WorldWideScience

Sample records for current management practices

  1. Current Risk Management Practices in Psychotherapy Supervision.

    Science.gov (United States)

    Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

    2017-12-01

    Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

  2. Current waste management practices at PINSTECH

    International Nuclear Information System (INIS)

    Ul Haq, E.; Aslam, M.; Orfi, S.D.

    2002-01-01

    The waste being generated at PINSTECH is of the intermediate and low level Category that is in the form of gas, liquid and solids. It is collected, monitored, segregated, treated, packed and immobilized for its final disposal. Basic concepts of delay decay, disposal and containment of radioactive waste are followed to prevent its direct contact with human and its environment. PINSTECH follows shallow ground disposal in the restricted area. The disposal site has favorable characteristics e.g. sun shine dry climate and high evaporation rate. The gaseous waste is directed towards stack, where it passes through charcoal and HEPA filters and then released to the atmosphere. Post disposal monitoring of the disposal area is performed to check leaching/migration of radionuclides from disposal locations to the surrounding environment. No migration of radioactivity has been detected indicating satisfactory performance of the waste management system. (author)

  3. Analysis of Current Supplier Relationship Management Practices: A Solution Proposal

    OpenAIRE

    Gomes Campelo Filho, Eulalio

    2009-01-01

    The work contributes with the existing literature by investigating current SRM practices. Based on the research, the author has designed an information system framework, which provides companies with an innovative SRM solution to manage their indirect material purchasing process through an environment that supports companies entire plan-to-order activities, including functionalities such as central data management, spend data management, e-sourcing and the usual e-procurement features.

  4. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  5. Current practice in airway management: A descriptive evaluation.

    Science.gov (United States)

    Kjonegaard, Rebecca; Fields, Willa; King, Major L

    2010-03-01

    Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

  6. Biomedical waste management in Ayurveda hospitals - current practices & future prospectives.

    Science.gov (United States)

    Rajan, Renju; Robin, Delvin T; M, Vandanarani

    2018-03-16

    Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  7. Individual Performance Management: A Review of Current Practices

    Directory of Open Access Journals (Sweden)

    Ian O’ Boyle

    2013-05-01

    Full Text Available This paper provides a review of current practice in relation to individual performance management systems and process within the traditional business environment. There is a consensus that the role of the individual is central to the overall performance of any organization and how individual performances are managed and evaluated can have significant impacts on overall organizational success. Many organizations employ the traditional performance appraisal in order to monitor and assess individual employee performances. However, new approaches, such as 360-degree feedback have also become commonplace within the business environment. An analysis of each approach including benefits and challenges associated with each process is presented within this paper.

  8. Current UK practices in the management of subacromial impingement

    Science.gov (United States)

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  9. Current UK practices in the management of subacromial impingement.

    Science.gov (United States)

    Bryceland, James K; Drury, Colin; Tait, Gavin R

    2015-07-01

    Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

  10. Current practice for diagnosis and management of silent atrial fibrillation

    DEFF Research Database (Denmark)

    Dobreanu, Dan; Svendsen, Jesper Hastrup; Lewalter, Thorsten

    2013-01-01

    for the diagnosis and management of silent AF. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network partners. Responses were received from 33 centres in 16 countries. The preferred screening methods for silent AF in patients with rhythm control...... for such patients. Most responders preferred rate control over rhythm control in patients with silent AF, although some favoured pulmonary vein isolation in young patients. However, oral anticoagulant therapy in patients at high thromboembolic risk was considered mandatory by most, provided that at least one......Although it is well known that silent atrial fibrillation (AF) is associated with morbidity and mortality rates similar to those of symptomatic AF, no specific strategy for screening and management of this form of AF has been advocated. The purpose of this survey was to identify current practices...

  11. Local air quality management: some evidence of current practices

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, Clare; Newton, Alex; Longhurst, Jim [University of the West of England, Air Quality Research Group, Bristol (United Kingdom)

    1998-12-01

    The recent legislative changes, notably the Environment Act 1995 and resultant National Air Quality Strategy have brought new powers and obligations to local authorities to reach specified air quality standards and objectives. Initially this will involve local authorities carrying out a review and assessment of air quality in their locality by December 1999. This paper will outline a project currently being undertaken within the University of the West of England investigating how this legislation is being put into practice and present the results from a nation-wide questionnaire survey of environmental health officers. The study found that local authorities are still at an early stage of the process. It seems probable that one possible barrier to the implementation of Air Quality Management will be communication and cooperation within local authorities. (Author)

  12. Current best practice in the management of Turner syndrome

    Science.gov (United States)

    Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

    2017-01-01

    Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

  13. Emergency room management of ureteral calculi: current practices.

    Science.gov (United States)

    Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

    2009-06-01

    To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

  14. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    National Research Council Canada - National Science Library

    Apte, Aruna U; Apte, Uday M; Rendon, Rene G

    2008-01-01

    .... Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/ management structure, and training provided to services acquisition personnel...

  15. Postoperative electrolyte management: Current practice patterns of surgeons and residents.

    Science.gov (United States)

    Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

    2015-07-01

    Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Best practice in English Local Air Quality Management: principles illustrated by some examples of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, C.I.; Ling, K.; Longhurst, J.W.S. [Univ. of the West of England, Faculty of Applied Sciences, Bristol (GB)] [and others

    1999-07-01

    The Local Air Quality Management (LAQM) process, a holistic approach to management, is well underway in England. The process aims to tackle air pollution problems from a variety of diverse sources, operating over different time scales and spatial areas. Although technical guidance from the Government has been published over the last two years, little guidance has been available for the management aspects of the process. Arguably, the management of air quality will be the crucial test of the LAQM process. Only by collaboration can technologies and policy actions, such as traffic management schemes, be put into effective action. The authors present an overview of the process, including a model of current LAQM procedures in the UK. Current practice is illustrated by way of results from a questionnaire survey of local authorities, health authorities and the Environment Agency and also by reference to specific examples from local authorities. (Author)

  17. Current practice in out-of-hospital cardiac arrest management

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent

    2012-01-01

    AIMS: The purpose of this EP wire is to examine clinical practice in the field of out-of-hospital cardiac arrest (OHCA) management, with special focus on in-hospital diagnostic and therapeutic strategies. METHODS AND RESULTS: Fifty-three European centres, all members of the EHRA-EP Research network......, completed the questions of the survey. A dedicated strategy for OHCA management is active in 85% of the centres. Shockable tachyarrhythmias such as initial OHCA rhythm are reported in >70% of the patients in 64% of the centres. In-hospital therapeutic hypothermia was applied in >50% of the patients in 53...... management strategy, including coronary angiography/PCI and implantable cardioverter defibrillator therapy, while therapeutic hypothermia appears to be underused....

  18. China's spent nuclear fuel management: Current practices and future strategies

    International Nuclear Information System (INIS)

    Zhou Yun

    2011-01-01

    Although China's nuclear power industry is relatively young and the management of its spent nuclear fuel is not yet a concern, China's commitment to nuclear energy and its rapid pace of development require detailed analyses of its future spent fuel management policies. The purpose of this study is to provide an overview of China's fuel cycle program and its reprocessing policy, and to suggest strategies for managing its future fuel cycle program. The study is broken into four sections. The first reviews China's current nuclear fuel cycle program and facilities. The second discusses China's current spent fuel management methods and the storage capability of China's 13 operational nuclear power plants. The third estimates China's total accumulated spent fuel, its required spent fuel storage from present day until 2035, when China expects its first commercialized fast neutron reactors to be operational, and its likely demand for uranium resources. The fourth examines several spent fuel management scenarios for the present period up until 2035; the financial cost and proliferation risk of each scenario is evaluated. The study concludes that China can and should maintain a reprocessing operation to meet its R and D activities before its fast reactor program is further developed. - Highlights: → This study provides an overview of China's fuel cycle program and its reprocessing policy.→ This study suggests strategies for managing its future fuel cycle program.→ China will experience no pressure to lessen the burden of spent fuel storage in the next 30 years.→ China should maintain sufficient reprocessing operations to meet its demands for R and D activities.→ China should actively invest on R and D activities of both fuel cycling and fast reactor programs.

  19. Corporate visual identity management: current practices, impact, and assessment

    NARCIS (Netherlands)

    van den Bosch, A.L.M.

    2005-01-01

    This dissertation is about Corporate Visual Identity (CVI) management. Its purpose is to gain more insight into activities associated with managing CVI and the impact of these activities on the outcome: the degree of consistency in CVI.

  20. Challenges of Environmental Management Accounting –- Current Accounting Practices

    Directory of Open Access Journals (Sweden)

    Prof. Ph.D. Gheorghe Popescu

    2008-12-01

    Full Text Available The goal of our paper is to reduce some of the international confusion generated on such animportant topic by providing a general framework and set of definitions for Environmental ManagementAccounting (EMA.Environmental Management Accounting is a relatively new tool in environmental management definedas the identification, collection, estimation, analysis, internal reporting, and use of materials and energyflow information, environmental cost information, and other cost information for both conventionaland environmental decision-making within an organization.Due to their special role, accountants, since they are the ones with access to the important monetarydata and information systems needed for management accounting activities, must to improve both theirability to verify the quality of such information and the skills to use that information for decision making.

  1. Perceptions of dry eye disease management in current clinical practice.

    Science.gov (United States)

    Williamson, Jennifer F; Huynh, Kyle; Weaver, Mark A; Davis, Richard M

    2014-03-01

    To assess the perceptions of eye care providers regarding the clinical management of dry eye. Invitations to complete a 17-question online survey were mailed to 400 members of the North Carolina Ophthalmology and Optometry Associations including community optometrists, comprehensive ophthalmologists, and cornea specialists. The survey was completed by 100 eye care providers (25% response rate). Providers reported burning (46.5%) as the most frequent symptom described by patients, followed by foreign body sensation (30.3%) and tearing (17.2%). Most respondents (80.8%) listed artificial tears as the recommended first-line treatment, even though providers reported high failure rates for both artificial tears and cyclosporine A (Restasis). Rheumatoid arthritis, Sjögren syndrome, affective disorders such as anxiety and depression, history of photorefractive surgery, smoking, and thyroid disease were acknowledged as common comorbid conditions. The survey provided an informative snapshot into the preferences of eye care providers concerning the diagnosis and management of dry eye disease. Overall, burning was the most common symptom reported by patients. Providers relied more on patient history in guiding their clinical decisions than objective signs. The survey underscores the incongruence when comparing subjective symptoms with objective signs, thereby highlighting the urgent need for the development of reliable metrics to better quantify dry eye symptoms and also the development of a more sensitive and specific test that can be used as the gold standard to diagnose dry eye.

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

    Science.gov (United States)

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

    2018-06-01

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

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

    Science.gov (United States)

    Klaess, Cynthia C; Jungquist, Carla R

    2018-06-01

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

  4. Evaluation and management of patients with peripheral artery disease by interventional radiologists: current practices.

    Science.gov (United States)

    Prince, Ethan A; Murphy, Timothy P; Dhangana, Raj; Soares, Gregory M; Ahn, Sun H; Dubel, Gregory J

    2008-05-01

    Traditionally, surgeons have served as primary consultants for patients with peripheral vascular disease for whom revascularization is considered. An important component of care for patients with peripheral artery disease (PAD) is risk factor management. The present study was undertaken to determine current management practices of interventional radiologists for patients with PAD and compare them to published data for vascular surgeons. If PAD patient management practices are similar, this would support direct referral of PAD patients who are considered for revascularization from primary care doctors to interventional radiologists. An online survey was administered to full members of the Society of Interventional Radiology with e-mail addresses on file. Filtering was done to examine and compare interactions among several responses. The margin of error for the survey was +/-2%, based on 95% CIs for the entire surveyed population (N=2,371). Seventy-five percent of respondents see PAD patients in ambulatory office settings. Only eight percent see themselves as the physician responsible for risk factor management, similar to reported results of vascular surgeons (10%). Other variables examined, such as frequency of inquiring about Framingham risk factors, indicate similar practices to those previously reported for vascular surgeons. For interventional radiologists who accept direct referrals for medical management of patients with PAD, disease management by interventional radiologists is similar to that previously reported for vascular surgeons. This supports the role of interventional radiologists who accept direct referrals of patients with PAD as primary consultants to primary care doctors.

  5. Cancer pain management in China: current status and practice implications based on the ACHEON survey

    Directory of Open Access Journals (Sweden)

    Xia Z

    2017-08-01

    Full Text Available Zhongjun Xia Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, ChinaPurpose: Cancer pain can seriously impact the quality of life (QoL of patients, and optimal management practices are therefore of paramount importance. The ACHEON survey queried physicians and patients from 10 Asian countries/regions to assess current clinical practices in cancer pain management in Asia. This study presents the data obtained for cancer pain management in mainland China, with an emphasis on practices related to opioid drugs.Materials and methods: In several tertiary hospitals across China, 250 patients experiencing cancer pain and 100 physicians were surveyed on questions designed to assess current cancer pain management practices and cancer pain impact on QoL.Results: The patient survey showed that 88% of patients reported moderate-to-severe cancer pain, with a median duration of 6 months. The physician survey showed that medical school/residency training with regard to cancer pain management was inadequate in ~80% of physicians. A total of 80% of physicians and 67.2% of patients reported that pain scale was used during pain assessment; 84% of physicians expressed that physician-perceived pain severity was not completely consistent with actual pain the patient experienced. Of the 147 patients who recalled the medication received, 83.7% were administered opioid prescriptions. Of the 240 patients who received treatment, 43.8% perceived the inadequacy of controlling pain. The primary barriers from physicians perceived to optimal pain management included patients’ fear of side effects (58%, patients’ fear of addiction (53%, patients’ reluctance to report pain (43%, physicians’ reluctance to prescribe (29%, physicians’ inadequacy of pain assessment (27% and excessive regulation of opioid analgesics (47%.Conclusion: Knowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain

  6. Practice management.

    Science.gov (United States)

    Althausen, Peter L; Mead, Lisa

    2014-07-01

    The practicing orthopaedic traumatologist must have a sound knowledge of business fundamentals to be successful in the changing healthcare environment. Practice management encompasses multiple topics including governance, the financial aspects of billing and coding, physician extender management, ancillary service development, information technology, transcription utilization, and marketing. Some of these are universal, but several of these areas may be most applicable to the private practice of medicine. Attention to each component is vital to develop an understanding of the intricacies of practice management.

  7. A survey of current practice of vascular surgeons in venous disease management.

    Science.gov (United States)

    Bush, Ruth L; Gloviczki, Peter

    2013-01-01

    Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

  8. A survey of current practices in management of Hirschsprung′s disease in Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulrasheed A. Nasir

    2014-01-01

    Full Text Available Background: Although there are several modalities of treatment for Hirschsprung′s disease (HD, there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting. Materials and Methods: An online questionnaire was designed using survey Monkey ® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey ® . The survey was also administered at the 12 th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirty-one paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey. Results: Sixteen (52% respondents see up to 20% of their patients with HD in the neonatal period. Twenty-six (84% respondents do routine barium enema. Twenty six (84% respondents do full thickness rectal biopsy under general anaesthesia (GA. There was no consistency in operative techniques, with transabominal Swenson′s operation being practiced by 17 (57% respondents and 11 (37% transanal endorectal pull through. 14 (45% do pull through at any age. 12 (39% respondents do more than half of their patient as primary pull through. Conclusion: Full thickness rectal biopsy under GA is still the vogue with variations in the surgical technique for management of Hirshsprung′s disease in Nigeria. Primary pull through procedures is becoming increasingly popular. There′s a need for Paediatric Surgeons in Nigeria to come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.

  9. 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

  10. Developing a Knowledge Management Framework to Assist With Current USMC Information Management Practices

    Science.gov (United States)

    2010-09-01

    OF CONTENTS I. INTRODUCTION ........................................................................................................1 II. LITERATURE...LEFT BLANK 1 I. INTRODUCTION Marine Corps Information Management is performed in accordance with Marine Corps Warfighting Publication (MCWP) 3...November 13). Air Force Center of Excellence for Knowledge Mangement Briefing. Washington, D.C. Alavi, M., & Leidner, D. E. (2001). Review: Knowledge

  11. 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.

  12. Current industrial practice of managing risks in product development project portfolios

    DEFF Research Database (Denmark)

    Weng, R.; Oehmen, Josef; Ben-Daya, M.

    2013-01-01

    Managing portfolios of development and engineering projects currently presents significant challenges to companies. This is even more the case in the management of portfolio risks, where both industry and academia currently lack a clear conceptual understanding of what portfolio risks are and what...

  13. Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

    Directory of Open Access Journals (Sweden)

    Liezel Schwellnus

    2017-08-01

    Conclusion: Physiotherapy related to early mobilisation in hospital is in line with evidence-based practice, but further education is needed regarding the need for physiotherapy post hospital discharge and pain management.

  14. On current crowd management practices and the need for increased situation awareness, prediction, and intervention

    NARCIS (Netherlands)

    Martella, C.; Li, J.; Conrado, C.; Vermeeren, A.

    2017-01-01

    Recent accidents (News, 2006, 2010, 2013, 2015) show that crowded events can quickly turn into tragedies. The goal of crowd management is to avoid such accidents through careful planning and implementation. Crowd management practices are collaborative efforts between the different actors of the

  15. Previous management practices for naturally occurring radionuclide wastes: current radiological status

    International Nuclear Information System (INIS)

    Goldsmith, W.A.; Crawford, D.J.; Haywood, F.F.; Leggett, R.Q.

    1979-01-01

    Many installations used during the early days of the United States atomic energy program have been released in recent years for unrestricted private uses. These installations include lands and buildings used for the storage of radioactive wastes resulting from refining and processing of uranium and thorium. Waste management practices at these sites in the 1940's and 1950's were not conducted with today's emphasis on as-low-as-reasonably-achievable (ALARA) principles. Consequently, many of these older waste storage areas are contaminated with naturally occurring radionuclides in concentrations which are orders of magnitude greater than those found ordinarily in the earth's crust. current and potential elevated human exposures at fifteen of these sites are due primarily to radon daughters and external-gamma radiation. A wide variety of exposure conditions may be found at these sites - ranging from slightly above background to more than thirty times the guidelines recommended for the public. Remedial actions are contemplated for a number of these sites where contamination levels or radiaion exposures exceed current guidelines

  16. Current practices for the management and confinement of uranium mill tailings

    International Nuclear Information System (INIS)

    1992-01-01

    This report discusses the current practices used in the design siting, construction and closeout of impoundment facilities for uranium mill tailings. The objective is to present an integrated overview of the technological, safety and radiation protection aspects of these topics in order to ensure that the potential radiological and non-radiological risks associated with the management of uranium mill tailings are minimized now and in the future. The report: identifies the nature and source of radioactive and non-radioactive pollutants in uranium mill tailings; identifies the important mechanisms by which pollutants can be released from the tailings impoundment; reviews radiation protection aspects of these mechanisms; describes the pathways by which the pollutants may reach humans; describes some of the site selection and design options and considerations for final stabilization and rehabilitation of tailings impoundments; describes the methods of assessing closure strategies; describes long term responsibilities for tailings management and financial assurance to ensure these responsibilities; and reviews the magnitude and probability of occurrence of the hazards arising, with the aim of ensuring that the risks presented are acceptable. Because of the complexity of the pollutant release mechanisms and the site specific nature of the design and management controls that can be used, it is not possible for a report of this nature to be either exhaustive or detailed in all respects. The methods of confinement employed for any particular tailings impoundment will depend on the country, its climate, demography and its site specific performance criteria which should be defined by the relevant competent authorities. Both operating and post-operating conditions are considered. After shutdown of the mill and stabilization of the tailings, continuing surveillance and maintenance should be considered until the integrity and durability of the tailings impoundment have been

  17. The Use of Virtual Worlds in Management Education: An Investigation of Current Practices in Second Life

    Science.gov (United States)

    Klein, Amarolinda Zanela; Freitas, Angilberto; Machado, Lisiane; da Silva Freitas, José Carlos, Jr.; Graziola, Paulo Gaspar; Schlemmer, Eliane

    2014-01-01

    Frequently, research on management education does not take into account the role of Information Technology as a key resource to support teaching and learning processes. In this article, the authors explore the current applications of Three Dimensional Virtual Worlds (3DVW) for Management education. The authors researched the educational…

  18. Naturopathic Management of Females with Cervical Atypia: A Delphi Process to Explore Current Practice

    Directory of Open Access Journals (Sweden)

    Cynthia Ann Leaver

    2013-01-01

    Full Text Available Background Human papillomavirus is the most significant factor contributing to cervical cancer. Naturopathic doctors (NDs implement an integrative approach to treat cervical atypia. This study explored practice consensus and variance among NDs. Methods A purposefully selected panel of six NDs participated in a modified Delphi study to validate practice. Three electronic web-based surveys were completed over nine months. Results Local and systemic treatments were included in all ND protocols. Six protocols included cervical cancer screening guidelines, green tea suppositories, and oral folic acid. Five protocols included oral green tea, diindoylemethane (DIM, and cartenoids. Four protocols incorporated Vitamin C. Two NDs considered escharotics when managing cervical atypia. All NDs included health behavior management in their protocols. Conclusion Naturopathic management of cervical atypia varies across practitioners. However, in general, elements of management include (1 cervical cancer screening guidelines, (2 local and systemic treatments, (3 health behavior/lifestyle recommendations, and (4 immune system support.

  19. Managing caries: the need to close the gap between the evidence base and current practice.

    Science.gov (United States)

    Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

    2015-11-13

    Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

  20. Management Communication in Non-U.S. MBA Programs: Current Trends and Practices

    Science.gov (United States)

    Knight, Melinda

    2005-01-01

    A study of top-ranked, full-time, global MBA programs suggests that management communication is indeed both an important focus and component in the curriculum. The methods of delivery, however, do not seem to follow any particular model, such as the common U.S. practice of a separate program or department. Required courses are found at 10 of the…

  1. Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

    Science.gov (United States)

    Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

    2017-11-01

    While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2014-12-01

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

  3. Management of cancer pain--a survey of current practice in West Africa.

    Science.gov (United States)

    Soyannwo, A; Amanor-Boadu, S D

    2001-12-01

    A comprehensive management plan for cancer pain is yet to be formulated in the West African sub region despite the priority that the World Health Organisation (WHO) has devoted to the problem over the past decade. As a prerequisite to our cancer pain management curriculum development a structured questionnaire on cancer pain management practice was administered to 80 Fellows attending the Annual Scientific Conference of the West African College of Surgeons in 1996. They were asked how often they treated cancer patients, the causes of cancer pain, their methods of assessment and therapeutic measures and complications of management techniques. Forty-four fellows from Nigeria, Ghana, Liberia and Sierra Leone, all consultants and trainers, responded to the questionnaire. About 80% of them treated cancer patients all the time. Specific anti-cancer therapy such as surgery, chemotherapy and hormone therapy were available in the four countries but radiotherapy was only available in two centers in Nigeria. The respondents estimated that 70-90% of their patients had severe pain at presentation. Pain was thought by 52% of respondents to be due to cancer and its treatment while 47% thought it was due to cancer and the fear of dying. Pain assessment was mostly by the verbal rating scale, only 20% included psychological measurement in their schedules. Oral preparations of strong opioids were not available in most countries andfor severe pain, the parenteral route was employed. Only 18% knew about the 'by the clock' dosing schedule. The study revealed that the standard of practice of the respondents falls below accepted practice. There is thus an urgent need for the formal education of personnel involved in the care of these patients.

  4. Current practice in Europe

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dagres, Nikolaos; Marinskis, Germanas

    2013-01-01

    The purpose of the EP wire is to examine the clinical practice in the management of sustained ventricular tachycardia (VT), with special focus on diagnostic and therapeutic strategies. Forty-five European centres, all members of the EHRA-EP Research network completed the questions of the survey...

  5. Physiotherapy management of patients with coronary artery disease: a report on current practice in South Africa

    Directory of Open Access Journals (Sweden)

    R. Roos

    2011-02-01

    Full Text Available Coronary artery disease (CAD is a worldwide health problem with  an  increased  prevalence  in  sub-Saharan  Africa.  Physiotherapists  inter-nationally  are  involved  in  the  care  of  these  patients  from  the  acute  stage following  a  cardiac  event  until  phase  III  cardiac  rehabilitation  is  completed.  The  purpose  of  this  study  was  to  determine  the  current  physiotherapy management  of  patients  with  CAD  in  South  Africa.  An  observational  cross-sectional  study  was  conducted  over  two  months  with  a  questionnaire  that  was  sent  to  the  government  and  private  health  care  sectors.  Results  showed  that  more  cardiopulmonary  physiotherapists  provided  care  (62%  than  those who  didn’t  (38%.  Care  was  mostly  provided  in  a  hospital  setting  (81%  and  out- patient phase III cardiac rehabilitation was lacking (11%. In-hospital physiotherapy treatment was mostly provided once daily. Deep breathing exercises (99%, circulatory exercises (95% and manual chest clearance techniques (88% were mostly used during physiotherapy. Evidence based practice was consistent regarding early mobilization but was inconsistent with regards to the use of manual chest clearance techniques.

  6. Current waste-management practices and operations at Oak Ridge National Laboratory, 1982

    Energy Technology Data Exchange (ETDEWEB)

    Eisenhower, B.M.; Oakes, T.W.; Coobs, J.H.; Weeter, D.W.

    1982-09-01

    The need for efficient management of industrial chemical wastes, especially those considered hazardous or radioactive, is receiving increased attention in the United States. During the past five years, several federal laws have addressed the establishment of stronger programs for the control of hazardous and residual wastes. At a facility such as Oak Ridge National Laboratory (ORNL), an efficient waste management program is an absolute necessity to ensure protection of human health and compliance with regulatory requirements addressing the treatment and disposal of hazardous, nonhazardous, and radioactive wastes. This report highlights the major regulatory requirements under which the Laboratory must operate and their impact on ORNL facilities. Individual waste streams, estimates of quantities of waste, and current waste management operations are discussed.

  7. Current waste-management practices and operations at Oak Ridge National Laboratory, 1982

    International Nuclear Information System (INIS)

    Eisenhower, B.M.; Oakes, T.W.; Coobs, J.H.; Weeter, D.W.

    1982-09-01

    The need for efficient management of industrial chemical wastes, especially those considered hazardous or radioactive, is receiving increased attention in the United States. During the past five years, several federal laws have addressed the establishment of stronger programs for the control of hazardous and residual wastes. At a facility such as Oak Ridge National Laboratory (ORNL), an efficient waste management program is an absolute necessity to ensure protection of human health and compliance with regulatory requirements addressing the treatment and disposal of hazardous, nonhazardous, and radioactive wastes. This report highlights the major regulatory requirements under which the Laboratory must operate and their impact on ORNL facilities. Individual waste streams, estimates of quantities of waste, and current waste management operations are discussed

  8. A review of legal framework applicable for the management of healthcare waste and current management practices in Ethiopia.

    Science.gov (United States)

    Haylamicheal, Israel Deneke; Desalegne, Solomon Akalu

    2012-06-01

    The management of healthcare waste (HCW) requires special attention due to the risk posed by the presence of hazardous waste. The first step towards this is the issuance of national legislation complemented by policy documents, regulations and technical guidelines. In Ethiopia there is no specific legislation for healthcare waste management (HCWM). However, there are various legislations which may provide a legal framework for the management of HCW. This review assesses the various legislations that are relevant to HCWM. It also looks into the institutional arrangements put in place and waste management practices that prevail in the country. It was found that, although the existing legislations have provisions that may provide a legal framework for the management of HCW in Ethiopia, they are not comprehensive and lack specificity in terms of defining hazardous HCW and its categories; in indicating legal obligations of healthcare facilities (HCFs) in handling, transporting, treating and disposing HCW, and record keeping and reporting. There is overlapping of mandates and lackof co-ordination among various government institutions that are responsible for HCWM. The HCWM practices also do not conform to the principles of waste management in general and HCWM in particular. Thus, to better manage HCW in Ethiopia, a specific and comprehensive legislation and policy document on HCWM with clear designation of responsibilities to various stakeholders should be issued immediately. Moreover, training and awareness raising activities on proper HCWM should be undertaken targeting medical staffs, HCF administrators, waste handlers, policy and decision makers and the general public.

  9. Current practice of antiplatelet and anticoagulation management in post-cardiac surgery patients: a national audit.

    Science.gov (United States)

    Hosmane, Sharath; Birla, Rashmi; Marchbank, Adrian

    2012-04-01

    The Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery recently published a guideline on antiplatelet and anticoagulation management in cardiac surgery. We aimed to assess the awareness of the current guideline and adherence to it in the National Health Service through this National Audit. We designed a questionnaire consisting of nine questions covering various aspects of antiplatelet and anticoagulation management in post-cardiac surgery patients. A telephonic survey of the on-call cardiothoracic registrars in all the cardiothoracic centres across the UK was performed. All 37 National Health Service hospitals in the UK with 242 consultants providing adult cardiac surgical service were contacted. Twenty (54%) hospitals had a unit protocol for antiplatelet and anticoagulation management in post-cardiac surgery. Only 23 (62.2%) registrars were aware of current European Association for Cardio-Thoracic Surgery guidelines. Antiplatelet therapy is variable in the cardiac surgical units across the country. Low-dose aspirin is commonly used despite the recommendation of 150-300 mg. The loading dose of aspirin within 24 h as recommended by the guideline is followed only by 60.7% of surgeons. There was not much deviation from the guideline with respect to the anticoagulation therapy.

  10. The trophy hunting of African lions: scale, current management practices and factors undermining sustainability.

    Science.gov (United States)

    Lindsey, Peter Andrew; Balme, Guy Andrew; Funston, Paul; Henschel, Philipp; Hunter, Luke; Madzikanda, Hilary; Midlane, Neil; Nyirenda, Vincent

    2013-01-01

    The trophy hunting of lions Panthera leo is contentious due to uncertainty concerning conservation impacts and because of highly polarised opinions about the practice. African lions are hunted across at least ~558,000 km(2), which comprises 27-32% of the lion range in countries where trophy hunting of the species is permitted. Consequently, trophy hunting has potential to impart significant positive or negative impacts on lions. Several studies have demonstrated that excessive trophy harvests have driven lion population declines. There have been several attempts by protectionist non-governmental organisations to reduce or preclude trophy hunting via restrictions on the import and export of lion trophies. We document the management of lion hunting in Africa and highlight challenges which need addressing to achieve sustainability. Problems include: unscientific bases for quota setting; excessive quotas and off-takes in some countries; fixed quotas which encourage over-harvest; and lack of restrictions on the age of lions that can be hunted. Key interventions needed to make lion hunting more sustainable, include implementation of: enforced age restrictions; improved trophy monitoring; adaptive management of quotas and a minimum length of lion hunts of at least 21 days. Some range states have made important steps towards implementing such improved management and off-takes have fallen steeply in recent years. For example age restrictions have been introduced in Tanzania and in Niassa in Mozambique, and are being considered for Benin and Zimbabwe, several states have reduced quotas, and Zimbabwe is implementing trophy monitoring. However, further reforms are needed to ensure sustainability and reduce conservation problems associated with the practice while allowing retention of associated financial incentives for conservation.

  11. The trophy hunting of African lions: scale, current management practices and factors undermining sustainability.

    Directory of Open Access Journals (Sweden)

    Peter Andrew Lindsey

    Full Text Available The trophy hunting of lions Panthera leo is contentious due to uncertainty concerning conservation impacts and because of highly polarised opinions about the practice. African lions are hunted across at least ~558,000 km(2, which comprises 27-32% of the lion range in countries where trophy hunting of the species is permitted. Consequently, trophy hunting has potential to impart significant positive or negative impacts on lions. Several studies have demonstrated that excessive trophy harvests have driven lion population declines. There have been several attempts by protectionist non-governmental organisations to reduce or preclude trophy hunting via restrictions on the import and export of lion trophies. We document the management of lion hunting in Africa and highlight challenges which need addressing to achieve sustainability. Problems include: unscientific bases for quota setting; excessive quotas and off-takes in some countries; fixed quotas which encourage over-harvest; and lack of restrictions on the age of lions that can be hunted. Key interventions needed to make lion hunting more sustainable, include implementation of: enforced age restrictions; improved trophy monitoring; adaptive management of quotas and a minimum length of lion hunts of at least 21 days. Some range states have made important steps towards implementing such improved management and off-takes have fallen steeply in recent years. For example age restrictions have been introduced in Tanzania and in Niassa in Mozambique, and are being considered for Benin and Zimbabwe, several states have reduced quotas, and Zimbabwe is implementing trophy monitoring. However, further reforms are needed to ensure sustainability and reduce conservation problems associated with the practice while allowing retention of associated financial incentives for conservation.

  12. Waste management in the Irkutsk Region, Siberia, Russia: Environmental assessment of current practice focusing on landfilling

    DEFF Research Database (Denmark)

    Starostina, Vlada; Damgaard, Anders; Rechberger, Helmut

    2014-01-01

    The municipal waste management system of the region of Irkutsk is described and a life cycle assessment (LCA) performed to assess the environmental performance of the system. Annually about 500 000 tons of waste are managed. The waste originates from three sources: household waste (27%), commercial...... waste (23%) and office & institutional waste (44%). Other waste of unknown composition constitutes 6%. Only 3% of the waste is recycled; 97% of the municipal waste is disposed of at the old Alexandrovsky landfill. The environmental impact from the current system is dominated by the landfill, which has...... no gas or leachate collection system. The global warming contribution is due to the emission of methane of the order of 420 000 tons CO2-equivalents per year. Collection and transport of the waste are insignificant compared with impacts from the landfill. As the old landfill runs out of capacity in a few...

  13. MO-B-201-00: Motion Management in Current Stereotactic Body Radiation Therapy (SBRT) Practice

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanics of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and

  14. Current issues in dental practice management. Part 1. The importance of shared values.

    Science.gov (United States)

    Newsome, Philip R H

    2003-04-01

    There can be few who would argue with the notion that the nature of dental practice in the United Kingdom has changed dramatically over the last couple of decades. A variety of factors, including new clinical techniques, growing consumerism, a much greater awareness of health-related and well-being issues in the public at large, as well as a marked deregulation within the dental profession, the development of vocational training and recently mandatory lifelong learning, the growing number of females working in the profession, and an increasing reluctance of young dentists to finance dental practices have all combined to create an environment which has enabled and encouraged a move away from traditional forms of dental care delivery. Instead, there has been considerable growth in independently-funded practice and a commensurate growth in the number of practices operating under a corporate body umbrella of one form or another. Currently there are 27 corporate bodies registered with the General Dental Council (GDC) with the likelihood of more in the future given the proposed GDC review. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable. Although they still have only a small share of the dental market--with 4% of all dentists in the UK in 1999--they have expanded rapidly from a small base. The data available at the time the paper was written indicate that the global total of fees earned from dentistry in the UK in the financial year 2001/2002 was almost 3 billion Pounds, of which 1.9 billion Pounds (64%) came from NHS fees and 1.1 billion Pounds (36%) from private fees. Of this 1.9 billion Pounds received in NHS fees in 2001/2002, 0.55 billion Pounds were paid by patients who were not exempt from charges, bringing the total amount actually paid out of patients' pockets for dental treatment to 1.65 billion Pounds. Compare these figures with 1996

  15. The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice

    Directory of Open Access Journals (Sweden)

    Jung Sub Lim

    2013-03-01

    Full Text Available Cardiovascular disease (CVD is a leading cause of death worldwide including Korea. The risk factors of CVD are known as positive family history of early CVD, obesity, hypertension, diabetes, and dyslipidemia. Among those, dyslipidemia is one of modifiable risk factors. Dyslipidemia starts in childhood and progress to adulthood. Furthermore, dyslipidemia cause atherosclerosis and is closely related to other CVD risks. On the rationale that early identification and control of pediatric dyslipidemia will reduce the risk and severity of CVD in adulthood, the National Heart, Lung, and Blood Institute guidelines expanded to universal screening for lipid levels. However, there was no guideline for lipid screening and management in Korean children and adolescents yet. This review deals with the rationale of early identification and control of pediatric dyslipidemia along with the current Korean status of pediatric dyslipidemia. This review also deals with how to screen, diagnosis, and treatment of pediatric dyslipidemia.

  16. A national survey of current practices of preparation and management of radical prostate radiotherapy patients during treatment

    International Nuclear Information System (INIS)

    Nightingale, H.; Conroy, R.; Elliott, T.; Coyle, C.; Wylie, J.P.; Choudhury, A.

    2017-01-01

    Aims: Radiotherapy is an important radical treatment for prostate cancer patients with services continually evolving. This survey aims to gain an insight in to the variation of radiotherapy practices in the UK, focussing on pre-treatment preparations, on-treatment review and management of radical prostate cancer patients undergoing radiotherapy. To our knowledge this is the first survey reported focussing on prostate radiotherapy practices with responses from a mix of health professionals. Materials and methods: A national survey was designed based on current known practices in supportive care and management of prostate cancer patients. The survey was distributed to lead radiotherapy personnel in radiotherapy services across the UK with a 77% response rate (n = 54). Results: Pre-treatment protocols were mandated in the majority of departments. Use of bladder filling (98%) and bowel emptying (66%) were frequently deployed. Bowel preparation varied between use of laxatives (13%) or enemas (41%) to achieve consistency. On-treatment reviews were carried out by a mix of health professionals; most commonly shared between oncologists and radiographers (20%). Radiographers reviewing patients were independent prescribers in 22% of departments. Toxicity grading tools were not used by almost half of departments (47%) either at baseline and/or on-treatment reviews. Written information about follow-up was given to patients towards the end of their radiotherapy; however, fewer departments included the length of hormone duration (13%). Conclusion: This survey has demonstrated variations in practice exist across the UK. These variations suggest that important questions about the best methods for treatment accuracy and patient management need to be established through further research. - Highlights: • Results of a national survey demonstrate wide variations in UK practice. • Lack of a clear evidence base could be a contributing factor to such variation. • Practices are

  17. Medication management policy, practice and research in Australian residential aged care: Current and future directions.

    Science.gov (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

    2017-02-01

    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Scrap automotive electronics: A mini-review of current management practices.

    Science.gov (United States)

    Cucchiella, Federica; D'Adamo, Idiano; Rosa, Paolo; Terzi, Sergio

    2016-01-01

    End-of-life vehicles, together with waste from electric and electronic equipment, are known as an important source of secondary raw materials. For many years, their recovery has allowed the restoring of great amounts of metals for new cars production. This article provides a comprehensive mini-review on the end-of-life vehicles recycling topic between 2000 and 2014, with a particular focus on automotive electronics recycling. In fact, in the last years, experts focused their attention on a better exploitation of automotive shredder residue fraction, but not sufficiently on eventual electronic scraps embedded in it. Hence, studies assessing the value embedded in these scraps are rarely available in literature, causing an important gap in both recycling policies and research. The fact that, at present, the management of electronic control units (the most valuable component among automotive electronic equipment) is, as yet, off the radar in both end-of-life vehicles and waste from electric and electronic equipment Directives demonstrates the theory. Of course, their recycling would not contribute in a relevant way to reach the weighted-based recycling and recovery targets characterising current regulations, but would be very important under a critical raw materials recovery view. Results coming from the literature analysis confirm these assumptions. © The Author(s) 2015.

  19. Fatigue risk management in aviation maintenance : current best practices and potential future countermeasures.

    Science.gov (United States)

    2011-06-01

    The unregulated hours and frequent night work characteristic of maintenance can produce significant levels of : employee fatigue, with a resultant risk of maintenance error. Fatigue Risk Management Systems (FRMS) are : widely used to manage fatigue a...

  20. Managing player load in professional rugby union: a review of current knowledge and practices.

    Science.gov (United States)

    Quarrie, Kenneth L; Raftery, Martin; Blackie, Josh; Cook, Christian J; Fuller, Colin W; Gabbett, Tim J; Gray, Andrew J; Gill, Nicholas; Hennessy, Liam; Kemp, Simon; Lambert, Mike; Nichol, Rob; Mellalieu, Stephen D; Piscione, Julien; Stadelmann, Jörg; Tucker, Ross

    2017-03-01

    The loads to which professional rugby players are subjected has been identified as a concern by coaches, players and administrators. In November 2014, World Rugby commissioned an expert group to identify the physical demands and non-physical load issues associated with participation in professional rugby. To describe the current state of knowledge about the loads encountered by professional rugby players and the implications for their physical and mental health. The group defined 'load' as it relates to professional rugby players as the total stressors and demands applied to the players. In the 2013-2014 seasons, 40% of professional players appeared in 20 matches or more, and 5% of players appeared in 30 matches or more. Matches account for ∼5-11% of exposure to rugby-related activities (matches, team and individual training sessions) during professional competitions. The match injury rate is about 27 times higher than that in training. The working group surmised that players entering a new level of play, players with unresolved previous injuries, players who are relatively older and players who are subjected to rapid increases in load are probably at increased risk of injury. A mix of 'objective' and 'subjective' measures in conjunction with effective communication among team staff and between staff and players was held to be the best approach to monitoring and managing player loads. While comprehensive monitoring holds promise for individually addressing player loads, it brings with it ethical and legal responsibilities that rugby organisations need to address to ensure that players' personal information is adequately protected. Administrators, broadcasters, team owners, team staff and the players themselves have important roles in balancing the desire to have the 'best players' on the field with the ongoing health of players. In contrast, the coaching, fitness and medical staff exert significant control over the activities, duration and intensity of training

  1. Analysis of the Current Nutrient Management Practices in Semi-Arid Areas of Eastern Kenya: A Nutmon Approach

    International Nuclear Information System (INIS)

    Karuku, A.M.

