′ performance in management of obesity and overweight

    Directory of Open Access Journals (Sweden)

    Tahereh Changiz

    2014-01-01

    Conclusion: SP could be a powerful instrument for evaluating medical performance of general practitioners in the field of obesity/overweight management. Further research is needed to find the more aspects of training and validation of unannounced SPs in this field.

  1. Review of guidance on recurrence risk management for general practitioners in breast cancer, colorectal cancer and melanoma guidelines.

    NARCIS (Netherlands)

    Spronk, I.; Korevaar, J.C.; Burgers, J.S.; Albreht, T.; Schellevis, F.G.

    2017-01-01

    Background. General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. Objective. To explore what

  2. Validated Competency Task Lists for General Merchandise Retailing, Food Service Management, and Business and Personal Services Marketing.

    Science.gov (United States)

    Faught, Suzanne G.

    This publication contains competency task lists that address principal entry-level and career-sustaining jobs in the occupational categories of general merchandise retailing, food service management, and business and personal services marketing. Section I, Development of the Competency Task Lists, provides details on how the competencies were…

  3. 78 FR 9721 - Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management...

    Science.gov (United States)

    2013-02-11

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5613-N-06-C] Privacy Act of 1974; New System of Records, Office of General Counsel E-Discovery Management System: Republication of System.... SUMMARY: Pursuant to the provision of the Privacy Act of 1974, HUD is providing notice of its formal...

  4. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial.

    Science.gov (United States)

    Druss, Benjamin G; Singh, Manasvini; von Esenwein, Silke A; Glick, Gretl E; Tapscott, Stephanie; Tucker, Sherry Jenkins; Lally, Cathy A; Sterling, Evelina W

    2018-02-01

    Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

  5. Do General Practices of Management Play Role as Drivers for Employee Job Satisfaction in Pakistani Entrepreneurial Companies?

    Directory of Open Access Journals (Sweden)

    Sergey Nikolaevich Polbitsyn

    2017-03-01

    Full Text Available Using general practices of management is management philosophy; many organizations practice these tools that endeavor to improve their efficiency and competitiveness in the business markets. It is an integrated approach to reaching and maintaining high-quality production and services focusing on the maintenance and continuous improvement of operations in order to satisfy or exceed the customer satisfaction. Many researchers have done a lot of work on other management practices; total quality management is an important one of them in this competitive era, which has rarely studied especially in small and medium size entrepreneurial companies in Pakistan. This quantitative research study tried to determine the impact of Total Quality Management practices on job satisfaction level of the employees of those small and medium size companies based on new and creative ideas in the capital city. The conducted survey among 550 employees of small and medium size entrepreneurial companies in the capital of Pakistan got 200 employees response properly in filling out the questionnaire. The collected data was analyzed after applying software (version 20 Statistical Package for Social Sciences. Multiple regression was applied to test the proposed model, which was found satisfied. Leadership and top management support were founded the most dominant practice among the selected Total Quality Management practices which has a significant effect on employee job satisfaction. The findings of this study prove that the implementation of Total Quality Management practices can help in increasing employees’ job satisfaction which intern would increase Productivity of small and medium size entrepreneurial companies.

  6. 76 FR 56220 - Draft Environmental Impact Statement for General Management Plan for Golden Gate National...

    Science.gov (United States)

    2011-09-12

    ... serve as a blueprint to guide management of these units of the National Park System over the next 15-20... Recreation Area (GGNRA) has been operating under its first GMP, approved in 1980. During the 30 years since... cultural resources. The fundamental resources of each showcased site would be managed at the highest level...

  7. Teacher Professional Knowledge and Classroom Management: On the Relation of General Pedagogical Knowledge (GPK) and Classroom Management Expertise (CME)

    Science.gov (United States)

    König, Johannes; Kramer, Charlotte

    2016-01-01

    Due to the need for measurement instruments that allow an investigation of teachers' situational cognition and thus go beyond the limited scope of classical paper-and-pencil-tests, we ask how a specific video-based measurement of teachers' classroom management expertise can provide additional information when compared with an established…

  8. Participation of general practitioners in disease management: experiences from the Netherlands

    Directory of Open Access Journals (Sweden)

    L.M.G. Steuten

    2002-03-01

    Full Text Available Objective: To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. Methods: The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs barring those involved in the testing of the questionnaire. Results: At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. Conclusions: The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

  9. Modelo de dirección estratégica para el departamento de Medicina General Integral Model of strategical management for the Department of General Comprehensive Medicine

    Directory of Open Access Journals (Sweden)

    Alcides Abad Ochoa Alonso

    2005-12-01

    Full Text Available La creciente complejidad del proceso organizacional del Departamento de Medicina General Integral, de la Facultad de Ciencias Médicas “Mariana Grajales Coello” de Holguín, evidenció la necesidad de una intervención de carácter estratégico, capaz de guiar la gestión del cambio y de facilitar la sostenibilidad de las estrategias en curso en el departamento. Valiéndose de métodos de investigación científica, como son, el dialéctico, la modelación y la triangulación, y otros propios de las ciencias de la administración, se construyó un modelo de dirección estratégica específico para este departamento. El proyecto de intervención concebido es producto del análisis crítico de los modelos de dirección estratégica estudiados, y de la introducción de momentos, procedimientos y técnicas adecuados a las condiciones del departamento. Los enfoques rectores del proceso, aplicados en el modelo construido, permiten una mayor integración entre los niveles estratégico, táctico y operativo, con el consiguiente impacto esperado sobre la eficacia y la eficiencia en el alcance de los objetivos.The increasing complexity of the organizational process of the Department of General Comprehensive Medicine of “Mariana Grajales Coello” Faculty of Medical Sciences, in Holguin , evidenced the need of an intervention of strategical character capable of guiding the change management and of facilitating the sustainability of the strategies under way in the department. By using methods of scientific research, such as the dialectic methods, modeling, triangulation and others characteristic of the management science, it was constructed a specific model of strategical management for this department.The intervention project created is the result of the critical analysis of studied strategic management models, and of the introduction of moments, procedures and techniques adjusted to the conditions of the department. The ruling approaches of the

  10. The Centralized Temporary Storage (ATC) Spanish. General and operational readiness in the management of high level radioactive waste

    International Nuclear Information System (INIS)

    Reyes, S.; Diaz, A.; Dilla, A.; Gonzalez, J. R.; Haro, R.

    2014-01-01

    The high-level waste will go to Centralized Temporary Storage (ATC) in Villar de Canas (Cuenca), which is the solution to your management until finished designing its final disposal in the Deep Geological Storage (AGP). Transport containers of high activity radioactive waste will be stored on arrival at the ATC. In time of management, waste will be taken remotely, will be encapsulated in secure conditions and stored in vaults designed to be cooled by natural convection of air confinement. The buildings in the facility will have a general provision optimize the movement of packages and people for the development of all these activities. (Author)

  11. Combating information overload: a six-month pilot evaluation of a knowledge management system in general practice.

    Science.gov (United States)

    O'Brien, C; Cambouropoulos, P

    2000-01-01

    A six-month prospective study was conducted on the usefulness and usability of a representative electronic knowledge management tool, the WAX Active Library, for 19 general practitioners (GPs) evaluated using questionnaires and audit trail data. The number of pages accessed was highest in the final two months, when over half of the access trails were completed within 40 seconds. Most GPs rated the system as easy to learn, fast to use, and preferable to paper for providing information during consultations. Such tools could provide a medium for the activities of knowledge officers, help demand management, and promote sharing of information within primary care groups and across NHSnet or the Internet. PMID:10962792

  12. General Services Administration. STAR-PBS' New Program for Tracking and Managing Real Property

    National Research Council Canada - National Science Library

    King, Ron

    1999-01-01

    STAR is a real estate inventory management software application that maintains data on projects, leases, buildings, and space assignments that is, who is in what space-in an integrated database environment...

  13. 76 FR 81962 - Final Environmental Impact Statement for General Management Plan, Ross Lake National Recreation...

    Science.gov (United States)

    2011-12-29

    ... soundscapes, and scenery through traditional outdoor activities. The NPS would actively manage to reduce... Ross Lake NRA in order to protect and enhance soundscapes and wilderness character, experience, and...

  14. Medicaid program; Medicaid Management Information Systems; performance standards--HCFA. General notice.

    Science.gov (United States)

    1983-05-31

    The purpose of this notice is to respond to the comments we received on the Medicaid Management Information Systems Performance Standards that we published in a notice with comment period on June 30, 1981 (46 FR 33653).

  15. NELS 2.0 - A general system for enterprise wide information management

    Science.gov (United States)

    Smith, Stephanie L.

    1993-01-01

    NELS, the NASA Electronic Library System, is an information management tool for creating distributed repositories of documents, drawings, and code for use and reuse by the aerospace community. The NELS retrieval engine can load metadata and source files of full text objects, perform natural language queries to retrieve ranked objects, and create links to connect user interfaces. For flexibility, the NELS architecture has layered interfaces between the application program and the stored library information. The session manager provides the interface functions for development of NELS applications. The data manager is an interface between session manager and the structured data system. The center of the structured data system is the Wide Area Information Server. This system architecture provides access to information across heterogeneous platforms in a distributed environment. There are presently three user interfaces that connect to the NELS engine; an X-Windows interface, and ASCII interface and the Spatial Data Management System. This paper describes the design and operation of NELS as an information management tool and repository.

  16. Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and registrars in general practice.

    Science.gov (United States)

    Stone, Louise

    2014-12-05

    Patients with medically unexplained symptoms (MUS) commonly present in general practice. They often experience significant disability and have difficulty accessing appropriate care. Many feel frustrated and helpless. Doctors also describe feeling frustrated and helpless when managing these patients. These shared negative feelings can have a detrimental effect on the therapeutic relationship and on clinical outcomes. The aim of this study was to explore how novice and experienced GPs manage patients with MUS and how these skills are taught and learned in GP training. A constructivist grounded theory study with 24 general practice registrars and supervisors in GP training practices across Australia. Registrars lacked a framework for managing patients with MUS. Some described negative feelings towards patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the practical, interpersonal and therapeutic challenges associated with the care of these patients. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness, are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings so that consultations are more effective. The care of these patients also raises issues of professional identity, roles and responsibilities. Supervisors can assist their registrars by proactively sharing models of the consultation, strategies for managing their own feelings and frustrations, and ways of understanding and managing the therapeutic relationship in this difficult area of practice.

  17. Management of chronic orofacial pain: a survey of general dentists in german university hospitals

    NARCIS (Netherlands)

    Wirz, Stefan; Ellerkmann, Richard K.; Buecheler, Marcus; Putensen, Christian; Nadstawek, Joachim; Wartenberg, Hans-Christian

    2010-01-01

    AIM: This survey assessed procedures performed by general dentists in German university hospitals treating patients with chronic orofacial pain (COP). METHODS: A standardized questionnaire was sent to dentists at all 42 German universities. Doctors were asked to describe demographics, diagnoses,

  18. Are managers' and the general public's perceptions of risk communication needs in line? A French alpine valley case study

    Science.gov (United States)

    Charrière, Marie; Sprague, Teresa; Bogaard, Thom; Greiving, Stefan; Malet, Jean-Philippe; Mostert, Erik

    2013-04-01

    Risk communication is a crucial element of risk management. It contributes to social capacity building by influencing the knowledge, attitude, behavior, psychology, as well as social and organizational aspects1,2. It is globally recognized that effective risk communication should address needs and requirements of targeted audiences, especially those of the public. This study compares needs and requirements related to risk communication as seen by the risk managers, with the needs and requirements as expressed by the general public. Two surveys were conducted in a mountainous region facing multi-hazards, the Ubaye valley (France). The first survey, conducted within the context of the Marie Curie Research and Training Network 'Mountain Risk', was addressed to the local community. It aimed at gathering perceptions, needs and requirements of the general public (344 respondents) on risk communication3. The second survey, conducted in the context of the Marie Curie Initial Training Network 'CHANGES', targeted risk managers (16 stakeholders of the authorities, technical services and emergency units) at both the local and the regional scale to evaluate their perceptions regarding risk communication with the general public. The needs and requirements were analyzed with respect to several dimensions: 1) the information provided to the public, 2) the legal requirements for communication, 3) the level of trust the population has in risk managers, 4) insights on awareness and preparedness, and 5) information on the media used in past communication efforts. Results of the analysis concerning the last dimension reveal that, while the general public mentioned press, official reports and technical reports as the top three media by which they received information, the risk managers cited the press but in contrast also selected radio and television. Other results indicate that a potential mismatch exists as more than 80% of the respondents of the population find all listed topics

  19. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    Science.gov (United States)

    van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

    2016-01-01

    To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

  20. Implementation of Supply Chain Management (SCM in pharmaceutical company, general principles and case study

    Directory of Open Access Journals (Sweden)

    Zoran Nakov

    2014-12-01

    Full Text Available Supply Chain Management (SCM in pharmaceutical industry is defined as a “responsible SCM” and its implementation is according to the principles of: business ethics, rights of labor and principles of healthy and safe working environment. Pharmaceutical companies with implemented “responsible SCM” have to use management systems to facilitate continuous improvement in accordance with their working principles. The main purpose of this management system is to ensure the consistency, reliability and continuous improvement of all workflows within an organization.The analyzed case describes the project of European generic pharmaceutical company, which intends to implement best practice SCM operations for five European manufacturing sites and European logistics organizations (active ingredients supply, distribution centers, affiliate customers and third party manufacturers. The main objectives of the project were the creation of the future improved To-Be situation through implementation of new SCM models to the existing To-Day situation.

  1. Development and implementation of a decision pathway for general practitioners for the management or referral of suspected allergy

    Directory of Open Access Journals (Sweden)

    Ray B. Jones

    2014-07-01

    Full Text Available Many patients with suspected allergy are referred to specialist care inappropriately. We aimed to develop and implement an online decision pathway to aid General Practitioners’ (GPs management decisions in suspected allergy. Our study involved 1487 GPs, 3 referral management centres, 5 GP system suppliers, 4 primary care trusts, and 1 specialist allergy clinic. The pathway was implemented by 3/5 GP system suppliers, published to Map of Medicine and on a specialist clinic website. In the first year, the pathway ranked in the top 10/160 local care maps accessed via Map of Medicine and was viewed 900 times. Only 96 GPs registered to use the clinic website. Only 110 (7% GPs responded to the feedback request, of which 13/110 (12% had used the pathway; nearly all thought it useful. It was used by referral management centres as explanation of rejected referrals. Alternative approaches to embed its use are required.

  2. Report of the JAERI's Institution Evaluation Committee on general organizational managements

    International Nuclear Information System (INIS)

    1999-11-01

    In accordance with the National Guidelines on the Method of Evaluation for Government R and D, the Institution Evaluation Committee of JAERI conducted the extensive review on overall aspects in the JAERI's organizational management, starting with the Committee Meeting held in December 1998. This report describes the results of the review on 'JAERI's organizational management in view of the National Guidelines', 'Summary of evaluation of R and D themes' and 'Recommendations by the Committee and its Members', The contents, reported to news agencies in March 1999, are also available in the JAERI's internet home page. (author)

  3. General Employee Radiological Training and Radiological Worker Training: Program management manual

    International Nuclear Information System (INIS)

    1992-10-01

    This manual defines and describes the DOE General Employee Radiological Training (GERT) and Radiological Worker I and II (RW I and II) Training programs. It includes material development requirements, standards and policies, and program administration. This manual applies to General Employee Radiological Training and Radiological Worker Training at all DOE contractor sites. The training materials of both GERT and RW I and II training reflect the requirements identified in the DOE Radiological Control Manual and DOE Order 5480.11. The training programs represent the minimum requirement for the standardized core materials. Each contractor shall implement the program in its entirety and may augment the standardized core materials to increase the general employee and radiological worker level of competency

  4. Management of dental implant complications among general dental practitioners in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Nasser Mansour Assery

    2018-01-01

    Conclusion: Dentists who participated in dental implantology workshops had a higher tendency to answer correctly compared to dentists who were given didactic courses in their undergraduate studies in issues associated with hands-on training. This shows that hands-on training in the undergraduate studies would result in a better understanding of dental implants, its complications, and management.

  5. Conditions, factors and criteria for successful project implementation: generalization of experience of project management

    Directory of Open Access Journals (Sweden)

    Feraru Galina Sergeevna

    2014-11-01

    Full Text Available The article addresses issues characterizing features of project management contributing to their competitive advantage; shows the factors and criteria of success of projects and the main reasons for their failures, making the failed efforts of developers to create projects.

  6. Role of general people in solid waste management in Khorramabad city

    Directory of Open Access Journals (Sweden)

    ghodratollah Shams Khoramabadi

    2007-01-01

    Conclusion: We figured out that a majority of Khorramabad citizens had a good attitude but a weak knowledge and performance on solid waste management. Therefore we suggest that the knowledge and performance levels of the community can be increased via adopting good educational programs by related organizations and social media.

  7. Environment: General; Grammar & Usage; Money Management; Music History; Web Page Creation & Design.

    Science.gov (United States)

    Web Feet, 2001

    2001-01-01

    Describes Web site resources for elementary and secondary education in the topics of: environment, grammar, money management, music history, and Web page creation and design. Each entry includes an illustration of a sample page on the site and an indication of the grade levels for which it is appropriate. (AEF)

  8. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-Van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting

  9. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting with

  10. Public management, context, and performance: in quest of a more general theory

    NARCIS (Netherlands)

    O'Toole, Laurence J.; Meier, Kenneth J.

    2015-01-01

    Recent years have seen a substantial growth in the large-N quantitative study of public management and performance. Much of the progress can be attributed to a small number of data sets on local governments in a few countries. The range of data sets suggests the validity of the overall hypothesis of

  11. General Practitioners' Management of Psychostimulant Drug Misuse: Implications for Education and Training

    Science.gov (United States)

    Alkhamis, Ahmed; Matheson, Catriona; Bond, Christine

    2009-01-01

    Aims: To provide baseline data regarding GPs' knowledge, experience, and attitudes toward the management of PsychoStimulant Drug Misuse (PSDM) patients to inform future education and training initiatives. Methods: A structured cross-sectional postal questionnaire was developed following initial content setting interviews, piloted then sent to a…

  12. Tourism and natural resource management: a general overview of research and issues.

    Science.gov (United States)

    Jeffrey D. Kline

    2001-01-01

    In recent years, growing awareness among tourism researchers of the relations between tourism and natural resource management has resulted in a substantial body of academic literature examining tourism issues under a relatively new set of tourism concepts. Seemingly new forms of tourism, such as nature-based tourism, ecotourism, and sustainable tourism, now are...

  13. [General background and practical implementation of the health management service institution in Korea].

    Science.gov (United States)

    Okahara, Shintaro; Lee, Byeong-Woo; Ogasawara, Takayuki; Mori, Koji

    2014-09-01

    The Korean Occupational Safety and Health Act requires an employer with more than 50 employees to assign a health manager or an occupational physician. However, there are many cases where it is difficult for medium-scale enterprises to perform occupational health practices autonomously because their financial base is weaker than that of large-scale enterprises. The Korean Occupational Safety and Health Act was amended in 1990 so that medium-scale enterprises could entrust a health management service institution with their health management tasks. This system is similar to the outsourcing of medical examinations, occupational physicians, or the measurement of the working environment in Japan, but its legal background and actual activities are korea-specific, and it has some different points. In particular, the quality control of health management service institutions by legal and administrative regulations, and the multidisciplinary provision of services contribute to the development of occupational health in medium-scale enterprises. This will be a good reference for occupational health services in small- and medium-scale enterprises in the future in Japan.

  14. A revolutionary approach to composite construction and flight management systems for small, general aviation airplanes

    Science.gov (United States)

    Roskam, Jan; Wenninger, ED

    1992-01-01

    The design studies for two composite general aviation airplanes are presented. The main consideration for both of the designs was to avoid the typical 'metal replacement' philosophy that has hindered the widespread use of composites in general aviation aircraft. The first design is for a low wing aircraft based on the Smith Aircraft Corporation GT-3 Global Trainer. The second aircraft is a composite version of the Cessna 152. The project was conducted as a graduate level design class under the auspices of the KU/NASA/USRA Advanced Design Program in aeronautics. The results obtained from the Fall semester of 1991 and the Spring semester of 1992 are presented.

  15. Grazing management effects on sediment, phosphorus, and pathogen loading of streams in cool-season grass pastures.

    Science.gov (United States)

    Schwarte, Kirk A; Russell, James R; Kovar, John L; Morrical, Daniel G; Ensley, Steven M; Yoon, Kyoung-Jin; Cornick, Nancy A; Cho, Yong Il

    2011-01-01

    Erosion and runoff from pastures may lead to degradation of surface water. A 2-yr grazing study was conducted to quantify the effects of grazing management on sediment, phosphorus (P), and pathogen loading of streams in cool-season grass pastures. Six adjoining 12.1-ha pastures bisected by a stream in central Iowa were divided into three treatments: continuous stocking with unrestricted stream access (CSU), continuous stocking with restricted stream access (CSR), and rotational stocking (RS). Rainfall simulations on stream banks resulted in greater ( CSR pastures. Bovine enterovirus was shed by an average of 24.3% of cows during the study period and was collected in the runoff of 8.3 and 16.7% of runoff simulations on bare sites in CSU pastures in June and October of 2008, respectively, and from 8.3% of runoff simulations on vegetated sites in CSU pastures in April 2009. Fecal pathogens (bovine coronavirus [BCV], bovine rotavirus group A, and O157:H7) shed or detected in runoff were almost nonexistent; only BCV was detected in feces of one cow in August of 2008. Erosion of cut-banks was the greatest contributor of sediment and P loading to the stream; contributions from surface runoff and grazing animals were considerably less and were minimized by grazing management practices that reduced congregation of cattle by pasture streams. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  16. [Management of patients with bronchial asthma received general anesthesia and surgical intervention].

