WorldWideScience

Sample records for pharmacological management strategies

  1. New pharmacological and technological management strategies in heart failure

    Directory of Open Access Journals (Sweden)

    Chaudhry SP

    2017-03-01

    Full Text Available Sunit-Preet Chaudhry,1 Garrick C Stewart2 1Division of Cardiology, St Vincent Indianapolis, Indianapolis, IN, 2Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women’s Hospital, Boston, MA, USA Abstract: Heart failure is a complex clinical syndrome resulting from impairment of ventricular filling or ejection of blood associated with symptoms of dyspnea, fatigue, as well as peripheral and/or pulmonary edema. This syndrome is progressive and characterized by worsening quality of life despite escalating levels of care, affecting 5.7 million Americans with an annual cost of over $30 billion US dollars. Treatment for this syndrome has evolved over three distinct eras: the nonpharmacological era, the pharmacological era, and the device era, with the focus shifting from symptomatic relief to decreasing morbidity and mortality. Over the past 10 years, the field has undergone a renaissance, with the development of new pharmacologic, hemodynamic monitoring, and device therapies proven to improve outcomes in patients with heart failure. This article will review several recent innovations in the management of patients with heart failure. Keywords: heart failure, heart-assist devices, disease management

  2. Impaired cognition and attention in adults: pharmacological management strategies.

    Science.gov (United States)

    Allain, Hervé; Akwa, Yvette; Lacomblez, Lucette; Lieury, Alain; Bentué-Ferrer, Danièle

    2007-02-01

    Cognitive psychology has provided clinicians with specific tools for analyzing the processes of cognition (memory, language) and executive functions (attention-concentration, abstract reasoning, planning). Neuropsychology, coupled with the neurosciences (including neuroimaging techniques), has authenticated the existence of early disorders affecting the "superior or intellectual" functions of the human brain. The prevalence of cognitive and attention disorders is high in adults because all the diseases implicating the central nervous system are associated with cognitive correlates of variable intensity depending on the disease process and the age of the patient. In some pathologies, cognitive impairment can be a leading symptom such as in schizophrenia, posttraumatic stress disorder or an emblematic stigmata as in dementia including Alzheimer's disease. Paradoxically, public health authorities have only recognized as medications for improving cognitive symptoms those with proven efficacy in the symptomatic treatment of patients with Alzheimer's disease; the other cognitive impairments are relegated to the orphanage of syndromes and symptoms dispossessed of medication. The purpose of this review is to promote a true "pharmacology of cognition" based on the recent knowledge in neurosciences. Data from adult human beings, mainly concerning memory, language, and attention processes, will be reported. "Drug therapeutic strategies" for improving cognition (except for memory function) are currently rather scarce, but promising perspectives for a new neurobiological approach to cognitive pharmacology will be highlighted.

  3. Health care professionals' familiarity with non-pharmacological strategies for managing cancer pain.

    Science.gov (United States)

    Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P

    1999-01-01

    Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under-utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals' familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two-hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self-report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals' interest in NPS has important implications for the supportive care of cancer patients.

  4. Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents.

    Science.gov (United States)

    Idvall, Ewa; Holm, Charlotta; Runeson, Ingrid

    2005-09-01

    Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.

  5. Treatment outcomes of a Numeric Rating Scale (NRS)-guided pharmacological pain management strategy in symptomatic knee and hip osteoarthritis in daily clinical practice.

    NARCIS (Netherlands)

    Snijders, G.F.; Ende, C.H.M. van den; Bemt, B.J.F van den; Riel, P.L.C.M. van; Hoogen, F.H.J. van den; Broeder, A. den

    2012-01-01

    OBJECTIVES: To describe the results of a Numeric Rating Scale (NRS)-guided pharmacological pain management strategy in symptomatic knee and hip osteoarthritis (OA) in daily clinical practice. METHODS: In this observational cohort study, standardised conservative treatment was offered to patients

  6. Pharmacological management of panic disorder

    Directory of Open Access Journals (Sweden)

    Carlo Marchesi

    2008-03-01

    Full Text Available Carlo MarchesiPsychiatric Section, Department of Neuroscience, University of Parma, Parma, ItalyAbstract: Panic disorder (PD is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require longterm treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.Keywords: panic disorder, pharmacological treatment, treatment guidelines

  7. Quality management of pharmacology and safety pharmacology studies

    DEFF Research Database (Denmark)

    Spindler, Per; Seiler, Jürg P

    2002-01-01

    to safety pharmacology studies, and, when indicated, to secondary pharmacodynamic studies, does not influence the scientific standards of studies. However, applying formal GLP standards will ensure the quality, reliability and integrity of studies, which reflect sound study management. It is important...... to encourage a positive attitude among researchers and academics towards these lines, whenever possible. GLP principles applied to the management of non-clinical safety studies are appropriate quality standards when studies are used in the context of protecting public health, and these quality standards...... of pharmacology studies (ICH S7A): primary pharmacodynamic, secondary pharmacodynamic and safety pharmacology studies, and guidance on the quality standards (expectations for GLP conformity) for these study types have been provided. Primary pharmacodynamic studies are the only study types that are fully exempt...

  8. Targeting HIV latency: pharmacologic strategies toward eradication

    Science.gov (United States)

    Xing, Sifei; Siliciano, Robert F.

    2013-01-01

    The latent reservoir for HIV-1 in resting CD4+ T cells remains a major barrier to HIV-1 eradication, even though highly active antiretroviral therapy (HAART) can successfully reduce plasma HIV-1 levels to below the detection limit of clinical assays and reverse disease progression. Proposed eradication strategies involve reactivation of this latent reservoir. Multiple mechanisms are believed to be involved in maintaining HIV-1 latency, mostly through suppression of transcription. These include cytoplasmic sequestration of host transcription factors and epigenetic modifications such as histone deacetylation, histone methylation and DNA methylation. Therefore, strategies targeting these mechanisms have been explored for reactivation of the latent reservoir. In this review, we discuss current pharmacological approaches toward eradication, focusing on small molecule latency-reversing agents, their mechanisms, advantages and limitations. PMID:23270785

  9. Pharmacological Strategies to Retard Cardiovascular Aging

    Science.gov (United States)

    Alfaras, Irene; Di Germanio, Clara; Bernier, Michel; Csiszar, Anna; Ungvari, Zoltan; Lakatta, Edward G.; de Cabo, Rafael