    2002-01-01

    Declining soil fertility caused mainly by continuous cultivation without adequate replenishment of nutrients, is a major factor contributing to low crop yields in the arid and semi arid areas of Kenya. Development of appropriate nutrient management strategies for suitable agricultural production in these areas is, therefore, a priority issue. in the study reported here, analyses of the current nutrient management practices were carried out using the nutrient monitoring (NUTMON) approach in order to create farm house-hold awareness on nutrient management aspects. The procedure involved participatory soil and nutrient flow maps and soil sampling at farm level. laboratory analysis of the soil samples was later carried out. Structured questionnaires were used for systematic collection of information on farm management practices in order to quantify flows of materials with emphasis on soil nutrients and cash. Results of the laboratory soil analysis were also presented to the farmers and discussed during feedback sessions. The test was carried out in three places namely, Kibwezi, Kasikeu and Kiomo. In all the three clusters, off-farm income was an important component of the total family income. Farm net cash flow was highest in Kibwezi cluster due to horticultural crop production activities. Household net cash flow was highest in Kasikeu, largely originating from off-farm income. It was concluded that NUTMON methodology appeared a suitable tool for the diagnostic of the farming system analysis and design in the arid and semi-arid lands of Kenya

  2. Multi-criteria decision making to support waste management: A critical review of current practices and methods.

    Science.gov (United States)

    Goulart Coelho, Lineker M; Lange, Liséte C; Coelho, Hosmanny Mg

    2017-01-01

    Solid waste management is a complex domain involving the interaction of several dimensions; thus, its analysis and control impose continuous challenges for decision makers. In this context, multi-criteria decision-making models have become important and convenient supporting tools for solid waste management because they can handle problems involving multiple dimensions and conflicting criteria. However, the selection of the multi-criteria decision-making method is a hard task since there are several multi-criteria decision-making approaches, each one with a large number of variants whose applicability depends on information availability and the aim of the study. Therefore, to support researchers and decision makers, the objectives of this article are to present a literature review of multi-criteria decision-making applications used in solid waste management, offer a critical assessment of the current practices, and provide suggestions for future works. A brief review of fundamental concepts on this topic is first provided, followed by the analysis of 260 articles related to the application of multi-criteria decision making in solid waste management. These studies were investigated in terms of the methodology, including specific steps such as normalisation, weighting, and sensitivity analysis. In addition, information related to waste type, the study objective, and aspects considered was recorded. From the articles analysed it is noted that studies using multi-criteria decision making in solid waste management are predominantly addressed to problems related to municipal solid waste involving facility location or management strategy.

  3. Management Tools for Bus Maintenance: Current Practices and New Methods. Final Report.

    Science.gov (United States)

    Foerster, James; And Others

    Management of bus fleet maintenance requires systematic recordkeeping, management reporting, and work scheduling procedures. Tools for controlling and monitoring routine maintenance activities are in common use. These include defect and fluid consumption reports, work order systems, historical maintenance records, and performance and cost…

  4. Environmental assessment of waste management in Greenland: current practice and potential future developments

    DEFF Research Database (Denmark)

    Eisted, Rasmus; Christensen, Thomas Højlund

    2013-01-01

    ) for a system serving 56 000 inhabitants), but significant environmental loads are caused by air emissions from the incinerators and leachate from the landfills. Several alternative management scenarios were modelled and results show that increased use of incineration, full utilization of the heat production...... for district heating and separation of hazardous waste probably could improve Greenland’s waste management system. Segregation of recyclable materials as paper, cardboard and biowaste will do little to environmentally improve the waste management system due to loss of energy recovery from incineration...... and the long transport of the recyclables to markets. Export of waste to Denmark for incineration at modern waste incinerators with advanced flue gas cleaning could also be considered as a means to achieve better environmental performance of the waste management system....

  5. Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses

    Directory of Open Access Journals (Sweden)

    Aaberg Jr TM

    2014-12-01

    Full Text Available Thomas M Aaberg Jr,1 Robert W Cook,2 Kristen Oelschlager,2 Derek Maetzold,2 P Kumar Rao,3 John O Mason III41Michigan State University Medical School and Retina Specialists of Michigan, Grand Rapids, MI, 2Castle Biosciences, Friendswood, TX, 3Washington University School of Medicine in St Louis, St Louis, MO, 4Retina Consultants of Alabama and University of Alabama Birmingham, Birmingham, AL, USA Objective: Assess current clinical practices for uveal melanoma (UM and the impact of molecular prognostic testing on treatment decisions.Design: Cross-sectional survey and sequential medical records review.Participants: Ophthalmologists who treat UM.Methods: (A Medical records review of all Medicare beneficiaries tested by UM gene expression profile in 2012, conducted under an institutional review board-approved protocol. (B 109 ophthalmologists specializing in the treatment of UM were invited to participate in 24-question survey in 2012; 72 were invited to participate in a 23-question survey in 2014.Main outcome measures: Responses analyzed by descriptive statistics, frequency analyses (percentages, Tukey, histograms, and Fisher’s exact test. Descriptive presentation of essay answers.Results: The review of Medicare medical records included 191 evaluable patients, 88 (46% with documented medical treatment actions or institutional policies related to surveillance plans. Of these 88, all gene expression profiling (GEP Class 1 UM patients were treated with low-intensity surveillance. All GEP Class 2 UM patients were treated with high-intensity surveillance (P<0.0001 versus Class 1. There were 36 (19% with information concerning referrals after initial diagnosis. Of these 36, all 23 Class 2 patients were referred to medical oncology; however, none of the 13 Class 1 patients were referred (P<0.0001 versus Class 1. Only Class 2 patients were recommended for adjunctive treatment regimens. 2012 survey: 50 respondents with an annual median of 35 new UM

  6. Challenges and Strength of Current Industrial Energy Efficiency Management Practices in Steam Industries

    Science.gov (United States)

    Nkosi, S. B.; Pretorius, J. H. C.

    2017-07-01

    The aim of this study is to achieve greater output by examining the existing way of coordinating the determined attempts of Steam Industries in South Africa to successfully reach a sustainable industrial development by using energy source adequately in a more competent way. Furthermore into the study we look at obstacles that prevent and those that leads to maximum utilization of energy management measures and also highlights the effects of implementing cheap available energy source in South Africa. The investigation and analysis have shown that energy is not well managed in Steam Industries and that the use of energy is minimized and not fully utilized due to poor management and lack of knowledge. Another detection was that lack of government structured and strategic measures of implementing and motivating the use of energy effectively. The effective and rational use of available power by Steam Industries in South Africa is a key player in developing a sustainable industrial development. The use of energy efficiency management strategies has contributed an increase in economic and improve environmentally friendly in the industrial sector. The slow pace adoption of energy saving and cost effective management programmes are negatively impacting on the benefits to Steam Industries in South Africa. In conclusion the study finds that the economy can be boosted by implementing energy efficiency management programmes and environmentally friendly. These will also stabilize the negative impact of energy raising prices.

  7. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis.

    Science.gov (United States)

    Walsh, Nicola E; Hurley, Michael V

    2009-03-01

    To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis. Questionnaire survey of chartered physiotherapists. 300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery. Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1-2 hours, whilst most group interventions lasted 5-6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy. Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated.

  8. An audit of current practice and management of metastatic spinal cord compression at a regional cancer centre.

    LENUS (Irish Health Repository)

    Sui, J

    2012-02-01

    Metastatic spinal cord compression (MSCC) is an oncological emergency requiring prompt recognition and management to preserve neurological function and mobility. We performed an audit to assess current practice of MSCC against current best practice as outlined by NICE. Our retrospective audit identified 10 patients from January to December 2009 with confirmed MSCC. The most common primary tumours were prostate 3 (30%), breast 3 (30%) and lung 2 (20%). Pain was the main presenting symptom 9 (90%), followed by weakness 7 (70%) and sensory changes 1 (10%). 5 (50%) had MRI within 24 hours and only 6 (60%) underwent full MRI scan. 8 (80%) had corticosteroids before MRI scan. 6 (60%) received radiotherapy within 24 hours. Only 4 (40%) were referred to orthopaedics and none of these patients had been recommended surgery. Up 14 days following radiological confirmation of MSCC, the number of patients who were unable to walk increased by 20%. Only 5 (50%) were discharged during this period of study. Our audit reported a number of variances in management compared to NICE guideline. These can be improved by following a\\'fast track\\' referral pathway and regular education for junior doctors and primary care doctors.

  9. A survey of current practices in management of Hirschsprung′s disease in Nigeria

    OpenAIRE

    Abdulrasheed A. Nasir; Emmanuel A. Ameh

    2014-01-01

    Background: Although there are several modalities of treatment for Hirschsprung′s disease (HD), there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting. Materials and Methods: An online questionnaire was designed using survey Monkey ® to determine current clin...

  10. Current biomedical waste management practices and cross-infection control procedures of dentists in India.

    Science.gov (United States)

    Singh, Balendra Pratap; Khan, Suleman A; Agrawal, Neeraj; Siddharth, Ramashanker; Kumar, Lakshya

    2012-06-01

    To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross-infection control. A national survey was conducted. Self-administered questionnaires were sent to 800 dentists across India. A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste. © 2012 FDI World Dental Federation.

  11. Partnering for long-term management of radioactive waste. Evolution and current practice in thirteen countries

    International Nuclear Information System (INIS)

    2010-01-01

    National radioactive waste management programmes are in various phases of siting facilities and rely on distinct technical approaches for different categories of waste. In all cases, it is necessary for institutional actors and the potential or actual host community to build a meaningful, workable relationship. Partnership approaches are effective in achieving a balance between the requirements of fair representation and competent participation. With host community support, they also help ensure the desirable combination of a licensable site and management concept as well as a balance between compensation, local control and development opportunities. This report provides up-to-date information on experience with local partnership arrangements in 13 countries. The characteristics, advantages and aims of community partnerships are also described in addition to the concept's evolution over the past decade. (authors)

  12. Fatigue Risk Management in Aviation Maintenance: Current Best Practices and Potential Future Countermeasures

    Science.gov (United States)

    2011-06-01

    a maintenance organization to permit a maintainer who is significantly impaired by fatigue or a psychoactive substance to carry out maintenance on...of the topic, while the second contains detail on fatigue, fatigue management strate- gies, as well as information on nutrition, drugs , alcohol...recommended that the person avoids the routine consumption of caffeinated drinks, as caffeine is less effective as an alerting agent for people

  13. A Case Analysis to Increase Awareness of Current USMC Knowledge Management (KM) Practices

    Science.gov (United States)

    2013-09-01

    Knowledge Management System KPI Key Performance Indicator KS Knowledge Superiority KVA Knowledge Value Added MAGTF Marine Air Ground Task Force...quantitative KPIs [key performance indicators] developed to monitor efficiency and some qualitative KPIs to assess effectiveness in the implementation...integration,” and the level of control is “qualitative and quantitative KPIs in place to monitor the implementation of an effective and efficient KM

  14. Waste management, decommissioning and environmental restoration for Canada's nuclear activities: 'Current practices and future needs'

    International Nuclear Information System (INIS)

    2006-01-01

    The Canadian Nuclear Society conference on Waste Management, Decommissioning and Environmental Restoration for Canada's Nuclear Activities was held on May 8-11, 2005 in Ottawa, Ontario, Canada. The objective of this Conference was to provide a forum for discussion and exchange of views on the technical, regulatory and social challenges and opportunities in radioactive waste management, nuclear facility decommissioning and environmental restoration activities in Canada. The Conference was organized into several plenary sessions and eight technical tracks: Low- and intermediate-level wastes; Uranium mining and milling wastes; Used nuclear fuel; Decommissioning; Environmental restoration; Policy, economics and social issues; Licensing and regulatory issues; and, Radioactive materials transportation. The three-day Conference involved waste management, decommissioning and environmental technology practitioners; delegates from industry, academia, and government agencies and regulators; consulting engineers; financial and legal experts; and other specialists working in the field. While the Conference had a primarily Canadian focus, about 10 per cent of the submissions received came from foreign and international organizations, which provided insights into how other countries are dealing with similar issues

  15. Promoting practical clinical management learning: the current situation about Information and Communications Technology capability development in student nurses.

    Science.gov (United States)

    Willmer, Marian

    2005-11-01

    This paper is about work-based learning in information management for student nurses. It seeks, through a literature review, to make a case for and promote Information and Communications Technology capability development in student nurses within their clinical environment. The profession of nursing, like many other jobs, is facing the increasing usage of information technology in day-to-day operations. Admission and discharges of patients have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. Nurse education therefore needed to reflect this need and support trainee nurses to acquire skills in Information and Communications Technology. This paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology capability development in student nurses. A literature search was conducted on teaching information and technology skills via Cumulative Index to Nursing and Allied Health Literature. Most of the available studies were neither based on the UK nor were they about student nurses. As there is a dearth of published work in this specific area, relevant, related and tangential literature was reviewed. It is argued that current practice and published work on Information and Communications Technology capability development by student nurses hardly exists. The literature confirmed that success in this area requires sound change management, an understanding of National Health Service culture, and effective people leadership skills. Nurse educators and managers need to pay more attention to understand how organizations work, particularly organizations where student nurses carry out their work. As the search revealed a significant gap in the literature in this area, a practical conceptual framework to fully analyse, develop and

  16. Fournier's Gangrene: Current Practices

    Science.gov (United States)

    Mallikarjuna, M. N.; Vijayakumar, Abhishek; Patil, Vijayraj S.; Shivswamy, B. S.

    2012-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes. PMID:23251819

  17. The current status of radiopharmacy laboratories in Turkey, conveniences to good radiopharmacy practice (GRP) and quality management systems (ISO)

    International Nuclear Information System (INIS)

    Atak, I.E.

    2004-01-01

    This study ha been conducted in the Radiopharmacy Laboratories of Nuclear Medicine departments of various hospitals and private nuclear medicine laboratories. A total of 35 laboratories from 7 regions of Turkey have been selected by layered sampling method from 131 Radiopharmacy Laboratories located in 30 different cities. During the study, a GRP investigation list with 67 questions and direct communication technique have been used. The aim was determine the current status of the Radiopharmacy Laboratories in general and the administration of radiopharmaceuticals on patients, and good practices in radiopharmacy and conformance with quality assurance systems. In this respect, questions have been asked to determine a) General status, b) Information level of lab workers regarding to the GRP and ISO concepts (i-Status of lab managers, ii- Responsibilities and knowledge of lab workers and iii- regarding to GRP and ISO-9000), c) Conditions of infrastructure, and lab services and its quality, d) Status of organizations. Results showed that only two of the 35 managers of laboratories were radiopharmacists, the rest were Nuclear Medicine specialists. There were less knowledge on GRP than ISO, the labs holding ISO certificate were in minority even though ISO is known concept, radiopharmacist were more knowledgeable in GRP while nuclear medicine specialists were in ISO, the labs with better GRP knowledge have better infrastructure, the GRP knowledge were better in the university and armed forces hospitals while ISO knowledge and certificates were more in private labs and hospitals, the armed forces hospitals better paraphernalia, practically almost all radiopharmaceutical kits were imported goods and there were important problems in quality control

  18. Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

    Science.gov (United States)

    Sellars, Marcus; Detering, Karen M; Silvester, William

    2015-04-23

    Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

  19. Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study.

    Science.gov (United States)

    Karel, Yasmaine H J M; Scholten-Peeters, Wendy G M; Thoomes-de Graaf, Marloes; Duijn, Edwin; Ottenheijm, Ramon P G; van den Borne, Maaike P J; Koes, Bart W; Verhagen, Arianne P; Dinant, Geert-Jan; Tetteroo, Eric; Beumer, Annechien; van Broekhoven, Joost B; Heijmans, Marcel

    2013-02-11

    Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.

  20. Current practice in the management of superficial bladder cancer in the Netherlands and Belgian Flanders: a survey.

    NARCIS (Netherlands)

    Witjes, J.A.; Melissen, D.O.; Kiemeney, L.A.L.M.

    2006-01-01

    OBJECTIVE: Because there is no national guideline for the diagnosis, therapy and follow up of (superficial) bladder cancer in the Netherlands and Belgium, the actual patient management may differ between urologists. The purpose of this study is to get insight in the current way urologists diagnose,

  1. Engineering change management report 2012: Survey results on causes and effects, current practice, problems, and strategies in Brazil

    DEFF Research Database (Denmark)

    Chucholowski, Nepomuk; Langer, Stefan; Ferreira, Marcelo Gitirana Gomes

    Engineering changes (ECs) are well known for generating additional costs and decreasing de-velopment efficiency. Yet, they are a fundamental part of product and service development and they are necessary to keep up with, for example, competitors, market trends or new technolo-gies. The effective...... management of engineering changes is a crucial precondition for Brazilian companies to successfully compete not only on the fast growing Brazilian market, but also on the world market which becomes more interesting due to the rising industrial power of Brazil. To achieve improvements in engineering change...... management practice, industry and universities need to work together. In this report the main findings of our study on Engineering Change Management (ECM) in Brazilian companies are presented, which indicate possible solution strategies and further research needs. Our survey aimed on the investigation...

  2. Current practices in economic appraisal

    NARCIS (Netherlands)

    Mossink, J.C.M.

    2000-01-01

    By means of economic appraisal, the costs and the benefits of health, environment and safety management can be made clear, both at the national level and at the company level. As such it is a tool in advocating good practices. This paper explores the possibilities of economic appraisal for policy

  3. Neurogenic bladder evaluation and management after spinal cord injury: Current practice among urologists working in Saudi Arabia.

    Science.gov (United States)

    Al Taweel, Waleed; Alkhayal, Abdullah

    2011-01-01

    The aim of this study is to determine the current trends in the management and surveillance of the NB population secondary to spinal cord injury (SCI) or myelomeningocele by certified urologist working in Saudi Arabia and to compare it to the current guidelines. A cross-sectional study was conducted using a 12-points questionnaire distributed to urologists working in Saudi Arabia and registered at the Saudi medical association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry. Of the 272 urologists surveyed, 105 responded, yielding a response rate of 38%. Eighty-nine percent of respondents said that ultrasound was their diagnostic tool of choice for upper tract evaluation. Sixty-one percent of respondents said that they would follow their patients with a multichannel urodynamic study. Forty percent of urologists stated that they would treat asymptomatic bacteriuria. Clean intermittent catheterization (CIC) was the most common modality chosen for the management of neurogenic bladder in patients with emptying difficulties. This study confirms that most urologists in Saudi Arabia involved with neurogenic bladder management. However, more than one third of the urologists do not have urodynamic machine and only two of the reporting practitioners has a videourodynamic machine. The results emphasize the need for clear guidelines in this field of urology in Saudi Arabia. Highly specialized rehabilitation centers for neurogenic bladder secondary to SCI are required for optimal care and urologist teaching.

  4. Management of Current Psychiatric Disorders

    Science.gov (United States)

    Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine

    2016-01-01

    Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

  5. Brain abscess: Current management

    Directory of Open Access Journals (Sweden)

    Hernando Alvis-Miranda

    2013-01-01

    Full Text Available Brain abscess (BA is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

  6. Neurogenic bladder evaluation and management after spinal cord injury: Current practice among urologists working in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Waleed Al Taweel

    2011-01-01

    Full Text Available Aim: The aim of this study is to determine the current trends in the management and surveillance of the NB population secondary to spinal cord injury (SCI or myelomeningocele by certified urologist working in Saudi Arabia and to compare it to the current guidelines. Materials and Methods: A cross-sectional study was conducted using a 12-points questionnaire distributed to urologists working in Saudi Arabia and registered at the Saudi medical association. The assessment and follow-up of upper and lower urinary tract function in neurogenic bladder patients, their optimal frequency and management of related infections were the topics of inquiry. Results: Of the 272 urologists surveyed, 105 responded, yielding a response rate of 38%. Eighty-nine percent of respondents said that ultrasound was their diagnostic tool of choice for upper tract evaluation. Sixty-one percent of respondents said that they would follow their patients with a multichannel urodynamic study. Forty percent of urologists stated that they would treat asymptomatic bacteriuria. Clean intermittent catheterization (CIC was the most common modality chosen for the management of neurogenic bladder in patients with emptying difficulties. Conclusion: This study confirms that most urologists in Saudi Arabia involved with neurogenic bladder management. However, more than one third of the urologists do not have urodynamic machine and only two of the reporting practitioners has a videourodynamic machine. The results emphasize the need for clear guidelines in this field of urology in Saudi Arabia. Highly specialized rehabilitation centers for neurogenic bladder secondary to SCI are required for optimal care and urologist teaching.

  7. [Current management of epilepsy].

    Science.gov (United States)

    Mizobuchi, Masahiro

    2013-09-01

    Epilepsy is one of the most common neurological disorders. Global neurological knowledge is essential for differential diagnosis of epileptic syndromes due to the diversity of ictal semiology, causes and syndromes. Neurologists play an important role in planning the medical care for patients with epilepsy, as medication is the most fundamental therapeutic strategy. Some patients with early-onset epilepsy require joint care by pediatric neurologists, those with intractable epilepsy by neurosurgeons, and those with psychological comorbidity by psychiatrists, and neurologists should play a coordinating role. While there is a great need for neurologists to participate in epilepsy care, neurologists in Japan currently do not participate substantially in the epilepsy management system. It is necessary to train more neurologists who can provide epilepsy care and conduct basic and clinical research on epilepsy by providing continuous education on epilepsy for general neurologists as well as pre- and post-graduate medical students. Most of the patients who require long-term treatment experience many medical problems and social handicaps, such as adverse effects of medication, social stigma, educational disadvantages and difficulties in obtaining driver's license. To improve the quality of life of patients with epilepsy, it is desirable to build broad medical-social networks participated by patients, doctors, neurological nurses, psychologists, social workers, school teachers, managers of employment support facilities and care givers.

  8. MO-B-201-01: Overcoming the Challenges of Motion Management in Current Lung SBRT Practice

    Energy Technology Data Exchange (ETDEWEB)

    Shang, C. [Boca Raton Regional Hospital (United States)

    2016-06-15

    The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanics of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and

  9. MO-B-201-01: Overcoming the Challenges of Motion Management in Current Lung SBRT Practice

    International Nuclear Information System (INIS)

    Shang, C.

    2016-01-01

    The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanics of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and

  10. practice managers in Scotland

    Directory of Open Access Journals (Sweden)

    Lisa Hanna

    2011-03-01

    Conclusion Practice managers are likely to play a central role in the introduction of new consultation/ communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics.Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/ communication technologies.

  11. The Impact of Therapeutic Antibodies on the Management of Digestive Diseases: History, Current Practice, and Future Directions.

    Science.gov (United States)

    Sofia, M Anthony; Rubin, David T

    2017-04-01

    The development of therapeutic antibodies represents a revolutionary change in medical therapy for digestive diseases. Beginning with the initial studies that confirmed the pathogenicity of cytokines in inflammatory bowel disease, the development and application of therapeutic antibodies brought challenges and insights into their potential and optimal use. Infliximab was the first biological drug approved for use in Crohn's disease and ulcerative colitis. The lessons learned from infliximab include the importance of immunogenicity and the influence of pharmacokinetics on disease response and outcomes. Building on this foundation, other therapeutic antibodies achieved approval for inflammatory bowel disease and many more are in development for several digestive diseases. In this review, we reflect on the history of therapeutic antibodies and discuss current practice and future directions for the field.

  12. Management and disposal of alpha-contaminated wastes. A survey of current practices, strategies and R and D activities in some EC countries and the USA

    International Nuclear Information System (INIS)

    Mannone, F.

    1983-01-01

    In view of the rationalization of radwaste treatment, conditioning and storage procedures so far applied at the Ispra Establishment, a survey of alpha-waste management practices and strategies currently in use or under development in some EC countries and in the USA has been carried out. In considering radwastes arising at nuclear research centres and nuclear plants, the most importance has been attached here to their alpha- rather than to their beta- or gamma-contamination degree. Various process technologiques currently practised for pre-treatment, conditioning, storage and/or disposal of alpha-waste at several European nuclear centres and plants, as well as at some US DOE laboratories, have been scrutinized, including also process operations aimed at recovering Pu, both for economical and ecological reasons. The present alpha-waste management and disposal scenario has been completed by the survey of research, development and demonstration work underway in Europe and in the USA in this field. Finally, national organizations, policies and strategies for radwastes management and disposal have been briefly outlined. As main source of information, the proceeding of several technical seminars, symposia, meetings and conferences, individually and jointly organized by the NEA (OECD), IAEA, CEC and published during about the last 20 years have been utilized. This report is intended to give the necessary background for the critical review of waste management practices so far applied at the Ispra Establisment, as well as for their possible modifications according to more up-to-date management schemes

  13. Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices.

    Science.gov (United States)

    Soriano-Arandes, Antoni; Angheben, Andrea; Serre-Delcor, Nuria; Treviño-Maruri, Begoña; Gómez I Prat, Jordi; Jackson, Yves

    2016-05-01

    Identifying pregnant women infected with Trypanosoma cruzi is one of the major challenges for preventing and controlling Chagas disease (CD) in non-endemic countries. The aim of this paper was to perform a policy evaluation of the current practices of congenital Chagas disease (CCD) control in non-endemic countries and to propose specific targets for enhanced interventions to tackle this emerging health problem outside the endemic areas of Latin America. We conducted a mixed method review of CCD policy strategies by searching the literature in the PubMed, Google Scholar and the World Health Organization (WHO) databases using the key terms 'CCD', 'paediatric Chagas disease' and 'non-endemic countries'; as free text and combined as one phrase to increase the search sensitivity. Reviews, recommendations, guidelines and control/surveillance programme reports were included. Of 427 CCD papers identified in non-endemic countries, 44 matched the inclusion. Although local programmes were launched in different countries with large numbers of Latin American immigrants, there were considerable disparities in terms of the programmes' distribution, delivery, integration and appropriated CCD control strategies. Moreover, Catalonia, Spain is the only region/country with an established systematic monitoring of CCD in pregnant women from Latin American countries. Given the worldwide dissemination of CD, the nature of its vertical transmission, and the gaps of the current strategies in non-endemic countries, there is an urgent need to standardise, expand and reinforce the control measures against CCD transmission. © 2016 John Wiley & Sons Ltd.

  14. Management of primary adrenal insufficiency: Review of current clinical practice in a developed and a developing country

    Directory of Open Access Journals (Sweden)

    Uzma Khan

    2017-01-01

    Full Text Available Treatment of primary adrenal insufficiency (PAI requires lifelong hormone replacement with glucocorticoids (GCs and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

  15. Management of Primary Adrenal Insufficiency: Review of Current Clinical Practice in a Developed and a Developing Country.

    Science.gov (United States)

    Khan, Uzma; Lakhani, Om J

    2017-01-01

    Treatment of primary adrenal insufficiency (PAI) requires lifelong hormone replacement with glucocorticoids (GCs) and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

  16. Epidemiology, associated burden, and current clinical practice for the diagnosis and management of Alzheimer's disease in Japan.

    Science.gov (United States)

    Montgomery, William; Ueda, Kaname; Jorgensen, Margaret; Stathis, Shari; Cheng, Yuanyuan; Nakamura, Tomomi

    2018-01-01

    The burden of dementia in Japan is large and growing. With the world's fastest aging population, it is estimated that one in five elderly people will be living with dementia in Japan by 2025. The most common form of dementia is Alzheimer's disease (AD), accounting for around two-thirds of dementia cases. A systematic review was conducted to examine the epidemiology and associated burden of AD in Japan and to identify how AD is diagnosed and managed in Japan. English and Japanese language databases were searched for articles published between January 2000 and November 2015. Relevant Japanese sources, clinical practice guideline registers, and reference lists were also searched. Systematic reviews and cohort and case-control studies were eligible for inclusion, with a total of 60 studies included. The most recent national survey conducted in six regions of Japan reported the mean prevalence of dementia in people aged ≥65 years to be 15.75% (95% CI: 12.4, 22.2%), which is much higher than the previous estimated rate of 10% in 2010. AD was confirmed as the predominant type of dementia, accounting for 65.8% of all cases. Advancing age and low education were the most consistently reported risk factors for AD dementia. Japanese guidelines for the management of dementia were released in 2010 providing specific guidance for AD about clinical signs, image findings, biochemical markers, and treatment approaches. Pharmacotherapies and non-pharmacotherapies to relieve cognitive symptoms were introduced, as were recommendations to achieve better patient care. No studies reporting treatment patterns were identified. Due to population aging and growing awareness of AD in Japan, health care expenditure and associated burden are expected to soar. This review highlights the importance of early detection, diagnosis, and treatment of AD as strategies to minimize the impact of AD on society in Japan.

  17. Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

    Directory of Open Access Journals (Sweden)

    Oliver Rojas Claros

    2012-01-01

    Full Text Available OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%. The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs (p = 0.014. Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

  18. Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey.

    Science.gov (United States)

    Agrawal, Hitesh; Mery, Carlos M; Day, Patrick E; Sexson Tejtel, S Kristen; McKenzie, E Dean; Fraser, Charles D; Qureshi, Athar M; Molossi, Silvana

    2017-09-01

    Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes in the USA. Long-term outcome data for these patients are lacking to date. There is insufficient knowledge on the best approach to these patients and they are managed in a nonuniform manner. An online survey of 15 questions regarding management of AAOCA was sent out to 198 cardiac healthcare providers. The goal was to define gaps in knowledge to justify a dedicated scientific forum for discussion of AAOCA. Descriptive statistics were performed. A total of 91 providers (46%) completed the survey including pediatric cardiology subspecialists (40%), general pediatric cardiologists (24%), cardiovascular (CV) surgeons (22%), adult cardiologists (10%), nurse practitioners (8%), cardiology fellows (3%) and CV anesthesiologist (1%). Forty-eight percent had been practicing for over 15 years and 28% were in their first 5 years of practice. Fifty-two percent of the providers cared for adults and 93% cared for children/adolescents. Eighty-eight percent were affiliated with an academic institution. All but one provider practiced in the USA, 62% practiced in Texas. Half of participants (50%) were very comfortable managing AAOCA patients and 36% were somewhat comfortable. Providers utilized various imaging tests to confirm the anatomy including computed tomography angiography 88%, cardiac magnetic resonance imaging 70%, cardiac catheterization 60%, echocardiogram 12%, IVUS 2% and myocardial perfusion scan 1%. The majority felt comfortable in counseling the families and felt that depending on the type of lesion these patients should get surgical referral (85%) vs clinical follow up (67%) with exercise restriction (65%). There is heterogeneity in the way AAOCA patients are currently evaluated and managed. A knowledge gap exists even with participants from academic institutions. Long-term data with a defined approach to management of these patients may help to

  19. The effects of farm management practices on liver fluke prevalence and the current internal parasite control measures employed on Irish dairy farms.

    Science.gov (United States)

    Selemetas, Nikolaos; Phelan, Paul; O'Kiely, Padraig; de Waal, Theo

    2015-01-30

    Fasciolosis caused by Fasciola hepatica is responsible for major production losses in cattle farms. The objectives of this study were to assess the effect of farm management practices on liver fluke prevalence on Irish dairy farms and to document the current control measures against parasitic diseases. In total, 369 dairy farms throughout Ireland were sampled from October to December 2013, each providing a single bulk tank milk (BTM) sample for liver fluke antibody-detection ELISA testing and completing a questionnaire on their farm management. The analysis of samples showed that cows on 78% (n=288) of dairy farms had been exposed to liver fluke. There was a difference (P0.05) between positive and negative farms in (a) the grazing of dry cows together with replacement cows, (b) whether or not grazed grassland was mowed for conservation, (c) the type of drinking water provision system, (d) spreading of cattle manure on grassland or (e) for grazing season length (GSL; mean=262.5 days). Also, there were differences (Pmanagement practices between Irish farms with dairy herds exposed or not exposed to liver fluke and stressed the need of fine-scale mapping of the disease patterns even at farm level to increase the accuracy of risk models. Also, comprehensive advice and professional support services to farmers on appropriate farm management practices are very important for an effective anthelmintic control strategy. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists' and surgeons' current practice

    International Nuclear Information System (INIS)

    Pritchard, M.G.; Townend, J.N.; Lester, W.A.; England, D.W.; Kearins, O.; Bradley, S.A.

    2008-01-01

    Aim: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. Materials and methods: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. Results: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. Conclusion: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested

  1. Municipal asset management or mismanagement? A six ‘Whats’ perspective on current practices and challenges in Ethiopia’s urban water sector

    Directory of Open Access Journals (Sweden)

    Tendayi GONDO

    2010-06-01

    Full Text Available Effective systems of asset management can strengthen the performance of a local economy and community significantly. Despite the existence of new and interactive technologies for recording and communicating assets and asset management, many local authorities across the developing world have not taken advantage of the emerging revolutionary ways in which technologies may benefit municipal asset management. The analysis reviews the current practices, challenges and policy options for Ethiopian cities with regard to the state of the art technology for Municipal Asset Management (MAM in the water and sanitation sector. Empirical evidence relate to a number of independent studies carried out in a sample of Ethiopian cities and towns. The pooling together of these findings was achieved through the Comparative Studies framework. In addition, data was also solicited from a panel of experts dealing with water and sanitation issues. The overall analysis was done within the context of the six Whats? Framework. Results indicate that, the water sector has gone through a number of reforms that have not cascaded into improved infrastructure asset management. Lack of financial resources, human resource expertise and appropriate organizational strategy has constrained the adoption and application of system software for effective asset management.

  2. Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

    Science.gov (United States)

    2012-08-01

    risk of ischemia Murphy (2007) Colorectal surgery Higher risk of postoperative infection and intra- abdominal sepsis Chang (2000) ICU...SUBJECT TERMS Blood Management , Transfusion, Training, Trauma, Hemorrhage, Donor, PBM, Surgery , Allogenic, 16. SECURITY CLASSIFICATION OF: 17...Mazyar Javidroozi, M.D., Institute for Patient Blood Management & Bloodless Medicine and Surgery , EHMC Dr. John Sokolowski, Ph.D., Virginia Modeling

  3. Historical and current fire management practices in two wilderness areas in the southwestern United States: The Saguaro Wilderness Area and the Gila-Aldo Leopold Wilderness Complex

    Science.gov (United States)

    Molly E. Hunter; Jose M. Iniguez; Calvin A. Farris

    2014-01-01

    Fire suppression has been the dominant fire management strategy in the West over the last century. However, managers of the Gila and Aldo Leopold Wilderness Complex in New Mexico and the Saguaro Wilderness Area in Arizona have allowed fire to play a more natural role for decades. This report summarizes the effects of these fire management practices on key resources,...

  4. Data Management in Practice

    DEFF Research Database (Denmark)

    Hansen, Karsten Kryger; Hüser, Falco Jonas; Lavanchy, Paula Maria Martinez

    covering all aspects of the lifecycle of research data: from application, through the research phase, and finally to the dissemination of results and sharing of research data. The setup was to be based on researchers’ demands, and the suggestions and results of the project were to be at an international......This report presents the results of the Data Management i Praksis (DMiP) project (in English: Data Management in Practice). The project was funded by Denmark’s Electronic Research Library (DEFF), the National Danish Archives and the participating main Danish libraries. The following partners...... level. The project should also demonstrate that research libraries have a role to play regarding research data. Furthermore, the project should ensure development of competences at the libraries, which can then be used in the future process of managing research data....

  5. Thai pediatricians' current practice toward childhood asthma.

    Science.gov (United States)

    Kamalaporn, Harutai; Chawalitdamrong, Pongpan; Preutthipan, Aroonwan

    2018-04-01

    Childhood asthma is a substantial health burden in Thailand. Due to a lack of pediatric respiratory specialists (pediatric pulmonologists and allergists; RS), most Thai children are cared for by general pediatricians (pediatric primary care providers (PCP)). We investigated whether current practices of Thai pediatricians complied with asthma guidelines and compared practices (diagnosis and treatments) provided by PCP and RS. A cross-sectional study was conducted using electronic surveys including four case scenarios of different asthma phenotypes distributed to Thai pediatricians. Asthma diagnosis and management were evaluated for compliance with standard guidelines. The practices of PCP and RS were compared. From 800 surveys distributed, there were 405 respondents (51%). Most respondents (81%) were PCP, who preferred to use clinical diagnosis rather than laboratory investigations to diagnose asthma. For acute asthmatic attacks, 58% of the pediatricians prescribed a systemic corticosteroid. For uncontrolled asthma, 89% of the pediatricians prescribed at least one controller. For exercise-induced bronchospasm, 55% of the pediatricians chose an inhaled bronchodilator, while 38% chose a leukotriene receptor antagonist (LTRA). For virus-induced wheeze, 40% of the respondents chose an LTRA, while 15% chose inhaled corticosteroids (ICS). PCP prescribed more oral bronchodilators (31% vs. 18%, p = 0.02), antibiotics (20% vs. 6%, p attack. Most of the Thai pediatricians' practices toward diagnosis and treatment of acute asthmatic attack and uncontrolled asthma conform to the guidelines. PCP prescribed more oral bronchodilators, antibiotics, and antihistamines than RS.

  6. Current Challenges in Social Media Management

    DEFF Research Database (Denmark)

    Tørning, Kristian; Jaffari, Zeshan Ali; Vatrapu, Ravi

    2015-01-01

    and sales, customer support, product innovation etc. To investigate current social media managerial practices, we conducted a multiple case study, employing structured in-depth interviews with social media managers at some of the leading multi-national companies headquartered in Denmark (LEGO®, Mærsk...

  7. Factors in Sustainable Development: Current and Innovative Livestock and Range Management Practices as Perceived by Cattle-Producing Ejidatarios and Private Cattle Ranchers of Sonora, Mexico. A Summary Report of Research. Department Information Bulletin 99-4.

    Science.gov (United States)

    Hamlett, Peggy J.

    A study was conducted to identify and compare livestock production and range management practices currently in use in the Texas/Mexico border corridor, and to determine the acceptance of selected innovative practices among cattle ranchers in the State of Sonora, Mexico. Information was collected from private livestock producers who were members of…

  8. Identifying enabling management practices for employee engagement

    Directory of Open Access Journals (Sweden)

    Marius Joubert

    2011-12-01

    Full Text Available Orientation: A currently emerging viewpoint is that today's management practices no longer add value to organisations. The focus of this article is to conduct a systematic review of the scholarly literature on management practices that could be related to employee engagement. Research purpose: This study searched for evidence in support of the notion of a management value chain, and enabling management practices within each value chain component that could relate to employee engagement. Motivation for the study: An alternative management value chain model could contribute towards a better understanding of which management practices may potentially impact employee engagement. Research design, approach, and method: This is a non-empirical (theoretical study, based on a systematic, in-depth literature review to identify the key management components and enabling practices within this proposed management value chain. Scholarly research databases were sourced for relevant peer reviewed research conducted since 1990, not excluding important contributions prior to 1990. The literature was systematically searched, selected, studied, and contextualized within this study. Main findings: Support was found for the notion of a management value chain, for enabling management practices within each proposed management value chain component, and it was also established these management practices indeed have an impact on employee engagement. Practical/managerial/implications: The possibility that management work can be presented as a generic management value chain allows managers to approach engaging management practices more systematically. Contribution/value-add: This study highlights the importance of some management practices that have never been seen as part of management work.

  9. Assessment and applicability of evaluation tools: Current practice in a sample of European countries and steps towards a state-of-the-art approach. Road Infrastructure Safety Management Evaluation Tools (RISMET), Deliverables No. 4 and 5.

    NARCIS (Netherlands)

    Elvik, R.

    2014-01-01

    This report surveys current practice in a sample of European countries with respect to the use of ten different tools for safety management of road systems. The report also proposes steps that can be taken to bring the use of these management tools closer to their state-of-the-art versions. These

  10. Current practice in transvenous lead extraction

    DEFF Research Database (Denmark)

    Bongiorni, Maria Grazia; Blomström-Lundqvist, Carina; Kennergren, Charles

    2012-01-01

    AIM: Current practice with regard to transvenous lead extraction among European implanting centres was analysed by this survey. METHODS AND RESULTS: Among all contacted centres, 164, from 30 countries, declared that they perform transvenous lead extraction and answered 58 questions...... with a compliance rate of 99.9%. Data from the survey show that there seems to be an overall increasing experience of managing various techniques of lead extraction and a widespread involvement of cardiac centres in this treatment. Results and complication rates seem comparable with those of main international...... registries. CONCLUSION: This survey gives an interesting snapshot of lead extraction in Europe today and gives some clues for future research and prospective European registries....