    Science.gov (United States)

    To, Masako; Tajima, Makoto; Ogawa, Cyuhei; Otomo, Mamoru; Suzuki, Naohito; Sano, Yasuyuki

    2002-01-01

    Stimulation to bronchial mucosa is one of the major risk factor of asthma attack. When patients receive surgical intervention and general anesthesia, they are always exposed to stimulation to bronchial mucosa. Prevention method of bronchial asthma attack during surgical intervention is not established yet. We investigated that clinical course of patients with bronchial asthma who received general anesthesia and surgical intervention. Seventy-six patients with bronchial asthma were received general anesthesia and surgical intervention from 1993 to 1998. Twenty-four patients were mild asthmatic patients, 39 were moderate asthmatic patients and 13 were severe asthmatic patients. Preoperative treatment for preventing asthma attack was as follows; Eight patients were given intravenous infusion of aminophylline before operation. Fifty-two patients were given intravenous infusion of aminophylline and hydrocortisone before operation. Three patients were given intravenous infusion of hydrocortisone for consecutive 3 days before operation. Thirteen patients were given no treatment for preventing asthma attack. One patient was suffered from asthma attack during operation. She was given no preventing treatment for asthma attack before operation. Three patients were suffered from asthma attack after operation. No wound dehiscence was observed in all patients. To prevent asthma attack during operation, intravenous infusion of steroid before operation is recommended, when patients with asthma receive general anesthesia and surgical intervention.

  17. Professional reimbursement and management of time in general practice: A international comparison

    NARCIS (Netherlands)

    Calnan, M.; Groenewegen, P.P.; Hutten, J.

    1992-01-01

    A hypothetical model was proposed for explaining the relationship between general practitioners' system of payment and the amount of time spent in patient and non-patient work. It was hypothesized that GPs reactions to higher workload vary according to the payment system. In this paper we compare

  18. Agency, Managed Care and Financial-Risk Sharing in General Medical Practice

    NARCIS (Netherlands)

    A. Vermaas

    2006-01-01

    textabstractWhich techniques can and do third-party agents apply within their relationships with general practitioners in order to reduce the agency problems within the patient-physician relationship? We gave an overview of techniques that are used by third parties rather commonly – that is to

  19. Cholesterol management in Dutch general practice: a comparison with national guidelines.

    NARCIS (Netherlands)

    Weijden, T. van der; Hutten, J.B.F.; Brandenburg, B.J.; Grol, R.P.T.M.; Velden, K. van der

    1994-01-01

    OBJECTIVE: To examine cholesterol diagnosis and treatment by Dutch general practitioners (GPs) in the period before publication of national guidelines, in order to develop implementation strategies based on discrepancies found between daily practice and the guidelines. DESIGN: Data of the 'Dutch

  20. General Stroke Management In Stroke Unit: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2015-08-01

    Full Text Available In this section, in the light of evidence-based data concerning essentiality that the stoke patients should be treated in A stroke unit and related centers, a brief and current information about general stroke treatment of patients with stroke during acute phase will be offered.

  1. Generalities on nuclear accidents and their short-dated and middle-dated management

    International Nuclear Information System (INIS)

    2003-03-01

    All the nuclear activities present a radiation risk. The radiation exposure of the employees or the public, may occur during normal activity or during an accident. The IRSN realized a document on this radiation risk and the actions of protection. The sanitary and medical aspects of a radiation accident are detailed. The actions of the population protection during an accident and the post accident management are also discussed. (A.L.B.)

  2. DEFINING ASPECTS OF HUMAN RESOURCE MANAGEMENT STRATEGY WITHIN THE GENERAL STRATEGY OF THE MODERN ORGANIZATION

    OpenAIRE

    Emanoil MUSCALU; Silvana Nicoleta MUNTEAN

    2013-01-01

    The field of human resources requires the presence and action of several categories of persons and managerial structures interested in the quality of human resources and the activities developed by them. Besides managers and employees there are also the shareholders, the unions, the customers, the different national or local agencies, the local community, etc., with major interests regarding decisions in the human resources area. In order to harmonize their activities and achieve an optimal p...

  3. Adding Hierarchical Objects to Relational Database General-Purpose XML-Based Information Managements

    Science.gov (United States)

    Lin, Shu-Chun; Knight, Chris; La, Tracy; Maluf, David; Bell, David; Tran, Khai Peter; Gawdiak, Yuri

    2006-01-01

    NETMARK is a flexible, high-throughput software system for managing, storing, and rapid searching of unstructured and semi-structured documents. NETMARK transforms such documents from their original highly complex, constantly changing, heterogeneous data formats into well-structured, common data formats in using Hypertext Markup Language (HTML) and/or Extensible Markup Language (XML). The software implements an object-relational database system that combines the best practices of the relational model utilizing Structured Query Language (SQL) with those of the object-oriented, semantic database model for creating complex data. In particular, NETMARK takes advantage of the Oracle 8i object-relational database model using physical-address data types for very efficient keyword searches of records across both context and content. NETMARK also supports multiple international standards such as WEBDAV for drag-and-drop file management and SOAP for integrated information management using Web services. The document-organization and -searching capabilities afforded by NETMARK are likely to make this software attractive for use in disciplines as diverse as science, auditing, and law enforcement.

  4. General Biology and Current Management Approaches of Soft Scale Pests (Hemiptera: Coccidae).

    Science.gov (United States)

    Camacho, Ernesto Robayo; Chong, Juang-Horng

    We summarize the economic importance, biology, and management of soft scales, focusing on pests of agricultural, horticultural, and silvicultural crops in outdoor production systems and urban landscapes. We also provide summaries on voltinism, crawler emergence timing, and predictive models for crawler emergence to assist in developing soft scale management programs. Phloem-feeding soft scale pests cause direct (e.g., injuries to plant tissues and removal of nutrients) and indirect damage (e.g., reduction in photosynthesis and aesthetic value by honeydew and sooty mold). Variations in life cycle, reproduction, fecundity, and behavior exist among congenerics due to host, environmental, climatic, and geographical variations. Sampling of soft scale pests involves sighting the insects or their damage, and assessing their abundance. Crawlers of most univoltine species emerge in the spring and the summer. Degree-day models and plant phenological indicators help determine the initiation of sampling and treatment against crawlers (the life stage most vulnerable to contact insecticides). The efficacy of cultural management tactics, such as fertilization, pruning, and irrigation, in reducing soft scale abundance is poorly documented. A large number of parasitoids and predators attack soft scale populations in the field; therefore, natural enemy conservation by using selective insecticides is important. Systemic insecticides provide greater flexibility in application method and timing, and have longer residual longevity than contact insecticides. Application timing of contact insecticides that coincides with crawler emergence is most effective in reducing soft scale abundance.

  5. Interference Calculus A General Framework for Interference Management and Network Utility Optimization

    CERN Document Server

    Schubert, Martin

    2012-01-01

    This book develops a mathematical framework for modeling and optimizing interference-coupled multiuser systems. At the core of this framework is the concept of general interference functions, which provides a simple means of characterizing interdependencies between users. The entire analysis builds on the two core axioms scale-invariance and monotonicity. The proposed network calculus has its roots in power control theory and wireless communications. It adds theoretical tools for analyzing the typical behavior of interference-coupled networks. In this way it complements existing game-theoretic approaches. The framework should also be viewed in conjunction with optimization theory. There is a fruitful interplay between the theory of interference functions and convex optimization theory. By jointly exploiting the properties of interference functions, it is possible to design algorithms that outperform general-purpose techniques that only exploit convexity. The title “network calculus” refers to the fact tha...

  6. Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia.

    Science.gov (United States)

    Saraghi, Mana

    2015-01-01

    Intravenous fluids are administered in virtually every parenteral sedation and general anesthetic. The purpose of this article is to review the physiology of body-water distribution and fluid dynamics at the vascular endothelium, evaluation of fluid status, calculation of fluid requirements, and the clinical rationale for the use of various crystalloid and colloid solutions. In the setting of elective dental outpatient procedures with minor blood loss, isotonic balanced crystalloid solutions are the fluids of choice. Colloids, on the other hand, have no use in outpatient sedation or general anesthesia for dental or minor oral surgery procedures but may have several desirable properties in long and invasive maxillofacial surgical procedures where advanced hemodynamic monitoring may assess the adequacy of intravascular volume.

  7. HEMODYNAMIC STATUS IN AIRWAY MANAGEMENT DURING GENERAL ANESTHESIA: COMPARISON OF THREE METHODS

    OpenAIRE

    K MONTAZERI; KH NAGHIBI; A.A AKHOUNDI

    2000-01-01

    Introduction. The laryngeal mask airway (LMA) was recently introduced in general anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. Methods. The effects of LMA insertion, face mask or tracheal intubation on homodynamic status were studied in 195 normotensive patients who underwent elective transurethral lithotripsy (TUL). The patients were monitored with blood pressure measurement and pulse oximetry. Anesthesia was induced with sodium thiopental,...

  8. [Survey of general practioners in the management of diabetes in primary health facilities of Casablanca city, Morocco: opportunities and constraints].

    Science.gov (United States)

    Nani, S; Hassoune, S; Chinab, N; Boumdi, Z; Maaroufi, A

    2013-06-01

    Diabetes is a global health problem in full expansion, because of its increasing frequency, it frightening complications and the costs of its medical covering. In this study, we tried to make the current situation of the diabetes management in first-line public structures of the city of Casablanca. The survey of transverse observation to descriptive aiming was conducted using a pre questionnaire tested and selfadministered. It shows that 46.7 % of the questioned general practitioner judged that the quantity and the quality of average therapeutic existing in the center were insufficient to meet the needs for their diabetic patients. The weak socio-economic statute of the patients (78.8% of the cases), the lack of personnel (76.6%), the low educational level of patients (75.2%) and the problem of access to hospital (73.3%) constituted major problems of the correct diabetic medical covering. However, the majority of the doctors (98.1%) estimated to need training on diabetes management. The most required topics requested are: The control of the insulin treatment (97%), the diabetic education (91%) and the follow-up of diabetic (89%). The training of general practitioners particularly motivated and interested in diabetes could be the solution to improve the management of diabetes especially because of the lack of specialists in our country.

  9. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

    Science.gov (United States)

    Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

    2016-01-01

    Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment

  10. Exploring the opinions and perspectives of general practitioners towards the use of social networking sites for concussion management.

    Science.gov (United States)

    Ahmed, Osman; Sullivan, S John; Schneiders, Anthony; Moon, Sam; McCrory, Paul

    2013-03-01

    Social networking sites (SNSs) are increasingly being used for health-related purposes. Many patients now use sites such as Facebook to discuss symptoms, seek support, and search for advice on health conditions, including concussion. Innovative methods of delivering health information using these technologies are starting to emerge and it is important to seek the input of key stakeholder groups (including general practitioners) to establish their feasibility and to highlight areas of concern. This study aimed to seek the opinions of general practitioners towards the use of SNSs in concussion management. Semi-structured interviews were captured with a digital voice recorder and analysed using interpretative description methodology. Participants were general practitioners whose caseload included persons with a concussion between the ages of 16 and 30 years, and who had treated a patient with a concussion in the past 12 months. The clinical experience of the participants ranged from 3 to 35 years and 50% of the participants had a Facebook account themselves. While all participants were positive towards the use of SNSs for this purpose, concerns were raised regarding the issues of privacy and moderation. SNSs, particularly Facebook, have the potential (if correctly utilised) to be a viable adjunct to traditional concussion management programmes. In order for SNSs to be successfully used in this manner, the quality of information shared needs to be accurate and patients using them need to ensure that they get adequate cognitive rest.

  11. Retrospective audit of the acute management of stroke in two district general hospitals in the uk.

    Science.gov (United States)

    Faluyi, O O; Omodara, J A; Tay, K H; Muhiddin, K

    2008-06-01

    There is some evidence to suggest that the standard of acute medical care provided to patients with cerebrovascular disease is a major determinant of the eventual outcome. Consequently, the Royal College of Physicians (RCP) of London issues periodic guidelines to assist healthcare providers in the management of patients presenting with stroke. An audit of the acute management of stroke in two hospitals belonging to the same health care trust in the UK. Retrospective review of 98 randomly selected case-notes of patients managed for cerebrovascular disease in two acute hospitals in the UK between April and June 2004. The pertinent guidelines of RCP (London) are highlighted while audit targets were set at 70%. 84% of patients presenting with cerebrovascular disease had a stroke rather than a TIA, anterior circulation strokes were commonest. All patients with stroke were admitted while those with TIAs were discharged on the same day but most patients with TIA were not followed up by Stroke specialists. Most CT-imaging of the head was done after 24 hours delaying the commencement of anti-platelets for patients with ischaemic stroke or neurosurgical referral for haemorrhagic stroke. Furthermore, there was a low rate of referral for carotid ultrasound in patients with anterior circulation strokes. Anti-platelets and statins were commenced for most patients with ischaemic stroke while diabetes was well controlled in most of them. However, ACE-inhibitors and diuretics such as indapamide were under-utilized for secondary prevention in such patients. Warfarin anti-coagulation was underutilized in patients with ischaemic stroke who had underlying chronic atrial fibrillation. While there was significant multi-disciplinary team input, dysphagia and physiotherapy assessments were delayed. Similarly, occupational therapy input and psychological assesment were omitted from the care of most patients. Hospital service provision for the management of cerebrovascular disease needs to

  12. Minimum intervention dentistry and the management of tooth wear in general practice.

    Science.gov (United States)

    Meyers, I A

    2013-06-01

    The incidence of tooth wear, or non-carious tooth surface loss (NCTSL), is increasing and oral rehabilitation of patients with non-carious tooth loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the condition. The multifactorial nature of tooth wear and the variability in its clinical presentation provides treatment challenges for the clinician and successful management must be more than just restoration. Management must include an appropriate mix of preventive and restorative strategies and an understanding that long-term restorative success is affected by the patient's oral environment, and how diet, lifestyle and medical status can modify this environment. Ultimately, the success of any restorative intervention is very dependent on the stability of the oral environment and the condition of the remaining tooth structure. Minimum intervention dentistry (MID) philosophies are ideally suited to tooth wear cases and an overall MID strategy involving diagnosis, recognition and control of predisposing factors, stabilization of the oral environment, remineralization and restoration of the tooth structure, and ongoing maintenance can be implemented. When restorative treatment is required, contemporary materials and techniques are available that can provide cost-effective and conservative restorative alternatives for patients unable to undergo the complex indirect restorative techniques that are both costly and time consuming to implement. These minimally invasive approaches are not only an economically viable solution, but can provide aesthetic and functional rehabilitation and maintain tooth structure as a precursor to more complex restorative options when required. © 2013 Australian Dental Association.

  13. Office of Inspector General audit report on aircraft and air service management programs

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-01-01

    The Department of Energy`s (DOE) Albuquerque Operations Office (Albuquerque) owns seven aircraft that support defense programs, research and development efforts, emergency response programs, and official travel of Government and contractor employees. An Office of Inspector General (OIG) report, issued in 1994, identified concerns with Albuquerque`s cost for air service. Since that report, there have been reductions in cost and personnel indicating changes in air service requirements. This audit was conducted to determine (1) whether costs to operate Albuquerque`s aircraft were excessive and (2) if individual aircraft in the fleet were justified.

  14. Scientific forum during the 46th regular session of the IAEA General Conference. Topical issues: Nuclear Power - Life Cycle Management; Managing Nuclear Knowledge; Nuclear Security. Programme and synopses

    International Nuclear Information System (INIS)

    2002-01-01

    In response to the recommendations of several Agency advisory committees, to address issues related to nuclear power life cycle management, knowledge management in the field of nuclear power, and security of radiation sources and other nuclear material the IAEA is organizing the scientific forum to be held during the General Conference. The purpose of the meeting is to sharpen awareness and understanding of the emerging concerns about the aging of nuclear power plants, maintenance and preservation of knowledge and expertise in nuclear science, technology and applications, to emphasise the significance of security and physical protection of radiation sources and other radioactive material, and to better comprehend the role of the Agency in these processes

  15. Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

    Science.gov (United States)

    Medford, Andrew Rl; Pepperell, Justin Ct

    2007-10-01

    In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

  16. Higher order generalized perturbation theory for boiling water reactor in-core fuel management optimization

    International Nuclear Information System (INIS)

    Moore, B.R.; Turinsky, P.J.

    1998-01-01

    Boiling water reactor (BWR) loading pattern assessment requires solving the two-group, nodal form of the neutron diffusion equation and drift-flux form of the fluid equations simultaneously because these equation sets are strongly coupled via nonlinear feedback. To reduce the computational burden associated with the calculation of the core attributes (that is, core eigenvalue and thermal margins) of a perturbed BWR loading pattern, the analytical and numerical aspects of a higher order generalized perturbation theory (GPT) method, which correctly addresses the strong nonlinear feedbacks of two-phase flow, have been established. Inclusion of Jacobian information in the definition of the generalized flux adjoints provides for a rapidly convergent iterative method for solution of the power distribution and eigenvalue of a loading pattern perturbed from a reference state. Results show that the computational speedup of GPT compared with conventional forward solution methods demanding consistent accuracy is highly dependent on the number of spatial nodes utilized by the core simulator, varying from superior to inferior performance as the number of nodes increases

  17. 2015 annual report of the managing director of the CEA general and nuclear inspection for nuclear safety and radiation protection

    International Nuclear Information System (INIS)

    2016-08-01

    After an introduction by the managing director of the CEA general and nuclear inspection about activities and events of 2015, this report proposes some key figures and indicators to illustrate these activities and events. The next parts discuss, present and comment how a culture of safety is at the heart of the continuous progress approach by the CEA. The next chapters propose overviews and comments of lessons learned from nuclear inspections within the frame of audit programme or within the frame of centres' safety audits, and from reactive inspections. The last parts address the follow-up of recommendations, and progress orientations and perspectives

  18. HEMODYNAMIC STATUS IN AIRWAY MANAGEMENT DURING GENERAL ANESTHESIA: COMPARISON OF THREE METHODS

    Directory of Open Access Journals (Sweden)

    K MONTAZERI

    2000-03-01

    Full Text Available Introduction. The laryngeal mask airway (LMA was recently introduced in general anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. Methods. The effects of LMA insertion, face mask or tracheal intubation on homodynamic status were studied in 195 normotensive patients who underwent elective transurethral lithotripsy (TUL. The patients were monitored with blood pressure measurement and pulse oximetry. Anesthesia was induced with sodium thiopental, succynilcholine and fentanyl and maintained with halothane, nitrous oxide and oxygen. Findings. The heart rate (HR and mean arterial pressure increased after LMA insertion. face mask or tracheal intubation, compared with baseline (P<0.05. The hemodynamic changes were significantly greater after tracheal intubation and face mask than after LMA insertion (P<0.05. Conclusion. We conclude that insertion of LMA is associated with less hemodynamic disturbances than face mask or tracheal intubation in normotensive patients undergoing elective operations.

  19. Risk in technical and scientific studies: general introduction to uncertainty management and the concept of risk

    International Nuclear Information System (INIS)

    Apostolakis, G.E.

