Sample records for disease management strategies

  1. Management Strategies for CLN2 Disease.

    Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela


    CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Multidisciplinary strategies in the management of early chronic kidney disease.

    Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M


    Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

  3. Pain management strategies for neuropathic pain in Fabry disease--a systematic review

    Schuller, Y.; Linthorst, G. E.; Hollak, C. E. M.; van Schaik, I. N.; Biegstraaten, M.


    Neuropathic pain is one of the key features of (classical) Fabry disease (FD). No randomized clinical trials comparing effectiveness of different pain management strategies have been performed. This review aims to give an overview of existing pain management strategies. PubMed and Embase were

  4. Genetic management strategies for controlling infectious diseases in livestock populations

    Bishop Stephen C


    Full Text Available Abstract This paper considers the use of disease resistance genes to control the transmission of infection through an animal population. Transmission is summarised by R0, the basic reproductive ratio of a pathogen. If R0 > 1.0 a major epidemic can occur, thus a disease control strategy should aim to reduce R0 below 1.0, e.g. by mixing resistant with susceptible wild-type animals. Suppose there is a resistance allele, such that transmission of infection through a population homozygous for this allele will be R02 01, where R01 describes transmission in the wildtype population. For an otherwise homogeneous population comprising animals of these two groups, R0 is the weighted average of the two sub-populations: R0 = R01ρ + R02 (1 - ρ, where ρ is the proportion of wildtype animals. If R01 > 1 and R02 0 ≤ 1, i.e. ρ ≤ (R0 - R02/(R01 - R02. If R02 = 0, the proportion of resistant animals must be at least 1 - 1/R01. For an n genotype model the requirement is still to have R0 ≤ 1.0. Probabilities of epidemics in genetically mixed populations conditional upon the presence of a single infected animal were derived. The probability of no epidemic is always 1/(R0 + 1. When R0 ≤ 1 the probability of a minor epidemic, which dies out without intervention, is R0/(R0 + 1. When R0 > 1 the probability of a minor and major epidemics are 1/(R0 + 1 and (R0 - 1/(R0 + 1. Wherever possible a combination of genotypes should be used to minimise the invasion possibilities of pathogens that have mutated to overcome the effects of specific resistance alleles.

  5. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, GOLD Executive Summary

    Vestbo, Jørgen; Hurd, Suzanne S; Agusti, Alvar G


    Chronic obstructive pulmonary disease (COPD) is a global health problem and since 2001 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5...

  6. Strategies to manage hepatitis C virus (HCV) disease burden

    Wedemeyer, H; Duberg, A S; Buti, M


    The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant...

  7. Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.

    Wu, Xian-Rui; Remzi, Feza H; Liu, Xiu-Li; Lian, Lei; Stocchi, Luca; Ashburn, Jean; Shen, Bo


    To evaluate the disease course and management strategy for pouch neoplasia. Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified. All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013). The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.

  8. Self-management strategies in chronic obstructive pulmonary disease: a first step toward personalized medicine.

    Barrecheguren, Miriam; Bourbeau, Jean


    Self-management has gained increased relevance in the management of chronic obstructive pulmonary disease patients. The heterogeneity in self-management interventions has complicated the development of recommendations for clinical practice. In this review, we present the latest findings regarding conceptual definition, effectiveness of self-management interventions and self-management strategies in chronic obstructive pulmonary disease as a first step toward personalized medicine: what, how and to whom? Self-management interventions have shown benefits in improving health-related quality of life and reducing hospital admissions. Favorable outcomes can only be achieved if patients have an ultimate goal, that is their desired achievements in their life. In the continuum of care, the components of the self-management program will vary to adapt to the condition of the patient (disease severity, comorbidities) and to factors such as patient motivation, confidence (self-efficacy), access to health care, family and social support. A combination of education, case management and patient-centric action plan has shown the best chance of success. The individual patient's needs, own preferences and personal goals should inform the design of any intervention with a behavioral component. A continuous loop process has to be implemented to constantly assess what work and does not work, aiming at achieving the desired outcomes for a given patient.

  9. Enhancing chronic disease management: a review of key issues and strategies.

    Willison, Kevin D; Williams, Paul; Andrews, Gavin J


    This paper highlights three selected issues and potential strategies towards meeting chronic disease management needs. First, the orientation of the biomedical science model often gives insufficient attention to chronic health care needs. A second issue is that the use of complementary and alternative medicine (CAM) may offer for some an opportunity to enhance their chronic disease management efforts. A third issue is that our understanding of this potential is limited, as many who use CAM do not disclose such use. With reference to proposed solutions/strategies, first, an improved focus to respect patient/client values and goals may encourage people to disclose their use of CAM. Second, a community-based participatory approach shows promise in enhancing communication plus helps integrate CAM within new models of chronic disease management. Lastly, those in public health could help facilitate such an approach plus be a monitor of CAM practices. Overall, this review provides a springboard for further research and practice in CAM and the management of chronic diseases.

  10. Fungal Biofilms: Targets for the Development of Novel Strategies in Plant Disease Management.

    Villa, Federica; Cappitelli, Francesca; Cortesi, Paolo; Kunova, Andrea


    The global food supply has been facing increasing challenges during the first decades of the 21 st century. Disease in plants is an important constraint to worldwide crop production, accounting for 20-40% of its annual harvest loss. Although the use of resistant varieties, good water management and agronomic practices are valid management tools in counteracting plant diseases, there are still many pathosystems where fungicides are widely used for disease management. However, restrictive regulations and increasing concern regarding the risk to human health and the environment, along with the incidence of fungicide resistance, have discouraged their use and have prompted for a search for new efficient, ecologically friendly and sustainable disease management strategies. The recent evidence of biofilm formation by fungal phytopathogens provides the scientific framework for designing and adapting methods and concepts developed by biofilm research that could be integrated in IPM practices. In this perspective paper, we provide evidence to support the view that the biofilm lifestyle plays a critical role in the pathogenesis of plant diseases. We describe the main factors limiting the durability of single-site fungicides, and we assemble the current knowledge on pesticide resistance in the specific context of the biofilm lifestyle. Finally, we illustrate the potential of antibiofilm compounds at sub-lethal concentrations for the development of an innovative, eco-sustainable strategy to counteract phytopathogenic fungi. Such fungicide-free solutions will be instrumental in reducing disease severity, and will permit more prudent use of fungicides decreasing thus the selection of resistant forms and safeguarding the environment.

  11. Comparison of provider and plan-based targeting strategies for disease management.

    Annis, Ann M; Holtrop, Jodi Summers; Tao, Min; Chang, Hsiu-Ching; Luo, Zhehui


    We aimed to describe and contrast the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. Health plan epidemiologists partnered with university health services researchers to conduct a quasi-experimental, mixed-methods study of a 2-year pilot. We used semi-structured interviews to assess the characteristics of program-targeting strategies, and calculated target and engagement rates from clinical encounter data. Five physician organizations (POs) with 51 participating practices implemented care management. Health plan member lists were sent monthly to the practices to accept patients, and then the practices sent back data reports regarding targeting and engagement in care management. Among patients accepted by the POs, we compared those who were targeted and engaged by POs with those who met health plan targeting criteria. The health plan's targeting process combined claims algorithms and employer group preferences to identify candidates for disease management; on the other hand, several different factors influenced PO practices' targeting approaches, including clinical and personal knowledge of the patients, health assessment information, and availability of disease-relevant programs. Practices targeted a higher percentage of patients for care management than the health plan (38% vs 16%), where only 7% of these patients met the targeting criteria of both. Practices engaged a higher percentage of their targeted patients than the health plan (50% vs 13%). The health plan's claims-driven targeting approach and the clinically based strategies of practices both provide advantages; an optimal model may be to combine the strengths of each approach to maximize benefits in care management.

  12. Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease.

    Mager, Amy; Pelot, Kristin; Koch, Kathryn; Miller, Lawrence; Hubler, Collin; Ndifor, Anisah; Coan, Canice; Leonard, Cynthia; Field, Joshua J

    A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD. In a prospective study, adults with SCD with ≥10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared. Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04). An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use.

  13. Using epidemiological information to develop effective integrated virus disease management strategies.

    Jones, Roger A C


    Virus diseases cause serious losses in yield and quality of cultivated plants worldwide. These losses and the resulting financial damage can be limited by controlling epidemics using measures that minimise virus infection sources or suppress virus spread. For each combination of virus, cultivated plant and production system, there is an 'economic threshold' above which the financial damage is sufficient to justify using such measures. However, individual measures used alone may bring only small benefits and they may become ineffective, especially over the long term. When diverse control measures that act in different ways are combined and used together, their effects are complementary resulting in far more effective overall control. Such experiences have led to the development of integrated management concepts for virus diseases that combine available host resistance, cultural, chemical and biological control measures. Selecting the ideal mix of measures for each pathosystem and production situation requires detailed knowledge of the epidemiology of the causal virus and the mode of action of each individual control measure so that diverse responses can be devised to meet the unique features of each of the different scenarios considered. The strategies developed must be robust and necessitate minimal extra expense, labour demands and disruption to standard practices. Examples of how epidemiological information can be used to develop effective integrated disease management (IDM) strategies for diverse situations are described. They involve circumstances where virus transmission from plant-to-plant occurs in four different ways: by contact, non-persistently or persistently by insect vectors, and by root-infecting fungi. The examples are: Subterranean clover mottle virus (SCMoV) (contact-transmitted) and Bean yellow mosaic virus (BYMV) (non-persistently aphid-transmitted) in annually self-regenerating clover pasture; three seed-borne viruses (all non-persistently aphid

  14. Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis.

    Strand, Vibeke; Wright, Grace C; Bergman, Martin J; Tambiah, Jeyanesh; Taylor, Peter C


    To identify how patients perceive the broad effect of active rheumatoid arthritis (RA) on their daily lives and indicate how RA disease management could benefit from the inclusion of individual goal-setting strategies. Two multinational surveys were completed by patients with RA. The "Good Days Fast" survey was conducted to explore the effect of disease on the daily lives and relationships of women with RA. The "Getting to Your Destination Faster" survey examined RA patients' treatment expectations and goal-setting practices. Respondents from all countries agreed that RA had a substantial negative effect on many aspects of their lives (work productivity, daily routines, participation in social and leisure activities) and emotional well-being (loss of self-confidence, feelings of detachment, isolation). Daily pain was a paramount issue, and being pain- and fatigue-free was considered the main indicator of a "good day." Setting personal, social, and treatment goals, as well as monitoring disease progress to achieve these, was considered very beneficial by patients with RA, but discussion of treatment goals seldom appeared to be a part of medical appointments. Many patients with RA feel unable to communicate their disease burden and treatment goals, which are critically important to them, to their healthcare provider (HCP). Insights gained from these 2 surveys should help to guide patients and HCP to better focus upon mutually defined goals for continued improvement of management and achievement of optimal care in RA.

  15. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

    Edelstein, Burton L; Ng, Man Wai


    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

  16. Update on Pharmaceutical and Minimally Invasive Management Strategies for Chronic Obstructive Pulmonary Disease

    Rokhsara Rafii


    Full Text Available Chronic obstructive pulmonary disease (COPD is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical lung-volume reduction interventions that may prove to be of significant benefit in the future.

  17. Annosus Root Disease Hazard Rating, Detection, and Management Strategies in the Southeastern United States

    S. A. Alexander


    Annosus root disease (ARD), is the major root disease of pines in the southeastern United States where severely affected trees exhibit growth loss. Assessing the potential damage of ARD is essential for making effective disease control and management decisions. A soil hazard rating system developed to identify potential for tree mortality is described. The Annosus...

  18. Management strategies for fibromyalgia

    Le Marshall KF


    Full Text Available Kim Francis Le Marshall, Geoffrey Owen LittlejohnDepartments of Rheumatology and Medicine, Monash Medical Centre and Monash University, Victoria, AustraliaDate of preparation: 14 June 2011Clinical question: What are the effective, evidence-based strategies available for the management of fibromyalgia?Conclusion: There are a number of management strategies available with robust evidence to support their use in clinical practice.Definition: Fibromyalgia is a complex pain syndrome characterized by widespread, chronic muscular pain and tenderness, disordered sleep, emotional distress, cognitive disturbance, and fatigue. Its prevalence is estimated to be 3%–5% in the population and higher yet in patients with comorbid rheumatic diseases.Level of evidence: Systematic reviews, meta-analyses, randomized controlled trials (RCTs.Search sources: PubMed, Cochrane Library, manual searchConsumer summary: Key messages for patients and clinicians are:1. There are many effective pharmacological management strategies available for fibromyalgia.2. A nonpharmacological, multicomponent approach utilizing education, aerobic exercise, psychological therapy, and other strategies is also effective for fibromyalgia.3. Despite the significant and, at times, disabling physical and psychological symptoms, fibromyalgia can be a manageable condition with a potentially good outcome.Keywords: fibromyalgia, pain, treatment, management, evidence 

  19. Assessing the value of disease management: impact of 2 disease management strategies in an underserved asthma population.

    Galbreath, Autumn Dawn; Smith, Brad; Wood, Pamela R; Inscore, Stephen; Forkner, Emma; Vazquez, Marilu; Fallot, Andre; Ellis, Robert; Peters, Jay I


    The goal of disease management (DM) is to improve health outcomes and reduce cost through decreasing health care utilization. Although some studies have shown that DM improves asthma outcomes, these interventions have not been examined in a large randomized controlled trial. To compare the effectiveness of 2 previously successful DM programs with that of traditional care. Nine hundred two individuals with asthma (429 adults; 473 children) were randomly assigned to telephonic DM, augmented DM (ADM; DM plus in-home visits by a respiratory therapist), or traditional care. Data were collected at enrollment and at 6 and 12 months. Primary outcomes were time to first asthma-related event, quality of life (QOL), and rates of asthma-related health care utilization. Secondary outcomes included rate of controller medication initiation, number of oral corticosteroid bursts, asthma symptom scores, and number of school days missed. There were no significant differences between groups in time to first asthma-related event or health care utilization. Adult participants in the ADM group had greater improvement in QOL (P = .04) and a decrease in asthma symptoms (P = .001) compared with other groups. Of children not receiving controller medications at enrollment (13%), those in the intervention groups were more likely to have controller medications initiated than the control group (P = .01). Otherwise, there were no differences in outcomes. Overall, participation in asthma DM did not result in significant differences in utilization or clinical outcomes. The only significant impact was a higher rate of controllermedication initiation in children and improvement in asthma symptoms and QOL in adults who received ADM.

  20. Ecology of Fungus Gnats (Bradysia spp.) in Greenhouse Production Systems Associated with Disease-Interactions and Alternative Management Strategies.

    Cloyd, Raymond A


    Fungus gnats (Bradysia spp.) are major insect pests of greenhouse-grown horticultural crops mainly due to the direct feeding damage caused by the larvae, and the ability of larvae to transmit certain soil-borne plant pathogens. Currently, insecticides and biological control agents are being used successively to deal with fungus gnat populations in greenhouse production systems. However, these strategies may only be effective as long as greenhouse producers also implement alternative management strategies such as cultural, physical, and sanitation. This includes elimination of algae, and plant and growing medium debris; placing physical barriers onto the growing medium surface; and using materials that repel fungus gnat adults. This article describes the disease-interactions associated with fungus gnats and foliar and soil-borne diseases, and the alternative management strategies that should be considered by greenhouse producers in order to alleviate problems with fungus gnats in greenhouse production systems.

  1. Ecology of Fungus Gnats (Bradysia spp. in Greenhouse Production Systems Associated with Disease-Interactions and Alternative Management Strategies

    Raymond A. Cloyd


    Full Text Available Fungus gnats (Bradysia spp. are major insect pests of greenhouse-grown horticultural crops mainly due to the direct feeding damage caused by the larvae, and the ability of larvae to transmit certain soil-borne plant pathogens. Currently, insecticides and biological control agents are being used successively to deal with fungus gnat populations in greenhouse production systems. However, these strategies may only be effective as long as greenhouse producers also implement alternative management strategies such as cultural, physical, and sanitation. This includes elimination of algae, and plant and growing medium debris; placing physical barriers onto the growing medium surface; and using materials that repel fungus gnat adults. This article describes the disease-interactions associated with fungus gnats and foliar and soil-borne diseases, and the alternative management strategies that should be considered by greenhouse producers in order to alleviate problems with fungus gnats in greenhouse production systems.

  2. Conservative versus invasive stable ischemic heart disease management strategies: what do we plan to learn from the ISCHEMIA trial?

    Cheng-Torres, Kathleen A; Desai, Karan P; Sidhu, Mandeep S; Maron, David J; Boden, William E


    Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.

  3. Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review.

    Lee, Jung-Ah; Choi, Mona; Lee, Sang A; Jiang, Natalie


    Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion. Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system. Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

  4. Strategies to control costs and quality: a focus on outcomes research for disease management.

    Villagra, Victor


    Rapid adoption of disease management has outpaced systematic evaluation of its net value in improving health outcomes and mitigating healthcare cost. This article identifies areas in which outcomes research in disease management is needed to demonstrate its value or to enhance its performance. Patient identification for disease management relies on administrative database queries but the trade-offs in sensitivity, specificity, and predictive value of alternative queries are not well known. Large-scale deployment, rapid patient engagement, and repeated interactions between patients and nurses could be important attributes for attaining measurable improvements in quality and cost reduction over short periods of time, but these hypothesis need to be tested. There is a trend toward integration of multiple chronic disease management programs onto a single platform. To support this trend, there is a need for a corresponding set of integrated clinical guidelines or "meta-guidelines" that combine the contents of individual practice guidelines. The relative contribution of various disease management interventions in improving clinical results, lowering costs, and their respective ease of implementation is not known. Research leading to a better understanding of tradeoffs could lead to more rational resource allocation and better overall outcomes. Coordination between disease management programs and physician practices is lacking. Research aimed at defining operational and technical interfaces and cultural and behavioral professional adjustments necessary to achieve integration and coordination is needed. The lack of a consistent analytical framework for evaluating clinical and financial outcomes has made comparisons of reported results impossible and has rendered many reports unreliable. Theoretical work on a standard methodology that integrates clinical and financial outcomes and empiric validation is needed.

  5. Reconsideration of Secondary Risk Management Strategies in Patients with Ischemic Heart Disease.

    Kashiyama, Kuninobu; Sonoda, Shinjo; Otsuji, Yutaka


    The main risk factors in ischemic heart diseases, including myocardial infarction, are hypertension, dyslipidemia, diabetes, obesity and smoking. The incidence of ischemic heart disease in Japan has been lower than that in Western countries because of differences in lifestyle and the anatomy of the coronary arteries, but the situation has been changing recently because of the westernization of lifestyle. Cardiovascular diseases have become the second most common cause of death in Japan, and 40% of those deaths are attributed to ischemic heart disease. Patients with a history of myocardial infarction, especially, have an increased risk of re-infarction, so strict management of coronary risk factors is important for the prevention of secondary ischemic heart disease. Although there are many guidelines about how to manage the risk factors, there are still many problems. Although lipid management has been demonstrated to have a protective effect against coronary artery disease and arteriosclerotic guidelines have been developed, it is reported that only about one third of patients achieved the low-density lipoprotein (LDL) target value under secondary prevention. Moreover, it is unclear whether the lower target value is required for high-risk patients. Recent research on diabetes has reported increased mortality in patients with intensive glycemic control. We should discuss when to start treatment, which medicine to use, and to what extent we should manage glycemic control. Strict management based on current therapeutic guidelines is effective for secondary prevention of ischemic heart disease, with target values of less than 135/85 mmHg for home blood pressure, less than 100 mg/dl for LDL-C, more than 40 mg/dl for HDL-C, less than 150 mg/dl for TG, and, for diabetic patients, less than 7.0% for HbA1c (NGSP).

  6. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

    Rabe, K.F.; Hurd, S.; Anzueto, A.; Barnes, P.J.; Buist, S.A.; Calverley, P.; Fukuchi, Y.; Jenkins, C.; Rodriguez-Roisin, R.; Weel, C. van; Zielinski, J.


    Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its manage...

  7. Management Strategies for Annosus Root Disease in Pacific Northwest Coastal Western Hemlock

    Kenelm W. Russell


    Actual loss from annosus root disease infections in hemlock stands is difficult to determine. As political trends move toward protecting old-growth timber, greater market demand will be placed on second growth western hemlock. These stands must be kept healthy for maximum productivity. The paper compares the following 70-year rotation timber management scenarios: The...

  8. Systematic review of management strategies to control chronic wasting disease in wild deer populations in North America.

    Uehlinger, F D; Johnston, A C; Bollinger, T K; Waldner, C L


    Chronic wasting disease (CWD) is a contagious, fatal prion disease affecting cervids in a growing number of regions across North America. Projected deer population declines and concern about potential spread of CWD to other species warrant strategies to manage this disease. Control efforts to date have been largely unsuccessful, resulting in continuing spread and increasing prevalence. This systematic review summarizes peer-reviewed published reports describing field-applicable CWD control strategies in wild deer populations in North America using systematic review methods. Ten databases were searched for peer-reviewed literature. Following deduplication, relevance screening, full-text appraisal, subject matter expert review and qualitative data extraction, nine references were included describing four distinct management strategies. Six of the nine studies used predictive modeling to evaluate control strategies. All six demonstrated one or more interventions to be effective but results were dependant on parameters and assumptions used in the model. Three found preferential removal of CWD infected deer to be effective in reducing CWD prevalence; one model evaluated a test and slaughter strategy, the other selective removal of infected deer by predators and the third evaluated increased harvest of the sex with highest prevalence (males). Three models evaluated non-selective harvest of deer. There were only three reports that examined primary data collected as part of observational studies. Two of these studies supported the effectiveness of intensive non-selective culling; the third study did not find a difference between areas that were subjected to culling and those that were not. Seven of the nine studies were conducted in the United States. This review highlights the paucity of evaluated, field-applicable control strategies for CWD in wild deer populations. Knowledge gaps in the complex epidemiology of CWD and the intricacies inherent to prion diseases currently

  9. Raising awareness of upper airway diseases: Overview of management and prevention strategies

    De-yun WANG


    Full Text Available The nose together with the paranasal sinuses is the main part of the upper airway, which is lined with pseudostratified columnar ciliated epithelium. There are several important physiological functions such as conditioning and filtration of the inspired air and the provision of end organ for the sense of smell. Besides the nose also fulfills a physical and immunological barrier as the nasal epithelium is the first site of interaction between the host tissue and foreign invaders, such as viruses, bacteria, fungi, allergens, and harmful particulates. Hence, nasal diseases such as rhinitis (allergic and infectious and rhinosinusitis are the most common health problems worldwide, affecting millions of people of all ages. In the past 10 to 20 years, our understanding of the immuno-pathophysiological mechanisms underlying the common nasal diseases has been significantly enhanced by in vivo and in vitro studies. This allows the development of novel therapeutic strategies designed to improve the physiological and immune defense functions of the nose, as well as for other common airway diseases. Since the dynamically external changes of atmosphere, environment (pollution and susceptible population, we are now facing some of new features on epidemiology and the types of upper airway diseases that require us to in-deep study the diseases through basic and clinical researches, so as to further understand the prevention, diagnosis and treatment of the diseases. DOI: 10.118555/j.issn.0577-7402.2017.10.01

  10. Manufacturing knowledge management strategy

    Shaw , Duncan; Edwards , John


    Abstract The study sought to understand the components of knowledge management strategy from the perspective of staff in UK manufacturing organisations. To analyse this topic we took an empirical approach and collaborated with two manufacturing organisations. Our main finding centres on the key components of a knowledge management strategy, and the relationships between it and manufacturing strategy and corporate strategy. Other findings include: the nature of knowledge in manufact...

  11. Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction.

    Chu, Paula; Pandya, Ankur; Salomon, Joshua A; Goldie, Sue J; Hunink, M G Myriam


    Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  12. Management strategies for business

    Alexander Sumets


    The paper aims to systematize business management strategies and identify their potential opportunities for the development of the competitive business advantages in transition economies. Characteristics of the features of modern business in developing countries (on the example of Ukraine) are given in the article in concise form. The relevance of the study of the relationship between strategy and business management is substantiated. Modern interpretations of the concepts of «strategy», «str...

  13. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

    Vogelmeier, Claus F; Criner, Gerard J; Martinez, Fernando J; Anzueto, Antonio; Barnes, Peter J; Bourbeau, Jean; Celli, Bartolome R; Chen, Rongchang; Decramer, Marc; Fabbri, Leonardo M; Frith, Peter; Halpin, David M G; López Varela, M Victorina; Nishimura, Masaharu; Roche, Nicolas; Rodriguez-Roisin, Roberto; Sin, Don D; Singh, Dave; Stockley, Robert; Vestbo, Jørgen; Wedzicha, Jadwiga A; Agusti, Alvar


    This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed. Copyright ©2017 the American Thoracic Society. Published with permission from the American Thoracic Society. Design and branding are copyright ©ERS 2017.

  14. Innovations in management of cardiac disease: drugs, treatment strategies and technology.

    Foëx, P


    Within the last generation, the management of patients with heart disease has been transformed by advances in drug treatments, interventions and diagnostic technologies. The management of arterial hypertension saw beta-blockers demoted from first- to third-line treatment. Recent studies suggest that the goal of treatment may have to change to lower systolic blood pressures to prevent long-term organ damage. Today less than 15% of coronary revascularizations are surgical and more than 85% are done by interventional cardiologists inserting coronary stents. Thus, managing patients on dual antiplatelet therapy has become an important issue. With new generations of coronary stents, recommendations are changing fast. In the past, decisions concerning non-cardiac surgery after acute myocardial infarction were based on the delay between infarction and non-cardiac surgery. Today, the main concern is the patient's status in respect of dual antiplatelet therapy after primary percutaneous intervention. There have been advances in the management of heart failure but new drugs (ivabradine, sacubitril/valsartan) and cardiac resynchronization are recommended only in patients with an ejection fraction below 35% on optimal medication. Heart failure remains a major perioperative risk factor. Prospective studies have shown that troponin elevations represent myocardial injury (not necessarily myocardial infarction), are mostly silent and are associated with increased 30-day mortality. Monitoring (troponin assays) for myocardial injury in non-cardiac surgery (MINS) seems increasingly justified. The treatment of MINS needs further research. Technological advances, such as intelligent, portable monitors benefit not only patients with cardiac disease but all patients who have undergone major surgery and are on the wards postoperatively. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please

  15. Eosinophilic Esophagitis (EoE: an emerging disease in childhood - Review of diagnostic and management strategies

    Jorge Amil Dias


    Full Text Available Eosinophilic esophagitis (EoE is a chronic immune/antigen mediated inflammatory disease of the esophagus. It comprises a separate entity of increasing incidence and prevalence in children and adults. The disease is characterized by histological evidence of dense esophageal tissue eosinophilia in the presence of a variety of upper GI symptoms including vomiting, dysphagia, food impaction and odynophagia. Cornerstone of treatment is dietary intervention and/or the off-label use of swallowed topical corticosteroids. New drug therapies are under investigation. In this review we focus on the diagnostic approach and the currently available treatment strategies. Keywords: Eosinophilic esophagitis, oral viscous budesonide, fluticasone propionate, oral steroids, amino acid-based formula, empiric elimination diet, targeted elimination dietKey points:1.A trial with antisecretory medication is necessary to exclude GERD and PPI-responsive esophageal eosinophilia and to fulfil the diagnostic criteria of EoE. 2.Elimination diet and/or off-label use of topical corticosteroids are effective measures for treating EoE. 3.Elimination diet is the first line treatment in atopic children. 4.Systemic corticosteroids are reserved for patients with severe disease requiring immediate relief, or when other treatments have failed. 5.Cromolyn sodium (sodium cromoglycate and leukotriene receptor antagonists, are not currently recommended for treating EoE, due to lack of solid evidence of benefit.6.Immunosuppressive drugs and biologics have shown some value but effect has been limited and therefore not yet recommended as standard therapy.

  16. Immunosuppressive strategies and management

    Shi-hui PAN


    Advances in immunosuppressive therapy have significantly improved short-term allograft and patient survival.However,chronic allograft failure,antibody mediated rejection,recurrent diseases and immunosuppressive drug associated adverse effects remain serious barriers to long-term survival and quality of life.New immunosuppressive agents and protocols are being evaluated to combat these problems.Importantly,clinicians must work to manage post-transplant complications and avoid complex medication regimens,which will potentiate drug interactions and non.compliance.Different organs have different immunogenicities and each recipient has a unique clinical and immunologic profile.The clinician must recognize these variations and customize the immunosuppressive regimens and treatment protocols based on the individual condition.The general principles of an individualized immunosuppressive protocol should take the following factors into account:organ type,donor and recipient characteristics,quality of the donor organ,recipienVs medical history,recipient's undedying disease,immunologic risk for acute rejection,potential co-morbidity related to immunosuppression,significant druginteractions,medication costs and patient compliance.In addition,the combination of immunosuppressive drugs must have a pharmacologic rationale to achieve the desired goal of suppressing the individual's immune system to render the patient tolerant to the allograft while minimizing co-morbidities.For the past few years,many clinical strategies have been applied in an attempt to improve graft survival or to reduce immunsuppressants induced side-effects.Specific protocols include steroid or CNI avoidance,minimization or withdraw,desensitization,and treatment for antibody mediated rejection,disease specific,and pediatric specific.The short-term outcomes from these different strategies are promising but the long-term results remain to be determined.Unfortunately,current immunosuppressive agents or strategies

  17. Supportive monitoring and disease management through the internet: an internet-delivered intervention strategy for recurrent depression.

    Kordy, Hans; Backenstrass, Matthias; Hüsing, Johannes; Wolf, Markus; Aulich, Kai; Bürgy, Martin; Puschner, Bernd; Rummel-Kluge, Christine; Vedder, Helmut


    Major depression is a highly prevalent, disabling disorder associated with loss of quality of life and large economic burden for the society. Depressive disorders often follow a chronic or recurrent course. The risk of relapses increases with each additional episode. The internet-deliverable intervention strategy SUMMIT (SUpportive Monitoring and Disease Management over the InTernet) for patients with recurrent depression has been developed with the main objectives to prolong symptom-free phases and to shorten symptom-loaden phases. This paper describes the study design of a six-sites, three-arm, randomized clinical trial intended to evaluate the efficacy of this novel strategy compared to treatment as usual (TAU). Two hundred thirty six patients who had been treated for their (at least) third depressive episode in one of the six participating psychiatric centers were randomized into one of three groups: 1) TAU plus a twelve-month SUMMIT program participation with personal support or 2) TAU plus a twelve-month SUMMIT program participation without personal support, or 3) TAU alone. Primary outcome of this study is defined as the number of "well weeks" over 24months after index treatment assessed by blind evaluators based on the Longitudinal Interval Follow-Up Evaluation. If efficacious, the low monetary and nonmonetary expenditures of this automated, yet individualized intervention may open new avenues for providing an acceptable, convenient, and affordable long-term disease management strategy to people with a chronic mental condition such as recurrent depression. © 2013.

  18. Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy.

    Vergnat, Mathieu; Asfour, Boulos; Arenz, Claudia; Suchowerskyj, Philipp; Bierbach, Benjamin; Schindler, Ehrenfried; Schneider, Martin; Hraska, Victor


    Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analysed AoV repair effectiveness across the whole age spectrum of children, excluding neonates and AoV disease secondary to congenital heart disease. From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% disease. The procedures performed were commissurotomy shaving (n = 74; 38%), leaflet replacement (n = 78; 40%), leaflet extension (n = 21; 11%) and neocommissure creation (n = 21; 11%). Post-repair geometry was tricuspid in 137 (71%) patients. The 10-year survival rate was 97.1%. Freedom from reoperation and replacement at 7 years was, respectively, 57% (95% confidence interval, 47-66) and 68% (95% confidence interval, 59-76). In multivariate analysis, balloon dilatation before 6 months, the absence of a developed commissure, a non-tricuspid post-repair geometry and cross-clamp duration were predictors for reoperation and replacement. After a mean follow-up period of 5.1 ± 3.0 years, 145 (75%) patients had a preserved native valve, with undisturbed valve function (peak gradient <40 mmHg, regurgitation ≤mild) in 113 (58%). Aortic valve repair in children is safe and effective in delaying the timing for more definitive solution. Surgical strategy should be individualized according to the age of the patient. Avoidance of early balloon dilatation and aiming for a tricuspid post-repair arrangement may improve outcomes. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. Management strategies for fibromyalgia

    Le Marshall KF; Littlejohn GO


    Kim Francis Le Marshall, Geoffrey Owen LittlejohnDepartments of Rheumatology and Medicine, Monash Medical Centre and Monash University, Victoria, AustraliaDate of preparation: 14 June 2011Clinical question: What are the effective, evidence-based strategies available for the management of fibromyalgia?Conclusion: There are a number of management strategies available with robust evidence to support their use in clinical practice.Definition: Fibromyalgia is a complex pain syndrome characterized ...

  20. Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies.

    Wagner, Jeffrey; Fleseriu, Cara M; Ibrahim, Aly; Cetas, Justin S


    Idiopathic intracranial hypertension (IIH) in patients with Cushing disease (CD), after treatment, is rarely described, in adults. The cause is believed to be multifactorial, potentially related to a relative decrease in cortisol after surgical resection or medical treatment of a corticotroph pituitary adenoma. We investigate our center's CD database (140 surgically and 60 medically [primary or adjunct] treated patients) for cases of IIH, describe our center's experience with symptomatic IIH, and review treatment strategies in adults with CD after transsphenoidal resection. We present the case of a 22-year-old woman who presented with worsening headache, nausea, vomiting, blurry vision, diplopia, visual loss, and facial numbness 14 weeks after surgical resection of adrenocorticotropic hormone-positive pituitary adenoma. Her CD had been in remission since surgery, with subsequent adrenal insufficiency (AI), which was initially treated with supraphysiologic glucocorticoid replacement, tapered down to physiologic doses at the time the IIH symptoms developed. Symptomatic IIH is rare in adult patients but can be severe and result in permanent vision loss. A high index of suspicion should be maintained and a fundus examination is necessary to exclude papilledema, whenever there are suggestive symptoms that initially may overlap with AI. It is possible that some cases of mild IIH are misdiagnosed as GC withdrawal or AI; however, further studies are needed. Treatment consists of reinitiation of higher steroid doses together with acetazolamide with or without cerebrospinal fluid diversion and the priority is to preserve vision and reverse any visual loss. Published by Elsevier Inc.

  1. Strategies to improve chronic disease management in seven metro Boston community health centers.

    Ndumele, Chima D; Russell, Beverley E; Ayanian, John Z; Landon, Bruce E; Keegan, Thomas; O'Malley, A James; Hicks, Leroi S


    The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.

  2. Barriers and strategies for identifying and managing risk factors of cardiovascular diseases in levels of preventing, screening, and treating

    Saber Azami Aghdash


    Full Text Available Introduction: Cardiovascular diseases (CVD are of the main causes of mortality in the world and impose a heavy economic, social, and health burden on society. Therefore, the objective of this study was to determine the barriers and strategies for identifying and managing risk factors of CVD in levels of preventing, screening, and treating. Methods: During present qualitative study with phenomenological approach, 60 subjects of cardiologists, nurses, patients, and their relatives were selected based on purposive sampling from educational-medical cardiothoracic subspecialty centers. Data were collected using an open-ended questionnaire and was extracted and analyzed with content analysis method. Results: Barriers were divided into three groups of individual barriers (low awareness, delay in referring for treatment and screening, incorrect beliefs, and not caring about health, socio-economic barriers (high costs, lack of resources, mental and psychological pressures, and health care barriers (non-alignment of doctors, being therapy-oriented, managerial and planning weaknesses, and lack of health care facilities. The most important presenting strategies are: providing public educations, improving family physician program, reduction of costs, cooperation of patients, and using functional indices to evaluate and improve the quality of services. Conclusion: Low awareness of people, high costs of services, lack of health care facilities, socio-cultural problems of people, and delay in referring of people, for treatment and screening are of the most important barriers of proper identifying and managing risk factors of CVD. Strategies provided in this study to overcome these barriers could be used.

  3. A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers.

    Simpson, Grant G; Hahn, Hallie R; Powel, Alex A; Leverence, Robert R; Morris, Linda A; Thompson, Lara G; Zumberg, Marc S; Borde, Deepa J; Tyndall, Joseph A; Shuster, Jonathan J; Yealy, Donald M; Allen, Brandon R


    A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily. We evaluated the effects of a single-site interventional study targeted at a population of adult sickle-cell disease super-utilizers using a pre- and post-implementation design. The pre-intervention period was 06/01/13 to 12/31/13 (seven months) and the post-intervention period was 01/01/14 to 02/28/15 (14 months). Our approach included patient-specific best practice advisories (BPA); an ED management protocol; and formation of a "medical home" for these patients. For 10 subjects targeted initially we developed and implemented coordinated care plans; after deployment, we observed a tendency toward reduction in ED and inpatient utilization across all measured indices. Between the annualized pre- and post-implementation periods we found the following: ED visits decreased by 16.5 visits/pt-yr (95% confidence interval [CI] [-1.32-34.2]); ED length of state (LOS) decreased by 115.3 hours/pt-yr (95% CI [-82.9-313.5]); in-patient admissions decreased by 4.20 admissions/pt-yr (95% CI [-1.73-10.1]); in-patient LOS decreased by 35.8 hours/pt-yr (95% CI [-74.9-146.7]); and visits where the patient left before treatment were reduced by an annualized total of 13.7 visits. We observed no patient mortality in our 10 subjects, and no patient required admission to the intensive care unit 72 hours following discharge. This effort suggests that a targeted approach is both feasible and potentially effective, laying a foundation for broader study.

  4. Randomized Trial of Hypnosis as a Pain and Symptom Management Strategy in Adults with Sickle Cell Disease

    Wallen, Gwenyth R; Middleton, Kimberly R; Ames, Nancy; Brooks, Alyssa T; Handel, Daniel


    Sickle cell disease (SCD) is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality), anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. TRIAL REGISTRATION NCT00393250 PMID:25520557

  5. Canadian Men's Self-Management of Chronic Diseases: A Literature Analysis of Strategies for Dealing With Risks and Promoting Wellness.

    Zanchetta, Margareth S; Maheu, Christine; Kolisnyk, Olesya; Mohamed, Mohamed; Guruge, Sepali; Kinslikh, Diana; Christopher, Joneet J; Stevenson, Melissa; SanJose, CaroLine; Sizto, Terry; Byam, Aaron


    This article reviews the qualitative research on men's self-management of mental and physical chronic diseases, with emphasis on strategies for dealing with risks and promoting wellness. Using Bardin's method of document analysis, it was focused on the findings of Canadian qualitative studies published in French or English from 2005 to 2011. Boltanski's theory on social uses of the body inspired the analysis. Living with a chronic disease threatens men's sense of masculinity and self-image, as well as their perceived ability to fulfill expected social roles. Social images of men's bodies influence how men express their emotions, attributes, and attitudes, or acknowledge the need for and seek social affirmation. Self-management has been documented in Canadian qualitative literature as a complex phenomenon influenced by the social environment, personal capacities, feelings, perceptions, and potentials. The extent of how all these features interact within the scope of men's mental and physical health and illness experiences was partially revealed in this study. The findings underscore the social invisibility of men's bodies, especially those of men facing social inequities. Attending to principles of social justice can ensure that future research on men's health will amplify the range of men's voices and allow them to be heard. Recommendations address also the international scientific community interested in advancing men's health research, especially in those countries that lack a national men's health policy.