  11. Overview of current chelation practices

    Directory of Open Access Journals (Sweden)

    Y. Aydinok

    2011-12-01

    , should provide long-term survival and quality of life for patients with iron loading anemias. The goal of this review is to summarize current concepts in iron chelation therapies based on the considerable amount of prospective data obtained by clinical studies. 去铁胺 (DFO)是自20世纪80年以来输血引起铁过载的参考标准疗法。 虽然它是一种高效的铁螯合剂,但是去铁胺皮下给药的遵从性问题依旧是主要问题。 口服螯合剂去铁酮(DFP)在北美没有销售许可证,但是,它在1994年获得印度许可,1999年欧洲联盟(EU)批准授予去铁酮销售许可证,特别是当去铁胺不足、无法忍受或无法接受时,去铁酮可用于重型地中海贫血患者。 还可获得关于在6岁至10岁之间的儿童身上使用去铁酮的有限数据,但是没有关于在6岁以下儿童身上使用去铁酮的数据。 随后美国食品和药品管理局(FDA)和欧洲药品管理局(EMA)分别在2005年和2006年批准口服螯合剂去铁酮作为第一疗法来治疗2岁以上输血引起铁过载的患者。 铁螯合的主要目的是将身体铁维持在安全水平,但一旦铁累积起来,铁螯合的目标是把组织铁降低到安全级别,这是一个缓慢的过程。 确定螯合剂的螯合方案、剂量和频率管理的主要依据是身体铁负担、心肌铁的状态和输血铁负载速率。 适当监控螯合对测量特殊方案的反应速率和提供计量调整来加强螯合效果和避免毒效尤其重要。 由于一些因素,诸如:螯合剂的吸收和代谢,螯合方案的效果可能呈现个别变化。 耐受性和遵从性也是影响螯合反应的个别变量。 了解螯合剂的优点和局限性,准确确定铁过载患者的螯合需求以及设计毒效更小但效果更优的个性化螯合方案,可以向铁过载贫血患者提供长期的生存和生活质量。 此次调研的目的是在临床研究获得的相当数

  12. Waste dumping sites as a potential source of POPs and associated health risks in perspective of current waste management practices in Lahore city, Pakistan

    Energy Technology Data Exchange (ETDEWEB)

    Hafeez, Saba [Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320 (Pakistan); Mahmood, Adeel [Department of Biosciences, COMSATS Institute of Information Technology, Islamabad PO: 45550 (Pakistan); State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640 (China); Syed, Jabir Hussain; Li, Jun [State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640 (China); Ali, Usman [Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320 (Pakistan); Malik, Riffat Naseem, E-mail: r_n_malik2000@yahoo.co.uk [Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320 (Pakistan); Zhang, Gan [State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640 (China)

    2016-08-15

    Persistent organic pollutants (POPs) including polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and dechloran plus (DP) were analyzed in air, dust, soil and water samples from waste dump site, Lahore, Pakistan. It was revealed that PCB levels were detected higher in all matrices than PBDEs and DPs. Principal Component Analysis (PCA) showed higher usage of BDE-47, -99 and di-CBs, tri-CBs, tetra-CBs and penta-CBs. Health risk assessment of PCBs and PBDEs from soil and dust indicated low to moderate risk to the local population via different exposure pathways. It is recommended to improve current waste management practices in order to avoid emissions of contaminants and open dumping grounds should be modified into sanitary landfill. - Highlights: • The pioneer study provides the baseline data from waste dumping site from Lahore. • Dump site of Lahore is the potential source of PCBs, PBDEs and DPs in nearby environment. • Fugacity fractions indicated air to soil deposition of PCBs and PBDEs.

  13. Waste dumping sites as a potential source of POPs and associated health risks in perspective of current waste management practices in Lahore city, Pakistan

    International Nuclear Information System (INIS)

    Hafeez, Saba; Mahmood, Adeel; Syed, Jabir Hussain; Li, Jun; Ali, Usman; Malik, Riffat Naseem; Zhang, Gan

    2016-01-01

    Persistent organic pollutants (POPs) including polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and dechloran plus (DP) were analyzed in air, dust, soil and water samples from waste dump site, Lahore, Pakistan. It was revealed that PCB levels were detected higher in all matrices than PBDEs and DPs. Principal Component Analysis (PCA) showed higher usage of BDE-47, -99 and di-CBs, tri-CBs, tetra-CBs and penta-CBs. Health risk assessment of PCBs and PBDEs from soil and dust indicated low to moderate risk to the local population via different exposure pathways. It is recommended to improve current waste management practices in order to avoid emissions of contaminants and open dumping grounds should be modified into sanitary landfill. - Highlights: • The pioneer study provides the baseline data from waste dumping site from Lahore. • Dump site of Lahore is the potential source of PCBs, PBDEs and DPs in nearby environment. • Fugacity fractions indicated air to soil deposition of PCBs and PBDEs.

  14. Building new WDM regulations for the Namibian tourism sector on factors influencing current water-management practices at the enterprise level

    Science.gov (United States)

    Schachtschneider, Klaudia

    Namibia's aridity is forcing its water sector to resort to new water resource management approaches, including water demand management (WDM). Such a change in management approach is facilitated through the country's opportunity at independence to rewrite and adapt its old policies, including those for water and tourism. Legal support for WDM through the Water Act and other sector-specific Acts is crucial to plan the practical implementation of WDM throughout the different water use sectors of Namibia. In order to be able to put the policy into practice, it is imperative to understand which factors motivate people to adopt WDM initiatives. Within the Namibian tourism industry three main factors have been identified which influence the water-management approaches at tourist facilities. This paper discusses how the water and tourism decision makers can consider these factors when developing new regulations to introduce WDM in the tourism sector.

  15. Interaction of ice storms and management practices on current carbon sequestration in forests with potential mitigation under future CO2 atmosphere

    Science.gov (United States)

    Heather R. McCarthy; Ram Oren; Hyun-Seok Kim; Kurt H. Johnsen; Chris Maier; Seth G. Pritchard; Michael A. Davis

    2006-01-01

    Ice storms are disturbance events with potential impacts on carbon sequestration. Common forest management practices, such as fertilization and thinning, can change wood and stand properties and thus may change vulnerability to ice storm damage. At the same time, increasing atmospheric CO2 levels may also influence ice storm vulnerability. Here...

  16. Practice management companies improve practices' financial position.

    Science.gov (United States)

    Dupell, T

    1997-11-01

    To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

  17. Current management of hepatocellular carcinoma

    Science.gov (United States)

    Tabrizian, Parissa; Roayaie, Sasan; Schwartz, Myron E

    2014-01-01

    Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and leading cause of death among patients with cirrhosis. Treatment guidelines are based according to the Barcelona Clinic Liver Cancer staging system. The choice among therapeutic options that include liver resection, liver transplantation, locoregional, and systemic treatments must be individualized for each patient. The aim of this paper is to review the outcomes that can be achieved in the treatment of HCC with the heterogeneous therapeutic options currently available in clinical practice. PMID:25132740

  18. Process management practice

    International Nuclear Information System (INIS)

    Pyeon, In Beom

    1983-04-01

    This book gives descriptions of qualifying subject and test scope like production plan and control, economic feasibility, process management, quality management and operations research, industrial economics like materials and marketing management, production management such as meaning and goals of process management and production plan and control, basic economic concept, official interest and equivalence, and depreciation, and OR concept such as network analysis and PERT CPM and stimulation.

  19. Risk Management Practices by Barbadian Banks

    Directory of Open Access Journals (Sweden)

    Anthony Wood

    2013-07-01

    The main findings of the paper are: risk managers perceive risk management as critical to their banks’ performance; the types of risks causing the greatest exposures are credit risk, operational risk, country/sovereign risk, interest rate risk and market risk; there was a high level of success with current risk management practices and these practices have evolved over time in line with the changing economic environment and regulatory updates. Overall, the findings suggest strongly that in light of the current depressed economic climate, banks operating in Barbados are indeed risk-focused or might we say “risk intelligent”.

  20. Efficient silvicultural practices for eastern hardwood management

    Science.gov (United States)

    Gary W. Miller; John E. Baumgras

    1994-01-01

    Eastern hardwood forests are now managed to meet a wide range of objectives, resulting in the need for silvicultural alternatives that provide timber, wildlife, aesthetics, recreation, and other benefits. However, forest management practices must continue to be efficient in terms of profiting from current harvests, protecting the environment, and sustaining production...

  1. Current obstetrical practice and umbilical cord prolapse.

    Science.gov (United States)

    Usta, I M; Mercer, B M; Sibai, B M

    1999-01-01

    The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

  2. Management practices for health physicists

    International Nuclear Information System (INIS)

    Gibson, J.L.

    1982-01-01

    Th essence of management is obtaining results through the efforts of other people. The efforts obtained, or performance, are enhanced by those who practice management with certain understandings of the work, role and behavior of management, who have the will to manage, and who have requisite skill and aptitude. Discussion of managerial work, role, and behavior comprises the major part of the following paper. The paper concludes with the suggestion that ineffective management is not the result of lack of knowledge about managing, rather ineffective management is more often the result of a lack of will to manage

  3. Current management of wound healing

    DEFF Research Database (Denmark)

    Gottrup, F; Karlsmark, T

    2009-01-01

    in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing......While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information...... containing active substances will be accentuated. Further developments in the management structure and education will also continue and consensus of treatment guidelines, recommendations and organization models will hopefully be achieved....

  4. An Evaluation of Current Stormwater Best Management Practice Relationships Between Design and Efficiency: A Series of Local and National Case Studies

    OpenAIRE

    Goodwin, Amanda Ann

    2013-01-01

    Water quality continues to be threatened by human development activities such as stormwater runoff from urbanization. This study addresses the question of how stormwater Best Management Practice (BMP) system design choices affect pollutant removal efficiency, through the examination of 12 case study sites (across five states) that use three common BMP system design types (detention, retention, and wetland channel). Water quality information was obtained from the International Stormwater Datab...

  5. Practical management of hyperthyroidism

    International Nuclear Information System (INIS)

    Houston, M.S.; Hay, I.D.

    1990-01-01

    There are several causes of hyperthyroidism, and correct diagnosis is essential for management. Graves' disease is most commonly managed with radioactive iodine therapy ( 131 I), antithyroid drugs or surgery. Toxic adenomas (single or multiple) may be treated with 131 I or surgery. Most types of thyroiditis are managed expectantly. Pregnant women, children and the elderly deserve special consideration. Follow-up is vital to identify the later development of hypothyroidism.18 references

  6. Practical management of hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Houston, M.S.; Hay, I.D. (Mayo Clinic, Rochester, MN (USA))

    1990-03-01

    There are several causes of hyperthyroidism, and correct diagnosis is essential for management. Graves' disease is most commonly managed with radioactive iodine therapy ({sup 131}I), antithyroid drugs or surgery. Toxic adenomas (single or multiple) may be treated with {sup 131}I or surgery. Most types of thyroiditis are managed expectantly. Pregnant women, children and the elderly deserve special consideration. Follow-up is vital to identify the later development of hypothyroidism.18 references.

  7. Configuration management theory, practice, and application

    CERN Document Server

    Quigley, Jon M

    2015-01-01

    Configuration Management: Theory, Practice, and Application details a comprehensive approach to configuration management from a variety of product development perspectives, including embedded and IT. It provides authoritative advice on how to extend products for a variety of markets due to configuration options. The book also describes the importance of configuration management to other parts of the organization. It supplies an overview of configuration management and its process elements to provide readers with a contextual understanding of the theory, practice, and application of CM. Explaining what a configuration item is and what it implies, the book illustrates the interplay of configuration and data management with all enterprise resources during each phase of a product lifecycle. It also demonstrates the interrelationship of CM to functional resources. Shedding light on current practice, the book describes CM baselines, configuration identification, management baseline changes, and acceptance criteria ...

  8. Current economic trends in equine practice.

    Science.gov (United States)

    Clark, Andrew R

    2009-12-01

    Current economic trends in equine practice are trends of weakness. Most practices, after a decade of double-digit growth, have migrated to survival mode within a few months. Understanding that all regions and disciplines are affected differently, using the Porter five forces model, we can identify changes that must be made in our business models first to survive and then to position ourselves to prosper when the recession ends. If we are to avoid long-term damage to our practices, we must use cost control and work efficiency in addition to price concessions.

  9. Employability management practices in the Polish ICT sector

    NARCIS (Netherlands)

    Marzec, I.; van der Heijden, Beatrice; Scholarios, D.; van der Schoot, E.; Jedrzejowicz, P.; Bozionelos, N.; Epitropaki, O.; Knauth, P.; Mikkelsen, A.; van der Heijde, C.M.

    2009-01-01

    This article examines current career thinking and employability management practices within the Polish Information and Communication Technology (ICT) sector. The aim of this contribution is to identify career management problems and to determine obstacles for implementing employability management

  10. How Advertising History Helps Explain Current Practices.

    Science.gov (United States)

    Lanfranco, Leonard W.

    Students majoring in advertising can benefit from a study of that field in its historical context because such study helps them to understand current practices and to foresee future developments. One model of teaching advertising history within a required course about advertising and society begins with some basic definitions of the advertising…

  11. Teaching Math Online: Current Practices in Turkey

    Science.gov (United States)

    Akdemir, Omur

    2011-01-01

    Changing nature of student population, developments in technology, and insufficient number of traditional universities have made online courses popular around the globe. This study was designed to investigate the current practices of teaching mathematics online in Turkish Universities through a qualitative inquiry. The snowball sampling method was…

  12. Canonical discrimination of the effect of a new broiler production facility on soil chemical profiles as related to current management practices.

    Directory of Open Access Journals (Sweden)

    Cynthia L Sheffield

    Full Text Available The effect dirt-floored broiler houses have on the underlying native soil, and the potential for contamination of the ground water by leaching under the foundation, is an understudied area. This study examines alterations in fifteen quantitative soil parameters (Ca, Cu, electrical conductivity, Fe, K, Mg, Mn, Na, NO3, organic matter, P, pH, S, soil moisture and Zn in the underlayment of a newly constructed dirt-floored broiler house over the first two years of production (Native through Flock 11. The experiment was conducted near NW Robertson County, Texas, where the native soil is a fine, smectitic thermic Udertic Paleustalfs and the slopes range from zero to three percent. Multiple samples were collected from under each of three water and three feed lines the length of the house, in a longitudinal study during February 2008 through August 2010. To better define the relationship between the soil parameters and sampling times, a canonical discriminant analysis approach was used. The soil profiles assembled into five distinctive clusters corresponding to time and management practices. Results of this work revealed that the majority of parameters increased over time. The management practices of partial and total house clean-outs markedly altered soil profiles the house underlayment, thus reducing the risk of infiltration into the ground water near the farm. This is important as most broiler farms consist of several houses within a small area, so the cumulative ecological impact could be substantial if not properly managed.

  13. Management Accounting in Denmark; Theory and Practice

    DEFF Research Database (Denmark)

    Israelsen, Poul; Andersen, Michael; Rohde, Carsten

    1996-01-01

    The article describes the present state of cost and management accounting in Denmark within “mainstream accounting”, both as regards theory and practice. In the case of theory, there has been a gradual convergence of views. The essence of these views is briefly described. Concerning practice......, the main results of two new empirical studies are presented one on product costing and the other on identifying the adoption of “modern cost management techniques” in Denmark. The article places both current theory and practice in their historical context. In the former, this is done through an outline...

  14. Contemporary management of pericardial effusion: practical aspects for clinical practice.

    Science.gov (United States)

    Imazio, Massimo; Gaido, Luca; Battaglia, Alberto; Gaita, Fiorenzo

    2017-03-01

    A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.

  15. Curating research data a handbook of current practice

    CERN Document Server

    Johnston, Lisa R

    2017-01-01

    Curating Research Data, Volume Two: A Handbook of Current Practice guides you across the data lifecycle through the practical strategies and techniques for curating research data in a digital repository setting. The data curation steps for receiving, appraising, selecting, ingesting, transforming, describing, contextualizing, disseminating, and preserving digital research data are each explored, and then supplemented with detailed case studies written by more than forty international practitioners from national, disciplinary, and institutional data repositories. The steps in this volume detail the sequential actions that you might take to curate a data set from receiving the data (Step 1) to eventual reuse (Step 8). Data curators, archivists, research data management specialists, subject librarians, institutional repository managers, and digital library staff will benefit from these current and practical approaches to data curation.

  16. Environmental management as situated practice

    DEFF Research Database (Denmark)

    Lippert, Ingmar; Krause, Franz; Hartmann, Niklas Klaus

    2015-01-01

    We propose an analysis of environmental management (EM) as work and as practical activity. This approach enables empirical studies of the diverse ways in which professionals, scientists, NGO staffers, and activists achieve the partial manageability of specific “environments”. In this introduction......, we sketch the debates in Human Geography, Management Studies, and Science and Technology Studies to which this special issue contributes. We identify the limits of understanding EM though the framework of ecological modernisation, and show how political ecology and work-place studies provide...... to be assessed, or as simply the implementation of dominant projects and the materialisation of hegemonic discourse. Such a shift renders EM as always messy practices of engagement, critique and improvisation. We conclude that studying the distributed and situated managing agencies, actors and their practices...

  17. Human resource management practices stimulating knowledge sharing

    Directory of Open Access Journals (Sweden)

    Matošková Jana

    2017-12-01

    Full Text Available The major goal of the paper was to develop a theoretical framework that conceptualizes the indirect impact on human resource management practice on knowledge sharing in the organization. In the current competitive environment, the ability to use knowledge assets and to continuously renovate it is required for organizational success. Therefore, the field of human resource management should dedicate great effort to understanding how to enhance the knowledge flows within the organization. Theoretical indications were provided about HRM practices that influence the quality and quantity of knowledge sharing within an organization. Further, a conceptual model of relations between HRM practices and factors influencing knowledge sharing within an organization was introduced. It is supposed that HRM practices have direct impacts on personality traits of employees, organizational culture, characteristics of managers, and instruments used for knowledge sharing. Subsequently, these factors have direct effects on the perceived intensity of knowledge sharing. The paper offers 12 testable propositions for the indirect relation between HRM practices and knowledge sharing in the organization. The suggested model could assist future research to examine the influence of HRM practices upon managing knowledge is a more complex way. Via a theoretical contribution to the debate on the influence on HRM practices upon managing knowledge, the study contributes to further research development in this field.

  18. Professional courtesy--current practices and attitudes.

    Science.gov (United States)

    Levy, M A; Arnold, R M; Fine, M J; Kapoor, W N

    1993-11-25

    Physicians have long provided care free of charge or at a reduced rate as a professional courtesy to other physicians and their families. We conducted a stratified national mail survey to assess the extent to which this practice has changed in recent years. Using the American Medical Association's 1991 master list of physicians, we selected a random sample of 4800 practicing physicians from 12 direct-care specialties. These physicians were asked about their current policy and opinions regarding professional courtesy. Of the 2224 respondents, 2127 (96 percent) offered professional courtesy, defined as providing free or discounted health care to physicians and their families. Psychiatrists were less likely to offer professional courtesy than physicians in any of the other specialties (80 percent vs. 91 to 99 percent, P courtesy included billing only the insurance company (75 percent), providing care at no charge (49 percent), and giving a partial discount (23 percent). Twenty-three percent of the respondents reported that they had changed their policy regarding professional courtesy since starting to practice. Among those who had changed their policy, the most common changes were to increase the practice of billing only the insurance company (67 percent) and to provide care at no charge less often (58 percent). The majority of physicians responding to the survey thought that professional courtesy solidified bonds between physicians (79 percent) and was sound business practice (62 percent); 12 percent believed that it was too expensive to offer free or discounted care as a professional courtesy, and 14 percent thought that the practice had negative effects on the physician-patient interaction. Our survey of physicians involved in direct patient care indicates that, with the exception of psychiatrists, almost all American physicians offer free or discounted care as a professional courtesy and support the practice.

  19. Current Chemical Risk Management Activities

    Science.gov (United States)

    EPA's existing chemicals programs address pollution prevention, risk assessment, hazard and exposure assessment and/or characterization, and risk management for chemicals substances in commercial use.

  20. Current management of fungal infections.

    NARCIS (Netherlands)

    Meis, J.F.G.M.; Verweij, P.E.

    2001-01-01

    The management of superficial fungal infections differs significantly from the management of systemic fungal infections. Most superficial infections are treated with topical antifungal agents, the choice of agent being determined by the site and extent of the infection and by the causative organism,

  1. Native vegetation establishment for IDOT erosion control best management practices.

    Science.gov (United States)

    2014-05-01

    The objective of this report was to develop native roadside vegetation best management practices for : the Illinois Department of Transportation. A review of current practices was undertaken, along with a : review of those of other state departments ...

  2. Multidisciplinary management of clear-cell renal cell carcinoma in Africa and the Middle East: current practice and recommendations for improvement

    Directory of Open Access Journals (Sweden)

    Zekri J

    2015-07-01

    Full Text Available Jamal Zekri,1 Lydia M Dreosti,2 Marwan Ghosn,3 Emad Hamada,4 Mohamed Jaloudi,5 Ola Khorshid,6 Blaha Larbaoui7 1College of Medicine, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Jeddah, Saudi Arabia; 2Department of Medical Oncology, University of Pretoria, Pretoria, South Africa; 3Faculty of Medicine Hematology, Oncology Department, Saint Joseph University, Beirut, Lebanon; 4Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt; 5Oncology Hematology Department, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates; 6National Cancer Institute, Cairo University, Kasr El Ainy, Cairo, Egypt; 7Oncology Service, Université Djillali Liabés, Sidi Bel Abbés, Algeria Abstract: The management of renal cell carcinoma (RCC has evolved considerably in recent years. This report represents the consensus of 22 relevant medical specialists from Africa and the Middle East region engaged in the management of RCC. Partial or radical nephrectomy is the standard of care for most patients with localized RCC. It is essential that patients are followed up appropriately after surgery to enable local and distant relapses to be identified and treated promptly. The treatment of advanced/metastatic disease has changed dramatically with the introduction of targeted therapies. Follow-up of these patients enables therapy optimization and assessment of response to treatment. There was universal agreement on the importance of management of RCC by a multidisciplinary team supported by a multidisciplinary tumor board. Barriers hindering this approach were identified. These included lack of awareness of the benefits of multidisciplinary team role, poor communication among relevant disciplines, time constraints, and specifics of private practice. Other challenges include shortage of expert specialists as urologists and oncologists and lack of local management guidelines in some countries. Solutions were proposed and discussed. Medical

  3. Revisiting current “barefoot doctors” in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI

    Directory of Open Access Journals (Sweden)

    Li Xiuyun

    2012-08-01

    Full Text Available Abstract Background Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas. Methods The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6% were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics. Results The study found that the New Rural Cooperative Medical Scheme (NRCMS coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling

  4. Current management of peptic ulcer perforations

    International Nuclear Information System (INIS)

    Menakuru, S.R.

    2004-01-01

    Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

  5. Clinical Practices in Collegiate Concussion Management.

    Science.gov (United States)

    Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P

    2016-06-01

    In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying

  6. PRACTICAL METHODS OF BANKING MANAGEMENT – APPLICATION IN PRACTICE

    Directory of Open Access Journals (Sweden)

    Bodretskiy M.

    2018-03-01

    Full Text Available Introduction. The article presents the latest trends in the development of banking management in Ukraine. Purpose. The research is aimed at the study of practical methods of banking institutions management in Ukraine. Results. The results of the research, which prove the determination by most banks of such management methods based on the principles of minimizing operating costs of a banking institution, are proved. The main areas of such a minimization, most banks identified: the involvement of inexperienced staff, increase the level of automation of banking processes, increasing attention to non-price methods of attracting customers. A classification of non-price methods of attracting customers is made. The use of mathematical tools for determining the quality of management by a banking institution is proposed. The article states that in order to prevent the manifestations of crisis phenomena in a banking institution (predictors of which may be: the emergence of a negative spread, loss-making activity of the bank, etc. it is necessary to have an optimal, economically sound portfolio of practical management methods that can be practically useful for execution on operational and tactical level of managerial decisions of banking management. The article contains the results of the survey of specialists and scientists who took part in the scientific and practical conference “Anti-crisis management of economy and finances”, held in 2017. The main areas of work of the mentioned conference were: search of ways of overcoming of crisis phenomena in economy and finances of Ukraine; definition of strategic aspects of the development of the financial system of the state in the context of the growth of the negative consequences of the growth of tension in international and economic relations; definition of fiscal policy of Ukraine and the impact of its quality on the quality of the banking system in the conditions of stagnation of financial markets, etc

  7. Physician Asthma Management Practices in Canada

    Directory of Open Access Journals (Sweden)

    Robert Jin

    2000-01-01

    Full Text Available OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.

  8. Fertility Management. Contraception in Practice Management of ...

    African Journals Online (AJOL)

    developing countries. Having worked in the family planning Unit of Tygerberg ... The main theme is patient care and management, thus high ... The chapter approaches two groups - those in which ... markers and gene therapy, but may well ponder their current ... the Decline and Fall of cancer surgery - is written. The receipt ...

  9. Case management: developing practice through action research.

    Science.gov (United States)

    Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen

    2013-09-01

    This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.

  10. A synopsis on current practice in the diagnosis and management of patients with Turner syndrome in Turkey: A survey of 18 pediatric endocrinology centers*

    Science.gov (United States)

    Uçar, Ahmet; Abacı, Ayhan; Pirgon, Özgür; Dündar, Bumin; Tütüncüler, Filiz; Çatlı, Gönül; Anık, Ahmet; Kılınç Uğurlu, Aylin; Büyükgebiz, Atilla

    2018-04-27

    A comprehensive survey was conducted courtesy of the Turkish Turner study group to evaluate the shortcomings of clinical care in patients with Turner syndrome (TS) in Turkey. A structured questionnaire prepared by the Turner study group in Turkey, which covers relevant aspects of the care of patients with TS, was sent to all pediatric endocrinology centers. Eighteen centers (41%) returned the questionnaire. In the majority of the centers, diagnostic genetic testing, screening for Y chromosomal material, protocols regarding the timing and posology of growth hormone (GH) and estrogen, thrombophilia screening, fertility information, and screening for glucose intolerance, thyroid, and coeliac diseases in patients with TS were in line with the current consensus. Thirteen centers (72.2%) performed GH stimulation tests. Only four centers (22.2%) used oxandrolone in patients with TS with very short stature. The majority of the centers relied on bone age and breast development to assess estrogen adequacy, though together with variable combinations of oestrogen surrogates. Two centers (11.1%) reported performing serum estradiol measurements. Eight centers (44.4% ) routinely conducted cardiac/thoracic aorta magnetic resonance imaging. Screening for hearing, dental, and ophthalmologic problems were performed by thirteen (72.2%), six (33.3%), and ten (55.6 %) centers, respectively. Psychiatric assessments were made by four centers (22.2%) at diagnosis, with only one center (5.6% ) requiring annual reassessments. Although we found some conformity between the current consensus and practice of the participating centers in Turkey regarding TS, further improvements are mandatory in the multi-disciplinary approach to address co-morbidities, which if unrecognized, may be associated with reduced quality of life, and even mortality.

  11. Knowledge management systems in practice

    DEFF Research Database (Denmark)

    Tørning, Kristian

    which has the strategy of working with knowledge in the form of "best practices" meant to boost performance. The thesis explores the situation that workers are in, since they are meant to share and develop "best practices" knowledge in a portal based Knowledge Management System (KMS). The study...... indentifies a set of problems that prevents knowledge sharing from taking place to the degree to which management was specifically aiming. It was explored whether these problems could, to some degree, be mitigated by employing persuasive design, which is a new stance towards design where the aim...... is to directly seek to change the user's behavior, i.e., persuading more knowledge sharing. The main contribution is an indication of an anomaly with regards to the strategic approach towards knowledge management, where knowledge sharing is seen as an effort by which companies can gain a competitive advantage...

  12. E-waste: Environmental Problems and Current Management

    Directory of Open Access Journals (Sweden)

    D. Aktsoglou

    2010-01-01

    Full Text Available In this paper the environmental problems related with the discarded electronic appliances, known as e-waste, are reviewed.Moreover, the current and the future production of e-waste, the potential environmental problems associated with theirdisposal and management practices are discussed whereas the existing e-waste management schemes in Greece and othercountries (Japan, Switzerland are also quoted.

  13. Evaluating Current Practices in Shelf Life Estimation.

    Science.gov (United States)

    Capen, Robert; Christopher, David; Forenzo, Patrick; Huynh-Ba, Kim; LeBlond, David; Liu, Oscar; O'Neill, John; Patterson, Nate; Quinlan, Michelle; Rajagopalan, Radhika; Schwenke, James; Stroup, Walter

    2018-02-01

    The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) methods for determining the supported shelf life of a drug product, described in ICH guidance documents Q1A and Q1E, are evaluated in this paper. To support this evaluation, an industry data set is used which is comprised of 26 individual stability batches of a common drug product where most batches are measured over a 24 month storage period. Using randomly sampled sets of 3 or 6 batches from the industry data set, the current ICH methods are assessed from three perspectives. First, the distributional properties of the supported shelf lives are summarized and compared to the distributional properties of the true shelf lives associated with the industry data set, assuming the industry data set represents a finite population of drug product batches for discussion purposes. Second, the results of the ICH "poolability" tests for model selection are summarized and the separate shelf life distributions from the possible alternative models are compared. Finally, the ICH methods are evaluated in terms of their ability to manage risk. Shelf life estimates that are too long result in an unacceptable percentage of nonconforming batches at expiry while those that are too short put the manufacturer at risk of possibly having to prematurely discard safe and efficacious drug product. Based on the analysis of the industry data set, the ICH-recommended approach did not produce supported shelf lives that effectively managed risk. Alternative approaches are required.

  14. Challenges for current University management

    Directory of Open Access Journals (Sweden)

    Pedro Rodríguez Vargas

    2016-03-01

    Full Text Available The Ecuadorian university through a change of era, this complex pathway mediated by globalization imposes imminently. The aim of this paper is to present a review of literature on the main aspects of management that are generated for the interaction University - context. This scan was performed on secondary sources, and grounded in scienti?c data abstraction. College education is an information and training process that allows the scientific, technological, economic, political, social and cultural development of a region or country; however, some phenomena such as globalization, technological revolution or multiculturalism are key to this, same that can be considered as a problem or a challenge.

  15. Massive transfusion protocols: current best practice

    Directory of Open Access Journals (Sweden)

    Hsu YM

    2016-03-01

    Full Text Available Yen-Michael S Hsu,1 Thorsten Haas,2 Melissa M Cushing1 1Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA; 2Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland Abstract: Massive transfusion protocols (MTPs are established to provide rapid blood replacement in a setting of severe hemorrhage. Early optimal blood transfusion is essential to sustain organ perfusion and oxygenation. There are many variables to consider when establishing an MTP, and studies have prospectively evaluated different scenarios and patient populations to establish the best practices to attain improved patient outcomes. The establishment and utilization of an optimal MTP is challenging given the ever-changing patient status during resuscitation efforts. Much of the MTP literature comes from the trauma population, due to the fact that massive hemorrhage is the leading cause of preventable trauma-related death. As we come to further understand the positive and negative clinical impacts of transfusion-related factors, massive transfusion practice can be further refined. This article will first discuss specific MTPs targeting different patient populations and current relevant international guidelines. Then, we will examine a wide selection of therapeutic products to support MTPs, including newly available products and the most suitable of the traditional products. Lastly, we will discuss the best design for an MTP, including ratio-based MTPs and MTPs based on the use of point-of-care coagulation diagnostic tools. Keywords: hemorrhage, MTP, antifibrinolytics, coagulopathy, trauma, ratio, logistics, guidelines, hemostatic

  16. Telehealth: current practices and future directions

    Science.gov (United States)

    David, Yadin B.

    1996-02-01

    When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

  17. [Current management of thalassemia intermedia].

    Science.gov (United States)

    Thuret, I

    2014-11-01

    Thalassemia intermedia is a clinical entity where anemia is mild or moderate, requiring no or occasional transfusion. Non-transfusion-dependent thalassemia encompasses 3 main clinical forms: beta-thalassemia intermedia, hemoglobin E/beta-thalassemia and alpha-thalassemia intermedia (HbH disease). Clinical severity of thalassemia intermedia increases with age, with more severe anemia and more frequent complications such as extramedullary hematopoiesis and iron overload mainly related to increased intestinal absorption. Numerous adverse events including pulmonary hypertension and hypercoagulability have been associated with splenectomy, often performed in thalassemia intermedia patients. The potential preventive benefit of transfusion and chelation therapies on the occurrence of numerous complications supports the strategy of an earlier therapeutic intervention. Increasing knowledge about pathophysiological mechanisms involved in thalassemia erythropoiesis and related iron overload is currently translating in novel therapeutic approaches. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Current pharmacotherapies for obesity: A practical perspective.

    Science.gov (United States)

    Golden, Angela

    2017-10-01

    To review the currently available pharmacotherapies for obesity management with a particular focus on the United States. Narrative review based on literature searches and the latest prescribing information (up to July 2017). Obesity pharmacotherapies may assist those individuals who have obesity, or overweight with comorbidities, who have failed to maintain weight loss with lifestyle modifications alone (caloric restriction and increased physical activity). Currently approved options in the United States include phentermine for short-term use and five obesity pharmacotherapies that can be used long-term (orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, and liraglutide 3.0 mg). If the use of an obesity pharmacotherapy is indicated, treatment should be selected to provide the most appropriate option for each individual and their circumstances. Variables such as contraindications, individual comorbidities, patient choice, patient readiness to incorporate additional behavioral changes (e.g., alcohol prohibition), and cost should guide choices. Each of the obesity pharmacotherapies has advantages and disadvantages that can help guide treatment choice. Those receiving treatment may also have individual preferences based on factors such as administration route, frequency of dosing, and/or safety profile. In addition, some options may be particularly appropriate for patients with common obesity-related complications such as depression or diabetes. ©2017 American Association of Nurse Practitioners.

  19. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  20. Orofacial pain management: current perspectives.

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

  1. Current management of overactive bladder.

    Science.gov (United States)

    Cartwright, Rufus; Renganathan, Arasee; Cardozo, Linda

    2008-10-01

    The concept of overactive bladder has helped us address the problem of urgency and urge incontinence from a symptomatic perspective. In this review, we provide a critical summary of clinically relevant recent publications, focusing in particular on advances in our understanding of assessment methods and therapeutic interventions for overactive bladder in women. According to current definitions, the prevalence of overactive bladder in western nations is now estimated as 13.0%. Although the prevalence increases with age, the symptoms of overactive bladder may follow a relapsing and remitting course. There has been a proliferation of validated symptom and quality of life measures and increasing sophistication in the analysis of bladder diaries. The role of urodynamics in the evaluation of urgency remains uncertain, with many trials showing limited benefit as a preoperative investigation. Fluid restriction and bladder retraining remain important first-line interventions. Many new anticholinergic medications have been licensed, with limited benefits compared with existing preparations. Intravesical botulinum toxin has become a popular alternative for patients who fail oral therapies. Although there have been few important therapeutic innovations, recent publications have led to greater sophistication in assessment methods and a clearer understanding of the role of existing interventions.

  2. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol.

    Science.gov (United States)

    Benger, Jonathan Richard; Voss, Sarah; Coates, David; Greenwood, Rosemary; Nolan, Jerry; Rawstorne, Steven; Rhys, Megan; Thomas, Matthew

    2013-01-01

    Effective cardiopulmonary resuscitation with appropriate airway management improves outcomes following out-of-hospital cardiac arrest (OHCA). Historically, tracheal intubation has been accepted as the optimal form of OHCA airway management in the UK. The Joint Royal Colleges Ambulance Liaison Committee recently concluded that newer supraglottic airway devices (SADs) are safe and effective devices for hospital procedures and that their use in OHCA should be investigated. This study will address an identified gap in current knowledge by assessing whether it is feasible to use a cluster randomised design to compare SADs with current practice, and also to each other, during OHCA. The primary objective of this study is to assess the feasibility of a cluster randomised trial to compare the ventilation success of two newer SADs: the i-gel and the laryngeal mask airway supreme to usual practice during the initial airway management of OHCA. The secondary objectives are to collect data on ventilation success, further airway interventions required, loss of a previously established airway during transport, airway management on arrival at hospital (or termination of the resuscitation attempt), initial resuscitation success, survival to intensive care admission, survival to hospital discharge and patient outcome at 3 months. Ambulance paramedics will be randomly allocated to one of the three methods of airway management. Adults in medical OHCA attended by a trial paramedic will be eligible for the study. Approval for the study has been obtained from a National Health Service Research Ethics Committee with authority to review proposals for trials of a medical device in incapacitated adults. The results will be made publicly available on an open access website, and we will publish the findings in appropriate journals and present them at national and international conferences relevant to the subject field. ISRCTN: 18528625.

  3. IMPROVING SITE MANAGEMENT PRACTICES IN THE NIGERIAN ...

    African Journals Online (AJOL)

    Osondu

    This study assessed management practices on ... technological methods adopted and huge ... Ethiopian Journal of Environmental Studies and Management EJESM Vol. 5 No. .... perspectives. .... specifications, cost data, programmes, plus.

  4. Current practices and options for confinement of uranium mill tailings

    International Nuclear Information System (INIS)

    1981-01-01

    At the United Nations Conference on the Human Environment, which took place in Stockholm from 4 to 6 June 1972, national governments were asked to explore, with the International Atomic Energy Agency and other appropriate international organizations, international co-operation on radioactive waste matters including those of mining and tailings disposal. Since that time the IAEA has been active in the field of uranium and thorium mill tailings management. As part of this activity, the present report describes current practices and options for confinement of uranium mill tailings. It is addressed to technical and administrative personnel who are involved in planning and implementing national and industrial programmes on the management of such tailings. In 1974 and 1975 the IAEA convened meetings of experts to review matters of interest and importance in the management of uranium and thorium mine and mill tailings. These activities led to the publication in 1976 of Management of Wastes from the Mining and Milling of Uranium and Thorium Ores, a Code of Practice and Guide to the Code, IAEA Safety Series No. 44. As a continuation of this activity, the IAEA is here dealing more specifically with the design and siting considerations for the management of uranium mill tailings

  5. 21 CFR 225.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 225.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS General Provisions § 225.1 Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act...

  6. 21 CFR 110.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 110.5 Section...) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PACKING, OR HOLDING HUMAN FOOD General Provisions § 110.5 Current good manufacturing practice. (a) The criteria and...

  7. 21 CFR 1271.150 - Current good tissue practice requirements.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Current good tissue practice requirements. 1271... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150 Current good tissue practice requirements. (a) General. This subpart D and subpart C of this part set...

  8. 21 CFR 226.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 226.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES General Provisions § 226.1 Current good manufacturing practice. (a) The criteria in §§ 226.10 through 226.115, inclusive...

  9. 40 CFR 503.24 - Management practices.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.24 Section... FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Surface Disposal § 503.24 Management practices. (a) Sewage... the permitting authority that through management practices public health and the environment are...

  10. Cardioversion for atrial fibrillation in current European practice

    DEFF Research Database (Denmark)

    Hernández-Madrid, Antonio; Svendsen, Jesper Hastrup; Lip, Gregory Y.H.

    2013-01-01

    This survey was conducted to provide an insight into the current clinical practice regarding the use of cardioversion for atrial fibrillation (AF) in Europe. Responses were received from 57 centres across Europe, 71.9% of which were university hospitals. For electrical cardioversion, general...... anaesthesia was managed by an anaesthesiologist in 73.9% of centres and by a cardiologist in 37%. In the majority of centres, electrical cardioversion was performed using a biphasic defibrillator (85.1%). Antiarrhythmic drugs were routinely prescribed prior to electrical cardioversion by 54.3% of hospitals...

  11. Strategic Information Resources Management: Fundamental Practices.

    Science.gov (United States)

    Caudle, Sharon L.

    1996-01-01

    Discusses six fundamental information resources management (IRM) practices in successful organizations that can improve government service delivery performance. Highlights include directing changes, integrating IRM decision making into a strategic management process, performance management, maintaining an investment philosophy, using business…

  12. Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

    Science.gov (United States)

    Arnold, Lesley M; Clauw, Daniel J

    2017-09-01

    The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

  13. Translating Management Practices in Hierarchical Organizations

    DEFF Research Database (Denmark)

    Wæraas, Arild; Nielsen, Jeppe Agger

    structures affect translators’ approaches taken towards management ideas. This paper reports the findings from a longitudinal case study of the translation of Leadership Pipeline in a Danish fire department and how the translators’ approach changed over time from a modifying to a reproducing mode. The study......This study examines how translators in a hierarchical context approach the translation of management practices. Although current translation theory and research emphasize the importance of contextual factors in translation processes, little research has investigated how strongly hierarchical...... finds that translation does not necessarily imply transformation of the management idea, pointing instead to aspects of exact imitation and copying of an ”original” idea. It also highlights how translation is likely to involve multiple and successive translation modes and, furthermore, that strongly...

  14. 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.

  15. 21 CFR 120.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 120.5 Section... Provisions § 120.5 Current good manufacturing practice. Part 110 of this chapter applies in determining whether the facilities, methods, practices, and controls used to process juice are safe, and whether the...

  16. 21 CFR 129.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 129.1 Section... Current good manufacturing practice. The applicable criteria in part 110 of this chapter, as well as the..., methods, practices, and controls used in the processing, bottling, holding, and shipping of bottled...

  17. 21 CFR 113.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 113.5 Section... CONTAINERS General Provisions § 113.5 Current good manufacturing practice. The criteria in §§ 113.10, 113.40..., methods, practices, and controls used by the commercial processor in the manufacture, processing, or...

  18. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  19. Healthcare resource utilization for anemia management: current practice with erythropoiesis-stimulating agents and the impact of converting to once-monthly C.E.R.A.