    2004-01-01

    George Apostolakis (MIT) presented an introduction to the concept of risk and uncertainty management and their use in technical and scientific studies. He noted that Quantitative Risk Assessment (QRA) provides support to the overall treatment of a system as an integrated socio-technical system. Specifically, QRA aims to answer the questions: - What can go wrong (e.g., accident sequences or scenarios)? - How likely are these sequences or scenarios? - What are the consequences of these sequences or scenarios? The Quantitative Risk Assessment deals with two major types of uncertainty. An assessment requires a 'model of the world', and this preferably would be a deterministic model based on underlying processes. In practice, there are uncertainties in this model of the world relating to variability or randomness that cannot be accounted for directly in a deterministic model and that may require a probabilistic or aleatory model. Both deterministic and aleatory models of the world have assumptions and parameters, and there are 'state-of-knowledge' or epistemic uncertainties associated with these. Sensitivity studies or eliciting expert opinion can be used to address the uncertainties in assumptions, and the level of confidence in parameter values can be characterised using probability distributions (pdfs). Overall, the distinction between aleatory and epistemic uncertainties is not always clear, and both can be treated mathematically in the same way. Lessons on safety assessments that can be learnt from experience at nuclear power plants are that beliefs about what is important can be wrong if a risk assessment is not performed. Also, precautionary approaches are not always conservative if failure modes are not identified. Nevertheless, it is important to recognize that uncertainties will remain despite a quantitative risk assessment: e.g., is the scenario list complete, are the models accepted as reasonable, and are parameter probability distributions representative of

  20. Knowledge management for systems biology a general and visually driven framework applied to translational medicine

    Directory of Open Access Journals (Sweden)

    Falciani Francesco

    2011-03-01

    Full Text Available Abstract Background To enhance our understanding of complex biological systems like diseases we need to put all of the available data into context and use this to detect relations, pattern and rules which allow predictive hypotheses to be defined. Life science has become a data rich science with information about the behaviour of millions of entities like genes, chemical compounds, diseases, cell types and organs, which are organised in many different databases and/or spread throughout the literature. Existing knowledge such as genotype - phenotype relations or signal transduction pathways must be semantically integrated and dynamically organised into structured networks that are connected with clinical and experimental data. Different approaches to this challenge exist but so far none has proven entirely satisfactory. Results To address this challenge we previously developed a generic knowledge management framework, BioXM™, which allows the dynamic, graphic generation of domain specific knowledge representation models based on specific objects and their relations supporting annotations and ontologies. Here we demonstrate the utility of BioXM for knowledge management in systems biology as part of the EU FP6 BioBridge project on translational approaches to chronic diseases. From clinical and experimental data, text-mining results and public databases we generate a chronic obstructive pulmonary disease (COPD knowledge base and demonstrate its use by mining specific molecular networks together with integrated clinical and experimental data. Conclusions We generate the first semantically integrated COPD specific public knowledge base and find that for the integration of clinical and experimental data with pre-existing knowledge the configuration based set-up enabled by BioXM reduced implementation time and effort for the knowledge base compared to similar systems implemented as classical software development projects. The knowledgebase enables the

  1. Feasibility and impact of a computer-guided consultation on guideline-based management of COPD in general practice.

    Science.gov (United States)

    Angus, Robert M; Thompson, Elizabeth B; Davies, Lisa; Trusdale, Ann; Hodgson, Chris; McKnight, Eddie; Davies, Andrew; Pearson, Mike G

    2012-12-01

    Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution. To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellence-based chronic obstructive pulmonary disease (COPD) guidance and prompts clinical decision-making is feasible in primary care and to assess its impact on diagnosis and management in reviews of COPD patients. Practice nurses, one-third of whom had no specific respiratory training, undertook a computer-guided review in the usual consulting room setting using a laptop computer with the screen visible to them and to the patient. A total of 293 patients (mean (SD) age 69.7 (10.1) years, 163 (55.6%) male) with a diagnosis of COPD were randomly selected from GP databases in 16 practices and assessed. Of 236 patients who had spirometry, 45 (19%) did not have airflow obstruction and the guided clinical history changed the primary diagnosis from COPD in a further 24 patients. In the 191 patients with confirmed COPD, the consultations prompted management changes including 169 recommendations for altered prescribing of inhalers (addition or discontinuation, inhaler dose or device). In addition, 47% of the 55 current smokers were referred for smoking cessation support, 12 (6%) for oxygen assessment, and 47 (24%) for pulmonary rehabilitation. Computer-guided consultations are practicable in general practice. Primary care COPD databases were confirmed to contain a significant proportion of incorrectly assigned patients. They resulted in interventions and the rationalisation of prescribing in line with recommendations. Only in 22 (12%) of those fully assessed was no management change suggested. The introduction of a computer-guided consultation offers the prospect of comprehensive guideline quality management.

  2. Management of the acute scrotum in a district general hospital: 10-year experience.

    LENUS (Irish Health Repository)

    Tajchner, Lukas

    2012-01-31

    The acutely painful scrotum is a common urologic emergency. The primary objective of management is to avoid testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. In our series conducted between January 1996 and December 2005, 119 patients (age range: 4-62 years) underwent emergency operative exploration for acute scrotal pain. The most common finding was torted cyst of Morgagni (63\\/119, 52.9%), followed by testicular torsion (41\\/119, 34.4%). The majority of testicular torsions occurred in the pubertal group (22\\/41, 53.6%). Only one patient in this group had an unsalvageable testis necessitating orchidectomy, a testicular loss rate in torsion of 2.4%. There were no postoperative wound infections or scrotal haematomas. Testicular salvage depends critically on early surgical intervention, so the delay incurred in diagnostic imaging may extend the period of ischaemia. Furthermore, all radiological investigations have a certain false-negative rate. We advocate immediate surgical exploration of the acute scrotum. We report a low orchidectomy rate (2.4%) in testicular torsion.

  3. Multicenter papillary thyroid carcinoma, general aspects and management at Hospital Calderon Guardia

    International Nuclear Information System (INIS)

    Madden Hernandez, Manfred

    2014-01-01

    Over 80% of all thyroid cancers are diagnosed in the United States of papillary carcinoma type and have been more common in women than in men. Thyroids can be in childhood, but is almost always seen in adults between the ages of 30 and 50 years. The cause of this cancer is unknown. The intervention of a genetic defect may occur. Differentiated thyroid tumors (both papillary and follicular) are susceptible curable. A total of 13 criteria systems are managed, among which the most frequent are: - Age, degree, tumor extension, size; -Age, metastasis, tumor size and size; - Metastasis, age for presentation, degree of surgical resection, extrathyroidal invasion and size. The survival rate for papillary thyroid cancer has been excellent; more than 95% of adults with this type of cancer have survived at least 10 years. The prognosis is best for patients younger than 40 years and for those with smaller tumors. Some methods of diagnosis before the appearance of a suspicious nodule have included an ultrasound, BAAF, gammagraphy, among others. The best way to choose which has been the best surgical method at the time of definitive treatment was determined in this review. (author) [es

  4. Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia.

    Science.gov (United States)

    Blumer, Sigalit; Costa, Liora; Peretz, Benjamin

    To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N 2 O-O 2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N 2 O-O 2 alone had a 6.1-fold greater risk of failure compared to N 2 O-O 2 +midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). The GA mode yielded significantly greater success than the N 2 O-O 2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N 2 O-O 2 . When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

  5. Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: results from a nationally representative cross-sectional general practice study.

    Directory of Open Access Journals (Sweden)

    Christopher Harrison

    Full Text Available OBJECTIVES: Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. METHODS: Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners. Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012. Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007 and post-vaccine (July 2007-June 2012 were also calculated. RESULTS: Management rate of genital warts among women potentially covered by program (aged 15-27 years decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (p<0.0001 and a significant increase in the management rate of control conditions per year (p<0.0001. For all other age-sex groups there was no significant change in the management rate of genital warts between the Pre- and Post-program periods. CONCLUSION: The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community.

  6. General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care.

    Science.gov (United States)

    Brijnath, Bianca; Bunzli, Samantha; Xia, Ting; Singh, Nabita; Schattner, Peter; Collie, Alex; Sterling, Michele; Mazza, Danielle

    2016-07-20

    In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman's correlation, and multiple ordered logistic regressions were performed. Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education

  7. Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia.

    Science.gov (United States)

    Bosnic-Anticevich, Sinthia; Kritikos, Vicky; Carter, Victoria; Yan, Kwok Yin; Armour, Carol; Ryan, Dermot; Price, David

    2018-06-01

    The first aim of the study (i) assess the current asthma status of general-practitioner-managed patients receiving regular fixed-dose combination inhaled corticosteroid and long-acting beta 2 agonist (FDC ICS/LABA) therapy and (ii) explore patients' perceptions of asthma control and attitudes/behaviors regarding preventer inhaler use. A cross-sectional observational study of Australian adults with a current physician diagnosis of asthma receiving ≥2 prescriptions of FDC ICS/LABA therapy in the previous year, who were recruited through general practice to receive a structured in-depth asthma review between May 2012 and January 2014. Descriptive statistics and Chi-Square tests for independence were used for associations across asthma control levels. Only 11.5% of the patients had controlled asthma based on guideline-defined criteria. Contrarily, 66.5% of the patients considered their asthma to be well controlled. Incidence of acute asthma exacerbations in the previous year was 26.5% and 45.6% of the patients were without a diagnosis of rhinitis. Asthma medication use and inhaler technique were sub-optimal; only 41.0% of the preventer users reported everyday use. The side effects of medication were common and more frequently reported among uncontrolled and partially controlled patients. The study revealed the extent to which asthma management needs to be improved in this patient cohort and the numerous unmet needs regarding the current state of asthma care. Not only there is a need for continuous education of patients, but also education of health care practitioners to better understand the way in which patient's perceptions impact on asthma management practices, incorporating these findings into clinical decision making.

  8. Averting a Disaster with Groundwater Depletion in India: The General Case of Water Management Principles and Development (Invited)

    Science.gov (United States)

    Lall, U.

    2013-12-01

    Many countries, including the USA, China, and India are experiencing chronic groundwater depletion. In part this unsustainable water use results from climatic factors that reduce surface water availability and also the recharge to the aquifer system. However, a more critical factor is uncontrolled use for agriculture and energy and mineral processing. Interestingly in places such as India endowments have been politically created that lead to ever increasing use, through the provision of free energy for pumping. Reversing the situation is considered politically challenging, and the concept of metering and payment for what is essentially economic use of water is also considered difficult to apply. In this talk I use the Indian situation as a general example and discuss the role central planning strategies for demand and resource management can play recognizing the private action by millions of users as an inevitable tool that needs to be leveraged without necessarily the high transaction costs that come with monitoring and fee collection for monitored use. Specifically, targeting and stimulating potential cropping strategies and on farm water and energy management emerge as a choice in a difficult management environment. In a broader development context, I argue that the role of private sector aggregators in developing farm to market procurement strategies can play a role in both improving rural economies and providing a trajectory for more efficient water use through technology and crop choice.

  9. A tool to measure whether business management capacity in general practice impacts on the quality of chronic illness care.

    Science.gov (United States)

    Holton, Christine H; Proudfoot, Judith G; Jayasinghe, Upali W; Grimm, Jane; Bubner, Tanya K; Winstanley, Julie; Harris, Mark F; Beilby, Justin J

    2010-11-01

    Our aim was to develop a tool to identify specific features of the business and financial management of practices that facilitate better quality care for chronic illness in primary care. Domains of management were identified, resulting in the development of a structured interview tool that was administered in 97 primary care practices in Australia. Interview items were screened and subjected to factor analysis, subscales identified and the overall model fit determined. The instrument's validity was assessed against another measure of quality of care. Analysis provided a four-factor solution containing 21 items, which explained 42.5% of the variance in the total scores. The factors related to administrative processes, human resources, marketing analysis and business development. All scores increased significantly with practice size. The business development subscale and total score were higher for rural practices. There was a significant correlation between the business development subscale and quality of care. The indicators of business and financial management in the final tool appear to be useful predictors of the quality of care. The instrument may help inform policy regarding the structure of general practice and implementation of a systems approach to chronic illness care. It can provide information to practices about areas for further development.

  10. Roles and practices of general practitioners and psychiatrists in management of depression in the community

    Directory of Open Access Journals (Sweden)

    Blin Patrick

    2006-01-01

    Full Text Available Abstract Background Little is known about depressed patients' profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1° sociodemographic and clinical profile of their patients considered as depressed 2° patterns of care provision. Methods The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder. Results Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% – OR = 2.4, educated (42.4% v 25.4% – OR = 3.9, met DSM-IV criteria for depression (94.6% v 85.6% – OR = 2.9, had been hospitalized for depression (26.1% v 15.6% – OR = 2.0 and were younger at onset of depressive problems (all adjusted p Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8 with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3 and less psychotherapy (72.2% v 89.1% OR = 3.1 (all adjusted p Conclusion Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.

  11. [Evaluation of general practitioners' knowledge about diagnostic and therapeuthic management of erysipelas in the city of Marrakech].

    Science.gov (United States)

    Ihbibane, Fatima; Arsène, Ntini Lebi; Adarmouch, Latifa; Amine, Mohamed; Tassi, Noura

    2018-01-01

    Erysipelas is the most common non necrotizing bacterial dermohypodermitis (NNBDH). This study aimed to evaluate the adequacy of general practitioners' knowledge about literature data on the diagnostic and therapeuthic management of erysipelas. We conducted a cross-sectional descriptive and analytical survey of 167 general practitioners in the public and private sectors in Marrakech over the period from 19 May to 20 October 2014. The 114 questionnaires which had been returned revealed that local and general risk factors were often reported for erysipelas. 92 (80.7%) physicians thought that positive diagnosis of common types was based on clinical examination. 97(85.1%) physicians thought that it required only out-patient service and that hospitalization and para-clinical examinations should only be performed in patients with severe, atypical or complicated erysipelas. 25 (21.9%) physicians thought that oral amoxicillin should be the gold standard therapy. 15(13.2%) physicians thought that bi-antibiotic therapy including antistreptococcique molecule should be the gold standard. 16 doctors (14%) advocated anti-inflammatory drugs. The primary and secondary prevention levels generated interest from physicians of whom 108 (94.7%) were favorable to the treatment of the portals of entry in the skin while 53 (46.5%) to the antibioprophylaxis after the second recurrence. Our study highlights that erysipelas is relatively frequent in city medical practice; clinical diagnosis guidelines should be shared between the specialists in order to improve the diagnostic and therapeutic approch of our physicians.

  12. Experiences of Public Doctors on Managing Work Difficulties and Maintaining Professional Enthusiasm in Acute General Hospitals: A Qualitative Study.

    Science.gov (United States)

    Luk, Andrew Leung; Yau, Adrian Fai To

    2018-01-01

    Overseas studies suggest that 10-20% of doctors are depressed, 30-45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training. Ten public doctors with reputation were invited respectively from three acute general hospitals for an in-depth interview. Interviews were audio recorded and transcribed. Content analysis was carried out to identify major themes in relation to the research questions. Three themes emerging from difficulties encountered were (1) managing people, mostly are patients, followed by colleagues and then patients' relatives; (2) constraints at work, include time and resources; and (3) managing self with decision-making within a short time. Three themes generating from managing work difficulties included (1) self-adjustment with practicing problem solving and learning good communication appeared more frequently, followed by maintaining a professional attitude and accumulating clinical experiences; (2) seeking help from others; and (3) organizational support is also a theme though it is the least mentioned. Four themes emerging from maintaining work enthusiasm were (1) personal conviction and discipline: believing that they are helping the needy, having the sense of vocation and support from religion; disciplining oneself by continuing education, maintaining harmonious family relationship and volunteer work. (2) Challenging work: different challenging natures of their job. (3) Positive feedback from patients: positive encounters with patients keep a connectedness with their clients. (4) Organization support: working with

  13. Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

    Science.gov (United States)

    Ford, Elizabeth; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

    2017-08-01

    Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients. © British Journal of General Practice 2017.

  14. A survey of the assessment and management of gout in general practitioners and medical officers within the Illawarra Network, Australia.

    Science.gov (United States)

    Terrill, Matthew; Riordan, John

    2017-08-01

    To review the assessment and management of gout by general practitioners (GPs) and medical officers (MOs) within the Illawarra Network, Australia. A survey was sent to GPs and MOs within the Illawarra Network. Of 110 GPs, 45 responded. Of 129 MOs, 42 responded. The overall response was 32.6%. On analysis, 65.1% felt their knowledge of gout to be adequate and 61.6% thought they had been educated well. In acute assessment, 59.1% of GPs responded that the diagnosis of gout best be confirmed with a joint aspiration and 36.4% clinical suspicion. Differing, 85.7% of MOs chose a joint aspiration. In acute management, if colchicine were used, 59.1% of GPs would give 1 mg followed by 0.5 mg an hour later, then 0.5 mg twice daily, compared to 9.5% of MOs, while 20.5% of GPs would use 1 mg twice daily. Chronic management was answered poorly. After an acute attack, urate lowering therapy (ULT) would be started 14 days after by 47.7% of GPs, compared to 69.0% of MOs. GPs were more likely to start ULT within 7 days (52.3% vs. 31.0%). With dosing of ULT, 45.3% would treat to target, while 46.5% would dose to the creatinine clearance. Prophylactic therapy with ULT would be started by 81.8%, although only 17.4% would continue it for 3-6 months. There is poor adherence to recommended practice for dosing of colchicine in acute gout. Also in the management of chronic gout, in particular, the timing of starting ULT and the use of prophylaxis when initiating ULT. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  15. The effectiveness of Cognitive Behavioral Therapy (CBT) with general exercises versus general exercises alone in the management of chronic low back pain.

    Science.gov (United States)

    Khan, Muhammad; Akhter, Saeed; Soomro, Rabail Rani; Ali, Syed Shahzad

    2014-07-01

    To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p=0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone.

  16. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case

  17. PWR in-core nuclear fuel management optimization utilizing nodal (non-linear NEM) generalized perturbation theory

    International Nuclear Information System (INIS)

    Maldonado, G.I.; Turinsky, P.J.; Kropaczek, D.J.

    1993-01-01

    The computational capability of efficiently and accurately evaluate reactor core attributes (i.e., k eff and power distributions as a function of cycle burnup) utilizing a second-order accurate advanced nodal Generalized Perturbation Theory (GPT) model has been developed. The GPT model is derived from the forward non-linear iterative Nodal Expansion Method (NEM) strategy, thereby extending its inherent savings in memory storage and high computational efficiency to also encompass GPT via the preservation of the finite-difference matrix structure. The above development was easily implemented into the existing coarse-mesh finite-difference GPT-based in-core fuel management optimization code FORMOSA-P, thus combining the proven robustness of its adaptive Simulated Annealing (SA) multiple-objective optimization algorithm with a high-fidelity NEM GPT neutronics model to produce a powerful computational tool used to generate families of near-optimum loading patterns for PWRs. (orig.)

  18. Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Vrangbaek, Karsten; Birk, Hans Okkels

    2015-01-01

    OBJECTIVES: To evaluate the utilization of a policy for strengthening general practitioner's case management and quality of care of diabetes patients in Denmark incentivized by a novel payment mode. We also want to elucidate any geographical variation or variation on the basis of practice features...... of the GP were are able to determine differences in use of the policy in relation to the practice-specific information. RESULTS: At the end of the study period (2007-2012) approximately 30% of practices have enrolled extending services to approximately 10% of the diabetes population. There is regional...... structure defined in the policy not strong enough to move the majority of GPs to change their way of delivering and financing care for patients with diabetes within a period of more than 5 years....

  19. Science, the public, and social elites: how the general public, scientists, top politicians and managers perceive science.

    Science.gov (United States)

    Prpić, Katarina

    2011-11-01

    This paper finds that the Croatian public's and the social elites' perceptions of science are a mixture of scientific and technological optimism, of the tendency to absolve science of social responsibility, of skepticism about the social effects of science, and of cognitive optimism and skepticism. However, perceptions differ significantly according to the different social roles and the wider value system of the observed groups. The survey data show some key similarities, as well as certain specificities in the configuration of the types of views of the four groups--the public, scientists, politicians and managers. The results suggest that the well-known typology of the four cultures reveals some of the ideologies of the key actors of scientific and technological policy. The greatest social, primarily educational and socio-spatial, differentiation of the perceptions of science was found in the general public.

  20. STRATEGIC KNOWLEDGE MANAGEMENT IN THE ARMED FORCES ACADEMY OF GENERAL M. R. ŠTEFÁNIK IN LIPTOVSKÝ MIKULÁŠ, THE SLOVAK REPUBLIC

    Directory of Open Access Journals (Sweden)

    Mária PETRUFOVÁ

    2015-10-01

    Full Text Available The article stresses the importance of strategic knowledge management in the era of global competition. Strategic knowledge management raises the demand for permanent learning stressing the visions and personal aspirations of everyone within the modern effi cient organisation. Within the AFA of General M.R. Štefánik and, inherently, in the Armed Forces of the Slovak Republic, strategic knowledge management employs and implements knowledge as the ultimate step in the knowledge pyramid.

  1. General anesthesia and postoperative pain management in analgesic intolerant patients with/without asthma: is it safe?

    Science.gov (United States)

    Celiker, V; Basgül, E; Karakaya, G; Oguzalp, H; Bozkurt, B; Kalyoncu, A F

    2004-01-01

    Analgesic intolerance (AI) appears in approximately 1 % of the general population. The triad of bronchial asthma, nasal polyposis, and analgesic intolerance is called analgesic-induced asthma (AIA). These patients are frequently referred to adult allergy clinics for preoperative evaluation for possible analgesic cross reactivity and intolerance to anesthetic agents. To determine allergic problems related to anesthesia and postoperative pain management in AI patients with and without asthma. The medical records of 45 patients who had been diagnosed with AI between January 1991 and December 2002 in the adult allergy unit and who underwent surgery in the same hospital in the last 4 years were retrospectively analyzed. The mean age of the patients was 44.4 13.4 years and 30 (66.6 %) were female. Thirty-six (80 %) had AIA, 34 (75.6 %) had persistent allergic rhinitis and 21 (46.7 %) had nasal polyps. Fifty-one surgical procedures were performed in 45 patients, in whom ear, nose and throat surgery was the main procedure (64.7 %). Anesthesia was induced with propofol, fentanyl, and vecuronium and was maintained by sevoflurane or isoflurane. Fentanyl was used for early postoperative pain relief. No complications appeared in relation to anesthesia or early pain management except in a 44-year-old AIA woman who had a reaction in the postoperative period after receiving an inappropriate analgesic. None of the patients had anesthesia-related allergic problems. Atropine and diazepam in the premedication, propofol and fentanyl during induction, muscle relaxation facilitation by vecuronium, and sevoflurane or isoflurane for maintenance seem to be a safe general anesthetic choice for analgesic intolerant patients with and without asthma.

  2. Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?

    Science.gov (United States)

    Fazal, Muhammad W; Andrews, Jane M; Thomas, Josephine; Saffouri, Eliana

    2017-08-01

    Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long-term morbidity and allows for prompt iron repletion, avoiding ID anaemia (IDA) and the need for blood transfusion. To evaluate the management of ID in two internal medicine units (general medical (GM) and gastroenterology (GE)) in a large metropolitan hospital and compare it to international guidelines. All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities. Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM (P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient. There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia. © 2017 Royal Australasian College of Physicians.