  6. Randomized Trial of Hypnosis as a Pain and Symptom Management Strategy in Adults with Sickle Cell Disease

    Gwenyth R. Wallen


    Full Text Available Sickle cell disease (SCD is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality, anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. TRIAL REGISTRATION: NCT00393250

  7. Fault Management Design Strategies

    Day, John C.; Johnson, Stephen B.


    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  8. The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management.

    Arthur, H M; Suskin, N; Bayley, M; Fortin, M; Howlett, J; Heckman, G; Lewanczuk, R


    In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009. The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD. TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP. Specific actionable recommendations for CR are made in accordance with the key principles of the CCM. The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada.

  9. Comparative effectiveness of personalized lifestyle management strategies for cardiovascular disease risk reduction

    P. Chu (Paula); A. Pandya; J.A. Salomon (Joshua A); S.J. Goldie (Sue J); Hunink, M.G.M. (M.G. Myriam)


    textabstractBackground-Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year

  10. Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus: management strategies

    Soedamah-Muthu, S.S.; Stehouwer, C.D.A.


    There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification

  11. Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus: Management Strategies

    Soedamah-Muthu, S.S.; Stehouwer, C.D.A.


    There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification

  12. Invited review: Determinants of farmers' adoption of management-based strategies for infectious disease prevention and control.

    Ritter, Caroline; Jansen, Jolanda; Roche, Steven; Kelton, David F; Adams, Cindy L; Orsel, Karin; Erskine, Ron J; Benedictus, Geart; Lam, Theo J G M; Barkema, Herman W


    The prevention and control of endemic pathogens within and between farms often depends on the adoption of best management practices. However, farmers regularly do not adopt recommended measures or do not enroll in voluntary disease control programs. This indicates that a more comprehensive understanding of the influences and extension tools that affect farmers' management decisions is necessary. Based on a review of relevant published literature, we developed recommendations to support policy-makers, industry representatives, researchers, veterinarians, and other stakeholders when motivating farmers to adopt best management practices, and to facilitate the development and implementation of voluntary prevention and control programs for livestock diseases. Farmers will make management decisions based on their unique circumstances, agricultural contexts, beliefs, and goals. Providing them with rational but universal arguments might not always be sufficient to motivate on-farm change. Implementation of recommended management practices is more likely if farmers acknowledge the existence of a problem and their responsibility to take action. The perceived feasibility and effectiveness of the recommended management strategy and sufficient technical knowledge further increase the likelihood of adequate adoption. Farmers will also weigh the expected advantages of a proposed change against the expected disadvantages, and these considerations often include internal drivers such as pride or the desire to conform with perceived standards. Extension tools and farmers' social referents (e.g., veterinarians, peers) not only provide technical information but also influence these standards. Whereas mass media have the potential to deliver information to a broad audience, more personal approaches such as participatory group learning or individual communication with farm advisors can enable the tailoring of recommendations to farmers' situations. Approaches that appeal to farmers

  13. Marketing Management and Strategy

    This book gives readers an understanding of the factors that shape the marketing decisions of managers who operate in African economies. It brings together fifteen African cases written by scholars and executives with rich knowledge of business practices in Africa. By combining theoretical insights...... undergraduate and graduate students in marketing, international strategy and international business who require an understanding of African business...... with practical information from the cases, the reader is introduced to issues relating to marketing strategy formulation, managerial actions in designing and implementing marketing decisions, as well as the operational contexts within which these actions are taken. The book is essential reading for both...

  14. Endolymphatic sac tumour in von Hippel-Lindau disease: management strategies.

    Zanoletti, E; Girasoli, L; Borsetto, D; Opocher, G; Mazzoni, A; Martini, A


    Endolymphatic sac tumour (ELST) is infrequent, as emerges from small series reported in the literature. It is a slow-growing malignancy with local aggressiveness and a low risk of distant metastases. It is often misdiagnosed because of the late onset of symptoms and difficulty in obtaining a biopsy. Its frequency is higher in von Hippel-Lindau (VHL) disease (a genetic systemic syndrome involving multiple tumours), with a prevalence of around 25%. The diagnosis is based on radiology, with specific patterns on contrast-enhanced MRI and typical petrous bone erosion on bone CT scan. Our experience of ELST in the years between 2012-2015 concerns 7 cases, one of which was bilateral, in patients with VHL disease. Four of the 7 patients underwent 5 surgical procedures at our institution. Each case is described in detail, including clinical symptoms, and the intervals between symptom onset, diagnosis and therapy. Postoperative morbidity was low after early surgery on small tumours, whereas extensive surgery for large tumours was associated with loss of cranial nerve function (especially VII, IX, X). The critical sites coinciding with loss of neurological function were the fallopian canal, jugular foramen, petrous apex and intradural extension into the posterior cranial fossa. Early surgery on small ELST is advocated for patients with VHL disease, in whom screening enables a prompt diagnosis and consequently good prognosis. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  15. [Strategies for cardiovascular disease prevention].

    Gabus, Vincent; Wuerzner, Grégoire; Saubade, Mathieu; Favre, Lucie; Jacot Sadowski, Isabelle; Nanchen, David


    Atherosclerosis is a disease which develops very gradually over decades. Under the influence of modifiable cardiovascular risk factors, such as blood pressure, LDL-cholesterol level, smoking or lifestyle, clinical symptoms of atherosclerosis manifest more or less early in life. When cardiovascular risk factors accumulate, the risk of having a cardiovascular event increases and the benefits of prevention measures are greater. This article summarizes existing strategies for controlling modifiable cardiovascular risk factors in primary prevention. The physician can rely on an interprofessional network of cardiovascular prevention. Managing risk factors while respecting the autonomy and priorities of the patient will bring the greatest benefit.

  16. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease

    Harskamp, Ralf E.; Wang, Tracy Y.; Bhatt, Deepak L.; Wiviott, Stephen D.; Amsterdam, Ezra A.; Li, Shuang; Thomas, Laine; de Winter, Robbert J.; Roe, Matthew T.


    Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. We evaluated patterns of use and patient features

  17. Management strategy of enterprise

    Osovskiy O.A.


    Full Text Available The development of market relations, increasing competition result in the accelerated necessity in strategic management as one of the most efficient and progressive means of organization management. The article deals with such researching methods as SWOT analysis (studying strength and weak points, manufacturing feasibilities of an enterprise and threats caused by environment, BCG matrix (while determining marketing roles of output, Mack Kinsey (determining branch attraction, the tree of aims (looking for perspective directions of development, and also other well-known tools of strategic management. SE «Zhytomyr distillery» is the enterprise with over century traditions of production quality of its output. The results of the SWOT analysis has allowed to determine the lines of behavior due to favorable and unfavorable factors of environment. At present, the enterprise has much strength and manufacturing feasibilities, therefore, the principal directions of its activity have to become the improvement of its technological base, the expansion of output range and sale at the expense of free financial resources. The calculations made by the authors allowed them to develop the main strategies for development of an enterprise. The practical value of the calculations lies in keeping competitive lines both on the domestic market of Ukraine and on the foreign international market.

  18. How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

    Apps, Lindsay D; Harrison, Samantha L; Williams, Johanna E A; Hudson, Nicky; Steiner, Michael; Morgan, Mike D; Singh, Sally J


    There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients' prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.

  19. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment.

    Giannini, Edoardo G; Zentilin, Patrizia; Dulbecco, Pietro; Vigneri, Sergio; Scarlata, Pamela; Savarino, Vincenzo


    Whether patients with typical gastroesophageal reflux disease (GERD) symptoms and without alarm features should be treated empirically or undergo endoscopy first is a debated issue. In this study, our aim was to assess the efficacy, and to compare the direct costs and impact on health-related quality of life (HRQL), of two treatment strategies (empirical vs endoscopy-oriented treatment) in a large population of patients with GERD. In total, 612 patients were randomized to either empirical treatment with esomeprazole 40 mg once daily (od) (group 1, N = 309) or endoscopy and treatment according to endoscopic findings (group 2, N = 303, esomeprazole 40 mg od in patients with reflux esophagitis and esomeprazole 20 mg od in patients without esophagitis) for 4 wk, followed by esomeprazole 20 mg od maintenance treatment in both groups. Direct costs and HRQL were analyzed in both treatment arms. At the end of the acute treatment phase (week 4), 267 patients in group 1 (86.4%) and 265 patients in group 2 (87.5%) were considered responders to treatment (intention-to-treat analysis, P= 0.878). Empirical treatment proved to be cost-effective by saving 38.72 euros per treated patient. At the end of the maintenance phase (week 24), a similar proportion of patients responded to treatment in the two groups (71.8%vs 68.3%, P= 0.389). HRQL improved from baseline to week 24 in both groups (difference between study groups not significant). In patients with GERD, empirical treatment with esomeprazole proved to be cost-effective compared with endoscopy-oriented treatment, and did not negatively affect patient HRQL. These results should be taken into account in the management of GERD patients in clinical practice.

  20. Management strategies for autoimmune pancreatitis.

    Kamisawa, Terumi; Takuma, Kensuke; Hara, Seiichi; Tabata, Taku; Kuruma, Sawako; Inaba, Yoshihiko; Gopalakrishna, Rajesh; Egawa, Naoto; Itokawa, Fumihide; Itoi, Takao


    Autoimmune pancreatitis (AIP) is a newly developed concept for a peculiar type of pancreatitis, and at present is recognized as a pancreatic lesion reflecting IgG4-related systemic disease. It is of utmost importance to differentiate AIP from pancreatic cancer to avoid unnecessary surgery. The current management strategies for AIP, including its clinical features, diagnostic criteria, clinical subtypes, steroid therapy and prognosis are discussed, based on our 66 AIP cases and papers searched in PubMed from 1992 to March 2011, using the term 'autoimmune pancreatitis'. A new clinicopathological entity, an 'IgG4-related sclerosing disease' is also mentioned. AIP should be considered in the differential diagnosis in elderly male patients presented with obstructive jaundice and pancreatic mass. Steroids are a standard therapy for AIP, but their regimen including maintenance therapy should be evaluated in prospective trials.

  1. Invited review : Determinants of farmers' adoption of management-based strategies for infectious disease prevention and control

    Ritter, Caroline; Jansen, Jolanda; Roche, Steven; Kelton, David F; Adams, Cindy L; Orsel, Karin; Erskine, Ron J; Benedictus, Geart; Lam, Theo J G M; Barkema, Herman W


    The prevention and control of endemic pathogens within and between farms often depends on the adoption of best management practices. However, farmers regularly do not adopt recommended measures or do not enroll in voluntary disease control programs. This indicates that a more comprehensive

  2. Implementing a self-management strategy in inflammatory bowel disease (IBD): patient perceptions, clinical outcomes and the impact on service.

    Squires, Seth Ian; Boal, Allan John; Lamont, Selina; Naismith, Graham D


    Patient self-management and its service integration is not a new concept but it may be a key component in the long-term sustainability of inflammatory bowel disease (IBD) service provision, when considering growing disease prevalence and limited resources. The IBD team at the Royal Alexandra and Vale of Leven Hospitals in the Clyde Valley region developed a self-management tool, called the 'flare card'. Patients were asked to complete a questionnaire which reflected their opinion on its viability as a self-management intervention. In addition, its utility in terms of service use over a 10-month period in 2016 was compared with a similar cohort of patients over 10 months in 2015. Patients overall felt that the 'flare card' was a viable self-management tool. Positive feedback identified that the intervention could help them aid control over their IBD, improve medication adherence, reduce symptoms and reflected a feeling of patient-centred IBD care. The comparison between 2015 and 2016 service use revealed a significant reduction in IBD and non-IBD service usage, Steroid prescribing and unscheduled IBD care in the flare card supported cohort. IBD services must continue to adapt to changes within the National Health Service bearing in mind long-term sustainability and continued care provision. The 'flare card' goes further in an attempt to optimise Crohn's disease and ulcerative colitis management by harmonising clinician evaluation and patient's self-initiation of therapy and investigation.

  3. Human capital strategy: talent management.

    Nagra, Michael


    Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

  4. Radioactive Waste Management Strategy


    This strategy defines methods and means how collect, transport and bury radioactive waste safely. It includes low level radiation waste and high level radiation waste. In the strategy are foreseen main principles and ways of storage radioactive waste

  5. Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

    Rubin, David T; Krugliak Cleveland, Noa


    The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

  6. A Modern History of 'Imperial Medicine' Surrounding Hansen's Disease: Strategies to Manage Public Opinion in Modern Japanese Media.

    Seo, Gijae


    The purpose of this study is to understand the reality of imperial medicine by exploring the strategic attitude of the Japanese authority targeting the public who were not patients of Hansen's disease. For this purpose, this study examines the mass media data related to Hansen's disease published in Korea and Japan during the Japanese colonial rule. Research on Hansen's disease can be divided into medical, sociohistorical, social welfare, and human rights approach. There are medical studies and statistics on the dissemination of medical information about Hansen's disease and management measures, the history of the management of the disease, guarantee of the rights of the patients and the welfare environment, and studies on the autobiographical, literary writings and oral statements on the life and psychological conflicts of the patients. Among existing research, the topics of the study on Hansen's disease under the Japanese colonial rule include the history of the Sorokdo Island Sanatorium, investigation on the forced labor of the patients in the island, human rights violations against the patients, oral memoirs of the patients and doctors who practiced at that time. All of these studies are important achievements regarding the research on the patients. An important study of Hansen's disease in modern Japan is the work of Hujino Utaka, which introduces the isolation of and discrimination against the patients of Hansen's disease. Hujino Utaka's study examines the annihilation of people with infectious diseases in Japan and its colonies by the imperial government, which was the consequence of the imperial medical policies, and reports on the isolation of Hansen's disease patients during the war. Although these researches are important achievements in the study of Hansen's disease in modernity, their focus has mainly been on the history of isolation and exploitation in the Sorokdo Island Sanatorium and discrimination against the patients within the sanatorium, which

  7. An Overview of Dietary Interventions and Strategies to Optimize the Management of Non-Alcoholic Fatty Liver Disease

    Brandon J. Perumpail


    Full Text Available Aim: To investigate the efficacy of lifestyle adjustment strategies as a preventive measure and/or treatment of obesity-related non-alcoholic fatty liver disease in adults. Method: A systematic review of literature through 1 July 2017 on the PubMed Database was performed. A comprehensive search was conducted using key terms, such as non-alcoholic fatty liver disease (NAFLD, combined with lifestyle intervention, diet, and exercise. All of the articles and studies obtained from the search were reviewed. Redundant literature was excluded. Results: Several types of dietary compositions and exercise techniques were identified. Most studies concluded and recommended reduction in the intake of saturated and trans fatty acids, carbohydrates, and animal-based protein, and increased intake of polyunsaturated fatty acids (PUFAs, monounsaturated fatty acids (MUFAs, plant-based proteins, antioxidants, and other nutrients was recommended. The Mediterranean and Paleo diet both seem to be promising schemes for NAFLD patients to follow. Exercise was also encouraged, but the type of exercise did not affect its efficacy as a NAFLD treatment when the duration is consistent. Conclusions: Although these different dietary strategies and exercise regimens can be adopted to treat NAFLD, current literature on the topic is limited in scope. Further research should be conducted to truly elucidate which lifestyle adjustments individually, and in combination, may facilitate patients with obesity-related NAFLD.

  8. An Overview of Dietary Interventions and Strategies to Optimize the Management of Non-Alcoholic Fatty Liver Disease.

    Perumpail, Brandon J; Cholankeril, Rosann; Yoo, Eric R; Kim, Donghee; Ahmed, Aijaz


    Aim : To investigate the efficacy of lifestyle adjustment strategies as a preventive measure and/or treatment of obesity-related non-alcoholic fatty liver disease in adults. Method : A systematic review of literature through 1 July 2017 on the PubMed Database was performed. A comprehensive search was conducted using key terms, such as non-alcoholic fatty liver disease (NAFLD), combined with lifestyle intervention, diet, and exercise. All of the articles and studies obtained from the search were reviewed. Redundant literature was excluded. Results : Several types of dietary compositions and exercise techniques were identified. Most studies concluded and recommended reduction in the intake of saturated and trans fatty acids, carbohydrates, and animal-based protein, and increased intake of polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), plant-based proteins, antioxidants, and other nutrients was recommended. The Mediterranean and Paleo diet both seem to be promising schemes for NAFLD patients to follow. Exercise was also encouraged, but the type of exercise did not affect its efficacy as a NAFLD treatment when the duration is consistent. Conclusions : Although these different dietary strategies and exercise regimens can be adopted to treat NAFLD, current literature on the topic is limited in scope. Further research should be conducted to truly elucidate which lifestyle adjustments individually, and in combination, may facilitate patients with obesity-related NAFLD.

  9. Symptom management in Behcets disease.

    Ozel, Filiz; Tureyen, Aynur Esen; Aykar, Fisun Senuzun


    To determine the symptoms experienced by patients diagnosed with Behcet's Disease and how they cope with them. The qualitative study was conducted from September 2013 to March 2014 at Ege University Medical Faculty Hospital, Turkey, comprising patients having all symptoms of Behcet's Disease. Data was collected through semi-structured focus-group interview form. The findings were assessed using Theory of Unpleasant Symptoms and Symptom Management Theory. SPSS 20 and Nvivo 10 were used for data analysis. Of the 35 patients, 16(45.8%) were female and 19(54.2%) were male. The symptoms affected patients' lives, and the patients used either positive or negative symptom management strategies, leading to either positive or negative results during symptom management. Behcet's Disease patients needed effective symptom management.

  10. Protocol-driven remote monitoring of cardiac resynchronization therapy as part of a heart failure disease management strategy.

    Smeets, Christophe J P; Verbrugge, Frederik H; Vranken, Julie; Van der Auwera, Jo; Mullens, Wilfried; Dupont, Matthias; Grieten, Lars; De Cannière, Hélène; Lanssens, Dorien; Vandenberk, Thijs; Storms, Valerie; Thijs, Inge M; Vandervoort, Pieter


    Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure (HF) with reduced ejection fraction. CRT devices are equipped with remote monitoring functions, which are pivotal in the detection of device problems, but may also facilitate disease management. The aim of this study was to provide a comprehensive overview of the clinical interventions taken based on remote monitoring. This is a single centre observational study of consecutive CRT patients (n = 192) participating in protocol-driven remote follow-up. Incoming technical- and disease-related alerts were analysed together with subsequently triggered interventions. During 34 ± 13 months of follow-up, 1372 alert-containing notifications were received (2.53 per patient-year of follow-up), comprising 1696 unique alerts (3.12 per patient-year of follow-up). In 60%, notifications resulted in a phone contact. Technical alerts constituted 8% of incoming alerts (0.23 per patient-year of follow-up). Rhythm (1.43 per patient-year of follow-up) and bioimpedance alerts (0.98 per patient-year of follow-up) were the most frequent disease-related alerts. Notifications included a rhythm alert in 39%, which triggered referral to the emergency room (4%), outpatient cardiology clinic (36%) or general practitioner (7%), or resulted in medication changes (13%). Sole bioimpedance notifications resulted in a telephone contact in 91%, which triggered outpatient evaluation in 8% versus medication changes in 10%. Clinical outcome was excellent with 97% 1-year survival. Remote CRT follow-up resulted in 0.23 technical- versus 2.64 disease-related alerts annually. Rhythm and bioimpedance notifications constituted the majority of incoming notifications which triggered an actual intervention in 22% and 15% of cases, respectively.

  11. Management: A Strategy for Change.

    White, Herbert S.


    Traces the recent history of libraries and mentions loss of status, insufficient funds, insufficient evaluation methods, and unspecified goals as major contributors to contemporary management problems. Also outlined is a management strategy, which includes public relations, long-range and short-range goals, and budget and financing. (JVP)

  12. Strategy of fuel management

    Guesdon, B.; Le Bars, M.; Mathonniere, G.


    The management of nuclear fuels in PWR type reactors has been adapted to improve the safety and the competitiveness of brackets. The economic optimum, at the park level, depends on many parameters, variable with time and in function of them, we favour the annual campaigns and the economy won on the cost of cycle, or long campaigns with benefit on availability. The reduction of the number of stopping improves the availability, limits the doses integrated by the personnel of intervention and reduces the number of incidents during the stopping. An other determining factor is connected to the policy of closed cycle with the the principle of equality between the reprocessing flux and the valorization of reprocessed fuels: plutonium and reprocessed uranium. The progress of fuel have allowed significant improvements in the managements of cores. With the safety, the aim is also to keep if not improve the competitiveness of the Nuclear park by valorizing the matter coming from reprocessing. (N.C.)

  13. The office of strategy management.

    Kaplan, Robert S; Norton, David P


    There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

  14. Impacts of the creation, expansion and management of English wetlands on mosquito presence and abundance - developing strategies for future disease mitigation.

    Medlock, Jolyon M; Vaux, Alexander G C


    The incidence of mosquito-borne diseases is increasing in Europe, partly due to the incursion of a number of invasive species known to be vectors of dengue and chikungunya viruses, but also due to the involvement of native species in the transmission of West Nile virus and malaria. For some of these pathogens, there is a risk of the re-emergence of vector-borne diseases that were once widespread in Europe, but declined partly due to large-scale land-drainage projects. Some mosquito species exploit container habitats as breeding sites in urban areas; an adaptation to human-made micro-habitats resulting from increased urbanisation. However, many species thrive in natural wetland ecosystems. Owing to the impacts of climate change there is an urgent need for environmental adaptation, such as the creation of new wetlands to mitigate coastal and inland flooding. In some cases, these initiatives can be coupled with environmental change strategies to protect a range of endangered flora and fauna species by enhancing and extending wetland landscapes, which may by driven by European legislation, particularly in urban areas. This paper reviews field studies conducted in England to assess the impact of newly created wetlands on mosquito colonisation in a) coastal, b) urban and c) arable reversion habitats. It also considers the impact of wetland management on mosquito populations and explores the implications of various water and vegetation management options on the range of British mosquito species. Understanding the impact of wetland creation and management strategies on mosquito prevalence and the potential risk of increasing the levels of nuisance or disease vector species will be crucial in informing health and well-being risk assessments, guiding targeted control, and anticipating the social effects of extreme weather and climate change. Although new wetlands will certainly extend aquatic habitats for mosquitoes, not all species will become a major nuisance or a vector

  15. Management of coronary artery disease

    Safri, Z.


    Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.


    Li Li


    Full Text Available This article emphasizes the strategic and operations aspects of managing a farm. In this article, farm management performance is analyzed based on yearly Illinois Farm Business Farm Management (FBFM panel data across 9,831 farms from 1996 through 2014. The alpha scores (or skill estimates for farm managers are analyzed to determine if most profitable farmers possess specific skills or knowledge against adverse events in a volatile environment. Farms are evaluated under different scenarios of management skill portfolios. Fundamental farm management basics are discussed in this study, including budgeting, production planning, financial analysis, financial management, investment analysis, and control management. We find substantial difference of farm management styles and performance efficiency in management skill portfolios. We also find evidence of most skilled farm managers are more efficient on both revenue side and costs side. The approaches used in this study also allow comparison among farms of different sizes and types. The activities of top farms can be replicated by poorer performers and the study provide a unique way for comparing the farm management styles and ability of most skilled farm managers to that of less skilled ones. The innovative method is framed by comparing business strategies and performance styles in the following aspects: production and operations planning, land management and control, and production costs evaluation. Farm managers will want to consult it as well to improve the effectiveness, objectivity, and success of their decisions.

  17. Strategies for radwaste management

    Forsberg, C.W.


    The production of electricity by any technology produces waste: coal burning creates ash and air pollution, solar-cell wastes contain hazardous heavy metals such as arsenic and cadmium, and nuclear power generates radioactive waste. Protecting the environment requires careful control of all of these wastes. Radioactive wastes are also a by-product of defense activities, research, medical applications, and industrial production. ORNL has long engaged in development of new technology to ensure safe and environmentally benign disposal of these wastes. The basis of radioactive waste management is simple. Because radioactive materials become less radioactive over time, the way to safely dispose of radioactive materials is to store them until they become nonradioactive. Different radioactive materials have different half-lives, so their storage times are different. A rule of thumb is that, after 10 half-lives have passed, the material is essentially no longer radioactive. In contrast, chemical wastes, such as dioxin, can be destroyed by incineration, and toxic heavy-metal wastes, such as lead and arsenic, remain toxic forever and require other waste management technologies to isolate them from the environment

  18. CEGB's radioactive waste management strategy

    Passant, F.H.; Maul, P.R.


    The Central Electricity Generating Board (CEGB) produces low-level and intermediate-level radioactive wastes in the process of operating its eight Magnox and five Advanced Gas Cooled Reactor (AGR) nuclear power stations. Future wastes will also arise from a programme of Pressurised Water Reactors (PWRs) and the decommissioning of existing reactors. The paper gives details of how the UK waste management strategy is put into practice by the CEGB, and how general waste management principles are developed into strategies for particular waste streams. (author)

  19. National surveys: a way to manage treatment strategies in Parkinson's disease? Pharmaceutical prescribing patterns and patient experiences of symptom control and their impact on disease

    Skogar Ö


    Full Text Available Örjan Skogar,1,2 Mats Nilsson,1 Carl-Johan Törnhage,3 Johan Lökk2 1Futurum Health Care Academy, Jönköping, 2Institution of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, 3Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden Background: The purpose of this study was to draw conclusions from patient-reported experiences in two national surveys from Scandinavia with the intention of comparing treatment strategies and increasing our knowledge of factors that affect the experiences of patients with Parkinson's disease (PD. Methods: A total of 2000 individuals in Sweden and 1300 in Norway were invited to complete postal surveys covering PD-related issues. Patient experiences of diagnostic procedures, symptom control, and follow-up in PD and the effects on symptom-related quality of life were collected. Pharmaceutical prescription data on anti-PD drugs and administrative data were collected from national registries. Results: The surveys were completed by 1553 (78% of the Swedish cohort and 1244 (96% of the Norwegian cohort. Only small differences were seen in disease duration and age distribution. Statistically as well as clinically significant differences in symptom control, diagnostic, and follow-up procedures, as well as in pharmacological treatment and impact on quality of life, were found between the national cohorts independent of disease duration. Conclusion: Information from separate national surveys has the potential to increase our knowledge of patient experiences in PD and can be used to compare, evaluate, educate, and guide health care staff and administrators in optimizing health care for patients with the disease. Keywords: parkinson's disease, diagnosis, follow-up, pharmaceutical prescription, quality of life, survey




    Full Text Available During the financial and economic crisis, the management of an entity must establish a plan and apply strategies needed to mitigate the negative effects due to the action of disturbing factors. Management must have a vision of business evolution, of costumer and supplier perspective, of how to develop the technological equipment in order to increase profitability and product quality. The manager must give utmost importance to all economic information he receives, to analyze it, to group it into categories depending on the effects they can produce, to establish the extent to which it influences the activity. The strategies a manager applies are also based on his flair, culture, knowledge or the human and material resources at its disposal

  1. Funding strategies for wilderness management

    Carolyn Alkire


    Funding wilderness protection will continue to be a challenge for public land managers. With continuing competition for federal funds and balanced budget goals, other sources of funds may be necessary to supplement annual federal appropriations. This paper identifies and evaluates five potential funding strategies and provides examples of each that are currently in use...


    Bens Pardamean; Anindito; Anjela Djoeang; Nana Tobing


    The study designed an information system model for Disease Management (DisMan) that met the specifications and needs of a consumer electronics manufacturer. The diseases monitored by this study were diabetes, hypertension and tuberculosis. Data were collected through interviews with the companyâs human resources department and occupational health provider. As for the model, literature and online research were conducted to collect health standards and information system standards on existing D...

  3. New strategies for the treatment of Parkinson's disease hold considerable promise for future management of neurodegenerative disorders

    Bjarkam, Carsten Reidies; Sørensen, Jens Christian; Sunde, Niels Å


    or more. Parkinson's disease ischaracterized by a massive loss of dopaminergicneurons in the substantia nigra, leading tosevere functional disturbance of the neuronalcircuitry in the basal ganglia. A thoroughdescription of basal ganglia circuitry inhealth and disease is presented. We describehow...... the functional disturbances seen inParkinson's disease may be corrected atspecific sites in this circuitry by medicaltreatment or, in advanced stages of Parkinson'sdisease, by neurosurgical methods. The latterinclude lesional surgery, neuraltransplantation and deep brain stimulation,together with future...... in otherneurodegenerative diseases are discussed, withspecial emphasis on deep brain stimulation....

  4. Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study)

    Dawood, Farah Z; Khan, Faraaz; Roediger, Mollie P


    the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ± 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men......Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from...... and women separately, and values in the upper quartile were considered as a widened angle (values >74° for women and >93° for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11...

  5. Comprehensive Self-Management Strategies.

    Bourbeau, J; Lavoie, K L; Sedeno, M


    In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Repeat interventions as a long-term treatment strategy in the management of progressive coronary artery disease.

    K.G. Lehmann (Kenneth); P.W.J.C. Serruys (Patrick); M.J.B.M. van den Brand (Marcel); P.J. de Feyter (Pim); A.C.P. Maas (Arthur); R.T. van Domburg (Ron)


    textabstractObjectives. This study investigates whether repeat coronary interventions, applied over an extended time period, can successfully curtail the progression of ischemic symptoms and angiographic lumen narrowing. Background. Coronary artery disease is a chronic and generally progressive

  7. Application of risk perception and communication strategies to manage disease outbreaks of coastal shrimp farming in developing countires

    Ahsan, Dewan


    Coastal shrimp aquaculture is one of the major economic activities of the people of developing countries especially in Southeast Asia and Latin America. Risk and uncertainty are very common issues in coastal shrimp industry like in any other business. Various types of risks are associated in shrimp...... farming like, production risks, technical risks, economical risks and disease of shrimp. However, risk of economic losses due to shrimp mortality (for diseases) is the major concern of the shrimp producers of Bangladesh, India, Thailand, China and many other countries. Poor water quality and high stocking...... density usually initiate the rapid growth of virus and bacteria in a shrimp farm which in turn cause the disease and mortality of shrimp. Coastal shrimp farms are very densely located in Bangladesh and other Southeast Asian countries. As a result, the viral and bacterial diseases can be easily spread from...

  8. An Approach Towards Structure Based Antimicrobial Peptide Design for Use in Development of Transgenic Plants: A Strategy for Plant Disease Management.

    Ilyas, Humaira; Datta, Aritreyee; Bhunia, Anirban


    Antimicrobial peptides (AMPs), also known as host defense peptides (HDPs), are ubiquitous and vital components of innate defense response that present themselves as potential candidates for drug design, and aim to control plant and animal diseases. Though their application for plant disease management has long been studied with natural AMPs, cytotoxicity and stability related shortcomings for the development of transgenic plants limit their usage. Newer technologies like molecular modelling, NMR spectroscopy and combinatorial chemistry allow screening for potent candidates and provide new avenues for the generation of rationally designed synthetic AMPs with multiple biological functions. Such AMPs can be used for the control of plant diseases that lead to huge yield losses of agriculturally important crop plants, via generation of transgenic plants. Such approaches have gained significant attention in the past decade as a consequence of increasing antibiotic resistance amongst plant pathogens, and the shortcomings of existing strategies that include environmental contamination and human/animal health hazards amongst others. This review summarizes the recent trends and approaches used for employing AMPs, emphasizing on designed/modified ones, and their applications toward agriculture and food technology. Copyright© Bentham Science Publishers; For any queries, please email at

  9. Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study.

    Knight, Josh; Wells, Susan; Marshall, Roger; Exeter, Daniel; Jackson, Rod


    Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients' multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country's total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30-84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each 'synthetic' person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere.

  10. Management of pilonidal disease.

    Kallis, Michelle P; Maloney, Caroline; Lipskar, Aaron M


    Pilonidal disease, and the treatment associated with it, can cause significant morbidity and substantial burden to patients' quality of life. Despite the plethora of surgical techniques that have been developed to treat pilonidal disease, discrepancies in technique, recurrence rates, complications, time to return to work/school and patients' aesthetic satisfaction between treatment options have led to controversy over the best approach to this common acquired disease of young adults. The management of pilonidal disease must strike a balance between recurrence and surgical morbidity. The commonly performed wide excision without closure has prolonged recovery, while flap closures speed recovery time and improve aesthetics at the expense of increased wound complications. Less invasive surgical techniques have recently evolved and are straightforward, with minimal morbidity and satisfactory results. As with any surgical intervention, the ideal treatment for pilonidal disease would be simple and cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate and require minimal time off from school or work. Less invasive procedures for pilonidal disease may be favourable as an initial approach for these patients reserving complex surgical treatment for refractory disease.

  11. Surgical management of Crohn's disease.

    Lu, Kim C; Hunt, Steven R


    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial.

    Godycki-Cwirko, Maciek; Zakowska, Izabela; Kosiek, Katarzyna; Wensing, Michel; Krawczyk, Jaroslaw; Kowalczyk, Anna


    Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners' adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners' adherence to guidelines. A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians' adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients' records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care. The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care. This trial has been registered with Clinical Trials Protocol Registration System. NCT01893476.

  13. Comparative Analysis of Principals' Management Strategies in ...

    It was recommended among others that principals of secondary schools should adopt all the management strategies in this study as this will improve school administration and consequently students‟ academic performance. Keywords: Management Strategies; Secondary Schools; Administrative Effectiveness ...

  14. Alpha-synuclein, epigenetics, mitochondria, metabolism, calcium traffic, & circadian dysfunction in Parkinson's disease. An integrated strategy for management.

    Phillipson, Oliver T


    The motor deficits which characterise the sporadic form of Parkinson's disease arise from age-related loss of a subset of dopamine neurons in the substantia nigra. Although motor symptoms respond to dopamine replacement therapies, the underlying disease process remains. This review details some features of the progressive molecular pathology and proposes deployment of a combination of nutrients: R-lipoic acid, acetyl-l-carnitine, ubiquinol, melatonin (or receptor agonists) and vitamin D3, with the collective potential to slow progression of these features. The main nutrient targets include impaired mitochondria and the associated oxidative/nitrosative stress, calcium stress and impaired gene transcription induced by pathogenic forms of alpha- synuclein. Benefits may be achieved via nutrient influence on epigenetic signaling pathways governing transcription factors for mitochondrial biogenesis, antioxidant defences and the autophagy-lysosomal pathway, via regulation of the metabolic energy sensor AMP activated protein kinase (AMPK) and the mammalian target of rapamycin mTOR. Nutrients also benefit expression of the transcription factor for neuronal survival (NR4A2), trophic factors GDNF and BDNF, and age-related calcium signals. In addition a number of non-motor related dysfunctions in circadian control, clock genes and associated metabolic, endocrine and sleep-wake activity are briefly addressed, as are late-stage complications in respect of cognitive decline and osteoporosis. Analysis of the network of nutrient effects reveals how beneficial synergies may counter the accumulation and promote clearance of pathogenic alpha-synuclein. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  15. Communication strategies for conflict management

    Schlange, L.E.


    The current debates in Swiss nuclear power policy about the power increase in one nuclear generating unit and about a repository for radioactive waste are used as models for strategic decisionmaking. For this purpose, two independent, but complementary, schools of thought are combined: First, a sensitivity model is employed to analyze societal mechanisms in a coherent, holistic frame of reference; secondly, a meta-analysis concentrates on the process of conflict management among the Federal Government, the managers of the electricity utilities, their political opponents, and the public. The way in which the participating groups make decisions and implement them is of critical importance to their behavior in the next phase. This is the stage at which models show how the behavior of the players will develop over time. The establishment of a highly flexible strategic knowledge base illustrates how the findings made can be employed in designing successful communication strategies. (orig.) [de

  16. Management of Cushing disease.

    Tritos, Nicholas A; Biller, Beverly M K; Swearingen, Brooke


    Cushing disease is caused by a corticotroph tumor of the pituitary gland. Patients with Cushing disease are usually treated with transsphenoidal surgery, as this approach leads to remission in 70-90% of cases and is associated with low morbidity when performed by experienced pituitary gland surgeons. Nonetheless, among patients in postoperative remission, the risk of recurrence of Cushing disease could reach 20-25% at 10 years after surgery. Patients with persistent or recurrent Cushing disease might, therefore, benefit from a second pituitary operation (which leads to remission in 50-70% of cases), radiation therapy to the pituitary gland or bilateral adrenalectomy. Remission after radiation therapy occurs in ∼85% of patients with Cushing disease after a considerable latency period. Interim medical therapy is generally advisable after patients receive radiation therapy because of the long latency period. Bilateral adrenalectomy might be considered in patients who do not improve following transsphenoidal surgery, particularly patients who are very ill and require rapid control of hypercortisolism, or those wishing to avoid the risk of hypopituitarism associated with radiation therapy. Adrenalectomized patients require lifelong adrenal hormone replacement and are at risk of Nelson syndrome. The development of medical therapies with improved efficacy might influence the management of this challenging condition.

  17. Deployment strategies of managed lanes on arterials.


    This report investigates issues related to planning, financing, deployment, and operation of managed : lanes on arterials. In this report, a strategy for managed lanes refers to a combination of the managed : lane type, the design and implementation,...

  18. Managing service quality: Human resource management strategies

    K. K. Govender


    Full Text Available This article reports the results of an empirical evaluation of a conceptual service encounter management model (Govender, 1999. The various hypotheses proposed to show a relationship between formal and informal socialisation strategies, and the bank employees' perception of the organisational climate and their role are empirically evaluated. Furthermore, the mediated effects of these socialization tactics on the bank customers perception of the service quality was also ascertained by matching a random sample of 210 bank employees with 1050 customers. Opsomming Hierdie artikel rapporteer die resultate van n empiriese evaluering van n konseptuele dienservaringsbestuursmodel (Govender, 1999. Verskeie hipoteses word voorgehou om n verband tussen formele en informele sosialise- ringstrategiee aan te toon, en die bankwerkers se persepsie van die organisatoriese klimaat en hulle rolle word empirics geevalueer.Verder word die modererende effek van hierdie sosialiseringstrategie op die bankkliente se persepsie van dienskwaliteit bepaal deur 'n ewekansige steekproefvan 210 bankwerkers met 1050 kliente af te paar.

  19. Management Accounting and Supply Chain Strategy

    Hald, Kim S.; Thrane, Sof


    Research positioned in the intersection between management accounting and supply chain management is increasing. However, the relationship between management accounting and supply chain strategies has been neglected in extant research. This research adds to literature on management accounting and supply chain management through exploring how supply chain strategy and management accounting is related, and how supply chain relationship structure modifies this relation. Building on a contingency...