    Science.gov (United States)

    Saueressig, Ulrich; Kwan, Jonathan T C; De Cock, Erwin; Sapède, Claudine

    2008-01-01

    Background andMethods: A prospective, observational study in 12 German and UK dialysis centers which quantified personnel time for anemia treatment using erythropoiesis-stimulating agents (ESAs). Tasks directly observable were measured through the time-and-motion method; time for non-observable tasks was estimated by healthcare staff. Using activity-based costing methods, time was converted into monetary units. Modeling was used to estimate potential time and cost savings using once-monthly C.E.R.A., a continuous erythropoietin receptor activator. For current ESAs in Germany and the UK, respectively: mean observed time was 1.67 and 2.67 min/patient/administration, corresponding to 31 and 42 days/year/center/100 patients; mean total time/center/100 patients/year was estimated at 79 and 95 days, equivalent to EUR 17,031 and GBP 18,739. Assuming 100% once-monthly C.E.R.A. uptake, the observed time/patient/year may decrease by 79 and 84% in Germany and the UK, respectively, compared with traditional ESAs. Conversion to once-monthly C.E.R.A. may offer the potential to reduce time spent on ESA administration in hemodialysis centers. Copyright 2008 S. Karger AG, Basel.

  20. Management of inflammatory bowel disease-related anemia and iron deficiency with specific reference to the role of intravenous iron in current practice.

    Science.gov (United States)

    Stein, Jürgen; Aksan, Ayşegül; Farrag, Karima; Dignass, Axel; Radeke, Heinfried H

    2017-11-01

    Anemia is a common extraintestinal manifestation in patients with inflammatory bowel disease, impacting disease prognosis, morbidity, hospitalization rates and time lost from work. While iron deficiency anemia and anemia of chronic inflammation predominate, combinations of hematimetric and biochemical markers facilitate the diagnosis and targeted therapy of other etiologies according to their underlying pathophysiological causes. Intravenous iron replacement is currently recommended in IBD patients with moderate to severe anemia or intolerance to oral iron. Areas covered: This review examines the impact, pathophysiology and diagnostics of iron deficiency and anemia, compares the characteristics and safety profiles of available oral and intravenous iron preparations, and highlights issues which require consideration in decision making for therapy administration and monitoring. Expert opinion: Modern intravenous iron formulations have been shown to be safe and effective in IBD patients, allowing rapid anemia correction and repletion of iron stores. While traditional oral iron preparations are associated with increased inflammation, negative effects on the microbiome, and poor tolerance and compliance, first clinical trial data indicate that newer oral compounds such as ferric maltol and sucrosomial iron offer improved tolerability and may thus offer a viable alternative for the future.

  1. Principles and practices of sustainable water management

    Institute of Scientific and Technical Information of China (English)

    Bixia Xu

    2010-01-01

    Literature related to sustainable water management is reviewed to illustrate the relationship among water management, sustainability (sustainable development), and sustainable water management. This review begins with the explanation on the definition of sustainable water management, followed by a discussion of sustainable water management principles and practices.

  2. Australian Correctional Management Practices for Terrorist Prisoners

    Directory of Open Access Journals (Sweden)

    Nathan Tompson

    2018-03-01

    Full Text Available Management practices for incarcerated terrorists is an important counterterrorism policy consideration. Moreover, there is a misconception that once incarcerated, terrorists cease to be a risk. If correctional management regimes are implemented poorly, terrorist prisoners may be afforded the opportunity to remain active while incarcerated, including the recruitment of other prisoners, and the planning of future attacks. Equally, they may be viewed as role models or martyrs for sympathisers to aspire to. Despite the magnitude of the consequences, there is no agreed approach to managing Australian terrorist prisoners. As such, a dichotomy of dominant models has emerged; that is, to either segregate terrorist prisoners, or conversely, to disperse them throughout the wider prisoner population. Each strategy presents its own set of benefits and risks. This paper compares the management practices for terrorist prisoners in the states of New South Wales and Victoria to determine the strengths and vulnerabilities of each of these approaches. The paper concludes that policy-makers should consider reassessing current strategies. It suggests that a focus that extends the immediate containment considerations to encompass post-release factors would bring benefits for society.

  3. Understanding the Effectiveness of Performance Management Practices

    Science.gov (United States)

    2010-03-01

    practitioners.” Priem and Rosenstein (2001) and Rynes, Bartunek, and Daft (2001) have documented the science- practice gap between OB and other...provided the foundation for effective leadership and project management. Informally the author sought ways to motivate and focus the efforts of...predominate part of his leadership and project management philosophy. This thesis further investigates leadership and management practices focused

  4. Soil Quality Impacts of Current South American Agricultural Practices

    Directory of Open Access Journals (Sweden)

    Ana B. Wingeyer

    2015-02-01

    Full Text Available Increasing global demand for oil seeds and cereals during the past 50 years has caused an expansion in the cultivated areas and resulted in major soil management and crop production changes throughout Bolivia, Paraguay, Uruguay, Argentina and southern Brazil. Unprecedented adoption of no-tillage as well as improved soil fertility and plant genetics have increased yields, but the use of purchased inputs, monocropping i.e., continuous soybean (Glycine max (L. Merr., and marginal land cultivation have also increased. These changes have significantly altered the global food and feed supply role of these countries, but they have also resulted in various levels of soil degradation through wind and water erosion, soil compaction, soil organic matter (SOM depletion, and nutrient losses. Sustainability is dependent upon local interactions between soil, climate, landscape characteristics, and production systems. This review examines the region’s current soil and crop conditions and summarizes several research studies designed to reduce or prevent soil degradation. Although the region has both environmental and soil resources that can sustain current agricultural production levels, increasing population, greater urbanization, and more available income will continue to increase the pressure on South American croplands. A better understanding of regional soil differences and quantifying potential consequences of current production practices on various soil resources is needed to ensure that scientific, educational, and regulatory programs result in land management recommendations that support intensification of agriculture without additional soil degradation or other unintended environmental consequences.

  5. Microalgal bioremediation : Current practices and perspectives

    OpenAIRE

    BISWAJIT RATH

    2011-01-01

    During last two decades, extensive attention has been paid on the management of environmental pollution caused by hazardous materials. A number of methods has been developed for removal of such substances like precipitation, evaporation, ion-exchange etc. However these methods have several disadvantages. This review highlights the alternative biological agent abundantly present in nature i.e Microalgae as a potential sink for removal of such toxic substances from the surrounding. Microalgal b...

  6. Fundamentals of Value Based Management in practice of Quality management

    Directory of Open Access Journals (Sweden)

    Katarzyna Szczepańska

    2010-03-01

    Full Text Available The article discusses the practical aspects of using the theory of value management in quality management. Presents the essence of value based management (VBM as a background of reflection on its links with quality management. Coherence of the concept in practice, been reviewed in the author’s own studies. The discovery of absence of sufficient procedural structure of the metrics of an economic – financial, to measure the value of the quality management system, points to a gap between the theoretical and practical considerations in managing the value of the company quality management system.  

  7. Current operating practices of nuclear insurance pools

    International Nuclear Information System (INIS)

    O'Connell, J.M.

    1993-01-01

    This paper discusses the nuclear pooling system and co-operation between the pools, present practice and capacity, with a breakdown of the limits for third party liability and material damage. The author also describes the relationship between the pools and the nuclear operators (the policyholders), and concludes that the nuclear pools have been successful in serving the interests of their member companies, their policyholders and the governments as they have provided a stable insurance market by making available capacity in amounts that had never before been assembled and placed at risk in a single location. 2 tabs

  8. Workplace road safety risk management: An investigation into Australian practices.

    Science.gov (United States)

    Warmerdam, Amanda; Newnam, Sharon; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark

    2017-01-01

    In Australia, more than 30% of the traffic volume can be attributed to work-related vehicles. Although work-related driver safety has been given increasing attention in the scientific literature, it is uncertain how well this knowledge has been translated into practice in industry. It is also unclear how current practice in industry can inform scientific knowledge. The aim of the research was to use a benchmarking tool developed by the National Road Safety Partnership Program to assess industry maturity in relation to risk management practices. A total of 83 managers from a range of small, medium and large organisations were recruited through the Victorian Work Authority. Semi-structured interviews aimed at eliciting information on current organisational practices, as well as policy and procedures around work-related driving were conducted and the data mapped onto the benchmarking tool. Overall, the results demonstrated varying levels of maturity of risk management practices across organisations, highlighting the need to build accountability within organisations, improve communication practices, improve journey management, reduce vehicle-related risk, improve driver competency through an effective workplace road safety management program and review organisational incident and infringement management. The findings of the study have important implications for industry and highlight the need to review current risk management practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Current management of severe dengue infection.

    Science.gov (United States)

    Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin

    2017-01-01

    Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.

  10. Cancer pain management-current status

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2011-01-01

    Full Text Available Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain. The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included.

  11. Current and Future Parts Management at NASA

    Science.gov (United States)

    Sampson, Michael J.

    2011-01-01

    This presentation provides a high level view of current and future electronic parts management at NASA. It describes a current perspective of the new human space flight direction that NASA is beginning to take and how that could influence parts management in the future. It provides an overview of current NASA electronic parts policy and how that is implemented at the NASA flight Centers. It also describes some of the technical challenges that lie ahead and suggests approaches for their mitigation. These challenges include: advanced packaging, obsolescence and counterfeits, the global supply chain and Commercial Crew, a new direction by which NASA will utilize commercial launch vehicles to get astronauts to the International Space Station.

  12. Management practices in substance abuse treatment programs.

    Science.gov (United States)

    McConnell, K John; Hoffman, Kim A; Quanbeck, Andrew; McCarty, Dennis

    2009-07-01

    Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

  13. Retention practices in education human resources management ...

    African Journals Online (AJOL)

    Retention practices in education human resources management. ... education system in South Africa, particularly in public schools, faces serious problems. ... of quality management which aim at continual increase of the accountability in ...

  14. knowledge management practices in higher learning institutions

    African Journals Online (AJOL)

    user

    Knowledge Management (KM) Practices in Institutions of Higher Learning in .... quality and skills to cope with the labour market demands. .... Total. 44. 100.0. Source: Field Data (2012/13). Staff's Level of Awareness of Knowledge Management.

  15. Practical project management: tips, tactics, and tools

    National Research Council Canada - National Science Library

    Levine, Harvey A

    2002-01-01

    ... Elements of Resource Management 4.2 Role-based Needs for Managing Resources in a Project-driven Organization 4.3 Resource Leveling and Games of Chance 4.4 Practical Resource Scheduling 117 119 12...

  16. Ketamine use in current clinical practice

    Science.gov (United States)

    Gao, Mei; Rejaei, Damoon; Liu, Hong

    2016-01-01

    After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings. PMID:27018176

  17. Psychological assessment for bariatric surgery: current practices.

    Science.gov (United States)

    Flores, Carolina Aita

    2014-01-01

    The prevalence of obesity on a global scale has alarmed health institutions, the general population and professionals involved in its treatment. Bariatric surgery has emerged as an effective and lasting alternative for weight reduction and improved general health. In this context and as part of a multidisciplinary team, psychologists are responsible for the preoperative psychological assessment of bariatric candidates. To investigate how psychological assessments are occurring, including the identification of utilized resources; factors that are addressed; the duration of the process; existing protocols; and to evaluate the importance of this practice. A systematic review of national and international literature, through PubMed and Scielo's databases, using "psychological assessment", "obesity" and "surgery", as keywords. There is an agreement about the main factors that should be investigated during the preoperative assessment, as well as the main contraindications for the surgical procedure. The importance of the psychological assessment is well established in the field of bariatric surgery. However, this area needs a standard protocol to guide the mental health professionals that deal with bariatric patients.

  18. Footwear in rock climbing: Current practice.

    Science.gov (United States)

    McHenry, R D; Arnold, G P; Wang, W; Abboud, R J

    2015-09-01

    Many rock climbers wear ill-fitting and excessively tight footwear during activity. However, there is insufficient evidence of the extent or harms of this practice. To investigate footwear use in rock climbers with a focus on issues surrounding fit. A cross-sectional study with active rock climbers of over one year of experience completing a survey on their activity and footwear. Additionally, the authors quantified foot and shoe lengths and sizes alongside demographic data. Ill-fitting and excessively tight footwear was found in 55 out of 56 rock climbers. Foot pain during activity was also commonplace in 91% of the climbers. A mean size reduction of almost 4 UK shoe sizes was found between the climbers' street shoe size and that of their climbing footwear using a calibrated foot/shoe ruler. There is an unfortunate association of climbers of higher abilities seeking a tighter shoe fit (pfootwear use amongst rock climbers, further investigation may aim to quantify its impact and seek a solution balancing climbing performance while mitigating foot injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Topical steroids in the current clinical practice

    Directory of Open Access Journals (Sweden)

    T. A. Belousova

    2014-01-01

    Full Text Available The article discusses issues related to current criteria for selection of glucocorticosteroids for external use as the basic therapy for a great number of allergic and inflammatory skin diseases. The authors emphasize that non-fluorinated GCSs having the best efficacy-to-safety ratio must be the drugs of first choice. The article provides data on a positive clinical experience of using a non-halogenated glucocorticosteroid for external use - hydrocortisone 17-butyrate (Laticort - for treatment of steroid-sensitive dermatoses in children and adults. The drug has a high anti-inflammatory action and minimum risk of the development of side effects, which is sufficient for using it in sensitive areas of skin (face, neck, folds, genitals both in children and in adults. The availability of three forms of the drug (solution, cream and ointment ensures the expedience and convenience of its application at any stage of the inflammatory process and for any localization.

  20. 21 CFR 123.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 123.5 Section...) FOOD FOR HUMAN CONSUMPTION FISH AND FISHERY PRODUCTS General Provisions § 123.5 Current good manufacturing practice. (a) Part 110 of this chapter applies in determining whether the facilities, methods...

  1. Current practice in paediatric basic life support

    Directory of Open Access Journals (Sweden)

    Heczková Jana

    2017-06-01

    Full Text Available Introduction. Although the incidence of cardiac arrest in children is much lower than in adults, the condition is still considered a major health problem with a very low chance for survival. As in adults, the timely provision of cardiopulmonary resuscitation (CPR in children is crucial. Current guidelines for CPR in children were published along with the guidelines for CPR in adults in 2015. As in previous years, they are based on consensus provided by International Liaison Committee on Resuscitation (ILCOR. Guidelines of particular ILCOR member councils may vary and reflect regional characteristic such as different access to health care, education methods or willingness of population to provide emergency assistance. Moreover, the conditions requiring CPR in children are characterized not only by different incidence, but also by aetiology or techniques used for different age groups. Therefore, emphasis is put on simplicity and feasibility as well as on consistency with adult guidelines to improve retention of the paediatric sequences. Nurses may be first rescuers not only in health care facilities. Better understanding of CPR guidelines might help them to improve their ability to detect conditions requiring CRP and also initiate and provide effective emergency care.

  2. Brainstem tumors: Current management and future directions

    Directory of Open Access Journals (Sweden)

    Pablo F Recinos

    2012-01-01

    Full Text Available Tumors arising in the brainstem comprise 10-20% of all pediatric central nervous system (CNS tumors and account for a small percentage in adults. The prognosis for these tumors was considered uniformly poor prior to the era of modern neuroimaging and the location was fraught with disaster being considered a ′no man′s land′ for neurosurgeons. Following the introduction of advanced imaging modalities and neurophysiological monitoring, striking progress has occurred in the management of these lesions. Brainstem tumors are presently classified based on their anatomic location, focality, and histopathology. This article reviews the current classification of brainstem tumors, current management options, and future directions in the treatment for these rare tumors.

  3. International online survey to assess current practice in equine anaesthesia.

    Science.gov (United States)

    Wohlfender, F D; Doherr, M G; Driessen, B; Hartnack, S; Johnston, G M; Bettschart-Wolfensberger, R

    2015-01-01

    Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. Online questionnaire survey. An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the

  4. Aptamer therapeutics: A review of current practice

    International Nuclear Information System (INIS)

    Perkins, A.C.; Missailidis, S.

    2007-01-01

    meet the criteria for robust, generic drug discovery technology and open new horizons for the development of future radiopharmaceuticals. We have shown that aptamers directed against the MUC1 antigen, a tumour marker previously extensively used in tumour imaging and therapy, demonstrated high specificity and uniform penetration in tumour xenografts. The future strategy will be to manipulate the molecular weight of the molecules to achieve an optimum balance between the low immunogenicity and excellent tumour penetration for diagnostic imaging and targeted therapy. In this way, a balance can be achieved between the rapid renal clearance and adequate tumour uptake required for diagnostic imaging and targeted therapy. The current work and future prospects for aptamer therapeutics will be described. (author)

  5. Overview of current and alternative slaughter practices

    Directory of Open Access Journals (Sweden)

    Troeger K.

    2004-01-01

    Full Text Available The conventional cattle slaughtering process includes some critical stages where a dissemination of Specified Risk Material (SRM: brain, spinal cord within or onto the carcass and within the slaughterhouse environment can occur. These processes are captive bolt stunning, removal of the head and first of all carcass splitting (sawing the spine lengthways. Captive bolt (CB stunning results in massive brain tissue damage with bleeding, and in some cases brain tissue also emerges from the CB hole. As the heart is still functioning, there is a risk of brain tissue particles being transferred v i a the blood flow to heart and lungs or even in the whole carcass. This contamination risk is actually assessed to be low, but a continuing leakage of Central Nervous System (CNS material from the captive bolt aperture in the further slaughter process may lead to direct and indirect contamination of carcass, meat and equipment. Therefore alternative stunning methods like electrical stunning or concussion stunning are discussed. A further critical point is the treatment of the head. When the head is removed, the spinal cord is cut with a knife. There is a danger of cross contamination due to spinal protein that may adhere to the knife and because of liquid cerebralis, which leaks from the foramen occipitale magnum. Further head cleaning with hand-held hoses following skinning also includes the danger of cross contamination from cleaning water or aerosol. Therefore measures regarding the safe handling of head and harvesting of head meat are proposed. The most critical point in terms of contamination of the meat surface with SRM is the currently common practise of sawing the spine vertically in the middle with hand-guided belt-type saws. A m i x t u r e of sawing residues and rinsing water (“sawing sludge” collects in the housing of the saw, and if it contains infectious material this leads to contamination of the subsequent carcasses. The most promising

  6. Understanding management practices in business incubators

    NARCIS (Netherlands)

    Blok, Vincent; Thijssen, Sander; Pascucci, Stefano

    2017-01-01

    Following the call for process-oriented research on business incubation processes, this paper investigates the process of business incubation (BI) via an understanding of management practices and interactions. Based on a comprehensive literature review and empirical evidence of management practices

  7. 40 CFR 503.45 - Management practices.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...

  8. 40 CFR 503.14 - Management practices.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...

  9. Linking Theory with Practice in Basic Management

    Science.gov (United States)

    Carroll, Archie B.

    1974-01-01

    Instructors of management in higher education have not been cautious in explaining the relation between practice and theory in their basic courses. The author distinguished between the two in suggesting that management theory is based on observed practices and may or may not have broader application. (AG)

  10. RISK MANAGEMENT APPROACHES AND PRACTICES IN IT PROJECTS

    Directory of Open Access Journals (Sweden)

    BRANDAS Claudiu

    2012-07-01

    Full Text Available Risk is identified in project management literature as an important factor influencing IT projects success, and it is relevant for both academic and practitionersn#8217; communities. The paper presents the past and current approaches to risk management in IT projects. The objective of this paper is to compare the different approaches and relate them to existing practices. Project management literature and practice have brought different approaches to risk management, and as a result, many projects ended in failure. We present how risk management is considered in the literature, and we compare the main two approaches: the evaluation approach and the management approach. The contingency approach does not consider risk management to be a specific process as it is an embedded process in the other project management processes. Then, we present the main practices in risk management. The methodology applied is based on documentary study review and analysis of the concepts used by the literature. We analyzed the literature published between 1978 and 2011 from the main journals for IT project management and found out that the essence of project management is risk management. The risk management practices have a considerable influence on stakeholdersn#8217; perception of project success. But, regardless of the chosen approach, a standard method for identifying, assessing, and responding to risks should be included in any project as this influences the outcome of the project.

  11. Practice of Management of Technology

    International Nuclear Information System (INIS)

    2011-01-01

    This book deals with management of technology on analysis technology for research resource, conception of technique road-map and construction and case about discover process for new idea, technique infrastructure such as Matrix system, Dual Ladder system, management of research and development project using CCPM and case about personnel management system for research and development for creation of outcome, technical development like stage-Gate technique and TRIZ, and case about SKC Quality management system, technical commercialization with project NABC and case about efficient management of intellectual property.

  12. Best Management Practice Fact Sheet. 12, Filtering Practices

    OpenAIRE

    Sample, David; Barlow, Stefani

    2013-01-01

    This fact sheet is one of a 15-part series on urban stormwater management practices. This fact sheet discusses filtering practices, what they are, where they are used, how they work, maintenance, limitations, performance, expected costs and includes a glossary of terms.

  13. Evaluating Water Management Practice for Sustainable Mining

    OpenAIRE

    Xiangfeng Zhang; Lei Gao; Damian Barrett; Yun Chen

    2014-01-01

    To move towards sustainable development, the mining industry needs to identify better mine water management practices for reducing raw water use, increasing water use efficiency, and eliminating environmental impacts in a precondition of securing mining production. However, the selection of optimal mine water management practices is technically challenging due to the lack of scientific tools to comprehensively evaluate management options against a set of conflicting criteria. This work has pr...

  14. Human Resource Management Practices in Nigeria

    OpenAIRE

    Sola Fajana; Oluwakemi Owoyemi; Tunde Elegbede; Mariam Gbajumo-Sheriff

    2011-01-01

    The globalization of business is having a significant impact on human resource management practices; and it is has now become more imperative than ever for business organizations to engage in human resource management practices on an international standard. While the management of people is mostly associated with HRM, the definition, parameter and context are contested by different writers. Some authors such as Kane (1996) argued that HRM is in its infancy, while other authors such as Welbour...

  15. Theory and Practice of Marine Regional Management in China

    Institute of Scientific and Technical Information of China (English)

    Shangjie; JI; Qunzhen; QU

    2014-01-01

    With the development of marine economy in coastal provinces and cities,there comes a series of environmental problems. Marine regional management,as a completely new marine management mode,transforms traditional management mode and can protect marine ecosystem. Thus,the marine regional management is feasible and applicable in China. This paper firstly discussed connotation and development of the marine regional management in China and pointed that the marine regional management is integrated management of a certain marine region. Next,it summarized characteristics of the marine regional management at current stage,for example,land-based pollution of trans-geographic system and marine management under regional government cooperative mechanism. Finally,it came up with recommendations including combining theory and practice of the marine regional management,and establishing marine regional management system as soon as possible,to realize benign interaction and sustainable development of marine economy and ecological environment.

  16. Current DOE direction in low-level waste management

    International Nuclear Information System (INIS)

    Wilhite, E.L.; Dolenc, M.R.; Shupe, M.W.; Waldo, L.C.

    1989-01-01

    The U.S. Department of Energy (DOE) is implementing revised DOE Order 5820.2A Radioactive Waste Management. Chapter III of the revised order provides prescriptive requirements for managing low-level waste and is the subject of this paper. The revised order requires that all DOE low-level radioactive and mixed waste be systematically managed, using an approach that considers the combination of waste management practices used in waste generation reduction, segregation, treatment, packaging, storage, and disposal. The Order defines performance objectives for protecting groundwater, for protecting against intrusion, and for maintaining adequate operational practices. A performance assessment will be required to ensure that waste management operations comply with these performance objectives. DOE implementation of the revised Order includes work in the areas of leach testing, waste stabilization, waste certification, facility monitoring, and management of unique waste streams. This paper summarizes the status of this work and the current direction DOE is taking in managing low-level waste under DOE 5820.2A

  17. Sleep bruxism: Current knowledge and contemporary management

    Science.gov (United States)

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052

  18. Management of scalp psoriasis: current perspectives

    Directory of Open Access Journals (Sweden)

    Blakely K

    2016-03-01

    Full Text Available Kim Blakely,1 Melinda Gooderham2 1Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Skin Centre for Dermatology, Peterborough, ON, Canada Abstract: Psoriasis is a chronic inflammatory condition. The age of onset, chronicity, physical, and psychosocial consequences of the disease cause psoriasis to have a significant impact on patient quality of life. Scalp psoriasis is no different, and effective treatment results in an improvement in quality of life. Successful management of scalp psoriasis includes topical therapies that are acceptable to the patient for mild-to-moderate disease, and systemic therapies for recalcitrant or moderate-to-severe disease. The most effective topical therapies are corticosteroid products, or combination products with calcipotriol and corticosteroid. Newer vehicle options provide more attractive and pleasing products for patients and may improve adherence. The current perspectives for management of scalp psoriasis are discussed including available data for systemic therapy of severe disease. Keywords: psoriasis, scalp psoriasis, topical therapies, systemic therapies, biologics

  19. Sleep bruxism: Current knowledge and contemporary management.

    Science.gov (United States)

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

  20. Incident Management: Process into Practice

    Science.gov (United States)

    Isaac, Gayle; Moore, Brian

    2011-01-01

    Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…

  1. Current practices of construction waste reduction through 3R practice among contractors in malaysia: Case study in penang

    Science.gov (United States)

    Ng, L. S.; Tan, L. W.; Seow, T. W.

    2017-11-01

    The effectiveness of the implementation of construction waste reduction through 3R reflects the sustainability in construction waste management. Weak implementation of construction waste reduction through 3R among contractors will lead to unsustainable construction waste management. Increase in construction waste on landfills is critical especially on islands where land is very limited for solid waste disposal. This aim of this paper is to investigate current practice of construction waste reduction through 3R practice among contractors in Penang, Malaysia. The findings reported herein is based on feedbacks from 143 construction contractors of grade CIDB G7, G6 and G5 in Penang and experts from Penang Local Authority, CIDB in Penang and its Headquarters, National Solid Waste Management Department, and Headquarters of Solid Waste and Public Cleansing Management Corporation. Interviews and questionnaire surveys have been found that 3R practice is not mandatory in construction waste management in Penang. Only 39.8% construction contractors practiced 3R in managing their waste. Therefore, 3R practices should be emphasized in construction industry. Reducing wastes through 3R practices in construction industry is a way forward towards sustainable construction waste management especially in expanding the lifetime of landfill.

  2. Pharmacovigilance in oncology: evaluation of current practice and future perspectives.

    Science.gov (United States)

    Baldo, Paolo; De Paoli, Paolo

    2014-10-01

    Pharmacovigilance (PV), or drug safety monitoring, aims to improve patient safety through the detection and management of drug-related adverse reactions. It is implemented both by spontaneous reporting of adverse drug reactions (ADRs) and by careful detection of signals suggestive of drug toxicity. PV is an important clinical topic in clinical practice and pharmacotherapy, assuring the maintenance of a safe risk/benefit ratio throughout the commercial life cycle of a drug. We conducted a structured literature search on PubMed, Scopus, Cinahl and the Cochrane Library. We also performed manual searches in international databases of ADR individual reports to outline a structured profile on the topic. Our goal was to review key elements that affect safety monitoring of cancer drugs and their appropriate use, highlighting the strengths and weaknesses of PV in oncology. This paper provides an understanding of the methodologies used by PV in current clinical practice and particularly in cancer drug therapy; a focus upon reporting of ADRs by health professionals and patients; and a focus upon methods used by PV to detect new signals of risk/harm related to medicines utilization. To our knowledge, few articles focus upon the importance of PV and post-marketing surveillance of cancer drug therapies. Structured management of spontaneous reports of ADRs and data collection is essential to monitoring the safe use of drugs in this field in which pharmacotherapy is affected by high incidence of drug-related complications and by a narrow benefit/risk ratio. © 2014 John Wiley & Sons, Ltd.

  3. Current possibilities in occlusal caries management

    Directory of Open Access Journals (Sweden)

    Hrvoje Jurić

    2013-11-01

    Full Text Available Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan. Conclusion. Current possibilities in occlusal caries prevention and management are very effective. Therefore, dentists today do not have any excuse for avoiding the philosophy of Minimally Invasive Dentistry, especially when we talk about caries management of occlusal surfaces in permanent molars.

  4. Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management.

    Science.gov (United States)

    Taeb, Abdalsamih M; Hooper, Michael H; Marik, Paul E

    2017-06-01

    Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.

  5. REVIEW OF CURRENT PRACTICE IN CHARACTERIZATION AND MONITORING

    Energy Technology Data Exchange (ETDEWEB)

    M.A.Ebadian, Ph.D.

    2001-01-01

    Characterization and monitoring are important parts of environmental remediation of contaminated sites by the Department of Energy--Office of Environmental Management (DOE-EM). The actual remediation process often cannot begin or even be planned until characterization is complete. Monitoring is essential to verify the progress of remediation and of the waste stream. However, some contaminated sites are difficult, costly, or have a high exposure risk to personnel to characterize or monitor using the baseline technology or current practice. Therefore, development of new characterization and monitoring technologies is time-critical to remediate these sites. The main task of the Characterization, Monitoring, and Sensor Technology Crosscutting Program (CMST-CP) is to develop and deploy innovative characterization and monitoring technologies that improve performance and reduce personnel exposure, cost, and detection limits. However, to evaluate different proposals for new technologies to decide which ones to develop or deploy, it is necessary to compare their cost and performance to the baseline technology. The goal of this project is to facilitate the direct comparison of new technologies to the baseline technology by documenting the current practices for site characterization and monitoring at DOE sites and by presenting the information in an easy-to-use, concise database. The database will assist the CMST-CP and others in evaluating or designing new technologies by identifying the baseline technologies and describing their performance and cost. The purpose of this document is to report on the completion of this project and to describe the database. Section 2.0 describes the data assessment methodology. Section 3.0 presents the database and serves as a user manual. Section 4.0 lists the references used for each baseline technology in the database. The full references can be found in the Appendix.

  6. REVIEW OF CURRENT PRACTICE IN CHARACTERIZATION AND MONITORING

    International Nuclear Information System (INIS)

    Ebadian, M.A.

    2001-01-01

    Characterization and monitoring are important parts of environmental remediation of contaminated sites by the Department of Energy--Office of Environmental Management (DOE-EM). The actual remediation process often cannot begin or even be planned until characterization is complete. Monitoring is essential to verify the progress of remediation and of the waste stream. However, some contaminated sites are difficult, costly, or have a high exposure risk to personnel to characterize or monitor using the baseline technology or current practice. Therefore, development of new characterization and monitoring technologies is time-critical to remediate these sites. The main task of the Characterization, Monitoring, and Sensor Technology Crosscutting Program (CMST-CP) is to develop and deploy innovative characterization and monitoring technologies that improve performance and reduce personnel exposure, cost, and detection limits. However, to evaluate different proposals for new technologies to decide which ones to develop or deploy, it is necessary to compare their cost and performance to the baseline technology. The goal of this project is to facilitate the direct comparison of new technologies to the baseline technology by documenting the current practices for site characterization and monitoring at DOE sites and by presenting the information in an easy-to-use, concise database. The database will assist the CMST-CP and others in evaluating or designing new technologies by identifying the baseline technologies and describing their performance and cost. The purpose of this document is to report on the completion of this project and to describe the database. Section 2.0 describes the data assessment methodology. Section 3.0 presents the database and serves as a user manual. Section 4.0 lists the references used for each baseline technology in the database. The full references can be found in the Appendix

  7. Evaluating Water Management Practice for Sustainable Mining

    Directory of Open Access Journals (Sweden)

    Xiangfeng Zhang

    2014-02-01

    Full Text Available To move towards sustainable development, the mining industry needs to identify better mine water management practices for reducing raw water use, increasing water use efficiency, and eliminating environmental impacts in a precondition of securing mining production. However, the selection of optimal mine water management practices is technically challenging due to the lack of scientific tools to comprehensively evaluate management options against a set of conflicting criteria. This work has provided a solution to aid the identification of more sustainable mine water management practices. The solution includes a conceptual framework for forming a decision hierarchy; an evaluation method for assessing mine water management practices; and a sensitivity analysis in view of different preferences of stakeholders or managers. The solution is applied to a case study of the evaluation of sustainable water management practices in 16 mines located in the Bowen Basin in Queensland, Australia. The evaluation results illustrate the usefulness of the proposed solution. A sensitivity analysis is performed according to preference weights of stakeholders or managers. Some measures are provided for assessing sensitivity of strategy ranking outcomes if the weight of an indicator changes. Finally, some advice is given to improve the mine water management in some mines.

  8. Best Practices for Management of Biocontaminated Waste ...

    Science.gov (United States)

    Report The purpose of these best practices is to provide federal, state, territorial, and local waste management entities information on techniques and methodologies that have the potential to improve the handling and management of biocontaminated waste streams after a biological agent incident. These best practices are intended to be general in nature serving as a resource to a variety of biological agents in a variety of situations; however, these best practices also present a specific homeland security scenario – a biological attack with Bacillus anthracis (B. anthracis) – to help illustrate specific waste management considerations.

  9. Survey of Current Best Practices for Diving in Contaminated Water

    National Research Council Canada - National Science Library

    Steigleman, W

    2002-01-01

    .... Navy divers operating in contaminated water. This survey attempted to identify the current best practices and equipment for diving in contaminated water, including personal protective equipment as well as hazard identification, diver training...

  10. Best Practices in Facility Management

    National Research Council Canada - National Science Library

    Neve, Trevor

    1999-01-01

    .... While the Logistics Management Institute's benchmark database has served as a cornerstone in helping to initiate change, data and metrics go only so far in implementing better ways of doing business...

  11. CONCUSSION IN SPORT: PRACTICAL MANAGEMENT ...

    African Journals Online (AJOL)

    Enrique

    The monitoring of symptoms of concussion is important in order to manage the concussed player ... develop prolonged disability charac- terised by poor ... Feeling 'dinged', stunned or 'dazed' .... The baseline test ensures reliable com- parative ...

  12. 21 CFR 114.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 114.5 Section...) FOOD FOR HUMAN CONSUMPTION ACIDIFIED FOODS General Provisions § 114.5 Current good manufacturing practice. The criteria in §§ 114.10, 114.80, 114.83, 114.89, and 114.100, as well as the criteria in part...

  13. Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

    Science.gov (United States)

    Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth

    2014-01-01

    Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

  14. The Impact of Knowledge Management Capability, Organizational Learning, and Supply Chain Management Practices on Organizational Performance

    Directory of Open Access Journals (Sweden)

    Ingy Essam Eldin Salama

    2017-03-01

    Full Text Available The focus of this research is developing and examining a conceptual framework relating resource-based organizational capabilities and inter-organizational practices with organizational performance. Specifically, it investigates the relationship between knowledge management capability, organizational learning, supply chain management practices and organizational performance. Such a study is important as it contributes to the growing body of literature that links organizational capabilities and practices with organizational performance. In addition, it also contributes to empirical knowledge by applying the proposed conceptual framework in the Egyptian context, which is currently under-researched. The research approach adopted in this research includes empirical examination of the hypothesized relationships among research variables applied on 63 factories with more than 100 employees located at New Borg Al-Arab industrial city using self-administrated questionnaires. The findings of this research provide evidence that knowledge management capability has an impact on organizational learning as well as on supply chain management practices. However, none of the research variables; i.e. knowledge management capability, organizational learning and supply chain management practices have an impact on organizational performance. The main conclusion drawn from this study is that knowledge management capability may be useful to managers for predicting organizational learning and coordinating supply chain management practices between supply chain members. In addition, it could be concluded that organizational performance, in the factories under study, is affected by variables other than knowledge management capability, organizational learning and supply chain management practices.

  15. Current Practices in the Delivery of Undergraduate Exercise Physiology Content

    Science.gov (United States)

    Fisher, Michele M.

    2013-01-01

    The purpose of this study was to identify current practices for the delivery of exercise physiology content at the undergraduate level. An anonymous 22-item survey was sent to instructors of exercise physiology to collect information concerning the structure of course offerings and instructional practices. One hundred ten instructors responded to…

  16. Hospital administrative characteristics and volunteer resource management practices.

    Science.gov (United States)

    Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug

    2016-05-16

    Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.

  17. Epistaxis management: current understanding amongst junior doctors.

    Science.gov (United States)

    Fox, R; Nash, R; Liu, Z-W; Singh, A

    2016-03-01

    Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. A cross-sectional study was conducted of foundation year one and two doctors based at three National Health Service trusts within a single region of the UK, assessing basic understanding and procedural confidence. A total of 111 foundation doctors completed this survey. The average duration of undergraduate exposure to otolaryngology was 8.1 days. Forty-one per cent of respondents stated that they would apply pressure to the nasal bones to control epistaxis. Seventy-five per cent lacked confidence in their ability to manage epistaxis. Those with two weeks or more of undergraduate exposure to otolaryngology were more confident than those with one week or less of exposure (p epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools.

  18. Implications of Risk Management Practices on Financial ...

    African Journals Online (AJOL)

    Implications of Risk Management Practices on Financial Performance of Sugar ... The respondents were functional heads of the companies under the survey. ... of downside losses in order to minimize the negative impact of risk on returns.

  19. Radioactive waste management - objectives and practices

    International Nuclear Information System (INIS)

    Ali, S.S.

    2002-01-01

    This article deals with the objectives, the legal frame works, regulations and the regulating authorities in India and also the technologies and practices being used for the safe management of radioactive wastes in the country

  20. Green Remediation Best Management Practices: Mining Sites

    Science.gov (United States)

    This fact sheet describes best management practices (BMPs) that can be used to reduce the environmental footprint of cleanup activities associated with common project components, cleanup phases, and implementation of remediation technologies.

  1. Managing hyperthyroidism in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Andersen SL

    2016-09-01

    Full Text Available Stine Linding Andersen,1,2 Peter Laurberg1,3,† 1Department of Endocrinology, Aalborg University Hospital, 2Department of Clinical Biochemistry, Aalborg University Hospital, 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark †Peter Laurberg passed away on June 20, 2016 Abstract: Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs. These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the

  2. Managing hyperthyroidism in pregnancy: current perspectives.

    Science.gov (United States)

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves' disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6-10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy.

  3. Managing hyperthyroidism in pregnancy: current perspectives

    Science.gov (United States)

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy. PMID:27698567

  4. 75 FR 62809 - Transmission Vegetation Management Practices; Notice of Technical Conference

    Science.gov (United States)

    2010-10-13

    ... Vegetation Management Practices; Notice of Technical Conference October 5, 2010. Take notice that the Federal... the conference is to discuss current vegetation management programs and practices as required under... landowners and other affected parties have raised concerns about changes in vegetation management practices...

  5. Practice management: observations, issues, and empirical evidence.

    Science.gov (United States)

    Wong, H M; Braithwaite, J

    2001-02-01

    The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.

  6. Practices of Talent Management in Organisations in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Lucie Vnoučková

    2016-01-01

    Full Text Available As theory still lacks consistent definition of successful talent management, the praxis is characterized by dissimilar interpretations of the term talent. The lack of integrity of definitions appears to be the reason to analyse talent management practices. The article focuses on consistency of suggested practices in management of organisational strategies. The aim is to reveal current approach of Czech organisations towards talent management practices and to specify the main factors affecting employee development in talent management in the tested organisations. Bivariate and multivariate statistical methods and analyses were used to lower the number of possible single approaches and practices. Analyses formed valid factors, which influence and determine employee development as key principles of talent management: alignment with strategy, internal consistency, cultural embeddedness, management involvement, and employer branding through differentiation. Results identified and verified different ways of support of talented employees. Firstly, it is Talent management in its original shape (25.9%, secondly, Learning organisation based on common learning (23.5% and the third factor name is Plain promises (12.4%. Organisations grouped in the factor only declare possibility of development, but do not practically use it.

  7. Neutralized current acid waste consolidation management plan

    International Nuclear Information System (INIS)

    Powell, W.J.; Brown, R.G.; Galbraith, J.; Jensen, C.; Place, D.E.; Reddick, G.W.; Zuroff, W.; Brothers, A.J.

    1996-01-01

    The scope of this evaluation is to recommend a management plan for the high-heat tank waste, including neutralized current acid waste (NCAW) in AY and AZ Tank Farms, and tank C-106 waste. The movement of solids, liquids and salt cake in the designated tank farms is included. Decision analysis techniques were used to determine a recommended alternative. The recommended course of action was replacement of a 75-hp mixer pump in tank AY-102 and in-tank concentration of tank AZ-102 supernate. The alternative includes transfer fo tank C-106 sludge to tank AY-102, then transfer to tank AY-102 and tank C-106 sludge to tank AZ-101 using the new 75-hp mixer pump installed in tank AY-102. Tank AZ-101 becomes a storage tank for high-level waste (HLW) sludge, with the capacity to mix and transfer sludge as desired

  8. Optimal management of genital herpes: current perspectives.

    Science.gov (United States)

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease.

  9. Management of infantile hemangiomas: Current trends

    Directory of Open Access Journals (Sweden)

    Gomathy Sethuraman

    2014-01-01

    Full Text Available Infantile hemangiomas (IH are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.

  10. Critical leadership and management skills for pathology practice.

    Science.gov (United States)

    Brimhall, Bradley B; Wright, Louis D; McGregor, Kelli L; Hernandez, James S

    2007-10-01

    Managed care has changed the nature of medical practice. The practice of pathology has also changed and is likely to undergo further modification. Additional skills in leadership and management are needed to perform optimally in the current medical marketplace. To determine whether pathologists view business and informatics skills as being important and valuable in their practices. A survey was sent electronically (via e-mail) to 2566 pathologists and pathology administrators. Two hundred sixteen survey recipients (8.4%) responded to the survey. The response rate to individual questions ranged from 86% to 99% (186 to 214 of 216 total respondents). Most who took the survey ranked communication (203/209; 97%), leadership skills (165/209; 79%), and systems thinking skills (155/209; 74%) as either "very important" or "essential." Fewer respondents were willing to offer salary premiums for marketing (108/196; 55%), business or finance (92/196; 47%), or staff leadership (95/196; 48%) skills unless the candidate had a track record of measurable achievement using these skills. Those practicing in academia as well as those making hiring decisions by themselves were more likely to value leadership and management skills. Fewer than 1% of respondents in any category considered current pathology residency training in leadership and management to be adequate. Prospective employers value leadership and management skills. Pathology residency programs must include meaningful training in pathology practice management and informatics to satisfy the demand for these skills in the modern pathology marketplace.