  3. The role of the internal medicine specialist in the management of infective complications in general surgical wards

    Directory of Open Access Journals (Sweden)

    Patrizia Zoboli

    2013-05-01

    Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

  4. Experiences of Public Doctors on Managing Work Difficulties and Maintaining Professional Enthusiasm in Acute General Hospitals: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Andrew Leung Luk

    2018-03-01

    Full Text Available BackgroundOverseas studies suggest that 10–20% of doctors are depressed, 30–45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training.MethodTen public doctors with reputation were invited respectively from three acute general hospitals for an in-depth interview. Interviews were audio recorded and transcribed. Content analysis was carried out to identify major themes in relation to the research questions.ResultsThree themes emerging from difficulties encountered were (1 managing people, mostly are patients, followed by colleagues and then patients’ relatives; (2 constraints at work, include time and resources; and (3 managing self with decision-making within a short time. Three themes generating from managing work difficulties included (1 self-adjustment with practicing problem solving and learning good communication appeared more frequently, followed by maintaining a professional attitude and accumulating clinical experiences; (2 seeking help from others; and (3 organizational support is also a theme though it is the least mentioned. Four themes emerging from maintaining work enthusiasm were (1 personal conviction and discipline: believing that they are helping the needy, having the sense of vocation and support from religion; disciplining oneself by continuing education, maintaining harmonious family relationship and volunteer work. (2 Challenging work: different challenging natures of their job. (3 Positive feedback from patients: positive encounters with patients keep a connectedness with their clients. (4

  5. Management of the General Process of Parenteral Nutrition Using mHealth Technologies: Evaluation and Validation Study.

    Science.gov (United States)

    Cervera Peris, Mercedes; Alonso Rorís, Víctor Manuel; Santos Gago, Juan Manuel; Álvarez Sabucedo, Luis; Wanden-Berghe, Carmina; Sanz-Valero, Javier

    2018-04-03

    Any system applied to the control of parenteral nutrition (PN) ought to prove that the process meets the established requirements and include a repository of records to allow evaluation of the information about PN processes at any time. The goal of the research was to evaluate the mobile health (mHealth) app and validate its effectiveness in monitoring the management of the PN process. We studied the evaluation and validation of the general process of PN using an mHealth app. The units of analysis were the PN bags prepared and administered at the Son Espases University Hospital, Palma, Spain, from June 1 to September 6, 2016. For the evaluation of the app, we used the Poststudy System Usability Questionnaire and subsequent analysis with the Cronbach alpha coefficient. Validation was performed by checking the compliance of control for all operations on each of the stages (validation and transcription of the prescription, preparation, conservation, and administration) and by monitoring the operative control points and critical control points. The results obtained from 387 bags were analyzed, with 30 interruptions of administration. The fulfillment of stages was 100%, including noncritical nonconformities in the storage control. The average deviation in the weight of the bags was less than 5%, and the infusion time did not present deviations greater than 1 hour. The developed app successfully passed the evaluation and validation tests and was implemented to perform the monitoring procedures for the overall PN process. A new mobile solution to manage the quality and traceability of sensitive medicines such as blood-derivative drugs and hazardous drugs derived from this project is currently being deployed. ©Mercedes Cervera Peris, Víctor Manuel Alonso Rorís, Juan Manuel Santos Gago, Luis Álvarez Sabucedo, Carmina Wanden-Berghe, Javier Sanz-Valero. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 03.04.2018.

  6. Top-Management Decision Making and Strategies : An Approach to a Theory of Leadership-Initiated Strategies(General Contribution)

    OpenAIRE

    藤田, 東久夫; Tokuo, FUJITA; 株式会社サトー; Sato Corporation

    2006-01-01

    The article clarifies the relationship between top-management decisions and strategies. Whereas prior theoretical treatments of top-management strategies are both logical and managerial, the author recognizes the ad hoc nature of top-management decisions, which rely upon intuition and inspiration, and proposes a theory of strategies that emerge through top-management leadership. This theory of leadership-initiated strategies sees a balance between leadership and management functions as essent...

  7. The emergency Management Alternative Center (EMAC). Requirements and general considerations; Centro Alternativo de Gestion de la Emergencia (CAGE). Requisitos y consideraciones generales

    Energy Technology Data Exchange (ETDEWEB)

    Turrion, F.; Barrio, M. A. del; Cobos, A.

    2014-10-01

    The Emergency Management Alternative Center (EMAC) will give support to the emergency Organization Response on site, combining the continuity of the accident mitigation actions with the rest and the protection of personnel, adjusting these works to the conditions of the Power Plant and the evolution of the emergency. It must be operational in the Spanish NNPP by December 2015 and the design must be in accordance with the criteria by the Nuclear Safety Council. (Author)

  8. Radioactive waste management. Introductory statement of the 3rd scientific forum during the 44th session of the IAEA General Conference. Vienna, 19 September 2000

    International Nuclear Information System (INIS)

    ElBaradei, M.

    2000-01-01

    The document reproduces the text of the introductory statement made by the Director General of the IAEA at the 3rd scientific forum organized during the 44th session of the IAEA General Conference, Vienna, 19 september 2000, on the management of radioactive waste. He emphasized the following aspects: progress made in technology and public acceptance, global challenges, international co-operation, building a stronger framework

  9. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings.

    Science.gov (United States)

    Uccioli, Luigi; Izzo, Valentina; Meloni, Marco; Vainieri, Erika; Ruotolo, Valeria; Giurato, Laura

    2015-04-01

    Medical knowledge about wound management has improved as recent studies have investigated the healing process and its biochemical background. Despite this, foot ulcers remain an important clinical problem, often resulting in costly, prolonged treatment. A non-healing ulcer is also a strong risk factor for major amputation. Many factors can interfere with wound healing, including the patient's general health status (i.e., nutritional condition indicated by albumin levels) or drugs such as steroids that can interfere with normal healing. Diabetic complications (i.e., renal insufficiency) may delay healing and account for higher amputation rates observed in diabetic patients under dialysis treatment. Wound environment (e.g., presence of neuropathy, ischaemia, and infection) may significantly influence healing by interfering with the physiological healing cascade and adding local release of factors that may worsen the wound. The timely and well-orchestrated release of factors regulating the healing process, observed in acute wounds, is impaired in non-healing wounds that are blocked in a chronic inflammatory phase without progressing to healing. This chronic phase is characterised by elevated protease activity (EPA) of metalloproteinases (MMPs) and serine proteases (e.g., human neutrophil elastase) that interfere with collagen synthesis, as well as growth factor release and action. EPA (mainly MMP 9, MMP-8 and elastase) and inflammatory factors present in the wound bed (such as IL-1, IL-6, and TNFa) account for the catabolic state of non-healing ulcers. The availability of wound dressings that modulate EPA has added new therapeutic options for treating non-healing ulcers. The literature confirms advantages obtained by reducing protease activity in the wound bed, with better outcomes achieved by using these dressings compared with traditional ones. New technologies also allow a physician to know the status of the wound bed environment, particularly EPA, in a clinical

  10. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMP2ART qualitative study.

    Science.gov (United States)

    Morrow, Susan; Daines, Luke; Wiener-Ogilvie, Sharon; Steed, Liz; McKee, Lorna; Caress, Ann-Louise; Taylor, Stephanie J C; Pinnock, Hilary

    2017-07-18

    Despite an overwhelming evidence base, supported self-management of asthma is poorly implemented into routine practice. Strategies for implementation must address organisational routines, as well as provide resources for patients and training to improve professionals' skills. We aimed to explore the priority that primary care practices attach to asthma self-management, to describe their existing asthma management routines, and to generate innovative implementation strategies. We recruited 33 participants (23 general practitioners; seven nurses; three administrative staff) from 14 general practices. The 12 interviews and three focus groups were transcribed, coded and analysed thematically. Supported self-management was largely a nurse-led task within clinic-based annual reviews. Barriers included poor attendance at asthma clinics, lack of time, demarcation of roles, limited access to a range of tailored resources, and competing agendas in consultation, often due to multimorbidity. Suggestions for initiatives to improve the provision of supported self-management included emphasising the evidence for benefit (to influence prioritisation), improving teamwork (including team-based education), organisational strategies (including remote consulting) which need to fit within existing practice routines. Technology offers some potential solutions (e.g., improved templates, 'app'-based plans), but must be integrated with the practice information technology systems. Building on these insights, we will now develop a theoretically-based implementation strategy that will address patient, professional, and organisational buy-in, provide team-based education and offer a range of practical options and tools, which can be adapted and integrated within existing routines of individual practices.OVERCOMING THE ORGANISATIONAL BARRIERS TO IMPLEMENTING ASTHMA SELF-MANAGEMENT: Understanding the routines of primary care practices can suggest strategies to implement supported self-management

  11. Some Contributions of General Systems Theory, Cybernetics Theory and Management Control Theory to Evaluation Theory and Practice. Research on Evaluation Program Paper and Report Series. Interim Draft.

    Science.gov (United States)

    Cook, Desmond L.

    This document, one of a series of reports examining the possible contribution of other disciplines to evaluation methodology, describes the major elements of general systems theory (GST), cybernetics theory (CT) and management control theory (MCT). The author suggests that MCT encapsulates major concerns of evaluation since it reveals that…

  12. Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management.

    Science.gov (United States)

    Fernández, O; Delvecchio, M; Edan, G; Fredrikson, S; Giovannoni, G; Hartung, H-P; Havrdova, E; Kappos, L; Pozzilli, C; Soerensen, P S; Tackenberg, B; Vermersch, P; Comi, G

    2018-05-01

    The European Charcot Foundation supported the development of a set of surveys to understand current practice patterns for the diagnosis and management of multiple sclerosis (MS) in Europe. Part 2 of the report summarizes survey results related to secondary progressive MS (SPMS), primary progressive MS (PPMS), pregnancy, paediatric MS and overall patient management. A steering committee of MS neurologists developed case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Respondents generally favoured changing rather than stopping disease-modifying treatment (DMT) in patients transitioning from relapsing-remitting MS to SPMS, particularly with active disease. Respondents would not initiate DMT in patients with typical PPMS symptoms, although the presence of ≥1 spinal cord or brain gadolinium-enhancing lesion might affect that decision. For patients considering pregnancy, respondents were equally divided on whether to stop treatment before or after conception. Respondents strongly favoured starting DMT in paediatric MS with active disease; recommended treatments included interferon, glatiramer acetate and, in John Cunningham virus negative patients, natalizumab. Additional results regarding practice-based questions and management are summarized. Results of part 2 of the survey of diagnostic and treatment practices for MS in Europe largely mirror results for part 1, with neurologists in general agreement about the treatment and management of SPMS, PPMS, pregnancy and paediatric MS as well as the general management of MS. However, there are also many areas of disagreement, indicating the need for evidence-based recommendations and/or guidelines. © 2018 EAN.

  13. Nuclear power life cycle management, managing nuclear knowledge, and nuclear security. Introductory statement to the 5th scientific forum during the 46th session of the IAEA General Conference. Vienna, 17 September 2002

    International Nuclear Information System (INIS)

    ElBaradei, M.

    2002-01-01

    The document reproduces the text of the introductory statement made by the Director General of the IAEA at the 5th scientific forum organized during the 46th session of the IAEA General Conference, Vienna, 17 september 2002, on the nuclear power life cycle management, managing nuclear knowledge, and nuclear security. In the area of nuclear power life cycle management two aspects were emphasized: licence extension and facility decommissioning. Nuclear knowledge management includes ensuring the continued availability of the qualified personnel. Nuclear security must be considered for all nuclear applications, in a manner that encompasses all phases of nuclear activity - the use, storage and transport of nuclear and other radioactive material, as well as the design, operation, and decommissioning of nuclear facilities

  14. Siting of nuclear power plants in accordance with the scenario of a ''fossil nuclear energy mix'' prepared by the CDU/CSU and FDP in the inquiry commission of the Bundestag on ''Sustainable energy supply in times of globalisation and deregulation''. Short study

    International Nuclear Information System (INIS)

    Benik, G.; Gundelach, T.

    2002-01-01

    In effect the present study makes concrete proposals for the installation of a nuclear power plant capacity of 91.8 GW as determined by the CDU/CSU and FDP in the inquiry commission on ''Sustainable development''. Because of the infrastructural requirements and the large number of plants that would have to be planned in Germany alone these siting proposals must be regarded as an outline for the implementation of a nuclear climate protection strategy. Without extensive assessment work a short study such as this cannot of course replace the detailed planning that would be required for authorisation procedures. The primary benefit of the study is that it makes clear the true consequences of a nuclear climate protection policy that is now being discussed as a hypothetical possibility [de

  15. Summary of DoD Office of the Inspector General Audits of DoD Financial Management Challenges

    Science.gov (United States)

    2015-07-07

    were not always recorded using accrual accounting . Additionally, Army systems did not always record the transaction on an accrual basis as...mission is to provide independent, relevant, and timely oversight of the Department of Defense that supports the warfighter; promotes accountability ...financial management. The most prevalent areas of concern were DoD financial management systems, accounting entries, compliance with laws and

  16. 49 CFR 1242.83 - Officers-general superintendence; accounting, auditing and finance; management services and data...

    Science.gov (United States)

    2010-10-01

    ..., auditing and finance; management services and data processing; personnel and labor relations; legal and... on corporate income or payrolls; and other (accounts XX-63-01, XX-63-86, XX-63-87, XX-63-91, XX-63-92..., auditing and finance; management services and data processing; personnel and labor relations; legal and...

  17. Food Management System--Daily Production Reports: General Description and Users Guide. Project SIMU-School: Dallas Component.

    Science.gov (United States)

    Cronshey, Raymond W.; Dunklau, M. William

    This booklet describes the Daily Production Reports subsystem of the School Food Management System, a computer program package developed as one part of a family of educational management systems. The Daily Production Reports system produces two major types of reports on a daily basis. Business Analysis Reports display all food service costs, as…

  18. Is the Current Management of Patients Presenting With Spinal Trauma to District General Hospitals Fit for Purpose? Our Experience of Delivering a Spinal Service Using an Electronic Referral Platform in a Large District General Teaching Hospital Without Onsite Spinal Services.

    Science.gov (United States)

    Hill, Daniel S; Marynissen, Hans

    2018-04-12

    A retrospective cross-sectional analysis. To describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and quantify time taken to obtain definitive management plans whilst under prescribed spinal immobilization. Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist centre. A retrospective review of 104 patients admitted following vertebral during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that "spinal immobilisation is not recommended for more than 48 hours" was the standard of care measured against. 100 patients occupied a total of 975 hospital inpatient bed days. 117 radiological investigations were requested after the point of external referral (47 CT-scans, 37 MRI-scans, and 33 weight bearing radiographs). The period between initial referral to the regional spinal service and then receiving a definitive final management had a median value of 72 hours and a range of 0 - 33 days. Patients will have been under some form of prescribed spinal immobilisation until the definitive management plan was communicated. 34 patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. 80 patients had vertebral injuries (73 stable, 6 unstable), 3 patients had prolapsed intervertebral disks, 1 had metastatic disease, and 17 had not evidence of an acute injury following evaluation. Patients are being placed under prescribed immobilisation for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan. 4.

  19. General Practitioners' Perceptions on Clinical Management and Training Needs regarding the Healthcare of Community-Dwelling People with Intellectual Disability: A Preliminary Survey in Singapore.

    Science.gov (United States)

    Sajith, Sreedharan Geetha; Goh, Yen-Li; Wee, Joshua Marcus

    2017-11-01

    Studies worldwide indicate that people with intellectual disability have high risks of physical and mental morbidities, and poor quality of health care. This study was aimed at determining general practitioners' perceptions on barriers in clinical assessment and training needs with regard to the healthcare of community-dwelling people with intellectual disability. A survey questionnaire was developed specifically for the study through focus group discussions and a literature review. The study was conducted as a cross-sectional anonymous survey of private general practitioners practicing in Singapore. The survey contained questions on their experience and training needs in assessing and treating patients with intellectual disability. Forty-nine of the 272 questionnaires sent out were returned. The respondents were predominantly male general practitioners working in "solo" practices. For most general practitioners, the proportion of patients with intellectual disability ranged from 1% to 5%. Nearly 90% of general practitioners identified problems in communicating with such patients as an important barrier that affected the quality of assessment of their health conditions. Other barriers identified were behavioral issues and sensory impairments. Only one-third of the general practitioners were confident that they had sufficient knowledge of physical and mental health conditions related to patients with intellectual disability. Three-fourths of the general practitioners believed that further training in this area would be beneficial. Appropriate interventions to address barriers in assessment and management of patients with intellectual disability with further training for general practitioners may improve the standard of healthcare provided to this population group.

  20. Apple-CORE: Microgrids of SVP cores: flexible, general-purpose, fine-grained hardware concurrency management

    NARCIS (Netherlands)

    Poss, R.; Lankamp, M.; Yang, Q.; Fu, J.; van Tol, M.W.; Jesshope, C.; Nair, S.

    2012-01-01

    To harness the potential of CMPs for scalable, energy-efficient performance in general-purpose computers, the Apple-CORE project has co-designed a general machine model and concurrency control interface with dedicated hardware support for concurrency control across multiple cores. Its SVP interface

  1. Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Walters, Julia A E; Courtney-Pratt, Helen; Cameron-Tucker, Helen; Nelson, Mark; Robinson, Andrew; Scott, Jenn; Turner, Paul; Walters, E Haydn; Wood-Baker, Richard

    2012-01-01

    The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

  2. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia – case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    2016-07-01

    Full Text Available Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Resumo: Justificativa e objetivos: O aumento na prevalência da obesidade na população geral se estende para mulheres na idade reprodutiva. O objetivo deste estudo é relatar o controle perioperatório de uma gestante obesa mórbida com índice de massa corporal >50 Kg/m2, submetida a parto cesariano sob anestesia geral. Relato do caso: Gestante de 35 anos com índice de massa corporal

  3. The Effectiveness of Group Training of CBT-Based Stress Management on Anxiety, Psychological Hardiness and General Self-Efficacy Among University Students.

    Science.gov (United States)

    Molla Jafar, Hamdam; Salabifard, Seddigheh; Mousavi, Seyedeh Maryam; Sobhani, Zahra

    2015-09-28

    Admission to university is a very sensitive period of life for efficient, active, and young workforces in any country, and it is mostly associated with many changes in social and human relationships. These changes lead to anxiety in students. Moreover, humans need certain functions in order to adaptively deal with different life situations and challenges. By training stress management, these functions can help human acquire the required abilities. The present study was aimed at investigating the effectiveness of stress management training in anxiety, psychological hardiness, and general self-efficacy among university students. The study was a quasi-experimental intervention (pretest-posttest-follow-up) including a control group, it was a fundamental applied study. The statistical population consisted of all students of Islamic Azad University, Karaj, Iran. Convenient sampling was employed to select 30 students who were divided into an experimental group (n=15) and a control group (n=15). Before stress management training, both groups filled out Beck Anxiety Inventory, Long and Goulet scale of psychological hardiness, and General Self-efficacy Scale (GSE-10). Afterwards, the experimental group was provided with stress management training. And after the experiment, the abovementioned questionnaires and scales were responded by the two groups. Finally the collected data were analyzed and compared using one-way MANOVA. The results of MANOVA indicated that there was a significant difference between the two groups in terms of anxiety, hardiness, and general self-efficacy (pstress management among university students cause anxiety to drop; moreover, it enhances their psychological hardiness and self-efficacy. In regard with the role and importance of stress management, training this skill should be included in educational plans of university.

  4. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia.

    Science.gov (United States)

    Song, Ki Un; Nam, Ok Hyung; Kim, Mi Sun; Choi, Sung Chul; Lee, Hyo-Seol

    2015-12-01

    Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.

  5. Financial Management: Processing General Services Administration Rent Bills for DoD Customers in the National Capital Region

    National Research Council Canada - National Science Library

    Granetto, Paul

    2003-01-01

    .... The Washington Headquarters Services (WHS) is responsible for the oversight and management of administrative space occupied by DoD agencies and Military departments in the National Capital Region...

  6. 75 FR 19422 - Availability of a Final Environmental Impact Statement for the General Management Plan (FEIS/GMP...

    Science.gov (United States)

    2010-04-14

    .... Alternative A is the No-Action Alternative, which would continue current management practices and trends, with no major changes in direction. Alternative B emphasizes the natural environment by keeping the site...

  7. Investigating patients' and general practitioners' views of computerised decision support software for the assessment and management of cardiovascular risk

    Directory of Open Access Journals (Sweden)

    Anne Wilson

    2007-01-01

    Conclusion Computer decision support programs are becoming more prevalent, but little is known about their usability and acceptability to both health professionals and consumers. The complexities of cardiovascular risk assessment and management can be adequately managed with such programs. As a contemporary report this study contributes to the growing knowledge required for developers of medical software and decision support systems to better understand the needs of endusers.

  8. The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain.

    Science.gov (United States)

    Khan, Muhammad; Soomro, Rabail Rani; Ali, Syed Shahzad

    2014-09-01

    To evaluate the effectiveness of isometric exercises as compared to general exercises in chronic non-specific neck pain. For this randomised controlled trial total 68 patients (34 each group) with chronic non-specific neck pain were recruited from Alain Poly Clinic and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences, Karachi between May, 2012 and August, 2012. Simple randomisation method was used to assign participants into isometric exercise group and general exercise groups. The isometric exercise group performed exercises for neck muscle groups with a rubber band and general exercises group performed active range of movement exercises for all neck movements. Patients in both groups received 3 supervised treatment sessions per week for 12 weeks. Visual Analogue Scale (VAS), North wick Park Neck Pain Questionnaire and goniometer were used to assess pain, disability and neck range of movements at baseline and after 12 weeks. Both interventions showed statistically significant improvements in pain, function and range of movement p = 0.001f or isometric exercise group, p = 0.04 for general exercises group and p = 0.001 for range of movement. However, mean improvements in post intervention VAS score and North wick Park Neck Pain Questionnaire score was better in isometric exercises group as compared to general exercise group. In conclusion, both interventions are effective in the treatment of chronic non-specific neck pain however; isometric exercises are clinically more effective than general exercises.