  20. Configuration Management Process Assessment Strategy

    Henry, Thad


    Purpose: To propose a strategy for assessing the development and effectiveness of configuration management systems within Programs, Projects, and Design Activities performed by technical organizations and their supporting development contractors. Scope: Various entities CM Systems will be assessed dependent on Project Scope (DDT&E), Support Services and Acquisition Agreements. Approach: Model based structured against assessing organizations CM requirements including best practices maturity criteria. The model is tailored to the entity being assessed dependent on their CM system. The assessment approach provides objective feedback to Engineering and Project Management of the observed CM system maturity state versus the ideal state of the configuration management processes and outcomes(system). center dot Identifies strengths and risks versus audit gotcha's (findings/observations). center dot Used "recursively and iteratively" throughout program lifecycle at select points of need. (Typical assessments timing is Post PDR/Post CDR) center dot Ideal state criteria and maturity targets are reviewed with the assessed entity prior to an assessment (Tailoring) and is dependent on the assessed phase of the CM system. center dot Supports exit success criteria for Preliminary and Critical Design Reviews. center dot Gives a comprehensive CM system assessment which ultimately supports configuration verification activities.*

  1. Optimizing diabetes management: managed care strategies.

    Tzeel, E Albert


    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  2. Diabetes benefit management: evolving strategies for payers.

    Tzeel, Albert L


    Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

  3. Wharton’s Jelly-Derived Mesenchymal Stromal Cells as a Promising Cellular Therapeutic Strategy for the Management of Graft-versus-Host Disease

    Joseph P. McGuirk


    Full Text Available Allogeneic hematopoietic cell transplantation (allo-HCT, a treatment option in hematologic malignancies and bone marrow failure syndromes, is frequently complicated by Graft-versus-host disease (GVHD. The primary treatment for GVHD involves immune suppression by glucocorticoids. However, patients are often refractory to the steroid therapy, and this results in a poor prognosis. Therefore alternative therapies are needed to treat GVHD. Here, we review data supporting the clinical investigation of a novel cellular therapy using Wharton’s jelly (WJ-derived mesenchymal stromal cells (MSCs as a potentially safe and effective therapeutic strategy in the management of GVHD. Adult-derived sources of MSCs have demonstrated signals of efficacy in the management of GVHD. However, there are limitations, including: limited proliferation capacity; heterogeneity of cell sources; lengthy expansion time to clinical dose; expansion failure in vitro; and a painful, invasive, isolation procedure for the donor. Therefore, alternative MSC sources for cellular therapy are sought. The reviewed data suggests MSCs derived from WJ may be a safe and effective cellular therapy for GVHD. Laboratories investigated and defined the immune properties of WJ-MSCs for potential use in cellular therapy. These cells represent a more uniform cell population than bone marrow-derived MSCs, displaying robust immunosuppressive properties and lacking significant immunogenicity. They can be collected safely and painlessly from individuals at birth, rapidly expanded and stored cryogenically for later clinical use. Additionally, data we reviewed suggested licensing MSCs (activating MSCs by exposure to cytokines to enhance effectiveness in treating GVHD. Therefore, WJCs should be tested as a second generation, relatively homogeneous allogeneic cell therapy for the treatment of GVHD.

  4. Management strategies for idiopathic urethritis.

    Henderson, L; Farrelly, P; Dickson, A P; Goyal, A


    Williams and Mikhael (1971) described idiopathic urethritis (IU) as a self-limiting condition that affects boys aged 5-15 years, with symptoms of urethrorrhagia, dysuria and haematuria. However, a proportion of boys will remain symptomatic for several years, and may develop urethral stricture (Poch et al., 2007; Palagiri et al., 2003). There is no universally effective treatment for IU, although various strategies have been employed. To review the presentation and long-term outcomes of boys with IU, and present the efficacy of management strategies that have been utilised. A retrospective review was performed of all boys with IU. It was based on clinical and cystoscopic findings for presentation, medical history, management and clinical progress. Fifty-four boys were included, with a median age of 11 years (range 5-15 years) at presentation. The median duration of symptoms was 18 months (range 2-132 months). The median follow-up was 18.5 months (range 1-120 months). Seven (13.0%) boys had early urethral stricture at initial cystourethroscopy, and one (1.9%) developed stricture during follow-up. Thirty-six boys (66.7%) had previous circumcision and four (7.4%) had meatal stenosis. Eight (14.8%) had previous hypospadias repair. Whilst 50% of boys with IU do not require any specific treatment, those with severe/unremitting symptoms may benefit from a trial of urethral steroids or short-term urethral catheterisation. The mechanisms of benefit from these modalities are unclear and they require further evaluation. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  5. Economic value evaluation in disease management programs.

    Magnezi, Racheli; Reicher, Sima; Shani, Mordechai


    Chronic disease management has been a rapidly growing entity in the 21st century as a strategy for managing chronic illnesses in large populations. However, experience has shown that disease management programs have not been able to demonstrate their financial value. The objectives of disease management programs are to create quality benchmarks, such as principles and guidelines, and to establish a uniform set of metrics and a standardized methodology for evaluating them. In order to illuminate the essence of disease management and its components, as well as the complexity and the problematic nature of performing economic calculations of their profitability and value, we collected data from several reports that dealt with the economic intervention of disease management programs. The disease management economic evaluation is composed of a series of steps, including the following major categories: data/information technology, information generation, assessment/recommendations, actionable customer plans, and program assessment/reassessment. We demonstrate the elements necessary for economic analysis. Disease management is one of the most innovative tools in the managed care environment and is still in the process of being defined. Therefore, objectives should include the creation of quality measures, such as principles and guidelines, and the establishment of a uniform set of metrics and a standardized methodology for evaluating them.

  6. Managing Conflict: 50 Strategies for School Leaders

    Edmonson, Stacey; Combs, Julie; Harris, Sandra


    This book offers 50 easy-to-read strategies for managing conflicts in your school involving students, parents, and teachers. Individually, these strategies provide specific insights into conflict resolution, reduction, and management. As a whole, the 50 strategies provide a comprehensive method to lead constructive change in your school. With…

  7. Application of risk perception and communication strategies to manage disease outbreaks of coastal shrimp farming in developing countries

    Ahsan, Dewan


      Risk and uncertainty are very common issues in coastal shrimp industry like in any other business. A variety of risks are associated in shrimp farming like, production risks, technical risks, economical risks and disease of shrimp. However, risk of economic losses due to shrimp mortality (for...... diseases) is the major concern of shrimp producers of developing countries like Bangladesh, India, Thailand, China and many other countries. The risk of disease outbreaks in shrimp farms could be effectively prevented and managed by early identification of disease occurrence and by rapid communication...

  8. Maritime Domain Awareness Architecture Management Hub Strategy


    This document provides an initial high level strategy for carrying out the responsibilities of the national Maritime Domain Awareness Architecture Management Hub to deliver a standards based service...

  9. Perforated Sigmoid Diverticular Disease: a Management Protocol

    Moin, Thajammul


    Background: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. Methods: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this. Results: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination. Conclusions: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease. PMID:18435896

  10. A strategy model for management

    Friis, Ole Uhrskov; Holmgren, Jens; Eskildsen, Jacob Kjær


    Purpose: Developing a strategy model which explains what organisations should focus on in their strategy work, both in terms of the environment as well as how the strategy is implemented. In addition, the purpose is to demonstrate how this can influence and improve the organisations’ performance....

  11. Managing Amphibian Disease with Skin Microbiota.

    Woodhams, Douglas C; Bletz, Molly; Kueneman, Jordan; McKenzie, Valerie


    The contribution of emerging amphibian diseases to the sixth mass extinction is driving innovative wildlife management strategies, including the use of probiotics. Bioaugmentation of the skin mucosome, a dynamic environment including host and microbial components, may not provide a generalized solution. Multi-omics technologies and ecological context underlie effective implementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Global strategies to prevent chronic diseases1


    leading global causes of death and disability, are ... global strategies for the prevention and control of chronic ... Preventing Chronic Diseases: A Vital Investment, will ..... Millennium Development Goals for Health In Europe and Central Asia.

  13. The notion of strategy in facility management

    Holzweber, Markus


    and components of strategy in Facility Management (FM). Since strategy refers to a complex network of thoughts, insights, experiences, expertise, and expectations that provide general guidance for management action, organizations must keep pace with the changing environment to increase market shares and business......Strategy implementation is critical for any type of organization. Strategy implementation is complex despite previous research describing mechanisms related to the construction of strategy and strategy use of organizations. In this article I attempt to fill this vacuity by examining strategy...... success. Based on a literature review, the findings of the study report a service-strategy classification grid. Such a service-strategy grid provides for a better understanding of the business environment. The study findings are intended to enhance business managers’ understandings of the issues behind FM...

  14. Selection of intellectual capital management strategies

    Shcherbachenko Viktoriia Oleksiivna


    This article deals with the selection of intellectual capital management strategy. The attention is paid to the structure of intellectual capital, which consists of human capital, customer capital, process capital, intellectual property, intangible assets. The algorithm of selection of intellectual capital management strategy was created by author.

  15. Selection of intellectual capital management strategies

    Shcherbachenko Viktoriia Oleksiivna


    Full Text Available This article deals with the selection of intellectual capital management strategy. The attention is paid to the structure of intellectual capital, which consists of human capital, customer capital, process capital, intellectual property, intangible assets. The algorithm of selection of intellectual capital management strategy was created by author.

  16. [Alzheimer's disease: New therapeutic strategies].

    Villegas, Sandra


    The rapid increase in prevalence rates of Alzheimer's disease means that treatments to prevent, stop or reverse this devastating disease are urgently needed. Despite advances in understanding its molecular pathology, there are no drugs that can halt its progression. This review takes a tour through phase 2, or higher studies, probing receptor agonist agents interfering with aggregation, inhibitors/modulators of secretases, lipid-lowering agents, and, finally and most extensively, immunotherapy. The fact that phase 3 studies with bapineuzumab and solaneuzumab have recently failed does not invalidate the potential of immunotherapy, as more information is available and new clinical trials are being initiated. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Containment severe accident management - selected strategies

    Duco, J.; Royen, J.; Rohde, J.; Frid, W.; De Boeck, B.


    The OECD Nuclear Energy Agency (NEA) organized in June 1994, in collaboration with the Swedish Nuclear Power Inspectorate (SKI), a Specialist Meeting on Selected Containment Severe Accident Management Strategies, to discuss their feasibility, effectiveness, benefits and drawbacks, and long-term impact. The meeting focused on water reactors, mainly on existing systems. The technical content covered topics such as general aspects of accident management strategies in OECD Member countries, hydrogen management techniques and other containment accident management strategies, surveillance and protection of the containment function. The main conclusions of the meeting are summarized in the paper. (author)

  18. Linking corporate strategy and supply chain management

    Hofmann, Erik


    Purpose of this paper: The paper researches the linkages between corporate and supply chain strategy. It represents a stage of an on-going research initiative aimed at providing a framework for understanding systematically the integration of corporate strategy making and supply chain management. Design/methodology/approach: The paper engaged itself in the theory/literature related to strategic and supply chain management. Four generic levels of strategy are linked to supply chain ma...

  19. Risk evaluation of accident management strategies

    Dingman, S.; Camp, A.


    The use of Probabilistic Risk Assessment (PRA) methods to evaluate accident management strategies in nuclear power plants discussed in this paper. The PRA framework allows an integrated evaluation to be performed to give the full implications of a particular strategy. The methodology is demonstrated for a particular accident management strategy, intentional depressurization of the reactor coolant system to avoid containment pressurization during the ejection of molten debris at vessel breach

  20. Strategies in Managing Rapport in Classroom Discussion

    Reski Reski


    This paper aims to find out the strategies, applied by students in classroom interaction particularly in discussion, to maintain their interpersonal rapport as well as to enhance their rapport management with their fellow students. There are five strategies based on Spencer-Oatey (2008) that the interactants apply in social interactions. The strategies are request, compliments, apologies, gratitude and disagreement. The research is done to see whether the students realize the management of ra...

  1. A model to evaluate quality and effectiveness of disease management.

    Lemmens, K M M; Nieboer, A P; van Schayck, C P; Asin, J D; Huijsman, R


    Disease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control healthcare costs. So far, however, the effects of this strategy remain unclear. Although current models define the concept of disease management, they do not provide a systematic development or an explanatory theory of how disease management affects the outcomes of care. The objective of this paper is to present a framework for valid evaluation of disease-management initiatives. The evaluation model is built on two pillars of disease management: patient-related and professional-directed interventions. The effectiveness of these interventions is thought to be affected by the organisational design of the healthcare system. Disease management requires a multifaceted approach; hence disease-management programme evaluations should focus on the effects of multiple interventions, namely patient-related, professional-directed and organisational interventions. The framework has been built upon the conceptualisation of these disease-management interventions. Analysis of the underlying mechanisms of these interventions revealed that learning and behavioural theories support the core assumptions of disease management. The evaluation model can be used to identify the components of disease-management programmes and the mechanisms behind them, making valid comparison feasible. In addition, this model links the programme interventions to indicators that can be used to evaluate the disease-management programme. Consistent use of this framework will enable comparisons among disease-management programmes and outcomes in evaluation research.

  2. Updates in management of coronary artery disease

    Yang, Dong Heon; Chae, Shung Chull


    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed

  3. Updates in management of coronary artery disease

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)


    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  4. Managing regional innovation strategy projects

    Wolf, Patricia; Hanisch, Christoph


    This paper presents a qualitative interview study with 28 RIS project managers that aimed at understanding whether or not this is true in the context of regional innovation and what the specifics of managing regional innovation projects are. In taking up a recent claim for policy intervention studies which allow to “derive precise suggestions for their design and management”.  The study investigated the interrelation between the agility of the management approach and the achievements of RIS p...

  5. Recycling - Danish Waste Management Strategy

    Romann, Anne Funch; Thøgersen, John; Husmer, Lis

    The report challanges recycling as the only waste handling strategy. The tonnes of recycled materials should not be the only goal - it is essential to minimize the waste production and focus on eliminating hazardous materials.......The report challanges recycling as the only waste handling strategy. The tonnes of recycled materials should not be the only goal - it is essential to minimize the waste production and focus on eliminating hazardous materials....

  6. Cattle farmers’ perceptions of risk and risk management strategies

    Bishu, Kinfe G.; O'Reilly, Seamus; Lahiff, Edward


    This study analyzes cattle farmers’ perceptions of risk and risk management strategies in Tigray, Northern Ethiopia. We use survey data from a sample of 356 farmers based on multistage random sampling. Factor analysis is employed to classify scores of risk and management strategies, and multiple...... utilization were perceived as the most important strategies for managing risks. Livestock disease and labor shortage were perceived as less of a risk by farmers who adopted the practice of zero grazing compared to other farmers, pointing to the potential of this practice for risk reduction. We find strong...... evidence that farmers engage in multiple risk management practices in order to reduce losses from cattle morbidity and mortality. The results suggest that government strategies that aim at reducing farmers’ risk need to be tailored to specific farm and farmer characteristics. Findings from this study have...

  7. Present and New Treatment Strategies in the Management of Glaucoma

    Kolko, Miriam


    risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has...... of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current...

  8. Managing price risk - setting and implementing strategies

    Haines, D.


    The three hedging strategies for price risk management within the natural gas industry are described. The three strategies are: (1) speculative trader (characterized by 'trading for profit, i.e. small margin/large volumes); (2) price optimizer (the objective here is to outperform the market in the establishment of a price); and (3) strategic hedger( the characteristic concern in this strategy is to manage long-term company goals, i.e. balance sheet orientation). The strategies are not mutually exclusive, but overlapping areas can be the source of considerable confusion. Any firm can enter into more than one of these strategies. Integrated companies will adopt very different strategies for upstream versus downstream operations. Details of the three strategies are provided

  9. Management strategies in antithrombotic therapy

    Lincoff, A. Michael; Messerli, Adrian W; Askari, Arman


    ... in the management of non-st-elevation ACS 4.5 GP IIb/IIIa inhibitors in the management of acute STEMI 4.6 Safety of GP IIb/IIIa inhibitors 4.7 Summary 77 77 78 80 87 91 94 96 Chapter 5 Unfractionated Hepa...

  10. Evaluating risk management strategies in resource planning

    Andrews, C.J.


    This paper discusses the evaluation of risk management strategies as a part of integrated resource planning. Value- and scope-related uncertainties can be addressed during the process of planning, but uncertainties in the operating environment require technical analysis within planning models. Flexibility and robustness are two key classes of strategies for managing the risk posed by these uncertainties. This paper reviews standard capacity expansion planning models and shows that they are poorly equipped to compare risk management strategies. Those that acknowledge uncertainty are better at evaluating robustness than flexibility, which implies a bias against flexible options. Techniques are available to overcome this bias

  11. Project management strategies for prototyping breakdowns

    Granlien, Maren Sander; Pries-Heje, Jan; Baskerville, Richard


    , managing the explorative and iterative aspects of prototyping projects is not a trivial task. We examine the managerial challenges in a small scale prototyping project in the Danish healthcare sector where a prototype breakdown and project escalation occurs. From this study we derive a framework...... of strategies for coping with escalation in troubled prototyping projects; the framework is based on project management triangle theory and is useful when considering how to manage prototype breakdown and escalation. All strategies were applied in the project case at different points in time. The strategies led...

  12. Contemporary management of pericardial diseases.

    Imazio, Massimo


    Pericardial diseases are relatively common in clinical practice, either as isolated disease or as manifestation of a systemic disorder. The aim of the present study is to review more recent updates on their contemporary management. The cause of pericardial diseases is varied according to the epidemiologic background, patient population, and clinical setting. Most cases remain idiopathic, and empiric anti-inflammatory therapy should be considered as first-line therapy in most cases with the possible adjunct of colchicine in the setting of inflammatory pericardial diseases, especially relapsing or not responding to first-line drugs. A triage has been proposed to select high-risk cases requiring admission and specific cause search. The prognosis of pericardial diseases is essentially determined by the cause. The most feared complication is constriction, the risk of which is higher in bacterial forms, intermediate for postpericardiotomy syndromes and systemic inflammatory diseases, low for viral and idiopathic cases. Chronic constriction has a definite surgical therapy, whereas transient cases should be recognized and may be reversible with empirical anti-inflammatory therapy. Contemporary management of pericardial diseases is largely empirical, although first clinical trials and new studies on diagnostic modalities and prognosis of pericardial diseases are bringing the contemporary management of pericardial diseases along a more evidence-based road. Integrated cardiovascular imaging is required for optimal management of the patient with suspected pericardial disease.

  13. Time management strategies for research productivity.

    Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S


    Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

  14. Waste Management Strategy in The Netherlands. Part 3. Strategy Selection

    Haverkate, B.R.W.


    This report reflects the Dutch input prepared in the framework of work package 3 of the EU thematic network COMPAS, which dealt with the evaluation and comparison of waste management strategies in EU member states and their applicant countries. Based on three generic decision trees the current strategy as well as the reason(s) for the selected options regarding radioactive waste management in The Netherlands is extensively described in this report. The trees are represented in terms of (numbered) decision nodes. Each node is discussed in the context of the Dutch situation, with relevant potential outcomes being highlighted where possible. After a short introduction (chapter 1) followed by a brief waste management policy overview (chapter 2), this approach is considered, in chapter 3, for: spent nuclear fuel and high level waste; low and intermediate level waste; disposal strategy


    Eva Fitriani Syarifah; Raynesa Noor Emiliasari


    In a foreign language context, classroom management is very important to be considered by the teachers since the target language is taught mostly in classroom. However, managing classroom is not an easy task to do. Most of teachers think it is difficult because they need to organize the class, deal with students‘ behavior and manage the time. Taking the issues above into account, this research was conducted to find out strategies in managing EFL classrooms applied by a teacher ...

  16. Control Strategies for Corridor Management


    Integrated management of travel corridors comprising of freeways and adjacent arterial streets can potentially improve the performance of the highway facilities. However, several research gaps exist in data collection and performance measurement, ana...

  17. Rapid prototyping of energy management charging strategies

    Ciulavu, Oana [Hella Electronics Romania, Timisoara (Romania); Starkmuth, Timo; Jesolowitz, Reinhard [Hella KGaA Hueck und Co., Lippstadt (Germany)


    This paper presents an approach to develop charging strategies to support a vehicle energy management aiming for the reduction of CO{sub 2} emissions and decreased fuel consumption by using the Hardware-in-the-loop (HIL) environment. (orig.)

  18. Developments in weather responsive traffic management strategies.


    This report provides a comprehensive overview of weather-responsive traffic management practices. It focuses on what WRTM strategies exist, where they have been used, the benefits realized, what improvements are needed, and how to implement and evalu...

  19. Psychological Strategies in Managing Television Commercial Efficacy

    familiar versus novel), and information source (credible versus non-credible) as psychological strategies of managing television commercial efficacy. Subject's total score on recall of advert information, attitude to an advert, and intention to buy an ...

  20. Management ethics and strategies towards sustainable tourism ...

    Management ethics and strategies towards sustainable tourism development in ... embark on tourism because of the huge economic benefits, which it accrues on ... The park was gazzetted in 1972 for the purposes of conservation, education ...

  1. Responsive Multimodal Transportation Management Strategies And IVHS



  2. Mild TBI Diagnosis and Management Strategies

    Department of Veterans Affairs — The Mild Traumatic Brain Injury (TBI) Diagnosis and Management Strategies will assist in the study of TBI issues, such as the Influence of Concussion on Persistent...

  3. Management strategy 3: fixed rate fertilizer applications

    Previous chapters outlined management strategies for pond fertilization that take into account specific individual pond nutrient needs. Those methods would most likely be more ecologically efficient than a pre-determined fixed-rate nutrient addition strategy. However, the vast majority of available ...

  4. Social Distancing Strategies against Disease Spreading

    Valdez, L. D.; Buono, C.; Macri, P. A.; Braunstein, L. A.


    The recurrent infectious diseases and their increasing impact on the society has promoted the study of strategies to slow down the epidemic spreading. In this review we outline the applications of percolation theory to describe strategies against epidemic spreading on complex networks. We give a general outlook of the relation between link percolation and the susceptible-infected-recovered model, and introduce the node void percolation process to describe the dilution of the network composed by healthy individual, i.e., the network that sustain the functionality of a society. Then, we survey two strategies: the quenched disorder strategy where an heterogeneous distribution of contact intensities is induced in society, and the intermittent social distancing strategy where health individuals are persuaded to avoid contact with their neighbors for intermittent periods of time. Using percolation tools, we show that both strategies may halt the epidemic spreading. Finally, we discuss the role of the transmissibility, i.e., the effective probability to transmit a disease, on the performance of the strategies to slow down the epidemic spreading.

  5. Identifying species conservation strategies to reduce disease-associated declines

    Gerber, Brian D.; Converse, Sarah J.; Muths, Erin L.; Crockett, Harry J.; Mosher, Brittany A.; Bailey, Larissa L.


    Emerging infectious diseases (EIDs) are a salient threat to many animal taxa, causing local and global extinctions, altering communities and ecosystem function. The EID chytridiomycosis is a prominent driver of amphibian declines, which is caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd). To guide conservation policy, we developed a predictive decision-analytic model that combines empirical knowledge of host-pathogen metapopulation dynamics with expert judgment regarding effects of management actions, to select from potential conservation strategies. We apply our approach to a boreal toad (Anaxyrus boreas boreas) and Bd system, identifying optimal strategies that balance tradeoffs in maximizing toad population persistence and landscape-level distribution, while considering costs. The most robust strategy is expected to reduce the decline of toad breeding sites from 53% to 21% over 50 years. Our findings are incorporated into management policy to guide conservation planning. Our online modeling application provides a template for managers of other systems challenged by EIDs.


    Glintborg, Dorte; Andersen, Marianne


    controls within all diagnose categories including antibiotics. The causal relationship between PCOS and autoimmune disease represents an interesting new area of research. PCOS is a lifelong condition and long term morbidity could be worsened by obesity, sedentary way of life, western style diet and smoking...

  7. Need for a new skin cancer management strategy

    Geer, van der S.; Reijers, H.A.; Tuijl, van H.F.J.M.; Vries, de H.; Krekels, G.A.M.


    The worldwide incidence of skin cancer (especially nonmelanoma skin cancer) has increased markedly during the last decades. Skin cancer should be considered a chronic disease. To manage the future costs and quality of care for patients with skin cancer, a revised health strategy is needed. These new

  8. The Changing Career Strategies of Managers.

    Wilson, Tony; Davies, Goronwy


    Faced with reduced employment security, managers are redefining careers to include work/personal life balance. Changes in any area can cause revision of career strategies. Depending on how they define careers, managers recognize career development as an individual, not an organizational, responsibility. (SK)

  9. Role of management devices in enacting strategy

    Harritz, Daniel


    the SSC’s creation. Originality/value - This study is the first to use a performative method to highlight the temporary and local nature of enacting strategic decisions to construct an SSC in the public sector. Keywords: Management control, SSC, strategic change, actor-network theory, organizational......Purpose - This study illustrates the role of management devices in enacting strategy and strategic decisions, resulting in the development of a Shared Service Centre (SSC) in a Danish municipality. It shows how devices interact in defending, rejecting and reframing strategy, leading to the closure...... the active role of non-human entities, such as management devices, in enacting and reformulating strategy. Findings - Different devices have become key actants in shaping and formulating the new strategy in the municipality and the strategic decision to construct a SSC. However, different devices mobilise...

  10. Hydrogen management strategy for the Loviisa NPP

    Lundstrom, P.; Routamo, T.; Tuomisto, H.; Theofanous, T.G.


    A new hydrogen management scheme has been developed for the Loviisa ice condenser containment as a part of a comprehensive severe accident management (SAM) strategy. The scheme is based on providing sufficient mixing of the containment atmosphere, effective energy removal from the containment, and controlled removal of hydrogen through passive catalytic recombination. The objective of the paper is to demonstrate how this hydrogen management scheme works for a range of relevant severe accident scenarios. (author)

  11. Risk impact of two accident management strategies

    Dingman, S.; Camp, A.


    This report probabilistic Risk Assessment is used to evaluate two accident management strategies: intentionally depressurizing the reactor coolant system of a pressurized water reactor to prevent containment-pressurization during high pressure melt ejection, and flooding the containment of a boiling water reactor to prevent or delay vessel breach. Sensitivity studies indicated that intentional depressurization would not provide a significant risk reduction at Surry. A preliminary evaluation of the containment flooding strategy indicated that it might prove beneficial for some plants, but that further strategy development would be needed to fully evaluate the strategy-

  12. Diverticular Disease: Epidemiology and Management

    Adam V Weizman


    Full Text Available Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and/or obstruction.

  13. Diverticular disease: Epidemiology and management

    Weizman, Adam V; Nguyen, Geoffrey C


    Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and/or obstruction. PMID:21876861

  14. Celiac Disease Diagnosis and Management

    Leffler, Daniel


    Celiac disease is one of the most prevalent autoimmune gastrointestinal disorders but as the case of Ms. J illustrates, diagnosis is often delayed or missed. Based on serology studies, the prevalence of celiac disease in many populations is estimated to be approximately 1% and has been increasing steadily over the last 50 years. Evaluation for celiac disease is generally straightforward, and uses commonly available serologic tests, however the signs and symptoms of celiac disease are nonspecific and highly heterogeneous making diagnosis difficult. While celiac disease is often considered a mild disorder treatable with simple dietary changes, in reality celiac disease imparts considerable risks including reduced bone mineral density, impaired quality of life, and increased overall mortality. In addition, the gluten free diet is highly burdensome and can profoundly affect patients and their families. For these reasons, care of individuals with celiac disease requires prompt diagnosis and ongoing multidisciplinary management. PMID:21990301

  15. The CEA's waste management strategy

    Behar, Ch.; Dall'ava, D.; Fillion, E.


    The CEA is tasked with carrying out certain research activities: within the Military Applications Division (DAM), research is focused on the nuclear deterrence and, within the Nuclear Energy Division, on developing the industrial nuclear systems of the future and optimising existing nuclear systems in partnership with EDF and AREVA. These major research and development themes entail a need for nuclear research and support facilities which must be maintained at a high level of performance and safety and, also, constantly upgraded to handle the research activities and programmes for which they are used. The CEA strategy is based on the right packaging of the radioactive liquid or solid waste into a form required for its transport, storage or disposal. The Caraibes software allows an efficient traceability of the waste packages. Most of the radioactive effluent processing stations of CEA are being upgraded

  16. The AREVA's waste management strategy

    Poncet, Ph.


    In accordance with its policy of sustainable development and continuous progress, AREVA is permanently seeking to reduce the impact of the management of its waste, of whatever type, and its radioactive waste in particular. This goal is taken into consideration very early in industrial projects and concerns all the phases in the life of the installations and all the activities of the Group. The resulting actions aim to guarantee that an exhaustive inventory is made of the radioactive materials and waste, to optimise how they are characterised, to ensure their traceability and to determine the best management methods. Past and future progress relies primarily on the effectiveness of zoning (in particular the concept of radiological cleanness), how work is organized, the account taken of operating experience feedback, the search for recycling solutions or appropriate removal routes, optimisation of waste storage and, whenever possible, online processing, plus of course the professionalism of all those involved. A participatory approach by the Group will enable the focus areas and required actions to be defined: networks and multidisciplinary working groups, whenever possible in association with other stake-holders or partners from the nuclear industry. (author)

  17. Banana Xanthomonas wilt: a review of the disease, management ...

    ... a review of the disease, management strategies and future research directions. ... Plants are infected either by insects through the inflorescence or by ... wilt is not fully understood but its impact on food security in the region is very significant.

  18. Management strategies for acne vulgaris

    Whitney, Kristen M; Ditre, Chérie M


    Clinical question: What are the most effective treatment(s) for mild, moderate, severe, and hormonally driven acne? Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients. Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of child-bearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral. PMID:21691566

  19. [Global brain metastases management strategy: a multidisciplinary-based approach].

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É


    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. Copyright © 2015. Published by Elsevier SAS.

  20. Principles for assessing disease management outcomes.

    Fitzner, Karen; Sidorov, Jaan; Fetterolf, Don; Wennberg, David; Eisenberg, Edward; Cousins, Michael; Hoffman, Joel; Haughton, John; Charlton, Warwick; Krause, David; Woolf, Allen; Mcdonough, Kenneth; Todd, Warren; Fox, Kathe; Plocher, David; Juster, Iver; Stiefel, Matt; Villagra, Victor; Duncan, Ian


    Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation.

  1. Pediatric Cushing′s disease: Management Issues

    Martin O Savage


    Full Text Available Cushing′s disease (CD, caused by an ACTH-secreting pituitary corticotroph adenoma, is the commonest cause of Cushing syndrome in children over 5 years of age. It is rare in the pediatric age range and presents difficult diagnostic and therapeutic challenges. Key presenting features include weight gain, growth failure and change in facial appearance. Most pediatric endocrinologists have limited experience managing children or adolescents with CD and thus benefit from close consultation with adult colleagues. We describe a diagnostic protocol which broadly follows the model for adult patients. Treatment strategies are examined and appraised. The management of pediatric CD patients after cure is also discussed.

  2. Weight management strategies for those with chronic kidney disease - a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting.

    Lambert, Kelly; Beer, Jo; Dumont, Ruth; Hewitt, Katie; Manley, Karen; Meade, Anthony; Salamon, Karen; Campbell, Katrina


    Develop a consensus report to guide dietetic management of overweight or obese individuals with Chronic Kidney Disease (CKD). Six statements relating weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥ 75% agreement. The recommendations were developed via a mini Delphi process. Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian. This article is protected by copyright. All rights reserved.

  3. Information Technology Management Strategies to Implement Knowledge Management Systems

    McGee, Mary Jane Christy


    More than 38% of the U.S. public workforce will likely retire by 2030, which may result in a labor shortage. Business leaders may adopt strategies to mitigate knowledge loss within their organizations by capturing knowledge in a knowledge management system (KMS). The purpose of this single case study was to explore strategies that information…

  4. Policies and strategies for radioactive waste management


    A policy for spent fuel and radioactive waste management should include a set of goals or requirements to ensure the safe and efficient management of spent fuel and radioactive waste in the country. Policy is mainly established by the national government and may become codified in the national legislative system. The spent fuel and radioactive waste management strategy sets out the means for achieving the goals and requirements set out in the national policy. It is normally established by the relevant waste owner or nuclear facility operator, or by government (institutional waste). Thus, the national policy may be elaborated in several different strategy components. To ensure the safe, technically optimal and cost effective management of radioactive waste, countries are advised to formulate appropriate policies and strategies. A typical policy should include the following elements: defined safety and security objectives, arrangements for providing resources for spent fuel and radioactive waste management, identification of the main approaches for the management of the national spent fuel and radioactive waste categories, policy on export/import of radioactive waste, and provisions for public information and participation. In addition, the policy should define national roles and responsibilities for spent fuel and radioactive waste management. In order to formulate a meaningful policy, it is necessary to have sufficient information on the national situation, for example, on the existing national legal framework, institutional structures, relevant international obligations, other relevant national policies and strategies, indicative waste and spent fuel inventories, the availability of resources, the situation in other countries and the preferences of the major interested parties. The strategy reflects and elaborates the goals and requirements set out in the policy statement. For its formulation, detailed information is needed on the current situation in the country

  5. Management strategies for acne vulgaris

    Whitney KM


    Full Text Available Kristen M Whitney1, Chérie M Ditre21Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; 2Skin Enhancement Center and Cosmetic Dermatology, Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USADate of preparation: 30th November 2010Conflicts of interest: None declaredClinical question: What are the most effective treatment(s for mild, moderate, severe, and hormonally driven acne?Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients.Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of childbearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral.Keywords: acne vulgaris, benzoyl peroxide, retinoids, antibiotics, light and laser therapy, photodynamic therapy, photopneumatic therapy, chemical peels

  6. Major diseases of ornamental plants and their management

    Akhtar, M.A.; Zakria, M.; Sohail, F.


    Major diseases of ornamental plants are caused by infections agents (biotic) or non-infectious (abiotic) agents. Infectious agents are bacteria, fungi, nematodes and virus. Non infectious agents are nutritional imbalances, environmental stresses and chemical toxicities. Grouping of the diseases has been done on symptomatology basis. Disease management in ornamental plants has been described through cultural practices, chemical and other control strategies. (author)

  7. Overview on spent fuel management strategies

    Dyck, P.


    This paper presents an overview on spent fuel management strategies which range from reprocessing to interim storage in a centralised facility followed by final disposal in a repository. In either case, more spent fuel storage capacity (wet or dry, at-reactor or away-from-reactor, national or regional) is required as spent fuel is continuously accumulated while most countries prefer to defer their decision to choose between these two strategies. (author)

  8. Conflict Management Strategies for Rangeland Resources

    Rasmussen, G.A.


    Metadata only record Numerous strategies have been developed to cope with conflicts. Collaborative processes are one group of conflict management strategies used. When successful these processes have several common features: they are voluntary, build trust, develop a shared vision, and use consensus. These techniques have often led to false expectations because the source of the conflict was ignored or adequately trained facilitators were not used. The source of the conflict (lack of infor...

  9. Negotiation strategies in Supply Chain Management

    Zachariassen, Frederik


    Purpose - This paper seeks to explore the impact of different negotiation strategies on then negotiation setting in different buyer-supplier relationships. So far, the extant supply chain management (SCM) literature has only briefly touched this subject, though such a study has been advocated...... to reject or confirm the reached conclusions. Originality/value - The paper is the first to specifically investigate the role of negotiation strategies in the academic discipline of SCM from a qualitative angle using participant observations and interviews....

  10. Momentum management strategy during Space Station buildup

    Bishop, Lynda; Malchow, Harvey; Hattis, Philip


    The use of momentum storage devices to control effectors for Space Station attitude control throughout the buildup sequence is discussed. Particular attention is given to the problem of providing satisfactory management of momentum storage effectors throughout buildup while experiencing variable torque loading. Continuous and discrete control strategies are compared and the effects of alternative control moment gyro strategies on peak momentum storage requirements and on commanded maneuver characteristics are described.


    Rozitta Chittaie


    Full Text Available Changing in the current competitive environment, increasing simplicity of penetrating into the competitive market, and rapid growing of information technology are essential motives for performing activities in an environment. Nowadays, some companies step into rapid and instant development of their markets in order to improve customer relationship. These companies through adopting customer relationship management (CRM systems can earn and retain their customers' loyalty. As a result, designing customer relationship management strategies can lead to market protection, customer value increase, and greater customer satisfaction opportunities for continuous promotion of the enterprise. Regarding the complexity and the variety of strategies associated with managing a business, information-related capability seems to be an essential capability for earning profit from companies' activities and competition among peers. Hence, relation and information are employed for managing the firms are vital tools for seizing opportunities and tackling future issues. Giving the information only employed to support a company’s performance, making crucial decision about surrounding environment, increasing competitive ability of the enterprise will be difficult for company. Furthermore, since increase of competitive ability is accompanied by making greater profit on the deal, methods of raising competitive ability is an interesting and critical issue. Therefore, companies through information technology, cost reduction, and development of low-level relations with customers can achieve greater profitability. This paper probes into customer relationship management and business strategies. The implications of CRM strategies are discussed in detail.

  12. Characteristics of refractory gastroesophageal reflux disease (GERD) symptoms -is switching proton pump inhibitors based on the patient's CYP2C19 genotype an effective management strategy?

    Takeuchi, Toshihisa; Oota, Kazuhiro; Harada, Satoshi; Edogawa, Shoko; Kojima, Yuichi; Sanomura, Makoto; Sakaguchi, Masahiro; Hayashi, Katsuyoshi; Hongoh, Yasushi; Itabashi, Tsukasa; Kitae, Hidehiro; Hoshimoto, Masahiro; Takeuchi, Nozomi; Higuchi, Kazuhide


    We investigated factors related to proton pump inhibitor (PPI) -refractory gastroesophageal reflux disease (GERD) symptoms, particularly with respect to acid, the CYP2C19 genotype and psychological aspects. Patients with an Frequency Scale for the Symptoms of GERD (FSSG) score of ≥8 after the initial treatment were switched to therapy with rabeprazole at a dose of 20 mg once daily for eight weeks. We investigated the rate of improvement in PPI-refractory GERD symptoms, background factors, the Hospital Anxiety and Depression Scale (HADS) score and the CYP2C19 genotype. Patients Sixty patients endoscopically diagnosed with reflux esophagitis within the past six months who had received omeprazole at a dose of 20 mg once daily for eight weeks or longer were enrolled. In 71.6% of the patients, the FSSG score decreased to GERD symptoms. Significant factors related to omeprazole-refractory GERD symptoms included a longer disease duration (p=0.0004) and higher HADS score (p=0.01). Among the omeprazole-refractory cases, only 23.5% of the patients showed symptom improvement after switching to rabeprazole. There were no significant differences in the average scores for FSSG (p=0.089) or HADS (p=0.182), before or after the drug change. A total of 92% of the rabeprazole poor responders were homo/hetero extensive metabolizers for the CYP2C19 genotype. Our findings suggest that switching the PPI from omeprazole (20 mg once daily) to rabeprazole (20 mg once daily) is not a significant effective therapeutic strategy for improving PPI-refractory GERD symptoms, taking into consideration possible psychometric factors and patients who require stronger acid suppression than that achieved with a double dose of PPIs for PPI-refractory GERD symptoms.