    2016-01-01

    Aging is the major risk factor for cardiovascular diseases (CVD), which are the leading cause of death in the United States. Traditionally, the effort to prevent CVD has been focused on addressing the conventional risk factors, including hypertension, hyperglycemia, hypercholesterolemia, and high circulating levels of triglycerides. However, recent preclinical studies have identified new approaches to combat CVD. Calorie restriction has been reproducibly shown to prolong lifespan in various experimental model animals. This has led to the development of calorie restriction mimetics and other pharmacological interventions capable to delay age-related diseases. In this review, we will address the mechanistic effects of aging per se on the cardiovascular system and focus on the pro-longevity benefits of various therapeutic strategies that support cardiovascular health. PMID:27174954

  10. Neuropathic pain in people with cancer (part 2): pharmacological and non-pharmacological management.

    Science.gov (United States)

    Taverner, Tarnia

    2015-08-01

    The aim of this paper is to provide an overview of the management of neuropathic pain associated with cancer and to provide helpful clinical advice for nurses working with patients who may have neuropathic pain. While cancer pain is a mixed-mechanism pain, this article will focus only on neuropathic pain management. The impact of neuropathic pain on patients' quality of life is great and while many patients recover from their cancer, a significant number continue to suffer from a neuropathic pain syndrome. Management of neuropathic pain is significantly different from management of nociceptive pain with respect to pharmacological and non-pharmacological strategies. Neuropathic pain is complex, and as such requires complex management using pharmacological as well as non-pharmacological approaches. Specific drugs for neuropathic pain may be effective for some patients, but not all; therefore, ongoing and comprehensive assessment and management are required. Furthermore, these patients may require trials of several drugs before they find one that works for them. It is important for nurses to understand neuropathic pain, its manifestation, impact on quality of life and management when nursing patients with neuropathic pain associated with cancer.

  11. Pharmacologic management of chronic neuropathic pain

    Science.gov (United States)

    Mu, Alex; Weinberg, Erica; Moulin, Dwight E.; Clarke, Hance

    2017-01-01

    Abstract Objective To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain. Quality of evidence A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement. Main message Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents. Conclusion Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain. PMID:29138154

  12. Management strategies for fibromyalgia

    Directory of Open Access Journals (Sweden)

    Le Marshall KF

    2011-07-01

    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 

  13. The pharmacological management of metabolic syndrome.

    Science.gov (United States)

    Rask Larsen, Julie; Dima, Lorena; Correll, Christoph U; Manu, Peter

    2018-04-01

    The metabolic syndrome includes a constellation of several well-established risk factors, which need to be aggressively treated in order to prevent overt type 2 diabetes and cardiovascular disease. While recent guidelines for the treatment of individual components of the metabolic syndrome focus on cardiovascular benefits as resulted from clinical trials, specific recent recommendations on the pharmacological management of metabolic syndrome are lacking. The objective of present paper was to review the therapeutic options for metabolic syndrome and its components, the available evidence related to their cardiovascular benefits, and to evaluate the extent to which they should influence the guidelines for clinical practice. Areas covered: A Medline literature search was performed to identify clinical trials and meta-analyses related to the therapy of dyslipidemia, arterial hypertension, glucose metabolism and obesity published in the past decade. Expert commentary: Our recommendation for first-line pharmacological are statins for dyslipidemia, renin-angiotensin-aldosteron system inhibitors for arterial hypertension, metformin or sodium/glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1RAs) for glucose intolerance, and the GLP-1RA liraglutide for achieving body weight and waist circumference reduction.

  14. Pharmacological management of obesity in pediatric patients.

    Science.gov (United States)

    Boland, Cassie L; Harris, John Brock; Harris, Kira B

    2015-02-01

    To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. © The Author(s) 2014.

  15. Pharmacological management of narcolepsy with and without cataplexy.

    Science.gov (United States)

    Kallweit, Ulf; Bassetti, Claudio L

    2017-06-01

    Narcolepsy is an orphan neurological disease and presents with sleep-wake, motoric, neuropsychiatric and metabolic symptoms. Narcolepsy with cataplexy is most commonly caused by an immune-mediated process including genetic and environmental factors, resulting in the selective loss of hypocretin-producing neurons. Narcolepsy has a major impact on workableness and quality of life. Areas covered: This review provides an overview of the temporal available treatment options for narcolepsy (type 1 and 2) in adults, including authorization status by regulatory agencies. First- and second-line options are discussed as well as combination therapies. In addition, treatment options for frequent coexisting co-morbidities and different phenotypes of narcolepsy are presented. Finally, this review considers potential future management strategies. Non-pharmacological approaches are important in the management of narcolepsy but will not be covered in this review. Expert opinion: Concise evaluation of symptoms and type of narcolepsy, coexisting co-morbidities and patients´ distinct needs is mandatory in order to identify a suitable, individual pharmacological treatment. First-line options include Modafinil/Armodafinil (for excessive daytime sleepiness, EDS), Sodium Oxybate (for EDS and/with cataplexy), Pitolisant (for EDS and cataplexy) and Venlafaxine (for cataplexy (off-label) and co-morbid depression). New symptomatic and causal treatment most probably will be completed by hypocretin-replacement and immune-modifying strategies.

  16. Pharmacological management of chronic obstructive pulmonary ...

    African Journals Online (AJOL)

    The main objective of treatment is to relieve daily symptoms, improve quality of life and importantly decrease the risk of future exacerbations. Current guidelines are based on grade A and B evidence. Pneumococcal and annual influenza vaccinations are encouraged. A holistic approach that augments pharmacological ...

  17. Non-pharmacological strategies for blood conservation in cardiac surgery.

    Science.gov (United States)

    Ruel, M A; Rubens, F D

    2001-04-01

    Of all surgical specialties, cardiac operations are most often associated with coagulopathy, blood loss, and the need for transfusions. This not only represents a major burden on blood procurement and banking organizations at all levels, but also constitutes a risk for each patient receiving allogeneic blood products. This paper reviews current non-pharmacological strategies aimed at decreasing blood use in patients undergoing cardiac surgery. The literature pertaining to each blood conservation strategy was searched, reviewed, and appraised. Meta- analyses were also consulted and their results complemented with subsequent reports when available. Preoperative autologous donation programs are effective in decreasing allogeneic transfusions, but are costly and applicable to elective patients only. Off-pump revascularization strategies also appear to decrease transfusion requirements in suitable patients. The effectiveness of acute normovolemic hemodilution, retrograde autologous priming, small volume cardiopulmonary bypass circuits, platelet-rich plasmapheresis, alternative heparin strategies, and postoperative cell salvage are more difficult to appraise as a high proportion of available studies suffer from lack of transfusion guidelines or the absence of blinding. Biological glues, surgical adhesives, and postoperative increases in positive end-expiratory pressure (PEEP) have no demonstrated efficacy. The applicability or effectiveness of many of these modalities remains controversial and more studies are needed before they may be employed routinely in cardiac surgical patients. The judicious use of rational transfusion guidelines may still be the simplest and most cost-effective means of blood conservation today.