  9. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia

    OpenAIRE

    Song, Ki Un; Nam, Ok Hyung; Kim, Mi Sun; Choi, Sung Chul; Lee, Hyo-Seol

    2015-01-01

    Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management a...

  10. 40 CFR 63.7886 - What are the general standards I must meet for my affected remediation material management units?

    Science.gov (United States)

    2010-07-01

    ... refinery) is no longer subject to this subpart. (3) If the remediation material management unit is also... emissions limitations and work practice standards under the other subpart (e.g., you install and operate the required air pollution controls or have implemented the required work practice to reduce HAP emissions to...

  11. The Incredible Years Teacher Classroom Management Program: Using Coaching to Support Generalization to Real-World Classroom Settings

    Science.gov (United States)

    Reinke, Wendy M.; Stormont, Melissa; Webster-Stratton, Carolyn; Newcomer, Lori L.; Herman, Keith C.

    2012-01-01

    This article focuses on the Incredible Years Teacher Classroom Management Training (IY TCM) intervention as an example of an evidence-based program that embeds coaching within its design. First, the core features of the IY TCM program are described. Second, the IY TCM coaching model and processes utilized to facilitate high fidelity of…

  12. General directions and practices for management of radioactive waste; Indirizzi generali e pratiche di gestione dei rifiuti radioattivi

    Energy Technology Data Exchange (ETDEWEB)

    Fioroni, M [ENEA - Area Energia, Ambiente e Salute, Centro Ricerche Energia, Casaccia, Rome (Italy)

    1990-12-15

    The present work underlines and synthesises the essential principles, directions and methodologies developed by Industrialized Nations and by the International Organizations for management of radioactive waste of high, intermediate and low levels. It fills a gap in scientific Italian literature and represents a valid introduction to the subject. (author)

  13. Management of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia by general practitioners in Jakarta

    Directory of Open Access Journals (Sweden)

    Faisal Abdi Matondang

    2014-06-01

    Conclusions: Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still infrequently performed.

  14. Generalization and maintenance of a self-management program for drooling in children with neurodevelopmental disabilities: A second case series

    NARCIS (Netherlands)

    Burg, J.J.W. van der; Sohier, J.; Jongerius, P.H.

    2018-01-01

    In this case series (n = 10) with a non-concurrent multiple baseline design, a self-management program was shown to be effective during inpatient training in eight participants with oral-motor problems and normal intelligence or mild intellectual disabilities. They were taught to perform a

  15. Study of General Applicability and Particularity of Management Basis on Toyota Management%从丰田模式的发展看管理学的普适性和特殊性

    Institute of Scientific and Technical Information of China (English)

    常文娟

    2012-01-01

    在认同“社会科学领域内存在着普适的管理学”这一理论前题的条件下,通过剖析丰田管理模式与科学管理及文化之间的关系,探索决定管理学普适性和特殊性的因素。科学管理的思想决定了管理学的普适性,而科学管理思想与不同文化环境的结合决定了管理学的特殊性。%This article agrees with that there would be a generally applicable management theory in the field of social sciences. After analyzing the relationship between the Toyota Management and the scientific management and the culture , the deciding factors of the general applicability and particularity are explored. The conclusion is that the general applicability is determined by the thoughts of scientific management , and the particularity is determined by different cultures.

  16. [The management of osteoarthritis by general practitioners in Germany : Comparison of self-reported behaviour with international guidelines.

    NARCIS (Netherlands)

    Rosemann, T.J.; Joos, S.; Szecsenyi, J.

    2008-01-01

    BACKGROUND: In most countries, guidelines for the treatment of osteoarthritis (OA) are available. However, in Germany, no guideline for the primary care sector is available. The care provider of most patients is the general practitioner (GP). The aim of the study was to investigate the approaches in

  17. Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.

    NARCIS (Netherlands)

    Anderson, P.D.; Geurts-Laurant, M.G.H.; Kaner, E.; Wensing, M.J.P.; Grol, R.P.T.M.

    2004-01-01

    OBJECTIVE: A systematic review was undertaken of studies that test the effectiveness of different strategies used to increase general practitioners' rates of screening for and giving advice about hazardous and harmful alcohol consumption. METHOD: Resources were MEDLINE, EMBASE, Cinahl and the

  18. Management of Clostridium difficile diarrhoea in District General Hospital: audit for 3months and review of literature

    OpenAIRE

    Dr. J. Sellers; Dr. Varun Dixit

    2007-01-01

    Clostridium difficile is one of the most important causes of diarrhoea especially following antibiotic course. Elderly population is more susceptible and results in significant mortality and morbidity. We audited twenty four cases of Clostridium difficile in our hospital over duration of three months. We looked into the demographic features of the patient population and compliance with the Trust guidelines for the management of the diarrhoea.

  19. Management of Clostridium difficile diarrhoea in District General Hospital: audit for 3months and review of literature

    Directory of Open Access Journals (Sweden)

    Dr. J. Sellers

    2007-01-01

    Full Text Available Clostridium difficile is one of the most important causes of diarrhoea especially following antibiotic course. Elderly population is more susceptible and results in significant mortality and morbidity. We audited twenty four cases of Clostridium difficile in our hospital over duration of three months. We looked into the demographic features of the patient population and compliance with the Trust guidelines for the management of the diarrhoea.

  20. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice

    DEFF Research Database (Denmark)

    French, Simon D; McKenzie, Joanne E; O'Connor, Denise A

    2013-01-01

    Introduction: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. Methods: General practices were randomised to either access to a guideline for acute LBP...... and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs......, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1...

  1. The general principles and consequences of environmental radiation exposure in relation to Canada's nuclear fuel waste management concept

    International Nuclear Information System (INIS)

    Myers, D.K.

    1989-09-01

    This document reviews the general principles and biological consequences of environmental radiation exposure. Particular attention was paid to the ICRP principle that if individual humans are adequately protected, then populations of other living organisms are likely to be sufficiently protected. The data reviewed in this document suggest that this principle is usually valid, although some theoretical concerns were noted with respect to effects of bioaccumulation of certain radionuclides in aquatic organisms

  2. Section 3. General issues in management : Heuristics or experience-based techniques for making accounting judgments and learning

    OpenAIRE

    Schiller, Stefan

    2013-01-01

    The purpose of this paper is to further the development of initial accounting for internally generated intangible assets, relevant to both academics and practitioners, examining what happens when accountants are given principles-based discretion. This paper draws on existing insights into heuristics or experience-based techniques for making accounting judgments. Knowledge about judgment under uncertainty, and the general framework offered by the heuristics and biases program in particular, fo...

  3. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up.

    Science.gov (United States)

    McMain, Shelley F; Guimond, Tim; Streiner, David L; Cardish, Robert J; Links, Paul S

    2012-06-01

    The authors conducted a 2-year prospective naturalistic follow-up study to evaluate posttreatment clinical outcomes in outpatients who were randomly selected to receive 1 year of either dialectical behavior therapy or general psychiatric management for borderline personality disorder. Patients were assessed by blind raters 6, 12, 18, and 24 months after treatment. The clinical effectiveness of treatment was assessed on measures of suicidal and nonsuicidal self-injurious behaviors, health care utilization, general symptom distress, depression, anger, quality of life, social adjustment, borderline psychopathology, and diagnostic status. The authors conducted between-group comparisons using generalized estimating equation, mixed-effects models, or chi-square statistics, depending on the distribution and nature of the data. Both treatment groups showed similar and statistically significant improvements on the majority of outcomes 2 years after discharge. The original effects of treatment did not diminish for any outcome domain, including suicidal and nonsuicidal self-injurious behaviors. Further improvements were seen on measures of depression, interpersonal functioning, and anger. However, even though two-thirds of the participants achieved diagnostic remission and significant increases in quality of life, 53% were neither employed nor in school, and 39% were receiving psychiatric disability support after 36 months. One year of either dialectical behavior therapy or general psychiatric management was associated with long-lasting positive effects across a broad range of outcomes. Despite the benefits of these specific treatments, one important finding that replicates previous research is that participants continued to exhibit high levels of functional impairment. The effectiveness of adjunctive rehabilitation strategies to improve general functioning deserves additional study.

  4. Quantity & quality analysis and associated management practices of solid waste generated in the general dentistry offices in the city of Arak, 2015

    Directory of Open Access Journals (Sweden)

    Ali Koolivand

    2016-10-01

    Full Text Available Abstract Background: As dental solid waste are among the most important environmental pollutants due to its high contents of toxic and hazardous agents, suitable treatment and management of it are of great importance. The objective of this study was to quantity & quality analyses of dental solid waste and associated management practices in the general dentistry offices in the city of Arak. Materials and Methods: 15 samples of solid waste were taken from the 5 selected general dentistry offices, classified into 66 components and 4 fractions, and then the quantity & quality characteristics were evaluated. Management practices of the solid waste were also investigated by using a questionnaire. Results: According to the results, per capita and the average generation rate of each dentistry office were 66.71 g/day-patient and 1340.45 g/day, respectively. Potential infectious, domestic-type, chemical & pharmaceutical, and toxic wastes consisted of 54.25%, 35.14%, 8.19%, and 2.14% of the waste generated, respectively. 10 components including latex gloves, nylon & plastic, saliva & blood-contaminated kleenex, paper & cardboard, used ampoules, saliva ejector tubes, gypsum, food waste, saliva & blood-contaminated dental rolls, and nylon gloves were responsible for more than 80% of the total waste generated, respectively. Conclusion: Each fraction of dental solid waste (toxic, chemical & pharmaceutical, potential infectious and domestic-type wastes should be separately collected and disposed of according to the related criteria.

  5. Generalized Superconductivity. Generalized Levitation

    International Nuclear Information System (INIS)

    Ciobanu, B.; Agop, M.

    2004-01-01

    In the recent papers, the gravitational superconductivity is described. We introduce the concept of generalized superconductivity observing that any nongeodesic motion and, in particular, the motion in an electromagnetic field, can be transformed in a geodesic motion by a suitable choice of the connection. In the present paper, the gravitoelectromagnetic London equations have been obtained from the generalized Helmholtz vortex theorem using the generalized local equivalence principle. In this context, the gravitoelectromagnetic Meissner effect and, implicitly, the gravitoelectromagnetic levitation are given. (authors)

  6. Web 2.0 systems supporting childhood chronic disease management: a pattern language representation of a general architecture.

    Science.gov (United States)

    Timpka, Toomas; Eriksson, Henrik; Ludvigsson, Johnny; Ekberg, Joakim; Nordfeldt, Sam; Hanberger, Lena

    2008-11-28

    Chronic disease management is a global health concern. By the time they reach adolescence, 10-15% of all children live with a chronic disease. The role of educational interventions in facilitating adaptation to chronic disease is receiving growing recognition, and current care policies advocate greater involvement of patients in self-care. Web 2.0 is an umbrella term for new collaborative Internet services characterized by user participation in developing and managing content. Key elements include Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; weblogs (blogs) to describe new trends, wikis to share knowledge, and podcasts to make information available on personal media players. This study addresses the potential to develop Web 2.0 services for young persons with a chronic disease. It is acknowledged that the management of childhood chronic disease is based on interplay between initiatives and resources on the part of patients, relatives, and health care professionals, and where the balance shifts over time to the patients and their families. Participatory action research was used to stepwise define a design specification in the form of a pattern language. Support for children diagnosed with diabetes Type 1 was used as the example area. Each individual design pattern was determined graphically using card sorting methods, and textually in the form Title, Context, Problem, Solution, Examples and References. Application references were included at the lowest level in the graphical overview in the pattern language but not specified in detail in the textual descriptions. The design patterns are divided into functional and non-functional design elements, and formulated at the levels of organizational, system, and application design. The design elements specify access to materials for development of the competences needed for chronic disease management in specific community settings, endorsement of self-learning through online peer

  7. Web 2.0 systems supporting childhood chronic disease management: A pattern language representation of a general architecture

    Directory of Open Access Journals (Sweden)

    Ekberg Joakim

    2008-11-01

    Full Text Available Abstract Background Chronic disease management is a global health concern. By the time they reach adolescence, 10–15% of all children live with a chronic disease. The role of educational interventions in facilitating adaptation to chronic disease is receiving growing recognition, and current care policies advocate greater involvement of patients in self-care. Web 2.0 is an umbrella term for new collaborative Internet services characterized by user participation in developing and managing content. Key elements include Really Simple Syndication (RSS to rapidly disseminate awareness of new information; weblogs (blogs to describe new trends, wikis to share knowledge, and podcasts to make information available on personal media players. This study addresses the potential to develop Web 2.0 services for young persons with a chronic disease. It is acknowledged that the management of childhood chronic disease is based on interplay between initiatives and resources on the part of patients, relatives, and health care professionals, and where the balance shifts over time to the patients and their families. Methods Participatory action research was used to stepwise define a design specification in the form of a pattern language. Support for children diagnosed with diabetes Type 1 was used as the example area. Each individual design pattern was determined graphically using card sorting methods, and textually in the form Title, Context, Problem, Solution, Examples and References. Application references were included at the lowest level in the graphical overview in the pattern language but not specified in detail in the textual descriptions. Results The design patterns are divided into functional and non-functional design elements, and formulated at the levels of organizational, system, and application design. The design elements specify access to materials for development of the competences needed for chronic disease management in specific community

  8. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice: a stepped-wedge randomised controlled trial.

    Science.gov (United States)

    Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm; Siersma, Volkert Dirk; Waldorff, Frans Boch

    2014-04-09

    The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention. The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups. We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0

  9. Generalized Cartographic and Simultaneous Representation of Utility Networks for Decision-Support Systems and Crisis Management in Urban Environments

    Science.gov (United States)

    Becker, T.; König, G.

    2015-10-01

    Cartographic visualizations of crises are used to create a Common Operational Picture (COP) and enforce Situational Awareness by presenting relevant information to the involved actors. As nearly all crises affect geospatial entities, geo-data representations have to support location-specific analysis throughout the decision-making process. Meaningful cartographic presentation is needed for coordinating the activities of crisis manager in a highly dynamic situation, since operators' attention span and their spatial memories are limiting factors during the perception and interpretation process. Situational Awareness of operators in conjunction with a COP are key aspects in decision-making process and essential for making well thought-out and appropriate decisions. Considering utility networks as one of the most complex and particularly frequent required systems in urban environment, meaningful cartographic presentation of multiple utility networks with respect to disaster management do not exist. Therefore, an optimized visualization of utility infrastructure for emergency response procedures is proposed. The article will describe a conceptual approach on how to simplify, aggregate, and visualize multiple utility networks and their components to meet the requirements of the decision-making process and to support Situational Awareness.

  10. Knowledge, management and perceived barriers to treatment of molar-incisor hypomineralisation in general dental practitioners and dental nurses in Malaysia.

    Science.gov (United States)

    Hussein, A S; Ghanim, A M; Abu-Hassan, M I; Manton, D J

    2014-10-01

    Molar-incisor hypomineralisation (MIH) is a global dental problem, yet little is known about the knowledge of the general dental practitioners (GDPs) and dental nurses (DNs) regarding this defect in South East Asia. To assess and compare the knowledge of the GDPs and DNs in Malaysia regarding the frequency of occurrence of MIH within their practice, its diagnosis, putative aetiological factors and management. A questionnaire was distributed to GDPs and DNs during a nationwide dental conference in Melaka, Malaysia and who were asked to answer questions about demographic variables, knowledge, attitudes and practices in the management of MIH. Descriptive statistics and bivariate analysis were performed. A 5% level of statistical significance was applied for the analyses. A response rate of 58.2% (131/225) was obtained. Most respondents were aware of MIH and encountered it in their practice (GDPs = 82.5%, DNs = 82.4%). The condition was observed by respondents less in primary molars compared to first permanent molars. Full agreement between GDPs and DNs did not exist concerning the aetiological factors and management of MIH. Glass ionomer cements were the most popular material used in treating MIH. Most respondents (GDPs = 93%, DNs = 76.5%) indicated that they had not received sufficient information about MIH and were willing to have clinical training in the diagnosis and therapeutic modalities of MIH. MIH is identified and encountered by most respondents. Agreement did not exist between GDPs and DNs concerning MIH frequency of occurrence within their practice, its diagnosis, aetiological factors and management.

  11. Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

    Directory of Open Access Journals (Sweden)

    Julia Segar

    2014-10-01

    Full Text Available The English National Health Service (NHS is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs to general practitioners (GPs working together in Clinical Commissioning Groups (CCGs. This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars.

  12. Public debate on the general options relative to the management of high-medium activity and long-lived radioactive wastes

    International Nuclear Information System (INIS)

    2005-09-01

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. This document presents the organizational aspects of the debate: origin, organization committee (mission, members, commitments), framework (the December 31, 1991 law, technical enlargement, society aspects), topics (summary of the debate in ten questions), organization modalities (4 main steps, schedule, venues), objectives and perspectives (sharing information, decision making processes to be implemented by 2006). (J.S.)

  13. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey.

    Directory of Open Access Journals (Sweden)

    Hélène Dumesnil

    Full Text Available French general practitioners (GPs refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates.This qualitative study aims to explore general practitioners' (GP opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression.In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content.We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists.Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.

  14. Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.

    Science.gov (United States)

    Ironmonger, Dean; Edeghere, Obaghe; Gossain, Savita; Hawkey, Peter M

    2016-05-24

    There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community. The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination. Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.

  15. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey

    Science.gov (United States)

    Dumesnil, Hélène; Apostolidis, Thémis; Verger, Pierre

    2018-01-01

    Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area. PMID:29385155

  16. Proceedings of the public debate on the general options of management of high and intermediate activity and long-lived radioactive wastes

    International Nuclear Information System (INIS)

    2006-01-01

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprised 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is a summary of the main questions tackled during this debate from its preparation to its closing meeting and dealing with: the acceptation of the debate, the progress of the debate, the socio-technical problem of gathering the different points to be debated with respect to the different areas in concern, the general questions about the overall nuclear wastes and materials (radioactivity, health, radioprotection, management, reprocessing, control, actors organization, knowledge sharing, perenniality of the financing), the specific questions about long-lived wastes (inventory, separation-transmutation feasibility, nuclear energy and energy policy, management solutions, storage and geologic disposal feasibility, impact of debates on the 2006 law, long-lived waste territories), the conclusions for the 2006 law: mastering the overall nuclear wastes and materials and step-by-step building up of a solution for long-lived wastes (difficulties, lessons learnt from foreign experience, first draft of the 2006 law). Some opinions expressed by some participants about these proposals conclude

  17. Online Canton Fairs Ready for Convenient Trade--An Interview with Ding Qiang, General Manager of MOFCOM China International Electronic Commerce Center

    Institute of Scientific and Technical Information of China (English)

    Li Yinghong; Sun Yongjian

    2006-01-01

    @@ In 2006, the Canton Fairs will greet the 99th and 100th respectively in spring and fall. To meet the need of the development of the convenient trade, the Canton Fairs website, the platform of the online Canton Fairs run by MOFCOM China International Electronic Commerce Center is ready to take several effective measures to offer more convenient services. On March 24, China's Foreign Trade took the occasion to interview with Mr. Ding Qiang, General Manager of MOFCOM China International Electronic Commerce Center.

  18. Long-term management of chronic spontaneous urticaria with omalizumab.

    Science.gov (United States)

    Pinto Gouveia, M; Gameiro, A; Pinho, A; Gonçalo, M

    2017-10-01

    Clinical trials have shown the efficacy of omalizumabs efficacy in refractory chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), but real-life management strategies are lacking. To assess the long-term efficacy and safety of omalizumab, and to identify predictive factors and optimum dosage regimens. This was a prospective study of 13 patients (11 women, 2 men) with severe CSU [weekly urticaria activity score (UAS7) > 28] resistant to anti-H1 antihistamines. Patients were started on omalizumab 150 mg subcutaneously every 4 weeks. Dose and interval between administrations were adjusted according to clinical response (189 administrations; treatment duration range 2-38 months). Mean UAS7 was 36.3 ± 5.4. Of the 13 patients, all had experienced angio-oedema, while in addition, 7 had delayed pressure urticaria (DPU) and 1 had solar urticaria (SU). After omalizumab treatment, 4 (30.8%) of the 13 patients had complete response (CR), and the remaining 8 (61.5%) had partial response. CR was achieved with a dose of 150 mg every 4 (n = 2 patients) or 5 (n = 2) weeks. One of these patients remained disease-free after stopping treatment. Partial responses were achieved with 150 mg every 4 weeks (n = 4) and with 300 mg (n = 4) at intervals of 5 weeks (n = 1), 4 weeks (n = 2) or 3 weeks (n = 1). Only one patient (7.7%) did not show significant improvement, despite a dose of 300 mg every 4 weeks. There were no significant differences in epidemiological, clinical and laboratory data between the different response groups. Only two adverse events were observed: one was mild headache and the other was severe angio-oedema and aggravation of urticaria within 6 h of omalizumab administration. Omalizumab dose and interval between administrations could be individualized for long-term management of CSU. © 2017 British Association of Dermatologists.