  13. Strategies for successful software development risk management

    Marija Boban


    Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

  14. Strategies for Managing a Multigenerational Workforce

    Iden, Ronald

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to explore the multigenerational strategies used by 3 managers from a Franklin County, Ohio manufacturing facility with a population size of 6 participants. The conceptual framework for this study was built upon generational theory and cohort group theory. The data were collected through face-to-face semistructured interviews, company documents, and a reflexive journal. Member checking was completed to strengthen the credibility and trustworthiness of the interpretation of participants' responses. A modified van Kaam method enabled separation of themes following the coding of data. Four themes emerged from the data: (a) required multigenerational managerial skills, (b) generational cohort differences, (c) most effective multigenerational management strategies, and (d) least effective multigenerational management strategies. Findings from this study may contribute to social change through better understanding, acceptance, and appreciation of the primary generations in the workforce, and, in turn, improve community relationships.

  15. Assessment of two BWR accident management strategies

    Hodge, S.A.; Petek, M.


    Candidate mitigative strategies for management of in-vessel events during the late phase (after core degradation has occurred) of postulated BWR severe accidents were considered at Oak Ridge National Laboratory (ORNL) during 1990. The identification of new strategies was subject to the constraint that they should, to the maximum extent possible, make use of the existing equipment and water resources of the BWR facilities and not require major equipment modifications or additions. As a result of this effort, two of these candidate strategies were recommended for additional assessment. The first is a strategy for containment flooding to maintain the core and structural debris within the reactor vessel in the event that vessel injection cannot be restored to terminate a severe accident sequence. The second strategy pertains to the opposite case, for which vessel injection would be restored after control blade melting had begun; its purpose is to provide an injection source of borated water at the concentration necessary to preclude criticality upon recovering a damaged BWR core. Assessments of these two strategies have been performed during 1991 under the auspices of the Detailed Assessment of BWR In-Vessel Strategies Program. This paper provides a discussion of the motivation for and purpose of these strategies and the potential for their success. 33 refs., 9 figs

  16. Specification of data centre power management strategies

    Postema, Björn F.; Haverkort, Boudewijn R.


    In recent work, we proposed a flexible simulation framework (using AnyLogic) for the trade-off. analysis of power and performance in data centres. We now extend this framework with a versatile module to study the effect of advanced power management strategies based on both power and performance

  17. Essays in industrial organization and management strategy

    de Bijl, P.W.J.


    This thesis contains five essays in the theory of industrial organization and management strategy. An introduction makes the main ideas accessible to non-specialists by presenting the essays as fictitious cases. The first essay investigates strategic disclosure of verifiable information. The


    Дмитрий Георгиевич БЕЗУГЛЫЙ


    The methods and tools of the developed project promotion, the planning system of promotion strategy are suggested; the main approaches used in the project promotion have been identified. The conclusions about the importance, necessity and role in the promotion of a holistic project management system have been made.

  19. Management Strategies for Promoting Teacher Collective Learning

    Cheng, Eric C. K.


    This paper aims to validate a theoretical model for developing teacher collective learning by using a quasi-experimental design, and explores the management strategies that would provide a school administrator practical steps to effectively promote collective learning in the school organization. Twenty aided secondary schools in Hong Kong were…

  20. Electronic government: Rethinking channel management strategies

    Ebbers, Wolfgang E.; Pieterson, Willem Jan; Noordman, H.N.


    This article explores how an alternative multichannel management strategy can improve the way governments and citizens interact. Improvement is necessary because, based on empirical data from various sources, the conclusion can be drawn that there is a gap between the communication channels

  1. Water Resources: Management and Strategies in Nigeria ...

    Water Resources: Management and Strategies in Nigeria. ... the rational use of water resources poses a great problem and challenge to the nation. ... Suggestions were made on ways of planning sustainable water supply systems for Nigeria ... South Africa (96); South Sudan (1); Sudan (3); Swaziland (3); Tanzania (19) ...

  2. Product Portfolio Management: An Important Business Strategy

    Doorasamy Mishelle


    Full Text Available The aim of this article is to provide reader with a comprehensive insight on the theories, empirical findings and models of Product Portfolio Management (PPM during new product development. This article will allow for an in-depth theoretical approach on PPM and demonstrate to managers the importance of adopting PPM as business strategy during decision making. The objective of this paper is to present a literature review of models, theories, approaches and findings on the relationship between Product Portfolio Management and new product development. Relevant statistical trends, historical developments, published opinion of major writers in this field will be presented to provide concrete evidence of the problem being discussed.

  3. Time management strategies in nursing practice.

    Waterworth, Susan


    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.

  4. Managing the Chronically Overworked Team: Twenty Strategies.

    Hills, Laura


    Overwork, at first glance, seems like a problem that affects only the employee. But for medical practices and those who manage them, the problem is far greater than that. Chronically overworked employees may not be meeting their goals. They may be making more mistakes and letting things slip through the cracks. Ultimately, patients may have less-than-ideal experiences in a practice where the employees are stretched thin. And turnover may skyrocket in practices where employees are chronically overworked. This article offers practice managers 20 practical and affordable strategies they can use to manage a chronically overworked medical practice team. It suggests an effective technique they can use to tell their bosses that their employees are overworked. This article also suggests the costs to the practice of a chronically overworked staff, including a hidden cost many people overlook. It provides four coping strategies practice managers can teach to their overworked employees. It summarizes research exploring how overwork affects employees' sleep and eating habits, and additional research linking long hours of overwork to diminished productivity. Finally, this article provides five strategies practice managers can use to make their overworked employees feel valued.

  5. Irritable bowel syndrome: contemporary nutrition management strategies.

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E


    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

  6. Social Media Strategies and Destination Management

    Munar, Ana Maria


    This study provides insights into social media practices and strategic considerations used by destination management organizations (DMOs). It examines a theoretical model of generic social media strategies for destination management and applies qualitative methods to analyze the social media...... initiatives of DMOs of Denmark, Norway, Finland, Sweden and the Scandinavian Tourist Board Asia/Pacific in the Nordic European Region. The study provides empirical evidence of emerging social media strategies among DMOs and confirms the growing importance of these new media. The findings point...... to the conflicting relationship between corporate culture and social media culture, the challenges innovative communication tools present for traditional management structures, poor levels of formalization and the lack of a knowledge base which results in ad-hoc decision making. Overall, the paper discusses...

  7. Assessment of two BWR accident management strategies

    Hodge, S.A.; Petek, M.


    Candidate mitigative strategies for the management of in-vessel events during the late phase (after-core degradation has occurred) of postulated boiling water reactor (BWR) severe accidents were considered at Oak Ridge National Laboratory (ORNL) during 1990. The identification of new strategies was subject to the constraint that they should, to the maximum extent possible, make use of the existing equipment and water resources of the BWR facilities, and not require major equipment modifications or additions. As a result of this effort, two of these candidate strategies were recommended for further assessment. The first was a strategy for containment flooding to maintain the core and structural debris within the reactor vessel in the event that vessel injection cannot be restored to terminate a severe accident sequence. The second strategy pertained to the opposite case, for which vessel injection would be restored after control blade melting had begun; its purpose was to provide an injection source of borated water at the concentration necessary to preclude criticality upon recovering a damaged BWR core. Assessments of these two strategies were performed during 1991 and this paper provides a discussion of the motivation for and purpose of these strategies, and the potential for their success. ((orig.))

  8. Risk management - unappreciated instrument of supply chain management strategy

    Wojciech Machowiak


    Full Text Available Background: Unlike Enterprise Risk Management, which is certainly quite well rooted in business practice, Supply Chain Risk Management (SCRM still continues to be dynamically developing subject of academic research, whereas its practical applications are rather scarce. Material and methods: On the basis of broad review of the current state of the art in world literature, significant  relevancies to the core processes and enterprise strategy are discussed.   Results: The paper shows some interesting from the enterprise's performance and competitiveness point of view additional benefits, potentially resulting from the proactive, consistent and effective implementation of the SCRM system. Conclusions: Some additional advantages from proactive supply chain risk management account for perceiving SCRM as multifunctional instrument of strategic SC management, exceeding established understanding RM as security and threat-prevention  tool only. Positive influence from SCRM onto SC performance and competitiveness can make reasonable to enhance its position within SCM strategy.

  9. Strategy development management of Multimodal Transport Network

    Nesterova Natalia S.


    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  10. Balancing energy strategies in electricity portfolio management

    Moeller, Christoph; Rachev, Svetlozar T.; Fabozzi, Frank J.


    Traditional management of electricity portfolios is focused on the day-ahead market and futures of longer maturity. Within limits, market participants can however also resort to the balancing energy market to close their positions. In this paper, we determine strategic positions in the balancing energy market and identify corresponding economic incentives in an analysis of the German balancing energy demand. We find that those strategies allow an economically optimal starting point for real-time balancing and create a marketplace for flexible capacity that is more open than alternative marketplaces. The strategies we proffer in this paper we believe will contribute to an effective functioning of the electricity market. (author)

  11. Risk management - unappreciated instrument of supply chain management strategy

    Wojciech Machowiak


    Background: Unlike Enterprise Risk Management, which is certainly quite well rooted in business practice, Supply Chain Risk Management (SCRM) still continues to be dynamically developing subject of academic research, whereas its practical applications are rather scarce. Material and methods: On the basis of broad review of the current state of the art in world literature, significant  relevancies to the core processes and enterprise strategy are discussed.   Results: ...

  12. Flexible management: strategies for the changing workforce.

    Michaels, B


    In the year 2000, managers will supervise employees whose career aspirations differ drastically from their own. Success not only will be measured by salary and status, but will be tied to a person's family relationships. Twenty years ago, most managers were not concerned with the family problems of their subordinates. This notion is now out of date. The family responsibilities of staff have a direct effect on the company's productivity. An employee who is worried about the care of an elderly parent, or concerned with the safety of a preteen home alone after school, is unlikely to give full attention to the task at hand. Flexible management is a cost-effective way of dealing with these issues. Managers who have the skills to be flexible and the strategies to work with employees for a win-win situation will reduce distractions and tardiness and gain productivity and loyalty.

  13. Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care.

    Ramli, Anis S; Lakshmanan, Sharmila; Haniff, Jamaiyah; Selvarajah, Sharmini; Tong, Seng F; Bujang, Mohamad-Adam; Abdul-Razak, Suraya; Shafie, Asrul A; Lee, Verna K M; Abdul-Rahman, Thuhairah H; Daud, Maryam H; Ng, Kien K; Ariffin, Farnaza; Abdul-Hamid, Hasidah; Mazapuspavina, Md-Yasin; Mat-Nasir, Nafiza; Miskan, Maizatullifah; Stanley-Ponniah, Jaya P; Ismail, Mastura; Chan, Chun W; Abdul-Rahman, Yong R; Chew, Boon-How; Low, Wilson H H


    Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol. A pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure care and prescribing patterns. Patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated. Results from this study will provide objective evidence of the effectiveness and

  14. Invasive Management Strategies and Antithrombotic Treatments in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China).

    Yang, Qing; Wang, Ying; Liu, Jing; Liu, Jun; Hao, Yongchen; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Wang, Wei; Zhou, Yujie; Zhao, Dong


    Early invasive strategies and antithrombotic treatments are key treatments of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes. A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients. There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification. URL: Unique identifier: NCT02306616. © 2017 American Heart Association, Inc.

  15. Strategy on radioactive waste management in Lithuania

    Poskas, P.; Adomaitis, J.E.


    In Lithuania about 70-80% of all electricity is generated at a single power station, Ignalian NPP which has two non-upgradable RBMK-1500 type reactors. The unit 1 will be closed by 2005. The decision on unit 2 should be made in Lithuanian Parliament very soon taking into consideration substantial long-term financial assistance from the EU, G7 and other states as well as international institutions. The Government approved the Strategy on Radioactive Waste Management in 2002. Objectives of this strategy are to develop the radioactive waste management infrastructure based on modern technologies and provide for the set of practical actions that shall bring management of radioactive waste in Lithuania in compliance with radioactive waste management principles of IAEA and with good practices in force in EU Member States. Ignalina NPP is undertaking a program of decommissioning support projects, financed by grants from the International Ignalina Decommissioning Support Fund, administered by the European Bank for Reconstruction and Development. This program comprises also the implementation of investment projects in a number of pre-decommissioning facilities including the management of radioactive waste and spent nuclear fuel. (orig.)

  16. Taming wildlife disease: bridging the gap between science and management

    Joseph, Maxwell B.; Mihaljevic, Joseph R.; Arellano, Ana Lisette; Kueneman, Jordan G.; Cross, Paul C.; Johnson, Pieter T.J.


    1.Parasites and pathogens of wildlife can threaten biodiversity, infect humans and domestic animals, and cause significant economic losses, providing incentives to manage wildlife diseases. Recent insights from disease ecology have helped transform our understanding of infectious disease dynamics and yielded new strategies to better manage wildlife diseases. Simultaneously, wildlife disease management (WDM) presents opportunities for large-scale empirical tests of disease ecology theory in diverse natural systems. 2.To assess whether the potential complementarity between WDM and disease ecology theory has been realized, we evaluate the extent to which specific concepts in disease ecology theory have been explicitly applied in peer-reviewed WDM literature. 3.While only half of WDM articles published in the past decade incorporated disease ecology theory, theory has been incorporated with increasing frequency over the past 40 years. Contrary to expectations, articles authored by academics were no more likely to apply disease ecology theory, but articles that explain unsuccessful management often do so in terms of theory. 4.Some theoretical concepts such as density-dependent transmission have been commonly applied, whereas emerging concepts such as pathogen evolutionary responses to management, biodiversity–disease relationships and within-host parasite interactions have not yet been fully integrated as management considerations. 5.Synthesis and applications. Theory-based disease management can meet the needs of both academics and managers by testing disease ecology theory and improving disease interventions. Theoretical concepts that have received limited attention to date in wildlife disease management could provide a basis for improving management and advancing disease ecology in the future.

  17. Spill management strategy for the Chesapeake Bay

    Butler, H.L.; Chapman, R.S.; Johnson, B.H.


    The Chesapeake Bay Program is a unique cooperative effort between state and Federal agencies to restore the health and productivity of America's largest estuary. To assist in addressing specific management issues, a comprehensive three-dimensional, time-varying hydrodynamic and water quality model has ben developed. The Bay modeling strategy will serve as an excellent framework for including submodules to predict the movement, dispersion, and weathering of accidental spills, such as for petroleum products or other chemicals. This paper presents sample results from the Bay application to illustrate the success of the model system in simulating Bay processes. Also, a review of model requirements for successful spill modeling in Chesapeake Bay is presented. Recommendations are given for implementing appropriate spill modules with the Bay model framework and establishing a strategy for model use in addressing management issues

  18. Environmental Management Strategy: Four Forces Analysis

    Doyle, Martin W.; Von Windheim, Jesko


    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  19. Environmental management strategy: four forces analysis.

    Doyle, Martin W; Von Windheim, Jesko


    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.


    Haradhan Kumar Mohajan


    Full Text Available Every organization needs the proper knowledge management (KM strategy for the development of the organization. In the last decades the business environment has changed and recently it becomes more dynamic and more complex. At present KM is valuable not only for individuals, and organizations, but also, for global humanity. So, the directors of the organizations must emphasize on the existing knowledge and try to develop them to achieve the competitive advantage. The purpose of the study is to explore the recent KM practice in the organizations and to show the ways to develop the new KM strategy in future. An attempt has been taken here to apply KM strategy in business performance, business intelligence, and e-business.

  1. Big Rock Point severe accident management strategies

    Brogan, B.A.; Gabor, J.R.


    December 1994, the Nuclear Energy Institute (NEI) issued guidance relative to the formal industry position on Severe Accident Management (SAM) approved by the NEI Strategic Issues Advisory Committee on November 4, 1994. This paper summarizes how Big Rock Point (BRP) has and continues to address SAM strategies. The historical accounting portion of this presentation includes a description of how the following projects identified and defined the current Big Rock Point SAM strategies: the 1981 Level 3 Probabilistic Risk Assessment performance; the development of the Plant Specific Technical Guidelines from which the symptom oriented Emergency Operating Procedures (EOPs) were developed; the Control Room Design Review; and, the recent completion of the Individual Plant Evaluation (IPE). In addition to the historical presentation deliberation, this paper the present activities that continue to stress SAM strategies

  2. Essays in industrial organization and management strategy

    de Bijl, P.W.J.


    This thesis contains five essays in the theory of industrial organization and management strategy. An introduction makes the main ideas accessible to non-specialists by presenting the essays as fictitious cases. The first essay investigates strategic disclosure of verifiable information. The disclosed information concerns a hidden action, and the transmission of information takes place in a noisy environment. The second essay explores how search costs and informational asymmetries influence t...

  3. Strategy generation in accident management support

    Sirola, M.


    An increased interest for research in the field of Accident Management can be noted. Several international programmes have been started in order to be able to understand the basic physical and chemical phenomena in accident conditions. A feasibility study has shown that it would be possible to design and develop a computerized support system for plant staff in accident situations. To achieve this goal the Halden Project has initiated a research programme on Computerized Accident Management Support (CAMS project). The aim is to utilize the capabilities of computerized tools to support the plant staff during the various accident stages. The system will include identification of the accident state, assessment of the future development of the accident and planning of accident mitigation strategies. A prototype is developed to support operators and the Technical Support Centre in decision making during serious accident in nuclear power plants. A rule based system has been built to take care of the strategy generation. This system assists plant personnel in planning control proposals and mitigation strategies from normal operation to severe accident conditions. The ideal of a safety objective tree and knowledge from the emergency procedures have been used. Future prediction requires good state identification of the plant status and some knowledge about the history of some critical variables. The information needs to be validated as well. Accurate calculations in simulators and a large database including all important information form the plant will help the strategy planning. (author). 12 refs, 2 figs

  4. Precision medicine for managing chronic diseases.

    Śliwczynski, Andrzej; Orlewska, Ewa


    Precision medicine (PM) is an important modern paradigm for combining new types of metrics with big medical datasets to create prediction models for prevention, diagnosis, and specific therapy of chronic diseases. The aim of this paper was to differentiate PM from personalized medicine, to show potential benefits of PM for managing chronic diseases, and to define problems with implementation of PM into clinical practice. PM strategies in chronic airway diseases, diabetes, and cardiovascular diseases show that the key to developing PM is the addition of big datasets to the course of individually profiling diseases and patients. Integration of PM into clinical practice requires the reengineering of the health care infrastructure by incorporating necessary tools for clinicians and patients to enable data collection and analysis, interpretation of the results, as well as to facilitate treatment choices based on new understanding of biological pathways. The size of datasets and their large variability pose a considerable technical and statistical challenge. The potential benefits of using PM are as follows: 1) broader possibilities for physicians to use the achievements of genomics, proteomics, metabolomics, and other "omics" disciplines in routine clinical practice; 2) better understanding of the pathogenesis and epidemiology of diseases; 3) a revised approach to prevention, diagnosis, and treatment of chronic diseases; 4) better integration of electronic medical records as well as data from sensors and software applications in an interactive network of knowledge aimed at improving the modelling and testing of therapeutic and preventative strategies, stimulating further research, and spreading information to the general public.

  5. Disease and health management in Asian aquaculture.

    Bondad-Reantaso, Melba G; Subasinghe, Rohana P; Arthur, J Richard; Ogawa, Kazuo; Chinabut, Supranee; Adlard, Robert; Tan, Zilong; Shariff, Mohamed


    Asia contributes more than 90% to the world's aquaculture production. Like other farming systems, aquaculture is plagued with disease problems resulting from its intensification and commercialization. This paper describes the various factors, providing specific examples, which have contributed to the current disease problems faced by what is now the fastest growing food-producing sector globally. These include increased globalization of trade and markets; the intensification of fish-farming practices through the movement of broodstock, postlarvae, fry and fingerlings; the introduction of new species for aquaculture development; the expansion of the ornamental fish trade; the enhancement of marine and coastal areas through the stocking of aquatic animals raised in hatcheries; the unanticipated interactions between cultured and wild populations of aquatic animals; poor or lack of effective biosecurity measures; slow awareness on emerging diseases; the misunderstanding and misuse of specific pathogen free (SPF) stocks; climate change; other human-mediated movements of aquaculture commodities. Data on the socio-economic impacts of aquatic animal diseases are also presented, including estimates of losses in production, direct and indirect income and employment, market access or share of investment, and consumer confidence; food availability; industry failures. Examples of costs of investment in aquatic animal health-related activities, including national strategies, research, surveillance, control and other health management programmes are also provided. Finally, the strategies currently being implemented in the Asian region to deal with transboundary diseases affecting the aquaculture sector are highlighted. These include compliance with international codes, and development and implementation of regional guidelines and national aquatic animal health strategies; new diagnostic and therapeutic techniques and new information technology; new biosecurity measures including

  6. Parking management : strategies, evaluation and planning

    Litman, T.A.


    Parking facilities are a major cost to society. Current planning practices are based on the assumption that parking should be abundant and provided free, with costs borne indirectly. This report examined parking management strategies related to integrated parking plans. Problems with current parking planning practices were reviewed. The costs of parking facilities were examined, as well as the savings that can accrue from improved management techniques. Strategies included shared parking; remote parking and shuttle services; walking and cycling improvements; improved enforcement and control; and increasing the capacity of existing parking facilities. Parking pricing methods, financial incentives and parking tax reforms were reviewed. Issues concerning user information and marketing were examined. Overflow parking plans were evaluated. Three illustrative examples of parking management programs were outlined, along with details of implementation, planning and evaluation procedures. It was concluded that cost-effective parking management programs can often reduce parking requirements by 20 to 40 per cent compared with conventional planning requirements, in addition to providing economic, social and environmental benefits. 32 refs., 7 tabs., 3 figs

  7. Nuclear knowledge management strategies in Canada

    Torgerson, D.F.; Aly, A.M.M.; Shalaby, B.


    An effective knowledge management strategy must encompass three basic elements; a sound resource management and training strategy to maintain nuclear competency in the face of accelerated retirements of current generation of experts and the development of advanced products, effective engineering tools to preserve the current technology and design basis and effective information management systems to facilitate pooling and sharing of information amongst different entities. The Canadian Nuclear Industry and its regulatory agency, the Canadian Nuclear Safety Commission (CNSC) recognized the importance of nuclear knowledge management and have already implemented a number of initiatives, in order to maintain competency, capture and preserve existing knowledge, advance the nuclear technology, develop future nuclear workers and maintain a critical R and D capability. The paper describes activities and initiatives undertaken or in progress in Canada in order to ensure a smooth transition of nuclear knowledge to the next generation of nuclear workers. Although this paper intends to address the Canadian scene in general, special emphasis will be placed on activities currently underway at Atomic Energy of Canada Limited (AECL) as the design authority and guardian of the CANDU technology. (author)

  8. Management strategies for nuclear power plant outages


    More competitive energy markets have significant implications for nuclear power plant operations, including, among others, the need for more efficient use of resources and effective management of plant activities such as on-line maintenance and outages. Outage management is a key factor for safe, reliable and economic plant performance and involves many aspects: plant policy, coordination of available resources, nuclear safety, regulatory and technical requirements, and all activities and work hazards, before and during the outage. The IAEA has produced this report on nuclear power plant outage management strategies to provide both a summary and an update of a follow-up to a series of technical documents related to practices regarding outage management and cost effective maintenance. The aim of this publication is to identify good practices in outage management: outage planning and preparation, outage execution and post-outage review. As in in the related technical documents, this report aims to communicate these practices in such a way that they can be used by operating organizations and regulatory bodies in Member States. The report was prepared as part of an IAEA project on continuous process improvement. The objective of this project is to increase Member State capabilities in improving plant performance and competitiveness through the utilization of proven engineering and management practices developed and transferred by the IAEA

  9. Livestock Disease Management for Trading Across Different Regulatory Regimes.

    Bate, Andrew M; Jones, Glyn; Kleczkowski, Adam; Naylor, Rebecca; Timmis, Jon; White, Piran C L; Touza, Julia


    The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.

  10. Assessment of two BWR accident management strategies

    Hodge, S.A.; Petek, M.


    A recently completed Oak Ridge effort proposes two management strategies for mitigation of the events that might occur in-vessel after the onset of significant core damage in a BWR severe accident. While the probability of such an accident is low, there may be effective yet inexpensive mitigation measures that could be implemented employing the existing plant equipment and requiring only additions to the plant emergency procedures. In this spirit, accident management strategies have been proposed for use of a borated solution for reactor vessel refill should control blade damage occur during a period of temporary core dryout and for containment flooding to maintain the core debris within the reactor vessel if injection systems cannot be restored. The proposed strategy for poisoning of the water used for vessel reflood should injection systems be restored after control blade damage has occurred has great promise, using only the existing plant equipment but employing a different chemical form for the boron poison. The dominant BWR severe accident sequence is Station Blackout and without means for mechanical stirring or heating of the storage tank, the question of being able to form the poisoned solution under accident conditions becomes of supreme importance. On the other hand, the proposed strategy for drywell flooding to cool the reactor vessel bottom head and prevent the core and structure debris from escaping to the drywell holds less promise. This strategy does, however, have potential for future plant designs in which passive methods might be employed to completely submerge the reactor vessel under severe accident conditions without the need for containment venting

  11. Management of dry eye disease.

    Lemp, Michael A


    The management of dry eye disease (DED) encompasses both pharmacologic and nonpharmacologic approaches, including avoidance of exacerbating factors, eyelid hygiene, tear supplementation, tear retention, tear stimulation, and anti-inflammatory agents. Artificial tears are the mainstay of DED therapy but, although they improve symptoms and objective findings, there is no evidence that they can resolve the underlying inflammation in DED. Topical corticosteroids are effective anti-inflammatory agents, but are not recommended for long-term use because of their adverse-effect profiles. Topical cyclosporine--currently the only pharmacologic treatment approved by the US Food and Drug Administration specifically for DED--is safe for long-term use and is disease-modifying rather than merely palliative. Treatment selection is guided primarily by DED severity. Recently published guidelines propose a severity classification based on clinical signs and symptoms, with treatment recommendations according to severity level.

  12. Contemporary disease management in Quebec.

    Gogovor, Amédé; Savoie, Michelle; Moride, Yola; Krelenbaum, Marilyn; Montague, Terrence


    Health or disease management (DM) has emerged as a promising solution to improve the quality of healthcare and patient outcomes in a cost-efficient way. This solution is particularly relevant in the care of our increasing, and aging, patient populations with multiple chronic diseases. This article reviews the recent history and current status of DM in the province of Quebec and summarizes its evolving perspectives and future prospects. Most DM projects in Quebec have developed from a public-private partnership, and they have addressed several disease states. The results of completed programs confirmed the presence of care gaps--the differences between best and usual care in several disease states. They also identified process changes leading to improved practices and enhanced professional satisfaction among stakeholders. Priorities identified for further research include increased knowledge of the underlying causes of care gaps and greater concentration on the measurement of clinical, humanistic and fiscal outcomes and their causal links to DM structures and processes. Although still embryonic in Quebec and Canada, the available evidence suggests that DM partnerships are practical and functional vehicles to expedite knowledge creation and transfer in the care of whole populations of patients. Future projects offer the promise of updated knowledge and continuously improved care and outcomes.

  13. Hybrid electric vehicles energy management strategies

    Onori, Simona; Rizzoni, Giorgio


    This SpringerBrief deals with the control and optimization problem in hybrid electric vehicles. Given that there are two (or more) energy sources (i.e., battery and fuel) in hybrid vehicles, it shows the reader how to implement an energy-management strategy that decides how much of the vehicle’s power is provided by each source instant by instant. Hybrid Electric Vehicles: •introduces methods for modeling energy flow in hybrid electric vehicles; •presents a standard mathematical formulation of the optimal control problem; •discusses different optimization and control strategies for energy management, integrating the most recent research results; and •carries out an overall comparison of the different control strategies presented. Chapter by chapter, a case study is thoroughly developed, providing illustrative numerical examples that show the basic principles applied to real-world situations. In addition to the examples, simulation code is provided via a website, so that readers can work on the actua...

  14. Method of assessing severe accident management strategies

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.; Okrent, D.; Jae, M.; Lim, H.; Milici, T.; Park, H.; Swider, J.; Xing, L.; Yu, D.


    Accident management can be defined as the innovative use of existing and or alternative resources, systems, and actions to prevent or mitigate a severe accident. A significant number of probabilistic safety assessments (PSAs) have been completed that yield the principal plant vulnerabilities. These vulnerabilities can be categorized as (1) dominant sequences with respect to core-melt frequency. (2) dominant sequences with respect to various risk measures. (3) dominant threats that challenge safety functions. (4) dominant threats with respect to failure of safety systems. For each sequence/threat and each combination of strategy, there may be several options available to the operator. Each strategy/option involves phenomenological and operational considerations regarding uncertainty. These considerations include uncertainties in key phenomena, operator behavior, system availability and behavior, and available information. This paper presents a methodology for assessing severe accident management strategies given the key uncertainties delineated at two workshops held at the University of California, Los Angeles. Based on decision trees and influence diagrams, the methodology is currently being applied to two case studies: cavity flooding in a pressurized water reactor (PWR) to prevent vessel penetration or failure, and drywell flooding in a boiling water reactor to prevent vessel and/or containment failure

  15. Asthma disease management and the respiratory therapist.

    Kallstrom, Thomas J; Myers, Timothy R


    The role of the respiratory therapist (RT) is expanding with the growing acceptance and use of the disease-management paradigm for managing chronic diseases. RTs are key members of the asthma disease-management team, in acute-care settings, patients' homes, out-patient clinics, emergency departments, and in the community. Utilizing RTs as disease managers allows patients to be treated faster and more appropriately, discharged to home sooner, and decreases hospital admissions. RT are leaders in the emerging field of asthma disease management.

  16. Management strategies in hospitals: scenario planning

    Ghanem, Mohamed


    Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  17. Designing a fuzzy expert system for selecting knowledge management strategy

    Ameneh Khadivar


    Full Text Available knowledge management strategy is mentioned as one of the most important success factors for implementing knowledge management. The KM strategy selection is a complex decision that requires consideration of several factors. For evaluation and selection of an appropriate knowledge management strategy in organizations, many factors must be considered. The identified factors and their impact on knowledge management strategy are inherently ambiguous. In this study, an overview of theoretical foundations of research regarding the different knowledge management strategies has been done And factors influencing the knowledge management strategy selection have been extracted from conceptual frameworks and models. How these factors influence the knowledge management strategy selection is extracted through the fuzzy Delphi. Next a fuzzy expert system for the selection of appropriate knowledge management strategy is designed with respect to factors that have an impact on knowledge management strategy. The factors which influence the selection of knowledge management strategy include: general business strategy, organizational structure, cultural factors, IT strategy, strategic human resource management, social level, the types of knowledge creation processes and release it. The factors which influence the knowledge management strategy selection include: business strategy general, organizational structure, cultural factors, IT strategy, human resource management strategies, socialization level, knowledge types and its creation and diffusion processes. According to identified factors which affect the knowledge management strategy, the final strategy is recommended based on the range of human-oriented and system-oriented by keep the balance of explicit and implicit knowledge. The Designed system performance is tested and evaluated by the information related to three Iranian organization.

  18. Designing a fuzzy expert system for selecting knowledge management strategy

    Ameneh Khadivar; Shohreh Nasri Nasr Abadi; Elham Fallah


    knowledge management strategy is mentioned as one of the most important success factors for implementing knowledge management. The KM strategy selection is a complex decision that requires consideration of several factors. For evaluation and selection of an appropriate knowledge management strategy in organizations, many factors must be considered. The identified factors and their impact on knowledge management strategy are inherently ambiguous. In this study, an overview of theoretical found...

  19. TASKILLAN II - Pilot strategies for workload management

    Segal, Leon D.; Wickens, Christopher D.


    This study focused on the strategies used by pilots in managing their workload level, and their subsequent task performance. Sixteen licensed pilots flew 42 missions on a helicopter simulation, and were evaluated on their performance of the overall mission, as well as individual tasks. Pilots were divided in four groups, defined by the presence or absence of scheduling control over tasks and the availability of intelligence concerning the type and stage of difficulties imposed during the flight. Results suggest that intelligence supported strategies that yielded significant higher performance levels, while scheduling control seemed to have no impact on performance. Both difficulty type and the stage of difficulty impacted performance significantly, with strongest effects for time stresss and difficulties imposed late in the flight.

  20. Fibromyalgia: management strategies for primary care providers.

    Arnold, L M; Gebke, K B; Choy, E H S


    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  1. Manage zebra chip: Understand the life stages of the disease vector, the potato psyllid, to determine which control strategies to apply

    The potato psyllid, Bactericera cockerelli, is as an economically important insect pest of potatoes in the western U.S., Mexico, Central America and New Zealand. This insect has historically been linked to psyllid yellows disease, but more recently has been shown to be the vector of a bacterium that...

  2. Building a foundation for 'One Health': an education strategy for enhancing and sustaining national and regional capacity in endemic and emerging zoonotic disease management.

    Vink, W D; McKenzie, Joanna S; Cogger, Naomi; Borman, Barry; Muellner, Petra


    The rapid global spread of diseases such as SARS, H5N1, and H1N1 influenza has emphasized the pressing need for trans-disciplinary collaboration and cross-border action, and has also exposed a serious deficit of capacity and coordination in dealing effectively with emerging disease threats. The need for capacity development is particularly acute in the developing world, which is the least well-equipped to respond adequately. Such capacity development can be achieved through education and the implementation of applied 'One Health' activities. This chapter describes the establishment of a 'One Health' capacity development program in South Asia, consisting of two phases. The first phase provides Masters level training for public health doctors and veterinarians, with a focus on epidemiology, and disease control. The second phase reinforces the postgraduate training by establishing a sustainable framework for the implementation of collaborative 'One Health' activities such as the development of multidisciplinary professional networks, implementation of applied zoonotic disease investigation projects, and support for continuing professional development. The objectives are to provide individual skills required to strengthen capacity; to develop an appreciation of the cross-cutting issues which affect human and animal health, set within an institutional context; and to facilitate the development of regional professional networks which will be instrumental in implementing 'One Health' activities.

  3. Clinical multi-omics strategies for the effective cancer management.

    Yoo, Byong Chul; Kim, Kyung-Hee; Woo, Sang Myung; Myung, Jae Kyung


    Cancer is a global health issue as a multi-factorial complex disease, and early detection and novel therapeutic strategies are required for more effective cancer management. With the development of systemic analytical -omics strategies, the therapeutic approach and study of the molecular mechanisms of carcinogenesis and cancer progression have moved from hypothesis-driven targeted investigations to data-driven untargeted investigations focusing on the integrated diagnosis, treatment, and prevention of cancer in individual patients. Predictive, preventive, and personalized medicine (PPPM) is a promising new approach to reduce the burden of cancer and facilitate more accurate prognosis, diagnosis, as well as effective treatment. Here we review the fundamentals of, and new developments in, -omics technologies, together with the key role of a variety of practical -omics strategies in PPPM for cancer treatment and diagnosis. In this review, a comprehensive and critical overview of the systematic strategy for predictive, preventive, and personalized medicine (PPPM) for cancer disease was described in a view of cancer prognostic prediction, diagnostics, and prevention as well as cancer therapy and drug responses. We have discussed multi-dimensional data obtained from various resources and integration of multisciplinary -omics strategies with computational method which could contribute the more effective PPPM for cancer. This review has provided the novel insights of the current applications of each and combined -omics technologies, which showed their powerful potential for the establishment of PPPM for cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    Schwartz, Steven


    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.

  5. Management of Gastroesophageal Reflux Disease.

    Gyawali, C Prakash; Fass, Ronnie


    Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can also be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive and behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  6. The strategy of radwaste management in Slovenia

    Loose, A.; Babsek, B.; Jeran, M.


    This paper's intention is to show the present situation and future activities of the Agency for radwaste management. It was established by the slovene government to provide the strategy for a safe management of radioactive waste. The safety is the main concern of the Agency, since the situation in Slovenia is quite complex as it is a small country with a limited number of suitable locations and a strong public opposition towards anything connected with nuclear power generation or radioactivity in general. The emphasis of the Agency's activities at the moment is siting and technology selection for low level waste and intermediate level waste repository as well as solutions on interim storage of high level waste

  7. Neuromuscular diseases: Diagnosis and management.

    Mary, P; Servais, L; Vialle, R


    Neuromuscular diseases (NMDs) affect the peripheral nervous system, which includes the motor neurons and sensory neurons; the muscle itself; or the neuromuscular junction. Thus, the term NMDs encompasses a vast array of different syndromes. Some of these syndromes are of direct relevance to paediatric orthopaedic surgeons, either because the presenting manifestation is a functional sign (e.g., toe-walking) or deformity (e.g., pes cavus or scoliosis) suggesting a need for orthopaedic attention or because orthopaedic abnormalities requiring treatment develop during the course of a known NMD. The main NMDs relevant to the orthopaedic surgeon are infantile spinal muscular atrophy (a motor neuron disease), peripheral neuropathies (chiefly, Charcot-Marie-Tooth disease), congenital muscular dystrophies, progressive muscular dystrophies, and Steinert myotonic dystrophy (or myotonic dystrophy type 1). Muscle weakness is a symptom shared by all these conditions. The paediatric orthopaedic surgeon must be familiar, not only with the musculoskeletal system, but also with many other domains (particularly respiratory and cardiac function and nutrition) that may interfere with the treatment and require preoperative management. Good knowledge of the natural history of each NMD is essential to ensure optimal timing of the therapeutic interventions, which must be performed under the best possible conditions in these usually frail patients. Timing is particularly crucial for the treatment of spinal deformities due to paraspinal muscle hypotonia during growth: depending on the disease and natural history, the treatment may involve non-operative methods or growing rods, followed by spinal fusion. A multidisciplinary approach is always required. Finally, the survival gains achieved in recent years increasingly require attention to preparing for adult life, to orthopaedic problems requiring treatment before the patient leaves the paediatric environment, and to the transition towards the

  8. Evaluation of two communication strategies to improve udder health management.

    Jansen, J; Renes, R J; Lam, T J G M


    . When aiming to improve general udder health management, the central route seems to be effective if farmers are already motivated to optimize their udder health management. For farmers who are less motivated to work on udder health, the peripheral route seems to be most effective when aiming to change a single management practice. The evaluated communication strategies are examples of how management practices to control mastitis can be effectively communicated to farmers. As such, this study contributes to optimizing future programs to control and prevent diseases. Copyright 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  9. Achieving sustainable plant disease management through evolutionary principles.

    Zhan, Jiasui; Thrall, Peter H; Burdon, Jeremy J


    Plants and their pathogens are engaged in continuous evolutionary battles and sustainable disease management requires novel systems to create environments conducive for short-term and long-term disease control. In this opinion article, we argue that knowledge of the fundamental factors that drive host-pathogen coevolution in wild systems can provide new insights into disease development in agriculture. Such evolutionary principles can be used to guide the formulation of sustainable disease management strategies which can minimize disease epidemics while simultaneously reducing pressure on pathogens to evolve increased infectivity and aggressiveness. To ensure agricultural sustainability, disease management programs that reflect the dynamism of pathogen population structure are essential and evolutionary biologists should play an increasing role in their design. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Disease management: findings from leading state programs.