  18. Pharmacological strategies for protection of extrahepatic islet transplantation.

    Science.gov (United States)

    Omori, K; Komatsu, H; Rawson, J; Mullen, Y

    2015-06-01

    The safety and effectiveness of islet transplantation has been proven through world-wide trials. However, acute and chronic islet loss has hindered the ultimate objective of becoming a widely used treatment option for type 1 diabetes. A large islet loss is attributed, in part, to the liver being a less-than-optimal site for transplantation. Over half of the transplanted islets are destroyed shortly after transplantation due to direct exposure to blood and non-specific inflammation. Successfully engrafted islets are continuously exposed to the liver micro-environment, a unique immune system, low oxygen tension, toxins and high glucose, which is toxic to islets, leading to premature islet dysfunction/death. Investigations have continued to search for alternate sites to transplant islets that provide a better environment for prolonged function and survival. This article gathers courses and conditions that lead to islet loss, from organ procurement through islet transplantation, with special emphasis on hypoxia, oxidative stress, and antigen non-specific inflammation, and reviews strategies using pharmacological agents that have shown effectiveness in protecting islets, including a new treatment approach utilizing siRNA. Pharmacological agents that support islet survival and promote β-cell proliferation are also included. Treatment of donor pancreata and/or islets with these agents should increase the effectiveness of islets transplanted into extrahepatic sites. Furthermore, the development of methods designed to release these agents over an extended period, will further increase their efficacy. This requires the combined efforts of both islet transplant biologists and bioengineers.

  19. Modern strategy and prospects in pharmacological treatment of Parkinson's disease

    Directory of Open Access Journals (Sweden)

    А. V. Kutsak

    2017-02-01

    Full Text Available Aim – to analyze scientific literature to summarize data about contemporary views on the pharmacological therapy of Parkinson's disease (PD. PD is a chronic, neurodegenerative steadily progressive disease of the central nervous system, primarily associated with the degeneration of dopamine-producing neurons in the cerebral pulp, manifested by motor and non-motor disorders and leading to permanent disability. The duration of patient’s life with PD, provided with adequate treatment, can be closer to the one of the general population. At the same time, the course of the disease may change with the increase of life expectancy of the patients. And as the result, in the clinical picture, non-motor disorders and motor complications caused by a further degeneration of dopaminergic neurons and adverse reactions of pharmacological therapy, come out in the first place. The apropos and rational correction of which improves the course of the disease and patients' quality of life. Within the age PD frequency in the population is increasing; taking into account the global trend to an increase in the duration of human life, this disease performs even bigger medical and social problem. And the need for further development of pharmacotherapy practices becomes more relevant. This review presents the current recommendations for the pharmacological treatment of PD. The attention is directed to the need for evidence when assessing the effectiveness of any treatment strategy. The data on the ongoing development of pharmaceuticals. Conclusions. At this time the existing therapeutic tactics in the pharmacological therapy of BP, despite the fact that they are quite successful in leveling manifestations of the disease, do not stop the disease, and are in fact symptomatic treatment. All successful clinical development, for the time being, are the emergence of new drugs belonging to the group of BP symptomatic therapy with the best bioavailability and tolerability

  20. Pharmacological and physical vessel modulation strategies to improve EPR-mediated drug targeting to tumors.

    Science.gov (United States)

    Ojha, Tarun; Pathak, Vertika; Shi, Yang; Hennink, Wim E; Moonen, Chrit T W; Storm, Gert; Kiessling, Fabian; Lammers, Twan

    2017-09-15

    The performance of nanomedicine formulations depends on the Enhanced Permeability and Retention (EPR) effect. Prototypic nanomedicine-based drug delivery systems, such as liposomes, polymers and micelles, aim to exploit the EPR effect to accumulate at pathological sites, to thereby improve the balance between drug efficacy and toxicity. Thus far, however, tumor-targeted nanomedicines have not yet managed to achieve convincing therapeutic results, at least not in large cohorts of patients. This is likely mostly due to high inter- and intra-patient heterogeneity in EPR. Besides developing (imaging) biomarkers to monitor and predict EPR, another strategy to address this heterogeneity is the establishment of vessel modulation strategies to homogenize and improve EPR. Over the years, several pharmacological and physical co-treatments have been evaluated to improve EPR-mediated tumor targeting. These include pharmacological strategies, such as vessel permeabilization, normalization, disruption and promotion, as well as physical EPR enhancement via hyperthermia, radiotherapy, sonoporation and phototherapy. In the present manuscript, we summarize exemplary studies showing that pharmacological and physical vessel modulation strategies can be used to improve tumor-targeted drug delivery, and we discuss how these advanced combination regimens can be optimally employed to enhance the (pre-) clinical performance of tumor-targeted nanomedicines. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Pharmacological management of spasticity in multiple sclerosis

    DEFF Research Database (Denmark)

    Otero-Romero, Susana; Sastre-Garriga, Jaume; Comi, Giancarlo

    2016-01-01

    Background and objectives: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients. Methods...... improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity...... and suboptimal response to oral drugs. Conclusion: The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence...