  19. [Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

    Science.gov (United States)

    López-Collada Estrada, María; Olvera Martínez, Rosalba

    2016-01-01

    Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Speleoclimate dynamics in Santana Cave (PETAR, São Paulo State, Brazil: general characterization and implications for tourist management

    Directory of Open Access Journals (Sweden)

    Heros Augusto Santos Lobo

    2015-01-01

    Full Text Available Show caves provide tourists with the opportunity to have close contact with natural underground spaces. However, visitation to these places also creates a need for management measures, mainly the definition of tourist carrying capacity. The present work describes the results of climate monitoring and atmospheric profiling performed in Santana Cave (Alto Ribeira State and Tourist Park – PETAR, Brazil between 2008 and 2011. Based on the results, distinct preliminary zones with different levels of thermal variation were identified, which classify Santana Cave as a warm trap. Two critical points along the tourist route (Cristo and Encontro Halls were identified where the temperature of the locality increased by 1.3 °C when tourists were present. Air flow from the inner cave to the outside occurs during the austral summer, and the opposite flow occurs when the outside environment is colder than the air inside the cave during the austral winter. The temperature was used to establish thresholds to the tourist carrying capacity by computing the recovery time of the atmospheric conditions after the changes caused by the presence of tourists. This method suggests a maximum limit of approximately 350 visits per day to Santana Cave. The conclusion of the study is that Santana Cave has an atmosphere that is highly connected with the outside; daily variations in temperature and, to a lesser extent, in the relative humidity occur throughout the entire studied area of the cave. Therefore, the tourist carrying capacity in Santana Cave can be flexible and can be implemented based on the climate seasonality, the tourism demand and other management strategies.

  1. FIDIC contracts: analysis of the impact of general and particular conditions on the financial risk management in Romanian infrastructure projects

    Directory of Open Access Journals (Sweden)

    Constanţa-Nicoleta Bodea

    2016-12-01

    Full Text Available Construction projects are characterized by risks and uncertainties mainly due to technical and economic complexity. Risk management is an important tool in making decisions involving the identification and reduction, avoidance or transfer risk and uncertainties consequences of events that occurs during project implementation. For this reason, the objective of the contract between the beneficiary and the contractor is the allocation of risk. The distribution of risk in contracts for the execution of construction works was and is an ongoing challenge faced by parties having a significant impact on the type of contract is used. On the one hand, the beneficiaries tend to transfer to the contractors as many of the project risks and uncertainties, on the other hand, the contractors look to exploit any weakness contract, so as to reduce their impact on the expected profit. One of the most important risks assumed by the contractor by signing the contract which is also increasingly common in the current economic situation is the reduced financial capacity to support the project. A purely legal or purely technical interpretation is not meant to describe the complexity of issues related to implementation of construction projects. For this reason the authors have adopted a multi-disciplinary approach, which includes the legal issues related to the nature of the contract, but also the financial and technical aspects of construction projects. The paper aims to analyze how special contract clauses can influence the implementation of construction projects and in particular the financial management of contractors. The authors propose a model for analyzing the impact of FIDIC contract conditions applied on a case study of five transport infrastructure projects.

  2. What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

    Science.gov (United States)

    Ketterer, Frederic; Symons, Linda; Lambrechts, Marie-Claire; Mairiaux, Philippe; Godderis, Lode; Peremans, Lieve; Remmen, Roy; Vanmeerbeek, Marc

    2014-06-14

    General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians. Twenty Belgian GPs were interviewed. De Vries' Integrated Change Model was used to guide the interviews and qualitative data analyses. GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients' situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients' responsibilities in managing their own health as well the GPs' abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers

  3. Evaluation critique of state of the art dyslipidemia management in general and with a special emphasis on the Indian population.

    Science.gov (United States)

    Whayne, Thomas F

    2007-01-01

    Classically, there have been three well established major cardiovascular risk factors, hypercholesterolemia, hypertension and tobacco abuse. With accumulating clinical evidence, diabetes can now be added as a fourth major risk factor. Much interest in various other risk factors and possible causative factors has been generated, but it should be remembered that of all these, low density lipoproteins (LDL) remains the gold standard for evaluating risk. The common perception is that only caucasians in the western world have significant cardiovascular (CV) risk. However, much clinical information to the contrary has accumulated and now it is realized that many other ethnic groups also have significant CV disease, such as in India, especially in the urban population. Dyslipidemias of specific lipoproteins and their treatment is an important part of understanding and managing CV disease and risk. Various plasma factors such as homocysteine and lipoprotein (a) [(a)] have been considered to have definite associations with CV disease, but any treatment benefit remains in doubt. In addition, inflammatory risk factors are considered to be of significant clinical interest, especially high sensitivity C-Reactive protein (hsCRP). Where do these factors fit into routine clinical practice still awaits clarification. Only two of these inflammatory risk (Lp-factors can be tested commercially on a routine clinical basis and these are hsCRP and Lipoprotein-associated Phospholipase A2 Lp-PLA2). Their clinical utillity is not established and acceptance is limited: some third party health coverage organizations refuse to pay for such analyses. In the past, women have been looked upon as not having significant CV disease. More recently, evidence suggests that women may have more CV disease than men, and that physicians may have failed to realize this and act accordingly. The true situation is that women have less CV disease than men prior to menopause and then they slowly catch up

  4. General general game AI

    OpenAIRE

    Togelius, Julian; Yannakakis, Georgios N.; 2016 IEEE Conference on Computational Intelligence and Games (CIG)

    2016-01-01

    Arguably the grand goal of artificial intelligence research is to produce machines with general intelligence: the capacity to solve multiple problems, not just one. Artificial intelligence (AI) has investigated the general intelligence capacity of machines within the domain of games more than any other domain given the ideal properties of games for that purpose: controlled yet interesting and computationally hard problems. This line of research, however, has so far focuse...

  5. The effect of chronic liver disease on venous thromboembolism among medically managed patients in Singapore General Hospital.

    Science.gov (United States)

    Yang, Yong; Zhang, Xiao Zhu; Ng, Han Seong; Fong, Jeffrey Chern Hui; Lee, Lai Heng

    2015-09-01

    Chronic liver disease (CLD) has been suggested to be associated with venous thromboembolism (VTE) in western populations. However, little is known about the risk effects of CLD on VTE among Asians. To compute the prevalence of VTE among hospitalised Asian patients, and to evaluate the pattern and scale of risk effects of CLD on VTE occurrence. Retrospective study of hospital discharge database from 2004 to 2011 to identify patients with VTE and CLD using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. Of 199904 medically managed inpatients during the 8years, 1744 (0.9%) patients had VTE. Patients with CLD had significant higher prevalence of VTE (non-cirrhosis CLD 1.5%, cirrhosis 2.0%) than patients without CLD (0.8%, pCLD (odds ratio, OR 1.4, 95% CI 1.2-1.7, pCLD, particular liver cirrhosis, increases the risks of VTE in hospitalised Asian patients. As CLD patients are perceived to be at risks of bleeding due to the prolonged clotting times and thrombocytopenia, the results of this study brings attention to opposite end of the haemostatic pendulum in patients with chronic liver disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

    International Nuclear Information System (INIS)

    Toyoda, Kazunori; Koga, Masatoshi; Shiokawa, Yoshiaki

    2010-01-01

    Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72±12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with ≥4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score ≤1. Analysis of 399 patients with a premorbid mRS score ≤1 who met the criteria of the European license (≤80 years old, an initial NIHSS score ≤24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS ≤1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

  7. Stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. General results and subanalyses

    Energy Technology Data Exchange (ETDEWEB)

    Toyoda, Kazunori; Koga, Masatoshi [National Cerebral and Cardiovascular Center, Suita, Osaka (Japan); Shiokawa, Yoshiaki [Kyorin Univ., School of Medicine, Mitaka, Tokyo (Japan)

    2010-11-15

    Stroke Acute Management with Urgent Risk-factor Assessment and Improvement [SAMURAI] rt-PA Registry is a multicenter retrospective observational study from 10 Japanese stroke centers. A total of 600 patients (223 women, 72{+-}12 years old) treated with intravenous alteplase (0.6 mg/kg) were studied. Symptomatic intracerebral hemorrhage within 36 hours with {>=}4 point-increase from the baseline National Institutes of Health (NIH) Stroke Scale score developed in 8 patients (1.3%, 95% confidence interval (CI) 0.7-2.6%). At 3 months, 199 patients (33.2%, 29.5-37.0%) had a modified Rankin Scale (mRS) score {<=}1. Analysis of 399 patients with a premorbid mRS score {<=}1 who met the criteria of the European license ({<=}80 years old, an initial NIHSS score {<=}24, etc.) showed that 40.6% (35.9-45.5%) had a 3-month mRS {<=}1. In the subanalyses from this registry, early ischemic change on diffusion-weighted imaging assessed by the Alberta Stroke Programme Early CT Score, as well as reduced estimated glomerular filtration rate, was associated with early intracerebral hemorrhage and 3-month outcomes of patients. (author)

  8. [The management of osteoarthritis by general practitioners in Germany: comparison of self-reported behaviour with international guidelines].

    Science.gov (United States)

    Rosemann, T; Joos, S; Szecsenyi, J

    2008-01-01

    In most countries, guidelines for the treatment of osteoarthritis (OA) are available. However, in Germany, no guideline for the primary care sector is available. The care provider of most patients is the general practitioner (GP). The aim of the study was to investigate the approaches in diagnosing and treating OA of German GPs and to assess adherence to international guidelines. Cross-sectional study using a structured questionnaire with a random sample of 144 GPs. Regarding diagnosis, the importance of X-rays was overestimated. Regarding treatment approaches, exercising and weight reduction were regarded as primary treatment targets. Pharmacological treatment approaches were somewhat guideline oriented, but conservative approaches such as physical therapy were overestimated as invasive treatments such as intra-articular injections were underestimated in its benefit. Establishing a guideline specifically for primary care and increasing guideline adherence could help to prevent the present overuse of X-rays and the high amount of referrals to orthopaedics, save costs and reduce inadequate treatments.

  9. [Do general practitioners in Geneva (Switzerland) and Poitou-Charentes (France) have different approach to the management of addictions?].

    Science.gov (United States)

    Teoli, Romain; Haller, Dagmar M; Ingrand, Pierre; Binder, Philippe

    2016-01-01

    Addiction care is mostly provided by general practitioners (GPs) but the extent of their involvement is variable. Is this related to different training or practice contexts or to awareness campaigns? To study GPs' views and behaviours in relation to addiction patients in different practice and training contexts and different levels of exposure to awareness campaigns. Cross-sectional postal survey involving 526 GPs from the canton of Geneva, Switzerland, sensitized by specific addiction care campaigns, compared to 628 GPs from two rural Departments of Poitou-Charentes, France, not exposed to this type of awareness campaign. The response rate was 46% in Switzerland and 41% in France. The 243 responding GPs in Geneva saw as many patients with tobacco, alcohol, cannabis or opiate addiction as the 256 GPs in Poitou-Charentes. They shared similar views concerning their roles in relation to these addictions. Compared to Swiss GPs, a significantly higher number of French GPs provided first-line care for tobacco addiction. In both countries, care for addiction to other substances was mostly provided in collaboration with a specialist (>75% of cases). GPs in Geneva attributed greater importance to screening and recording of substance use. They were also more involved in training and in providing brief advice and expressed interest in the network. Awareness campaigns in Geneva could explain these differences. Sensitization of GPs to these issues may contribute to modifying certain professional attitudes, regardless of the context.

  10. General Assembly

    CERN Multimedia

    Staff Association

    2016-01-01

    5th April, 2016 – Ordinary General Assembly of the Staff Association! In the first semester of each year, the Staff Association (SA) invites its members to attend and participate in the Ordinary General Assembly (OGA). This year the OGA will be held on Tuesday, April 5th 2016 from 11:00 to 12:00 in BE Auditorium, Meyrin (6-2-024). During the Ordinary General Assembly, the activity and financial reports of the SA are presented and submitted for approval to the members. This is the occasion to get a global view on the activities of the SA, its financial management, and an opportunity to express one’s opinion, including taking part in the votes. Other points are listed on the agenda, as proposed by the Staff Council. Who can vote? Only “ordinary” members (MPE) of the SA can vote. Associated members (MPA) of the SA and/or affiliated pensioners have a right to vote on those topics that are of direct interest to them. Who can give his/her opinion? The Ordinary General Asse...

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

    Science.gov (United States)

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

    2017-10-01

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

  12. The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice.

    Science.gov (United States)

    Black, D A; Taggart, J; Jayasinghe, U W; Proudfoot, J; Crookes, P; Beilby, J; Powell-Davis, G; Wilson, L A; Harris, M F

    2013-01-01

    There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12-15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

  13. Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer's disease: pass or fail?

    Science.gov (United States)

    Veneziani, Federica; Panza, Francesco; Solfrizzi, Vincenzo; Capozzo, Rosa; Barulli, Maria Rosaria; Leo, Antonio; Lozupone, Madia; Fontana, Andrea; Arcuti, Simona; Copetti, Massimiliano; Cardinali, Valentina; Grasso, Alessandra; Tursi, Marianna; Iurillo, Annalisa; Imbimbo, Bruno Pietro; Seripa, Davide; Logroscino, Giancarlo

    2016-07-01

    We detected the general level of knowledge about the early diagnosis of Alzheimer's disease (AD) and subsequent care in general practitioners (GPs) from Southern Italy. We explored also the GP perception about their knowledge and training on diagnosis and management of AD. On a sample of 131 GPs, we administered two questionnaires: the GP-Knowledge, evaluating GPs' expertise about AD epidemiology, differential diagnosis, and available treatments, and the GP-QUestionnaire on Awareness of Dementia (GP-QUAD), assessing the GPs' attitudes, awareness, and practice regarding early diagnosis of dementia. Specific screening tests or protocols to diagnose and manage dementia were not used by 53% of our GPs. The training on the recognition of early AD signs and symptoms was considered inadequate by 55% of the participants. Females were more likely to consider their training insufficient (58%) compared to males (53%). Female GPs were less likely to prescribe antipsychotic drugs to control neuropsychiatric symptoms (NPS) and suggest specialist advice in late stage of cognitive impairment. Multiple Correspondence Analysis (MCA) performed only on GP-QUAD suggested two dimensions explaining 26.1% ("GP attitude") and 20.1% ("GP knowledge") of the inertia for a total of 46.2%, In our survey on GP clinical practice, several problems in properly recognizing early AD symptoms and subsequently screening patients to be referred to secondary/tertiary care centers for diagnosis confirmation have emerged. In the future, specific training programs and educational projects for GPs should be implemented also in Italy to improve detection rates and management of dementia in primary care.

  14. A cross-sectional study of the knowledge, attitude, and practice of general practitioners regarding dog bite management in nothern India

    Directory of Open Access Journals (Sweden)

    Abhishek Singh

    2013-01-01

    Full Text Available Context: There are many myths and false beliefs associated with wound management. These include application of oils, herbs, and red chilies on wound inflicted by rabid animals, and not washing the wound properly. General practitioners (GPs constitute a key source of medical care in study area and are approached for anti-rabies treatment by victims of animal bites. Aim: The aim of the present study is to assess the knowledge and practices among the general practitioners (GPs regarding dog bite management. Settings and Design : Community-based cross-sectional study. Materials and Methods: The present study was carried out in the private and public clinics of Ambala city from January 2012 to April 2012 using a pre-tested self-administered questionnaire. The study population composed of 100 GPs comprising 45 MBBS or above degree holders (Group 1 and 55 other GPs like BAMS, RMPs, etc (Group 2. Statistical Analysis Used: Interpretation of data was done using percentages and proportions. χ2 -Test was used to test the statistical difference in the knowledge between the two groups. Results: Out of the total, 68% and 29% respondents in Group 1 and Group 2, respectively, correctly told that wound must be washed with soap and water for minimum period of 15 min. A total 71% and 11% respondents in Group 1 and Group 2, respectively, could correctly answer about the target groups for pre-exposure prophylaxis. A total 62% GPs did not know the high-risk groups to whom pre-exposure prophylaxis has to be given. Conclusions: There was an apparent lack of awareness among the GPs regarding appropriate animal wound management and vaccine administration. Reorientation programs and continued medical education for GPs are required to highlight the WHO guidelines regarding treatment of animal bite.

  15. Effects of pasture management and off-stream water on temporal/spatial distribution of cattle and stream bank characteristics in cool-season grass pastures.

    Science.gov (United States)

    Schwarte, K A; Russell, J R; Morrical, D G

    2011-10-01

    A 2-yr grazing experiment was conducted to assess the effects of grazing management on cattle distribution and pasture and stream bank characteristics. Six 12.1-ha cool-season grass pastures in central Iowa were allotted to 1 of 3 treatments: continuous stocking with unrestricted stream access (CSU), continuous stocking with stream access restricted to 4.9-m-wide stabilized crossings (CSR), or rotational stocking with stream access restricted to a riparian paddock (RP). Pastures were stocked with 15 fall-calving Angus cows (Bos taurus L.) from mid-May to mid-October for 153 d in 2008 and 2009. A global positioning system (GPS) collar recording cow position every 10 min was placed on at least 1 cow per pasture for 2 wk of each month from May through September. Off-stream water was provided to cattle in CSU and CSR treatments during the second of the 2 wk when GPS collars were on the cattle. A black globe temperature relative humidity index (BGTHI) was measured at 10-min intervals to match the time of the GPS measurements. Each month of the grazing season, forage characteristics (sward height, forage mass, and CP, IVDMD, and P concentrations) and bare and fecal-covered ground were measured. Stream bank erosion susceptibility was visually scored in May, August, and October (pre-, mid-, and post-stocking). Cattle in RP and CSR treatments spent less time (P CSR treatment reduced the probability (P CSR and RP treatments in the stream and streamside zones in September and October and in July and September. Streams in pastures with the CSU treatment had less stable banks (P CSR treatments. Results show that time spent by cattle near pasture streams can be reduced by RP or CSR treatments, thereby decreasing risks of sediment and nutrient loading of pasture streams even during periods of increased BGTHI.

  16. The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

    Directory of Open Access Journals (Sweden)

    Filipe Prazeres

    2016-11-01

    Full Text Available Multimorbidity’s high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information and society (media pressure, social/family support. Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

  17. The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions.

    Science.gov (United States)

    Prazeres, Filipe; Santiago, Luiz

    2016-11-08

    Multimorbidity's high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics' management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

  18. Comparison of diabetes management status between cancer survivors and the general population: results from a Korean population-based survey.

    Directory of Open Access Journals (Sweden)

    Ji-Yeon Shin

    Full Text Available This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls.We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years, who had participated in the 2007-2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups.Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively. Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively.Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives

  19. Hoisting the Sails, Shining the Bright Pearl——Interviewing LiQingPing, Vice Chairman of the Board of International Pearl Jadeite Jewelry Investment Company, General Manager & CEO of Ming Qin Jewelry Group

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Li Qingping was born in Wuning County, Jiangxi Province, in 1954. Now, he is Vice Chairman of the Board of International Pearl, Jadeite and Jewelry Investment Company, General Manager & CEO of Ming Qin Jewelry Group.

  20. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study.

    Science.gov (United States)

    van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda

    2017-02-07

    Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about

  1. Position statement for the use of omalizumab in the management of chronic spontaneous urticaria in Indian patients

    Directory of Open Access Journals (Sweden)

    Kiran Godse

    2016-01-01

    Full Text Available Chronic spontaneous urticaria (CSU affects 1% of the world population and also their quality of life, and 50% of these patients are refractory to H1-antihistamines. Omalizumab is a humanized monoclonal anti-IgE antibody that binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast-cell degranulation. The EAACI/GA2LEN/EDF/WAO guidelines recommend omalizumab as the third-line of therapy as an add-on to antihistamines. The recommended dose of omalizumab is 300 mg, 4 weekly in the management of CSU refractory to standard of care with H1-antihistamines in adults and adolescents ≥12 years of age. In some patients, a dose of 150 mg may be acceptable. Omalizumab has a good safety profile. However, due to the biologic nature of the drug, all patients administered omalizumab must be observed for 2 h after administration for anaphylactoid reactions. There have been no studies on the effect of impaired renal or hepatic function on the pharmacokinetics of omalizumab. While no particular dose adjustment is recommended, omalizumab should be administered with caution in these patients.

  2. Status of the public debate on the general options of management of high and intermediate activity and long-lived radioactive wastes

    International Nuclear Information System (INIS)

    2006-01-01

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprised 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is a status of the general organisation and progress of the debate from its preparing to its end in mid-January 2006. It shows the challenges the CNDP had to take up to treat the scientifical and technical questions in an accessible way, allowing the participation and the hearing of the large public. A status is made of the deception and satisfaction of the public. A lack of confidence in public authorities and scientists has been expressed several times. No pro-nuclear/anti-nuclear shock has occurred and the debate has revealed a remarkable richness in its content. One contribution of the debate to the future project of law is its enlargement to the overall nuclear wastes and valorizable materials and not only to the high/intermediate-level and long-lived wastes. (J.S.)

  3. [Investigation of urinary management after removal of indwelling urethral catheters in a general hospital: associations between bedridden state and impaired bladder emptying].

    Science.gov (United States)

    Tsuchiyama, Katsuki; Ueki, Osamu; Minami, Hidero; Kawaguchi, Kouhei; Aoki, Yoshitaka; Yokoyama, Osamu

    2010-06-01

    In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients,on lower urinary tract dysfunction and urinary management during hospital care. All 1,106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%,non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group,many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying,and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

  4. A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom.

    Science.gov (United States)

    Bush, J; Langley, C; Mills, S; Hindle, L

    2014-04-01

    This study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m(-2)). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic. © 2014 The Authors. Clinical Obesity © 2014 International Association for the Study of Obesity.

  5. Consumers' willingness to use a medication management service: the effect of medication-related worry and the social influence of the general practitioner.