    Wheatley, Ben


    Disease management programs are designed to contain costs by improving health among the chronically ill. More than 20 states are now engaged in developing and implementing Medicaid disease management programs for their primary care case management and fee-for-service populations.

  11. Management strategies in hospitals: scenario planning.

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph


    Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  12. Novel strategies in immunotherapy for allergic diseases.

    Rajakulendran, Mohana; Tham, Elizabeth Huiwen; Soh, Jian Yi; Van Bever, H P


    Conventional immunotherapy (IT) for optimal control of respiratory and food allergies has been fraught with concerns of efficacy, safety, and tolerability. The development of adjuvants to conventional IT has potentially increased the effectiveness and safety of allergen IT, which may translate into improved clinical outcomes and sustained unresponsiveness even after cessation of therapy. Novel strategies incorporating the successful use of adjuvants such as allergoids, immunostimulatory DNA sequences, monoclonal antibodies, carriers, recombinant proteins, and probiotics have now been described in clinical and murine studies. Future approaches may include fungal compounds, parasitic molecules, vitamin D, and traditional Chinese herbs. More robust comparative clinical trials are needed to evaluate the safety, clinical efficacy, and cost effectiveness of various adjuvants in order to determine ideal candidates in disease-specific and allergen-specific models. Other suggested approaches to further optimize outcomes of IT include early introduction of IT during an optimal window period. Alternative routes of administration of IT to optimize delivery and yet minimize potential side effects require further evaluation for safety and efficacy before they can be recommended.

  13. Research on Energy Management Strategy of Hybrid Electric Vehicle

    Deng Tao


    Full Text Available To improve the fuel economy and reduce emissions of hybrid electric vehicles, energy management strategy has received high attention. In this paper, by analyzing the deficiency of existing energy management strategy for hybrid cars, it not only puts forward the minimal equivalent fuel consumption adaptive strategy, but also is the first time to consider the driving dynamics target simultaneously, and to explain the future development direction of China’s hybrid energy management strategy.

  14. A Knowledge Management Strategy To Achieve Organisation Competitiveness

    Dr. St. Sukmawati.


    Full Text Available The purpose of this research is to study the influence of organizational environment on the selection of knowledge management strategies. The research focuses particularly on the relationship between business and knowledge management strategy and the success of the knowledge management initiatives. This research is a case study researching 2 South Sulawesi banking companies. The knowledge management initiatives were categorized by six criteria objectives processes problems content strategy knowledge type and their fit with the respective business strategy of the organizational unit was evaluated. The findings in this research suggest a relationship between the success of knowledge management and the alignment of knowledge management and business strategy. The research also shows that an organization whose business strategy requires process efficiency should rely primarily on a codification strategy. An organization whose business strategy requires productprocess innovation should rely primarily on a personalization strategy. The most successful knowledge management projects were driven by a strong business need and with the goal to add value to the organizational unit operations. The research shows there are limitations due to the qualitative nature of the research logical rather than statistical conclusions small sample size and subjectivity of interpretations. The research sees that a manager should be aware of the objectives and business processes of the organizational unit and chooses the knowledge management strategy and objective in accordance to the business strategy and objective. Originalityvalue. The research enhances understanding about the influence of organizational environment factors on the success of knowledge management initiatives.

  15. Management of patients with chronic kidney disease

    management of the complications of CKD, e.g. renal anaemia, ... ARTICLE. Management of patients with chronic kidney disease. T Gerntholtz,1 FCP (SA); G Paget,2 ..... Telmisartan, ramipril, or both in patients at high risk for vascular events.

  16. Facilities Management a new strategy at CERN

    Nonis, M; CERN. Geneva. ST Division


    Starting from 2002, the management of all the tertiary infrastructure of CERN in charge of ST Division shall be carried out through a single Contractor; this includes both maintenance activities on the buildings and their technical installations, and general services such as security, cleaning, gardening, and waste disposal. At present, all these activities are carried out by external contractors via several different contracts. The major purposes of the unification in one single contract is to transfer the coordination tasks of the contracts thus reducing the direct control operation costs, release internal resources in order to be better focused on the core business of the Division and the reduction of the costs of each activity by taking profit of the synergies among the different services. The authors will thoroughly report on the main aspects related to this new contract, focusing their attention in particular to the result oriented strategy through a Service Level Agreement, the key performance indicato...

  17. Radioactive waste management strategies: setting the scene

    Allan, C.J.


    This work deals with the radioactive waste management strategies. The objectives, concentrated on research and development activities to evaluate the safety and feasibility of various alternatives, on the selection of suitable disposal sites and on optimization studies covering safety, environmental, industrial and economical issues are presented. The disposal concepts for deep geological disposal are based on a combination of engineered barriers and the natural barrier provided by the host geological medium. Considerable efforts have been made to evaluate the behaviour of deep geological repositories with time, and their long-term safety and form the subject of the second part. The third part speaks about the incremental decision-making process that a number of countries are following in developing disposal facilities for nuclear fuel waste. The last part deals with public involvement which is required for establishing disposal facilities. (O.L.). 10 refs

  18. Pyroprocessing as a waste management strategy

    Hannum, W.H.; Chang, Y.I.; McPheeters, C.C.


    Pyroprocessing, as incorporated in the Integral Fast Reactor (IFR) program, is being developed as a resource-efficient means of providing fuel for a reactor which has outstanding safety characteristics and performance potential. This process has been shown to be an effective way to partition uranium, transuranic elements, and fissions products. Being a gross separation process, it is not compatible with production of pure plutonium, but permits the recycle of essentially all the transuranic material to the Integral Fast Reactor for consumption. Whether this process can also significantly simplify the LWR waste disposal problem depends on the outcome of process development -- estimated to take five years, and of the subsequent applications development programs. If successful, this program could influence the ultimate waste loading of the first repository and modify the requirements for a second repository. This document, discusses the possibility of pyroprocessing being utilized in waste management strategies

  19. Performance management vital in implementing new strategies

    Kruzner, D.; Trollinger, R.


    Wedged between the growing cost of environmental compliance and consumer protests over prices, the downstream oil and gas and petrochemical business segments are having to accelerate the changes that have engulfed their industry. Despite recent price increases, thinning margins have driven energy companies to rethink their role in life and to revaluate and reshape operations and assets in pursuit of new strategies. As companies concentrate on core competencies, shift to demand-pull production, and try to leverage their clout in selected regions for market dominance, performance of key operations has become paramount. In theory, performance management is a simple, straightforward proposition. It means deploying a comprehensive, strategy-linked framework for measuring performance across the entire enterprise and then using the results of these measurements to serve two critical managerial functions. First, performance measurement is the means for making informed, knowledge-based decisions about important business issues such as minimizing operational costs, manufacturing the right mix of products, identifying the most profitable distribution channels, and optimizing the utilization of assets. Second -- and in the long run more importantly -- measuring performance is a means for identifying and addressing areas where a company needs to make the kinds of organizational and process improvements that can develop, sustain, and amplify competitive advantage over the long haul. Experiences at a variety of companies, both within and outside the oil and gas and chemical business segments, demonstrate that progress towards comprehensive performance management is possible, with quantifiable benefits and results. Competitive advantage will be enjoyed by those companies that advance further and faster down this path

  20. Healthcare management strategies: interdisciplinary team factors.

    Andreatta, Pamela; Marzano, David


    Interdisciplinary team factors are significant contributors to clinical performance and associated patient outcomes. Quality of care and patient safety initiatives identify human factors associated with team performance as a prime improvement area for clinical patient care. The majority of references to interdisciplinary teams in obstetrics and gynecology in the literature recommends the use of multidisciplinary approaches when managing complex medical cases. The reviewed literature suggests that interdisciplinary team development is important for achieving optimally efficient and effective performance; however, few reports provide specific recommendations for how to optimally achieve these objectives in the process of providing interdisciplinary care to patients. The absence of these recommendations presents a significant challenge for those tasked with improving team performance in the workplace. The prescribed team development programs cited in the review are principally built around communication strategies and simulation-based training mechanisms. Few reports provide descriptions of optimal team-based competencies in the various contexts of obstetric and gynecology teams. However, team-based evaluation strategies and empirical data documenting the transfer of team training to applied clinical care are increasing in number and quality. Our findings suggest that research toward determining team factors that promote optimal performance in applied clinical practice requires definition of specific competencies for the variable teams serving obstetrics and gynecology.

  1. Strategy of image management in retail shops

    Sandra Soče Kraljević


    Full Text Available A sound positioning in consumers’ mind, along with strong promotion support, brought many retail shops to the top. This is mostly thanks to the image created in the consumers’ mind. A retail shop’s image may but need not conform to reality. Image often looks like a cliché. It overstates certain elements of the shop while simply omitting others. That is exactly why image is of great importance and often crucial to consumer behavior. This paper aims at determining the impact of image on customer behavior in the course of decision making about shopping and choosing a particular retail shop. Image is a significant factor of success of every company, hence also of a retail shops. It is a relatively strong value and a component of creating competitive advantage. But if we do not pay sufficient attention to image, it can become counterproductive. Instead to, like an additional value helps creating and maintaining the advantage in competition and realization of business aims, transforms into a limiting factor. Therefore, it is imperative to identify the elements of image that are of greatest importance to customers. Research has shown that customers choose the retail shop first and after that products and brands within this shop. When it comes to the supermarket, as a kind of retail shop, research has shown that two out of three shopping decisions are made by the customer on the spot, that is, without previous planning. That practically means that we can influence customers with different sales techniques. The paper suggests different strategies of image management for supermarkets and conventional shops. For supermarkets it is the “widest assortment” strategy, while for conventional shops the strategy is that of a “selected group of products“. Improvements to research methods will enable getting more information about customer behavior, while pressures of increased competition in the business environment will force retailers to get

  2. Effectiveness of alternative management strategies in meeting conservation objectives

    Richards S. Holthausen; Carolyn Hull Sieg


    This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

  3. Management of hair loss diseases

    Manabu Ohyama


    Full Text Available The treatment of hair loss diseases is sometimes difficult because of insufficient efficacy and limited options. However, recent advances in understanding of the pathophysiology and development of new remedies have improved the treatment of refractory hair loss conditions. In this article, an update on the management of hair loss diseases is provided, especially focusing on recently reported therapeutic approaches for alopecia areata (AA. An accurate diagnosis is indispensable to optimize treatment. Dry dermoscopy represents new diagnostic techniques, which could enable the differentiation of barely indistinguishable alopecias, e.g. AA and trichotillomania. An organized scalp biopsy adopting both vertical and transverse sectioning approaches also provides a deep insight into the pathophysiology of ongoing alopecias. Among various treatments for AA, intraregional corticosteroid and contact immunotherapy have been recognized as first-line therapies. However, some AA cases are refractory to both treatments. Recent studies have demonstrated the efficacy of pulse corticosteroid therapy or the combination of oral psoralen ultraviolet A therapy and systemic corticosteroids for severe AA. Previous clinical observations have suggested the potential role of antihistamines as supportive medications for AA. Experimental evaluation using AA model mice further supports their effectiveness in AA treatment. Finasteride opens up new possibilities for the treatment of androgenetic alopecia. For androgenetic alopecia patients refractory to finasteride, the combination of finasteride with topical minoxidil or the administration of dutasteride, another 5 alpha-reductase inhibitor, may provide better outcomes. Scarring alopecia is the most difficult form of hair loss disorder to treat. The bulge stem cell area is destroyed by unnecessary immune reactions with resultant permanent loss of hair follicle structures in scarring alopecia. Currently, treatment options for

  4. Primary immunodeficiency disease: a model for case management of chronic diseases.

    Burton, Janet; Murphy, Elyse; Riley, Patty


    Patient-centered chronic care management is a new model for the management of rare chronic diseases such as primary immunodeficiency disease (PIDD). This approach emphasizes helping patients become experts on the management of their disease as informed, involved, and interactive partners in healthcare decisions with providers. Because only a few patients are affected by rare illnesses, these patients are forced to become knowledgeable about their disease and therapies and to seek treatment from a healthcare team, which includes physicians and nurse specialists who are equipped to manage the complexity of the disease and its comorbidities. Importantly, therapy for PIDD can be self-administered at home, which has encouraged the transition toward a proactive stance that is at the heart of patient-centered chronic care management. We discuss the evolution of therapy, the issues with the disease, and challenges with its management within the framework of other chronic disease management programs. Suggestions and rationale to move case management of PIDD forward are presented with the intent that sharing our experiences will improve process and better manage outcomes in this patient population. The patient-centered model for the management of PIDD is applicable to the primary care settings, where nurse case managers assist patients through education, support them and their families, and facilitate access to community resources in an approach, which has been described as "guided care." The model also applies specifically to immunology centers where patients receive treatment or instruction on its self-administration at home. Patient-centered management of PIDD, with its emphasis on full involvement of patients in their treatment, has the potential to improve compliance with treatment, and thus patient outcomes, as well as patients' quality of life. The patient-centered model expands the traditional model of chronic disease management, which relies on evidence

  5. Yam diseases and its management in Nigeria | Amusa | African ...

    Dry rot of yams alone causes a marked reduction in the quantity, marketable value and edible portions of tubers and those reductions are more severe in stored yams. The management strategies adopted and advocated for combating the field diseases includes the use of crop rotation, fallowing, planting of healthy material, ...

  6. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

    Krumholz, Harlan M; Currie, Peter M; Riegel, Barbara; Phillips, Christopher O; Peterson, Eric D; Smith, Renee; Yancy, Clyde W; Faxon, David P


    form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden. This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.

  7. Managing rheumatic and musculoskeletal diseases - past, present and future.

    Burmester, Gerd R; Bijlsma, Johannes W J; Cutolo, Maurizio; McInnes, Iain B


    Progress in rheumatology has been remarkable in the past 70 years, favourably affecting quality of life for people with rheumatic and musculoskeletal diseases. Therapeutics have advanced considerably in this period, from early developments such as the introduction of glucocorticoid therapy to the general use of methotrexate and other disease-modifying agents, followed by the advent of biologic DMARDs and, most recently, small-molecule signalling inhibitors. Novel strategies for the use of such agents have also transformed outcomes, as have multidisciplinary nonpharmacological approaches to the management of rheumatic musculoskeletal disease including surgery, physical therapy and occupational therapy. Breakthroughs in our understanding of disease pathogenesis, diagnostics and the use of 'big data' continue to drive the field forward. Critically, the patient is now at the centre of management strategies as well as the future research agenda.

  8. [Chronic disease management: mistaken approach in the elderly].

    Veras, Renato Peixoto


    Lifestyle changes, including unhealthy eating habits and high rates of physical inactivity and stress, along with an increase in life expectancy have been accompanied by increasing rates of chronic non-communicable diseases. Chronic diseases are the main causes of death and disability in Brazil. Chronic disease management is one of the most important challenges facing health managers who are constantly seeking interventions and strategies to reduce costs and hospital admissions and to prevent other conditions. However, most existing models of health care have focused exclusively on disease, but it is a mistaken approach. An integrated approach is required to effectively meet patient needs. The purpose of this article was to further discuss policies and strategies for the development of new models of care for the elderly with an emphasis on prevention and resolution actions.

  9. Emergency management: Concepts and strategies for effective programs

    Lucus, Valerie


    Review of Emergency Management: Concepts and Strategies for Effective Programs By Lucien G. Canton, CEM. By taking a different perspective on local government emergency management programs, this book presents the vision for a very different model--one that includes an independent emergency manager leading an enterprise-wide program focused on strategies that promote disaster resilient communities.

  10. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    Nields, Allison N.


    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  11. A holistic strategy for adaptive land management

    Adaptive management is widely applied to natural resources management. Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adapta...

  12. Management Strategies in Advanced Uterine Leiomyosarcoma: Focus on Trabectedin

    Frédéric Amant


    Full Text Available The treatment of advanced uterine leiomyosarcomas (U-LMS represents a considerable challenge. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made postoperatively. Whilst a total abdominal hysterectomy is the cornerstone of management of early disease, the role of routine adjuvant pelvic radiotherapy and adjuvant chemotherapy is less clear, since they may improve local tumor control in high risk patients but are not associated with an overall survival benefit. For recurrent or disseminated U-LMS, cytotoxic chemotherapy remains the mainstay of treatment. There have been few active chemotherapy drugs approved for advanced disease, although newer drugs such as trabectedin with its pleiotropic mechanism of actions represent an important addition to the standard front-line systemic therapy with doxorubicin and ifosfamide. In this review, we outline the therapeutic potential and in particular the emerging evidence-based strategy of therapy with trabectedin in patients with advanced U-LMS.

  13. Comparative analysis of dynamic pricing strategies for managed lanes.


    The objective of this research is to investigate and compare the performances of different : dynamic pricing strategies for managed lanes facilities. These pricing strategies include real-time : traffic responsive methods, as well as refund options a...


    Stankovska, Iryna


    The article explores the use of  аdministrative instruments in implementing functional strategies competitiveness management. Due to providing strategic financial management competitiveness the use of administrative levers of control in the formulation and implementation of financial strategies were investigated. System of financial policies forming by individual policies of  general financial strategy, which is an administrative levers of influence on implementation strategies, was proposed...


    Bosch, Darrell J.; Johnson, Christian J.


    Variability in feed prices and crop yields are important sources of risk to dairy farmers. A simulation model of a representative dairy farm was used to evaluate crop insurance and hedging as risk management strategies. These strategies lowered expected net returns but also reduced risk. The preferred set of strategies at lower levels of risk aversion included hedging and crop insurance, although a base scenario in which no risk management strategies were employed was also efficient. The pref...

  16. Disease management strategy for macadamia quick decline

    Trees infected with Macadamia Quick Decline (MQD) exhibit excessive sap bleeding from the trunk, frass from ambrosia beetle feeding, orange fruiting bodies of the fungus Nectria rugulosa and yellowing and browning of the leaves within the tree canopy. MQD threatens commercial and residential product...

  17. Data warehousing in disease management programs.

    Ramick, D C


    Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care.

  18. Evolutionary space station fluids management strategies


    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  19. Strategy-driven talent management a leadership imperative

    Silzer, Rob


    A Publication of the Society for Industrial and Organizational Psychology Praise for Strategy-Driven Talent Management ""Silzer and Dowell''s Strategy-Driven Talent Management provides a comprehensive overview of the different elements of the best talent management processes used in organizations today. This is a valuable resource for leaders and managers, HR practitioners and anyone involved in developing leadership talent.""-Ed Lawler, Professor, School of Business, University of Southern California ""Talent is the key to successful execution of a winning business strategy. Strategy-Driven T

  20. Towards an Effective Management Strategy for Passive RFID Implementation

    Fisch, John N; Koch, David M


    .... However, many issues central to passive RFID implementation remain unresolved. First and foremost, a comprehensive management strategy, including a complete redesign of business practices, must be developed...

  1. Integrated Weed Management Strategies for Control of Hydrilla

    Nelson, Linda S; Shearer, Judy F


    ...), and the fungal pathogen Mycoleptodiscus terrestris (Gerd.) Ostazeski, applied alone and in combination with one another, as an integrated weed management strategy against the nuisance aquatic plant, hydrilla...

  2. Tickborne infectious diseases: diagnosis and management

    Cunha, Burke A


    ... to particular flora and fauna. The purpose of Tickborne Infectious Diseases: Diagnosis and Management is to condense in a single book different approaches and paradigms of tickborne infectious diseases. Three chapters are devoted to background information, including the natural history of ticks, the diagnostic procedures of tickborne diseases, and the new tick-transm...

  3. Inflammatory bowel disease: potential therapeutic strategies

    Nielsen, O H; Vainer, B; Bregenholt, S


    This review deals with potential and possibly primary therapeutics that, through insight into the inflammatory cascade, result in more rational treatment principles replacing the classical therapy of inflammatory bowel disease (IBD), i.e. Crohn's disease (CD) and ulcerative colitis (UC). These ne...

  4. Role for automated communication strategies in medication adherence management.

    Ross, S Michael


    Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.


    Iryna Stankovska


    Full Text Available The article explores the use of  аdministrative instruments in implementing functional strategies competitiveness management. Due to providing strategic financial management competitiveness the use of administrative levers of control in the formulation and implementation of financial strategies were investigated. System of financial policies forming by individual policies of  general financial strategy, which is an administrative levers of influence on implementation strategies, was proposed. Structure strategic alternatives of financial and investment strategy implementation based on the decomposition and decision tree was formed. To select strategic alternatives, to identify strategic gaps and evaluate deviations from specified target markers in the implementation of financial policies using GAP-analysis that is a tool of management analysis was proposed. Key words: functional strategy, financial strategy, competitiveness management, financial policy, administrative instruments, GAP-analysis.

  6. Bussines strategy or bussines policy management applied in modern firms

    Enea, C.


    Full Text Available In literature, the term widely used for all action levels of strategic management is that of strategy. For this reason, it is necessary to achieve a differentiation between corporate strategies (typical strategies, business strategies (with policies, operational strategies (business plans and operational strategies (programs and tactics.In the same context, strategies become the basis for the definition and implementation of policies, which differ by time horizon that is lower and their higher intake of detail. The latter are updated permanently, in order to remain set on, realistic, consistent with the changes that occur and detailing in concrete plans and programs as a logical scheme. So, strategic management is that management based on the application of strategies and policies with a view to setting and achieving goals.

  7. The notion of strategy in facility management

    Holzweber, Markus

    Based on a literature review, the findings of the study report a service-strategy classification grid. Such a service-strategy grid provides for a better understanding of the business environment. The study findings are intended to enhance business managers’ understandings of the issues behind FM...... strategy....

  8. Demyelinating diseases and potential repair strategies

    Radtke, C.; Spies, M.; Sasaki, M.; Vogt, PM; Kocsis, J. D.


    Demyelination is associated with a number of neurological disorders including multiple sclerosis (MS), spinal cord injury and nerve compression. MS lesions often show axon loss and therefore reparative therapeutic goals include remyelination and neuroprotection of vulnerable axons. Experimental cellular transplantation has proven successful in a number of demyelination and injury models to remyelinate and improve functional outcome. Here we discuss the remyelination and neuroprotective potential of several myelin-forming cells types and their behavior in different demyelination and injury models. Better understanding of these models and current cell-based strategies for remyelination and neuroprotection offer exciting opportunities to develop strategies for clinical studies. PMID:17408905

  9. Laparoscopic Management of Hepatic Hydatid Disease

    Palanivelu, C; Jani, Kalpesh; Malladi, Vijaykumar; Senthilkumar, R.; Rajan, P. S.; Sendhilkumar, K.; Parthasarthi, R.; Kavalakat, Alfie


    Background: Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. Methods: Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula sys...


    Ysa, Tamyko; Sierra, Vicenta; Esteve, Marc


    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized.

  11. Multinational corporations and infectious disease: Embracing human rights management techniques.

    Salcito, Kendyl; Singer, Burton H; Weiss, Mitchell G; Winkler, Mirko S; Krieger, Gary R; Wielga, Mark; Utzinger, Jürg


    by companies, governments and civil society provides a roadmap for engaging business enterprises in rights-based disease management strategies to mitigate disease transmission rates and improve human welfare outcomes.




    Full Text Available Sickle cell disease (SCD is a genetically transmitted multisystem disease1 which includes a group of disorders that differs in severity sign and symptoms, The disease is not uniformly seen everywhere but it has some topographical distribution. In India, it is frequently seen in Central India, in and around the vicinity of Chhattisgarh in some religions in caste like kurmis, satnami, mahar, other backward caste and some tribes, it has great pathological significance considering the high morbidity and mortality resulting from the disease process. We have studied the cases of SCD from 2001 to 2015 series of such patients, since there is no cure of this disease, in regards to prevention of this genetic autosomal recessive disorder by marriage counseling, the incidence can be significantly reduced by avoiding consanguineous marriages in the susceptible community.

  13. Strategies for sustainable management of renewable resources during environmental change.

    Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon


    As a consequence of global environmental change, management strategies that can deal with unexpected change in resource dynamics are becoming increasingly important. In this paper we undertake a novel approach to studying resource growth problems using a computational form of adaptive management to find optimal strategies for prevalent natural resource management dilemmas. We scrutinize adaptive management, or learning-by-doing, to better understand how to simultaneously manage and learn about a system when its dynamics are unknown. We study important trade-offs in decision-making with respect to choosing optimal actions (harvest efforts) for sustainable management during change. This is operationalized through an artificially intelligent model where we analyze how different trends and fluctuations in growth rates of a renewable resource affect the performance of different management strategies. Our results show that the optimal strategy for managing resources with declining growth is capable of managing resources with fluctuating or increasing growth at a negligible cost, creating in a management strategy that is both efficient and robust towards future unknown changes. To obtain this strategy, adaptive management should strive for: high learning rates to new knowledge, high valuation of future outcomes and modest exploration around what is perceived as the optimal action. © 2017 The Author(s).

  14. Evaluation of Advanced Data Centre Power Management Strategies

    Postema, Björn F.; Haverkort, Boudewijn R.


    In recent work, we proposed a new specification language for power management strategies as an extension to our AnyLogic-based simulation framework for the trade-off analysis of power and performance in data centres. In this paper, we study the quality of such advanced power management strategies

  15. Recreational user attitudes towards management strategies of Allegany State Park

    Michael Nisengard; Miklos Gratzer


    This project examines attitudes towards management strategies of four Allegany State Park recreational user groups: cabin users, recreational vehicle users, tent users, and day users. It investigates recreational user group attitude differences, and attitude change over a ten year time period, in regard to the following park management strategy categories: park...

  16. Crohn Disease: Epidemiology, Diagnosis, and Management.

    Feuerstein, Joseph D; Cheifetz, Adam S


    Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  17. Region of the eye. Strategy for the management of malignant tumours of the orbit

    Freeman, J.E.


    The strategy for the management of the various malignant tumours of the orbit was tabulated and also illustrated in diagrams. Table 1. Strategy for retinoblastoma; Table 2. Strategy for malignant melanoma: (a) intra-ocular, (b) epibulbar; Table 3. Strategy for squamous cell carcinoma: (a) conjunctival, (b) palpebral; Table 4. Strategy for basal cell carcinoma: (a) palpebral, (b) intra-orbital; Table 5. Strategy for rhabdomyosarcoma (and embryoma) of the orbit; Table 6. Strategy for lymphosarcoma of the orbit; Table 7. Strategy for other tumours of the orbit or adnexa: (A) hystiocytosis X, (B) adenocarcinoma of the lachrymal gland, (C) optic nerve glioma, (D) para-nasal sinus tumours involving orbit; Table 8. Strategy for systemic or metastatic disease involving the orbit or contents: (a) intra-ocular [(i) leukaemia, (ii) carcinoma of the breast or of the bronchus], (b) orbital or peri-orbital [(i) leukaemia, (ii) neuroblastoma, (iii) histiocytosis X, (iv) lymphoma

  18. International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management.

    Giacomelli, Roberto; Afeltra, Antonella; Alunno, Alessia; Baldini, Chiara; Bartoloni-Bocci, Elena; Berardicurti, Onorina; Carubbi, Francesco; Cauli, Alberto; Cervera, Ricard; Ciccia, Francesco; Cipriani, Paola; Conti, Fabrizio; De Vita, Salvatore; Di Benedetto, Paola; Doria, Andrea; Drosos, Alexandros A; Favalli, Ennio Giulio; Gandolfo, Saviana; Gatto, Mariele; Grembiale, Rosa Daniela; Liakouli, Vasiliki; Lories, Rik; Lubrano, Ennio; Lunardi, Claudio; Margiotta, Domenico Paolo Emanuele; Massaro, Laura; Meroni, Pierluigi; Minniti, Antonia; Navarini, Luca; Pendolino, Monica; Perosa, Federico; Pers, Jacques-Olivier; Prete, Marcella; Priori, Roberta; Puppo, Francesco; Quartuccio, Luca; Ruffatti, Amelia; Ruscitti, Piero; Russo, Barbara; Sarzi-Puttini, Piercarlo; Shoenfeld, Yehuda; Somarakis, George A; Spinelli, Francesca Romana; Tinazzi, Elisa; Triolo, Giovanni; Ursini, Francesco; Valentini, Gabriele; Valesini, Guido; Vettori, Serena; Vitali, Claudio; Tzioufas, Athanasios G


    Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity. Copyright © 2017. Published by Elsevier B.V.

  19. Legitimation Endeavors: Impression Management Strategies Used by an Organization.

    Allen, Myria Watkins; Caillouet, Rachel H.


    Investigates the impression management strategies embedded in the external discourse of an organization in crisis. Shows ingratiation to be the primary strategy. Finds that intimidation was used with special interest groups and that denouncement strategies were embedded in messages to competitors, special interest groups, and suppliers. (SR)

  20. Strategy Maps in University Management: A Comparative Study

    Han, Shuangmiao; Zhong, Zhou


    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  1. Scientists adopt new strategy to find Huntington's disease therapies

    ... Links PubMed Stem Cell Information OppNet NIDB NIH Blueprint for Neuroscience Research Institutes at NIH List of ... Release Friday, August 7, 2015 Scientists adopt new strategy to find Huntington’s disease therapies A skyline view ...

  2. New Directions in Chronic Disease Management

    Hun-Sung Kim


    Full Text Available A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.


    Nicolae PLATON


    Full Text Available For managerial practice it is important to know the methodology of developing a tourism business strategy, more than the theoretical concepts related to this field. The enterprise strategy is an important lever to boost and support the change of emphasis of the creative side of the organization's management. Based on these prerequisites, the author makes an overview of the need to adopt a management strategy within the enterprise, describes the defining features of the strategy in the view of some authors, classifies the strategies according to several criteria, proposes a management model specific to the tourism enterprise, carries out the comparative analysis of how to formulate and how to implement the strategy, characterizes the difficulties that arise in the process of strategy implementation.

  4. Assessment of uncertainties in severe accident management strategies

    Kastenberg, W.E.; Apostolakis, G.; Catton, I.; Dhir, V.K.; Okrent, D.


    Recent progress on the development of Probabilistic Risk Assessment (PRA) as a tool for qualifying nuclear reactor safety and on research devoted to severe accident phenomena has made severe accident management an achievable goal. Severe accident management strategies may involve operational changes, modification and/or addition of hardware, and institutional changes. In order to achieve the goal of managing severe accidents, a method for assessment of strategies must be developed which integrates PRA methodology and our current knowledge concerning severe accident phenomena, including uncertainty. The research project presented in this paper is aimed at delineating uncertainties in severe accident progression and their impact on severe accident management strategies

  5. Travel related diseases and optimizing preventive strategies

    Wieten, R.W.


    With the figure of 1 billion annual travellers continuously increasing, travel is becoming more and more common. The binding element of this thesis is the aim to contribute to the improvement of pre-travel healthcare. The diseases studied either carry a high mortality (rabies, malaria, yellow fever)

  6. Management strategies in the treatment of neonatal and pediatric gastroenteritis

    Ciccarelli S


    Full Text Available Simona Ciccarelli,1 Ilaria Stolfi,1 Giuseppe Caramia2 1Neonatal Intensive Care Unit, Sapienza University of Rome, Rome, Italy; 2Division of Neonatology and Pediatrics, Maternal and Child Hospital "G. Salesi", Ancona, Italy Abstract: Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron, some antidiarrheal agents (racecadotril, and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the

  7. Management strategies of sarcomas of the ankle and foot

    Douglas, R.M.; Mankin, H.J.; Jennings, L.C.; Gebhardt, M.C.; Harmon, D.; Ancukiewicz, M.; Suit, H.D.; Spiro, Ira J.


    Purpose: To evaluate the management and outcomes of 40 patients treated at the Massachusetts General Hospital between 1974 and September 1996 for soft tissue sarcomas of the foot or ankle. Materials and Methods: Seventy seven percent of patients had AJCC stage II or III disease. Primary disease was treated in 28 patients while recurrent disease was addressed in 12. The mean tumor size was 4.6 cm with a median tumor size of 4.0 cm, (range 1 to 15 cm). Seventeen patients were treated with surgery followed by radiation therapy for primary or recurrent disease. Preoperative radiation therapy was employed in 15 patients, 5 of whom received additional postoperative radiation therapy for close or positive margins. Six patients received radiation treatment alone. Amputations were performed in 5 patients. Two amputations were performed due to inadequate surgical margins obtained at the time of resection. Three amputations were performed due to local failure. The median preoperative radiation dose was 48 Gy. The median total dose was 59 Gy (range 22 Gy to 70 Gy). Chemotherapy was incorporated in the therapy of 6 patients. Results: After a mean follow-up of 4.9 years, 28 (70%) patients remain without evidence of disease. Four patients have died of disease. Five patients have died of intercurrent disease or another cancer. Three patients remain alive with disease. There were 5 isolated local failures, 4 distant failures and 1 combined local and distant failure. Of the 5 patients with isolated local failures, 3 were treated with radiation alone. The most common site of distant failure was the lung. Actuarial local control rates are 80% at 5 and 10 years in this population. Actuarial overall survival at 5 and 10 years are 83% and 69% respectively. Wound healing difficulties occurred in 13 patients. Seven patients suffered a wound dehiscence. Five patients required therapy for wound dehiscence and infection and one patient was treated for wound infection only. In six patients

  8. Effective strategies for comprehensive corridor management


    Despite the increasing importance of comprehensive corridor management at the state and local government level, questions remain regarding effective methods for developing and implementing corridor management plans. Further insight is also needed int...

  9. Morgellons Disease: Managing a Mysterious Skin Condition

    ... condition that affects your thinking, moods or behavior. Pearson ML, et al. Clinical epidemiologic, histopathologic and molecular ... Dermatology. 2014;15:71. Yan BY, et al. Management of Morgellons disease with low-dose trifluoperazine. JAMA ...

  10. Developing management strategies for riparian areas.

    D.E. Hibbs; S. Chan


    This talk outlines four principles that are critical to successful management of a riparian area. First, given problems both with defining historic conditions and with returning to them, attaining management goals based on restoration of ecological processes and functions will be far more successful. Second, the management goals for any stream reach must be placed in a...

  11. A national cohesive wildland fire management strategy

    Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination. Department of the Interior


    Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

  12. Can curriculum managers' reflections produce new strategies ...

    managers) who used Moodle visions to manage their school curriculum at a school in Durban, South Africa. The curriculum managers' main aim of using Moodle was to improve teacher and learner performance. The purpose of the study was to ...

  13. Strategies for Managing a Multigenerational Workforce

    Iden, Ronald


    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

  14. Environmental management: a re-emerging vector control strategy.

    Ault, S K


    Vector control may be accomplished by environmental management (EM), which consists of permanent or long-term modification of the environment, temporary or seasonal manipulation of the environment, and modifying or changing our life styles and practices to reduce human contact with infective vectors. The primary focus of this paper is EM in the control of human malaria, filariasis, arboviruses, Chagas' disease, and schistosomiasis. Modern EM developed as a discipline based primarily in ecologic principles and lessons learned from the adverse environmental impacts of rural development projects. Strategies such as the suppression of vector populations through the provision of safe water supplies, proper sanitation, solid waste management facilities, sewerage and excreta disposal systems, water manipulation in dams and irrigation systems, vector diversion by zooprophylaxis, and vector exclusion by improved housing, are discussed with appropriate examples. Vectors of malaria, filariasis, Chagas' disease, and schistosomiasis have been controlled by drainage or filling aquatic breeding sites, improved housing and sanitation, the use of expanded polystyrene beads, zooprophylaxis, or the provision of household water supplies. Community participation has been effective in the suppression of dengue vectors in Mexico and the Dominican Republic. Alone or combined with other vector control methods, EM has been proven to be a successful approach to vector control in a number of places. The future of EM in vector control looks promising.

  15. Conflict management strategies for effective performance of ...

    Community conflicts are becoming regular feature of social life in many developing countries since the 1960(s). This study proposes for the inclusion of conflict resolution strategies in agricultural extension programs as farmers and farm lands are the most affected. It also examines the various conflict survival strategies ...

  16. A holistic strategy for adaptive land management

    Herrick, Jeffrey E.; Duniway, Michael C.; Pyke, David A.; Bestelmeyer, Brandon T.; Wills, Skye A.; Brown, Joel R.; Karl, Jason W.; Havstad, Kris M.


    Adaptive management is widely applied to natural resources management (Holling 1973; Walters and Holling 1990). Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adaptation of management until desired results are achieved (Brown and MacLeod 1996; Savory and Butterfield 1999). However, adaptive management is often criticized because very few projects ever complete more than one cycle, resulting in little adaptation and little knowledge gain (Lee 1999; Walters 2007). One significant criticism is that adaptive management is often used as a justification for undertaking actions with uncertain outcomes or as a surrogate for the development of specific, measurable indicators and monitoring programs (Lee 1999; Ruhl 2007).

  17. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

    Mackey, Laura M; Doody, Catherine; Werner, Erik L; Fullen, Brona


    Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented. © The Author

  18. Analysis of Solid Waste Management and Strategies for Bangkok Metropolitan

    Palika Wannawilai


    Full Text Available This study aimed to examine and analyze strategic gaps and the environment of waste management of Bangkok Metropolitan Administration (BMA in order to suggest suitable waste management strategies for Bangkok Metropolitan. The study was conducted by interviewing BMA and districts’ administrators and officers, local leaders and people, and private sectors, conducting a focus group, as well as reviewing relevant documents. The data was analyzed by applying Gap analysis and SWOT analysis. The proposed five strategies are: 1 enhancement of efficiency in solid waste and hazardous waste management; 2 discipline, participation and responsibility of citizens and all sectors related to waste management; 3 appropriate and integrated waste management; 4 capacity building for BMA’s staff and improvement of solid waste management system; and 5 research and development of knowledge and technology in waste management. The study also suggested driving approaches for effective implementation of the strategies.

  19. Perceptions of Disease State Management Among Pakistani ...

    Purpose: To explore the perceptions of disease state management among Pakistani hypertensive patients. Methods: A focus group discussion was conducted with 19 hypertensive patients in order to obtain an insight into their self-management practices. The study was conducted in Sandeman Provincial Hospital, Quetta, ...

  20. Mobile phone technology in chronic disease management

    Blake, Holly


    Mobile phones are being used to improve nurse-patient communication and monitor health outcomes in chronic disease. Innovative applications of mobile technology are expected to increase over time in community management of cancer, heart disease, asthma and diabetes. This article focuses on mobile phone technology and its contribution to health care.

  1. Self-management education and support in chronic disease management.

    McGowan, Patrick T


    With the changing health care environment, prevalence of chronic health conditions, and burgeoning challenges of health literacy, obesity, and homelessness, self-management support provides an opportunity for clinicians to enhance effectiveness and, at the same time, to engage patients to participate in managing their own personal care. This article reviews the differences between patient education and self-management and describes easy-to-use strategies that foster patient self-management and can be used by health care providers in the medical setting. It also highlights the importance of linking patients to nonmedical programs and services in the community. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Effects of new forest management strategies on squirrel populations.