  2. Tackling HIV Persistence: Pharmacological versus CRISPR-Based Shock Strategies.

    Science.gov (United States)

    Darcis, Gilles; Das, Atze T; Berkhout, Ben

    2018-03-29

    Jan Svoboda studied aspects of viral latency, in particular with respect to disease induction by avian RNA tumor viruses, which were later renamed as part of the extended retrovirus family. The course of retroviral pathogenesis is intrinsically linked to their unique property of integrating the DNA copy of the retroviral genome into that of the host cell, thus forming the provirus. Retroviral latency has recently become of major clinical interest to allow a better understanding of why we can effectively block the human immunodeficiency virus type 1 (HIV-1) in infected individuals with antiviral drugs, yet never reach a cure. We will discuss HIV-1 latency and its direct consequence-the formation of long-lasting HIV-1 reservoirs. We next focus on one of the most explored strategies in tackling HIV-1 reservoirs-the "shock and kill" strategy-which describes the broadly explored pharmacological way of kicking the latent provirus, with subsequent killing of the virus-producing cell by the immune system. We furthermore present how the clustered regularly interspaced palindromic repeats (CRISPR) and associated protein (Cas) system can be harnessed to reach the same objective by reactivating HIV-1 gene expression from latency. We will review the benefits and drawbacks of these different cure strategies.

  3. Manufacturing knowledge management strategy

    OpenAIRE

    Shaw , Duncan; Edwards , John

    2006-01-01

    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...

  4. Pharmacological management of chronic obstructive pulmonary ...

    African Journals Online (AJOL)

    plan: (i) assess and monitor disease; (ii) reduce risk factors; (iii) manage stable COPD ... The correct diagnosis of COPD and its severity is essential if the .... processes associated with COPD. .... Bateman ED, Mahler DA, Vogelmeier CF, et al.

  5. Management strategies for business

    OpenAIRE

    Alexander Sumets

    2018-01-01

    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...

  6. Immunosuppressive strategies and management

    Institute of Scientific and Technical Information of China (English)

    Shi-hui PAN

    2008-01-01

    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

  7. Holistic Management of Schizophrenia Symptoms Using Pharmacological and Non-pharmacological Treatment.

    Science.gov (United States)

    Ganguly, Pronab; Soliman, Abdrabo; Moustafa, Ahmed A

    2018-01-01

    Individuals with schizophrenia lead a poor quality of life, due to poor medical attention, homelessness, unemployment, financial constraints, lack of education, and poor social skills. Thus, a review of factors associated with the holistic management of schizophrenia is of paramount importance. The objective of this review is to improve the quality of life of individuals with schizophrenia, by addressing the factors related to the needs of the patients and present them in a unified manner. Although medications play a role, other factors that lead to a successful holistic management of schizophrenia include addressing the following: financial management, independent community living, independent living skill, relationship, friendship, entertainment, regular exercise for weight gained due to medication administration, co-morbid health issues, and day-care programmes for independent living. This review discusses the relationship between different symptoms and problems individuals with schizophrenia face (e.g., homelessness and unemployment), and how these can be managed using pharmacological and non-pharmacological methods. Thus, the target of this review is the carers of individuals with schizophrenia, public health managers, counselors, case workers, psychiatrists, and clinical psychologists aiming to enhance the quality of life of individuals with schizophrenia.

  8. Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy

    Directory of Open Access Journals (Sweden)

    Małgorzata Malec-Milewska

    2015-05-01

    Full Text Available Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions. Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions. Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin. Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms. Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.

  9. Management strategies for fibromyalgia

    OpenAIRE

    Le Marshall KF; Littlejohn GO

    2011-01-01

    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 ...

  10. An observational study of clozapine induced sedation and its pharmacological management.

    Science.gov (United States)

    Ramos Perdigués, Sònia; Sauras Quecuti, Rosa; Mané, Anna; Mann, Louisa; Mundell, Clare; Fernandez-Egea, Emilio

    2016-01-01

    Clozapine induced sedation is common but its management is unclear. We analyzed the factors associated with clozapine-induced sedation and the efficacy of common pharmacological strategies. We conducted a naturalistic observational study using two years electronic records of a cohort patients and three analyses: a cross sectional analysis of factors associated with total number of hours slept (as an objective proxy of sedation), and two prospective analyses of which factors were associated with changes in hours slept and the efficacy of two pharmacological strategies. 133 patients were included, of which 64.7% slept at least 9h daily. Among monotherapy patients (n=30), only norclozapine levels (r=.367, p=.03) correlated with hours slept. Using the prospective cohort (n=107), 42 patients decreased the number of hours slept, due to decreasing clozapine (40%) or augmenting with aripiprazole (36%). These two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects respectively but the majority (81.8% and 73.9%) did not reduce number of hours slept. Thus, pharmacological and non-pharmacological factors are involved in sedation. Norclozapine plasma levels correlated with total sleeping hours. Reducing clozapine and aripiprazole augmentation were associated to amelioration of sedation, although both strategies were effective only in a limited numbers of subjects. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

  11. Advances in the nutritional and pharmacological management of phenylketonuria

    Science.gov (United States)

    Ney, Denise M.; Blank, Robert D.; Hansen, Karen E.

    2014-01-01

    Structural Abstract Purpose of review The purpose is to discuss advances in the nutritional and pharmacological management of phenylketonuria (PKU). Recent findings Glycomacropeptide (GMP), a whey protein produced during cheese production, is a low-phe intact protein that represents a new dietary alternative to synthetic amino acids (AAs) for people with PKU. Skeletal fragility is a long-term complication of PKU that based on murine research, appears to result from both genetic and nutritional factors. Skeletal fragility in murine PKU is attenuated with the GMP diet, compared with an AA diet, allowing greater radial bone growth. Pharmacologic therapy with tetrahydrobiopterin (BH4), acting as a molecular chaperone for phenylalanine hydroxylase, increases tolerance to dietary phe in some individuals. Large neutral AAs (LNAA) inhibit phe transport across the intestinal mucosa and blood brain barrier; LNAA are most effective for individuals unable to comply with the low-phe diet. Summary Although a low-phe synthetic AA diet remains the mainstay of PKU management, new nutritional and pharmacological treatment options offer alternative approaches to maintain lifelong low phe concentrations. GMP medical foods provide an alternative to AA formula that may improve bone health, and BH4 permits some individuals with PKU to increase tolerance to dietary phe. Further research is needed to characterize the long-term efficacy of these new approaches for PKU management. PMID:24136088

  12. Pharmacologic management of isolated low high-density lipoprotein syndrome.

    Science.gov (United States)

    Bermúdez, Valmore; Cano, Raquel; Cano, Clímaco; Bermúdez, Fernando; Arraiz, Nailet; Acosta, Luis; Finol, Freddy; Pabón, María Rebeca; Amell, Anilsa; Reyna, Nadia; Hidalgo, Joaquin; Kendall, Paúl; Manuel, Velasco; Hernández, Rafael