  11. Haiyang nuclear power construction management and practice

    International Nuclear Information System (INIS)

    Wang Fengxue

    2010-01-01

    The paper introduces the basic situation of Shandong Haiyang Nuclear Power Plant, as well as the management and progress of the project. Through the construction management practice, problems encountered in nuclear power construction are put forward for peer exchange and discussion. (author)

  12. Blurred Boundaries in Wildlife Management Practices

    NARCIS (Netherlands)

    Boonman-Berson, S.H.

    2016-01-01

    Human-wildlife conflicts have been increasing at alarming rates over the last few decades. Wildlife management practices deal with preventing and disentangling these conflicts. However, which approach should be taken is widely disputed in research, policy, in-the-field-wildlife management and local

  13. Risk Management Practices: The Ghanaian Firms' Perspective ...

    African Journals Online (AJOL)

    Using a quantitative approach the findings of the study are that Ghanaian firms understand risk and risk management. Additionally, operational, liquidity and credit risk are the most dominant risks experienced while risk identification and selection jointly determine risk management practices in Ghana. Based on the findings ...

  14. Inventory Management Practices and Business Performance for ...

    African Journals Online (AJOL)

    Inventory constitutes much of the working capital held by SSEs and poor working capital management has been identified as one of the major causes of SSE failures. With this backdrop, this study investigated the relationship between inventory management practices and the business performance of SSEs in Kisii ...

  15. Current Trends in the Management of Retinoblastoma

    Directory of Open Access Journals (Sweden)

    Hayyam Kıratlı

    2014-09-01

    Full Text Available Retinoblastoma is the most common primary intraocular malignant tumor of early childhood, and 95% of all cases are diagnosed before the age of 5 years. Tumors are evaluated and classified based on laterality, genetic features, the number, location and size of foci. Currently, systemic and intaarterial chemotherapy are the most commonly used management options worldwide. Group A tumors are treated with focal techniques including transpupillary thermotherapy, cryotherapy, or laser photocoagulation. Groups B and C tumors are managed with systemic chemotherapy and focal consolidation techniques. Group D lesions are best treated with systemic chemotherapy, subtenon carboplatin injection or external beam radiotherapy. Alternatively, groups B, C and D tumors can be primarily treated with intraarterial chemotherapy. Intravitreal melphalan injection can be an alternative treatment for eyes with recurrent or persistent vitreous seeding. Group E eyes are often enucleated, however, depending on the fellow eye, systemic or intraarterial chemotherapy may be administered. Systemic chemotherapy is also mandatory if high-risk histopathological features are found after enucleation. (Turk J Ophthalmol 2014; 44: Supplement 22-8

  16. Current management of obsessive and phobic states

    Directory of Open Access Journals (Sweden)

    Goljevscek S

    2011-09-01

    Full Text Available Serena Goljevscek1, Livia A Carvalho21Psychiatric Clinic, University of Udine, Udine, Italy; 2Health Science Research Centre, Department of Life Sciences, Roehampton University, London, UKAbstract: Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.Keywords: obsessive

  17. Postoperative delirium in elderly citizens and current practice

    Directory of Open Access Journals (Sweden)

    Siddareddygari Velayudha Reddy

    2017-01-01

    Full Text Available Postoperative delirium (POD represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD. On literature search in EMBASE, CINAHL, and PUBMED between January 2000 and September 2015 using search words delirium, POD, acute postoperative confusion, and brain dysfunction resulted in 9710 articles. Among them, 73 articles were chosen for review, in addition, National Institute for Health and Clinical Excellence guidelines, American Geriatric Society guidelines, hospital elderly life program-confusion assessment method training manual, New York geriatric nursing protocols, World Health Organization's International Classification of Diseases, 10th Revision classification of mental disorders, Food and Drug Administration requests boxed warnings on older class of antipsychotic drugs 2008 and delirium in Miller's text book of anesthesia were reviewed and relevant information presented in this article.

  18. Selecting practice management information systems.

    Science.gov (United States)

    Worley, R; Ciotti, V

    1997-01-01

    Despite enormous advances in information systems, the process by which most medical practices select them has remained virtually unchanged for decades: the request for proposal (RFP). Unfortunately, vendors have learned ways to minimize the value of RFP checklists to where purchasers now learn little about the system functionality. The authors describe a selection methodology that replaces the RFP with scored demos, reviews of vendor user manuals and mathematically structured reference checking. In a recent selection process at a major medical center, these techniques yielded greater user buy-in and favorable contract terms as well.

  19. Quality management in a radiological practice

    International Nuclear Information System (INIS)

    Kirsch, Michael; Vogg, Ingrid; Hosten, Norbert; Flessa, Steffen

    2010-01-01

    This paper describes the introduction of a total quality management system in a radiological practice. Certification was based on DIN EN ISO 9001:2000. The implementation of the quality management system had to overcome a number of barriers, for instance, legal obligations of a partnership association, leadership problems, and the fear to loose all hindered implementation. The knowledge of these barriers induces a faster and cheaper implementation of a quality management system in a radiological practice as a foundation of improved quality and competitiveness.

  20. Quality management in a radiological practice

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, Michael, E-mail: kirschm@uni-greifswald.d [Department of Radiology, Universitaetsklinikum Greifswald der Ernst-Moritz-Arndt-Universitaet Greifswald AOR, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald (Germany); Vogg, Ingrid, E-mail: ivmobil2@medimpuls.d [Stapelfelder Strasse 84, 22143 Hamburg (Germany); Hosten, Norbert, E-mail: hosten@uni-greifswald.d [Department of Radiology, Universitaetsklinikum Greifswald der Ernst-Moritz-Arndt-Universitaet Greifswald AOR, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald (Germany); Flessa, Steffen, E-mail: Steffen.Flessa@uni-greifswald.d [General Business Studies and Health Management, Friedrich-Loeffler-Strasse 70, 17487 Greifswald (Germany)

    2010-07-15

    This paper describes the introduction of a total quality management system in a radiological practice. Certification was based on DIN EN ISO 9001:2000. The implementation of the quality management system had to overcome a number of barriers, for instance, legal obligations of a partnership association, leadership problems, and the fear to loose all hindered implementation. The knowledge of these barriers induces a faster and cheaper implementation of a quality management system in a radiological practice as a foundation of improved quality and competitiveness.

  1. Social media best practices in emergency management.

    Science.gov (United States)

    Siskey, Ashley; Islam, Tanveer

    2016-01-01

    Social media platforms have become popular as means of communications in emergency management. Many people use social media sites such as Facebook and Twitter on a daily basis including during disaster events. Emergency management agencies (EMAs) need to recognize the value of not only having a presence on social media but also actively engaging stakeholders and the public on these sites. However, identifying best practices for the use of social media in emergency management is still in its infancy. The objective of this article is to begin to create or further define best practices for emergency managers to use social media sites particularly Facebook and Twitter in four key areas: 1) implementation, 2) education, 3) collaboration, and 4) communication. A list of recommendations of best practices is formulated for each key area and results from a nationwide survey on the use of social media by county EMAs are discussed in this article.

  2. Management of Pediatric Migraine: Current Therapies.

    Science.gov (United States)

    Khrizman, Marina; Pakalnis, Ann

    2018-02-01

    Migraine is one of the most common neurologic conditions in pediatrics. It can be a significant stressor, causing absences from school and interruption of parents' work and family schedules. The mainstay of treatment remains educating patients about healthy lifestyle practices and the influences of sleep, stressors, and hydration on triggering migraine attacks. Psychological therapies such as biofeedback or cognitive-behavioral therapy may be beneficial in some patients, especially those with prominent psychological comorbidities. New advances in the pathophysiology of migraine and additional pediatric approval of abortive therapy with triptans have led to significant advances in the management of migraine in children. Some challenges to preventive therapy were recently noted with the negative results obtained in the Childhood and Adolescent Migraine Prevention Study, which compared prescription drugs to placebo. Inherent differences between adult and pediatric headaches, with shorter duration of pediatric migraine and prominent placebo effect, present recurring challenges for clinicians. [Pediatr Ann. 2018;47(2):e55-e60.]. Copyright 2018, SLACK Incorporated.

  3. Clinical practice guidelines in patient management

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2001-01-01

    Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

  4. Information management competencies for practicing nurses and new graduates

    Directory of Open Access Journals (Sweden)

    Corina Saratan

    2015-09-01

    Full Text Available Nursing informatics skills are required at all levels of nursing practice. Of those basic skills, management of information through the electronic health record (EHR is paramount. Previous research has explored computer literacy of nurses but has not investigated the competencies that relate specifically to information management. The purpose of this research study was to gather practicing nurses’ views of current information management competencies published by the Technology Informatics Guiding Education Reform (TIGER initiative, as they pertain to new graduates. A convenience sample of members from the InspireNet online user group was surveyed. The results suggest that overall, nurses tend to agree with the information management competencies; however, informatics education is most needed for those who have been practicing nursing for longer, rather than for novice nurses.

  5. Knowledge management (KM) processes in organizations theoretical foundations and practice

    CERN Document Server

    McInerney, Claire R

    2011-01-01

    Knowledge Management (KM) is an effort to increase useful knowledge in the organization. It is a natural outgrowth of late twentieth century movements to make organizational management and operations more effective, of higher quality, and more responsive to constituents in a rapidly changing global environment. This document traces the evolution of KM in organizations, summarizing the most influential research and literature in the field. It also presents an overview of selected common and current practices in knowledge management, including the relationship between knowledge management and de

  6. Current earthquake engineering practice for Japanese nuclear power plants

    International Nuclear Information System (INIS)

    Hofmayer, C.H.; Park, Y.J.; Costello, J.F.

    1992-01-01

    This paper provides a brief overview of seismic research being conducted in Japan and describes USNRC efforts to understand Japanese seismic practice. Current earthquake engineering practice for Japanese nuclear power plants is descried in JEAG 4601-1987, ''Technical Guidelines for Aseismic Design of Nuclear Power Plants.'' The USNRC has sponsored BNL to translate this document into English. Efforts are underway to study and understand JEAG 4601-1987 and make the translation more readily available in the United States

  7. Financial Management: Cash Management Practices in Florida Community Colleges.

    Science.gov (United States)

    Spiwak, Rand S.

    A study was conducted to identify those variables appearing to affect cash management practices in Florida community colleges, and recommend prescriptive measures concerning these practices. The study methodology included informal discussions with the chief fiscal officers of each Florida community college and appropriate state board staff,…

  8. A Study of Hospital Waste Generation and Management Practice in ...

    African Journals Online (AJOL)

    This study was carried out in Akure, the capital of Ondo State, Nigeria to assess the current practice of hospital wastes management, the magnitude and variety of wastes and the awareness of the stakeholders on the implications of their activities. The composition of wastes found in the 20 healthcare facilities visited ...

  9. Construction quality management principles and good practice

    CERN Document Server

    Watson, Paul

    2011-01-01

    Quality management is essential for facilitating the competitiveness of modern day commercial organizations. Excellence in quality management is a requisite for construction organizations who seek to remain competitive and successful. The challenges presented by competitive construction markets and large projects that are dynamic and complex necessitate the adoption and application of quality management approaches. This textbook is written in line with the ISO 9001:2008 standard and provides a comprehensive evaluation of quality management systems and tools. Their effectiveness in achieving project objectives is explored, as well as applications in corporate performance enhancement. Both the strategic and operational dimensions of quality assurance are addressed by focusing on providing models of best practice. The reader is supported throughout by concise and clear explanations and with self-assessment questions. Practical case study examples show how various evaluative-based quality management systems and t...

  10. Blood inventory management: hospital best practice.

    Science.gov (United States)

    Stanger, Sebastian H W; Yates, Nicola; Wilding, Richard; Cotton, Sue

    2012-04-01

    Blood is a perishable product, and hence good management of inventories is crucial. Blood inventory management is a trade-off between shortage and wastage. The challenge is to keep enough stock to ensure a 100% supply of blood while keeping time expiry losses at a minimum. This article focuses on inventory management of red blood cells in hospital transfusion laboratories to derive principles of best practice and makes recommendations that will ensure losses due to time expiry are kept to a minimum. The literature was reviewed to identify available models for perishable inventory management. Historical data from the UK blood supply chain was analyzed to identify hospitals with good inventory management practice and low wastage levels. Transfusion laboratory managers in the selected hospitals were interviewed in 7 case studies with the aim of identifying drivers for low wastage and good inventory management practice. The findings from the case studies were compared with the literature. The extant literature asserts that the drivers for good inventory performance are the use of complex inventory models and algorithms. This study has found this not to be the case. Instead, good performance is driven by the quality of transfusion laboratory staff, who must be skilled, regularly trained, and experienced. Electronic crossmatching, transparency of the inventory, and simple management procedures also facilitate good performance. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Mental Health Professionals' Suicide Risk Assessment and Management Practices.

    Science.gov (United States)

    Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Mitchell, Sean M; Taylor, Nathanael J; Quinnett, Paul; Ries, Richard

    2018-01-01

    Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

  12. Current management of oral cancer. A multidisciplinary approach.

    Science.gov (United States)

    Ord, R A; Blanchaert, R H

    2001-11-01

    Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

  13. Integrative learning for practicing adaptive resource management

    Directory of Open Access Journals (Sweden)

    Craig A. McLoughlin

    2015-03-01

    Full Text Available Adaptive resource management is a learning-by-doing approach to natural resource management. Its effective practice involves the activation, completion, and regeneration of the "adaptive management cycle" while working toward achieving a flexible set of collaboratively identified objectives. This iterative process requires application of single-, double-, and triple-loop learning, to strategically modify inputs, outputs, assumptions, and hypotheses linked to improving policies, management strategies, and actions, along with transforming governance. Obtaining an appropriate balance between these three modes of learning has been difficult to achieve in practice and building capacity in this area can be achieved through an emphasis on reflexive learning, by employing adaptive feedback systems. A heuristic reflexive learning framework for adaptive resource management is presented in this manuscript. It is built on the conceptual pillars of the following: stakeholder driven adaptive feedback systems; strategic adaptive management (SAM; and hierarchy theory. The SAM Reflexive Learning Framework (SRLF emphasizes the types, roles, and transfer of information within a reflexive learning context. Its adaptive feedback systems enhance the facilitation of single-, double-, and triple-loop learning. Focus on the reflexive learning process is further fostered by streamlining objectives within and across all governance levels; incorporating multiple interlinked adaptive management cycles; having learning as an ongoing, nested process; recognizing when and where to employ the three-modes of learning; distinguishing initiating conditions for this learning; and contemplating practitioner mandates for this learning across governance levels. The SRLF is a key enabler for implementing the "adaptive management cycle," and thereby translating the theory of adaptive resource management into practice. It promotes the heuristics of adaptive management within a cohesive

  14. Time management strategies in nursing practice.

    Science.gov (United States)

    Waterworth, Susan

    2003-09-01

    With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.

  15. Safe waste management practices in beryllium facilities

    International Nuclear Information System (INIS)

    Bhat, P.N.; Soundararajan, S.; Sharma, D.N.

    2012-01-01

    Beryllium, an element with the atomic symbol Be, atomic number 4, has very high stiffness to weight ratio and low density. It has good electrical conductive properties with low coefficient of thermal expansion. These properties make the metal beryllium very useful in varied technological endeavours, However, beryllium is recognised as one of the most toxic metals. Revelation of toxic effects of beryllium resulted in institution of stringent health and safety practices in beryllium handling facilities. The waste generated in such facilities may contain traces of beryllium. Any such waste should be treated as toxic waste and suitable safe waste management practices should be adopted. By instituting appropriate waste management practice and through a meticulously incorporated safety measures and continuous surveillance exercised in such facilities, total safety can be ensured. This paper broadly discusses health hazards posed by beryllium and safe methods of management of beryllium bearing wastes. (author)

  16. Managing plutonium in Britain. Current options

    International Nuclear Information System (INIS)

    1998-01-01

    This is the report of a two day meeting to discuss issues arising from the reprocessing of plutonium and production of mixed oxide nuclear fuels in Britain. It was held at Charney Manor, near Oxford, on June 25 and 26, 1998, and was attended by 35 participants, including government officials, scientists, policy analysts, representatives of interested NGO's, journalists, a Member of Parliament, and visiting representatives from the US and Irish governments. The topic of managing plutonium has been a consistent thread within ORG's work, and was the subject of one of our previous reports, CDR 12. This particular seminar arose out of discussions earlier in the year between Dr. Frank Barnaby and the Rt. Hon. Michael Meacher MP, Minister for the Environment. With important decisions about the management of plutonium in Britain pending, ORG undertook to hold a seminar at which all aspects of the subject could be aired. A number of on-going events formed the background to this initiative. The first was British Nuclear Fuels' [BNFL] application to the Environment Agency to commission a mixed oxide fuel [MOX] plant at Sellafield. The second was BNFL's application to vary radioactive discharge limits at Sellafield. Thirdly, a House of Lords Select Committee was in process of taking evidence, on the disposal of radioactive waste. Fourthly, the Royal Society, in a recent report entitled Management of Separated Plutonium, recommended that 'the Government should commission a comprehensive review... of the options for the management of plutonium'. Four formal presentations were made to the meeting, on the subjects of Britain's plutonium policy, commercial prospects for plutonium use, problems of plutonium accountancy, and the danger of nuclear terrorism, by experts from outside the nuclear industry. It was hoped that the industry's viewpoint would also be heard, and BNFL were invited to present a paper, but declined on the grounds that they were 'currently involved in a formal

  17. Continuous infusion in haemophilia: current practice in Europe

    NARCIS (Netherlands)

    Batorova, A.; Holme, P.; Gringeri, A.; Richards, M.; Hermans, C.; Altisent, C.; Lopez-Fernández, M.; Fijnvandraat, K.

    2012-01-01

    . Continuous infusion (CI) of factor VIII (FVIII) is an effective method for replacement therapy in haemophilia. Recently, concerns have been raised regarding association of CI with the development of inhibitors. The aim of this study was to gain information on the current practices in Europe

  18. Clinical Supervision of Substance Abuse Counselors: Current and Preferred Practices.

    Science.gov (United States)

    Culbreth, John R.

    1999-01-01

    Reports on a national survey of substance abuse counselors (N=134) to learn their current and preferred supervision practices. Results suggests that substance abuse counselor are receiving supervision similar to other counselors. No preference was indicated for the sex of the supervisor, nor for the 12-step recovery experience. Counselors did…

  19. The Current Practices and Problems of School Based Supervision in ...

    African Journals Online (AJOL)

    The purpose of this study was to identify the current practice and problems of school based supervision in government primary schools of Jile Timuga Woreda of Oromia Zone. A descriptive survey design of research methodology was employed. Regarding sampling, there were 39 primary schools grouped in 10 cluster ...

  20. The Current Teacher Education Programs in Ethiopia: Reflection on Practice

    Science.gov (United States)

    Mekonnen, Geberew Tulu

    2017-01-01

    This study threw light on the current practice of Postgraduate Diploma in Teaching Program at Addis Ababa University, Ethiopia. The study focused on the enrolment, graduation and attrition proportion of Postgraduate Diploma in Teaching candidates in the year 2011 and 2015. The 2011 and 2015 academic years have been purposively selected because the…

  1. APM Best Practices Realizing Application Performance Management

    CERN Document Server

    Sydor, Michael J

    2011-01-01

    The objective of APM Best Practices: Realizing Application Performance Management is to establish reliable application performance management (APM) practices - to demonstrate value, to do it quickly, and to adapt to the client circumstances. It's important to balance long-term goals with short-term deliverables, but without compromising usefulness or correctness. The successful strategy is to establish a few reasonable goals, achieve them quickly, and then iterate over the same topics two more times, with each successive iteration expanding the skills and capabilities of the APM team. This str

  2. Total quality management in orthodontic practice.

    Science.gov (United States)

    Atta, A E

    1999-12-01

    Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

  3. Human Factors Engineering: Current Practices and Development Needs in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Savioja, Paula; Norros, Leena; Liinasuo, Marja; Laarni, Jari [VTT Technical Research Centre of Finland, Finland (Finland)

    2011-08-15

    This paper describes initial findings from a study concerning the practices and development needs of Human Factors Engineering (HFE) in Finland. HFE is increasing in importance as the Radiation and Nuclear Safety Authority Finland (STUK) is renewing the regulatory guidelines and the intention is to include requirements concerning HFE. The motivation for the paper is to discover how HFE is conducted currently in order to envision what should be aimed at when modifying requirements for design practices. In an interview with STUK it was discovered that current HFE practices encompass mainly activities related to control room modifications and as such namely verification and validation of new designs. The adoption of the entire HFE process in design and modification projects requires changes that include better integration of technical and Human Factors Engineering approaches. Boundary objects that mediate between different design disciplines are needed in order to enforce the stronger integration. Concept of operations (CONOPS) is suggested as a such boundary object.

  4. Evidence-Based Practice: Management of Vertigo

    Science.gov (United States)

    Nguyen-Huynh, Anh T.

    2012-01-01

    Synopsis The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo (BPPV), the most common diagnosis of vertigo in both primary care and subspecialty settings. Like all articles in this compilation of evidence-based practice, an overview is presented along with evidence based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented. PMID:22980676

  5. Challenges of Best Agile Management Practices

    OpenAIRE

    Kulesovs, Ivans; Korkkinen, Max

    2013-01-01

    Agile software development and Agile leadership are widespread topics nowadays. Management 3.0 framework is a new framework for Agile leadership implementation within the software development organization. We have performed research that should answer such question as, what are the difficulties related to and the best practices of Agile leadership implementation in software development organizations through the prism of Management 3.0 framework views. In order to do this we have performed the...

  6. Croatian radioactive waste management program: Current status

    International Nuclear Information System (INIS)

    Matanic, R.; Lebegner, J.

    2001-01-01

    Croatia has a responsibility to develop a radioactive waste management program partly due to co-ownership of Krsko nuclear power plant (Slovenia) and partly because of its own medical and industrial radioactive waste. The total amount of generated radioactive waste in Croatia is stored in temporary storages located at two national research institutes, while radioactive waste from Krsko remains in temporary storage on site. National power utility Hrvatska Elektroprivreda (HEP) and Hazardous Waste Management Agency (APO) coordinate the work regarding decommissioning, spent fuel management and low and intermediate level radioactive waste (LILRW) management in Croatia. Since the majority of work has been done in developing the LILRW management program, the paper focuses on this part of radioactive waste management. Issues of site selection, repository design, safety assessment and public acceptance are being discussed. A short description of the national radioactive waste management infrastructure has also been presented. (author)

  7. Shifting currents: Progress, setbacks, and shifts in policy and practice

    Science.gov (United States)

    ,; Dunning, Charles; Robertson, Dale M.

    2016-01-01

    The Wisconsin Academy’s initial Waters of Wisconsin project (WOW I) facilitated a statewide conversation between 2000 and 2003 around one main question: How can we ensure healthy aquatic ecosystems and clean, abundant water supplies for tomorrow’s Wisconsin? Robust participation in this conversation underscored the important role citizens have in the stewardship of our waters, and we found enthusiastic support for farsighted policies—based on sound science—to manage our water legacy. Overall, we found that Wisconsinites cherish water and see our waters as essential to our way of life in Wisconsin. Nationally, our state ranks 25th in land area but has the fourth-highest area covered by water. Wisconsin is 20th in population but is second only to Florida in the number of fishing licenses sold each year. Clean water supports billions of dollars’ worth of economic activity through tourism, agriculture, and industry. From the Northwoods cabin to the Port of Milwaukee to the Wisconsin Dells, water shapes our state’s identity. Our tradition of safeguarding Wisconsin’s waters is grounded in values such as responsibility to family and future generations, respect for land and wildlife, protecting public health and safety, and caring for water as a common good, as articulated in the state’s Public Trust Doctrine (see page 9). These deeply held values have also shaped a conservation ethic, and its legacy has served many generations who depend upon and enjoy the waters of the state. Through WOW I, we identified the need to overcome the institutional and disciplinary separation of science, policy, and management protocols through a more integrated approach to water management. WOW also affirmed that the Wisconsin Department of Natural Resources (DNR) and other public agencies play a critical role in sound scientific application, citizen participation, and the practical implementation of policy while balancing public and private interests toward the goal of a

  8. Small Business and Defense Acquisitions: A Review of Policies and Current Practices

    Science.gov (United States)

    2011-01-01

    Office of Management and Budget xviii Small Business and Defense Acquisitions: A Review of Policies and Current Practices PSC Product and Service Code...themselves as minority-owned, women-owned, veteran- owned, or small disadvantaged businesses . The resulting database gives sourcing managers a tool for...REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Small Business and Defense Acquisitions: A

  9. Data Management in Practice Supplementary Files

    DEFF Research Database (Denmark)

    Hansen, Karsten Kryger; Madsen, Christina Guldfeldt; Kjeldgaard, Anne Sofie Fink

    This report presents the results of the Data Management i Praksis (DMiP) project (in English: Data Management in Practice). The project was funded by Denmark’s Electronic Research Library (DEFF), the National Danish Archives and the participating main Danish libraries. The following partners...... level. The project should also demonstrate that research libraries have a role to play regarding research data. Furthermore, the project should ensure development of competences at the libraries, which can then be used in the future process of managing research data....

  10. EIA systems in Nigeria: evolution, current practice and shortcomings

    International Nuclear Information System (INIS)

    Ogunba, Olusegun A.

    2004-01-01

    Amidst mounting criticism of Environmental Impact Assessments (EIAs) carried out in Nigeria under the three independent EIA systems--the EIA Decree 86 (1992), the Town and Country Planning Decree 88 (1992) and the Petroleum Act (1969)--the paper traces the evolution of Nigeria's systems and appraises current practice and shortcomings. The path of development of the systems was traced within the framework of Gibson's model of EIA evolution [Impact Assess. Proj. Apprais., 20 (3) 2002, 151-159], while current practice and shortcomings were explored in random interview surveys of consultant firms, approval authorities and the academia. It was seen that Gibson's four-stage model is not exactly representative of the Nigerian situation, and a more appropriate six-stage model was developed. It was also established that the current practices of the three EIA systems were at different stages of evolution: one of the EIA schemes (the Town and Country Planning Decree) has not evolved satisfactorily, while the other two EIA systems have produced intricate legislations and guidelines, but fall short of first-rate practice. The other discovery was that the simultaneous use of three independent systems creates unnecessary duplication of EIA preparation with considerable time and money costs. The paper advises that Nigeria can make substantial progress along the evolutionary path through a correction of observed system shortcomings and a merger of the three systems

  11. Australian survey on current practices for breast radiotherapy.

    Science.gov (United States)

    Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois

    2015-12-01

    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

  12. STORMWATER BEST MANAGEMENT PRACTICES TEST FACILITY - SWALES

    Science.gov (United States)

    The NRMRL swale evaluation is part of a larger collection of long-term research projects that evaluates many Best Management Practices. EPA has ongoing research examining the performance of constructed wet lands, and detention and retention ponds. Other projects will evaluate ra...

  13. Strategic human resource management practices and ...

    African Journals Online (AJOL)

    This paper examined the theoretical perspectives of Strategic Human Resource Management Practices (SHRMPs) and organizational growth. The essence was to establish a relationship between SHRMPs and organizational growth. A qualitative research approach was adopted in an attempt to draw a relationship ...

  14. Risk Management Practices of Multinational and indigenous ...

    African Journals Online (AJOL)

    Construction projects' high uncertainty rates make them unattractive to non-risk takers. Construction companies are therefore necessarily risk takers, albeit, to varying degrees. This study made an inquiry into the risk management (RM) practices of multinational and indigenous construction companies (MCCs and ICCs, ...

  15. Management practices and production constraints of central ...

    African Journals Online (AJOL)

    management practices of central highland goats and their major constraints. ... tance to improve the goat production potential and livelihood of the farmers in the study ... ing the productivity and income from keeping goats, there is a study gap in ..... and day time, possibly increasing the chance of getting contagious diseases.

  16. Forest management practices and silviculture. Chapter 12.

    Science.gov (United States)

    Donald A. Perala; Elon S. Verry

    2011-01-01

    This chapter is an overview of forest management and silviculture practices, and lessons learned, on the Marcell Experimental Forest (MEF). The forests there are a mosaic of natural regeneration and conifer plantations. Verry (1969) described forest-plant communities in detail for the study watersheds (Sl through S6) on the MEF. The remaining area is described in...

  17. Performance management practices in lean manufacturing organizations

    NARCIS (Netherlands)

    Bellisario, Andrea; Pavlov, Andrey

    2018-01-01

    This paper provides the first systematic look into the existing research on performance management (PM) practices employed in lean manufacturing organisations (LMOs). It adopts a systematic review method to examine the evidence generated in the period 2004 – 2015 and uses a comprehensive PM

  18. New Management Practices and Enterprise Training.

    Science.gov (United States)

    Smith, Andrew; Oczkowski, Eddie; Noble, Charles; Macklin, Robert

    The changing nature of the demand for training in Australian enterprises adopting new management practices and the implications of those changes for training providers were examined. More than 3,400 private sector enterprises were surveyed by mail, after which follow-up telephone interviews were conducted with 80 human resource practitioners from…

  19. Safety issues in established predisposal waste management practices

    International Nuclear Information System (INIS)

    Thomas, W.

    2000-01-01

    Radioactive wastes generated at various stages in the nuclear fuel cycle vary considerably in relation to volume, physical and chemical properties, and radioactivity. The management of these wastes prior to disposal has to be adapted to these conditions, which calls for suitable characterization and minimization, collection, interim storage and conditioning of the wastes. Experience gained over decades shows that current predisposal waste management practices are well advanced. Whereas problems related to inadequate waste management practices in the past have been encountered at several sites and need ongoing remedial actions, modern practices have good safety records. Considerable development and improvement of waste management practices have been achieved and as a consequence of delays in implementing repositories in several countries they remain important tasks. Decommissioning and dismantling of nuclear facilities also have to be taken into account. In most cases, these activities can be performed using existing technical means and practices. No significant safety concerns have been found for the long term storage of spent fuel and vitrified waste. Dry storage has reached technical maturity and appears to be attractive, especially for aged fuel. It has, however, to be stressed that long term storage is not the ultimate solution. Continued efforts to implement repositories are mandatory in order to maintain a credible and responsible strategy for waste management. (author)

  20. Building Theory for Management Science and Practice

    DEFF Research Database (Denmark)

    Sanchez, Ron; Heene, Aimé

    2017-01-01

    In this paper we examine some fundamental epistemological issues in building theory for applied management science, by which we mean theory that can be usefully applied in a scientific approach to management research and practice. We first define and distinguish “grand theory” from “mid......-range theory” in the social and management sciences. We then elaborate and contrast epistemologies for (i) building “grand theory” intended to be applicable to all cases and contexts, and (ii) building “mid-range theory” intended to apply to specific kinds of contexts. We illustrate the epistemological...... challenges in building grand theory in management science by considering important differences in the abilities of two “grand theories” in strategic management – industry structure theory and firm resources theory – to support development of conceptually consistent models and propositions for empirical...

  1. Practice management education during surgical residency.

    Science.gov (United States)

    Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

    2008-12-01

    Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business

  2. Current trends in endodontic practice: emergency treatments and technological armamentarium.

    Science.gov (United States)

    Lee, Michelle; Winkler, Johnathon; Hartwell, Gary; Stewart, Jeffrey; Caine, Rufus

    2009-01-01

    The current clinical practice of endodontics includes the utilization of a variety of new technological advances and materials. The last comprehensive survey that compared treatment modalities used in endodontic practices was conducted in 1990. The purpose of the current survey was to determine the frequency with which these new endodontic technologies and materials are being used in endodontic practices today. An e-mail questionnaire was sent to the 636 active diplomates of the American Board of Endodontics with current e-mail addresses. Two hundred thirty-two diplomates responded for a response rate of 35%. Calcium hydroxide was found to be the most frequently used intracanal medicament for all cases diagnosed with necrotic pulps. Ibuprofen was the most frequently prescribed medication for pain, and penicillin was the most frequently prescribed antibiotic when an active infection was present. Eighty-two percent of the respondents are still incorporating hand files in some fashion during the cleansing and shaping phase of treatment. Lateral condensation and continuous wave were the most common methods used for obturation. Digital radiography was reported as being used by 72.5% of the respondents, whereas 45.3% reported using the microscope greater than 75% of the patient treatment. Ultrasonics was used by 97.8% of the respondents. It appears from the results that new endodontic technology is currently being used in the endodontic offices of those who responded to the survey.

  3. Concierge and Second-Opinion Radiology: Review of Current Practices.

    Science.gov (United States)

    Shaikh, Shehbaz; Bafana, Rounak; Halabi, Safwan S

    2016-01-01

    Radiology's core assets include the production, interpretation, and distribution of quality imaging studies. Second-opinion services and concierge practices in radiology aim to augment traditional services by providing patient-centered and physician-centered care, respectively. Patient centeredness enhances patients' understanding and comfort with their radiology tests and procedures and allows them to make better decisions about their health care. As the fee-for-service paradigm shifts to value-based care models, radiology practices have begun to diversify imaging service delivery and communication to coincide with the American College of Radiology Imaging 3.0 campaign. Physician-centered consultation allows for communication of evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. There are disparate practice models and payment schema for the various second-opinion and concierge practices. This review article explores the current state and payment models of second-opinion and concierge practices in radiology. This review also includes a discussion on the benefits, roadblocks, and ethical issues that surround these novel types of practices. Copyright © 2015 Mosby, Inc. All rights reserved.

  4. Best Practices for Managing Organizational Diversity

    Energy Technology Data Exchange (ETDEWEB)

    Kreitz, Patricia A.; /SLAC

    2007-05-18

    should human resource specialists play in creating and managing diverse organizations? What are the best practices they should apply? The purpose of this review is to define workplace diversity, to identify best practices, and to identify how diversity management best practices can be applied in academic libraries. Finally, this review will provide a resource list for HR managers and leaders to learn more about those best practices with the goal of optimizing their organization's approach to diversity.

  5. European Communication Monitor: Current developments, issues and tendencies of the professional practice of public relations in Europe

    NARCIS (Netherlands)

    Moreno, A.; Zerfass, A.; Tench, R.; Verčič, D.; Verhoeven, P.

    2009-01-01

    The European Communication Monitor (ECM) research explores the current developments for communications disciplines, practices and instruments. It is an extensive research project to monitor trends in communication management, analyse the changing framework for the profession driven by European

  6. Specialization and the Current Practices of General Surgeons

    Science.gov (United States)

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

  7. Knowledge Management Practices for Development - Slovak Model

    Directory of Open Access Journals (Sweden)

    Aferdita Dervishi

    2016-11-01

    Full Text Available Knowledge and its management, innovation and technology are key elements for economic growth and sustainable development in technology and globalization era. The purpose of this paper is to study the effects of best practices of knowledge management in Slovakia, a$ empting to present a model that may serve to improve access to knowledge management and technology in Albania. This paper analyses practices of research & development, intellectual capital, the link between knowledge, innovation and technology transfer and trends of economic development in Slovakia. This study has used the qualitative method, supported on secondary source of data. From the assessment perspective, the findings are believable that investing on intellectual capital and managing knowledge properly, stable effects on the development of economy, industry and other fields is reached. Knowledge is managed by higher scientific institutions supported by the state. Today, in Slovakia are operating the most powerful companies. Albanians possess human capital that may face the difficult technological challenges and innovations. Both, Albania and Kosovo governments need to create a more coherent and national access to knowledge management and innovation through the establishment of National Council of Science, Knowledge and Technology Transfer.

  8. Gender Perspective to Vedic Education: Current Practices in Nepal

    Directory of Open Access Journals (Sweden)

    Rajendra Raj Timilsina

    2016-10-01

    Full Text Available Vedic civilization has seen changes in its history- from Satya Yug to current Kali Yug. There were equal rights and duties of both men and women at the beginning. Interpretations of Veda, brought out of the Puranas and externalities made the status unequal. Sanatan Dharma, which is still mainstream of Hinduism, has been challenged by reformist Arya Samaj. As a result, there are interpretive differences as well as practices. Such differences can be seen in contemporary Nepal for the last 130 years. Continuing the differences, classicism has been reviving in the education. This revival also commenced with the same dualism. In this qualitative approach of exploration, two different gurukuls of girls have been observed and analyzed from the field for the purpose of exploring the recent practices. The observation was based on respective scriptures as well as experts' interviews. These data have analyzed the confronting practices on gender in Veda and rooted ideas in contemporary Nepal.

  9. Remediation in Practicing Physicians: Current and Alternative Conceptualizations.

    Science.gov (United States)

    Bourgeois-Law, Gisèle; Teunissen, Pim W; Regehr, Glenn

    2018-04-24

    Suboptimal performance in practicing physicians is a decades-old problem. The lack of a universally accepted definition of remediation, the paucity of research on best remediation practices, and the ongoing controversy regarding the institutional responsibility for enacting and overseeing this activity suggests that the remediation of physicians is not merely a difficult problem to solve, but a problem that the community does not grapple with meaningfully. Undoubtedly, logistical and political considerations contribute to this state of affairs; however, other underlying conceptual issues may also play a role in the medical profession's difficulties in engaging with the challenges around remediation.Through a review of the medical education and other literatures, the authors examined current conceptualizations of both remediation itself and the individual being remediated, as well as how the culture of medicine influences these conceptions. The authors explored how conceptualizations of remediation and the surrounding culture might affect not only the medical community's ability to support, but also its willingness to engage with physicians in need of remediation.Viewing remediation as a means of supporting practice change-rather than as a means of redressing gaps in knowledge and skill-might be a useful alternative conceptualization, providing a good place to start exploring new avenues of research. However, moving forward will require more than simply a reconceptualizion of remediation; it will also necessitate a change in how the community views its struggling members and a change in the medical culture that currently positions professional autonomy as the foundational premise for individual practice improvement.

  10. Quality of the current low power and shutdown PSA practice

    International Nuclear Information System (INIS)

    Jang, Seung Cheol; Park, Jin Hee; Lim, Ho Gon; Kim, Tae Woon

    2004-01-01

    A probabilistic safety assessment (PSA) for the low-power and shutdown (LPSD) modes in a Korea standard nuclear power plant (KSNP) has been performed for the purpose of estimating the LPSD risk and identifying the vulnerabilities of LPSD operations. Both the operational experience and PSA results indicate that the risks from LPSD operations could be comparable with those from power operations. However, the application of the LPSD risk insights to risk-informed decision making has been slow to be adopted in practice. It is largely due to the question of whether the current LPSD PSA practice is appropriate for application to risk-informed decision making or not. Such a question has to do with the quality of the current LPSD PSA practice. In this paper, we have performed self-assessment of the KSNP LPSD PSA quality based on the ANS Standard (draft as of 13 Sep. 2002). The aims of the work are to find the LPSD PSA technical areas insufficient for application to risk-informed decision making and to efficiently allocate the limited research resources to improve the LPSD PSA model quality. Many useful findings regarding the current LPSD PSA quality are presented in this paper

  11. Current marketing practices in the nursing home sector.

    Science.gov (United States)

    Calhoun, Judith G; Banaszak-Holl, Jane; Hearld, Larry R

    2006-01-01

    Marketing is widely recognized as an essential business function across all industries, including healthcare. While many long-term care facilities adopted basic healthcare marketing practices and hired marketing staff by the early 1990s, a paucity of research on nursing home marketing exists in the literature. This study examines the extent to which nursing homes have developed more formulated marketing and related communication and promotional strategies as market competition has increased in this sector during the past two decades. In addition, we explored managers' perceptions of their control over marketing decision making, the impact of competition on the use of marketing practices, and areas for enhanced competitive positioning. Administrators from 230 nursing homes in 18 Southeastern Michigan counties were surveyed regarding (1) the adoption level of approximately 40 literature-based, best-practice marketing strategies; (2) the types of staff involved with the marketing function; and (3) their perception of their level of control over marketing functions and of local competition. Results from 101 (44 percent) survey participants revealed that although respondents viewed their markets as highly competitive, their marketing practices remained focused on traditional and relatively constrained practices. In relation to the importance of customer relationship management, the majority of the administrators reported intensive efforts being focused on residents and their families, referrers, and staff, with minimal efforts being extended to insurers and other types of payers. A significant positive relation was found between the intensity of marketing initiatives and the size of the facility (number of beds), whereas significant negative correlations were revealed in relation to occupancy and the perceived level of control over the function.