    Andrew B. Carey


    Two strategies for managing forests for multiple values have achieved prominence in debates in the Pacific Northwest: (1) legacy retention with passive management and long rotations, and (2) intensive management for timber with commercial thinnings and long rotations. Northern flying squirrels (Glaucomys sabrinus), Townsend's chipmunks (

  3. Open Source for Knowledge and Learning Management: Strategies beyond Tools

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.


    In the last years, knowledge and learning management have made a significant impact on the IT research community. "Open Source for Knowledge and Learning Management: Strategies Beyond Tools" presents learning and knowledge management from a point of view where the basic tools and applications are provided by open source technologies.…

  4. [Centralized management strategy of the infant incubators in NICUs].

    Liu, Hong-cheng


    There are many problems existing at present in the incubator applications and management. Among them, the prominent problems are their cleaning and disinfection. We hope to find, through the centralized management and clinical engineering, an efficient strategy in order to get more reasonable and better maintenance, cleaning and training for infant incubators in NICUs. Scientific management will provide an excellent service to infant patients.

  5. Community strategies of women in educational management ...

    Abstract. This article focuses on the communication strategies of women principals in ... and the implications for the workplace outlined by means of a literature review. ... the constraints of traditional culture regarding communication and coping ...

  6. Environmental factors and health information technology management strategy.

    Menachemi, Nir; Shin, Dong Yeong; Ford, Eric W; Yu, Feliciano


    : Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.


    Elena DOVAL


    Full Text Available The changes in organizations appear as a reaction to the organizational environment changes. In order to manage these changes successfully, the managers need to anticipate and design alternative strategies by preparing different options.  Nevertheless, the complexity of the global environment forces the managers to adopt strategies for their organizations that are facilitating the creation of new strategic competences and competitive advantages to face the environmental rapid changes. In this context, this paper is aiming to illustrate the main directions the change management may consider to change the organization strategies in order to harmonize them to the external environment, such as: integration versus externalization, flexible specialization and flexible organization, standardization versus adaptation, market segmentation, relationship building and maintaining and communication integration.  However, the new strategies are based on a changed attitude of the managers towards the competitive advantage that is dynamic and focused on creation rather then to operations.

  8. Effects of Levodopa on Postural Strategies in Parkinson's disease.

    Baston, Chiara; Mancini, Martina; Rocchi, Laura; Horak, Fay


    Altered postural control and balance are major disabling issues of Parkinson's disease (PD). Static and dynamic posturography have provided insight into PD's postural deficits; however, little is known about impairments in postural coordination. We hypothesized that subjects with PD would show more ankle strategy during quiet stance than healthy control subjects, who would include some hip strategy, and this stiffer postural strategy would increase with disease progression. We quantified postural strategy and sway dispersion with inertial sensors (one placed on the shank and one on the posterior trunk at L5 level) while subjects were standing still with their eyes open. A total of 70 subjects with PD, including a mild group (H&Y≤2, N=33) and a more severe group (H&Y≥3, N=37), were assessed while OFF and while ON levodopa medication. We also included a healthy control group (N=21). Results showed an overall preference of ankle strategy in all groups while maintaining balance. Postural strategy was significantly lower ON compared to OFF medication (indicating more hip strategy), but no effect of disease stage was found. Instead, sway dispersion was significantly larger in ON compared to OFF medication, and significantly larger in the more severe PD group compared to the mild. In addition, increased hip strategy during stance was associated with poorer self-perception of balance. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Management of thyroid eye disease

    Bartalena, Luigi; Tanda, Maria Laura; Marcocci, Claudio; Pinchera, Aldo


    Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists. (orig.)

  10. Management of thyroid eye disease

    Bartalena, Luigi; Tanda, Maria Laura [Department of Endocrinology, University of Insubria, Ospedale di Circolo, Viale Borri, 57, 21100 Varese (Italy); Marcocci, Claudio; Pinchera, Aldo [Department of Endocrinology and Metabolism, University of Pisa, Pisa (Italy)


    Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists. (orig.)

  11. Implementing practice management strategies to improve patient care: the EPIC project.

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna


    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  12. Immunotherapeutic Strategies for Alzheimer's Disease Treatment

    Beka Solomon


    Full Text Available Naturally occurring antibodies against amyloid-β peptides have been found in human cerebrospinal fluid and in the plasma of healthy individuals, but were significantly lower in Alzheimer's disease (AD patients, suggesting that AD may be an immunodeficient disorder. The performance of anti-amyloid-β antibodies in transgenic mice models of AD showed that they are delivered to the central nervous system, preventing and dissolving amyloid-β plaques. Moreover, these antibodies protected the mice from learning and age-related memory deficits. Active and/or passive immunization against the amyloid-β peptide has been proposed as a method for preventing and/or treating AD. Immunotherapy represents fascinating ways to test the amyloid hypothesis and offers genuine opportunities for AD treatment, but requires careful antigen and antibody selection to maximize efficacy and minimize adverse events.

  13. Benchmarking Outdoor Expeditionary Program Risk Management Strategies

    Meerts-Brandsma, Lisa; Furman, Nate; Sibthorp, Jim


    In 2003, the University of Utah and the National Outdoor Leadership School (NOLS) completed a study that developed a risk management taxonomy in the outdoor adventure industry and assessed how different outdoor expeditionary programs (OEPs) managed risk (Szolosi, Sibthorp, Paisley, & Gookin, 2003). By unifying the language around risk, the…

  14. 10 Budget-Savvy Content Management Strategies

    Hillis, David J.


    Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

  15. Strategies of management of the nuclear fuel

    Leon, J.R.; Perez, A.; Filella, J.M.


    The management of nuclear fuel is depending on several factors: - Regulatory commission. The enterprises owner of the NPPs.The enterprise owner of the energy distribution. These factors are considered for the management of nuclear fuel. The design of fuel elements, the planning of cycles, the design of core reactors and the costs are analyzed. (Author)

  16. Strategies of smallholder irrigation management in Zimbabwe

    Manzungu, E.


    The smallholder irrigation sub-sector in Zimbabwe, according to literature sources, is under threat due to what are called management problems. Poor water management and low crop yields have been cited, as has also been poor financial and economic viability, resulting in heavy government

  17. Strategies to address management challenges in larger intensive care units.

    Matlakala, M C; Bezuidenhout, M C; Botha, A D H


    To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

  18. Strategy Scriptions: On sociomaterial devices staging strategy formulation European Management Journal

    Friis, Ole Uhrskov


    is making strategic choices, then chose a strategy and then making and action plan. Most project groups worked as expected, one group constituting a rare exception, as staging and the mobilisation of devices lead to unanticipated events, triggering extraordinary management activity. Our study shows......Strategy formulation can be viewed as an entanglement of social and material elements, developing sociomaterial strategy devices. Devices contribute to arranging and staging occasions of strategy formulation. The article investigates which arenas are staged for strategy formulation, which types...... of devices is purposely mobilised by management. and consultants. First, one central device, based on a balanced scorecard, is staging the managers as active strategists in a more traditional strategy workshop, with the employees as distanced spectators. Second, the employees are staged in an open space...

  19. Management of inflammatory bowel disease in pregnancy.

    Smith, M A; Sanderson, J D


    Inflammatory bowel disease (IBD) affects body image, relationships, family planning, fertility and pregnancy outcomes. However, the common misconception that IBD is a contraindication, or serious concern, in pregnancy is essentially a myth. Most patients with IBD can expect to have uneventful pregnancies. We present an overview of the management of IBD during pregnancy, including management in those planning pregnancy, the suitability of relevant medication during pregnancy and breast feeding, investigation and monitoring of IBD during pregnancy, surgical management and considerations relating to delivery. While there are some definite alterations required in the management of IBD during pregnancy, management is essentially unchanged. With close attention to aspects such as nutrition and smoking cessation, and optimal disease control in the run-up to and during pregnancy, we have an opportunity to help our patients with IBD achieve good pregnancy outcomes.

  20. Pharmacologic management of Alzheimer disease.

    Downey, Deborah


    Although the diagnosis of AD can be devastating, treatment options exist that can slow the disease's progression and allow patients to continue performing ADLs, thereby improving the quality of life for both patient and caregiver. Research is ongoing, and it is estimated by the Alzheimer's Association that finding a treatment that could delay onset by only 5 years could reduce the number of individuals with AD by nearly 50% over the next 50 years (Alzheimer's Association, 2007). Although pharmacotherapy is not yet a cure, it does remain an important part of a total approach to caring for patients and families affected by AD.

  1. Developing green supply chain management strategies: A taxonomic approach

    Michael Mutingi


    Full Text Available Purpose: The objective of this research is to explore the empirical green supply chain activities found in literature, and to develop a taxonomic framework that can be used for formulating appropriate strategies for green supply chains, based on characteristic dimensions for the green supply chain. Design/methodology/approach: The taxonomic framework is developed through (i analysis of green supply chain activities found in existing empirical work or case studies recorded in literature, (ii identification of key dimensions that influence green supply chain management strategies, and (iii development of a taxonomic scheme for selecting or developing green strategies. Findings: The paper finds that this study yielded: a set of three characteristic dimensions that influence strategic green supply chain management, and a guided structured approach selecting appropriate green strategies, providing managerial insights. Research limitations/implications: This paper shows that future work includes development of specific performance management indices according to the taxonomy of green strategies developed in this study. Practical implications: This research provided a practical guided approach that enhances appropriate formulation of green strategies for green supply chain management, while providing sound managerial insights for the supply chain decision maker. The choice of supply chain strategy directly impacts the overall environmental, economic and operations performance of the supply chain. Originality/value: This study presents to supply chain decision makers a new taxonomic framework that simplifies and enhances the formulation of green strategies, and to researchers a comparative understanding of various strategies applicable to green supply chains.

  2. A Different Perspective for Management of Diabetes Mellitus: Controlling Viral Liver Diseases.

    Zhao, Yingying; Xing, Huichun


    Knowing how to prevent and treat diabetes mellitus (DM) earlier is essential to improving outcomes. Through participating in synthesis and catabolism of glycogen, the liver helps to regulate glucose homeostasis. Viral related liver diseases are associated with glycometabolism disorders, which means effective management of viral liver diseases may be a therapeutic strategy for DM. The present article reviews the correlation between DM and liver diseases to give an update of the management of DM rooted by viral liver diseases.

  3. Evaluating management strategies for grizzly bears in British Columbia, Canada

    Schroeder, Amanda


    In British Columbia, The Ministry of Forests, Lands and Natural Resource Operations manages grizzly bear hunting as the most rigid and conservatively managed hunt in the province. However, there has been concern raised in the media and from some members of the academic community over the sustainability of grizzly bear hunting. It is unclear whether the current management strategy effectively incorporates uncertainties in grizzly bear biology and management. My research intends to address thes...




    : The process of supply chain management is a huge challenge for managers of many companies. In today's market situation more and more often it is the effective supply of products at minimum cost and a guarantee of an adequate level of customer service which determine the competitiveness of organizations. As a result, companies implement strategies for supply chain management. The constantly increasing role of logistics and supply chain management results, among others, from the fact that bot...

  5. Vaccination strategies for SIR vector-transmitted diseases.

    Cruz-Pacheco, Gustavo; Esteva, Lourdes; Vargas, Cristobal


    Vector-borne diseases are one of the major public health problems in the world with the fastest spreading rate. Control measures have been focused on vector control, with poor results in most cases. Vaccines should help to reduce the diseases incidence, but vaccination strategies should also be defined. In this work, we propose a vector-transmitted SIR disease model with age-structured population subject to a vaccination program. We find an expression for the age-dependent basic reproductive number R(0), and we show that the disease-free equilibrium is locally stable for R(0) ≤ 1, and a unique endemic equilibrium exists for R(0) > 1. We apply the theoretical results to public data to evaluate vaccination strategies, immunization levels, and optimal age of vaccination for dengue disease.

  6. Emphysematous pyelonephritis with calculus: Management strategies

    Tanmaya Goel


    Full Text Available Objective: Emphysematous pyelonephritis (EPN with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units of EPN, out of which two patients (three renal units had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

  7. Emphysematous pyelonephritis with calculus: Management strategies.

    Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph


    Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

  8. Management strategy for unicameral bone cyst.

    Chuo, Chin-Yi; Fu, Yin-Chih; Chien, Song-Hsiung; Lin, Gau-Tyan; Wang, Gwo-Jaw


    The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re-fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula) managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts.

  9. Management Strategy for Unicameral Bone Cyst

    Chin-Yi Chuo; Yin-Chih Fu; Song-Hsiung Chien; Gau-Tyan Lin; Gwo-Jaw Wang


    The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of t...

  10. Management of Diverticular Disease in Scandinavia.

    Schultz, Johannes K; Yaqub, Sheraz; Øresland, Tom


    Throughout the last century, the incidence of diverticular disease of the colon has increased tremendously in industrialized countries; nevertheless, the management of this condition is still controversial. Although several international guidelines for the management of diverticular disease are based on the same evidence, the recommendations differ greatly, emphasizing the lack of high-quality prospective studies. In Scandinavia, official guidelines for the management of diverticular disease exist only in Denmark. However, the treatment policies are quite similar in all Scandinavian countries. Computed tomography is the first choice for imaging of acute diverticulitis and its complications. Furthermore, the use of antibiotics in uncomplicated diverticulitis is nearly abandoned in Scandinavia, whereas several international guidelines still recommend their use. There is a broad consensus that abscesses secondary to acute diverticulitis can safely be managed with percutaneous drainage, which is in line with international recommendations. The surgical management of perforated diverticulitis with peritonitis is still as controversial in Scandinavia as elsewhere. Common surgical options are laparoscopic peritoneal lavage, primary resection with anastomosis, and primary resection with terminal colostomy (Hartmann's procedure). Elective sigmoid resection in patients with diverticular disease seems to be performed less frequently in Scandinavia than in other European countries; the right indications are a current matter of debate. Symptomatic uncomplicated diverticular disease in the absence of diverticulitis has not gained great attention in Scandinavia.


    Mohammed Shahedul QUADER


    Full Text Available This paper looks at the key strategies being applied by wealth management and their competitive position.Each approach has merits, although the multi-channel ‘single brand’ approach seems to be gathering momentum. Ecommercefacilitates differentiation and requires focus, whilst making cost leadership more difficult Choices betweenbeing a traditional or extended wealth manager, or simply a wealth product provider, are increasingly being made.Moreover need for strategic choice in the wealth management market is presented, before looking in more detail at thewealth management strategies commonly adopted. The relative success of each is considered, together with thecompetitive advantages to be gained.

  12. Project Management and the Project Manager: A Strategy for ...

    International Journal of Development and Management Review ... collapse, project failure, project abandonment, project cost and time overruns, etc. ... component parts that constitute project management in the building construction industry.

  13. Managing consumer disengagement through green advertising strategies

    Loh, E-Jian


    A discord is apparent between consumers’ concerns and their actual green behaviour – a surfacing issue that has obstructed effective green messages by advertisers. Four distinct consumer disengagement issues, including consumer backlash, environmental exhaustion, motivational challenges and social pressures were identified. This thesis explored cultural discourses surrounding green marketing and proposes green advertising strategies that address consumer disengagement. Using the Grounded Theo...

  14. Negotiation Strategies in Supply Chain Management

    Zachariassen, Frederik


    Purpose of this paper This paper seeks to explore the impact of different negotiation strategies on the negotiation setting in different buyer-supplier relationships. So far, the extant SCM literature has only briefly touched this subject, though such a study has been advocated for on previous no...

  15. Energy management strategies for vehicle power nets

    Koot, M.W.T.; Jager, de A.G.; Kessels, J.T.B.A.; Heemels, W.P.M.H.; Bosch, van den P.P.J.


    In the near future a significant increase in electric power consumption in vehicles is to be expected. To limit the associated increase in fuel consumption and exhaust emissions, smart strategies for the generation, storage/retrieval, distribution, and consumption of the electric power can be used.

  16. Managing Reward Strategy to Enhance Employee Performance


    strategy in organizations with a view to ascertaining its efficacy on ... (contingent or variable pay), or for their services in the job (service-related pay). ... The concepts of rewards and incentives are interchangeably used by .... employee's base salary or in most cases organization use a combination of ... to the market values.

  17. Operating a sustainable disease management program for chronic obstructive pulmonary disease.

    Endicott, Linda; Corsello, Phillip; Prinzi, Michele; Tinkelman, David G; Schwartz, Abby


    Chronic obstructive pulmonary disease (COPD) is one of our nation's most rapidly growing chronic health conditions. It is estimated that over 16 million individuals are diagnosed with COPD (Friedman & Hilleman, 2001). In addition, another 16 million are misdiagnosed as asthma or not diagnosed at all. COPD is a condition that affects the working-age as well as the elderly. Despite the high mortality rate, COPD is a treatable and modifiable condition. Disease management programs (DMPs) for asthma are a common initiative within many health insurance plans and integrated delivery networks. Similar initiatives are not as common for COPD. This article will highlight the National Jewish Medical and Research Center's COPD DMP interventions and outcomes. To outline interventions and operational strategies critical in developing and operating a sustainable and effective disease management program for COPD. Disease Management is an effective model for managing individuals with COPD. Applying a case management model that includes (1) risk-identification and stratification; (2) education and empowerment regarding self-monitoring and management; (3) lifestyle modification; (4) communication and collaboration amongst patients, healthcare providers, and case managers to enhance the treatment plan; (5) providing after-hours support; and (6) monitoring care outcomes is crucial. Applying these interventions in a credible manner will improve the quality of life and quality of care delivered to individuals with mild, moderate, severe, and very severe COPD. Additionally, these interventions can significantly reduce utilization events.

  18. Coronary artery disease - strategies for primary prevention in Pakistan

    Khan, M.H.


    Coronary artery disease is the leading cause of death among middle aged and elderly population. The increase in prevalence of coronary artery disease in Pakistan, has also involved the younger population and about 30% of the patients of coronary artery disease are below the age of 40 years. It seems that with this high prevalence of coronary artery disease, we will be entering in the new millennium with coronary artery disease as number one killer in young adults in Pakistan. This is the time, though belated, we must embark on strategies for primary prevention of this disease so that we are able to reduce the incidence of the disease and the economic burden it entails on the national exchequer. Before suggesting the strategies for the prevention of coronary artery disease in Pakistan, let us briefly review the significance of modifiable risk factors for coronary artery disease. Several studies have been found a significant relationship between physical inactivity and coronary artery disease. (A.B./orig.)

  19. State of rare disease management in Southeast Asia.

    Shafie, Asrul Akmal; Chaiyakunapruk, Nathorn; Supian, Azuwana; Lim, Jeremy; Zafra, Matt; Hassali, Mohamed Azmi Ahmad


    Rare diseases, also referred to as orphan diseases, are characterised by their low prevalence with majority of them are chronically debilitating and life threatening. Given the low prevalence and the widely dispersed but very small patient base for each disease, there may often be a disproportion in the availability of treatments and resources to manage patients, spur research and train experts. This is especially true in Southeast Asian countries that are currently in the process of implementing or revising their universal health coverage schemes. This paper aims to examine the status of rare disease management in Southeast Asian countries. It will serve as the basis for a more active discussion on how countries in the region can address an under-recognised rare disease burden and enhance national and regional capacities. The study consists of literature reviews and key stakeholders interviews in six focus countries, including the Philippines, Singapore, Malaysia, Indonesia, Vietnam, and Thailand and five countries as best practice, comprising of France, Canada, Australia, Taiwan, and South Korea. Rare disease management initiatives across each country were examined based on the World Health Organization's framework for action in strengthening health systems. The results suggest rare disease management remains challenging across Southeast Asia, as many of the focus countries face fundamental issues from basic healthcare systems to funding. Nonetheless, there are substantial improvement opportunities, including leveraging best practices from around the world and organising a multi-stakeholder and regional approach and strategy. Southeast Asian countries have made significant progress in the management of rare disease, but there remain key areas for substantial development opportunities.

  20. Radioactive waste management and disposal strategies in the European community

    Orlowski, S.


    This paper presents an overview of the various radioactive waste management strategies, as they are defined, or even envisaged, in the EC Member States committed to nuclear power. The two main components of these strategies are looked at: content and basic supporting choices; and schedule of implementation. Most EC Countries currently have in common a nuclear history of several decades. Early approaches and local practices are progressively replaced by centralised management systems and by strategies making the best use of many years of research and technological development. All these strategies are aiming at a safe management of all waste types up to, and including, their final disposal. The various management steps are well in hand and very similar in the EC Countries. However, the final step ''disposal'', has been implemented only for low-level waste, and remains to be demonstrated for long lived and high level waste (or spent fuel)

  1. 118 cognitive –behavioural strategies for the management of ...

    DEPARTMENT OF PSYCHOLOGY. IMO STATE UNIVERSITY ... management strategy involves cognitive restructuring, relaxation, humor, adequate ... After clinical probing and analysis, my clinical impressions showed a man with a traditional ...

  2. Implementing active traffic management strategies in the U.S.


    Limited public funding for roadway expansion and improvement projects, coupled with continued growth in travel along congested urban freeway corridors, creates a pressing need for innovative congestion management approaches. Strategies to address con...

  3. Implementation of a records management strategy at the Botswana ...

    Implementation of a records management strategy at the Botswana Unified ... raising awareness on the importance of records; human capacity building and ... of records, appreciation of the importance of records as a strategic resource and the ...

  4. Competitive Strategy and Total Quality Management Culture in ...

    This paper discusses the elements of competitive strategy, total quality management culture and productivity improvement and their relationship in producing better outputs of goods and services and individual and organizational performance. Production remains fundamental to the sustenance of human existence.

  5. Study on National Sustainable Development Strategy Management Based on Stakeholders Management Theory

    Chen Huarong; Wang Xiaoming


    Based on the stakeholders management theory, this pa- per provides a new strategic management method for the National Sustainable Development Strategy. By taking China's National Sustainable Development Strategy Management as an example, this paper identifies all the stakeholders involved and then as- sesses stakeholders from two dimensions, namely "Importance" and "Attitude", by which all of the stakeholders are divided into six categories. On this basis, further analysis is made to work out strategic management programme by scheduling the strate- gic emphases, steps and management countermeasures for dif- ferent types of stakeholders so as to provide theortical evidence for the practice of National Sustainable Developnent Strategy management.

  6. Spatial strategies for managing visitor impacts in National Parks

    Leung, Y.-F.; Marion, J.L.


    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  7. Accidental oil spills - project management strategy

    Bobic, V.; Benkovic, Z.


    Planning and organisation, as well as actions taken during accidental discharging of hazardous substances (hydrocarbons) into the soil and water, show that without integrating all the functions of safety, occupational safety, fire and explosion protection, technical safety, all the way to the environmental protection, procedure of cleaning, rehabilitation and remediation of polluted areas into their original state cannot be successfully carried out. Neglecting any of the mentioned links/components of the procedure represents a risk to people's health and life, while pollution to the environment remains a constant threat. Development of technologies is quickly transforming the environment in which the professionals of all disciplines work. Therefore, the response to changes by application of new technologies and procedures in all domains is indispensable, however, through a comprehensive and expert perception and consideration of each of the essential correlations comprising the safety management in all the fields. Through management of safety projects in environmental protection, it has become obvious that a united management of different fields is necessary, as well as management of safety in general. Engineering, health, legislation, public, environmental standards, occupational safety, hazards, biophysical and socio-economic aspects are parts of an integral management. Experts joined efforts through interaction and communications are inter-disciplinary characteristics, i.e. multi-disciplinary safety management, but also the management of each project separately. Exactly this knowledge exchange is highly productive and becomes an indispensable element in recognition of indirect and cumulative actions, thus applicable in any field. Implementation of European standards and accreditation of procedures pursuant to the corresponding standards, from risk assessment through rehabilitation to independent expert confirmation of efficiency in implementing the entire

  8. Using decision analysis to support proactive management of emerging infectious wildlife diseases

    Grant, Evan H. Campbell; Muths, Erin L.; Katz, Rachel A.; Canessa, Stefano; Adams, Michael J.; Ballard, Jennifer R.; Berger, Lee; Briggs, Cheryl J.; Coleman, Jeremy; Gray, Matthew J.; Harris, M. Camille; Harris, Reid N.; Hossack, Blake R.; Huyvaert, Kathryn P.; Kolby, Jonathan E.; Lips, Karen R.; Lovich, Robert E.; McCallum, Hamish I.; Mendelson, Joseph R.; Nanjappa, Priya; Olson, Deanna H.; Powers, Jenny G.; Richgels, Katherine L. D.; Russell, Robin E.; Schmidt, Benedikt R.; Spitzen-van der Sluijs, Annemarieke; Watry, Mary Kay; Woodhams, Douglas C.; White, C. LeAnn


    Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases.

  9. Understanding the relationship between livelihood strategy and soil management

    Oumer, Ali Mohammed; Hjortsø, Carsten Nico Portefée; de Neergaard, Andreas


    help build livelihood strategies with high-economic return that in turn provide incentives to undertake improved soil management practices. The identified household types may guide entry points for development interventions targeting both food security and agricultural sustainability concerns......This paper aims to understand the relationship between households’ livelihood strategy and soil management using commonalities among rural households. We grouped households into four distinct types according to similar livelihood diversification strategies. For each household type, we identified...... the dominant income-generating strategies as well as the main agronomic activities pursued. The household types were: (I) households that pursue a cereal-based livelihood diversification strategy (23 %); (II) households predominantly engaged in casual off-farm-based strategy (15 %); (III) households...

  10. Stress Management and Coping Strategies among Nurses : A Literature Review

    Iyi, Obiora


    There is obvious need to have the safest working environments and the best quality of health care delivery to patients by nurses working in the hospitals. Effective stress management and coping strategies is one very important step towards this goal. This research aims to identify the major stressors for nurses and the most effective management and coping strategies as contained in literature. This involved excellent review of relevant articles in addition to deductive content analysis of the...

  11. A survey of managed care strategies for pregnant smokers

    Barker, D.; Robinson, L.; Rosenthal, A.


    OBJECTIVE—The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey.
DESIGN—This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy.
SUBJECTS—147 MCOs identifying a...

  12. Criticism and Counter-Criticism of Public Management: Strategy Models

    Luis C. Ortigueira


    Critical control is very important in scientific management. This paper presents models of critical and counter-critical public-management strategies, focusing on the types of criticism and counter-criticism manifested in parliamentary political debates. The paper includes: (i) a normative model showing how rational criticism can be carried out; (ii) a normative model for oral critical intervention; and (iii) a general motivational strategy model for criticisms and counter-criticisms. The pap...

  13. Optimal energy management strategy for self-reconfigurable batteries

    Bouchhima, Nejmeddine; Schnierle, Marc; Schulte, Sascha; Birke, Kai Peter


    This paper proposes a novel energy management strategy for multi-cell high voltage batteries where the current through each cell can be controlled, called self-reconfigurable batteries. An optimized control strategy further enhances the energy efficiency gained by the hardware architecture of those batteries. Currently, achieving cell equalization by using the active balancing circuits is considered as the best way to optimize the energy efficiency of the battery pack. This study demonstrates that optimizing the energy efficiency of self-reconfigurable batteries is no more strongly correlated to the cell balancing. According to the features of this novel battery architecture, the energy management strategy is formulated as nonlinear dynamic optimization problem. To solve this optimal control, an optimization algorithm that generates the optimal discharge policy for a given driving cycle is developed based on dynamic programming and code vectorization. The simulation results show that the designed energy management strategy maximizes the system efficiency across the battery lifetime over conventional approaches. Furthermore, the present energy management strategy can be implemented online due to the reduced complexity of the optimization algorithm. - Highlights: • The energy efficiency of self-reconfigurable batteries is maximized. • The energy management strategy for the battery is formulated as optimal control problem. • Developing an optimization algorithm using dynamic programming techniques and code vectorization. • Simulation studies are conducted to validate the proposed optimal strategy.

  14. Strategies Used by Primary School Teachers to Manage Dyslexia in ...

    Learning disabilities are a common phenomenon among learners in primary schools. Dyslexia is one such learning disability prevalent in mainstream classes. Research studies on strategies used by primary school teachers to manage learners with dyslexia in mainstream classes are scarce. This study analysed strategies ...

  15. Application of Pricing Strategy in the Management of Recreational Fishery

    Zhang, Chen; Han, Xingyong


    This paper analyzes the feasibility of carrying out various pricing strategies in recreational fishery management. It also introduces the four common pricing means, which are time (season) differential pricing, customer differential pricing, quantity discount and two-part tariff system. The effects of pricing strategy of recreational fishery on social welfare are studied taking time (season) differential pricing as an example.

  16. Development of a resistance management strategy for ixodid ticks ...

    The strategy developed for managing resistance in ticks with the acaricidal products on the market was based on mode of action of the active ingredients. The strategy requires the rotaional use of the acaricidal products in ways that reduces the selection pressure of active ingredients of same chemistry on the target-site in ...

  17. Knowledge Management and the Competitive Strategy of the Firm

    Halawi, Leila A.; McCarthy, Richard V.; Aronson, Jay E.


    Purpose: Knowledge management (KM) has emerged as a strategy to improve organizational competitiveness. Our purpose is to identify the relationship between KM and the firm's competitive advantage. Design/methodology/approach: We review the existing literature on KM and strategy formulation. We utilize the resource-based view approach as a lens for…

  18. Conditions for developing a successful Talent Management Strategy

    Naulleau , Mickaël


    International audience; The literature on Talent Management (TM) presupposes an exclusive alignment of TM with the organization's strategy, and the ability of any organization to engage a TM strategy. This article examines these principles by exploring the organizational contingency factors involved in the process of creation / development of TM strategy. We carried out a one-year Action-Research with the business leaders of a French medium-sized company (3 000 employees). We propose a comple...

  19. Management strategy for site characterization at candidate HLW repository sites

    Bartlett, J.W.


    This paper describes a management strategy for HLW repository site characterization which is aimed at producing an optimal characterization trajectory for site suitability and licensing evaluations. The core feature of the strategy is a matrix of alternative performance targets and alternative information-level targets which can be used to allocate and justify program effort. Strategies for work concerning evaluation of expected and disrupted repository performance are distinguished, and the need for issue closure criteria is discussed

  20. Determining disease intervention strategies using spatially resolved simulations.

    Mark Read

    Full Text Available Predicting efficacy and optimal drug delivery strategies for small molecule and biological therapeutics is challenging due to the complex interactions between diverse cell types in different tissues that determine disease outcome. Here we present a new methodology to simulate inflammatory disease manifestation and test potential intervention strategies in silico using agent-based computational models. Simulations created using this methodology have explicit spatial and temporal representations, and capture the heterogeneous and stochastic cellular behaviours that lead to emergence of pathology or disease resolution. To demonstrate this methodology we have simulated the prototypic murine T cell-mediated autoimmune disease experimental autoimmune encephalomyelitis, a mouse model of multiple sclerosis. In the simulation immune cell dynamics, neuronal damage and tissue specific pathology emerge, closely resembling behaviour found in the murine model. Using the calibrated simulation we have analysed how changes in the timing and efficacy of T cell receptor signalling inhibition leads to either disease exacerbation or resolution. The technology described is a powerful new method to understand cellular behaviours in complex inflammatory disease, permits rational design of drug interventional strategies and has provided new insights into the role of TCR signalling in autoimmune disease progression.

  1. Fistulizing Crohn's disease: Diagnosis and management.

    Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert


    Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

  2. Medication therapy disease management: Geisinger's approach to population health management.

    Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A


    Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  3. Can curriculum managers' reflections produce new strategies ...

    Simon Bhekimuzi Khoza


    Nov 5, 2016 ... sources are defined as objects and people that communicate learning .... vision, where teachers/managers use reflections to critique their ... Accounting, English, Geography, History,. Afrikaans .... curriculum, which made us to realise [sic] that it is important to ..... and enduring concerns (2nd ed). Thousand ...

  4. Strategy development for enterprise content management

    Smits, M.T.; O'Callaghan, R.; vom Brocke, J.; Simons, A.


    Many organizations maintain a variety of systems and databases in a complex ad-hoc information infrastructure that does not fulfill the need for company-wide unstructured information management in business processes, business functions, and the extended enterprise. We present a framework and a

  5. Quantitative investment strategies and portfolio management

    Guo, J.


    This book contains three essays on alternative investments and portfolio management. Taking from a portfolio investor’s perspective, the first essay analyzes the portfolio implication of investing in hedge funds when there is a hedge fund lockup period. The second essay studies the investment

  6. Management Strategy for Unicameral Bone Cyst

    Chin-Yi Chuo


    Full Text Available The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re-fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts.

  7. Managing reward strategy to enhance employee performance ...

    In a globalized economy with millions of businesses vying for talented workforce, an organization must be able to motivate and properly compensate ... that should be embedded in the organization's culture; management should identify employees' needs/preferences in developing organizations' compensation structure.

  8. Optimal grazing management strategies: evaluating key concepts ...

    Finally, overstocking will override key management initiatives, such as effective recovery periods, leading to rangeland degradation. Thus, in variable climates, stocking rate should be set conservatively to allow easier adaptation of animal numbers to rainfall variability from year to year. We suggest several key concepts that ...

  9. Weed management strategies for castor bean crops

    Augusto Guerreiro Fontoura Costa


    Full Text Available Castor bean crops are agriculturally relevant due to the quality and versatility of their oil, both for the chemical industry and for biodiesel production. Proper weed management is important for both the cultivation and the yield of castor bean crops; therefore, the intention of the present work is to review pertinent information regarding weed management, including the studies regarding weed interference periods, chemical controls for use in different crop production systems and herbicide selectivity, for castor bean crops. Weed science research for castor bean crops is scarce. One of the main weed management challenges for castor bean crops is the absence of herbicides registered with the Ministry of Agriculture, Livestock and Food Supply (MALFS. Research for viable herbicides for weed control in castor bean crops should be directed by research and/or rural extension institutions, associations and farmers cooperatives, as well as by manufactures, for the registration of these selective herbicides, which would be primarily used to control eudicotyledons in castor bean crops. New studies involving the integration of weed control methods in castor bean also may increase the efficiency of weed management, for both small farmers using traditional crop methods in the Brazilian Northeast region, as well as for areas with the potential for large scale production, using conservation tillage systems, such as the no-tillage crop production system.

  10. Knowledge Management: The Bedrock of Enterprise Strategy.

    Stevens, George H.; Krasner, Scott M.


    Discussion of information technology and competitive advantages in organizations focuses on the scope of knowledge management, its goals, components, and outcomes. Highlights include the relationship between effective identification and use of existing knowledge; the creation and re-use of new knowledge; and the ability of an organization to…

  11. Evaluating Executive Strategies (Management Strategies and Teaching-Learning Strategies) of Graduate Curriculum: Case Study in Isfahan University

    Rahmanpour, Muhammad; Ahmadi, Mojtaba; Hatami, Mostafa; Mirzaee, Hamzeh


    The present study seeks to evaluate executive strategies in graduate Curriculum of Isfahan University from the point of view of management and teaching-learning strategies. This study is an applied survey. The population comprised BA students and faculty members of the University of Isfahan. In order to do so, 141 professors and 278 students were…

  12. The Functioning of Strategic Management in the Control of Endemic Parasitic Diseases in Iran (Case: fascioliasis

    Bahador Hajimohammadi


    Full Text Available Strategic management in the control of endemic parasitic diseases is essential according to their widespread negative consequences. Fascioliasis is one of the most common diseases of this kind in Iran. Preventing and controlling of this disease requires the formulation of a suitable strategic plan with rational goals and main strategies as same as the development, implementing and monitoring of operational programs.

  13. Opportunities for administrators to promote disease management.

    Kash, Bita A; Gamm, Larry D; Bolin, Jane Nelson; Peck, B Mitchell


    Studies of disease management (DM) have shown that patients who participate in such programs achieve better health status and make fewer emergency room visits. Private and government payers have recently increased their efforts to promote DM initiatives through financial incentives to healthcare providers. This article explores opportunities for administrators of health services organizations (HSO) to promote DM in the current political and economic environment. Our survey of professionals (DM leaders, physicians, and DM nurses) in six DM programs reveals these professionals' assessments of the key players and resources that they deem important to their respective DM programs. They view DM programs as heavily dependent on the support of physicians, nurses, and health plan leaders but relatively less so on the support of HSO administrators- a situation that may suggest opportunities for administrators to take on greater leadership in moving the HSO toward developing DM programs. Survey results also indicate a strong need for the integration of resources such as communication systems, electronic medical records, and DM reporting. Taken collectively, these needs suggest a number of strategies for the administrator to play a larger role in supporting the adoption and effective implementation of DM. In the article, we propose that DM programs can benefit substantially from an administrator who can demonstrate a thorough knowledge of DM-related government and private-payer initiatives and who has the ability to provide leadership to develop and implement viable DM programs. Valued contributions that the administrator should bring to the table include support of standardized DM processes, use of practice guidelines, and provision of pertinent information systems.

  14. Adapting Knowledge Translation Strategies for Rare Rheumatic Diseases.

    Cellucci, Tania; Lee, Shirley; Webster, Fiona


    Rare rheumatic diseases present unique challenges to knowledge translation (KT) researchers. There is often an urgent need to transfer knowledge from research findings into clinical practice to facilitate earlier diagnosis and better outcomes. However, existing KT frameworks have not addressed the specific considerations surrounding rare diseases for which gold standard evidence is not available. Several widely adopted models provide guidance for processes and problems associated with KT. However, they do not address issues surrounding creation or synthesis of knowledge for rare diseases. Additional problems relate to lack of awareness or experience in intended knowledge users, low motivation, and potential barriers to changing practice or policy. Strategies to address the challenges of KT for rare rheumatic diseases include considering different levels of evidence available, linking knowledge creation and transfer directly, incorporating patient and physician advocacy efforts to generate awareness of conditions, and selecting strategies to address barriers to practice or policy change.

  15. Management accounting in support of strategy - a strategy as practice perspective

    Pitcher, GS


    The term Strategic Management Accounting (SMA) was coined in the 1980's to both describe and encourage the development of accounting techniques that addressed strategic decision-making. This prompted the production of books and research papers into SMA techniques. However, there is very little research into how management accounting supports strategy making. Adopting the lens of strategy-as-practice and utilising a narrative research \\ud approach this developmental paper addresses the questio...

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

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


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

  17. Strategies for managing impressions of racial identity in the workplace.

    Roberts, Laura Morgan; Cha, Sandra E; Kim, Sung Soo


    This article deepens understanding of the workplace experiences of racial minorities by investigating racial identity-based impression management (RIM) by Asian American journalists. Racial centrality, directly or indirectly, predicted the use of 4 RIM strategies (avoidance, enhancement, affiliation, and racial humor). Professional centrality also predicted strategy use, which was related to life satisfaction and perceived career success. By shedding light on proactive strategies that individuals use to influence colleagues' impressions of their racial identity, we contribute to research on diversity in organizations, impression management, and racial identity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).