    2008-01-01

    High-density lipoprotein (HDL) cholesterol is a heterogeneous group of lipoproteins exhibiting a variety of properties like prostacyclin production stimulation, decrease in platelet aggregation, endothelial cell apoptosis inhibition, and low-density lipoprotein oxidation blockade. Epidemiologic studies have shown an inverse relation between HDL cholesterol levels and cardiovascular risk. Low HDL cholesterol is associated with increased risk for myocardial infarction, stroke, sudden death, peripheral artery disease, and postangioplasty restenosis. In contrast, high HDL levels are associated with longevity and protection against atherosclerotic disease development. Given the evolving epidemic of obesity, diabetes mellitus, and metabolic syndrome, the prevalence of low HDL will continue to rise. In the United States, low HDL is present in 35% of men, 15% of women, and approximately 63% of patients with coronary artery disease. Data extracted from the Framingham study highlight that 1-mg increase in HDL levels decreases by 2% to 3% the risk of cardiovascular disease. There is no doubt regarding clinical importance about isolated low HDL, but relatively few clinicians consider a direct therapeutic intervention of this dyslipidemia. In this sense, lifestyle measures should be the first-line strategy to manage low HDL levels. On the other hand, pharmacologic options include niacin, fibrates, and statins. Fibrates appear to reduce risk preferentially in patients with low HDL with metabolic syndrome, whereas statins reduce risk across all levels of HDL. Torcetrapib, a cholesteryl esters transfer protein inhibitor, represented a hope to raise this lipoprotein; however, all clinical trials on this drug had ceased after ILLUMINATE, RADIANCE and ERASE trials had recorded an increase in mortality, rates of myocardial infarction, angina, and heart failure. In the near future, drugs as beta-glucans, Apo-A1 mimetic peptides, and ACAT inhibitors, are the new promises to treat this

  13. Psychosocial and pharmacological management of pain in pediatric sickle cell disease.

    Science.gov (United States)

    Hildenbrand, Aimee K; Nicholls, Elizabeth G; Daly, Brian P; Marsac, Meghan L; Tarazi, Reem; Deepti, Raybagkar

    2014-03-01

    For children with sickle cell disease (SCD), pain is associated with significant current and future morbidity and mortality. Unfortunately, few evidence-based guidelines exist for the management of pain episodes in children with SCD. To inform empirically based treatment strategies for pain management in pediatric SCD, this review integrates and evaluates the extant literature on psychosocial and pharmacological approaches to the management of pain. Findings reveal a paucity of rigorous investigations of psychosocial and pharmacological pain management interventions in children with SCD. Psychosocial interventions included were primarily cognitive-behavioral in nature, whereas pharmacological approaches targeted non-opioid analgesics (ie, nonsteroidal anti-inflammatory drugs and corticosteroids) and opioid medications (ie, morphine and oxycodone). However, to date there is not a "gold standard" for pain management among children with SCD. Because psychosocial and physiological processes each play a role in the etiology and experience of pain, effective pain management requires multidimensional, comprehensive treatment approaches. Considering the significant impact of pain on functional outcomes and quality of life among children with SCD, additional clinical trials are warranted to ensure that interventions are safe and efficacious.

  14. Fault Management Design Strategies

    Science.gov (United States)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    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.

  15. Marketing Management and Strategy

    DEFF Research Database (Denmark)

    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...

  16. Pharmacologic management of neuropathic pain: Evidence-based recommendations

    DEFF Research Database (Denmark)

    Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav

    2007-01-01

    Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered...... and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second......, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs...

  17. Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis

    NARCIS (Netherlands)

    Daien, Claire Immediato; Hua, Charlotte; Combe, Bernard; Landewe, Robert

    2017-01-01

    To perform a systematic literature review (SLR) on pharmacological and non-pharmacological treatments, in order to inform the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis (EA). The expert committee defined research questions concerning

  18. Learning how to learn: Meta-learning strategies for the challenges of learning pharmacology.

    Science.gov (United States)

    Alton, Suzanne

    2016-03-01

    Nursing students have difficulty with pharmacology courses because of the complicated nomenclature and the difficulty of applying drug information to actual patient care. As part of a new pharmacology course being created, meta-learning strategies designed to diminish the difficulties of learning this difficult content were part of the course pedagogy. Strategies were demonstrated, reviewed in class, and implemented through homework assignments. The setting was an Academic Health Center's School of Nursing in the southern United States. Participants were third-year nursing students in an undergraduate nursing program. Surveys of students' opinions of learning gains were conducted at the end of the course over several semesters. In addition, pharmacology scores on a standardized exit exam were compared prior to implementing the course and after. Students reported learning dry material more easily, having greater confidence, and finding substantial value in the learning strategies. Students indicated the most helpful strategies, in descending order, as follows: making charts to compare and contrast drugs and drug classes, writing out drug flash cards, making or reviewing creative projects, prioritizing information, making or using visual study aids, and using time and repetition to space learning. Implementation of the new course improved pharmacology scores on a standardized exit exam from 67.0% to 74.3%. Overall response to learning strategies was positive, and the increase in the pharmacology standardized exit exam scores demonstrated the effectiveness of this instructional approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Pharmacologic strategies in the prevention and treatment of corneal transplant rejection.

    Science.gov (United States)

    Tabbara, Khalid F

    2008-06-01

    Corneal transplantation remains one of the most successful organ transplantation procedures in humans. The unique structure of the cornea, with its absence of blood vessels and corneal lymphatic, allows the survival of corneal allograft. Recent advances in sutures, storage media, microsurgical instrumentation, and new pharmacological strategies have greatly improved the success of corneal transplantation and the prevention of corneal allograft rejection. Our strategies in the management and prevention of corneal graft rejection can modify and improve the survival of corneal allografts. Preoperative evaluation, understanding the risk factors, and management of ocular surface disorders may greatly improve the survival of the corneal transplant. Early recognition of corneal allograft rejection and aggressive treatment may improve the survival of the corneal graft. Furthermore, patients who undergo corneal transplantation should be maintained under close ophthalmic surveillance and patients should be informed to report immediately whenever symptoms of corneal graft rejection occur. The mainstay of therapy is topical corticosteroids. In severe cases, periocular, intravenous, and oral corticosteroids therapy can be rendered. New therapeutic modalities such as cyclosporine, tacrolimus, daclizumab, mycophenolate mofetil, leflunomide, rapamycin, and others may prove to be of help in the prevention and treatment of corneal graft rejection. Early recognition of corneal graft rejection and prompt treatment are mandatory for the successful survival of the corneal allograft.