    Science.gov (United States)

    Carter, Stephen R; Moles, Rebekah J; White, Lesley; Chen, Timothy F

    2013-01-01

    Some consumers at risk of experiencing medication-related problems have chosen not to use pharmacist-provided medication management services. Previous research has shown that consumers' willingness to use the Australian Home Medicines Review (HMR) service depends on the extent to which they believe that they will receive medication information to assist them with self-management. The aim of this study was to develop and test a model of willingness to use HMR among consumers who were eligible to receive the service but have not yet experienced it. Specifically, this study aimed to determine the effects of consumers' medication-related worry and the social influence of the consumer's general practitioner (GP) over willingness. A cross-sectional postal survey was conducted among 1600 members of Council on the Ageing (NSW, Australia). Respondents were included in the study if they had not experienced an HMR and were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed or were based on previous research. Confirmatory factor analysis was used to test the reliability and validity of the multi-item scales. Multiple regression analysis and structural equation modeling (SEM) were used to test the model. Surveys received from 390 respondents (24.3%) were analyzed. Respondents held overall low-to-neutral positive outcome expectancy (POE). The SEM analysis revealed that worry had a direct effect on POE (β=0.35, Psocial influence over willingness to use this medication management service. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

    Directory of Open Access Journals (Sweden)

    Cresswell Kathrin M

    2012-06-01

    Full Text Available Abstract Background There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Methods Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway, relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. Results We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent

  7. General physicians and the management of heart failure in an Argentine population Los médicos generales y el tratamiento de la insuficiencia cardíaca en una muestra de la población argentina

    Directory of Open Access Journals (Sweden)

    Mario A Ciruzzi

    2004-06-01

    Full Text Available The aim of this study was to assess how general physicians (GP think that heart failure (HF should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named"Improvement" already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a"perception survey", and later on how a representative sample of patients was managed, with an"actual practice survey". The electrocardiogram and the chest radiograph were recorded in most patients (≅90%, but the echocardiogram only in 67% of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16% of the patient records. Likewise coronary angiogram was performed in 7% of patients. Only 23% of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43% of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9% received these drugs in combination. At the last interview, 50% had hypertension (blood pressure > 140/90 and 15% had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.El objetivo de este estudio fue evaluar cómo los médicos generales (MG piensan que debe tratarse la insuficiencia cardíaca (IC y cómo ponen en práctica su conocimiento. Se realizó en la ciudad de Buenos Aires y su área suburbana, con la colaboración de 5 cardiólogos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicitó que

  8. Management

    OpenAIRE

    Daft, Richard L.; Kendrick, Martyn; Vershinina, Natalia

    2010-01-01

    The market-leading textbook for principles of management courses reaches a new level with Richard L. Daft being joined by Martyn Kendrick and Natalia Vershinina (both Leicester Business School) to provide an unparalleled resource for students in Europe, the Middle East and Africa (EMEA). After listening to the requirements of lecturers, the authors have maintained the same comprehensive coverage and structure of the original work but carefully threaded in new EMEA and wider global examples an...

  9. Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001–2012: interrupted time series regression analysis

    Science.gov (United States)

    Morales, Daniel R; Donnan, Peter T; Daly, Fergus; Staa, Tjeerd Van; Sullivan, Frank M

    2013-01-01

    Objectives To measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK. Design Interrupted time series regression analysis and incidence measures. Setting General practices in the UK contributing to the Clinical Practice Research Datalink (CPRD). Participants Patients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012. Interventions (1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery. Main outcome measures Incidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases. Results During the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (−6.3% (−11.0 to −1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (−0.8% per quarter (−1.4 to −0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (−1.7% per quarter (−2.2 to −1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated. Conclusions SBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in

  10. An evaluation of Birmingham Own Health® telephone care management service among patients with poorly controlled diabetes. a retrospective comparison with the General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Adab Peymané

    2011-09-01

    Full Text Available Abstract Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health® is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. Methods Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health® (intervention cohort and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD to create a pool of 21,052 controls (control cohort. Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/-30 days limits and within +/-90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. Results After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95%CI 0.1, 0.4% in HbA1c; 3.5 mmHg (1.5, 5.5 in systolic blood pressure, 1.6 mmHg (0.4, 2.7 in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0 in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2. More marked effects were seen for each clinical outcome among patients with worse baseline levels. Conclusions Despite the limitations of the study design, the results are consistent with the

  11. 41 CFR 101-39.100 - General.

    Science.gov (United States)

    2010-07-01

    ... FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management... fleet management systems. (a) Based on these studies, the Administrator of General Services, with the...

  12. Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education.

    Science.gov (United States)

    Sanguinetti, Claudio M; De Benedetto, Fernando; Donner, Claudio F; Nardini, Stefano; Visconti, Alberto

    2014-01-01

    Symptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease. Pneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients' phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented. 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country

  13. Comparative assessment and management of the health and environmental impacts of energy systems. General framework and preliminary results for the nuclear fuel cycle

    Energy Technology Data Exchange (ETDEWEB)

    Rostron, W; Schneider, T; Thieme, M; Dreicer, M

    1992-06-01

    The comparison of the effects of electricity producing systems is of growing importance in decision-making processes for energy planning. This report documents the preliminary results of a project for the CEC-DG XII Radiation Protection Programme on the comparative assessment and management of the health and environmental impacts of energy systems. The work reported in this document has also been supported by EDF - Mission Environnement. In order to profit from the comparative studies already existing, some of the most important ones were surveyed. The aim of these past energy comparison studies was mainly to obtain a global measure of the risks associated with an energy cycle, with a view to ranking the various electricity production systems; but this is now recognised as merely an academic exercise, with a limited impact in decision-making. For energy planning the development of a multi-dimensional approach seems more suitable, as this allows the different types of indicators and measures needed to assess the risks of different energy cycles to be compared. From the past studies it has been seen that health indicators are generally well established, but a weakness is noted with respect to indicators of environmental impacts. This remains a difficult subject, and until such indicators are established, surrogates like concentrations in the environment will have to be used, or qualitative comparisons must suffice. This report presents a general framework allowing for consistent comparisons between different energy systems. The key issues discussed are: assessment by fuel cycle, consideration of the dimensions of time and space, the impact pathway approach for assessing risk, and coherent indicators that can be used to measure the impacts. First results are presented for four activities of the nuclear fuel cycle according to the approach developed: (1) the construction and dismantling of a 900 MWe pressurized water reactor, (2) the transportation of materials between

  14. Professional Vision of Classroom Management and Learning Support in Science Classrooms--Does Professional Vision Differ across General and Content-Specific Classroom Interactions?

    Science.gov (United States)

    Steffensky, Mirjam; Gold, Bernadette; Holdynski, Manfred; Möller, Kornelia

    2015-01-01

    The present study investigates the internal structure of professional vision of in-service teachers and student teachers with respect to classroom management and learning support in primary science lessons. Classroom management (including monitoring, managing momentum, and rules and routines) and learning support (including cognitive activation…

  15. Evaluation of the fidelity of an interactive face-to-face educational intervention to improve general practitioner management of back pain

    Science.gov (United States)

    French, Simon D; Green, Sally E; Francis, Jill J; Buchbinder, Rachelle; O'Connor, Denise A; Grimshaw, Jeremy M; Michie, Susan

    2015-01-01

    Objectives Implementation intervention effects can only be fully realised and understood if they are faithfully delivered. However the evaluation of implementation intervention fidelity is not commonly undertaken. The IMPLEMENT intervention was designed to improve the management of low back pain by general medical practitioners. It consisted of a two-session interactive workshop, including didactic presentations and small group discussions by trained facilitators. This study aimed to evaluate the fidelity of the IMPLEMENT intervention by assessing: (1) observed facilitator adherence to planned behaviour change techniques (BCTs); (2) comparison of observed and self-reported adherence to planned BCTs and (3) variation across different facilitators and different BCTs. Design The study compared planned and actual, and observed versus self-assessed delivery of BCTs during the IMPLEMENT workshops. Method Workshop sessions were audiorecorded and transcribed verbatim. Observed adherence of facilitators to the planned intervention was assessed by analysing the workshop transcripts in terms of BCTs delivered. Self-reported adherence was measured using a checklist completed at the end of each workshop session and was compared with the ‘gold standard’ of observed adherence using sensitivity and specificity analyses. Results The overall observed adherence to planned BCTs was 79%, representing moderate-to-high intervention fidelity. There was no significant difference in adherence to BCTs between the facilitators. Sensitivity of self-reported adherence was 95% (95% CI 88 to 98) and specificity was 30% (95% CI 11 to 60). Conclusions The findings suggest that the IMPLEMENT intervention was delivered with high levels of adherence to the planned intervention protocol. Trial registration number The IMPLEMENT trial was registered in the Australian New Zealand Clinical Trials Registry, ACTRN012606000098538 (http://www.anzctr.org.au/trial_view.aspx?ID=1162). PMID:26155819

  16. A General Procedure to Assess the Internal Structure of a Noncognitive Measure--The Student360 Insight Program (S360) Time Management Scale. Research Report. ETS RR-11-42

    Science.gov (United States)

    Ling, Guangming; Rijmen, Frank

    2011-01-01

    The factorial structure of the Time Management (TM) scale of the Student 360: Insight Program (S360) was evaluated based on a national sample. A general procedure with a variety of methods was introduced and implemented, including the computation of descriptive statistics, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).…

  17. Generalized functions

    CERN Document Server

    Gelfand, I M; Graev, M I; Vilenkin, N Y; Pyatetskii-Shapiro, I I

    Volume 1 is devoted to basics of the theory of generalized functions. The first chapter contains main definitions and most important properties of generalized functions as functional on the space of smooth functions with compact support. The second chapter talks about the Fourier transform of generalized functions. In Chapter 3, definitions and properties of some important classes of generalized functions are discussed; in particular, generalized functions supported on submanifolds of lower dimension, generalized functions associated with quadratic forms, and homogeneous generalized functions are studied in detail. Many simple basic examples make this book an excellent place for a novice to get acquainted with the theory of generalized functions. A long appendix presents basics of generalized functions of complex variables.

  18. CSU Digital Ambassadors: An Empowering and Impactful Faculty Learning Community

    Science.gov (United States)

    Soodjinda, Daniel; Parker, Jessica K.; Ross, Donna L.; Meyer, Elizabeth J.

    2014-01-01

    This article chronicles the work of the California State University Digital Ambassador Program (DA), a Faculty Learning Community (FLC), which brought together 13 faculty members across the state to create ongoing, targeted spaces of support for colleagues and educational partners to learn about innovative technological and pedagogical practices…

  19. CSU-FDA Collaborative Radiological Health Laboratory annual report 1979

    International Nuclear Information System (INIS)

    1981-01-01

    Highlights of findings by the Collaborative Radiological Health Laboratory (CRHL) on lifetime hazards associated with prenatal and early postnatal exposure to discrete doses of gamma radiation are presented in this volume. The CRHL study is designed to provide information that will facilitate the evaluation of risks to human beings from medical exposure during early development. It is a life span study using beagles exposed at one of several specific times in early development. The CRHL program is multidisciplinary in nature and involves evaluation of a variety of diseases of potential concern for human health. Problems of growth and development, reproductive capacity, degenerative diseases, and aging are among those addressed. Separate abstracts of 20 studies have been prepared for inclusion in the Energy Data Base

  20. CSU's MWV Observatory: A Facility for Research, Education and Outreach

    Science.gov (United States)

    Hood, John; Carpenter, N. D.; McCarty, C. B.; Samford, J. H.; Johnson, M.; Puckett, A. W.; Williams, R. N.; Cruzen, S. T.

    2014-01-01

    The Mead Westvaco Observatory (MWVO), located in Columbus State University's Coca-Cola Space Science Center, is dedicated to education and research in astronomy through hands-on engagement and public participation. The MWVO has recently received funding to upgrade from a 16-inch Meade LX-200 telescope to a PlaneWave CDK 24-inch Corrected Dall-Kirkham Astrograph telescope. This and other technological upgrades will allow this observatory to stream live webcasts for astronomical events, allowing a worldwide public audience to become a part of the growing astronomical community. This poster will explain the upgrades that are currently in progress as well as the results from the current calibrations. The goal of these upgrades is to provide facilities capable of both research-class projects and widespread use in education and public outreach. We will present our initial calibration and tests of the observatory equipment, as well as its use in webcasts of astronomical events, in solar observing through the use of specialized piggy-backed telescopes, and in research into such topics as asteroids, planetary and nebula imaging. We will describe a pilot research project on asteroid orbit refinement and light curves, to be carried out by Columbus State University students. We will also outline many of the K-12 educational and public outreach activities we have designed for these facilities. Support and funding for the acquisition and installation of the new PlaneWave CDK 24 has been provided by the International Museum and Library Services via the Museums for America Award.

  1. General aspects of quality management applicable to R and D and I groups and laboratories; Aspectos generales de sistemas de gestion de la calidad aplicables a laboratorios y grupos de I+D+i

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Espartero, A.; Gonzalez Leiton, A.; Hernandez Tapia, J. P.

    2013-07-01

    In organizations such as CIEMAT that focus on Research, Development and Innovation, it is increasingly important to establish quality parameters, both in scientific and technological work and in the management activities that support and enable R and D and I activities, in order to increase the organizations own and customer confidence in the results obtained and to optimize the material and human costs by reducing errors. In the particular case of laboratories dedicated to calibration and analysis activities, the implementation of a Quality Management System ensures that the laboratory results will be consistent and reproducible over time and have a known associated uncertainty. (Author)

  2. General Editorial

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education. General Editorial. Articles in Resonance – Journal of Science Education. Volume 19 Issue 1 January 2014 pp 1-2 General Editorial. General Editorial on Publication Ethics · R Ramaswamy · More Details Fulltext PDF. Volume 19 Issue 1 January 2014 pp 3-3 ...

  3. Financial Management: Overall Plan Needed To Guide System Improvements at Education. United States General Accounting Office Report to the Secretary of Education.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    The U.S. Department of Education's financial management environment and effectiveness are described, together with the reliability of its accounting and internal control systems for the management of the money it gives or lends to schools, individual students, states, and local education agencies. The study found that key accounting and related…

  4. Logistics, Management and Efficiency

    OpenAIRE

    Mircea UDRESCU; Sandu CUTURELA

    2014-01-01

    The problem related to the efficiency of the management for organization is general being the concern off all managers. In the present essay we consider that the efficacy of the organization begins from the structural systemization of the organizational management into general management, management of logistics and management of production which demands a new managerial process, more competitive based on economic efficiency.

  5. The Forgotten Shrines: General Masaharu Homma – General Tomoyuki Yamashita Execution Shrines Depicting History, Significance, and Deterioration as a Study for Heritage and Cultural Tourism Attraction Management and Development in Los Baños, Laguna

    Directory of Open Access Journals (Sweden)

    Mercado Jame Monren T.

    2014-01-01

    Full Text Available Shrines and monuments represent honourable respect for a person or a significant scenario that affects the cultural and heritage value of a community or a nation. These are also considered as a potential tourism resource of a community that could be used as a unique attraction for impending tourists. This paper identified and analyzed the practices of the community of Los Baños, Laguna, Philippines for the conservation and development of General Masaharu Homma - General Tomoyuki Yamashita Execution Shrines. The objectives of the study are: to identify the significances of the shrines and used it as a tourism development resource; to assess the practices of the authority on conservation and preservation; and to furnish recommendation that they could use for implementing or revising their plans and programs. It was recognized by the researcher that the sites were already deteriorated and mismanagement was already a problem. These things happened due to lack of financial capabilities and poor knowledge on conservation and preservation. As a general recommendation, the researcher suggested to create an organization attached to the local government unit of Los Baños that will supervise and develop heritage and cultural sites of the municipality.

  6. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    Kwok, W.Y.; Kwaadsteniet, M.C. de; Harmsen, M.; Suijlekom-Smit, L.W. van; Schellevis, F.G.; Wouden, J.C. van der

    2006-01-01

    BACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195 general

  7. GENERAL SURGERY

    African Journals Online (AJOL)

    http://www.facs.org/trauma/publications/abdominal.pdf. 4. Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS,. Arrillaga A, et al. Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group. The Journal Of Trauma. 2002;53(3):602-15. PubMed PMID: ...

  8. Generalized product

    OpenAIRE

    Greco, Salvatore; Mesiar, Radko; Rindone, Fabio

    2014-01-01

    Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.

  9. No need to change the steering course. Nuclear waste: Consensus about nuclear waste management strategy has to be based on a broad general acceptance

    International Nuclear Information System (INIS)

    Merkel, A.

    1995-01-01

    The nuclear waste management strategy continues to be confronted with harsh criticism, but so far the Government's policy has been backed by judgments of the administrative and civil courts and by the Federal Constitutional Court. Resolving the nuclear waste problem in good time will need firm adherence to the strategy adopted, and all attempts of blockaders to bribe waste management policy into a stalemate are inacceptable [de

  10. Publicly administrated nuclear waste management research programme 1994-1996. General plan for the research programme and research plan for 1994

    International Nuclear Information System (INIS)

    1994-01-01

    The nuclear energy legislation of Finland includes detailed stipulations concerning nuclear waste management. Each producer of nuclear waste is responsible for the safe handling, management and disposal of the waste, and for the financing of these operations. The authorities supervise and control the implementation of the national waste management programme and set the necessary safety and other requirements. The principal goal of the JYT programme is to provide the authorities with information and research results relevant for the safety of nuclear waste management in order to support the various activities of the authorities. The whole field of the research programme is subdivided into the following main topic areas: (1) bedrock structure and stability, rock investigation methods, and characteristics and flow of groundwater, (2) release of radionuclides from a repository and subsequent migration in the bedrock, (3) performance and safety assessment of repositories and other phases of nuclear waste management (4) natural analogue studies, (5) waste management technology and costs and (6) sociopolitical and other societal issues and environmental impact assessment

  11. Managing work-related psychological complaints by general practitioners, in coordination with occupational physicians: A pilot Study - Developing and testing a guideline

    NARCIS (Netherlands)

    Buijs, P.C.; Dijk, F.J.H. van; Evers, M.; Klink, J.J.L. van de; Anema, H.

    2007-01-01

    Increasingly, workers have psychological work-related complaints, endangering their work ability and causing considerable economic losses. Many employees consult their general practitioner (GP). He, however, often pays insufficient attention to work-relatedness or to coordination with occupational

  12. Testimony: Statement of Paul J. Granetto Director Defense Financial Auditing Service Office of the Inspector General Department of Defense to the Subcommittee on Government Efficiency and Financial Management House Government Reform Committee on Defense Financial Management

    National Research Council Canada - National Science Library

    Granetto, Paul

    2003-01-01

    .... Decision-makers responsible for planning military actions need reliable financial information so that they can prudently manage available resources and allocate dollars to those processes that yield...

  13. 41 CFR 101-39.300 - General.

    Science.gov (United States)

    2010-07-01

    ... FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.3-Use and Care of GSA Interagency Fleet Management System Vehicles § 101-39.300 General. (a) The objective of the General Services Administration (GSA) Interagency Fleet Management System...

  14. INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

    Science.gov (United States)

    Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

    2015-11-01

    The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

  15. General relativity

    International Nuclear Information System (INIS)

    Kenyon, I.R.

    1990-01-01

    General relativity is discussed in this book at a level appropriate to undergraduate students of physics and astronomy. It describes concepts and experimental results, and provides a succinct account of the formalism. A brief review of special relativity is followed by a discussion of the equivalence principle and its implications. Other topics covered include the concepts of curvature and the Schwarzschild metric, test of the general theory, black holes and their properties, gravitational radiation and methods for its detection, the impact of general relativity on cosmology, and the continuing search for a quantum theory of gravity. (author)

  16. Towards General Temporal Aggregation

    DEFF Research Database (Denmark)

    Boehlen, Michael H.; Gamper, Johann; Jensen, Christian Søndergaard

    2008-01-01

    associated with the management of temporal data. Indeed, temporal aggregation is complex and among the most difficult, and thus interesting, temporal functionality to support. This paper presents a general framework for temporal aggregation that accommodates existing kinds of aggregation, and it identifies...

  17. Management of patients under general anesthesia with mafutsu-san in Hanaoka-style surgery: comparisons of illustrations from Geka-Kihai-Zufu with descriptions from Mafutsuto-Ron and Yohka-Hiroku.

    Science.gov (United States)

    Dote, Kentaro; Yorozuya, Tosihiro; Ikemune, Keizo; Desaki, Yoko

    2015-02-01

    Seishu Hanaoka (1760-1835) left behind no books that he himself had written. This is why many aspects of Hanaoka-style general anesthesia using a mixture of herbal extracts, which he called mafutsu-san, remain unknown. We are able to learn about this technique today because there are several descriptions of it in books written by his students, such as Mafutsuto-Ron ("Treatise on Mafutsuto") by Gendai Kamata (1794-1854) and Yohka-Hiroku ("Secret Records of Surgery") by Gencho Homma (1804-1872). On the other hand, Geka-Kihai-Zufu ("Illustrations of Surgical Cases"), a surgical textbook, by Gendai Kamata, containing one of the oldest illustrations of general anesthesia published in 1840, was recently rediscovered (2011). For the first time, this book revealed, in the form of a picture image, the actual circumstances of Hanaoka-style general anesthesia. We therefore compared the descriptions of general anesthesia featured in these three documents, and thereby investigated the actual anesthetic management and the procedures used. We found that the circumstances under which Hanaoka-style general anesthesia, using fabrics and futon mattresses, as well as blindfolding and constraining the patient's body during surgery, were exactly as described in Mafutsuto-Ron and Yohka-Hiroku. In addition, besides a surgeon conducting an operation, there was a physician who observed the patient's general condition. Gendai Kamata, the author of Geka-Kihai-Zufu, is believed to have recognized the importance of anesthetic care of surgical patients.