    A.J. Buys


    Full Text Available

    ENGLISH ABSTRACT: In many organisations, a chasm exists between the development of strategy and its successful implementation. Failure to cross this chasm may ultimately result in strategy failure and the loss of competitive advantage, profits, and employment. Project Portfolio Management (PPM is theorised as a management methodology that links a portfolio of projects to the business strategy. However, current literature lacks empirical evidence of the levels of employment, functionality, and success of the Project Portfolio Management approach in South Africa. A survey of respondents in 32 technology organisations was used to analyze the reasons for the following: strategy implementation and project delivery failure in South African technology organisations; the South African situation regarding the chasm that exists in many organisations between strategy development and successful strategy implementation; and the extent to which – and with what success – Project Portfolio Management is employed in South African technology organisations.

    AFRIKAANSE OPSOMMING: In baie organisasies bestaan daar ’n gaping tussen strategie-ontwikkeling en suksesvolle strategie-implementering. Die onvermoë om die gaping te oorbrug sal uiteindelik lei tot strategiefaling en die verlies van mededingende voordeel, winste, en werksgeleenthede. Projekportefeuljebestuur (PPB word voorgehou as ’n bestuursmetodologie wat ’n portefeulje van projekte koppel aan die besigheidstrategie. Bestaande literatuur gaan egter mank aan empiriese bewyse ten opsigte van die vlakke van indiensneming, funksionaliteit, en sukses van die Projekportefeuljebestuursbenadering in Suid-Afrika. ’n Opname van respondente in 32 tegnologie-organisasies is gebruik om die volgende aspekte te ondersoek: die redes vir falings in strategie-implementering en projekaflewering in Suid-Afrikaanse tegnologie-organisasies; die Suid-Afrikaanse situasie rakende die gaping wat bestaan tussen

  19. Disease containment strategies based on mobility and information dissemination

    Pejović, Veljko; Lima, Antonio; De Domenico, Manlio; Musolesi, Mirco


    Human mobility and social structure are at the basis of disease spreading. Disease containment strategies are usually devised from coarse-grained assumptions about human mobility. Cellular networks data, however, provides finer-grained information, not only about how people move, but also about how they communicate. In this paper we analyze the behavior of a large number of individuals in Ivory Coast using cellular network data. We model mobility and communication between individuals by means...

  20. Strategies for Fostering the Efficacy of School-Based Management ...

    The study examined community participation in the School-Based Management Committees (SBMC), the challenges hindering participation, and strategies for fostering efficacy of the School Based Management Committee. The number 340 schools were selected from the population of 2543 public primary schools in ...

  1. Managing (Sales)People towards Performance: HR Strategy, Leadership & Teamwork

    H.M.S. Dietz (Bart)


    textabstractManaging people towards performance is one of the most critical priorities for managers in practice. This dissertation focuses on this important issue and explores how HR Strategy, Leaders, and Teams, impact performance. It addresses respectively how HR as a system of coherent

  2. Toward effective strategies for energy efficient network management

    Vreeswijk, Jacob Dirk; van Berkum, Eric C.; van Arem, Bart; van Vliet, H.; Abadi, A.; Bauer e.a., D.


    Trade-offs in efficiency, equity and acceptability arise as a central feature in traffic management. Today's urban traffic network management strategies focus on overall system performance and often overlook the interests of the individual road user. In addition, the emphasis is on travel time

  3. Socioeconomic evaluation of broad-scale land management strategies.

    Lisa K. Crone; Richard W. Haynes


    This paper examines the socioeconomic effects of alternative management strategies for Forest Service and Bureau of Land Management lands in the interior Columbia basin. From a broad-scale perspective, there is little impact or variation between alternatives in terms of changes in total economic activity or social conditions in the region. However, adopting a finer...

  4. Primary care referral management: a marketing strategy for hospitals.

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J


    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  5. A strategy for optimizing item-pool management

    Ariel, A.; van der Linden, Willem J.; Veldkamp, Bernard P.


    Item-pool management requires a balancing act between the input of new items into the pool and the output of tests assembled from it. A strategy for optimizing item-pool management is presented that is based on the idea of a periodic update of an optimal blueprint for the item pool to tune item

  6. Strategies for job creation through national forest management

    Susan Charnley


    This chapter explores the ways in which national forest managers may contribute to community well-being by designing projects that accomplish forest management in ways that not only meet their ecological goals, but also create economic opportunities for nearby communities. The chapter summarizes a number of strategies for enhancing the economic benefits to communities...

  7. A Candidate Army Energy and Water Management Strategy

    Fournier, Donald F; Westervelt, Eileen T


    .... This work augments on-going energy and water management initiatives within the Army by developing a new candidate Army level strategy that responds to anticipated legislation; reflects current DOD and DA requirements, vision, and values in light of the current world situation; incorporates sound science and management principles; and organizes and focuses efforts into an integrated program.

  8. Effective Strategies for Enhancing Waste Management at University Campuses

    Ebrahimi, Kianoosh; North, Leslie A.


    Purpose: The purpose of this study is to identify and assess the waste management strategies that should be priorities for higher education institutions. The role of policy instruments (i.e. purchasing policies and recycling initiatives) in implementing sustainable zero-waste management programs at higher education institutions was investigated…

  9. Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

    Shao, Fang

    The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

  10. Data management strategies for nuclear training

    Zerbo, J.N.; Gwinn, A.E.


    Use of systematic training development technologies has become a standard for the commercial nuclear power industry and for many Department of Energy facilities. Such systems involve detailed analysis of job functions, tasks and skill requirements and correlation of that information to the courses, curricula and testing instruments used in the training process. Nuclear training programs are subject to audit and evaluation by a number of government and industry organizations. The ability to establish an audit trail, from initial task analysis to final examination is crucial to demonstrating the completeness and validity of a systematic training program. This paper provides perspective on aspects of the training data management problem, status of technological solutions, and characteristics of data base management systems that are best suited for application to training programs

  11. Customer Relationship Management : Strategy Process Evaluation

    Din, Fazal


    Before the advent of globalization the mantra of "Customer is King", was preached by large organizations. With the development of technology and the business environment, multinationals better understand the importance of customer retention and customer loyalty. Customer loyalty, attained by sustainable customer relationship, is the focus of most of the companies around the world. For any large organization customer relationship management, under the umbrella of business vision, mission and o...

  12. Epilepsy during pregnancy: focus on management strategies

    Borgelt LM


    Full Text Available Laura M Borgelt,1 Felecia M Hart,2 Jacquelyn L Bainbridge2 1Departments of Clinical Pharmacy and Family Medicine, 2Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Abstract: In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy. Keywords: epilepsy, teratogens, anticonvulsants, medication therapy management

  13. Strategy plan for management of Hanford tank wastes

    Humphreys, L.L.; Morgan, S.R.


    The Secretary of Energy in 1992 directed Hanford to plan for the retrieval and processing of all stored high level waste at Hanford for disposal at an offsite repository. This substantial change in the tank disposal program's assignment has resulted in a reevaluation of the entire Tank Waste Remediation System (TWRS) strategy. This strategic plan covers that portion of the TWRS strategy related to management of stored tank waste until it is retrieved, processed, and disposed by the disposal program and covers the responsibilities assigned to the ''manage tank waste'' function. The ''manage tank waste'' function is one of the level 2 functions as set forth in the Tank Waste Remediation System Mission Analysis Report (Baynes et al. 1993) and depicted in Figure 1. The following level 3 functions have been developed below the level 2, ''manage tank waste'' function: (1) Store waste; (2) Transfer waste; (3) Characterize, surveil and monitor waste; (4) Restore and upgrade systems; (5) Manage tank waste management system


    Khadijeh Salmani


    Full Text Available Nowadays, striving to find an efficient way for developing or identifying appropriate knowledge management strategies in organizations has become so critical. Researchers and practitioners have attached great importance to information pyramids in organizations and have highlighted the lack of trained and skilled staff as a serious problem. On the other hand, having more flexibility at workplace, offering better service, and fulfilling customers' demands require a strategy for managing knowledge and its consequence. Knowledge management provides a wide range of different strategies and methods for identifying, creating, and sharing knowledge in organizations. This deep insight which consists of individual, organization’s experience, knowledge, and understanding helps organization respond to both internal and external stimuli and act in harmony. One fact which has seemingly achieved a consensus is the need for different strategies of knowledge management. Among the wide range of various and often unclear knowledge management strategies one can choose a strategy in a specific situation. The aim of this paper is to respond to strategic questions which emphasize competitive intelligence and internal knowledge retrieval system. The implications are discussed in detail.

  15. Anchorage strategies in geriatric hip fracture management

    Knobe Matthias


    Full Text Available There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment. For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.

  16. Effective managed care marketing strategies for evolving markets.

    Conlon, M K


    In a world of increased competition and changing consumer expectations, one of the keys to a fiscally sound health plan is having a dynamic marketing strategy that takes into account the shifting attitudes of consumers as managed care markets mature. The primary goal of any health plan marketing strategy should be the acquisition and retention of members. Providing cost-efficient and convenient service for enrollees, offering low or no deductibles, having convenient office locations, and minimizing paper-work are important elements of such a marketing strategy. Factors such as brand awareness and the perceived image of a health plan also are important considerations in acquiring and retaining market share. The relative importance of these consumer satisfaction criteria change as a managed care market evolves and matures. Financial and marketing managers, thus, should ascertain their market's stage of development and respond with appropriate marketing strategies.

  17. The management of gastro-oesophageal reflux disease.

    Keung, Charlotte; Hebbard, Geoffrey


    If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4-8 weeks. This should be taken 30-60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett's oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation.

  18. Self-management strategies in overweight and obese Canadians with arthritis.

    Bernatsky, S; Rusu, C; O'Donnell, S; Mackay, C; Hawker, G; Canizares, M; Badley, E


    To estimate the prevalence of overweight and obese Canadians with arthritis and to describe their use of arthritis self-management strategies, as well as explore the factors associated with not engaging in any self-management strategies. Respondents to the 2009 Survey on Living with Chronic Diseases in Canada, a nationally representative sample of 4,565 Canadians age ≥20 years reporting health professional-diagnosed arthritis (including more than 100 rheumatic diseases and conditions), were asked about the impact of their arthritis and how it was managed. Among the overweight (body mass index [BMI] 25-29.9 kg/m(2)) and obese (BMI ≥30 kg/m(2)) individuals with arthritis (n = 2,869), the use of arthritis self-management strategies (i.e., exercise, weight control/loss, classes, and community-based programs) were analyzed. Log binomial regression analyses were used to examine factors associated with engaging in none versus any (≥1) of the 4 strategies. More than one-quarter (27.4%) of Canadians with arthritis were obese and an additional 39.9% were overweight. The overweight and obese individuals with arthritis were mostly female (59.5%), age ≥45 years (89.7%), and reported postsecondary education (69.0%). While most reported engagement in at least 1 self-management strategy (84.9%), less than half (45.6%) engaged in both weight control/loss and exercise. Factors independently associated with not engaging in any self-management strategies included lower education, not taking medications for arthritis, and no clinical recommendations from a health professional. Fewer than half of the overweight and obese Canadians with arthritis engaged in both weight control/loss and exercise. The provision of targeted clinical recommendations (particularly low in individuals that did not engage in any self-management strategies) may help to facilitate participation. Copyright © 2012 by the American College of Rheumatology.

  19. Policies and Strategies for Radioactive Waste Management (Russian Edition)


    To assure the safe, technically optimal and cost effective management of spent fuel and radioactive waste, appropriate policies and strategies are required. This publication clarifies the differences between a policy and a strategy, and provides principal advice to Member States on the typical composition, mutual links and the process of compilation of such documents. It also offers options for and indicates approaches to the management of spent fuel and radioactive waste, thus enabling an effective spent fuel and radioactive waste management infrastructure to be developed.

  20. Integrated management system implementation strategy for PUSPATI TRIGA Reactor

    Phongsakorn Prak Tom; Shaharum Ramli; Mohamad Azman Che Mat Isa; Shahirah Abdul Rahman; Mohd Zaid Mohamed; Mat Zin Mat Husin; Nurfazila Husain; Mohamad Puad Abu


    Integrated Management System (IMS) designed to fulfil the requirements integrates safety, health, environmental, security, quality and economic elements. PUSPATI TRIGA Reactor (RTP) is currently implementing the Quality Assurance Program (QAP) and looking toward implementation of IMS. This paper discussed the implementation strategy of IMS for RTP. There are nine steps of IMS implementation strategy. In implementation of IMS, Gantt chart is useful project management tool in managing the project frame work. IMS is intended as a tool to enable the continuous development of safety culture and achieve higher safety levels. (author)

  1. Risk-based management of invading plant disease.

    Hyatt-Twynam, Samuel R; Parnell, Stephen; Stutt, Richard O J H; Gottwald, Tim R; Gilligan, Christopher A; Cunniffe, Nik J


    Effective control of plant disease remains a key challenge. Eradication attempts often involve removal of host plants within a certain radius of detection, targeting asymptomatic infection. Here we develop and test potentially more effective, epidemiologically motivated, control strategies, using a mathematical model previously fitted to the spread of citrus canker in Florida. We test risk-based control, which preferentially removes hosts expected to cause a high number of infections in the remaining host population. Removals then depend on past patterns of pathogen spread and host removal, which might be nontransparent to affected stakeholders. This motivates a variable radius strategy, which approximates risk-based control via removal radii that vary by location, but which are fixed in advance of any epidemic. Risk-based control outperforms variable radius control, which in turn outperforms constant radius removal. This result is robust to changes in disease spread parameters and initial patterns of susceptible host plants. However, efficiency degrades if epidemiological parameters are incorrectly characterised. Risk-based control including additional epidemiology can be used to improve disease management, but it requires good prior knowledge for optimal performance. This focuses attention on gaining maximal information from past epidemics, on understanding model transferability between locations and on adaptive management strategies that change over time. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

  2. Change in MSW characteristics under recent management strategies in Taiwan.

    Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing


    Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

  3. 20 strategies for marketing your managed care plan.

    Firshein, J


    In today's fiercely competitive managed care marketplace, healthcare executives must find a way to set their plans apart from the competition and build a sufficient customer base. At the same time, they must confront a growing anti-managed care backlash among a wary and confused public. Healthcare executive magazine talked with managed care experts to gather their views on key strategies to help executives meet both of these challenges. Here's what they suggest.

  4. A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline health workers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial.

    Praveen, Devarsetty; Patel, Anushka; McMahon, Stephen; Prabhakaran, Dorairaj; Clifford, Gari D; Maulik, Pallab K; Joshi, Rohina; Jan, Stephen; Heritier, Stephane; Peiris, David


    Blood Pressure related disease affected 118 million people in India in the year 2000; this figure will double by 2025. Around one in four adults in rural India have hypertension, and of those, only a minority are accessing appropriate care. Health systems in India face substantial challenges to meet these gaps in care, and innovative solutions are needed. We hypothesise that a multifaceted intervention involving capacity strengthening of primary healthcare doctors and non-physician healthcare workers through use of a mobile device-based clinical decision support system will result in improved blood pressure control for individuals at high risk of a cardiovascular disease event when compared with usual healthcare. This intervention will be implemented as a stepped wedge, cluster randomised controlled trial in 18 primary health centres and 54 villages in rural Andhra Pradesh involving adults aged ≥40 years at high cardiovascular disease event risk (approximately 15,000 people). Cardiovascular disease event risk will be calculated based on World Health Organisation/International Society of Hypertension's region-specific risk charts. Cluster randomisation will occur at the level of the primary health centres. Outcome analyses will be conducted blinded to intervention allocation. The primary study outcome is the difference in the proportion of people meeting guideline-recommended blood pressure targets in the intervention period vs. the control period. Secondary outcomes include mean reduction in blood pressure levels; change in other cardiovascular disease risk factors, including body mass index, current smoking, reported healthy eating habits, and reported physical activity levels; self-reported use of blood pressure and other cardiovascular medicines; quality of life (using the EQ-5D); and cardiovascular disease events (using hospitalisation data). Trial outcomes will be accompanied by detailed process and economic evaluations. The findings are likely to inform

  5. The development and implementation of a waste management strategy

    Fairhall, G.A.; Vickery, P.; Edmiston, L.


    Over the past forty years BNFL has operated 4 nuclear sites in the UK. Commercial operations on these sites span the full nuclear fuel cycle from enrichment, fuel fabrication, electricity generation, reprocessing, waste management, and decommissioning. Through the recent merger with Magnox Electric BNFL has acquired a further 8 Magnox reactor sites in the UK. Prior to 1980 BNFL adopted a policy of storing wastes generated by its activities in an unconditioned state in purpose built stores. This paper shows how BNFL's waste management strategy has developed to ensure how volume reduction technologies have been implemented for low level waste. Whilst immobilisation technologies have been implemented for high and intermediate level wastes. The paper describes how continual review of the strategy ensures waste management processes are continually monitored against progress and optimised to ensure all waste arisings are conditioned for final disposal. Finally the paper will show how the strategy can be used to develop waste management plans for customer sites. (author)




    Full Text Available In the world marketplace some firms compete successfully and others fail to gain global competitive advantage. Some researchers argue that innovation strategy is the answer to successfully meeting today’s and tomorrow’s global business challenges.  An important aspect of the innovation strategy is managing global teams effectively.  Thus, firms of tomorrow will be characterized by values such as teamwork, innovation, cultural diversity, and a global mindset.  The rapid globalization of business, and increasing competition will continue to drive the need for effective teamwork and/in innovation management.  The purpose of our research is to gain insight into global team management and its role as a major component of innovation strategy.  We discuss the changing and developing functions of teamwork, examine the characteristics of global teams, and finally offer a process to achieve effective global team management.

  7. Disease management research using event graphs.

    Allore, H G; Schruben, L W


    Event Graphs, conditional representations of stochastic relationships between discrete events, simulate disease dynamics. In this paper, we demonstrate how Event Graphs, at an appropriate abstraction level, also extend and organize scientific knowledge about diseases. They can identify promising treatment strategies and directions for further research and provide enough detail for testing combinations of new medicines and interventions. Event Graphs can be enriched to incorporate and validate data and test new theories to reflect an expanding dynamic scientific knowledge base and establish performance criteria for the economic viability of new treatments. To illustrate, an Event Graph is developed for mastitis, a costly dairy cattle disease, for which extensive scientific literature exists. With only a modest amount of imagination, the methodology presented here can be seen to apply modeling to any disease, human, plant, or animal. The Event Graph simulation presented here is currently being used in research and in a new veterinary epidemiology course. Copyright 2000 Academic Press.

  8. Personalized Medicine and Infectious Disease Management.

    Jensen, Slade O; van Hal, Sebastiaan J


    A recent study identified pathogen factors associated with an increased mortality risk in Staphylococcus aureus bacteremia, using predictive modelling and a combination of genotypic, phenotypic, and clinical data. This study conceptually validates the benefit of personalized medicine and highlights the potential use of whole genome sequencing in infectious disease management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Disease Management in the Dutch Context

    Schrijvers, Guus; Spreeuwenberg, Cor; Laag, Han van der; Rutten, Guy; Nabarro, Guido; Schene, Aart; Linden, Barbara van der; Acampo, Marianne


    This book explores the extent to which ten characteristics of the concept of disease management are advisable in the long-term for certain types of patient care in the Netherlands. The care in mind for this concept covers certain patient populations as well as a number of health problems. For this

  10. Management of patients with chronic kidney disease

    This article deals with these aspects, including follow-up guidelines and management and treatment ... those with ischaemic heart disease also require cardiac review at least once a year. .... doses when fluid losses are high, e.g. sweating in hot environments, ... dried beans, lentils, offal, salmon, chocolate, cola drinks and.

  11. Disease management in soilless culture systems

    Os, van E.A.


    EU legislation, laid down in the Water Framework Directive, demands to minimize emissions of nitrogen, phosphate and crop protection products to achieve an excellent chemical and ecological quality in 2015. The aim is to force growers to a better water and disease management. Supply water of

  12. Risk management: a proposal for communication strategies

    Michele Fontana


    Full Text Available Disasters related to natural hazards have increased in the last few decades. This increment makes it necessary to develop non-structural risk prevention and mitigation measures to improve people’s safety. An effective non-structural measure that can improve the preparedness of the population is a locally adapted communication campaign that is focused on natural hazards. We have developed a hypothetical communication campaign for a specific area in the north of Italy, in which hydro-geological risk is of considerable importance. The content of the campaign is defined by the combination of the requirements of the law with the results of a survey conducted in the study area. The aim of the survey is to evaluate the level of risk perception among the residents, and their attitudes towards prevention activities. The operative procedure of the campaign is modeled on advertising strategies. The campaign is designed to reach each family, and it is aimed at affecting people’s everyday life through a horizontal communication strategy that involves flyers, billboards, umbrellas and a website. The use of umbrellas as a medium for the campaign is the key. People mostly use umbrellas when it rains. Rain is linked with hydrogeological risk. As the content of the campaign is printed on the umbrellas, each time people use these umbrellas, they remember the campaign. The campaign is integrated into a broader communication program that includes meetings with stakeholders, activities in schools, and public conferences. The final goal is to foster the creation of a shared knowledge about risk in the whole population.

  13. Everyday walking with Parkinson's disease: understanding personal challenges and strategies

    Jones, D.A.; Rochester, L.; Birleson, A.; Hetherington, V.; Nieuwboer, A.; Willems, A.M.; van Wegen, E.E.H.; Kwakkel, G.


    Purpose. This qualitative study was designed to explore the personal experience of everyday walking with Parkinson's disease (PD), the challenges and the strategies employed to compensate for difficulties, to help contextualise the scientific knowledge base. Methods. Semi-structured interviews were

  14. Perioperative Management of Patients with Rheumatic Diseases

    Bissar, Lina; Almoallim, Hani; Albazli, Khaled; Alotaibi, Manal; Alwafi, Samar


    This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation PMID:24062860

  15. [Disease management for chronic heart failure patient].

    Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca


    Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

  16. Technological Advances in Huanglongbing (HLB or Citrus Greening Disease Management

    Krishna Prasad Paudyal


    Full Text Available Huanglongbing (HLB, previously citrus greening disease, is the most destructive of citrus species causing major threat to the world citrus industry. The disease was reported from China in 1919 and now known to occur in more than 40 different countries of Asia, Africa, South and North America. Three species of gram negative bacterium namely Candidatus Liberibacter asiaticus, Candidatus Liberibacter africanus and Candidatus Liberibacter americanus are the casual organisms of HLB, respectively prevailing in the continent of Asia, Africa and South America. It is one of the most extensively researched subjects in citriculture world. HLB was detected in 2004 and 2005, respectively in San Paulo of Brazil and Florida of USA: the two leading citrus production hub of the world causing huge economic loss within 5 years of first detection. Since then research on HLB detection and management was further accelerated in American continents. This paper presents the scientific advancement made on detection, spread, economic losses caused by HLB in different parts of the world and controlling management strategies. Remarkable achievements have been made on HLB detection techniques including iodine test, qPCR and more recently in spectroscopy. While efforts are being made to develop resistance varieties using conventional and biotechnological tools management strategy which includes reduction of inoculums source, vector control and replant with disease-free planting materials still remains major option for HLB control. Citrus intercropping with guava have shown promising results for vector reduction.

  17. Chronic disease management: it's time for transformational change!

    Muttitt, Sarah C; Alvarez, Richard C


    The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. However, an interoperable pan-Canadian health infostructure does not exist; funding is required to establish this across the continuum of care. An investment of $350 per capita would provide a robust health technology platform to support a national CDPM strategy. Such an investment would deliver annual benefits of $6-$7.6 billion; this could be leveraged to support national healthcare priorities such as CDPM. EHRs will improve decisions about care, reduce system errors and increase efficiency. They will also improve our ability to measure, assess and manage care. We cannot run a high-performing health system without sound data. This was a key step to enabling progress on wait times management. Leadership is required if a national CDPM strategy is to become reality. The authors made a convincing case for the development of a national strategy; we need to turn their words into actionable events to gain necessary momentum.

  18. Optimal sampling strategies for detecting zoonotic disease epidemics.

    Jake M Ferguson


    Full Text Available The early detection of disease epidemics reduces the chance of successful introductions into new locales, minimizes the number of infections, and reduces the financial impact. We develop a framework to determine the optimal sampling strategy for disease detection in zoonotic host-vector epidemiological systems when a disease goes from below detectable levels to an epidemic. We find that if the time of disease introduction is known then the optimal sampling strategy can switch abruptly between sampling only from the vector population to sampling only from the host population. We also construct time-independent optimal sampling strategies when conducting periodic sampling that can involve sampling both the host and the vector populations simultaneously. Both time-dependent and -independent solutions can be useful for sampling design, depending on whether the time of introduction of the disease is known or not. We illustrate the approach with West Nile virus, a globally-spreading zoonotic arbovirus. Though our analytical results are based on a linearization of the dynamical systems, the sampling rules appear robust over a wide range of parameter space when compared to nonlinear simulation models. Our results suggest some simple rules that can be used by practitioners when developing surveillance programs. These rules require knowledge of transition rates between epidemiological compartments, which population was initially infected, and of the cost per sample for serological tests.

  19. Optimal sampling strategies for detecting zoonotic disease epidemics.

    Ferguson, Jake M; Langebrake, Jessica B; Cannataro, Vincent L; Garcia, Andres J; Hamman, Elizabeth A; Martcheva, Maia; Osenberg, Craig W


    The early detection of disease epidemics reduces the chance of successful introductions into new locales, minimizes the number of infections, and reduces the financial impact. We develop a framework to determine the optimal sampling strategy for disease detection in zoonotic host-vector epidemiological systems when a disease goes from below detectable levels to an epidemic. We find that if the time of disease introduction is known then the optimal sampling strategy can switch abruptly between sampling only from the vector population to sampling only from the host population. We also construct time-independent optimal sampling strategies when conducting periodic sampling that can involve sampling both the host and the vector populations simultaneously. Both time-dependent and -independent solutions can be useful for sampling design, depending on whether the time of introduction of the disease is known or not. We illustrate the approach with West Nile virus, a globally-spreading zoonotic arbovirus. Though our analytical results are based on a linearization of the dynamical systems, the sampling rules appear robust over a wide range of parameter space when compared to nonlinear simulation models. Our results suggest some simple rules that can be used by practitioners when developing surveillance programs. These rules require knowledge of transition rates between epidemiological compartments, which population was initially infected, and of the cost per sample for serological tests.

  20. Severe accident management. Optimized guidelines and strategies

    Braun, Matthias; Löffler, Micha; Plank, Hermann; Asse, Dietmar; Dimmelmeier, Harald


    The highest priority for mitigating the consequences of a severe accident with core melt lies in securing containment integrity, as this represents the last barrier against fission product release to the environment. Containment integrity is endangered by several physical phenomena, especially highly transient phenomena following high-pressure reactor pressure vessel failure (like direct containment heating or steam explosions which can lead to early containment failure), hydrogen combustion, quasi-static over-pressure, temperature failure of penetrations, and basemat penetration by core melt. Each of these challenges can be counteracted by dedicated severe accident mitigation hardware, like dedicated primary circuit depressurization valves, hydrogen recombiners or igniters, filtered containment venting, containment cooling systems, and core melt stabilization systems (if available). However, besides their main safety function these systems often have also secondary effects that need to be considered. Filtered containment venting causes (though limited) fission product release into the environment, primary circuit depressurization leads to loss of coolant, and an ex-vessel core melt stabilization system as well as hydrogen igniters can generate high pressure and temperature loads on the containment. To ensure that during a severe accident any available systems are used to their full beneficial extent while minimizing their potential negative impact, AREVA has implemented a severe accident management for German nuclear power plants. This concept makes use of extensive numerical simulations of the entire plant, quantifying the impact of system activations (operational systems, safety systems, as well as dedicated severe accident systems) on the accident progression for various scenarios. Based on the knowledge gained, a handbook has been developed, allowing the plant operators to understand the current state of the plant (supported by computational aids), to predict

  1. Management of craniopharyngiomas: Role of conservative strategies

    Shibu Pillai


    Full Text Available Craniopharyngiomas are uncommon tumors and their management remains controversial. Despite gross total resection, recurrences can occur in 15-43% during long-term follow-up of more than 10 years. Furthermore, radical surgery can be associated with complications associated with hypothalamic damage, which can lead to a poor quality-of-life. Limited surgery followed by adjuvant radiotherapy (RT can provide excellent long-term tumor control with minimum complications and good functional outcome. RT can however, produce insidious onset of hypopituitarism and vasculopathy. Secondary malignancies are a rare complication of RT. Modern radiation techniques and intracystic radiation can reduce these complications. Intracystic radiation is highly effective for cystic craniopharyngiomas. Intracystic bleomycin (ICB and interferon alpha (IFN are rarely curative, but can produce long lasting control of tumor cysts and this is very useful in very young children who may not tolerate radical surgery or RT. IFN has fewer toxicity issues compared to ICB.

  2. Dust limit management strategy in tokamaks

    Rosanvallon, S.; Grisolia, C.; Andrew, P.; Ciattaglia, S.; Delaporte, P.; Douai, D.; Garnier, D.; Gauthier, E.; Gulden, W.; Hong, S.H.; Pitcher, S.; Rodriguez, L.; Taylor, N.; Tesini, A.; Vartanian, S.; Vatry, A.; Wykes, M.


    Dust is produced in tokamaks by the interaction between the plasma and the plasma facing components. Dust has not yet been of a major concern in existing tokamaks mainly because the quantity is small and these devices are not nuclear facilities. However, in ITER and in future reactors, it will represent operational and potential safety issues. From a safety point of view, in order to control the potential dust hazard, the current ITER strategy is based on a defense in depth approach designed to provide reliable confinement systems, to avoid failures, and to measure and minimise the dust inventory. In addition, R and D is put in place for optimisation of the proposed methods, such as improvement of measurement, dust cleaning and the reduction of dust production. The aim of this paper is to present the approach for the control of the dust inventory, relying on the monitoring of envelope values and the development of removal techniques already developed in the existing tokamaks or plasma dedicated devices or which will need further research and development in order to be integrated in ITER.

  3. Dust limit management strategy in tokamaks

    Rosanvallon, S.; Grisolia, C.; Andrew, P.; Ciattaglia, S.; Delaporte, P.; Douai, D.; Garnier, D.; Gauthier, E.; Gulden, W.; Hong, S. H.; Pitcher, S.; Rodriguez, L.; Taylor, N.; Tesini, A.; Vartanian, S.; Vatry, A.; Wykes, M.


    Dust is produced in tokamaks by the interaction between the plasma and the plasma facing components. Dust has not yet been of a major concern in existing tokamaks mainly because the quantity is small and these devices are not nuclear facilities. However, in ITER and in future reactors, it will represent operational and potential safety issues. From a safety point of view, in order to control the potential dust hazard, the current ITER strategy is based on a defense in depth approach designed to provide reliable confinement systems, to avoid failures, and to measure and minimise the dust inventory. In addition, R&D is put in place for optimisation of the proposed methods, such as improvement of measurement, dust cleaning and the reduction of dust production. The aim of this paper is to present the approach for the control of the dust inventory, relying on the monitoring of envelope values and the development of removal techniques already developed in the existing tokamaks or plasma dedicated devices or which will need further research and development in order to be integrated in ITER.

  4. Sustainability: orthopaedic surgery wait time management strategies.

    Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom


    The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

  5. Peer Support and Psychosocial Pain Management Strategies for Children with Systemic Lupus Erythematosus

    Laura Nabors


    Full Text Available This paper reviews information on Systemic Lupus Erythematosus (SLE in children. Children with this chronic illness often experience pain related to their condition. They also can experience social isolation. This paper reviews psychosocial information on peer support and cognitive behavioral pain management strategies. The information presented in this paper provides new insights for health professionals assisting children and families in coping with psychological facets of this disease. Research focusing on ways by which peers and friends can support the child’s use of psychological pain management strategies will provide new information for the literature.

  6. Care management actions in the Family Health Strategy

    Marcelo Costa Fernandes


    Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.

  7. Nurses' strategies for managing pain in the postoperative setting.

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari


    Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.

  8. Selection of a management strategy for depleted uranium

    Patton, S.; Hanrahan, E.; Bradley, C. Jnr.


    A consequence of the uranium enrichment process is the accumulation of a significant amount of depleted uranium hexafluoride (UF 6 ). Currently, in the United States approximately 560 000 tonnes of the material are stored at three different sites. The US Department of Energy (DOE) has recently initiated a programme to consider alternative strategies for the cost-effective and environmentally safe long-term management of this inventory of depleted UF 6 . The programme involves a technology and engineering assessment of proposed management options (which are: use/reuse, conversion, storage, or disposal) and an analysis of the potential environmental impacts and life-cycle costs of alternative management strategies. The information obtained from the studies will be used by the DOE to select a preferred long-term management strategy. Because of its provisions for considering a wide range of relevant issues and involving the public, this programme has become a model for future DOE materials disposition programmes. This paper presents an overview of the Depleted Uranium Hexafluoride Management Programme. Technical findings of the programme to date are presented, and major issues involved in selecting and implementing a management strategy are discussed. (author)

  9. Complexity Science Applications to Dynamic Trajectory Management: Research Strategies

    Sawhill, Bruce; Herriot, James; Holmes, Bruce J.; Alexandrov, Natalia


    The promise of the Next Generation Air Transportation System (NextGen) is strongly tied to the concept of trajectory-based operations in the national airspace system. Existing efforts to develop trajectory management concepts are largely focused on individual trajectories, optimized independently, then de-conflicted among each other, and individually re-optimized, as possible. The benefits in capacity, fuel, and time are valuable, though perhaps could be greater through alternative strategies. The concept of agent-based trajectories offers a strategy for automation of simultaneous multiple trajectory management. The anticipated result of the strategy would be dynamic management of multiple trajectories with interacting and interdependent outcomes that satisfy multiple, conflicting constraints. These constraints would include the business case for operators, the capacity case for the Air Navigation Service Provider (ANSP), and the environmental case for noise and emissions. The benefits in capacity, fuel, and time might be improved over those possible under individual trajectory management approaches. The proposed approach relies on computational agent-based modeling (ABM), combinatorial mathematics, as well as application of "traffic physics" concepts to the challenge, and modeling and simulation capabilities. The proposed strategy could support transforming air traffic control from managing individual aircraft behaviors to managing systemic behavior of air traffic in the NAS. A system built on the approach could provide the ability to know when regions of airspace approach being "full," that is, having non-viable local solution space for optimizing trajectories in advance.

  10. Features of the Development Strategy Customer Relationship Management

    I. M. Gurova


    Full Text Available Purpose: in the current economic situation one of the main conditions of competitiveness of the company is its customer focus. In this regard, the most promising strategy for strengthening the stability of the organization is the management of customer relationships.The presented article explores the process of developing a customer relationship management strategy. This is a crucial, fundamental stage, from the very outcome of which the very possibility of achieving the organization's global goal depends to a large extent. Therefore, the development of a strategy requires deep reflection and qualitative elaboration. The aim of this work is to identify specific features of development of strategy of customer relationship management through the systematization of theoretical and methodological framework and a detailed consideration of the algorithm of this process. Methods: the methodology of the study is based on the application of universal scientific methods of analysis and synthesis, analogy and modeling. In the process of collecting and collating data used content analysis, comparative analysis, methods of induction and deduction, system approach. Functional, strategic and economic analysis, methods of formalization, forecasting and expert assessments are used to generalize information and solve assigned tasks. Results: in the process of the study, a common algorithm for creating a customer relationship management strategy was developed. In particular, its main stages have been identified; the processes of solving the most important problems have been singled out and studied in detail. In addition, the article substantiates the basic theoretical and methodological guidelines, as well as the practical aspects of development of this type of strategy. Conclusions and Relevance: the main feature of development of the strategy of customer relationship management is the focus on the value characteristics of the analyzed elements. This is due to

  11. [Nutritional management of kidney diseases in children].

    Borovik, T E; Kutafina, E K; Tsygin, A N; Sergeeva, T V; Baranov, A A; Namazova-Baranova, L S; Voznesenskaya, T S; Zakharova, I N; Semenova, N N; Zvonkova, N G; Yatsyk, S P


    The prevalence of various kidney diseases in children remains high in recent decades. Adequate nutrition management can enhance the effectiveness of drug treatment, slow the frequency of relapses andprevent the progression of the disease. The article is devoted to modern approaches to diet therapy in various kidney diseases in children with the defeat of tubular and glomerular appa ratus. For the first time the therapeutic diets for children with various kidney diseases are presented. Particular attention is paid to diet therapy in nephrotic syndrome (steroid-responsive and steroid-refractory). Dietary approaches with modern formulas for enteral nutrition in cases of steroid therapy complications in children with renal insufficiency (in predialysis stage and on dialysis) are described. Differentiated nutritional approaches for patients with different types of crystalluria are separately presented.

  12. Reflex epilepsy: triggers and management strategies

    Okudan ZV


    Full Text Available Zeynep Vildan Okudan,1 Çiğdem Özkara2 1Department of Neurology, Bakirkoy Dr Sadi Konuk Education and Research Hospital, 2Department of Neurology and Clinical Neurophysiology, Cerrahpasa Faculty of Medicine, University of Istanbul, Istanbul, Turkey Abstract: Reflex epilepsies (REs are identified as epileptic seizures that are consistently induced by identifiable and objective-specific triggers, which may be an afferent stimulus or by the patient’s own activity. RE may have different subtypes depending on the stimulus characteristic. There are significant clinical and electrophysiologic differences between different RE types. Visual stimuli-sensitive or photosensitive epilepsies constitute a large proportion of the RE and are mainly related to genetic causes. Reflex epilepsies may present with focal or generalized seizures due to specific triggers, and sometimes seizures may occur spontaneously. The stimuli can be external (light flashes, hot water, internal (emotion, thinking, or both and should be distinguished from triggering precipitants, which most epileptic patients could report such as emotional stress, sleep deprivation, alcohol, and menstrual cycle. Different genetic and acquired factors may play a role in etiology of RE. This review will provide a current overview of the triggering factors and management of reflex seizures. Keywords: seizure, reflex epilepsy, photosensitivity, hot water, reading, thinking

  13. Applying risk management strategies to strengthen an IDS's investment policy.

    Fine, R P


    The increased financial risk that not-for-profit integrated delivery systems have assumed to function under managed care has required them to become increasingly reliant on income and gains from their investment portfolios. This reliance underscores the need for these organizations to take steps to effectively manage their investment risk. Not-for-profit IDSs should establish a systematic approach to investment risk management that is based on maintaining a sound fiduciary infrastructure and having a clear understanding of risk exposures, the most important of which are policy and market risk. Applying reasonable and common-sense risk management strategies to investment policy will enhance an IDS's overall financial and competitive strength.