  20. Huntington's disease: current epidemiology and pharmacological management in UK primary care.

    Science.gov (United States)

    Sackley, Catherine; Hoppitt, Thomas J; Calvert, Melanie; Gill, Paramjit; Eaton, Benjamin; Yao, Guiqing; Pall, Hardev

    2011-01-01

    Recent debate suggests Huntington's disease (HD) may be more prevalent than previously reported. In addition, relatively little is known about current disease management. This study aims to provide epidemiological data and describe the pharmacological management of HD in the United Kingdom. A primary care research database was accessed to identify incident and prevalent HD cases between January 1, 2004, and December 31, 2008. Patients with Read codes denoting a definite diagnosis or possible diagnosis, and undiagnosed patients with a positive family history were identified. A subset of patients with a definite diagnosis and prescribed medication indicating symptom onset was also identified. Epidemiological data were estimated. Pharmacological prescriptions to HD patients from 2004 to 2008 were identified, and prescription frequencies were grouped according to the British National Formulary categories. HD incidence estimates ranged from 0.44 to 0.78 per 100,000 person-years, and HD prevalence ranged from 5.96 to 6.54 per 100,000 of the population. Forty-four percent of pharmacological prescriptions targeted the central nervous system. Nearly half of the HD patients were prescribed antidepressants, and over 40% were prescribed analgesics. Although prevalence estimates fell short of figures suggested in recent debate, it is feasible that the true prevalence may be much higher than previously reported. Pharmacological management appears to rely heavily on central nervous system drugs and nutrition support. Many of these drugs are prescribed to HD patients for reasons other than the medication's primary use. Further work is required to evaluate the impact of alternative management strategies, such as therapist intervention, counselling, and organisation support, on the patients' quality of life. Copyright © 2011 S. Karger AG, Basel.

  1. Management strategy of enterprise

    Directory of Open Access Journals (Sweden)

    Osovskiy O.A.

    2017-03-01

    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.

  2. Recommendations for the pharmacologic management of allergic rhinitis.

    Science.gov (United States)

    Hoyte, Flavia C L; Meltzer, Eli O; Ostrom, Nancy K; Nelson, Harold S; Bensch, Greg W; Spangler, Dennis L; Storms, William W; Weinstein, Steven F; Katial, Rohit K

    2014-01-01

    Allergic rhinitis (AR) affects at least 60 million people in the United States each year, resulting in a major impact on patient quality of life, productivity, and direct and indirect costs. As new therapies, data, and literature emerge in the management of AR, there is a need to communicate and disseminate important information to health care professionals to advance the practice of medicine and lessen the disease burden from AR. Treatment recommendations for AR have not been updated since the 2012 Food and Drug Administration approval of nonaqueous intranasal aerosol agents using hydrofluoroalkane propellants and the first aqueous intranasal combination product. Here, we present an updated algorithm for the pharmacologic treatment of AR that includes these new treatment options. Treatment recommendations are categorized by disease severity (mild versus moderate/severe) and duration of symptoms (episodic versus nonepisodic, with episodic defined as well as alternative options for consideration by clinicians in the context of individual patient needs. This recommendation article also outlines the importance of treatment monitoring, which can be conducted using the recently developed Rhinitis Control Assessment Test. Successful therapeutic outcomes depend on multiple factors, including use of the most effective pharmacologic agents as well as patient adherence to therapy. Therefore, it is imperative that rhinitis patients not only receive the most effective therapeutic options, but that they also understand and are able to adhere to the comprehensive treatment regimen. Successful treatment, with all of these considerations in mind, results in better disease outcomes, improved quality of life for patients, and greater economic productivity in the home and workplace.

  3. Clinical and practical considerations in the pharmacologic management of narcolepsy.

    Science.gov (United States)

    Thorpy, Michael J; Dauvilliers, Yves

    2015-01-01

    Despite published treatment recommendations and the availability of approved and off-label pharmacologic therapies for narcolepsy, the clinical management of this incurable, chronic neurologic disorder remains challenging. While treatment is generally symptomatically driven, decisions regarding which drug(s) to use need to take into account a variety of factors that may affect adherence, efficacy, and tolerability. Type 1 narcolepsy (predominantly excessive daytime sleepiness with cataplexy) or type 2 narcolepsy (excessive daytime sleepiness without cataplexy) may drive treatment decisions, with consideration given either to a single drug that targets multiple symptoms or to multiple drugs that each treat a specific symptom. Other drug-related characteristics that affect drug choice are dosing regimens, tolerability, and potential drug-drug interactions. Additionally, the patient should be an active participant in treatment decisions, and the main symptomatic complaints, treatment goals, psychosocial setting, and use of lifestyle substances (ie, alcohol, nicotine, caffeine, and cannabis) need to be discussed with respect to treatment decisions. Although there is a lack of narcolepsy-specific instruments for monitoring therapeutic effects, clinically relevant subjective and objective measures of daytime sleepiness (eg, Epworth Sleepiness Scale and Maintenance of Wakefulness Test) can be used to provide guidance on whether treatment goals are being met. These considerations are discussed with the objective of providing clinically relevant recommendations for making treatment decisions that can enhance the effective management of patients with narcolepsy. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Beyond the drugs : non-pharmacological strategies to optimize procedural care in children

    NARCIS (Netherlands)

    Leroy, Piet L.; Costa, Luciane R.; Emmanouil, Dimitris; van Beukering, Alice; Franck, Linda S.

    2016-01-01

    Purpose of review Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of non-pharmacological strategies (NPS) in all cases, timely or

  5. Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review

    Directory of Open Access Journals (Sweden)

    Natany da Costa Ferreira

    2015-12-01

    Full Text Available ABSTRACT Objective: to identify and review the literature on non-pharmacological strategies used for reducing anxiety in patients receiving cardiac catheterization. Method: this study was an integrative literature review. The research was conducted using the databases LILACS, SciELO, Medline (through BVS and PubMed and Scopus. Studies were analyzed according to their objective, method, instruments used for evaluating patients' anxiety, and the results obtained. Results: the most used strategy for reducing anxiety in patients receiving cardiac catheterization was music therapy. However, no study identifying the most appropriate time for this intervention (before, during and/or after the procedure was found. Other strategies identified in this review were educational videos, massage, and palm therapy. Conclusion: the results found suggest that anxiety can be reduced using non-pharmacological strategies.