  12. Managing image collections a practical guide

    CERN Document Server

    Note, Margot

    2011-01-01

    This book explores issues surrounding all aspects of visual collection management, taken from real-world experience in creating management systems and digitizing core content. Readers will gain the knowledge to manage the digitization process from beginning to end, assess and define the needs of their particular project, and evaluate digitization options. Additionally, they will select strategies which best meet current and future needs, acquire the knowledge to select the best images for digitization, and understand the legal issues surrounding digitization of visual collections.<

  13. Soil management practices under organic farming

    Science.gov (United States)

    Aly, Adel; Chami Ziad, Al; Hamdy, Atef

    2015-04-01

    Organic farming methods combine scientific knowledge of ecology and modern technology with traditional farming practices based on naturally occurring biological processes. Soil building practices such as crop rotations, intercropping, symbiotic associations, cover crops, organic fertilizers and minimum tillage are central to organic practices. Those practices encourage soil formation and structure and creating more stable systems. In farm nutrient and energy cycling is increased and the retentive abilities of the soil for nutrients and water are enhanced. Such management techniques also play an important role in soil erosion control. The length of time that the soil is exposed to erosive forces is decreased, soil biodiversity is increased, and nutrient losses are reduced, helping to maintain and enhance soil productivity. Organic farming as systematized and certifiable approach for agriculture, there is no surprise that it faces some challenges among both farmers and public sector. This can be clearly demonstrated particularly in the absence of the essential conditions needed to implement successfully the soil management practices like green manure and composting to improve soil fertility including crop rotation, cover cropping and reduced tillage. Those issues beside others will be fully discussed highlighting their beneficial impact on the environmental soil characteristics. Keywords: soil fertility, organic matter, plant nutrition

  14. Current state of information technology use in a US primary care practice-based research network.

    Science.gov (United States)

    Andrews, James E; Pearce, Kevin A; Sydney, Carey; Ireson, Carol; Love, Margaret

    2004-01-01

    To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

  15. Individual competencies for managers engaged in corporate sustainable management practices

    OpenAIRE

    Wesselink, R.; Blok, V.; Leur, van, S.; Lans, T.; Dentoni, D.

    2015-01-01

    Corporations increasingly acknowledge the importance of sustainable practices. Corporate social responsibility is therefore gaining significance in the business world. Since solving corporate social responsibility issues is not a routine job, every challenge in corporate social responsibility requires its own approach; and management competencies are crucial for designing appropriate approaches towards the realization of sustainable solutions. On the basis of seven corporate social responsibi...

  16. Cost estimation for decommissioning: a review of current practice

    International Nuclear Information System (INIS)

    O'Sullivan, P.; Pescatore, C.

    2009-01-01

    inventory, decontamination and waste disposal. Several countries look for cost reduction possibilities through waste minimization processes. Consideration should be given to developing upgraded decommissioning management systems to deal with latest developments, data quality, completeness and safety, while offering flexibility in data processing and cost calculations. Regular interaction between system developers and users is necessary to develop the inventory and maintain user friendliness. Current good practices include the use of a standardised list of decommissioning activities, a strong quality-assurance programme, use of a dedicated decommissioning core group during the planning phase of decommissioning, and involvement of regulators and stakeholders in the drafting of decommissioning plans

  17. It's magic: a unique practice management strategy.

    Science.gov (United States)

    Schwartz, Steven

    2003-11-15

    For thousands of years prior to the advent of modern dentistry, magic has been used to entertain, impress, and motivate individuals. Today's dental professionals are using the concept of The Magic of a Healthy Smile through their use of modern clinical techniques and as a means for practice marketing, patient education, and the reduction of patient stress and fear. This article describes how dentists/magicians have incorporated magic into their practices and the benefits of this useful patient management strategy. A script of the "Happy Tooth Magic Show" and resources for dentists to create their own dental magic show are provided.

  18. Current Status of On-Site Wastewater Management

    Science.gov (United States)

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  19. Solid waste management. Principles and practice

    Energy Technology Data Exchange (ETDEWEB)

    Chandrappa, Ramesha [Karnataka State Pollution Control Board, Biomedical Waste, Bangalore (India); Bhusan Das, Diganta [Loughborough Univ. of Technology (United Kingdom). Dept. of Chemical Engineering

    2012-11-01

    Solid waste was already a problem long before water and air pollution issues attracted public attention. Historically the problem associated with solid waste can be dated back to prehistoric days. Due to the invention of new products, technologies and services the quantity and quality of the waste have changed over the years. Waste characteristics not only depend on income, culture and geography but also on a society's economy and, situations like disasters that affect that economy. There was tremendous industrial activity in Europe during the industrial revolution. The twentieth century is recognized as the American Century and the twenty-first century is recognized as the Asian Century in which everyone wants to earn 'as much as possible'. After Asia the currently developing Africa could next take the center stage. With transitions in their economies many countries have also witnessed an explosion of waste quantities. Solid waste problems and approaches to tackling them vary from country to country. For example, while efforts are made to collect and dispose hospital waste through separate mechanisms in India it is burnt together with municipal solid waste in Sweden. While trans-boundary movement of waste has been addressed in numerous international agreements, it still reaches developing countries in many forms. While thousands of people depend on waste for their lively hood throughout the world, many others face problems due to poor waste management. In this context solid waste has not remained an issue to be tackled by the local urban bodies alone. It has become a subject of importance for engineers as well as doctors, psychologist, economists, and climate scientists and any others. There are huge changes in waste management in different parts of the world at different times in history. To address these issues, an effort has been made by the authors to combine their experience and bring together a new text book on the theory and practice of the

  20. The green game: investigating golf management practices

    Directory of Open Access Journals (Sweden)

    Bianca de Klerk

    2014-01-01

    Full Text Available Worldwide, golf is the largest sports-related travel market segment showing tremendous economic growth. Unfortunately, tourism and the so-called ‘green game’ contribute to environmental damage. Golf tourism is a rapidly expanding special interest activity linked to tourism. With a degraded physical environment, a destination may be in danger of losing its original appeal, which may force ‘naturebased’ tourists to move on to other destinations. The private sector, governments and the environment will benefit from responsible and sustainable practices including the management of golf courses. This will ensure that destinations continue to attract tourists for future generations. Therefore, green golf tourism is the only logical option placing the responsibility on golf course management to take a second look at the nature of this game. The study focused on the effects that golf course management might have on the environment and the adaptation methods implemented to reduce environmental damage. The management of George Golf Club and Pinnacle Point, located along the Garden Route, one of South Africa’s prime attractions were included in the study. Results indicated that management did not specifically monitor the impact of the golf course on the environment and did not educate golf tourists about environmental friendly practices on golf courses. Little was also done to motivate golf tourists to demand environmental friendly golf courses.

  1. Practical Risk Management for the CIO

    CERN Document Server

    Scherling, Mark

    2007-01-01

    The growing complexity of today's interconnected systems has not only increased the need for improved information security, but also helped to move information from the IT backroom to the executive boardroom as a strategic asset. And, just like the tip of an iceberg is all you see until you run into it, the risks to your information are mostly invisible until disaster strikes. Detailing procedures that will help your team perform better risk assessments and aggregate results into more meaningful metrics, Practical Risk Management for the CIO approaches information risk management through impro

  2. Practical Methods for Information Security Risk Management

    Directory of Open Access Journals (Sweden)

    Cristian AMANCEI

    2011-01-01

    Full Text Available The purpose of this paper is to present some directions to perform the risk man-agement for information security. The article follows to practical methods through question-naire that asses the internal control, and through evaluation based on existing controls as part of vulnerability assessment. The methods presented contains all the key elements that concurs in risk management, through the elements proposed for evaluation questionnaire, list of threats, resource classification and evaluation, correlation between risks and controls and residual risk computation.

  3. IP Address Management Principles and Practice

    CERN Document Server

    Rooney, Timothy

    2010-01-01

    This book will be the first covering the subject of IP address management (IPAM). The practice of IPAM includes the application of network management disciplines to IP address space and associated network services, namely DHCP (Dynamic Host Configuration Protocol) and DNS (Domain Name System). The consequence of inaccurately configuring DHCP is that end users may not be able to obtain IP addresses to access the network. Without proper DNS configuration, usability of the network will greatly suffer as the name-to-address lookup process may fail. Imagine having to navigate to a website or send a

  4. Management of professionals in school practices

    DEFF Research Database (Denmark)

    Jacobsen, Alice Juel; Buch, Anders

    2016-01-01

    related to an under-standing of professionals are used to investigate the practices involved in the change processes. The article argues that the ambiguity of a primus inter pares management position among professionals leads to several paradoxes, deadlocks, and detours, all of which affect the work......This article investigates organizational reform changes as they are con-structed in the interaction between managers and teachers in a school context. The empirical basis is comprised of case studies carried out in Danish upper secondary schools. An ethnographic approach and a concept of paradox...

  5. Pancreaticoduodenal injuries: Re-evaluating current management ...

    African Journals Online (AJOL)

    Background. Pancreaticoduodenal injuries are uncommon owing to the protected position of the pancreas and duodenum in the retroperitoneum. Management depends on the extent of injury. This study was undertaken to document outcome of pancreaticoduodenal injuries and to re-evaluate our approach. Patients and ...

  6. Current management of locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn

    2011-01-01

    ABSTRACT Objective: A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). Method: A systematic literature search was undertaken using PubMed, Embase, Web...

  7. Spent fuel management: Current status and prospects

    International Nuclear Information System (INIS)

    1988-12-01

    The main objective of the Advisory Group on Spent Fuel Management is to review the world-wide situation in Spent Fuel Management, to define the most important directions of national efforts and international cooperation in this area, to exchange information on the present status and progress in performing the back-end of Nuclear Fuel Cycle and to elaborate the general recommendations for future Agency programmes in the field of spent fuel management. This report which is a result of the third IAEA Advisory Group Meeting (the first and second were held in 1984 and 1986) is intended to provide the reader with an overview of the status of spent fuel management programmes in a number of leading countries, with a description of the past and present IAEA activities in this field of Nuclear Fuel Cycle and with the Agency's plans for the next years, based on the proposals and recommendations of Member States. A separate abstract was prepared for each of 14 papers presented at the advisory group meeting. Refs, figs and tabs

  8. Practical Implementation of Sustainable Urban Management Tools

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev; Jensen, Jesper Ole; Hoffmann, Birgitte

    2006-01-01

    The paper discusses how to promote the use of decision support tools for urban sustainable development. The interest in decision support tools based on indicators is increasing among practitioners and researchers. The research has so far focused on indicator types and systems of indicators...... and goals for urban sustainability whereas less focus has been on the context of implementation and even less on what we can learn from practical experiences about the usefulness of urban sustainable indicator tools. This paper explores the practical implementation of urban sustainable management tools....... It is generally agreed that in order to make indicators and other sustainability management tools work it is necessary that they are integrated in the relevant urban organisational levels, in a way that creates commitment to the subsequent goals. This includes involvement of organisations, individuals and other...

  9. 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...

  10. Soil management practices for sustainable crop production

    International Nuclear Information System (INIS)

    Abalos, E.B.

    2005-01-01

    In a sustainable system, the soil is viewed as a fragile and living medium that must be protected and nurtured to ensure its long-term productivity and stability. However, due to high demand for food brought about by high population as well as the decline in agricultural lands, the soil is being exploited beyond its limit thus, leading to poor or sick soils. Sound soil management practices in the Philippines is being reviewed. The technologies, including the advantages and disadvantages are hereby presented. This includes proper cropping systems, fertilizer program, soil erosion control and correcting soil acidity. Sound soil management practices which conserve organic matter for long-term sustainability includes addition of compost, maintaining soil cover, increasing aggregates stability, soil tilt and diversity of soil microbial life. A healthy soil is a key component to sustainability as a health soil produce healthy crop plants and have optimum vigor or less susceptible to pests. (author)

  11. Management of Periprocedural Anticoagulation: A Survey of Contemporary Practice.

    Science.gov (United States)

    Flaker, Greg C; Theriot, Paul; Binder, Lea G; Dobesh, Paul P; Cuker, Adam; Doherty, John U

    2016-07-12

    Interruption of oral anticoagulation (AC) for surgery or an invasive procedure is a complicated process. Practice guidelines provide only general recommendations, and care of such patients occurs across multiple specialties. The availability of direct oral anticoagulants further complicates decision making and guidance here is limited. To evaluate current practice patterns in the United States for bridging AC, a survey was developed by the American College of Cardiology Anticoagulation Work Group. The goal of the survey was to assess how general and subspecialty cardiologists, internists, gastroenterologists, and orthopedic surgeons currently manage patients who receive AC and undergo surgery or an invasive procedure. The survey was completed by 945 physicians involved in the periprocedural management of AC. The results provide a template for educational and research projects geared toward the development of clinical pathways and point-of-care tools to improve this area of health care. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Cutaneous Scar Prevention and Management; Overview of current therapies

    Directory of Open Access Journals (Sweden)

    Sultan Al-Shaqsi

    2016-02-01

    Full Text Available Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management.

  13. Quality management in home care: models for today's practice.

    Science.gov (United States)

    Verhey, M P

    1996-01-01

    In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

  14. Endoscopy Practice Management, Fee Structures, and Marketing.

    Science.gov (United States)

    Divers, Stephen J

    2015-09-01

    Although our knowledge and appreciation of endoscopic procedures in exotic pets is extensive, associated management practices, including equipment preferences and fee structures, have rarely been discussed. This short article highlights the results of a small survey of 35 experienced exotic animal endoscopists and details their equipment ownership/preferences and fee structures. The importance of marketing is also emphasized. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Current Administrative court practice in the procedure of Public Procurement

    Directory of Open Access Journals (Sweden)

    Silvio Čović

    2017-01-01

    Full Text Available Under the current conditions of complex and difficult economic and social circumstances and given the comparative possibilities and economic effects, the system of public procurement which is firstly at a legal level regulated by the Public Procurement Act 8 (Zakon o javnoj nabavi of 2011 (further referred to as: PPA (ZN, is of particular importance for the entire legal, political and economic system of the Republic of Croatia. Public procurement in essence represents contracting the procurement of goods, works or services. The specifities of that system are comprised, above all, of regulation of entering contractual relations between the public and private sector. Therefore, this system in principle must be formal in order to protect equality of competitors in the public procurement procedure and also in the general interest. Appreciating the legal tradition and indigenous particularities, the author’s fundamental aims consisted of providing and analysing administrative court practice in the context of international legal acquis communautaire showing some legal regulation in practice of disputable aspects of the system of public procurement in Croatia and the doubts emerging from current administrative court practice.

  16. Introduction to Quality Management for EDXRF Practice

    International Nuclear Information System (INIS)

    2012-01-01

    The accelerated development of analytical methodologies during the last decades makes the analytical practice a field where competitiveness is ultimately defined by the confidence of the customers, based on their acceptance of the services provided. The IAEA assists its Member States laboratories to effectively utilize nuclear spectrometries for analytical services in environmental monitoring and other applications including nuclear energy systems-related needs. To support the IAEA Member States efforts the Agency implements various types of activities including production and distribution of reference materials, development of standardized analytical methods, conducting interlaboratory comparisons and proficiency tests as tools for quality control and provision of specialized training in Quality Management and Quality Control topics. This learning module was developed within the IAEA Project 1.4.3.4 (D.3.03) Nuclear Spectrometry for Analytical Applications, under the Nuclear Science Programme. The main objective of the Project is to enhance capability of interested Member States in effective utilization of nuclear spectrometries and analytical services in industry, human health, agriculture, and monitoring and evaluation of environmental pollution. The module aims at providing practical guidelines for the organization of work and quality management practice in x-ray fluorescence laboratories in IAEA Member States. The target users include the managers and technical staff of the analytical laboratories.

  17. Current Management of Sickle Cell Anemia

    Science.gov (United States)

    McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.

    2013-01-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  18. Current management of urethral stricture disease

    Directory of Open Access Journals (Sweden)

    Thomas G Smith

    2016-01-01

    Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts.

  19. Organizational change and current trends in management

    Directory of Open Access Journals (Sweden)

    Lect. Dr. Chirimbu Sebastian

    2011-05-01

    Full Text Available The challenge is to manage the organization's culture so that you can tap the company's strenghts to chieve superior performance and identify it's weaknesses in time to overcome them before they cause serious damage." Successful adaptation to change is as crucial within an organization as it is in the natural world. Just like plants and animals, organizations and the individuals in them inevitably encounter changing conditions that they are powerless to control.

  20. Medical Management of Uveitis ? Current Trends

    OpenAIRE

    Babu, Kalpana; Mahendradas, Padmamalini

    2013-01-01

    Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis.

  1. Bimodal Programming: A Survey of Current Clinical Practice.

    Science.gov (United States)

    Siburt, Hannah W; Holmes, Alice E

    2015-06-01

    The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

  2. The effect of recent amblyopia research on current practice in the UK.

    Science.gov (United States)

    Newsham, D

    2010-10-01

    Several studies have recently provided insights into how amblyopia may be most effectively managed. Despite the new evidence, a US study reported that a recent randomised controlled trial had made little influence on clinical practice. The aims of this research are to assess current practice of amblyopia management in the UK and to determine the comparability with the evidence-based recommendations. A questionnaire was constructed to assess current amblyopia management practice, particularly in relation to areas investigated by recent research and emailed to every head orthoptist within the UK. There was a great deal of variability in the amount of occlusion that was prescribed for moderate and severe amblyopia. Sixty per cent of clinicians indicated that the maximum they would prescribe was in excess of the 6 h recommended by research. Atropine was rarely recommended as a first-line treatment, with occlusion generally being considered to be more effective. Despite recommendations regarding education as a means of reducing non-compliance, only 39% of clinicians always gave written information, although various other methods of enhancing compliance were used. A period of refractive adaptation was allowed by most clinicians but often far less than recommended. The uptake of recent research evidence into clinical practice is sporadic and incomplete with one-third of respondents indicating that following the studies, they had made no changes whatsoever to their practice. This is similar to other areas of medicine; the reasons are likely to be varied, and is an area that would benefit from greater attention.

  3. Effective maintenance practices to manage system aging

    International Nuclear Information System (INIS)

    Chockie, A.; Bjorkelo, K.

    1992-01-01

    For a variety of economic and technical reasons, there has been a growing concern with the aging of complex systems and components and the role that maintenance can play in reducing this degradation. A study for the Nuclear Regulatory Commission was recently undertaken to identify effective maintenance practices that could be adapted by the nuclear industry in the United States to assist in managing the aging degradation of plant systems and components. Four organizations were examined to assess the influence that their maintenance programs have on their ability to address the systems and component aging degradation issues. An effective maintenance program was found to be essential to the management of system and component aging. The four key elements of an effective maintenance program that are important to an aging management program were identified. These are: the selection of critical systems and components; the development of an understanding of aging through the collection and analysis of equipment performance information; the development of appropriate preventive and predictive maintenance tasks to manage equipment and system aging degradation; the use of feedback mechanisms to continuously improve the management of aging systems and components. These elements were found to be common to all four organizations. In examining how the four organizations have structured their maintenance programs to include these key elements provides valuable lessons not only for the nuclear power industry, but also for any industrial organization that is concerned with the management of system and component aging degradation. This document provides detail, of these studies

  4. Process-oriented performance indicators for measuring ecodesign management practices

    DEFF Research Database (Denmark)

    Rodrigues, Vinicius Picanco; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

    2016-01-01

    In order to support ecodesign performance measurement from a business perspective, this paper performs an exploration of available process-oriented indicators to be applied to ecodesign management practices. With the Ecodesign Maturity Model as a background framework, a systematic literature review...... coupled with a cross-content analysis was carried out to assign proper indicators to the practices. Results show that the currently available indicators do not fully reflect the characteristics of ecodesign and there is significant room for improving the development of tailor-made indicators....

  5. Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?

    Science.gov (United States)

    Gardner, Tania; Refshauge, Kathryn; McAuley, James; Hübscher, Markus; Goodall, Stephen; Smith, Lorraine

    2018-01-18

    Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician's attitudes and beliefs and goal setting practice. A cross-sectional observational survey. The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.

  6. Cardiogenic shock. Current concepts in management.

    Science.gov (United States)

    Balakumaran, K; Hugenholtz, P G

    1986-10-01

    This article presents a categorisation of circulatory shock and discusses the causes, haemodynamics, and clinical recognition of cardiogenic shock. The first step in the management strategy in cardiogenic shock is to guide the patient from the state of shock to one of managed haemodynamic stability. The therapeutic manoeuvres of this first step constitute the management tactics, which can be grouped under 3 general headings: (a) making the most of a malfunctioning heart; (b) improving the state of the heart; and (c) reducing the demands on the heart. In order to make the most of the heart, i.e. to get the highest possible output at the lowest possible cost, clinicians need to use their judgement in stimulating an overtaxed heart on the one hand, and in manipulating the loads on it (the preload and afterload) on the other, for although these methods may be advantageous, they are not without their pitfalls. Efforts to improve the state of the heart often necessitate surgical (e.g. mitral valve replacement) or semisurgical (e.g. coronary angiography and recanalisation) techniques, although intravenous antithrombotic agents may achieve comparable results in a few cases at the bedside. Reducing the demands on the heart is an active process involving the takeover of at least a part of the work of the heart by ancillary devices such as the intra-aortic balloon pump, and of the work of breathing by intubation and artificial ventilation. The individuality of each case of cardiogenic shock emphasises the need for empirical modulation of therapy based on feedback information obtained by haemodynamic monitoring.

  7. Enhancing nurses' empowerment: the role of supervisors' empowering management practices.

    Science.gov (United States)

    Montani, Francesco; Courcy, François; Giorgi, Gabriele; Boilard, Amélie

    2015-09-01

    This study tests a theoretical model where: (a) nurses' dispositional resistance to change is indirectly negatively related to behavioural empowerment through the mediating role of psychological empowerment; and (b) supervisors' empowering management practices buffer both the negative relationship between dispositional resistance to change and psychological empowerment and the indirect negative relationship between resistance to change and behavioural empowerment via psychological empowerment. Promoting a high level of empowerment among nursing personnel is important to ensure their effectiveness in the context of organizational change. It is thus essential to advance our current understanding of the factors that hamper nurses' psychological and behavioural expressions of empowerment and to clarify supervisor practices that can overcome such barriers. A cross-sectional research design. We collected survey data during 2012 from a sample of 197 nurses from a Canadian hospital undergoing a major organizational change. Results from moderated mediation analyses provided evidence for an indirect negative relationship between dispositional resistance to change and behavioural empowerment through psychological empowerment, and for a moderating (buffering) effect of supervisors' empowering management practices on this mediated relationship. These findings provided support for our hypotheses. Supervisors' empowering management practices represent an important contextual buffer against the negative effects of dispositional resistance to change on nurses' empowerment. Organizations should develop empowering management skills among nurses' supervisors to counteract the detrimental effects of dispositional resistance to change and to sustain an empowered nursing workforce. © 2015 John Wiley & Sons Ltd.

  8. Current management of surgical oncologic emergencies.

    Science.gov (United States)

    Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J

    2015-01-01

    For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  9. Optimal management of chronic osteomyelitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Pande KC

    2015-08-01

    Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

  10. Self-Assessment in Librarianship: Current Practices and Future Possibilities

    Directory of Open Access Journals (Sweden)

    Ania Dymarz

    2015-07-01

    Full Text Available The authors of this qualitative study set out to investigate self-assessment practices within the library profession. The researchers conducted semi-structured interviews with a purposeful sample of nine librarians coming from a range of library settings and possessing a diversity of library experience. Interviews were then transcribed and coded in NVIVO to identify emergent themes. This paper details some of the results of that study, highlighting motivations, limitations, and strategies with regard to self-assessment. The findings present a summary of a range of approaches to the practice of assessment as reported by the interviewees. One area of possible growth for our profession, as highlighted by the findings, is in the development of peer networks as a support for the individual practice of self-assessment. While the results of this small case study cannot be generalized, the authors hope these preliminary findings can open up the conversation around self-assessment both for individual librarians and for those librarians and managers working to shape their workplace culture.

  11. Neuroimaging in refractory epilepsy. Current practice and evolving trends

    International Nuclear Information System (INIS)

    Ramli, N.; Rahmat, K.; Lim, K.S.; Tan, C.T.

    2015-01-01

    Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed

  12. Neuroimaging in refractory epilepsy. Current practice and evolving trends

    Energy Technology Data Exchange (ETDEWEB)

    Ramli, N. [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Rahmat, K., E-mail: katt_xr2000@yahoo.com [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Lim, K.S.; Tan, C.T. [Neurology Unit, Department of Medicine, University Malaya, Kuala Lumpur (Malaysia)

    2015-09-15

    Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

  13. Autopsy in Islam and current practice in Arab Muslim countries.

    Science.gov (United States)

    Mohammed, Madadin; Kharoshah, Magdy A

    2014-03-01

    Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  14. Work management practices that reduce dose and improve efficiency

    International Nuclear Information System (INIS)

    Miller, D.W.; Hulin, M.

    1998-01-01

    Work management practices at nuclear power plants can dramatically affect the outcome of annual site dose goals and outage costs. This presentation discusses global work management practices that contribute to dose reduction including work philosophy, work selection, work planning, work scheduling, worker training, work implementation and worker feedback. The presentation is based on a two-year international effort (sponsored by NEA/IAEA ISOE) to study effective work practices that reduce dose. Experts in this area believe that effective work selection and planning practices can substantially reduce occupational dose during refueling outages. For example, some plants represented in the expert group complete refueling outages in 12-18 days (Finland) with doses below 0,90 person-Sv. Other plants typically have 50-75 day outages with substantially higher site doses. The fundamental reasons for longer outages and higher occupational doses are examined. Good work management principles that have a proven track record of reducing occupational dose are summarized. Practical methods to reduce work duration and dose are explained. For example, scheduling at nuclear power plants can be improved by not only sequencing jobs on a time line but also including zone and resource-based considerations to avoid zone congestion and manpower delays. An ongoing, global, benchmarking effort is described which provides current duration and dose information for repetitive jobs to participating utilities world-wide. (author)

  15. Distributed Database Management Systems A Practical Approach

    CERN Document Server

    Rahimi, Saeed K

    2010-01-01

    This book addresses issues related to managing data across a distributed database system. It is unique because it covers traditional database theory and current research, explaining the difficulties in providing a unified user interface and global data dictionary. The book gives implementers guidance on hiding discrepancies across systems and creating the illusion of a single repository for users. It also includes three sample frameworksâ€"implemented using J2SE with JMS, J2EE, and Microsoft .Netâ€"that readers can use to learn how to implement a distributed database management system. IT and

  16. The "wins" of change: evaluating the impact of predicted changes on case management practice.

    Science.gov (United States)

    Stanton, Marietta P; Barnett Lammon, Carol Ann

    2008-01-01

    A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

  17. The current management of spinal cord cavernoma.

    Science.gov (United States)

    Velz, Julia; Bozinov, Oliver; Sarnthein, Johannes; Regli, Luca; Bellut, David

    2018-01-04

    Spinal cavernous malformations (SCM) were once thought to be rare lesions of the spinal cord. However, with the broad use of modern imaging techniques the incidence of SCM has significantly increased over the last decades. Management of both symptomatic and incidental findings is therefore of growing importance. However, experience with treatment and follow-up is very limited. We performed a single institution retrospective review of consecutive patients with SCM treated at our Department between 2006-2016 and discuss the clinical features as well as surgical versus conservative outcomes. We further provide a systematic literature search and discuss the best management of SCM, analyzing recent publications on SCM imaging techniques, surgical approaches and natural history. From a total number of 406 consecutive patients with cavernous malformations (CM) treated at our Department between 2006-2016, 29 (7.1 %) were found to be affected by SCM. The localization was cervical in 10 (34.5 %), cervicothoracic in 3 (10.4 %) and thoracic in 16 (55.2 %) patients. In 90 % of patients (n = 26) the diagnosis was made after onset of clinical symptoms. Conservative management was performed for 8 patients, whereas 21 patients underwent surgical removal of the lesion via a posterior approach using (hemi-) laminectomy or laminoplasty. Functional status improved in 15 patients (62. 5%) and remained unchanged in 6 patients (28.5 %) in the operative group, whereas 2 patients (25 %) improved and 6 patients (75 %) remained unchanged in the conservative group during long-term follow-up. Gross-total resection is the only definitive treatment option for symptomatic SCM. Surgical extirpation of the symptomatic SCM lesion through an unilateral laminectomy ( = hemilaminectomy) approach within 3 months of presentation seems to be good treatment option with an acceptable risk of complications and good long-term outcomes. Conservative treatment should be performed in asymptomatic patients and

  18. Challenges for municipal solid waste management practices in Vietnam

    Directory of Open Access Journals (Sweden)

    Nguyen Duc Luong

    2013-11-01

    Full Text Available Municipal solid waste (MSW management is currently one of the major environmental problems facing by Vietnam. Improper management of MSW has caused adverse impacts on the environment, community health, and social-economic development. This study attempts to provide a review of the generation and characterization, disposal and treatment technologies of MSW to evaluate the current status and identify the problems of MSW management practices in Vietnam. Finally, this study is concluded with fruitful recommendations which may be useful in encouraging the responsible agencies to work towards the further improvement of the existing MSW management system.Doi: http://dx.doi.org/10.12777/wastech.1.1.17-21Citation:  Luong, N.D., Giang, H.M., Thanh, B.X. and Hung, N.T.  2013. Challenges for municipal solid waste management practices in Vietnam. Waste Technology 1(1:6-9.Doi: http://dx.doi.org/10.12777/wastech.1.1.17-21

  19. On the Need for Rethinking Current Practice that Highlights Goal Achievement Risk in an Enterprise Context.

    Science.gov (United States)

    Aven, Eyvind; Aven, Terje

    2015-09-01

    This article addresses the issue of how performance and risk management can complement each other in order to enhance the management of an enterprise. Often, we see that risk management focuses on goal achievements and not the enterprise risk related to its activities in the value chain. The statement "no goal, no risk" is a common misconception. The main aim of the article is to present a normative model for describing the links between performance and risk, and to use this model to give recommendations on how to best structure and plan the management of an enterprise in situations involving risk and uncertainties. The model, which has several novel features, is based on the interaction between different types of risk management (enterprise risk management, task risk management, and personal risk management) and a structure where the enterprise risk management overrules both the task and personal risk management. To illustrate the model we use the metaphor of a ship, where the ship is loaded with cash-generating activities and has a direction over time determined by the overall strategic objectives. Compared to the current enterprise risk management practice, the model and related analysis are founded on a new perspective on risk, highlighting knowledge and uncertainties beyond probabilities. © 2015 Society for Risk Analysis.

  20. Facilities Management Practices in Malaysia: A Literature Review

    Directory of Open Access Journals (Sweden)

    Isa Nordiana Mohd

    2016-01-01

    Full Text Available Facilities management in Malaysia has been practiced for decades. The development of its formal practice parallels the improvement of the built environment in the nation. Involvement of the public and private sectors teaming up in arranging the National Asset and Facilities Management (NAFAM in demonstrates the vital collaboration in the facilities management area in Malaysia. Facilities management is seen distinctively as indicated by diverse geographical locations, interests and schools of thought. Facilities management is delegated a service-based industry which gives proficient counsel and administration of clients’ building facilities including residential, commercial, industrial, airports terminals and offices. The aim of this paper is to review the gaps that exist, especially on how FM is being practice in comparison with the published FM body of knowledge. Very relying upon literature, this paper discovered a gap that is an unclear description of current FM applications. This research aims to give new bits of knowledge to upgrade comprehension of FM execution in Malaysia.

  1. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  2. Current and future perspectives in clinical management

    International Nuclear Information System (INIS)

    Willett, Christopher

    1996-01-01

    In the past several years, there has been significant progress and controversy in the clinical management of patients with rectal cancer as well as important advances in the understanding the biology of these tumors. The panel will highlight relevant biologic and clinical developments. One of major advances has been in the understanding of the molecular basis for the development of colon and rectal cancer with many of the events leading to cancer development having been determined. Although there is much to be learned, there is now a much improved understanding of colon and rectal carcinogenesis with the prospect of being able to define high risk patient populations and the possibility of early detection (before cancer formation) now a real possibility. In addition, the identification of favorable or unfavorable subsets of patients wit rectal cancer based on molecular markers is under active investigation. These exciting developments will be summarized. In the clinical arena, there are a number of controversial issues in the management of patients with rectal cancer. For patients with distal rectal cancer, the goals of therapy have evolved from cure to cure with sphincter preservation. The role of resection with coloanal anastomosis as an alternative to an abdominoperineal resection is also being defined. A wide array of treatment programs of radiation therapy and chemotherapy and sphincter sparing surgery are under active investigation. The relative merits of preoperative chemo-irradiation versus postoperative chemo-irradiation continues to be debated. The utility of total mesorectal excision is being evaluated and the need for adjuvant therapy is being questioned. These clinical issues will be highlighted

  3. Peculiarities of the risk management system organization in current conditions

    OpenAIRE

    MIKHIN P.O.

    2014-01-01

    Risk-management system organization problem is topical nowadays. The innovation activity is defined as an activity vulnerable to risk and needs more attention. The basic approaches and elements of organization structure development in risk-management system are considered to find out the best structure for business modelling usage. Balance and combination of risk-management system types are required in current conditions.

  4. Clinical exome sequencing reports: current informatics practice and future opportunities.

    Science.gov (United States)

    Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

    2017-11-01

    The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Pediatric hospitalists: training, current practice, and career goals.

    Science.gov (United States)

    Freed, Gary L; Dunham, Kelly M

    2009-03-01

    To determine the range and frequency of experiences, clinical and nonclinical roles, training, work expectations, and career plans of practicing pediatric hospitalists. Mail survey study of a national sample of 530 pediatric hospitalists of whom 67% (N = 338) were from teaching hospitals, 71% (N = 374) were from children's hospitals, 43% (N = 230) were from freestanding children's hospitals, and 69% (N = 354) were from hospitals with >or=250 beds. The response rate was 84%. The majority (54%; N = 211) had been practicing as hospitalists for at least 3 years. Most reported that the pediatric inpatient unit (94%) and inpatient consultation service (51%) were a part of their regular clinical assignment. Most did not provide service in the normal newborn nursery (58%), subspecialty inpatient service (52%), transports (85%), outpatient clinics (66%), or as part of an emergency response team (53%). Many participated in quality improvement (QI) initiatives (84%) and practice guideline development (81%). This study provides the most comprehensive information available regarding the clinical and nonclinical roles, training, work expectations, and career plans of pediatric hospitalists. However, the field is currently a moving target; there is significant flux in the hospitalist workforce and variation in the roles of these professionals in their clinical and nonclinical work environment. (c) 2009 Society of Hospital Medicine.

  6. Figures in clinical trial reports: current practice & scope for improvement.

    Science.gov (United States)

    Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

    2007-11-19

    Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  7. Figures in clinical trial reports: current practice & scope for improvement

    Directory of Open Access Journals (Sweden)

    Travison Thomas G

    2007-11-01

    Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  8. Risk Management Techniques and Practice Workshop Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, T; Zosel, M

    2008-12-02

    At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk Management Techniques and Practice (RMTAP) workshop held September 18-19 at the Hotel Nikko in San Francisco. The purpose of the workshop, which was sponsored by the SC/Advanced Scientific Computing Research (ASCR) program and the National Nuclear Security Administration (NNSA)/Advanced Simulation and Computing (ASC) program, was to assess current and emerging techniques, practices, and lessons learned for effectively identifying, understanding, managing, and mitigating the risks associated with acquiring leading-edge computing systems at high-performance computing centers (HPCCs). Representatives from fifteen high-performance computing (HPC) organizations, four HPC vendor partners, and three government agencies attended the workshop. The overall workshop findings were: (1) Standard risk management techniques and tools are in the aggregate applicable to projects at HPCCs and are commonly employed by the HPC community; (2) HPC projects have characteristics that necessitate a tailoring of the standard risk management practices; (3) All HPCC acquisition projects can benefit by employing risk management, but the specific choice of risk management processes and tools is less important to the success of the project; (4) The special relationship between the HPCCs and HPC vendors must be reflected in the risk management strategy; (5) Best practices findings include developing a prioritized risk register with special attention to the top risks, establishing a practice of regular meetings and status updates with the platform partner, supporting regular and open reviews that engage the interests and expertise of a wide range of staff and stakeholders, and documenting and sharing the acquisition/build/deployment experience; and (6) Top risk categories include system scaling issues, request for proposal/contract and acceptance testing, and

  9. Innovative Soil Management Practices (SMP) Assessment in Europe and China

    Science.gov (United States)

    Barão, Lúcia

    2017-04-01

    The growing world population poses a major challenge to global agricultural food and feed production through the pressure to increase agricultural outputs either by increasing the land area dedicated to agriculture or by productivity increases. Whether in developed or developing regions, agricultural intensification based on conventional approaches has resulted in severe environmental impacts and innovative soil management practices are needed to halter ongoing soil degradation and promote sustainable land management capable to produce more from less. The iSQAPER project - Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience - aims to develop a Soil Quality app (SQAPP) linking soil and agricultural management practices to soil quality indicators. This easy friendly tool will provide a direct and convenient way to advise farmers and other suitable actors in this area, regarding the best management practices to be adopted in very specific and local conditions. In this particular study from iSQAPER, we aimed to identify the most promising innovative soil management practices (SMP) currently used and its geographical distribution along different pedo-climatic regions in Europe (Boreal, Atlantic, Mediterranean Temperate, Mediterranean Semi-Arid, Southern Sub-Continental and Northern Sub-Continental) and China (Middle Temperate, Warm temperate and Central Asia Tropical). So far we have identified 155 farms where innovative SMP's are used, distributed along 4 study site regions located in China (Qiyang, Suining, Zhifanggou and Gongzhuling) and 10 study site regions located in Europe (The Netherlands, France, Portugal, Spain, Greece, Slovenia, Hungary, Romania, Poland and Estonia) and covering the major pedo-climatic regions. From this identification we concluded that the most used innovative SMP's in the study site regions in Europe are Manuring & Composting (14%), Min-till (14%), Crop rotation (12

  10. Knowledge, Attitude and Self-management Practices of Patients with ...

    African Journals Online (AJOL)

    Knowledge, Attitude and Self-management Practices of Patients with Type 2 ... and its complications, self-care practices to recognize and manage diabetes crisis, ... Pre-tested questionnaire was administered to 200 randomly selected type 2 ...

  11. Best Management Practices Monitoring Guide for Stream Systems

    OpenAIRE

    Mesner, Nancy

    2011-01-01

    Best Management Practices Monitoring Guide for Stream Systems provides guidance on establishing a water quality monitoring program that will demonstrate the effectiveness of Best Management Practices (BMPs) to reduce nonpoint source pollution in stream systems.

  12. Global asessment of manure management policies and practices

    NARCIS (Netherlands)

    Teenstra, E.D.; Vellinga, Th.V.; Aktasaeng, N.; Amatayaku, W.; Ndambi, A.; Pelster, D.; Germer, L.; Jenet, A.; Opio, C.; Andeweg, K.

    2014-01-01

    The Livestock and Manure Management Component (LMMC) of the CCAC Agriculture Initiative supports integrated manure management practices by increasing knowledge and awareness, removing barriers to action and enhancing practice change. This Global Assessment report provides an overview of manure

  13. Current management of symptomatic intracranial stenosis.

    Science.gov (United States)

    Taylor, Robert A; Weigele, John B; Kasner, Scott E

    2011-08-01

    Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

  14. Current neurotrauma treatment practice in secondary medical service centers

    International Nuclear Information System (INIS)

    Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu

    2011-01-01

    Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

  15. Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

    Science.gov (United States)

    Montano, Diego

    2016-08-05

    The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

  16. TRACKING FARM MANAGEMENT PRACTICES WITH REMOTE SENSING

    Directory of Open Access Journals (Sweden)

    J. P. Stals

    2017-11-01

    Full Text Available Earth observation (EO data is effective in monitoring agricultural cropping activity over large areas. An example of such an application is the GeoTerraImage crop type classification for the South African Crop Estimates Committee (CEC. The satellite based classification of crop types in South Africa provides a large scale, spatial and historical record of agricultural practices in the main crop growing areas. The results from these classifications provides data for the analysis of trends over time, in order to extract valuable information that can aid decision making in the agricultural sector. Crop cultivation practices change over time as farmers adapt to demand, exchange rate and new technology. Through the use of remote sensing, grain crop types have been identified at field level since 2008, providing a historical data set of cropping activity for the three most important grain producing provinces of Mpumalanga, Freestate and North West province in South Africa. This historical information allows the analysis of farm management practices to identify changes and trends in crop rotation and irrigation practices. Analysis of crop type classification over time highlighted practices such as: frequency of cultivation of the same crop on a field, intensified cultivation on centre pivot irrigated fields with double cropping of a winter grain followed by a summer grain in the same year and increasing cultivation of certain types of crops over time such as soyabeans. All these practices can be analysed in a quantitative spatial and temporal manner through the use of the remote sensing based crop type classifications.

  17. Current management of urethral stricture disease

    Science.gov (United States)

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  18. Current management of gynecologic cancer in pregnancy.

    Science.gov (United States)

    Iavazzo, Christos; Minis, Evelyn Eleni; Gkegkes, Ioannis D

    2018-04-27

    Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbering at an advanced maternal age due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy are comprised of invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell mediated and humoral immunity), increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive, as there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow up of the children from different cancer centres and registries be shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.

  19. Skull base osteomyelitis: current microbiology and management.

    Science.gov (United States)

    Spielmann, P M; Yu, R; Neeff, M

    2013-01-01

    Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms. A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined. Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented. Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

  20. LIQUIDITY MANAGING A CURRENT JOB OF BANKING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    MEDAR LUCIAN-ION

    2014-02-01

    Full Text Available A credit institution liquidity managing, concerns on currency flows and operative funding needs, for customer satisfaction. Correlating bank liabilities and assets reflects the overall picture of the liquidity situation. The purpose of an efficient management of bank liquidity is to ensure the normal course of banking intermediation, to protect the interests of customers on one side and of the shareholders on the other side. Through an efficient bank liquidity management, are ensured reserve requirements and especially reasonable banking capacity of deposits reimbursement to customers, correlated with period in which they are or there are not returned to the credit institution, investments in the loans and other assets.