  14. Management strategies of enterovirus D68 outbreaks: current perspectives

    Milhano N


    Full Text Available Natacha Milhano, Kaja Sverdrup Borge, Karoline Bragstad, Susanne G Dudman Domain for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway Abstract: Following its discovery in California in 1962, enterovirus D68 (EV-D68 was reported only sporadically around the world. In August 2014, a marked increase of EV-D68 cases in young children with severe respiratory infections was reported in the USA and Canada and later in Europe and Asia. Some of these cases were also found to be associated with acute flaccid paralysis, which exacerbated public health concern, and has since triggered international efforts to strengthen both EV-D68 and acute flaccid paralysis surveillance systems. This review summarizes the current knowledge on EV-D68, offering an overview of EV-D68 epidemiology, clinical presentations, diagnostic methodologies, and treatment strategies, as well as surveillance and outbreak management. Keywords: enterovirus D68, AFP, diagnostics, treatment, surveillance, outbreak 

  15. Sports-related concussions: diagnosis, complications, and current management strategies.

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E


    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  16. Technical strategy map to employing nuclear power plant aging management

    Sekimura, Naoto; Kanno, Masanori


    Stated in this report are back ground of technical strategy map for nuclear power plant aging management, result of the first road map, significance of technical strategy map, introduction scenario, technology map, road map, upgrade in every year, three groups of academia, industry and government, plan of technical strategy map, upgrade system, comprehensive introduction scenario, measures of nuclear power plant aging management in Japan and the world, new inspection system, outline of 'technical strategy map 2008', preparation of technical information bases in industry, academia and government, collaboration of them, safety researches of neutron radiation damage, stress corrosion crack, fatigue, piping thinning, insulation degradation, concrete degradation, thermal aging, evaluation technologies of earthquake resistance, preparation of rules and standards, ideal maintenance, and training talent. (S.Y.)

  17. [The German National Disease Management Guideline "Chronic Heart Failure"].

    Weinbrenner, S; Langer, T; Scherer, M; Störk, S; Ertl, G; Muth, Ch; Hoppe, U C; Kopp, I; Ollenschläger, G


    Chronic heart failure (CHF) is an illness mostly affecting elderly people. In Germany CHF is one of the most common causes of death and at the same time one of the most common diagnosis in inpatient care. Due to the expected increase in life expectancy in the next few years experts predict a further step-up of the incidence. Against this background development of a national guideline on chronic heart failure was prioritised and accordingly the National Disease Management Guideline (NDMG) Chronic Heart Failure was developed by a multi- and interdisciplinary group. The guideline group comprised experts from all relevant scientific medical societies as well as a patient expert. The National Disease Management Guideline (NDMG) on Chronic Heart Failure aims at supporting patients and health care providers with respect to decisions on a specific health care problem by giving recommendations for actions. Recommendations are informed by the best available scientific evidence on this topic.Patients with CHF often suffer from multiple conditions. Due to this fact and the old age patients do have very complex and demanding health care needs. Thus accounting for co-morbidities is paramount in planning and providing health care for theses patients and communication between doctor and patient but also between all health care providers is crucial.Basic treatment strategies in chronic heart failure comprise management of risk factors and prognostic factors as well as appropriate consideration of co-morbidities accompanied by measures empowering patients in establishing a healthy life style and a self-dependant management of their illness.Psycho-social aspects have a very strong influence on patients' acceptance of the disease and their self-management. In addition they have a strong influence on therapy management of the treating physician thus they have to be addressed adequately during the consultation.The National Disease Management Guideline (NDMG) Chronic Heart Failure (CHF

  18. A framework for the assessment of severe accident management strategies

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.


    Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed

  19. Factors Affecting Mitigation of Methane Emission from Ruminants: Management Strategies

    Afshar Mirzaei-Aghsaghali


    Full Text Available Nowadays, greenhouse gas emission which results in elevating global temperature is an important subject of worldwide ecological and environmental concern. Among greenhouse gases, methane is considered a potent greenhouse gas with 21 times more global warming potential than carbon dioxide. Worldwide, ruminant livestock produce about 80 million metric tons of methane each year, accounting for about 28% of global emissions from human related activities. Therefore it is impelling animal scientists to finding solutions to mitigate methane emission from ruminants. It seems that solutions can be discussed in four topics including: nutrition (feeding, biotechnology, microbiology and management strategies. We have already published the first review article on feeding strategies. In the current review, management strategies such as emphasizing on animals - type and individual variability, reducing livestock numbers, improving animal productivity and longevity as well as pasture management; that can be leads to decreasing methane production from ruminant animal production are discussed.

  20. A framework for the assessment of severe accident management strategies

    Kastenberg, W.E. [ed.; Apostolakis, G.; Dhir, V.K. [California Univ., Los Angeles, CA (United States). Dept. of Mechanical, Aerospace and Nuclear Engineering] [and others


    Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed.

  1. Waste Management Strategy in The Netherlands. Part 2. Strategy Principles and Influencing Issues

    Haverkate, B.R.W.


    This report reflects the Dutch input prepared in the framework of work package 2 of the EU thematic network COMPAS, which deals with the identification of alternative waste management strategies and issues influencing strategy selection in EU member states and their applicant countries. All elements that could have an effect in identifying alternative policies to manage (long-lived) radioactive wastes are addressed in this report. After a short introduction, in chapter 1, about some general issues influencing decision-making such as public acceptance, involvement, perception and (European) legislation, the considered disposal methods and disposal requirements are given in chapter 2. Chapter 3 of this report deals with the background topics of the current waste management strategy in The Netherlands. A detailed overview of (basic) strategy principles and their influencing issues is the subject of chapter 4. Issues considered include: safety and environmental impact; technical limitations; nuclear materials safeguards; monitoring and retrievability; ethical issues; public acceptance; (timing of) strategy development and implementation; and economical considerations. Relevant additional issues that could have an effect in identifying alternative waste management strategy are provided in appendices, including signed treaties (appendix B) and nuclear statutory regulations (appendix C)


    Emanoil MUSCALU


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

  3. Laparoscopic management of hepatic hydatid disease.

    Palanivelu, C; Jani, Kalpesh; Malladi, Vijaykumar; Senthilkumar, R; Rajan, P S; Sendhilkumar, K; Parthasarthi, R; Kavalakat, Alfie


    Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula system used and the technique of operation are described. The majority of the patients presented with pain. Most of the patients had only a single cyst. The right lobe of the liver was most commonly involved. Cysts were bilateral in 4 patients. In 83.3%, simply evacuation of the hydatid cyst by the Palanivelu Hydatid System was done. In 13.7%, this was followed by a left lobectomy, as the cysts were large occupying almost the entire left lobe of the liver. The remnant cavity was dealt with by omentoplasty. The average follow-up period is 5.8 years. There have been no recurrences to date. We recommend Palanivelu Hydatid System for management of hepatic hydatid disease. We have found its efficacy to be optimum for preventing spillage, evacuating hydatid cyst contents, performing transcystic fenestration, and for dealing with cyst-biliary communications.

  4. Diagnosis and management of Crohn's disease.

    Wilkins, Thad; Jarvis, Kathryn; Patel, Jigneshkumar


    Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.

  5. Gestational trophoblastic disease with hyperthyroidism: Anesthetic management

    Puneet Khanna


    Full Text Available The coexistence of hyperthyroidism with gestational trophoblastic disease is a known albeit rare clinical condition. We herein report the successful anesthetic management of such a case in our institute. There are only few case reports in literature of this association. Often, the diagnosis of hyperthyroid state is retrospective one, as it can be missed in the emergency scenario of patient requiring molar evacuation. This case report highlights the perioperative management and optimization of hyperthyroid state prior to surgical evacuation of the invasive hydatidiform mole.

  6. Lafora disease: epidemiology, pathophysiology and management.

    Monaghan, Thomas S


    Lafora disease is a rare, fatal, autosomal recessive, progressive myoclonic epilepsy. It may also be considered as a disorder of carbohydrate metabolism because of the formation of polyglucosan inclusion bodies in neural and other tissues due to abnormalities of the proteins laforin or malin. The condition is characterized by epilepsy, myoclonus and dementia. Diagnostic findings on MRI and neurophysiological testing are not definitive and biopsy or genetic studies may be required. Therapy in Lafora disease is currently limited to symptomatic management of the epilepsy, myoclonus and intercurrent complications. With a greater understanding of the pathophysiological processes involved, there is justified hope for future therapies.

  7. Facebook Groups for the Management of Chronic Diseases.

    Partridge, Stephanie R; Gallagher, Patrick; Freeman, Becky; Gallagher, Robyn


    The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group "champions"; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations. ©Stephanie R Partridge, Patrick Gallagher, Becky Freeman, Robyn Gallagher. Originally published in the Journal of Medical Internet Research (, 17.01.2018.

  8. Diagnosis and management of right colonic diverticular disease: A review.

    Ferrara, Francesco; Bollo, Jesús; Vanni, Letizia V; Targarona, Eduardo M


    The aim of this narrative review is to define the clinical-pathological characteristics and to clarify the management of right colonic diverticular disease. It is rare in Europe, USA and Australia and more common in Asia. In the recent years its incidence has increased in the West, with various distributions among populations. Many studies have reported that it is difficult to differentiate the presenting symptoms of this disease from those of appendicitis before surgery, because the signs and symptoms are similar, so misdiagnosis is not infrequent. With accurate imaging studies it is possible to reach a precise preoperative diagnosis, in order to assess an accurate treatment strategy. Currently the management of this disease is not well defined, no clear guidelines have been proposed and it is not known whether the guidelines for left colonic diverticular disease can also be applied for it. Several authors have stated that conservative management is the best approach, even in case of recurrence, and surgery should be indicated in selected cases. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  9. Chronic Disease Management in Family Practice: Clinical Note.


    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




    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  11. Selection of a management strategy for depleted uranium hexafluoride

    Patton, S.E.; Hanrahan, E.J.; Bradley, C.E.


    A consequence of the uranium enrichment process used in the United States (US) is the accumulation of a significant amount of depleted uranium hexafluoride (UF 6 ). Currently, approximately 560,000 metric tons of the material are stored at three different sites. The US Department of Energy (DOE) has recently initiated a program to consider alternative strategies for the cost-effective and environmentally safe long-term management of this inventory of depleted UF 6 . The program involves a technology and engineering assessment of proposed management options (use/reuse, conversion, storage, or disposal) and an analysis of the potential environmental impacts and life-cycle costs of alternative management strategies. The information obtained from the studies will be used by the DOE to select a preferred long-term management strategy. The selection and implementation of a management strategy will involve consideration of a number of important issues such as environmental, health, and safety effects; the balancing of risks versus costs in a context of reduced government spending; socioeconomic implications, including effects on the domestic and international uranium industry; the technical status of proposed uses or technologies; and public involvement in the decision making process. Because of its provisions for considering a wide range of relevant issues and involving the public, this program has become a model for future DOE materials disposition programs. This paper presents an overview of the Depleted Uranium Hexafluoride Management Program. Technical findings of the program to date are presented, and major issues involved in selecting and implementing a management strategy are discussed

  12. The Role of Knowledge Management in E-Business Strategy

    Ali Khalouei


    Full Text Available The purpose of this research is to study the role of knowledge management in building an E-business strategy. In terms of purpose, nature and data collection, the research is respectively an applied, descriptive-survey and field study research. The population of the research consisted of two groups. The first one included 10 experts in the field of knowledge management and E-who determined the validity of the research instrument. In the second stage and to test hypothesizes, 180 usable questionnaires were gathered from people who were related to E-business. In the first stage of the research, the role of knowledge management in implementing each stage of E-business strategy bulling model of Hackbarth and Kettinger, including initiation, diagnosis, strategic choice, and transition, was verified by experts. Then the rate of using knowledge management in building an E-Business strategy by three great Iranian companies was studied. The result of the present research shows that in these three companies, knowledge management has a significant role in all stages of building an E-Business strategy. However, the importance of the mentioned role in each activity and is far different.

  13. Reflection of Strategic Thinking in Activating Organizational Conflict Management Strategies

    Ahmed Abed Mahmood Al-Janabi


    Full Text Available This research aims to determine the nature of the role of strategic thinking and its impact in improving organizational conflict management strategies in business organizations. Strategic thinking is the key driver of all changes that the organization can make to adapt to the environment in which it operates. Improving organizational conflict management strategies is one of the challenges Which face the top management of the contemporary organization to help them survive. The research problem indicated that there is a clear lack of strategic thinking in improving organizational conflict management strategies. The General Company for Vegetable Oils was chosen as the field of application. The sample was selected in a simple random sample of 104 persons. The questionnaire was adopted as a tool for obtaining On the data of the research, which was prepared based on a number of ready-made measurements after being subjected to tests of honesty and consistency. The statistical tools resulted in a number of results, most of which confirmed the existence of a relationship of correlation and effect of significance to strategic thinking in the sense of Organizational Conflict Management Strategies therefore been accepted and the main sub-hypotheses contained in the research.

  14. Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

    Schrader, Andrew J; Tribble, David R; Riddle, Mark S


    To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

  15. Managing scientists leadership strategies in research and development

    Sapienza, Alice M


    Managing Scientists Leadership Strategies in Research and Development Alice M. Sapienza "I found ...this book to be exciting ...Speaking as someone who has spent 30 years grappling with these issues, I certainly would be a customer." -Robert I. Taber, PhD Senior Vice President of Research & Development Synaptic Pharmaceutical Corporation In today's climate of enormous scientific and technologic competition, it is more crucial than ever that scientists involved in research and development be managed well. Often trained as individual researchers, scientists can find integration into teams difficult. Managers, from both scientific and nonscientific backgrounds, who are responsible for these teams frequently find effective team building a long and challenging process. Managing Scientists offers strategies for fostering communication and collaboration among scientists. It shows how to build cohesive, productive, and focused teams to succeed in the competitive research and development marketplace. This book wil...

  16. Improving nuclear plant management effectiveness: Aligning strategy, systems, and people

    Price, K.F.


    The effectiveness of any organization requires alignment of the appropriate financial, physical, and human resources. The manager's role is to efficiently utilize the right combination of these resources to achieve organizational objectives. In-depth studies of the nuclear programs of three major investor-owned utilities using a culture assessment process called the communication, values, and rewards (CVR) assessment have shown significant misalignments in those organizations' strategies, systems and people management. The CVR assessment related employees' perceptions of what drives their company's culture with the stated company strategic direction and management philosophies. Specifically, CVR provides a comparison of employee-held work-related values with those desired by management. Data obtained by a CVR assessment can be used to understand organizational misalignment and make changes to bring systems into alignment with corporate strategy and culture

  17. Roles of managers in academic health centers: strategies for the managed care environment.

    Guo, Kristina L


    This article addresses survival strategies of academic health centers (AHCs) in responding to market pressures and government reforms. Using six case studies of AHCs, the study links strategic changes in structure and management to managerial role performance. Utilizing Mintzberg's classification of work roles, the roles of liaison, monitor, entrepreneur, and resource allocator were found to be used by top-level managers as they implement strategies to enhance the viability of their AHCs. Based on these new roles, the study recommends improving management practices through education and training as well as changing organizational culture to support management decision making and foster the continued growth of managers and their AHCs.

  18. Capitated chronic disease management programs: a new market for pharmaceutical companies.

    Cave, D G


    With corporatism of the medical care delivery system, the pharmaceutical industry is searching for new ways to market prescription drug product lines. A new strategy focuses on developing chronic disease management programs. In doing so, pharmaceutical companies work with clinical leaders of HMOs or large physician groups on disease management guidelines to reduce practice pattern variations and improve the quality of patient care. In addition, pharmaceutical companies capitate payment to physicians treating chronic disease patients to give them financial incentives to comply with the disease management guidelines.

  19. Current management of urethral stricture disease

    Thomas G Smith


    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.

  20. Efficiency of Management and Marketing Strategies within The Dental Office

    Oprea Valentin BUSU; Elena Cristina ANDREI


    This article is based on research about the management and marketing strategies within the dental office and how we can better understand its importance. One of the major problems faced by dentists today is the management of the dental office. Certainly, from the outside, individuals perceive the dentist's office as a simple medical unit in which medical staff operate. However, people living in the field face each day multiple problems of both medical and bureaucratic nature. For the dentist/...

  1. Risk management strategies by Australian farmers: two case studies

    Nguyen, Nam C.; Wegener, Malcolm K.; Russell, Iean W.; Cameron, Donald; Coventry, David; Cooper, Ian M.


    Australian farmers operate in one of the most risky farming environments in the world. They have to cope with numerous sources of risk including weather uncertainty, variable market prices, and institutional changes in their business management. This paper reports results from two case studies undertaken to examine the issues of farming risks and risk management strategies in Australia. The first case study found that unpredictable weather, financial risk, marketing risk, and personal risk we...

  2. Optimal vaccination strategies against vector-borne diseases

    Græsbøll, Kaare; Enøe, Claes; Bødker, Rene


    Using a process oriented semi-agent based model, we simulated the spread of Bluetongue virus by Culicoides, biting midges, between cattle in Denmark. We evaluated the minimum vaccination cover and minimum cost for eight different preventive vaccination strategies in Denmark. The simulation model ...... results when index cases were in the vaccinated areas. However, given that the long-range spread of midge borne disease is still poorly quantified, more robust national vaccination schemes seem preferable....

  3. Using structured decision making to manage disease risk for Montana wildlife

    Mitchell, Michael S.; Gude, Justin A.; Anderson, Neil J.; Ramsey, Jennifer M.; Thompson, Michael J.; Sullivan, Mark G.; Edwards, Victoria L.; Gower, Claire N.; Cochrane, Jean Fitts; Irwin, Elise R.; Walshe, Terry


    We used structured decision-making to develop a 2-part framework to assist managers in the proactive management of disease outbreaks in Montana, USA. The first part of the framework is a model to estimate the probability of disease outbreak given field observations available to managers. The second part of the framework is decision analysis that evaluates likely outcomes of management alternatives based on the estimated probability of disease outbreak, and applies managers' values for different objectives to indicate a preferred management strategy. We used pneumonia in bighorn sheep (Ovis canadensis) as a case study for our approach, applying it to 2 populations in Montana that differed in their likelihood of a pneumonia outbreak. The framework provided credible predictions of both probability of disease outbreaks, as well as biological and monetary consequences of management actions. The structured decision-making approach to this problem was valuable for defining the challenges of disease management in a decentralized agency where decisions are generally made at the local level in cooperation with stakeholders. Our approach provides local managers with the ability to tailor management planning for disease outbreaks to local conditions. Further work is needed to refine our disease risk models and decision analysis, including robust prediction of disease outbreaks and improved assessment of management alternatives.

  4. Parkinson’s disease managing reversible neurodegeneration

    Hinz, Marty; Stein, Alvin; Cole, Ted; McDougall, Beth; Westaway, Mark


    Traditionally, the Parkinson’s disease (PD) symptom course has been classified as an irreversible progressive neurodegenerative disease. This paper documents 29 PD and treatment-induced systemic depletion etiologies which cause and/or exacerbate the seven novel primary relative nutritional deficiencies associated with PD. These reversible relative nutritional deficiencies (RNDs) may facilitate and accelerate irreversible progressive neurodegeneration, while other reversible RNDs may induce previously undocumented reversible pseudo-neurodegeneration that is hiding in plain sight since the symptoms are identical to the symptoms being experienced by the PD patient. Documented herein is a novel nutritional approach for reversible processes management which may slow or halt irreversible progressive neurodegenerative disease and correct reversible RNDs whose symptoms are identical to the patient’s PD symptoms. PMID:27103805

  5. Social networks in cardiovascular disease management.

    Shaya, Fadia T; Yan, Xia; Farshid, Maryam; Barakat, Samer; Jung, Miah; Low, Sara; Fedder, Donald


    Cardiovascular disease remains the leading cause of death in the USA. Social networks have a positive association with obesity, smoking cessation and weight loss. This article summarizes studies evaluating the impact of social networks on the management of cardiovascular disease. The 35 studies included in the article describe the impact of social networks on a decreased incidence of cardiovascular disease, depression and mortality. In addition, having a large-sized social network is also associated with better outcomes and improved health. The role of pharmacists is beginning to play an important role in the patient-centered medical home, which needs to be incorporated into social networks. The patient-centered medical home can serve as an adaptive source for social network evolvement.

  6. Gorham-Stout Disease Management during Pregnancy.

    Bargagli, Elena; Piccioli, Caterina; Cavigli, Edoardo; Scola, Marianna; Rosi, Elisabetta; Lavorini, Federico; Novelli, Luca; Ugolini, Dario; Notaristefano, Tommaso; Filippo, Pieralli; Miele, Vittorio; Comin, Camilla E; Pistolesi, Massimo; Voltolini, Luca


    Gorham-Stout Disease (GSD) is a rare lymphatic disorder affecting children or young adults with no predilection of sex. It is generally associated with vanishing bone osteolytic lesions, thoracic and abdominal involvement, and diffuse pulmonary lymphangiomatosis. Chylous effusions and chylothorax, consequent to the abnormal proliferation of lymphatic vessels, may induce respiratory failure with a high mortality risk. Extrapulmonary alterations may include chylous ascites, lymphopenia, and destructing bone disease for overgrowth of lymphatic vessels. Here, we report the case of a young woman who developed a severe and recalcitrant GSD with persistent unilateral chylothorax during pregnancy. The complex management of this patient during and after pregnancy was discussed and compared with literature data to contribute to the definition of a correct diagnostic and therapeutic approach to this rare lymphatic disease.

  7. Strategy-oriented display concept to assist severe accident management

    Jeong, Kwangsub; Ha, Jaejoo


    The Critical Function Monitoring System (CFMS) is a typical Safety Parameter Display System (SPDS) to assist the operation of Korean Standard Nuclear Power Plants during normal and emergency operation, and SPDS for severe accident is being developed in Korea. When the existing CFMS is used under a severe accident situation, some problems are expected from: (1) different design basis, i.e. prevention of core melt vs. protection of radiation release to environment, (2) different parameters for decision-making, and (3) different domain and depth of information to restore the plant. To resolve the above problems, a concept, 'Strategy-Oriented Information Display' concept, for displaying information for severe accident management is developed in this paper. Whereas the existing SPDS structure is based on the critical safety function, the developed concept is based on the severe accident management strategy. The display for each strategy includes the plant parameters to check the status of plant and component with the logical or graphical views necessary for executing the strategy. As the application of the proposed concept, KAERI is developing a display system, the prototype severe accident SPDS, Severe Accident Management Display System (SAMDIS), to assist plant personnel for executing Korean Severe Accident Management Guidelines. CFMS is developed for a general display suitable to all situations with various displays. On the contrary, SAMDIS provides all the relevant information on one screen based on the proposed concept. The SAMDIS screen shows more extensive area than CFMS and thus plant personnel can recognize the overall plant status at a glance. This concept is quite effective when used with severe accident management guidelines because of the relatively macroscopic characteristics of a severe accident management strategy. (author)

  8. Role of Emotional Intelligence in Conflict Management Strategies of Nurses.

    Başoğul, Ceyda; Özgür, Gönül


    This study analyzes the emotional intelligence levels and conflict management strategies of nurses and the association between them. This cross-sectional, descriptive study was conducted with 277 nurses in a stratified random sample from a university hospital in Turkey. The data were collected from nurses who gave their informed consent to participate using a personal information form, the Rahim Organizational Conflict Inventory-II and Bar-On's Emotional Quotient Inventory (EQ-I). Data were assessed by descriptive statistics, t tests, and Pearson correlation analyses, using SPSS software. The levels of the nurses' strategies were as follows: avoiding (M = 2.98), dominating (M = 2.76), and obliging (M = 2.71) were medium; compromising (M = 1.99) and integration (M = 1.96) were low. The levels of the emotional intelligence of nurses (mean = 2.75) were medium on a 5-point scale. Integration (r = .168), obliging (r = .25), dominating (r = .18), and compromising (r = .33), which are conflict management strategies, were positively correlated with scores of emotional intelligence, and avoiding (r = -.25) was negatively correlated with scores of emotional intelligence (p emotional intelligence affects conflict management strategies. To use effective strategies in conflict management, nurses must develop emotional intelligence. Training programs on conflict management and emotional intelligence are needed to improve effective conflict management in healthcare facilities. Copyright © 2016. Published by Elsevier B.V.

  9. A survey of managed care strategies for pregnant smokers.

    Barker, D C; Robinson, L A; Rosenthal, A C


    The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.

  10. Impact of Conflict Management Strategies on the Generation Mechanism of Miners' Unsafe Behavior Tendency

    Li, Ji-Zu; Zhang, Ya-Ping; Liu, Xiao-Guang; Liu, Yao-Long; Wang, Tian-Ri


    In this paper, we examine the relationship between the generation mechanism of miners' unsafe behavior tendency and conflict management strategies, including cooperative conflict management strategy, competitive conflict management strategy and avoidant conflict management strategy. Miners from 3 collieries in Shanxi province completed a…

  11. Cuba's Strategy for Alzheimer Disease and Dementia Syndromes.

    Bosch-Bayard, Rodolfo I; Llibre-Rodríguez, Juan J; Fernández-Seco, Alberto; Borrego-Calzadilla, Carmen; Carrasco-García, Mayra R; Zayas-Llerena, Tania; Moreno-Carbonell, Carmen R; Reymond-Vasconcelos, Ana G


    Dementia is a great challenge to public health in Cuba due to its impact on society and families. Cuba's National Intervention Strategy for Alzheimer Disease and Dementia Syndromes is designed to address this challenge. The Strategy includes working guidelines for primary and secondary care, education about rights of people with cognitive impairment, professional development, research, and health promotion and dementia prevention. An associated action plan, focused on primary care, includes proposals for creation of memory clinics, day centers and comprehensive rehabilitation services for cognitive stimulation. Short-term measures proposed include increasing early detection; creating a dementia morbidity and mortality registry; promoting professional training; providing support for families; and promoting basic and clinical research on dementia. Medium-term proposals aim to reduce dementia incidence and mortality by controlling risk factors and promoting healthy lifestyles, offering new treatment options and optimizing early detection. A set of indicators has been developed to evaluate strategy implementation. With this strategy, Cuba joins the small number of developing countries that have responded to WHO's call to improve care for patients with dementia and alleviate its impact on society and families. KEYWORDS Dementia, Alzheimer disease, aging, national health programs, social stigma, primary prevention, health promotion, civil rights, Cuba.

  12. An evaluation of management strategies for Atlantic tuna stocks

    L. T. Kell


    Full Text Available International agreements for the International Commission for the Conservation of Atlantic Tunas (ICCAT convention area imply that Atlantic tuna stocks should be managed by strategies based on maximum sustainable yield (MSY; however, there is concern whether this will actually ensure sustainability with sufficiently high probability consistent with the principals of the precautionary approach. Therefore, the performance of MSY management strategies based on current assessment procedures was evaluated using a computer simulation framework. The framework includes the data collection, assessment, prediction, and management processes, as well as the implementation of management regulations. It therefore provides an integrated way to evaluate the relative importance of and the interactions between each component of the system with regard to the overall success of the management strategy. The study elucidates guidelines about assessment and management that are general enough to be applied to all tunas in the Atlantic Ocean. It does so by comparing different hypotheses about management and assessment for three stocks (North Atlantic albacore, Atlantic bigeye and East Atlantic skipjack, which are representative of the variety encountered (i.e. from data rich to poor and tropical to temperate waters in ICCAT stocks. Management performance was especially sensitive to the carrying capacity of the stock. The type of proxy used for MSY was more important to the success of the procedure than the frequency of assessment or the number of indices used in the assessment. Whilst the procedure was successful at achieving the management objectives for albacore, it was only partially successful for bigeye and was too conservative for skipjack.

  13. How Managers' everyday decisions create or destroy your company's strategy.

    Bower, Joseph L; Gilbert, Clark G


    Senior executives have long been frustrated by the disconnection between the plans and strategies they devise and the actual behavior of the managers throughout the company. This article approaches the problem from the ground up, recognizing that every time a manager allocates resources, that decision moves the company either into or out of alignment with its announced strategy. A well-known story--Intel's exit from the memory business--illustrates this point. When discussing what businesses Intel should be in, Andy Grove asked Gordon Moore what they would do if Intel were a company that they had just acquired. When Moore answered, "Get out of memory," they decided to do just that. It turned out, though, that Intel's revenues from memory were by this time only 4% of total sales. Intel's lower-level managers had already exited the business. What Intel hadn't done was to shut down the flow of research funding into memory (which was still eating up one-third of all research expenditures); nor had the company announced its exit to the outside world. Because divisional and operating managers-as well as customers and capital markets-have such a powerful impact on the realized strategy of the firm, senior management might consider focusing less on the company's formal strategy and more on the processes by which the company allocates resources. Top managers must know the track record of the people who are making resource allocation proposals; recognize the strategic issues at stake; reach down to operational managers to work across division lines; frame resource questions to reflect the corporate perspective, especially when large sums of money are involved and conditions are highly uncertain; and create a new context that allows top executives to circumvent the regular resource allocation process when necessary.

  14. Generating optimized stochastic power management strategies for electric car components

    Fruth, Matthias [TraceTronic GmbH, Dresden (Germany); Bastian, Steve [Technische Univ. Dresden (Germany)


    With the increasing prevalence of electric vehicles, reducing the power consumption of car components becomes a necessity. For the example of a novel traffic-light assistance system, which makes speed recommendations based on the expected length of red-light phases, power-management strategies are used to control under which conditions radio communication, positioning systems and other components are switched to low-power (e.g. sleep) or high-power (e.g. idle/busy) states. We apply dynamic power management, an optimization technique well-known from other domains, in order to compute energy-optimal power-management strategies, sometimes resulting in these strategies being stochastic. On the example of the traffic-light assistant, we present a MATLAB/Simulink-implemented framework for the generation, simulation and formal analysis of optimized power-management strategies, which is based on this technique. We study capabilities and limitations of this approach and sketch further applications in the automotive domain. (orig.)

  15. Risk management strategies utilized by small scale poultry farmers ...

    Birds can only tolerate narrow temperature changes; therefore, poultry flocks are vulnerable to climate induced risk. This study investigated risk management strategies utilized by small scale poultry farmers in Oyo state. A total of 118 respondents were sampled using multi stage sampling procedure. Interview schedule was ...

  16. Coping Strategies for Managing Acculturative Stress among Asian International Students

    Ra, Young-An; Trusty, Jerry


    This article examines the effects of specific coping strategies on managing acculturative stress and acculturation of Asian international students, based on a sample of 220 Asian international students in the U.S. The data were analyzed with hierarchical multiple regression using Baron and Kenny's (1986) mediation procedure. The results supported…

  17. Rule-based energy management strategies for hybrid vehicles

    Hofman, T.; Druten, van R.M.; Serrarens, A.F.A.; Steinbuch, M.


    Int. J. of Electric and Hybrid Vehicles (IJEHV), The highest control layer of a (hybrid) vehicular drive train is termed the Energy Management Strategy (EMS). In this paper an overview of different control methods is given and a new rule-based EMS is introduced based on the combination of Rule-Based

  18. Managing Work and Family: Do Control Strategies Help?

    Versey, H. Shellae


    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping…

  19. San Francisco Bay Long Term Management Strategy for Dredging

    The San Francisco Bay Long Term Management Strategy (LTMS) is a cooperative effort to develop a new approach to dredging and dredged material disposal in the San Francisco Bay area. The LTMS serves as the Regional Dredging Team for the San Francisco area.

  20. How differential management strategies affect Ips typographus L. dispersal

    Montano, V.; Bertheau, C.; Doležal, Petr; Krumböck, S.; Okrouhlík, Jan; Stauffer, CH.; Moodley, Y.


    Roč. 360, 15 JAN (2016), s. 195-204 ISSN 0378-1127 R&D Projects: GA ČR GAP504/10/0843 Institutional support: RVO:60077344 Keywords : bark beetle outbreaks * management strategies * dispersal Subject RIV: EH - Ecology, Behaviour Impact factor: 3.064, year: 2016

  1. Strategies to improve clinical management of community-acquired pneumonia

    Meijvis, S.C.A.


    Despite advances during the last few decades in the prevention, diagnosis and treatment of community-acquired pneumonia (CAP), its incidence remains high. In this thesis, strategies are described for improvement of the quality of clinical management in patients with pneumonia and for the reduction

  2. GFC-Robust Risk Management Strategies under the Basel Accord

    M.J. McAleer (Michael); J.A. Jiménez-Martín (Juan-Ángel); T. Pérez-Amaral (Teodosio)


    textabstractA risk management strategy is proposed as being robust to the Global Financial Crisis (GFC) by selecting a Value-at-Risk (VaR) forecast that combines the forecasts of different VaR models. The robust forecast is based on the median of the point VaR forecasts of a set of conditional

  3. Gender Differences in Strategy and Human Resource Management

    Verheul, I.; Risseeuw, P.A.; Bartelse, G.


    The present study aims at investigating the existence of gender differences in entrepreneurship. The focus is on differences in strategy and human resource management (HRM) between male and female entrepreneurs in Dutch real estate brokerage. Several propositions are explored using data from

  4. University Students' Views of Obesity and Weight Management Strategies

    Okonkwo, Ononuju; While, Alison


    Objective: To investigate the knowledge and views of university students regarding obesity and weight management strategies. Design: Online questionnaire-based survey of undergraduate and postgraduate university students in a large London university with a diverse student population. Method: The survey was administered online and circulated…

  5. Maintenance management sourcing strategies and the condition of ...

    In the face of the deplorable state of buildings across the various tertiary institutions in Nigeria, the need to deploy appropriate maintenance management strategy cannot be overemphasized. However, sourcing decision for maintenance services remains a tough one for decision makers as different sourcing option suit ...

  6. Clothing for Elderly Persons: Management and Caring Strategies ...

    This paper examines the clothing requirements of the elderly across the globe and the management and caring strategies in supporting them. There is however, no specific requirement for the elderly in terms of what they wear or how they dress over and above the requirements of early adult life in many nations of the world.

  7. Coping strategies for managing occupational stress for improved ...

    Occupational stress is receiving increasing concern as killer of workers and productivity deterrent. This paper assessed its management and some coping strategies, with a view to improving productivity among workers. The paper adopted literature review approach to x-ray the concept of occupational stress, symptoms of ...

  8. Evaluation of two communication strategies to improve udder health management

    Jansen, J.; Renes, R.J.; Lam, T.J.G.M.


    Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers’ udder health management, tools such as

  9. National strategies in managing radioactive wastes in the Philippines

    Cabalfin, Edilberto A.


    Radioactive waste management in the Philippines is described. The paper traces the historical development of the program along with the development of nuclear energy in the country itself. Present strategies are described in response to the situation obtaining in the country. Lessons learned from the experience are also identified and some observations in resolving issues delaying problem are mentioned. (author)


    K. B. Dobrova


    Full Text Available Issues related to creation of tools making it possible to efficiently control financial and economic production capability of industrial corporations making part of Russian military-industrial complex are discussed on example of an aviation enterprise. A system of balanced indicators is proposed to be used to develop corporation’s adaptive management strategies.

  11. Should Cost: A Strategy for Managing Military Systems Money


    Defense AT&L: March-April 2016 38 Should Cost A Strategy for Managing Military Systems’ Money Jennifer A. Miller Miller is a Cost Analyst of the...and analysis O&S: operation and support or operation and sustainment, dependent on the context of phase of acquisition life cycle or money used

  12. Use of Participatory Forest Management as a Strategy for ...

    This study investigated the strategies for improving access to and use of information for forest management with particular reference to Kazimzumbwi and Pugu forest reserves in Coast Region located in the Pugu Hills area, about 20 km south-west of Dar es Salaam, in Tanzania. The review of literature and preliminary ...

  13. Board and Senior Management Alignment on School Strategy

    Sarros, James C.; Sarros, Anne M.; Cooper, Brian K.; Santora, Joseph C.; Baker, Robin


    This study examines the degree to which senior executive members of a school's decision-making team (senior management team and board of directors) are aligned on fundamental principles of school strategy. Our study is based on a conceptual framework of strategic leadership as it applies in an Australian independent school context. We also examine…

  14. Strategies for Talent Management: Greater Philadelphia Companies in Action

    Council for Adult and Experiential Learning (NJ1), 2008


    Human capital is one of the critical issues that impacts the Greater Philadelphia region's ability to grow and prosper. The CEO Council for Growth (CEO Council) is committed to ensuring a steady and talented supply of quality workers for this region. "Strategies for Talent Management: Greater Philadelphia Companies in Action" provides…

  15. Efficiency of Management and Marketing Strategies within The Dental Office

    Oprea Valentin BUSU


    Full Text Available This article is based on research about the management and marketing strategies within the dental office and how we can better understand its importance. One of the major problems faced by dentists today is the management of the dental office. Certainly, from the outside, individuals perceive the dentist's office as a simple medical unit in which medical staff operate. However, people living in the field face each day multiple problems of both medical and bureaucratic nature. For the dentist/manager, the dental office is perceived as a dual-purpose unit: providing oro-dental care and earning profit.

  16. Accident management strategy in Sweden - implementation and verification

    Loewenhielm, Gustaf; Engqvist, Alf; Espefaelt, Ralf


    A comprehensive program for severe accident mitigation was completed in Sweden by the end of 1988. As described in this paper, this program included plant modifications such as the introduction of filtered containment venting, and an accident management system comprising emergency operating strategies and procedures, training and emergency drills. The accident management system at Vattenfall has been further developed since 1988 and some results and experience from this development are reported in this paper. The main aspects covered concern the emergency organization and the supporting tools developed for use by the emergency response teams, the radiological implications such as accessibility to various locations and the long-term aspects of accident management. ((orig.))

  17. Radwaste Management in Small Nuclear Country - National Policy and Strategy

    Zagar, Tomaz


    The lecture will briefly present the Slovene nuclear program and its legal framework focused on the radioactive waste management policy and strategy aspect. Slovenia is an example of small EU member state with small shared nuclear power program demonstrating safe, secure and efficient management of radioactive waste. Different principles of radioactive waste management will be discoursed; among others including: minimization of waste generation, the polluter pays principle, safe storage followed by final disposal and also new findings on research and development of storage, disposal and recycling of radioactive waste. (author)

  18. Program strategies for maintenance management, organization and planning

    Czegeny, J.I.


    In this paper we look respectively at three specific examples showing program strategies for maintenance management, organization and planning. Starting with preventive maintenance optimization, we will look at one Bruce B Predefined task on the Reactor Regulating System to illustrate reduced maintenance requirement, a maintenance management strategy. Next discussed is the organizational strategy at Darlington to have an engineering program meet the jurisdictional requirements for maintaining certification for TSSA registered pressure vessels. The last look-see will show the earned value of the planning for the first Pickering A unit to be returned to service. Finally all the above is tied together in a compare and contrast of what works and what could be improved upon. (author)

  19. Current Management Strategy for Active Surveillance in Prostate Cancer.

    Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C


    Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes. Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.

  20. Formation of strategy and policy of banking credit operations management

    O.V. Lysenok


    Full Text Available The article examines the strategic management of credit operations as the activities on credit strategies of banking institutions, the formation of goals, objectives, and the choice of methods to achieve them. The basis of this is the strategic management analysis of the factors affecting the lending operations, strategic planning, communication mechanisms of strategic and tactical decisions, monitoring the implementation of the strategy and timely adjustments. For the purpose of effective implementation of the developed strategy, the article argues that banks in modern conditions should develop their own internal credit policy which should cover the essential elements and principles of credit at these banks. The study determines that the credit policy is based on the factors determined by the amount of capital assets and loan portfolio, the structure of its clientele, specialization, location, presence of branch network, the situation in the money market.