  6. Human capital strategy: talent management.

    Science.gov (United States)

    Nagra, Michael

    2011-01-01

    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.

  7. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

    Directory of Open Access Journals (Sweden)

    Mallick-Searle T

    2016-09-01

    Full Text Available Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin, tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine, or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence

  8. Radioactive Waste Management Strategy

    International Nuclear Information System (INIS)

    2002-01-01

    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

  9. Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation.

    Science.gov (United States)

    Lee, Vivian Wing-Yan; Tsai, Ronald Bing-Ching; Chow, Ines Hang-Iao; Yan, Bryan Ping-Yen; Kaya, Mehmet Gungor; Park, Jai-Wun; Lam, Yat-Yin

    2016-08-31

    Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY. Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.

  10. Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management.

    Science.gov (United States)

    Siniscalchi, Antonio; Gallelli, Luca; Labate, Angelo; Malferrari, Giovanni; Palleria, Caterina; Sarro, Giovambattista De

    2012-09-01

    Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders have shown a partial benefit with pharmacological approach.

  11. Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions

    Directory of Open Access Journals (Sweden)

    Konda VJA

    2011-11-01

    Full Text Available Vani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett's esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett's esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett's segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett's esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett's epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett's esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett's esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.Keywords: Barrett's esophagus, high

  12. Knowledge and pharmacological management of Alzheimer's disease by managing community pharmacists: a nationwide study.

    Science.gov (United States)

    Zerafa, Natalie; Scerri, Charles

    2016-12-01

    Background Managing community pharmacists can play a leading role in supporting community dwelling individuals with Alzheimer's disease and their caregivers. Objective The main purpose of this study was to assess knowledge of managing community pharmacists towards Alzheimer's disease and its pharmacological management. Setting Community pharmacies in the Maltese islands. Method A nationwide survey was conducted with full-time managing community pharmacists in possession of a tertiary education degree in pharmacy studies. The level of knowledge was investigated using the Alzheimer's Disease Knowledge Scale and the Alzheimer's Disease Pharmacotherapy Measure. Participants were also asked to rate a number of statements related to disease management. Results Maltese managing community pharmacists (57 % response rate) had inadequate knowledge on risk factors, caregiving issues and pharmacological management of Alzheimer's disease. Age and number of years working in a community pharmacy setting were found to be negatively correlated with increased knowledge. Conclusion The findings highlight the need of providing training and continued educational support to managing community pharmacists in order to provide quality advice to individuals with dementia and their caregivers in the community.

  13. Pharmacological Approaches for the Management of Persistent Pain in Older Adults What Nurses Need to Know

    NARCIS (Netherlands)

    Guerriero, Fabio; Bolier, Ruth; van Cleave, Janet H.; Reid, M. Cary

    2016-01-01

    The current article addresses pharmacological treatment issues regarding the management of persistent pain in later life, which is a worldwide problem associated with substantial disability. Recommendations from guidelines were reviewed and data are presented regarding the benefits and risks of

  14. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

    DEFF Research Database (Denmark)

    Fernandes, Linda; Hagen, Kåre B; Bijlsma, Johannes W J

    2013-01-01

    The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists...

  15. Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management

    OpenAIRE

    Siniscalchi, Antonio; Gallelli, Luca; Labate, Angelo; Malferrari, Giovanni; Palleria, Caterina; Sarro, Giovambattista De

    2012-01-01

    Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders ...

  16. Management: A Strategy for Change.

    Science.gov (United States)

    White, Herbert S.

    1978-01-01

    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)

  17. Strategy of fuel management

    International Nuclear Information System (INIS)

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

    1996-01-01

    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.)

  18. The office of strategy management.

    Science.gov (United States)

    Kaplan, Robert S; Norton, David P

    2005-10-01

    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.

  19. FARM PERFORMANCE AND MANAGEMENT STRATEGIES

    Directory of Open Access Journals (Sweden)

    Li Li

    2018-04-01

    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.

  20. Strategies for radwaste management

    International Nuclear Information System (INIS)

    Forsberg, C.W.

    1993-01-01

    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

  1. Overview of clinical efficacy and safety of pharmacologic strategies for blood conservation.

    Science.gov (United States)

    Levy, Jerrold H

    2005-09-15

    The pharmacologic management of hemostasis in patients undergoing surgery with cardiopulmonary bypass is discussed. Nearly 45 studies involving 7,000 patients have reported efficacy of aprotinin in blood conservation. Both in primary coronary artery bypass graft (CABG) surgeries and in repeat surgeries, aprotinin treatment significantly reduces the incidence of blood transfusions and the number of units of blood transfused. These effects have been observed for red blood cell, platelet, and other blood products. The safety of aprotinin treatment has been extensively evaluated in randomized clinical trials, in postmarketing databases, and in systematic reviews of the literature. Overall, data do not indicate that aprotinin treatment increases mortality, myocardial infarction, or renal failure. These findings are supported by the results of a recent meta-analysis of 35 studies in patients undergoing CABG surgery. In addition, the meta-analysis suggests that aprotinin treatment was associated with a reduced incidence of stroke and a trend toward a reduced incidence of atrial fibrillation. Although lysine analogs, desmopressin, and recombinant factor VIIa are sometimes used to reduce bleeding, only aprotinin is indicated for use during CABG surgery. The future of cardiac surgery will be marked by an increasingly complex, high-risk group of patients and a greater need for multiple pharmacologic options for reducing bleeding. Pharmacologic approaches that attenuate the activation of the hemostatic system and inflammation need to be employed to decrease coagulopathies and the need for allogeneic blood administration.

  2. CEGB's radioactive waste management strategy

    International Nuclear Information System (INIS)

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

    1989-01-01

    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)

  3. MANAGEMENT STRATEGIES DURING ECONOMIC CRISIS

    Directory of Open Access Journals (Sweden)

    SINTEA(ANGHEL LUCICA

    2014-05-01

    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

  4. Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management.