  1. Management of anaphylaxis in Latin America: current situation

    Directory of Open Access Journals (Sweden)

    Victoria Cardona

    2017-06-01

    Full Text Available Background: Anaphylaxis is a systemic and severe allergic reaction, which can be fatal. The first-line treatment of choice, according to international guidelines, is intramuscular adrenaline. However, different studies show that the performance of health professionals managing anaphylaxis is often inadequate Objective: To assess the current resources available in Latin American countries for the diagnosis and treatment of anaphylaxis. Methods: Online survey promoted by the Latin American Society of Allergy and Immunology to representatives of the national allergy societies of Latin American countries. Results: Responses were received from 10 countries out of the 14 countries invited to participate. Only five of the countries have clinical practice guidelines in anaphylaxis. Adrenaline autoinjectors are available only in two countries, Argentina and Brazil, but are not subsidized by public health systems. In all countries, adrenaline is available in ampoules, which is the presentation usually prescribed to patients for self-administration. The use of adrenaline was estimated to be less than 50 % of cases in five countries, while antihistamines and corticosteroids are almost always used. The determination of serum tryptase is possible in some health centers, often private, in five of the countries surveyed. Conclusion: It is necessary to improve resources related to the diagnosis and management of anaphylaxis in Latin American countries.

  2. Current and emerging treatment options in the management of lupus

    Science.gov (United States)

    Jordan, Natasha; D’Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  3. Methane emissions from natural gas pipelines - current estimates, technologies and practices

    International Nuclear Information System (INIS)

    Lang, M.C.; Crook, L.

    1997-01-01

    Methane is the major component of natural gas. World-wide methane emissions from gas systems is estimated to be between 50 and 25 tera grams or about 5 percent of the world-wide total of anthropogenic methane emissions. Technologies and practices are described that are currently being used or are planned to be used in the US to both measure and/or reduce methane emissions from natural gas pipelines. One of the technologies that is described includes a high flow sampling instrument. One of the practices that is described is the current voluntary program conducted by the US Environmental Protection Agency called the Natural Gas Star program. This program supports research into best management practices, information sharing and technology transfer to promote methane emissions reductions profitably. (R.P.)

  4. Current management of occult bacteremia in infants

    Directory of Open Access Journals (Sweden)

    Eduardo Mekitarian Filho

    2015-11-01

    Full Text Available Objectives: To summarize the main clinical entities associated with fever without source (FWS in infants, as well as the clinical management of children with occult bacteremia, emphasizing laboratory tests and empirical antibiotics. Sources: A non-systematic review was conducted in the following databases – PubMed, EMBASE, and SciELO, between 2006 and 2015. Summary of the findings: The prevalence of occult bacteremia has been decreasing dramatically in the past few years, due to conjugated vaccination against Streptococcus pneumoniae and Neisseria meningitidis. Additionally, fewer requests for complete blood count and blood cultures have been made for children older than 3 months presenting with FWS. Urinary tract infection is the most prevalent bacterial infection in children with FWS. Some known algorithms, such as Boston and Rochester, can guide the initial risk stratification for occult bacteremia in febrile infants younger than 3 months. Conclusions: There is no single algorithm to estimate the risk of occult bacteremia in febrile infants, but pediatricians should strongly consider outpatient management in fully vaccinated infants older than 3 months with FWS and good general status. Updated data about the incidence of occult bacteremia in this environment after conjugated vaccination are needed. Resumo: Objetivos: Listar as principais entidades clínicas associadas a quadros de febre sem sinais localizatórios (FSSL em lactentes, bem como o manejo dos casos de bacteremia oculta com ênfase na avaliação laboratorial e na antibioticoterapia empírica. Fonte dos dados: Foi realizada revisão não sistemática da literatura nas bases de dados PubMed, EMBASE e Scielo no período de 2006 a 2015. Síntese dos dados: A ocorrência de bacteremia oculta vem diminuindo sensivelmente em lactentes com FSSL, principalmente devido à introdução da vacinação conjugada contra Streptococcus pneumoniae e Neisseria meningitidis nos últimos anos

  5. Analyzing solid waste management practices for the hotel industry

    Directory of Open Access Journals (Sweden)

    S.T. Pham Phu

    2018-01-01

    Full Text Available The current study aims to analyze waste characteristics and management practices of the hotel industry in Hoi An, a tourism city in the center of Vietnam. Solid wastes from 120 hotels were sampled, the face-to-face interviews were conducted, and statistical methods were carried out to analyze the data. The results showed that the mean of waste generation rate of the hotels was 2.28 kg/guest/day and strongly correlated to internal influencing factors such as the capacity, the price of the room, garden, and level of restaurant. The differences in waste generation rate of the hotels were proved to be statistically significant. The higher the scale of hotels, the higher the waste generation rate. Moreover, the waste composition of the hotels was identified by 58.5% for biodegradable waste, 25.8% for recyclables and 15.7% for others. The relative differences in the waste composition of the hotels by climate, the features of hotels, and the types of the guest were explained. Whereby, the higher size of the hotels, the higher percentage of biodegradable and less proportion of recyclable waste. Also, this study revealed that the implementation status of waste management practices of the hoteliers initially reaped quite positive achievements with 76% for sorting, 39% for recycling, 29% for reduction, and 0.8% for composting. The rate of waste management practices was proportional to the scale of the hotel. This study provided information on waste management practice of hotel industry and contributed to the overall assessment of municipal solid waste management practices of Hoi An city.

  6. Images of Environment and Management Practice

    DEFF Research Database (Denmark)

    Schmidt, Kirsten; Remmen, Arne

    ; environment as a part of quality management; environment as a part of corporate branding and environment as a part of customer relations. The different images are distributed and coexist throughout the organization, where they may be a potential for conflicting priorities or a platform for organizational......Different images of environment can be found in relation to various understandings of environmental problems and solutions, such as cleaner production, environmental management, cleaner products and sustainability. Ascribed to these images are: environment as a part of license to operate...... as a technical issue as part of a formalized system created barriers for organizational learning in relation to sustainability, while the broader concept of social responsibility shaped a platform from which the employees could create meanings on sustainability more in line with their daily practices....

  7. Practical Management of Anaesthesia in the Elderly

    DEFF Research Database (Denmark)

    Strøm, Camilla; Rasmussen, Lars Simon; Steinmetz, Jacob

    2016-01-01

    The elderly population is rapidly growing and particularly diverse. Ageing leads to reduced organ function and a decline in physiologic reserve. Elderly patients are characterised by great inter-individual variability in physiological function with a high prevalence of chronic disease. In general......, older patients have a higher risk of postoperative adverse outcomes, and frailty is a very important risk factor. This review article aims to provide a practical guide to anaesthetic management of the elderly surgical patient. To optimise care, clinicians should be familiar with the typical physiologic...... changes related to ageing and the implications for anaesthetic management. All anaesthetic techniques, methods and agents can be applied, if tailored to the patient's physiologic and pathologic changes. The elderly are more sensitive to anaesthetics, meaning that desired sedative and analgesic effects...

  8. 7 CFR 205.271 - Facility pest management practice standard.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Facility pest management practice standard. 205.271... Requirements § 205.271 Facility pest management practice standard. (a) The producer or handler of an organic facility must use management practices to prevent pests, including but not limited to: (1) Removal of pest...

  9. Current Practices in Defining Seismic Input for Nuclear Facilities

    International Nuclear Information System (INIS)

    2015-05-01

    This report has been written in the framework of seismic subgroup of the OECD/NEA CSNI Working Group on Integrity and Ageing of Components and Structures (WGIAGE) to provide a brief review of current practices regarding the definition of the seismic input for design and reevaluation of nuclear power plants. It is taken for granted that, prior to conducting the seismic design of a nuclear facility, a seismic hazard analysis (SHA) has been conducted for the site where the facility is located. This provides some reference motions for defining those that will later be used as input for the dynamic analyses of the facility. The objective of the report is to clarify the current practices in various OECD Member States for defining the seismic input to be used in the dynamic calculations of NPPs, once the SHA results are already at hand. Current practices have been summarized for Canada, Czech Republic, Finland, France, Germany, Japan, Slovenia, South Korea, Spain, Sweden, The Netherlands, United Kingdom and United States. The main findings of the report are: a) The approaches followed by the regulatory bodies of OECD Member States differ substantially, certainly in relation with the consideration of site effects, but also in the probability level of the event that a nuclear facility should be required to withstand. b) In many countries a probabilistic approach is adopted for the design, in some cases combined with a deterministic one; in other cases, like France, Japan or South Korea, a deterministic approach is followed. c) The US and Japan have the more complete guidelines in relation with site effects. The former provide specific approaches for definition of the seismic input. The latter clearly recognizes the need to propagate the bedrock motion to foundation level, thereby introducing the site effect in some way. d) The definition of bedrock is very heterogeneous in the various countries, although this should not constitute a serious problem if the starting

  10. Therapeutic management of inflammatory bowel disease in real-life practice in the current era of anti-TNF agents: analysis of the French administrative health databases 2009-2014.

    Science.gov (United States)

    Kirchgesner, J; Lemaitre, M; Rudnichi, A; Racine, A; Zureik, M; Carbonnel, F; Dray-Spira, R

    2017-01-01

    Management of inflammatory bowel disease (IBD) has evolved in the last decade. To assess IBD therapeutic management, including treatment withdrawal and early treatment use in the current era of anti-TNF agents (anti-TNFs). All patients affiliated to the French national health insurance diagnosed with IBD were included from 2009 to 2013 and followed up until 31 December 2014. Medication uses, treatment sequences after introduction of thiopurine or anti-TNF monotherapies or both (combination therapy), surgical procedures and hospitalisations were assessed. A total of 210 001 patients were diagnosed with IBD [Crohn's disease (CD), 100 112; ulcerative colitis (UC), 109 889]. Five years after diagnosis, cumulative probabilities of anti-TNF monotherapy and combination therapy exposures were 33.8% and 18.3% in CD patients and 12.9% and 7.4% in UC patients, respectively. Among incident patients who received thiopurines or anti-TNFs, the first treatment was thiopurine in 69.1% of CD and 78.2% of UC patients. Among patients treated with anti-TNFs, 45.2% and 54.5% of CD patients and 38.2% and 39.9% of UC patients started monotherapy and combination therapy within 3 months after diagnosis, respectively; 31.3% of CD and 27.1% of UC incident patients withdrew from thiopurine or anti-TNFs for more than 3 months after their first course of treatment. Five years after diagnosis, the cumulative risks of first intestinal resection in CD patients and colectomy in UC patients were 11.9% and 5.7%, respectively. Step-up approach remains the predominant strategy, while exposure to anti-TNFs is high. Surgery rates are low. Treatment withdrawal in IBD is more common than expected. © 2016 John Wiley & Sons Ltd.

  11. Assessment of current practices in creating and using passwords as a control mechanism for information access

    Directory of Open Access Journals (Sweden)

    P. L. Wessels

    2007-11-01

    Full Text Available One of the critical issues in managing information within an organization is to ensure that proper controls exist and are applied in allowing people access to information. Passwords are used extensively as the main control mechanism to identify users wanting access to systems, applications, data files, network servers or personal information. In this article, the issues involved in selecting and using passwords are discussed and the current practices employed by users in creating and storing passwords to gain access to sensitive information are assessed. The results of this survey conclude that information managers cannot rely only on users to employ proper password control in order to protect sensitive information.

  12. Diagnosis and management of idiopathic pulmonary fibrosis: French practical guidelines

    Directory of Open Access Journals (Sweden)

    Bruno Crestani

    2014-06-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF is the most frequent chronic idiopathic interstitial pneumonia in adults. The management of rare diseases in France has been organised by a national plan for rare diseases, which endorsed a network of expert centres for rare diseases throughout France. This article is an overview of the executive summary of the French guidelines for the management of IPF, an initiative that emanated from the French National Reference Centre and the Network of Regional Competence Centres for Rare Lung Diseases. This review aims at providing pulmonologists with a document that: 1 combines the current available evidence; 2 reviews practical modalities of diagnosis and management of IPF; and 3 is adapted to everyday medical practice. The French practical guidelines result from the combined efforts of a coordination committee, a writing committee and a multidisciplinary review panel, following recommendations from the Haute Autorité de Santé. All recommendations included in this article received at least 90% agreement by the reviewing panel. Herein, we summarise the main conclusions and practical recommendations of the French guidelines.

  13. Typography and layout of technical reports - Survey of current practices

    Science.gov (United States)

    Pinelli, T. E.; Cordle, V. M.; Mccullough, R.

    1985-01-01

    As part of a review of the NASA Langley Research Center scientific and technical information program, 50 technical reports from industry, research institutions, and government agencies were systematically examined and analyzed to determine current usage and practice in regard to (1) typography, including composition method, type style, type size, and margin treatment; (2) graphic design, including layout and imposition of material on the page; and (3) physical media, including paper, ink, and binding methods. The results indicate that approximately 50 percent of the reports were typeset, 70 percent used Roman (serif) type, 80 percent used 10- or 11-point type for text, 60 percent used a ragged right-hand margin, slightly more than half used paragraph indentation, 75 percent used a single-column layout, 65 percent had one or more figures or tables placed perpendicular to (not aligned with) the text, and perfect binding was the most frequently used binding method.

  14. Articulating current service development practices: a qualitative analysis of eleven mental health projects.

    Science.gov (United States)

    Jun, Gyuchan Thomas; Morrison, Cecily; Clarkson, P John

    2014-01-17

    The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

  15. Concussion Management Practice Patterns Among Sports Medicine Physicians.

    Science.gov (United States)

    Stache, Stephen; Howell, David; Meehan, William P

    2016-09-01

    The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

  16. A review of sustainable facilities management knowledge and practice

    Directory of Open Access Journals (Sweden)

    Baaki Timothy Kurannen

    2016-01-01

    Full Text Available Sustainability is seen as a far-reaching issue now, and one which the facilities management [FM] profession cannot overlook. This paper explores current sustainable facilities management [SFM] knowledge and practice with specific focus on performance as part of a research focus toward proposing a sustainable FM performance management framework for sustainable healthcare waste management in Malaysia. This paper utilized a review of extant literature on the subject of SFM, FM performance and FM development in Malaysia as source of information. Findings reflect the increasing recognition of the need for the strategic FM function, and how facilities managers are best positioned to drive organizations’ sustainability agendas. In Malaysian context, this recognition is barely evident as findings show FM practice is still immature and predominantly operational. Unlike developed FM markets, FM relevance in Malaysia is being driven by the public sector. Also findings show a disharmony between organizations’ sustainability priority areas and the responsibilities for facilities managers to execute them where the sustainability policy of organizations prioritize one FM service and the facilities managers’ responsibilities prioritize another. As most of SFM implementation is driven by legislation this seems to strengthen the position that, organizations continue to view support services as non-value-adding, as unavoidable liabilities. The implication of this is the pressure on the FM function to continually express its strategic relevance to organizations by tangible value-adding performance output. This creates a new perspective to measuring and managing facilities performance. This paper therefore elevates the importance of FM performance management in SFM context taking into account the peculiar position of the facilities manager. This is seen as a way forward for FM to better express its value to the organization

  17. Urban strategies for Waste Management in Tourist Cities. D2.7 : Compendium of waste management practices in pilot cities and best practices in touristic cities

    NARCIS (Netherlands)

    Gruber, Iris; Mayerhofer, Johannes; Obersteiner, Gudrun; Ramusch, Roland; Romein, A.; Eriksson, Mattias; Grosse, Juliane; MC. Nascimento, Gisela; Bjorn Olsen, Trine; de Luca, Claudia; Zapata Aranda, Pilar; Kazeroni, Marie; Kovacs, Ernest

    2017-01-01

    This report (Deliverable D2.7) refers to URBANWASTE Work Package 2, Task 2.8. Under this Task the current waste prevention and management practices in the URBANWASTE pilot cases are investigated and best practices coming from the EU context (focussing on touristic processes) are identified. This

  18. Baby walkers--health visitors' current practice, attitudes and knowledge.

    Science.gov (United States)

    Kendrick, Denise; Illingworth, Rachel; Hapgood, Rhydian; Woods, Amanda J; Collier, Jacqueline

    2003-09-01

    Baby walkers are a commonly used item of nursery equipment. Between 12% and 50% of parents whose infant uses a walker report that their child has suffered a walker-related injury. Health visitors' knowledge, attitudes and practice with regard to walkers and related health education has not been explored so far. The aim of the study was to describe health visitors' knowledge of walkers and walker-related injuries, their attitudes towards walkers and current practice with regard to walker health education, and to examine the relationship between knowledge and attitudes and knowledge and practice. A survey was carried out with 64 health visitors prior to participation in a randomized controlled trial assessing the effectiveness of an educational package in reducing baby walker use. The response rate was 95%. Half of the health visitors always discussed walkers postnatally, most frequently at the 6-9 month check. Most did not usually discuss the frequency of walker-related injuries. Most had negative attitudes towards walkers, but believed that parents hold positive attitudes to them and that it is hard to persuade parents not to use them. Health visitors had a limited knowledge of walker use and walker-related injuries. Those giving advice on walkers most often had higher knowledge scores than those giving advice less often (P = 0.03). Those with higher knowledge scores held more negative attitudes towards walkers (rs = 0.29, P = 0.023) and believed parents to have more positive attitudes towards walkers (rs = -0.49, P negotiating alternatives to their use. The provision of audio-visual aids for discussing walkers might also be helpful.

  19. Evaluation of Sustainable Practices within Project Management Methods

    Directory of Open Access Journals (Sweden)

    Shah Satya

    2017-01-01

    Full Text Available The purpose of this research study is to investigate some of the sustainable practices within projects with a focus on social projects. The different research methodologies applied through this research consisted both primary and secondary research, including literature review and through case study. The stakeholder’s behavioural needs towards acting and implementing sustainable practices led to the adoption of sustainable practices within projects which are managed across profit and non-profit organisations. Nevertheless, lack of sustainable behaviour was outlined, and henceforth the integration of sustainable development within social projects is crucially important as such projects were identified as the drivers toward educating the society in order to help to produce generations of people who would be more sustainably aware. Currently, sustainable development is very often taken into account when it comes to managing projects. Nevertheless, if the adoption of sustainable practices is well established in some sectors such as construction, literature tends to demonstrate a lack of information regarding other sectors, especially within social projects. This research aims to investigate the adoption of sustainable practices within social projects and therefore to satisfy a literature gap.

  20. Renal biopsies in children: current practice and audit of outcomes.

    Science.gov (United States)

    Hussain, Farida; Mallik, Meeta; Marks, Stephen D; Watson, Alan R

    2010-02-01

    There is considerable variation in the way that children are prepared for and the techniques employed in a renal biopsy. There was national agreement between UK paediatric renal centres to review current practice and audit outcomes An initial questionnaire survey was undertaken and a 12-month prospective audit performed of renal biopsies against agreed standards for the number of needle passes, adequacy of biopsy material and complication rates. Eleven of 13 centres participated. Information leaflets are sent pre-biopsy in five centres with only one using play preparation. Six of 11 routinely perform biopsies as day-case (DC) procedures and 6 use general anaesthesia (GA). Real-time ultrasound is the favoured method in eight centres. Biopsies are performed by nephrologists only in four centres, nephrologists with radiologists in five and radiology alone in two. Of 531 biopsies (352 native), 31% were performed as a DC with 49% being done under GA. The standard for the number of passes of native kidneys (95%). The major complication rate was higher than the standard of practice with limited use of preparation materials and DC procedures. The results have stimulated constructive debate about preparation and indications for biopsy and training issues. The audit enables centres and individuals to monitor performance.

  1. Current nursing practice by hospital-based stoma specialist nurses.

    Science.gov (United States)

    Burch, Jennie

    Nurses frequently care for patients who have stomas. A common complication is sore peristomal skin (skin around the stoma). The study aim was to answer the research question: what is the current nursing practice for peristomal skin problems among UK stoma specialist nurses? The question was explored through investigation of descriptions, treatments and opinions of peristomal skin problems. Results were examined to ascertain if practice reflects the literature and if care was evidence-based. A questionnaire was posted in September 2009 to the stoma care nurses in all UK NHS hospitals (n=596). The proportion of completed or partially completed questionnaires was 15% (89 of 596). Most of the responding nurses held a stoma-related qualification (86%), a degree (55%) and had specialised in stoma care for over 5 years (67%). Respondents used erythema to describe sore skin (80%). Stoma powder (98%) and convex appliances (98%) were the most commonly used treatments. The most common cause of sore skin was appliance leakage (61%). The study population was deemed suitably qualified and experienced to answer the research question. Many responses were reflected in the literature (predominantly opinion articles), reflecting a degree of reliability and validity. It could be concluded that stoma specialist nurses can accurately assess and use stoma accessories to treat sore skin, but due to the paucity of research, the care cannot be defined as evidence-based. More research is needed to determine universally accepted definitions and treatments for sore peristomal skin.

  2. Is dosimetry still a necessity in current dental practice?

    International Nuclear Information System (INIS)

    Reddy, S S; Rakesh, N; Clint, Joseph Ben; Sharma, Shivani; Chauhan, Pallavi

    2015-01-01

    Today, dentists have a wide range of imaging modalities to choose from, the film based techniques, digital techniques, and the recent introduction of 3D volumetric or cone beam computed tomography (CBCT). The inherent design features of the new generation dental x-ray equipment has significantly improved over the years with no evidence of substandard x-ray units in operation. In dental facilities radiological workload is comparatively low, newer radiation equipments and accessories follow safety guidelines and employ better radiation protection measures for the patient and the operator. Dentists’ knowledge and expertise in radiation protection measures is good, enabling them to carry out riskfree radiation procedures in their practice. Therefore, the present study is aimed at assessing the need for dosimeters in current dental scenario.‘Is there currently a significant risk from dental radiography to merit the use of personal dosimetery in dental practice.’Dental health professionals (Oral radiologists) and radiographic assistants of fourteen dental colleges in Karnataka state participated in this questionnaire study. The questionnaire consisted of the following questions—the make, type, year of manufacture of radiographic machines used in their setup, number of radiographs made per day in the institution, type of receptors used, number of personnel at risk for radiation exposure, radiation protection measures used, regular monitoring by personal dosimeters, equivalent dosage readings for the past 12 months and whether the reading of thermoluminescent dosimeters (TLD) for any personnel had exceeded the recommended exposure value in the last 3 years.Dosimetry records of the radiology staff in the last three years shows doses no more than 1.50 mSv per year. The various institutions’ dose (person mSv) was in the range of 3.70 mSv–3.90 mSv.Personal monitoring for Dentists can be omitted in the dental colleges since the estimated dose of oral radiologists

  3. The role of management in an in vitro fertilization practice.

    Science.gov (United States)

    Masler, Steve; Strickland, Robert R

    2013-05-01

    An in vitro fertilization (IVF) practice is an enterprise. Like any enterprise, it has management that plays a major role, forming the structure, framework, and components that make the practice viable. Management of an IVF practice consists of two key teams: the fertility team and the management team. Management activities of the teams fall into eight core areas: business operations, financial, human resources, information technology, organizational governance, risk management, patient care systems, and quality management. Shady Grove Fertility Centers and Huntington Reproductive Center are two examples of professionally managed large fertility practices, one managed mostly centrally and the other largely managed in a decentralized way. Management is what takes a physician's IVF practice and converts it to a professional enterprise. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Colostomy irrigation: current knowledge and practice of WOC nurses.

    Science.gov (United States)

    Cobb, Martha D; Grant, Marcia; Tallman, Nancy J; Wendel, Christopher S; Colwell, Janice; McCorkle, Ruth; Krouse, Robert S

    2015-01-01

    This study builds on the authors' previous studies that demonstrate that persons living with a colostomy who practice colostomy irrigation (CI) experience quality-of-life benefits. Studies also reveal that patients may not be taught about CI. The purpose of this study was to determine current knowledge, attitudes, and practices of WOC nurses on CI. The target population was ostomy nurses who were members of the Wound, Ostomy and Continence Nurse's Society. Nine hundred eighty-five nurses out of a possible pool of 4191 members responded, providing a response rate of 24%. Their average age was 53 years (range, 25-79 years). Respondents averaged 12 years' experience as a WOC nurse (range, 1-40 years) and 90% (n = 875) were certified. Participants practiced in a variety of settings, including acute and long-term care facilities, home health, and ambulatory clinics. They saw an average of 37 ± 60.5 (mean ± SD) ostomy patients per year (range, 0-1100). A 1-time online survey (SurveyMonkey) of members of the Wound, Ostomy and Continence Nurses (WOCN) Society was conducted. In addition to demographic and educational information, questions also included (1) CI advantages and disadvantages; (2) CI content routinely taught; (3) challenges in assisting patients to learn CI; and (4) where preparation was received for teaching this procedure. Nurses were asked whether they believe CI is evidence-based. More than half identified irrigation as an evidence-based practice (59%), but half indicated they do not routinely teach CI. Multiple factors correlated with nurses' decisions to teach CI, including years of experience (P = .03), specific CI education (P < .001), and considering the intervention evidence-based (P < .001). Factors influencing CI instruction are multifactorial; they include nurses' attitudes, experience base, education, medical indications, setting characteristics, and patient interest and physical abilities. Education on this procedure is urgently needed for

  5. Employment of people with disabilities: Implications for HR management practices

    Directory of Open Access Journals (Sweden)

    P. Gida

    2007-12-01

    Full Text Available Purpose: The purpose of this paper is to, firstly, present the findings of an empirical study in which the human resource management practices associated with the employment of people with disabilities were investigated. The human resource management challenges related to employment of people with disabilities were also identified in the empirical study and are presented in this paper. A further purpose of this paper is to propose a number of recommendations focused on human resource management practices and principles aimed at assisting managers and human resource management specialists in their endeavours to effectively deal with the employment of people with disabilities. Design/Methodology/Approach: This paper is based on an empirical study in which interviews were conducted with respondents from 19 different organisations identified in the Financial Mail's 'Top 100 Organisations in South Africa' list. Findings: The findings from the empirical study suggest that very few organisations are dealing with the employment of people with disabilities as a priority in their equity strategies. Where attention is being given to this issue, respondents seem to either address it as a legal compliance issue or a social responsibility 'project'. Furthermore, very little has been done to review current human resource management practices to determine whether they are discriminatory towards people with disabilities. Based on the insights gained from these findings and in line with best practice principles identified in the relevant literature, a number of recommendations focusing on human resource management practices and principles in relation to the employment of people with disabilities are proposed. Implications: This paper provides a number of practical steps to consider as part of an organisation's response to equity strategies related to the employment of people with disabilities. Originality/Value: In the Employment Equity Commission's Annual Report

  6. Development and evaluation of best management practices (BMPS) for highway runoff pollution control.

    Science.gov (United States)

    2013-12-01

    Polluted storm water runoff is commonly transported through Municipal Separate Storm Sewer Systems (MS4s). Currently, : sufficient information is not available on development and evaluation of Best Management Practices (BMPs) within an MS4 : boundary...

  7. The mining sector of Liberia: current practices and environmental challenges.

    Science.gov (United States)

    Wilson, Samuel T K; Wang, Hongtao; Kabenge, Martin; Qi, Xuejiao

    2017-08-01

    Liberia is endowed with an impressive stock of mineral reserves and has traditionally relied on mining, namely iron ore, gold, and diamonds, as a major source of income. The recent growth in the mining sector has the potential to contribute significantly to employment, income generation, and infrastructure development. However, the development of these mineral resources has significant environmental impacts that often go unnoticed. This paper presents an overview of the Liberian mining sector from historical, current development, and economic perspectives. The efforts made by government to address issues of environmental management and sustainable development expressed in national and international frameworks, as well as some of the environmental challenges in the mining sector are analyzed. A case study was conducted on one of the iron ore mines (China Union Bong Mines Investment) to analyze the effects of the water quality on the local water environment. The results show that the analyzed water sample concentrations were all above the WHO and Liberia water standard Class I guidelines for drinking water. Finally the paper examines the application of water footprint from a life cycle perspective in the Liberian mining sector and suggests some policy options for water resources management.

  8. Managing Communities – Mining MNEs’ Community Risk Management Practices

    DEFF Research Database (Denmark)

    Taarup Esbensen, Jacob

    This PhD reflects the effort to close a gap in the multinational enterprise (MNE) risk management literature on the identification and mitigation of risk arising from local communities. Small villages and towns that are situated geographically close to the MNEs’ place of operation have increasingly......-to-date information about mining MNE operations. This improved outreach has meant that mines have been closed due to conflicts with local communities and therefor a need had arisen for MNEs to implement management practices that can effectively mitigate these types of risks....... been identified as a source of risk (BSR, 2003; ICMM, 2015). The mining industry is one of the most exposed to risks from local communities, where there historically have been many conflicts between mine owners on one side and the people living close to the mine on the other (Godoy, 1985; Hoskin, 1912...

  9. Test result communication in primary care: a survey of current practice.

    Science.gov (United States)

    Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

    2015-11-01

    The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the

  10. Urban strategies for Waste Management in Tourist Cities. D2.7: Compendium of waste management practices in pilot cities and best practices in touristic cities

    OpenAIRE

    Gruber, Iris; Mayerhofer, Johannes; Obersteiner, Gudrun; Ramusch, Roland; Romein, A.; Eriksson, Mattias; Grosse, Juliane; MC. Nascimento, Gisela; Bjorn Olsen, Trine; de Luca, Claudia; Zapata Aranda, Pilar; Kazeroni, Marie; Kovacs, Ernest

    2017-01-01

    This report (Deliverable D2.7) refers to URBANWASTE Work Package 2, Task 2.8. Under this Task the current waste prevention and management practices in the URBANWASTE pilot cases are investigated and best practices coming from the EU context (focussing on touristic processes) are identified. This document shall support the selection of innovative strategies to be carried out within Work Package WP 4. A comparative policy review of national waste management strategies and targets in the Europea...

  11. Child obesity prevention in primary health care: investigating practice nurse roles, attitudes and current practices.

    Science.gov (United States)

    Robinson, Alison; Denney-Wilson, Elizabeth; Laws, Rachel; Harris, Mark

    2013-04-01

    Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting. PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10). Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training. Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  12. Current management of Hirschsprung's disease in Egypt: A survey ...

    African Journals Online (AJOL)

    Background/purpose Significant progress has been made in the management of Hirschsprung's disease (HD). The choice of the management plan, surgical approach, and operative details is still variable among pediatric surgeons. This survey aims to determine the current preferences of Egyptian pediatric surgeons in the ...

  13. Current management of anorectal malformation in Egypt: a survey of ...

    African Journals Online (AJOL)

    Background/aim: Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM. Materials and methods: A survey was circulated individually to the ...

  14. Survey on current practices for neurological prognostication after cardiac arrest.

    Science.gov (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro

    2015-05-01

    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Mapping Best and Emerging Practices of Project Management

    OpenAIRE

    Thuesen, Christian; Aaris Boas, Charlotte; Thorslund, Michael V.; Marmier, Francois; Grex, Sara; Lybecker, Søren

    2013-01-01

    This paper presents results of a study of the connection between Best and Emerging practices of project management. Drawing upon network mapping as an analytical strategy, cases of Best and Emerging practices is analysed and juxtaposed. The case of Best practice is represented by the newly published ISO 21500 standard and the case for the Emerging practices by a deconstruction of the practices of a group of experienced project managers. The network analysis reveals a substantial difference be...

  16. Practice what you preach: how consultants frame management concepts as enacted practice

    NARCIS (Netherlands)

    Heusinkveld, S.; Visscher, Klaasjan

    2012-01-01

    To contribute to the understanding of management knowledge commodification, this research explores how management consultants frame management concepts as enacted practice. Despite the recognition of consultants as important knowledge entrepreneurs, little academic research considers how they

  17. Theoretical and Practical Aspects of Logistic Quality Management System Documentation Development Process

    Directory of Open Access Journals (Sweden)

    Linas Šaulinskas

    2013-12-01

    Full Text Available This paper addresses aspects of logistics quality management system documentation development and suggests models for quality management system documentation development, documentation hierarchical systems and authorization approval. It also identifies logistic processes and a responsibilities model and a detailed document development and approval process that can be practically applied. Our results are based upon an analysis of advanced Lithuanian and foreign corporate business practices, a review of current literature and recommendations for quality management system standards.

  18. Current management of Parkinson's disease | Salawu | Annals of ...

    African Journals Online (AJOL)

    Annals of African Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 2 (2010) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Current management of Parkinson's disease. F Salawu, A ...

  19. Ecological models and pesticide risk assessment: current modeling practice.

    Science.gov (United States)

    Schmolke, Amelie; Thorbek, Pernille; Chapman, Peter; Grimm, Volker

    2010-04-01

    Ecological risk assessments of pesticides usually focus on risk at the level of individuals, and are carried out by comparing exposure and toxicological endpoints. However, in most cases the protection goal is populations rather than individuals. On the population level, effects of pesticides depend not only on exposure and toxicity, but also on factors such as life history characteristics, population structure, timing of application, presence of refuges in time and space, and landscape structure. Ecological models can integrate such factors and have the potential to become important tools for the prediction of population-level effects of exposure to pesticides, thus allowing extrapolations, for example, from laboratory to field. Indeed, a broad range of ecological models have been applied to chemical risk assessment in the scientific literature, but so far such models have only rarely been used to support regulatory risk assessments of pesticides. To better understand the reasons for this situation, the current modeling practice in this field was assessed in the present study. The scientific literature was searched for relevant models and assessed according to nine characteristics: model type, model complexity, toxicity measure, exposure pattern, other factors, taxonomic group, risk assessment endpoint, parameterization, and model evaluation. The present study found that, although most models were of a high scientific standard, many of them would need modification before they are suitable for regulatory risk assessments. The main shortcomings of currently available models in the context of regulatory pesticide risk assessments were identified. When ecological models are applied to regulatory risk assessments, we recommend reviewing these models according to the nine characteristics evaluated here. (c) 2010 SETAC.

  20. Use of safety management practices for improving project performance.

    Science.gov (United States)

    Cheng, Eddie W L; Kelly, Stephen; Ryan, Neal

    2015-01-01

    Although site safety has long been a key research topic in the construction field, there is a lack of literature studying safety management practices (SMPs). The current research, therefore, aims to test the effect of SMPs on project performance. An empirical study was conducted in Hong Kong and the data collected were analysed with multiple regression analysis. Results suggest that 3 of the 15 SMPs, which were 'safety committee at project/site level', 'written safety policy', and 'safety training scheme' explained the variance in project performance significantly. Discussion about the impact of these three SMPs on construction was provided. Assuring safe construction should be an integral part of a construction project plan.

  1. Analyzing solid waste management practices for the hotel industry

    OpenAIRE

    S.T. Pham Phu; M.G. Hoang; T. Fujiwara

    2018-01-01

    The current study aims to analyze waste characteristics and management practices of the hotel industry in Hoi An, a tourism city in the center of Vietnam. Solid wastes from 120 hotels were sampled, the face-to-face interviews were conducted, and statistical methods were carried out to analyze the data. The results showed that the mean of waste generation rate of the hotels was 2.28 kg/guest/day and strongly correlated to internal influencing factors such as the capacity, the price of the room...

  2. DOE waste management program-current and future

    International Nuclear Information System (INIS)

    Coleman, J.A.

    1993-01-01

    The back end of the nuclear fuel cycle, as well as many operations in the Department of Energy, involves management of radioactive and hazardous waste and spent nuclear fuel. Described herein is the current and anticipated Department's Waste Management Program and general information about the Program for managing and disposing of waste that will illustrate the importance of air cleaning and treatment in assuring protection of the public and our environment. The structure and responsibilities of the Office of Environmental Restoration and Waste Management (EM) are described. The categories of waste managed by the Office of Waste Management (OWM) are defined. The problems of waste management, waste minimization, and waste treatment, storage, and disposal are discussed. 4 figs

  3. Clinical practice guideline: management of acute pancreatitis

    Science.gov (United States)

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  4. Current safety practices in nano-research laboratories in China.

    Science.gov (United States)

    Zhang, Can; Zhang, Jing; Wang, Guoyu

    2014-06-01

    China has become a key player in the global nanotechnology field, however, no surveys have specifically examined safety practices in the Chinese nano-laboratories in depth. This study reports results of a survey of 300 professionals who work in research laboratories that handle nanomaterials in China. We recruited participants at three major nano-research laboratories (which carry out research in diverse fields such as chemistry, material science, and biology) and the nano-chemistry session of the national meeting of the Chinese Chemical Society. Results show that almost all nano-research laboratories surveyed had general safety regulations, whereas less than one third of respondents reported having nanospecific safety rules. General safety measures were in place in most surveyed nano-research laboratories, while nanospecific protective measures existed or were implemented less frequently. Several factors reported from the scientific literature including nanotoxicology knowledge gaps, technical limitations on estimating nano-exposure, and the lack of nano-occupational safety legislation may contribute to the current state of affairs. With these factors in mind and embracing the precautionary principle, we suggest strengthening or providing nanosafety training (including raising risk awareness) and establishing nanosafety guidelines in China, to better protect personnel in the nano-workplace.

  5. Current Continuing Professional Education Practice among Malaysian Nurses

    Directory of Open Access Journals (Sweden)

    Mei Chan Chong

    2014-01-01

    Full Text Available Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562 of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6% and tertiary education was the most unpopular activity (10, 1.3%. The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses’ (RNs needs and not simply organizational requirements.

  6. Gender relations and health research: a review of current practices

    Directory of Open Access Journals (Sweden)

    Bottorff Joan L

    2011-12-01

    Full Text Available Abstract Introduction The importance of gender in understanding health practices and illness experiences is increasingly recognized, and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes. Methods To explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases. Results Through analysis of this literature we identified two main ways gender relations were integrated in health research: a as emergent findings; and b as a basis for research design. In the latter, gender relations are included in conceptual frameworks, guide data collection and are used to direct data analysis. Conclusions Current uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women are used to explore the influence and/or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health.

  7. Technical guidelines for maintaining occupational exposures as low as practicable. Phase I. Summary of current practices

    International Nuclear Information System (INIS)

    Gilchrist, R.L.; Selby, J.M.; Wedlick, H.L.

    1978-08-01

    Reducing radiation exposures to as low as practicable is a principle that was first introduced in 1949. However, the recent controversy over the low-level effects of radiation has led the Department of Energy (DOE) to review its programs. One such review was conducted by the Pacific Northwest Laboratory to survey the implementation of the ALAP principle in the DOE laboratories. This report contains the results of that survey, performed in 18 major DOE installations. The DOE contractors were asked questions concerning the following eight major areas: management, operational health physics, design, dosimetry, instrumentation, training, risk/cost-benefit, and impact of the ALAP philosophy. The survey revealed several potential areas of concern, which are described in this report. These areas will be addressed in the forthcoming manual, A Guide to Reducing Radiation Exposures As Low As Practicable

  8. A Practical Decision-Analysis Process for Forest Ecosystem Management

    Science.gov (United States)

    H. Michael Rauscher; F. Thomas Lloyd; David L. Loftis; Mark J. Twery

    2000-01-01

    Many authors have pointed out the need to firm up the 'fuzzy' ecosystem management paradigm and develop operationally practical processes to allow forest managers to accommodate more effectively the continuing rapid change in societal perspectives and goals. There are three spatial scales where clear, precise, practical ecosystem management processes are...

  9. 78 FR 36784 - Survey of Nanomaterial Risk Management Practices

    Science.gov (United States)

    2013-06-19

    ...-0010, Docket Number NIOSH-265] Survey of Nanomaterial Risk Management Practices AGENCY: National...), Department of Health and Human Services (HHS). ACTION: Proposed NIOSH Survey of Nanomaterial Risk Management... questions addressing risk management practices for ENMs? (5) What should be the maximum amount of time...

  10. Selection, Placement and Instatement of School Managers in Turkey: Evaluation of the Current Situation

    Science.gov (United States)

    Memisoglu, Salih Pasa

    2015-01-01

    The aim of this study is to evaluate the new regulations and current practices in terms of how they apply--to the selection, training and instatement of school administrators in Turkey. The successful implementation of Turkish National Development Plans is closely related to the knowledge and skills of managers working at various levels in every…

  11. Human Resource Management Practices and Innovation

    DEFF Research Database (Denmark)

    Laursen, Keld; Foss, Nicolai Juul

    We survey, organize, and discuss the literature on the role of organizational practices for explaining innovation outcomes. We discuss how individual practices influence innovation, and how the clustering of specific practices matters for innovation outcomes. Relatedly, we discuss various possibl...

  12. PUBLIC ADMINISTRATION: MODERNIZING THE CURRENT MODEL OF STATE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Evgenii V. Ohotskii

    2014-01-01

    Full Text Available Applying the method of retrospective analysis the article deals with the process of forming the scientific fundamentals and the search by the international community of effective and adequate to the current stage of social development public administration system. The author attempts to analyze, in a number of cases in terms of models, features of public administration systems at different stages of historical development, drawing attention to reasons why the Soviet model of public administration did not manage to meet competition, did not provide the required social effect and as a natural result suffered a defeat in the global confrontation between the two social systems. Current models and theoretical concepts of public administration, especially the "new public administration", which became scientific basis for administrative reforms implemented in many countries, are the particular subject of scientific analysis. The author draws attention to major comprehensive characteristics of modern state public administration: making it impossible to absolutize principles of traditional hierarchy system of forced administration; globalization - gradual destruction of boundaries between national and international levels of administration, the growing role of supranational subjects of administration relations; informatization - increasing importance of information and communication technologies and of political networks: development of civil society, especially political parties and non-governmental organizations, growing public involvement in discussion and adoption of the most important administrative decisions; making the state policy more pluralistic and which will result in the formation of nonlinear - humanistic social consciousness as the intellectual basis of modern social governance. The author's position is that Russia is yet to solve the issue of choosing a public administration model that would be effective for further administrative

  13. Plant life management processes and practices for heavy water reactors

    International Nuclear Information System (INIS)

    Kang, K.-S.; Cleveland, J.; Clark, C.R.