  18. General problems

    International Nuclear Information System (INIS)

    2005-01-01

    This article presents the general problems as natural disasters, consequences of global climate change, public health, the danger of criminal actions, the availability to information about problems of environment

  19. Generalized Recovery

    DEFF Research Database (Denmark)

    Jensen, Christian Skov; Lando, David; Pedersen, Lasse Heje

    We characterize when physical probabilities, marginal utilities, and the discount rate can be recovered from observed state prices for several future time periods. Our characterization makes no assumptions of the probability distribution, thus generalizing the time-homogeneous stationary model...

  20. General Conformity

    Science.gov (United States)

    The General Conformity requirements ensure that the actions taken by federal agencies in nonattainment and maintenance areas do not interfere with a state’s plans to meet national standards for air quality.

  1. Section 3. General issues in management : The benefits of a pre-deal purchase price allocation for acquisition decisions: An exploratory analysis

    NARCIS (Netherlands)

    Zülch, Henning; Detzen, Dominic; Wünsch, Martin; Wulf, Torsten; Meißner, Philip

    2013-01-01

    This paper analyzes the benefits of a pre-deal purchasing price allocation (pre-deal PPA), which acquirers have come to integrate into an acquisition process to examine the effects of a potential acquisition on the acquirer's financial statements. The authors take a management perspective and

  2. The Sophia-Antipolis Conference: General presentation and basic documents. [remote sensing for agriculture, forestry, water resources, and environment management in France

    Science.gov (United States)

    1980-01-01

    The procedures and techniques used in NASA's aerospace technology transfer program are reviewed for consideration in establishing priorities and bases for joint action by technicians and users of remotely sensed data in France. Particular emphasis is given to remote sensing in agriculture, forestry, water resources, environment management, and urban research.

  3. Evaluating the level of adherence to Ministry of Health guidelines in the management of Severe Acute Malnutrition at Garissa Provincial General hospital, Garissa, Kenya

    Science.gov (United States)

    Warfa, Osman; Njai, Daniel; Ahmed, Laving; Admani, Bashir; Were, Fred; Wamalwa, Dalton; Osano, Boniface; Mburugu, Patrick; Mohamed, Musa

    2014-01-01

    Introduction Half of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition. Methods Data was extracted from patients’ medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines. Results Non-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydration (step 3). Conclusion The level of adherence to MOH guidelines was documented in 5 out of the 8 steps. Appropriate management of children with severe acute malnutrition was inadequate at Garissa hospital. PMID:25237411

  4. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    W.Y. Kwok (Wing-Yee); M.C. Kwaadsteniet (Marjolein); M. Harmsen (Mirjam); L.W.A. van Suijlekom-Smit (Lisette); F.G. Schellevis (François); J.C. van der Wouden (Hans)

    2006-01-01

    textabstractBACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195

  5. Better Cash Management Can Reduce the Cost of the National Direct Student Loan Program. Report to the Congress by the Comptroller General of the United States.

    Science.gov (United States)

    Comptroller General of the U.S., Washington, DC.

    The Office of Education has allowed schools participating in the National Direct Student Loan Program to hold more than an annual average of $63 million in federal funds in excess of their 30-day needs. The General Accounting Office estimates that if the Treasury had this money it could save the government interest costs of as much as $4 million,…

  6. Generalized polygons

    CERN Document Server

    Van Maldeghem, Hendrik

    1998-01-01

    Generalized Polygons is the first book to cover, in a coherent manner, the theory of polygons from scratch. In particular, it fills elementary gaps in the literature and gives an up-to-date account of current research in this area, including most proofs, which are often unified and streamlined in comparison to the versions generally known. Generalized Polygons will be welcomed both by the student seeking an introduction to the subject as well as the researcher who will value the work as a reference. In particular, it will be of great value for specialists working in the field of generalized polygons (which are, incidentally, the rank 2 Tits-buildings) or in fields directly related to Tits-buildings, incidence geometry and finite geometry. The approach taken in the book is of geometric nature, but algebraic results are included and proven (in a geometric way!). A noteworthy feature is that the book unifies and generalizes notions, definitions and results that exist for quadrangles, hexagons, octagons - in the ...

  7. Integrated image data and medical record management for rare disease registries. A general framework and its instantiation to theGerman Calciphylaxis Registry.

    Science.gov (United States)

    Deserno, Thomas M; Haak, Daniel; Brandenburg, Vincent; Deserno, Verena; Classen, Christoph; Specht, Paula

    2014-12-01

    Especially for investigator-initiated research at universities and academic institutions, Internet-based rare disease registries (RDR) are required that integrate electronic data capture (EDC) with automatic image analysis or manual image annotation. We propose a modular framework merging alpha-numerical and binary data capture. In concordance with the Office of Rare Diseases Research recommendations, a requirement analysis was performed based on several RDR databases currently hosted at Uniklinik RWTH Aachen, Germany. With respect to the study management tool that is already successfully operating at the Clinical Trial Center Aachen, the Google Web Toolkit was chosen with Hibernate and Gilead connecting a MySQL database management system. Image and signal data integration and processing is supported by Apache Commons FileUpload-Library and ImageJ-based Java code, respectively. As a proof of concept, the framework is instantiated to the German Calciphylaxis Registry. The framework is composed of five mandatory core modules: (1) Data Core, (2) EDC, (3) Access Control, (4) Audit Trail, and (5) Terminology as well as six optional modules: (6) Binary Large Object (BLOB), (7) BLOB Analysis, (8) Standard Operation Procedure, (9) Communication, (10) Pseudonymization, and (11) Biorepository. Modules 1-7 are implemented in the German Calciphylaxis Registry. The proposed RDR framework is easily instantiated and directly integrates image management and analysis. As open source software, it may assist improved data collection and analysis of rare diseases in near future.

  8. General introduction

    NARCIS (Netherlands)

    Emmelkamp, P.; Ehring, T.; Emmelkamp, P.; Ehring, T.

    2014-01-01

    This introductory chapter of this two-volume handbook commences with an overview of the book, which is aimed to provide a comprehensive overview of the current knowledge on the phenomenology, classification, epidemiology, etiology, and clinical management of anxiety disorders. Whereas Volume 1

  9. GENERAL SURGERY

    African Journals Online (AJOL)

    pain or discomfort. While most BLTs can ... of this study was to assess the spectrum of hepatic resections for BLTs in an ... Demographic data, operative management and morbidity and mortality using the ..... Royal Infirmary in Edinburgh.21. As in other .... tools and techniques for parenchymal liver transection. S Afr J. Surg.

  10. General conclusions

    International Nuclear Information System (INIS)

    Tubiana, M.

    1993-01-01

    In conclusion, a general consensus of a number of points which the author endeavours to summarize in this article: -doctors are an excellent channel for passing on information to the public -doctors feel that they do not know enough about the subject and a training on radiobiology and radiation protection is a necessity for them -communication between doctors and the general public is poor in this field -research should be encouraged in numerous areas such as: carcinogenic effect of low doses of radiation, pedagogy and risk perception

  11. 41 CFR 101-27.101 - General.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true General. 101-27.101 Section 101-27.101 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 27-INVENTORY MANAGEMENT 27.1-Stock...

  12. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2006-04-01

    Full Text Available Abstract Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.

  13. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Science.gov (United States)

    Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

    2006-01-01

    Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

  14. GENERAL Iarticle

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 8; Issue 2. Supersymmetry. Akshay Kulkarni P Ramadevi. General Article Volume 8 Issue 2 February 2003 pp 28-41 ... Author Affiliations. Akshay Kulkarni1 P Ramadevi1. Physics Department, Indian Institute of Technology, Mumbai 400 076, India.

  15. General indicators

    International Nuclear Information System (INIS)

    2003-01-01

    This document summarizes the main 2002 energy indicators for France. A first table lists the evolution of general indicators between 1973 and 2002: energy bill, price of imported crude oil, energy independence, primary and final energy consumption. The main 2002 results are detailed separately for natural gas, petroleum and coal (consumption, imports, exports, production, stocks, prices). (J.S.)

  16. Generalized Recovery

    DEFF Research Database (Denmark)

    Jensen, Christian Skov; Lando, David; Pedersen, Lasse Heje

    We characterize when physical probabilities, marginal utilities, and the discount rate can be recovered from observed state prices for several future time periods. We make no assumptions of the probability distribution, thus generalizing the time-homogeneous stationary model of Ross (2015). Recov...

  17. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  18. GENERAL SURGERY

    African Journals Online (AJOL)

    effect of fatigue on patient safety, and owing to increasing emphasis on lifestyle issues .... increasing emphasis on an appropriate work-life balance in professional life.10 ... experience, were the most negative about the EWTD in general.3,13 ...

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    could cripple the global economy. Greater attention ... Africa and 5.7 general surgeons per 100 000 in the US.12 One of the key ... 100 000 insured population working in the private sector, which is comparable with the United States (US).

  1. Necklaces: Generalizations

    Indian Academy of Sciences (India)

    IAS Admin

    . A q-ary necklace of length n is an equivalence class of q-coloured strings of length n under rota- tion. In this article, we study various generaliza- tions and derive analytical expressions to count the number of these generalized necklaces.

  2. Generalized Recovery

    DEFF Research Database (Denmark)

    Lando, David; Pedersen, Lasse Heje; Jensen, Christian Skov

    We characterize when physical probabilities, marginal utilities, and the discount rate can be recovered from observed state prices for several future time periods. We make no assumptions of the probability distribution, thus generalizing the time-homogeneous stationary model of Ross (2015...... our model empirically, testing the predictive power of the recovered expected return and other recovered statistics....

  3. General Relativity

    CERN Document Server

    Straumann, Norbert

    2013-01-01

    This book provides a completely revised and expanded version of the previous classic edition ‘General Relativity and Relativistic Astrophysics’. In Part I the foundations of general relativity are thoroughly developed, while Part II is devoted to tests of general relativity and many of its applications. Binary pulsars – our best laboratories for general relativity – are studied in considerable detail. An introduction to gravitational lensing theory is included as well, so as to make the current literature on the subject accessible to readers. Considerable attention is devoted to the study of compact objects, especially to black holes. This includes a detailed derivation of the Kerr solution, Israel’s proof of his uniqueness theorem, and a derivation of the basic laws of black hole physics. Part II ends with Witten’s proof of the positive energy theorem, which is presented in detail, together with the required tools on spin structures and spinor analysis. In Part III, all of the differential geomet...

  4. To assess and create awareness among anesthetists regarding prevention and management of injuries to the teeth and their associated structures during general anesthesia

    Directory of Open Access Journals (Sweden)

    Amita M Tiku

    2014-01-01

    Full Text Available Aims: The aim of this study was to assess the awareness among anesthetists regarding prevention and management of injuries to the teeth and their associated structures during anesthesia. Study design, Materials and Methods: Fifty anesthetists practicing in various hospitals in Mumbai participated in this study. A questionnaire was devised and distributed among them. The completion of the questionnaire by the respondents was taken as their consent to participate in the study. Statistical analysis: The data thus collected was analyzed using statistical package Medcalc (Version 12.7.0.0. Results: The results showed that the injury to the oro-dental tissues is a common finding during anesthesia. The maxillary incisors underwent injuries more commonly than the mandibular incisors. Padding of the teeth was the most common precaution taken to prevent injuries to the teeth which, however, is not adequate. The management for such injuries was inadequate and in many cases, the patients′ referral to a dentist was not considered post-operatively. Conclusion: Pediatric dentists can play a major role in creating the awareness among the anesthesia providers regarding prevention of oro-dental injuries during anesthesia.

  5. An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?

    LENUS (Irish Health Repository)

    Barragry, Ruth A

    2016-01-01

    General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call (\\'K Doc\\'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013). The aim of the study was to determine if it was possible to reduce the rate of written complaints per 1000 consultations through a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis in continuing professional development at the Co-Operative.

  6. Generalizing entanglement

    Science.gov (United States)

    Jia, Ding

    2017-12-01

    The expected indefinite causal structure in quantum gravity poses a challenge to the notion of entanglement: If two parties are in an indefinite causal relation of being causally connected and not, can they still be entangled? If so, how does one measure the amount of entanglement? We propose to generalize the notions of entanglement and entanglement measure to address these questions. Importantly, the generalization opens the path to study quantum entanglement of states, channels, networks, and processes with definite or indefinite causal structure in a unified fashion, e.g., we show that the entanglement distillation capacity of a state, the quantum communication capacity of a channel, and the entanglement generation capacity of a network or a process are different manifestations of one and the same entanglement measure.

  7. Study of general awareness, attitude, behavior, and practice study on dog bites and its management in the context of prevention of rabies among the victims of dog bite attending the opd services of chc muradnagar

    Directory of Open Access Journals (Sweden)

    Piyush Jain

    2014-01-01

    Full Text Available Objectives: This is a recent study conducted during 15th September 2013 to 15th December 2013 at the community health centre (CHC, Muradnagar, distt Ghaziabad, among the victims of dog/animal bite attending the daily OPD services of CHC. To identify the level of general awareness and knowledge of wound management and rabies among the cases of dog bite and to study the awareness of people about antirabies vaccines and health service utilization. Methods: The study population composed of 250 victims of dog or animal bite, Patients were selected and approached after proper briefing, with well-prepared two page structured questionnaire designed in local language to assess their knowledge about the wound management, information about the epidemiology of dog bite. Results and conclusion: The result of the study reflect the very low level of awareness about the postdog bite management of wounds as well as about the disease rabies group of people questioned and also reveals serious gaps in understanding of wound severity ,classification and correct application of PEP with ARV vaccine and RIG. There is definitely a gap in people′s knowledge, attitude, and practices about dog bite and its management and there is need of taking serious measures for the control of stray dog population at the block level.

  8. General topology

    CERN Document Server

    Willard, Stephen

    2004-01-01

    Among the best available reference introductions to general topology, this volume is appropriate for advanced undergraduate and beginning graduate students. Its treatment encompasses two broad areas of topology: ""continuous topology,"" represented by sections on convergence, compactness, metrization and complete metric spaces, uniform spaces, and function spaces; and ""geometric topology,"" covered by nine sections on connectivity properties, topological characterization theorems, and homotopy theory. Many standard spaces are introduced in the related problems that accompany each section (340

  9. Generalized polygons

    CERN Document Server

    Maldeghem, Hendrik

    1998-01-01

    This book is intended to be an introduction to the fascinating theory ofgeneralized polygons for both the graduate student and the specialized researcher in the field. It gathers together a lot of basic properties (some of which are usually referred to in research papers as belonging to folklore) and very recent and sometimes deep results. I have chosen a fairly strict geometrical approach, which requires some knowledge of basic projective geometry. Yet, it enables one to prove some typically group-theoretical results such as the determination of the automorphism groups of certain Moufang polygons. As such, some basic group-theoretical knowledge is required of the reader. The notion of a generalized polygon is a relatively recent one. But it is one of the most important concepts in incidence geometry. Generalized polygons are the building bricks of Tits buildings. They are the prototypes and precursors of more general geometries such as partial geometries, partial quadrangles, semi-partial ge­ ometries, near...

  10. Expanding the National Drug Abuse Treatment Clinical Trials Network to address the management of substance use disorders in general medical settings

    Directory of Open Access Journals (Sweden)

    Tai B

    2014-07-01

    Full Text Available Betty Tai, Steven Sparenborg, Udi E Ghitza, David Liu Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA Abstract: The Patient Protection and Affordable Care Act (2010 and the Mental Health Parity and Addiction Equity Act (2008 expand substance use disorder (SUD care services in the USA into general medical settings. Care offered in these settings will engage substance-using patients in an integrated and patient-centered environment that addresses physical and mental health comorbidities and follows a chronic care model. This expansion of SUD services presents a great need for evidence-based practices useful in general medical settings, and reveals several research gaps to be addressed. The National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse can serve an important role in this endeavor. High-priority research gaps are highlighted in this commentary. A discussion follows on how the National Drug Abuse Treatment Clinical Trials Network can transform to address changing patterns in SUD care to efficiently generate evidence to guide SUD treatment practice within the context of recent US health care legislation. Keywords: Patient Protection and Affordable Care Act, National Drug Abuse Treatment Clinical Trials Network, substance use disorders, practice-based research network, electronic health records

  11. Public debate on the general options relative to the management of high-medium activity and long-lived radioactive wastes; Debat public sur les options generales en matiere de gestion des dechets radioactifs de haute activite et de moyenne activite a vie longue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-09-15

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. This document presents the organizational aspects of the debate: origin, organization committee (mission, members, commitments), framework (the December 31, 1991 law, technical enlargement, society aspects), topics (summary of the debate in ten questions), organization modalities (4 main steps, schedule, venues), objectives and perspectives (sharing information, decision making processes to be implemented by 2006). (J.S.)

  12. Proceedings of the public debate on the general options of management of high and intermediate activity and long-lived radioactive wastes; Compte-rendu du debat public sur les options generales en matiere de gestion des dechets radioactifs de haute activite et de moyenne activite a vie longue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprised 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is a summary of the main questions tackled during this debate from its preparation to its closing meeting and dealing with: the acceptation of the debate, the progress of the debate, the socio-technical problem of gathering the different points to be debated with respect to the different areas in concern, the general questions about the overall nuclear wastes and materials (radioactivity, health, radioprotection, management, reprocessing, control, actors organization, knowledge sharing, perenniality of the financing), the specific questions about long-lived wastes (inventory, separation-transmutation feasibility, nuclear energy and energy policy, management solutions, storage and geologic disposal feasibility, impact of debates on the 2006 law, long-lived waste territories), the conclusions for the 2006 law: mastering the overall nuclear wastes and materials and step-by-step building up of a solution for long-lived wastes (difficulties, lessons learnt from foreign experience, first draft of the 2006 law). Some opinions expressed by some participants about these proposals conclude

  13. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

    Science.gov (United States)

    French, Simon D; McKenzie, Joanne E; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Francis, Jill J; Michie, Susan; Spike, Neil; Schattner, Peter; Kent, Peter; Buchbinder, Rachelle; Page, Matthew J; Green, Sally E

    2013-01-01

    This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Australian New Zealand

  14. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

    Directory of Open Access Journals (Sweden)

    Simon D French

    Full Text Available INTRODUCTION: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP in general practice. METHODS: General practices were randomised to either access to a guideline for acute LBP (control or facilitated interactive workshops (intervention. We measured behavioural predictors (e.g. knowledge, attitudes and intentions and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP level: behavioural simulation (clinical decision about vignettes and rates of x-ray and CT-scan (medical administrative data. All those not involved in the delivery of the intervention were blinded to allocation. RESULTS: 47 practices (53 GPs were randomised to the control and 45 practices (59 GPs to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05 and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60. Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10 for x-ray or CT-scan. CONCLUSIONS: The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant

  15. 41 CFR 101-39.400 - General.

    Science.gov (United States)

    2010-07-01

    ... FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET... responsible for the operation of General Services Administration (GSA) Interagency Fleet Management System... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true General. 101-39.400...

  16. General chemistry

    International Nuclear Information System (INIS)

    Kwon, Yeong Sik; Lee, Dong Seop; Ryu, Haung Ryong; Jang, Cheol Hyeon; Choi, Bong Jong; Choi, Sang Won

    1993-07-01

    The book concentrates on the latest general chemistry, which is divided int twenty-three chapters. It deals with basic conception and stoichiometry, nature of gas, structure of atoms, quantum mechanics, symbol and structure of an electron of ion and molecule, chemical thermodynamics, nature of solid, change of state and liquid, properties of solution, chemical equilibrium, solution and acid-base, equilibrium of aqueous solution, electrochemistry, chemical reaction speed, molecule spectroscopy, hydrogen, oxygen and water, metallic atom; 1A, IIA, IIIA, carbon and atom IVA, nonmetal atom and an inert gas, transition metals, lanthanons, and actinoids, nuclear properties and radioactivity, biochemistry and environment chemistry.

  17. General relativity

    International Nuclear Information System (INIS)

    Gourgoulhon, Eric

    2013-01-01

    The author proposes a course on general relativity. He first presents a geometrical framework by addressing, presenting and discussion the following notions: the relativistic space-time, the metric tensor, Universe lines, observers, principle of equivalence and geodesics. In the next part, he addresses gravitational fields with spherical symmetry: presentation of the Schwarzschild metrics, radial light geodesics, gravitational spectral shift (Einstein effect), orbitals of material objects, photon trajectories. The next parts address the Einstein equation, black holes, gravitational waves, and cosmological solutions. Appendices propose a discussion of the relationship between relativity and GPS, some problems and their solutions, and Sage codes

  18. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Lucassen PL

    2008-04-01

    Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and

  19. Periodontal Emergencies in General Practice.

    Science.gov (United States)

    Wadia, Reena; Ide, Mark

    2017-05-01

    Diagnosing and managing periodontal emergencies is a common part of general dental practice. This article summarises the presentation, aetiology and management of the key periodontal emergencies, including gingival abscess, periodontal abscess, peri-coronitis/peri-coronal abscess, perio-endo lesion/ abscess, necrotising gingivitis and periodontitis, acute herpetic gingivostomatitis, acute physical/chemical/thermal injury and subgingival root fracture.

  20. The use of Collagenase Clostridium Histolyticum in the management of Dupuytren's contracture-outcomes of a pilot study in a District General Hospital setting.

    Science.gov (United States)

    Murphy, Lynn E; Murphy, Karen M; Kilpatrick, Shauneen M; Thompson, Neville W

    2017-05-01

    Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 52 0 (range, 0 - 75 0 ) and 35 0 (range, 0 - 84 0 ) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 - 10), which decreased to 8.6 (range, 6 - 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.