    2006-01-01

    In general, heavy water reactor (HWR) nuclear power plant (NPP) owners would like to keep their NPPs in service as long as they can be operated safely and economically. Their decisions are depending on essentially business model. They involve the consideration of a number of factors, such as the material condition of the plant, comparison with current safety standards, the socio-political climate and asset management/ business planning considerations. Continued plant operation, including operation beyond design life, called 'long term operation, depends, among other things, on the material condition of the plant. This is influenced significantly by the effectiveness of ageing management. Key attributes of an effective plant life management program include a focus on important systems, structure and components (SSCs) which are susceptible to ageing degradation, a balance of proactive and reactive ageing management programmes, and a team approach that ensures the co-ordination of and communication between all relevant nuclear power plant and external programmes. Most HWR NPP owners/operators use a mix of maintenance, surveillance and inspection (MSI) programs as the primary means of managing ageing. Often these programs are experienced-based and/or time-based and may not be optimised for detecting and/or managing ageing effects. From time-to-time, operational history has shown that this practice can be too reactive, as it leads to dealing with ageing effects (degradation of SSCs) after they have been detected. In many cases premature and/or undetected ageing cannot be traced back to one specific reason or an explicit error. The root cause is often a lack of communication, documentation and/or co-ordination between design, commissioning, operation or maintenance organizations. This lack of effective communication and interfacing frequently arises because, with the exception of major SSCs, such as the fuel channels or steam generators, there is a lack of explicit

  14. Talent management : Current theories and future research directions

    NARCIS (Netherlands)

    Al Ariss, A.; Cascio, W.F.; Paauwe, J.

    2014-01-01

    Research on Talent Management (TM) has been lagging behind businesses in offering vision and leadership in this field. After sketching a comprehensive outline of knowledge about TM, theoretical as well as practical, we introduce the papers in this special issue and their important contributions.

  15. 78 FR 4307 - Current Good Manufacturing Practice Requirements for Combination Products

    Science.gov (United States)

    2013-01-22

    ...-2009-N-0435] Current Good Manufacturing Practice Requirements for Combination Products AGENCY: Food and...) is issuing this regulation on the current good manufacturing practice (CGMP) requirements applicable... this subpart? (Sec. 4.2) D. What current good manufacturing practice requirements apply to my...

  16. 21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

    Science.gov (United States)

    2010-04-01

    ..., holding, or distribution of PET drugs intended for human use. Current good manufacturing practice is... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION...

  17. Practice management companies. Creating sound information technology strategies.

    Science.gov (United States)

    Cross, M A

    1997-10-01

    Practice management companies are becoming more prominent players in the health care industry. To improve the performance of the group practices that they acquire, these companies are striving to use updated information technologies.

  18. Snow management practices in French ski resorts

    Science.gov (United States)

    Spandre, Pierre; Francois, Hugues; George-Marcelpoil, Emmanuelle; Morin, Samuel

    2016-04-01

    Winter tourism plays a fundamental role in the economy of French mountain regions but also in other countries such as Austria, USA or Canada. Ski operators originally developed grooming methods to provide comfortable and safe skiing conditions. The interannual variability of snow conditions and the competition with international destinations and alternative tourism activities encouraged ski resorts to mitigate their dependency to weather conditions through snowmaking facilities. However some regions may not be able to produce machine made snow due to inadequate conditions and low altitude resorts are still negatively impacted by low snow seasons. In the meantime, even though the operations of high altitude resorts do not show any dependency to the snow conditions they invest in snowmaking facilities. Such developments of snowmaking facilities may be related to a confused and contradictory perception of climate change resulting in individualistic evolutions of snowmaking facilities, also depending on ski resorts main features such as their altitude and size. Concurrently with the expansion of snowmaking facilities, a large range of indicators have been used to discuss the vulnerability of ski resorts such as the so-called "100 days rule" which was widely used with specific thresholds (i.e. minimum snow depth, dates) and constraints (i.e. snowmaking capacity). The present study aims to provide a detailed description of snow management practices and major priorities in French ski resorts with respect to their characteristics. We set up a survey in autumn 2014, collecting data from 56 French ski operators. We identify the priorities of ski operators and describe their snowmaking and grooming practices and facilities. The operators also provided their perception of the ski resort vulnerability to snow and economic challenges which we could compare with the actual snow conditions and ski lift tickets sales during the period from 2001 to 2012.

  19. Knowledge Management in healthcare libraries: the current picture.

    Science.gov (United States)

    Hopkins, Emily

    2017-06-01

    Knowledge management has seen something of a resurgence in attention amongst health librarians recently. Of course it has never ceased to exist, but now many library staff are becoming more involved in organisational knowledge management, and positioning themselves as key players in the sphere. No single model of knowledge management is proliferating, but approaches that best fit the organisation's size, structure and culture, and a blending of evidence based practice and knowledge sharing. Whatever it is called and whatever models are used, it's clear that for librarians and information professionals, the importance of putting knowledge and evidence into practice, sharing knowledge well and capturing it effectively, are still what we will continue to do. © 2017 Health Libraries Group.

  20. Reflective practice: a framework for case manager development.

    Science.gov (United States)

    Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

    2011-01-01

    The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

  1. Transportation engineering project management : survey of practice.

    Science.gov (United States)

    2017-01-01

    Utah Department of Transportation (UDOT) project managers (PMs) have identified inefficiencies in the legacy : system electronic Program Management (ePM) used to manage consultant contracts and invoices. To help UDOT : prepare for potential system im...

  2. Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa

    Science.gov (United States)

    Daire, Judith; Gilson, Lucy

    2014-01-01

    In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better

  3. Managing Innovation under Time Pressure: A Practical Perspective

    Directory of Open Access Journals (Sweden)

    Blair Winsor

    2012-08-01

    Full Text Available This article examines the effects of time pressure on innovation. Does time pressure stimulate or eliminate innovation or, in other words, should managers increase or reduce time pressures if they are trying to enhance innovation in their firms? Unfortunately, current research on the subject is ambivalent. To provide some clarity, this innovation management dilemma was examined in a fast-growing, medium-sized communication and IT consultancy (“First”, which claimed to be “highly innovative”. Detailed data on five projects was collected over an 18-month period using practice-based methods. Each project team was followed in real time via observation and interviews. The data was then analyzed by dividing project work into three phases: i negotiating the project particulars with the client; ii conducting project work; and iii project evaluation. This detailed analysis revealed how time pressures eliminated innovation in First’s client-based project work and suggested three implications for the management of innovation. Firstly, managers should try to avoid imposing excessive time pressures on their project teams. Secondly, they should ensure that there is space between projects to enable reflection. Thirdly, managers should ensure that project debriefs occur and that they cover potential innovations.

  4. Status and current spent fuel storage practices in the United States

    International Nuclear Information System (INIS)

    Lake, W.H.

    1999-01-01

    Brief discussions are presented on the history and state of spent fuel generation by utilities that comprise the United States commercial nuclear power industry, the current situation regarding the Federal government's nuclear waste policy, and evolving spent fuel storage practices. These evolving spent fuel storage practices are the result of private sector initiatives, but appear to be influenced by various external factors. The paper is not intended to provide a comprehensive appraisal of the storage initiatives being conducted by the private sector. The focus, instead, is on the Federal government's role and activities related to spent fuel management. Although the Federal government has adopted a policy calling for deep geological disposal of spent fuel, the US Congress has recently begun to consider expanding that policy to include a centralized interim storage facility. In the absence of such an expanded policy, the Department of Energy has performed some preliminary activities that would expedite development of a centralized interim storage facility, if Congress were to enact such a policy. The Department's current activities with regard to developing a centralized interim storage facility, which are consistent with the current policy, are described in the paper. The paper also describes two important technical development activities that have been conducted by the Department of Energy to support improved efficiency in spent fuel management. The Department's activities regarding development of a burnup credit methodology, and a dry transfer system are summarized. (author)

  5. Mapping Best and Emerging Practices of Project Management

    DEFF Research Database (Denmark)

    Thuesen, Christian; Aaris Boas, Charlotte; Thorslund, Michael V.

    2013-01-01

    This paper presents results of a study of the connection between Best and Emerging practices of project management. Drawing upon network mapping as an analytical strategy, cases of Best and Emerging practices is analysed and juxtaposed. The case of Best practice is represented by the newly...... published ISO 21500 standard and the case for the Emerging practices by a deconstruction of the practices of a group of experienced project managers. The network analysis reveals a substantial difference between the Best and Emerging practices. Only two central concepts where shared namely Communication...... and Planning. Of these two concepts Communication where found to be the most central to both the Emerging and Best practices. The analysis further reveals a soft side of project management that is central in the Emerging practice but absent from the Best practices. Although this soft side might be interpreted...

  6. Impact of supply chain management practices on sustainability

    DEFF Research Database (Denmark)

    Govindan, Kannan; Azevedo, Susana G.; Carvalho, Helena

    2014-01-01

    elimination," "supply chain risk management" and "cleaner production." The following lean, resilient and green supply chain management practices do not have a significant impact on supply chain sustainability: "flexible transportation," "flexible sourcing," "ISO 14001 certification," and "reverse logistics...

  7. socio-eceonomic determinations of farmland management practice ...

    African Journals Online (AJOL)

    Jannifer

    *Department of Agricultural Economics, Management and Extension. Ebonyi State ... were to ascertain Farmland Management Practices of the farmers and to determine the relationship ..... Woman participation in agric-business in. Oboro area ...

  8. Signal systems asset management state-of-the-practice review

    Science.gov (United States)

    2004-04-01

    The purpose of this project is to obtain a better understanding of operations-level asset management by examining the specific case of signal systems. Key products will include: a synthesis of existing signal systems asset management practices; a gen...

  9. INTEGRATED WATERSHED MANAGEMENT: PRINCIPLES AND PRACTICE. Book Review

    Science.gov (United States)

    Through a wide range of information and topics, Integrated Watershed Management Principles and Practice shows how involved the watershed management planning process can be. The book is informative, and the author obviously has researched the subject thoroughly. The book's case...

  10. Financial Planning and Management Practices of Electrical Contractors

    Directory of Open Access Journals (Sweden)

    Lucko Gunnar

    2016-12-01

    Full Text Available Contractors must carefully manage their cash outflows (e.g., for materials to enable their work and inflows (after the work to be profitable, particularly in an economy that is still recovering from the 2008-2012 recession that grew out of the mortgage crisis. Their importance for business success is undisputed, as bankruptcies due to insufficient cash flow underline. Therefore, this study investigated current business practices of electrical contracting companies of different sizes with respect to their financial planning and management. A detailed questionnaire was developed with best guidelines on survey studies and pilot testing. It was sent to members of the National Electrical Contractors Association. Respondent anonymity was ensured. The survey recorded demographics, business practices, operating conditions, and other important factors using 57 subquestions. Each section allowed feedback to clarify the numerical responses. Responses were well distributed across company sizes, so that the results are representative for the entire industry. The results indicated that contractors generally have a substantial amount of experience in financial decision making. Their approach is conservative and focuses on healthy growth. Yet, opportunities to fine-tune business practices are identified, e.g., immediate invoicing, considering discounts to accelerate payment receipts, attempting to negotiate and use favorable credit terms, reviewing payment performance, and performing frequent cash flow forecasts. Some of the differences in the responses can be attributed to different company sizes. To help especially smaller companies in planning their cash flow, a spreadsheet for implementation has been created.

  11. Sarcopenia in daily practice: assessment and management.

    Science.gov (United States)

    Beaudart, Charlotte; McCloskey, Eugène; Bruyère, Olivier; Cesari, Matteo; Rolland, Yves; Rizzoli, René; Araujo de Carvalho, Islène; Amuthavalli Thiyagarajan, Jotheeswaran; Bautmans, Ivan; Bertière, Marie-Claude; Brandi, Maria Luisa; Al-Daghri, Nasser M; Burlet, Nansa; Cavalier, Etienne; Cerreta, Francesca; Cherubini, Antonio; Fielding, Roger; Gielen, Evelien; Landi, Francesco; Petermans, Jean; Reginster, Jean-Yves; Visser, Marjolein; Kanis, John; Cooper, Cyrus

    2016-10-05

    Sarcopenia is increasingly recognized as a correlate of ageing and is associated with increased likelihood of adverse outcomes including falls, fractures, frailty and mortality. Several tools have been recommended to assess muscle mass, muscle strength and physical performance in clinical trials. Whilst these tools have proven to be accurate and reliable in investigational settings, many are not easily applied to daily practice. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were afterwards organized for the whole group to make amendments and discuss further recommendations. This paper proposes some user-friendly and inexpensive methods that can be used to assess sarcopenia in real-life settings. Healthcare providers, particularly in primary care, should consider an assessment of sarcopenia in individuals at increased risk; suggested tools for assessing risk include the Red Flag Method, the SARC-F questionnaire, the SMI method or different prediction equations. Management of sarcopenia should primarily be patient centered and involve the combination of both resistance and endurance based activity programmes with or without dietary interventions. Development of a number of pharmacological interventions is also in progress. Assessment of sarcopenia in individuals with risk factors, symptoms and/or conditions exposing them to the risk of disability will become particularly important in the near future.

  12. Impact of management practices on job satisfaction

    Directory of Open Access Journals (Sweden)

    Alicia Omar

    2017-10-01

    Full Text Available Purpose: 1. to evaluate the effect of five human resource management practices (HRMP oriented towards results, employees, rigid systems, permanent recruitment of new markets, and open systems on job satis faction of employees; 2. to analyze whether perceptions of organizational justice act as mediators in such relationships. Originality/value: clarifying the mechanisms through which HRMP influence desirable organizational outcomes, such as job satisfaction. Design/methodology/approach: a quantitative and transversal study, framed within the guidelines of the associative-explanatory strategy, was carried out. A theoretical model was proposed and tested through structural equations, with confirmatory modeling strategy. The empirical verification was performed with a sample of 557 Argentine employees, who completed the scales of HRMP (25 items; Generic Work Satisfaction (7 items, and Organizational Justice (20 items. Findings: the HRMP that generate the greatest satisfaction among workers are those oriented to employees, and to open systems. Perceptions of justice partially mediate the relationships between HRMP and worker satisfaction.

  13. Waste management practices in decommissioning nuclear facilities

    International Nuclear Information System (INIS)

    Dickson, H.W.

    1979-01-01

    Several thousand sites exist in the United States where nuclear activities have been conducted over the past 30 to 40 years. Questions regarding potential public health hazards due to residual radioactivity and radiation fields at abandoned and inactive sites have prompted careful ongoing review of these sites by federal agencies including the Department of Energy (DOE) and the Nuclear Regulatory Commission (NRC). In some instances, these reviews are serving to point out poor low-level waste management practices of the past. Many of the sites in question lack adequate documentation on the radiological conditions at the time of release for unrestricted use or were released without appropriate restrictions. Recent investigations have identified residual contamination and radiation levels on some sites which exceed present-day standards and guidelines. The NRC, DOE, and Environmental Protection Agency are all involved in developing decontamination and decommissioning (D and D) procedures and guidelines which will assure that nuclear facilities are decommissioned in a manner that will be acceptable to the nuclear industry, various regulatory agencies, other stakeholders, and the general public

  14. Effects of management practices on grassland birds: Grasshopper Sparrow

    Science.gov (United States)

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

    1998-01-01

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

  15. Coliform Bacteria Monitoring in Fish Systems: Current Practices in Public Aquaria.

    Science.gov (United States)

    Culpepper, Erin E; Clayton, Leigh A; Hadfield, Catherine A; Arnold, Jill E; Bourbon, Holly M

    2016-06-01

    Public aquaria evaluate coliform indicator bacteria levels in fish systems, but the purpose of testing, testing methods, and management responses are not standardized, unlike with the coliform bacteria testing for marine mammal enclosures required by the U.S. Department of Agriculture. An online survey was sent to selected aquaria to document current testing and management practices in fish systems without marine mammals. The information collected included indicator bacteria species, the size and type of systems monitored, the primary purpose of testing, sampling frequency, test methods, the criteria for interpreting results, corrective actions, and management changes to limit human exposure. Of the 25 institutions to which surveys were sent, 19 (76%) responded. Fourteen reported testing for fecal indicator bacteria in fish systems. The most commonly tested indicator species were total (86%) and fecal (79%) coliform bacteria, which were detected by means of the membrane filtration method (64%). Multiple types and sizes of systems were tested, and the guidelines for testing and corrective actions were highly variable. Only three institutions performed additional tests to confirm the identification of indicator organisms. The results from this study can be used to compare bacterial monitoring practices and protocols in fish systems, as an aid to discussions relating to the accuracy and reliability of test results, and to help implement appropriate management responses. Received August 23, 2015; accepted December 29, 2015.

  16. Chronic Disease Management in Family Practice: Clinical Note.

    Science.gov (United States)

    1998-03-01

    disease management in the family practice selling. This paper discusses chronic disease management in the family practice selling....Chronic disease management is the process of evaluating and treating a medical condition or disease state which can not be readily cured so as to...minimize it’s negative impact on the individual. Examples of chronic disease management include the treatment of hypertension, diabetes, osteoporosis

  17. Practical management of adverse events related to apomorphine therapy

    DEFF Research Database (Denmark)

    Bhidayasiri, Roongroj; Garcia Ruiz, Pedro J; Henriksen, Tove

    2016-01-01

    The potential for adverse events is often cited as a barrier to the use of subcutaneous apomorphine therapy (intermittent injections and continuous infusion) in the management of Parkinson's disease. However, with proactive management most adverse effects are manageable if reported and tackled...... titration, initiation and long-term treatment, and discuss practical management strategies....

  18. Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

    Science.gov (United States)

    Abbott, Lisa M; Magnusson, Roger S; Gibbs, Emma; Smith, Saxon D

    2018-05-01

    Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession. © 2017 The Australasian College of Dermatologists.

  19. Impact on quality culture of total quality management practices factors

    Directory of Open Access Journals (Sweden)

    Faihan Mosaad Saud Alotaibi

    2014-09-01

    Full Text Available This study investigated total quality management practices and quality culture of Saudi Arabian contractors. Improving the quality can be achieved through implementation of total quality management although studies and researches work regarding this improvement is still lacking. A quantitative approach using the survey method was employed. With assistance from the Saudi Arabia Ministry of Municipal and Rural Affairs, survey questionnaires were distributed to selected contractors in Saudi Arabia. The collected data were analysed using correlation, and multiple regression analyses. The key findings were the confirmation of significant relationships between all total quality management practices and quality culture and a positive relationship between quality management practices and quality culture. Furthermore, total quality management practices were found to be able to explain 68.1% of the variance in quality culture, while quality culture explained 12.5% of the variance in competitiveness. Quality culture was found to only partially mediate the relationship between total quality management practices and competitiveness.

  20. Assessment of human resources management practices in Lebanese hospitals.

    Science.gov (United States)

    El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

    2010-01-01

    Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve

  1. Assessment of human resources management practices in Lebanese hospitals

    Directory of Open Access Journals (Sweden)

    Jamal Diana

    2009-11-01

    Full Text Available Abstract Background Sound human resources (HR management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. Methods A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. Results A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%, lack of qualified personnel (35.1%, and lack of a system for performance evaluation (28.9%. Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%, improving salaries (14.4%, and developing retention strategies (10.3%. Mismatch between reported challenges and strategies were observed. Conclusion To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully

  2. Innovative Human Resource Management Practices and Firm ...

    African Journals Online (AJOL)

    In this study, the effect of innovative HRM practices on the financial performance of banks in Nigeria is examined. Results indicate that strategic integration and devolvement of HRM are practiced to a moderate extent in the Nigerian banking sector. Findings also show that innovative HRM practices have significant positive ...

  3. Resources to Manage a Private Practice.

    Science.gov (United States)

    Aigner, John; Cheek, Fredricka; Donati, Georgia; Zuravicky, Dori

    1997-01-01

    Includes four theme articles: "The Digital Toolkit: Electronic Necessities for Private Practice" (John Aigner); "Organizing a Private Practice: Forms, Fees, and Physical Set-up (Fredricka Cheek); "Career Development Resources: Guidelines for Setting Up a Private Practice Library" (Georgia Donati); and "Books to…

  4. On the Current Measurement Practices in Agile Software Development

    OpenAIRE

    Javdani, Taghi; Zulzalil, Hazura; Ghani, Abdul Azim Abd; Sultan, Abu Bakar Md; Parizi, Reza Meimandi

    2013-01-01

    Agile software development (ASD) methods were introduced as a reaction to traditional software development methods. Principles of these methods are different from traditional methods and so there are some different processes and activities in agile methods comparing to traditional methods. Thus ASD methods require different measurement practices comparing to traditional methods. Agile teams often do their projects in the simplest and most effective way so, measurement practices in agile metho...

  5. Forensic Occupational Therapy in Canada: The Current State of Practice.

    Science.gov (United States)

    Chui, Adora L Y; Wong, Chantal Isabelle; Maraj, Sara A; Fry, Danielle; Jecker, Justine; Jung, Bonny

    2016-09-01

    Although occupational therapists have been practicing in forensic settings for many years, there is a paucity of literature regarding the nature of this practice in Canada. The purpose of this study was to describe the practices of Canadian occupational therapists in forensic mental health. An online survey was designed based on the Canadian Practice Process Framework. Following purposive and snowball sampling, responses were analysed with descriptive statistics and content analysis. Twenty-seven clinicians responded (56% response rate). Respondents indicated commonalities in workplaces, client caseloads and practice challenges. The outstanding need in Canada to demonstrate client outcomes through the use of evaluation instruments reflects those practice gaps identified internationally. Education, advocacy and research are critical areas for the development of Canadian forensic occupational therapy. Although findings heavily reflect one provincial context and may not be generalizable to nonhospital settings, a number of priority areas were identified. Future efforts should clarify the role of forensic occupational therapy to stakeholders, and validate their contributions through research that evaluates intervention efficacy and meaningful outcomes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  6. Best Practice in Environmental Management of Uranium Mining

    International Nuclear Information System (INIS)

    2010-01-01

    The modern uranium mining industry was born in the middle of the 20th century at a time of rapid industrial and social change and in an atmosphere of concern over the development of nuclear weapons. At many uranium mining operations, the need to produce uranium far outweighed the need to ensure that there were any more than vestigial efforts made in protecting the workers, the public and the environment from the impacts of the mining, both radiological and non-radiological. In the last quarter of the 20th century, the world began to take greater care of the total environment with the introduction of legislation and the development of operating procedures that took environmental protection into account. The uranium mining industry was part of this change, and standards of environmental management began to become of significance in corporate planning strategies. However, by the 1980s, as uranium mining companies began to address the issues of environment protection, the industry began to suffer a cyclical slowdown. By the 1990s, the industry was at a nadir, but the surviving uranium producers continued to develop and implement a series of procedures in environmental management that were regarded as best practices. This, in part, was necessary as a means to demonstrate to the regulators, governments and the public that the mining operations were being run with the intention of minimizing adverse impacts on the workers, people and the environment. This ensured that mining would be allowed to continue. The decline in uranium mining activity bottomed out in the 1990s, but a resurgence of activity began in the new century that is likely to continue for some time. This has been, in part, due to market conditions and concerns about the shortfall of current production from primary sources (uranium mines) against current reactor fuel demands; the anticipated decrease in future availability of secondary sources such as stockpiles; and the increased interest in nuclear power

  7. Obesity in Nigeria: Current trends and management | Akpa ...

    African Journals Online (AJOL)

    The objective of the study is to review the current knowledge on the problems associated with obesity, as well as the measures and strategies that have evolved in its management. A review of the literature on the subject of obesity, its epidemiology, risk factors, clinical complications and treatment (using Medline computer ...

  8. Current Standards in the Management of Cerebral Metastases

    Directory of Open Access Journals (Sweden)

    Pablo Goetz

    2012-01-01

    Full Text Available The last 30 years have seen major changes in attitude toward patients with cerebral metastases. This paper aims to outline the major landmarks in this transition and the therapeutic strategies currently used. The controversies surrounding control of brain disease are discussed, and two emerging management trends are reviewed: tumor bed radiosurgery and salvage radiation.

  9. Current problems regarding abortion, prenatal genetic testing and managing pregnancy

    Directory of Open Access Journals (Sweden)

    Klajn-Tatić Vesna

    2011-01-01

    Full Text Available Current ethical and legal issues with regard to abortion, prenatal genetic testing and managing pregnancy are discussed in this paper. These problems are considered from the legal theory point of view as well as from the standpoint of the Serbian Law, the European Convention for the Protection of Human Rights and Fundamental Freedoms, European Court of Human Rights, legal regulations of several EU countries, the USA, Japan, and their judicial practice. First, the pregnancy termination standards that exist in Serbia are introduced. Then the following issues are explained separately: the pro life and pro choice approaches to abortion; abortion according to the legal approach as a way of survival; the moral and legal status of the fetus; prenatal genetic testing, and finally matters regarding managing pregnancy today. Moral and legal principals of autonomy, namely freedom of choice of the individual, privacy and self-determination give women the right to terminate unwanted pregnancies. In addition, the basic question is whether the right of the woman to abortion clashes with the rights of others. Firstly, with the right of the "fetus to life". Secondly, with the right of the state to intervene in the interest of protecting "the life of the fetus". Third, with the rights of the woman’s partner. The fetus has the moral right to life, but less in relation to the same right of the woman as well as in relation to her right to control her life and her physical and moral integrity. On the other hand, the value of the life of the fetus increases morally and legally with the maturity of gestation; from the third trimester, the interest of the state prevails in the protection of the "life of the fetus" except when the life or health of the pregnant woman are at risk. As regards the rights of the woman’s partner, namely the husband’s opinion, there is no legal significance. The law does not request his participation in the decision on abortion because

  10. The role of practical wisdom in nurse manager practice: why experience matters.

    Science.gov (United States)

    Cathcart, Eloise Balasco; Greenspan, Miriam

    2013-10-01

    To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning. Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations. © 2013 John Wiley & Sons Ltd.

  11. Environmental management practices and engineering science: a review and typology for future research.

    Science.gov (United States)

    Evangelinos, Konstantinos I; Allan, Stuart; Jones, Keith; Nikolaou, Ioannis E

    2014-04-01

    Current literature describes a number of environmental management practices and cleaner production methods that facilitate different industrial sectors to address their various environmental impacts. The high number of present practices makes their use especially difficult and complicated. This paper aims to shed light on this field by providing a typology of those environmental management practices (such as environmental management systems, environmental indicators assessment methodologies, and cleaner productions methods) and their limitations. It also describes the strengths and weaknesses of using such tools and thoughts for future research. © 2013 SETAC.

  12. "That Doesn't Translate": The Role of Evidence-Based Practice in Disempowering Speech Pathologists in Acute Aphasia Management

    Science.gov (United States)

    Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

    2015-01-01

    Background: An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech…

  13. Adapting Project Management Practices to Research-Based Projects

    Science.gov (United States)

    Bahr, P.; Baker, T.; Corbin, B.; Keith, L.; Loerch, L.; Mullenax, C.; Myers, R.; Rhodes, B.; Skytland, N.

    2007-01-01

    From dealing with the inherent uncertainties in outcomes of scientific research to the lack of applicability of current NASA Procedural Requirements guidance documentation, research-based projects present challenges that require unique application of classical project management techniques. If additionally challenged by the creation of a new program transitioning from basic to applied research in a technical environment often unfamiliar with the cost and schedule constraints addressed by project management practices, such projects can find themselves struggling throughout their life cycles. Finally, supplying deliverables to a prime vehicle customer, also in the formative stage, adds further complexity to the development and management of research-based projects. The Biomedical Research and Countermeasures Projects Branch at NASA Johnson Space Center encompasses several diverse applied research-based or research-enabling projects within the newly-formed Human Research Program. This presentation will provide a brief overview of the organizational structure and environment in which these projects operate and how the projects coordinate to address and manage technical requirements. We will identify several of the challenges (cost, technical, schedule, and personnel) encountered by projects across the Branch, present case reports of actions taken and techniques implemented to deal with these challenges, and then close the session with an open forum discussion of remaining challenges and potential mitigations.

  14. 40 CFR 430.28 - Best management practices (BMPs).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Best management practices (BMPs). 430.28 Section 430.28 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT... Soda Subcategory § 430.28 Best management practices (BMPs). The definitions and requirements set forth...

  15. 40 CFR 430.58 - Best management practices (BMPs).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Best management practices (BMPs). 430.58 Section 430.58 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT... § 430.58 Best management practices (BMPs). The definitions and requirements set forth in 40 CFR 430.03...

  16. Student Teachers' Management Practices in Elementary Classrooms: A Qualitative Study

    Science.gov (United States)

    Hildenbrand, Susan M.; Arndt, Katrina

    2016-01-01

    This qualitative study of four student teachers completing certification in elementary and special education investigated the classroom management practices of the student teachers. This is an important area of study because management practices are essential for an effective classroom, and student teachers often lack confidence and skill in the…

  17. Evaluating current knowledge of legislation and practice of ...

    African Journals Online (AJOL)

    In South Africa (SA), several laws govern the management of fetal remains. ... Regulations in terms of the Environment Conservation Act 73 of. 1989, the .... [13] Regardless, there are systems in place that facilitate .... Incineration, n/N (%). Both,.

  18. Links between Conflict Management Research and Practice

    Science.gov (United States)

    Roloff, Michael E.

    2009-01-01

    This paper explicates the implications of my research on conflict management for self improvement and for practitioners who work to improve the conflict management of others. I also note how my experiences with practitioners have informed my research.

  19. [Description of current hypnosis practice in French university hospitals].

    Science.gov (United States)

    Chabridon, G; Nekrouf, N; Bioy, A

    2017-10-01

    Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  20. Management Practices: Are Not For Profits Different?

    NARCIS (Netherlands)

    J. Delfgaauw (Josse); A.J. Dur (Robert); C. Propper (Propper); S. Smith (Sarah)

    2011-01-01

    textabstractRecent studies have demonstrated the importance of good management for firm performance. Here, we focus on management in not-for-profits (NFPs). We present a model predicting that management quality will be lower in NFPs compared to for-profits (FPs), but that outputs may not be worse if

  1. Waste management in Greenland: current situation and challenges

    DEFF Research Database (Denmark)

    Eisted, Rasmus; Christensen, Thomas Højlund

    2011-01-01

    Waste management in Greenland (56 000 inhabitants) is characterized by landfilling, incineration and export to Denmark of small quantities of metals and hazardous waste. The annual amount of waste is estimated to about 50 000 tons but actual data are scarce. Data on the waste composition is basic...... are small and equipped with only moderate flue gas cleaning technology. This report summarizes the current waste management situation in Greenland and identifies important challenges in improving the waste management....... is basically lacking. The scattered small towns and settlements, the climate and the long transport distances between towns and also to recycling industries abroad constitute a complex situation with respect to waste management. The landfills have no collection of gas and leachate and the incinerators...

  2. 77 FR 16158 - Current Good Manufacturing Practice in Manufacturing, Processing, Packing, or Holding of Drugs...

    Science.gov (United States)

    2012-03-20

    .... FDA-1997-N-0518] (formerly 97N-0300) Current Good Manufacturing Practice in Manufacturing, Processing... labeling control provisions of the current good manufacturing practice (CGMP) regulations for human and... GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS 0 1. The authority citation for 21 CFR part...

  3. Human Resource Management Practices and Innovation

    OpenAIRE

    Laursen, Keld; Foss, Nicolai J.

    2012-01-01

    We survey, organize, and discuss the literature on the role of organizational practices for explaining innovation outcomes. We discuss how individual practices influence innovation, and how the clustering of specific practices matters for innovation outcomes. Relatedly, we discuss various possible mediators of the HRM/innovation link, such as knowledge sharing, social capital and network effects. We argue that the causal mechanisms underlying the HRM/innovation links are still ...

  4. New management practice in the hotel business – The case of the hotel Excelsior

    Directory of Open Access Journals (Sweden)

    Ivona Vrdoljak

    2004-01-01

    Full Text Available The paper analyses the new management practice in the hotel industry. Over recent years, the environment for hotel management in Croatia has changed radically. Difficult business conditions require the transformation of management in the hotel industry. From the old-style business model, in which hotel managers were focused inwards on the hotel and its operation, a new paradigm encompassing a more externally oriented focus is now required. The current transformation of socially-owned hotels into capital-based and market-oriented business enterprises will accelerate the general process of privatisation and promote incentive management strategies. The article gives the research results of the new management practice in the case of the hotel "Excelsior" in Dubrovnik. It is one of the most successful hotels on the Croatian coast, which practises modern management. The research referred to management level, sex, age and educational structure of managers, their continuing education, knowledge, skills and characteristics of management, main functions of management, delegation of authorities and responsibilities, management system, decision-making, styles of leading and governing of managers by their time. The received results have been compared with the earlier management approach of the above-mentioned hotel. The objective of the paper is to point out the importance of the new management practice and its contribution to the successful hotel business.

  5. Attaining and maintaining 'best practice' in environmental management

    International Nuclear Information System (INIS)

    McNally, P.

    1993-01-01

    While environmental issues are constantly changing and becoming increasingly regulated, the key to high performance in environmental management is the application of best practice - best practicable technology of sites - specific standards, practices and procedures. The author also emphasised that the application of best practice in environmental management of mine sites is a dynamic process and that requires a combination of efficient environmental management and efficient production. Timing of application of technology and social factors are also determining factors in this process. The particular case of the Ranger uranium mine site is presented were the major environmental issues relate to water management, tailing management and rehabilitation. The management procedure used at Ranger for a research project proposal is outlined

  6. VDOT manual of practice for planning stormwater management.

    Science.gov (United States)

    1992-01-01

    The final report is in the form of a manual of practice for the VDOT to use in planning its stormwater management strategies. The manual was proposed to aid in the selection and design of erosion control practices and stormwater control practices for...

  7. Key Practice for Green Building Management In Malaysia

    OpenAIRE

    Aghili Nasim; Bin Mohammed Abdul Hakim; Sheau-Ting Low

    2016-01-01

    This paper identifies the management practices for green building management in Malaysia. A set of practices was ascertained from the reviewed of various established Green Building Standard in the world. Green building practices are significant role in attaining sustainability particularly in the construction industry. Green building is constructed for minimizing impacts to environment as well as decreasing building effects on occupants. To achieve the goals of green buildings, set of managem...

  8. Pilot Projects in Water Management : Practicing Change and Changing Practice

    NARCIS (Netherlands)

    Vreugdenhil, H.S.I.

    2010-01-01

    Pilot projects are widely applied in water management. They can be used to test risky innovations at confined scale, but can also be used to delay policy decisions or to advocate a particular innovation. In this book the phenomenon ‘pilot project’ is explored both theoretically and empirically. A

  9. Management of Candida infections in liver transplant recipients: current perspectives

    Directory of Open Access Journals (Sweden)

    Lingegowda PB

    2014-07-01

    Full Text Available Pushpalatha B Lingegowda,1–3 Tan Ban Hock1,2,4,5 1Department of Infectious Diseases, Singapore General Hospital, 2DUKE-NUS Graduate Medical School, 3Yong Loo Lin School of Medicine, National University of Singapore, 4SingHealth Internal Medicine Residency Program, 5Faculty of Medicine, National University of Singapore, Singapore Abstract: Liver transplantation has emerged as a widely accepted lifesaving therapeutic option for many patients with a variety of liver diseases. Improved surgical and medical management has led to significant improvements in post-transplant survival rates with a 1 year and 5 year patient survival of 87% and 73%, respectively. A high mortality rate due to infections during the first post-transplant year persists. Invasive candidiasis is recognized as a significant problem associated with high morbidity and mortality. Recent surveillance data has helped to understand the changes in the epidemiology and the evolving trends in the use of antifungal agents for prophylaxis and treatment combined with the challenges of managing these invasive fungal infections, which has led the transplant community to explore the best management strategies. The emergence of resistant fungi and excess costs in managing these invasive fungal infections has added to the complexities of management. In this context, current perspectives in the management of Candida infections in liver transplant recipients will be reviewed. Keywords: Candida infections, management, liver transplant

  10. Current Practices In Infant Nutrition In Benin City, Nigeria ...

    African Journals Online (AJOL)

    Of the 780 mothers 432 (55.6%) had children who were less than 6 months while 348(44.6%) had older infants. About 98.0% of the mothers were practicing one form of breast-feeding or the other. The exclusive breastfeeding rate (EBR), predominant breastfeeding rate (PBR) and bottle-feed rates (BOTFR) were respectively ...

  11. Feedback matters current feedback practices in the EFL classroom

    CERN Document Server

    Reitbauer, Margit; Mercer, Sarah; Schumm-Fauster, Jennifer

    2013-01-01

    This varied collection of papers is concerned with feedback in the language learning context. With its blend of theoretical overviews, action research-based empirical studies and practical implications, this will be a valuable resource for all academics and practitioners concerned with generating feedback that matters.

  12. Teacher's current practices of teaching reading and grade four ...

    African Journals Online (AJOL)

    This study examined the practices and challenges of teaching reading strategies and ... Twelve grade 4 students were selected using simple random sampling ... The quantitative data disclosed lower student scores, while the qualitative data ... By Country · List All Titles · Free To Read Titles This Journal is Open Access.

  13. Equity crowdfunding in China : Current practice and important legal issues

    NARCIS (Netherlands)

    Li, Jing

    2017-01-01

    By studying two leading Chinese equity crowdfunding portals, namely, Renrentou and Zhongou8, this paper provides the very first empirical evidence on the practice and regulation of equity crowdfunding in China. In the case of Renrentou, I examine a hand-collected sample consisting of the investment

  14. Psychotherapy: a profile of current occupational therapy practice in Ontario.

    Science.gov (United States)

    Moll, Sandra E; Tryssenaar, Joyce; Good, Colleen R; Detwiler, Lisa M

    2013-12-01

    Psychotherapy can be an important part of psychosocial occupational therapy practice; however, it requires specialized training to achieve and maintain competence. Regulation varies by province, and in Ontario, occupational therapists were recently authorized to perform psychotherapy. The purpose of this study was to explore the psychotherapy practice, training, and support needs of Ontario occupational therapists. An online survey was sent to occupational therapists who had clients with mental health or chronic pain issues, asking about their expertise and support needs in relation to nine psychotherapy approaches. Of the 331 therapists who responded, there were variations in the nature and frequency of psychotherapy practice. Experienced therapists in outpatient settings were more likely to practice psychotherapy, and cognitive-behaviour therapy, motivational interviewing, and mindfulness were the most common approaches. Supervision and training varied, with many therapists interested in occupational therapy-specific training. Recommendations for a framework of support include education about the nature of psychotherapy, training and supervision guidelines, and advocacy for occupational therapy and psychotherapy.

  15. Management practices and influences on IT architecture decisions: a case study in a telecom company

    OpenAIRE

    Hsing, Chen Wen; Souza, Cesar Alexandre de

    2012-01-01

    The study aims to analyze the IT architecture management practices associated with their degree of maturity and the influence of institutional and strategic factors on the decisions involved through a case study in a large telecom organization. The case study allowed us to identify practices that led the company to its current stage of maturity and identify practices that can lead the company to the next stage. The strategic influence was mentioned by most respondents and the institutional in...

  16. Determination of significance in Ecological Impact Assessment: Past change, current practice and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk

    2013-01-15

    Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey of the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring

  17. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

    Science.gov (United States)

    Guttmann-Bauman, I; Thornton, P; Adhikari, S; Reifschneider, K; Wood, M A; Hamby, T; Rubin, K

    2018-03-26

    The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Human Resource Management Practices and Innovation

    DEFF Research Database (Denmark)

    Laursen, Keld; Foss, Nicolai Juul

    2014-01-01

    This article surveys, organizes, and critically discusses the literature on the role of human resource practices for explaining innovation outcomes. We specifically put an emphasis on what is often called ‘new’ or ‘modern’ HRM practices—practices that imply high levels of delegation of decisions...

  19. Knowledge Management Practice on Construction Project ...

    African Journals Online (AJOL)

    Likewise, the results further indicated 19 benefits of KM practice for improving construction project performance and include: improve project quality, cost and time; practice and process improvement; encourage effective teamwork and innovation; improve the client satisfaction; boost productivity of employees and processes; ...

  20. FINANCIAL ASPECTS OF CURRENT ASSETS MANAGEMENT IN SERBIAN ECONOMY

    Directory of Open Access Journals (Sweden)

    Jugoslav Aničić

    2017-04-01

    Full Text Available Efficient current assets management should provide optimum level of company’s net current assets as interrelation between current assets and short-term liabilities. The companies whose short-term liabilities are not proportionate to cashable current assets face the problem of insolvency and all negative consequences caused by insolvency. Rate of return to total assets measures how good is the management’s use of the company property for the purpose of creating operating profit, regardless of the fact how these assets are financed. Serbian economy is burdened by insolvency and significant indebtedness under unfavorable loan terms, so adequate attention has to be dedicated to the matters of the structure of operating property and its financing in order to improve competitiveness and efficiency of business.