    Science.gov (United States)

    Gélinas, Céline; Arbour, Caroline; Michaud, Cécile; Robar, Lauren; Côté, José

    2013-11-01

    Pain is a major stressor for critically ill patients. To maximize pain relief, non-pharmacological interventions are an interesting avenue to explore. The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the intensive care unit (ICU). A qualitative descriptive design was used. Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi-structured discussion guide, participants were asked to share their perspective about non-pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive-behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment. A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non-pharmacological interventions were discussed. The top four non-pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning. Four non-pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. While more evidence is required to conclude to their effectiveness, ICU nurses can

  5. Non-pharmacological management of migraine during pregnancy.

    Science.gov (United States)

    Airola, Gisella; Allais, Gianni; Castagnoli Gabellari, Ilaria; Rolando, Sara; Mana, Ornella; Benedetto, Chiara

    2010-06-01

    Migrainous women note a significant improvement in their headaches during pregnancy. However, persistent or residual attacks need to be treated, keeping in mind that many drugs have potential dangerous effects on embryo and foetus. It is evident, therefore, that hygiene and behaviour measures capable of ensuring the best possible well-being (regular meals and balanced diet, restriction of alcohol and smoking, regular sleeping pattern, moderate physical exercise and relaxation) are advisable during pregnancy. Among non-pharmacological migraine prophylaxis only relaxation techniques, in particular biofeedback, and acupuncture have accumulated sufficient evidence in support of their efficacy and safety. Some vitamins and dietary supplements have been proposed: the prophylactic properties of magnesium, riboflavin and coenzyme Q10 are probably low, but their lack of severe adverse effects makes them good treatment options.

  6. Funding strategies for wilderness management

    Science.gov (United States)

    Carolyn Alkire

    2000-01-01

    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...

  7. Pharmacological management of traumatic brain injury and implications for speech language pathology.

    Science.gov (United States)

    Rivera, José O

    2014-08-01

    This article provides an overview of the pharmacological management of traumatic brain injury (TBI). A basic introduction to key pharmacokinetic and pharmacodynamic principles is used to guide the reader. The goals of the pharmacological management of TBI are explained starting with mild TBI. The main medications used for each medical condition are described with a primary emphasis of effects that may interfere with the role of speech-language pathology (SLP). Some medications may interfere with cognitive, motor, and neuromuscular functions, and others may cause ototoxicity. A basic overview of the pharmacological management of moderate to severe TBI is included because the SLP practitioner may encounter patients with TBI during the recovery phase. The importance of assessment of swallowing evaluations is discussed because the oral route of administration of medications is preferred once the patient is stable. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. The Pharmacological management of Depression – Update 2017

    African Journals Online (AJOL)

    South Africans diagnosed with mental illness are not receiving treatment ... of a complex interaction between social, psychological and biological ..... Abrupt withdrawal causing ... in the management of mild to moderate depressive symptoms,.

  9. Molecular mechanisms of resistance to Rituximab and pharmacologic strategies for its circumvention.

    Science.gov (United States)

    Stolz, Claudia; Schuler, Martin

    2009-06-01

    The introduction of Rituximab has greatly improved therapeutic options for patients with B-cell non-Hodgkin lymphoma (B-NHL). However, a substantial fraction of patients with aggressive B-NHL fails first-line therapy, and most patients with relapsing indolent B-NHL eventually acquire Rituximab resistance. Molecular understanding of the underlying mechanisms facilitates the development of pharmacologic strategies to overcome resistance. Rituximab exerts its activity on CD20-expressing B-cells by indirect and direct effector mechanisms. Indirect mechanisms are complement-dependent cytotoxicity (CDC), and antibody-dependent cell-mediated cytotoxicity (ADCC). Direct activities, such as growth inhibition, induction of apoptosis and chemosensitisation, have been reported, but are less defined. Moreover, the relative contribution of CDC, ADCC and direct mechanisms to the activity of Rituximab in vivo is unclear. Down-regulation of CD20 and expression of complement inhibitors have been described as escape mechanisms in B-NHL. Recent reports suggest that deregulated phosphoinositide-3-kinase (PI3K)/Akt, mitogen-activated kinases (MAPK) and nuclear-factor kappaB (NF-kappaB), as well as up-regulation of anti-apoptotic proteins may determine the efficacy of Rituximab to kill B-NHL cells in vitro and in vivo. The latter signalling pathways are attractive targets for pharmacologic modulation of resistance to Rituximab. With the advent of new inhibitors and antibodies, rationally designed clinical trials addressing Rituximab resistance are feasible.

  10. Clinical inertia in the pharmacological management of hypertension: A systematic review and meta-analysis.

    Science.gov (United States)

    Milman, Tal; Joundi, Raed A; Alotaibi, Naif M; Saposnik, Gustavo

    2018-06-01

    Clinical Inertia is defined as "failure of health care providers to initiate or intensify therapy according to current guidelines". This phenomenon is gaining increasing attention as a major cause of clinicians' failure to adequately manage hypertension, thus leading to an increased incidence of cardiovascular events. We performed a systematic review and meta-analysis of randomized controlled trials to determine whether interventions aimed at reducing clinical inertia in the pharmacological treatment of hypertension improve blood pressure (BP) control. MEDLINE, Embase, and Cochrane Database of Systematic Reviews were searched from the start of their database until October 3, 2017 for the MESH terms "Hypertension" or "Blood Pressure", their subheadings, and the keywords "Therapeutic Inertia" or "Clinical Inertia". Studies were included if they addressed pharmacologic hypertension management, clinical inertia, were randomized controlled trials, reported an outcome describing prescriber behavior, and were available in English. Data for the included studies was extracted by two independent observers. Quality of studies was analyzed using the Cochrane Risk of Bias Assessment. Data was pooled for statistical analysis using both fixed- and random-effects models. The primary study outcome was the percentage of patients achieving blood pressure control as defined by the Joint National Committee guidelines or study authors. Of 474 citations identified, ten met inclusion criteria comprising a total of 26,871 patients, and eight were selected for meta-analysis. Interventions included Physician Education, Physician Reminders, Patient Education, Patient Reminders, Ambulatory BP Monitoring, Digital Medication Offerings, Physician Peer Visits, and Pharmacist-led Counselling. Pooled event rates revealed more patients with controlled BP in the intervention group versus control (55%, 95% CI 46-63% versus 45%, 95% CI 37-53%) and interventions significantly improved the odds of BP

  11. Impaired cognition and attention in adults: pharmacological management strategies

    OpenAIRE

    Allain, Herv?; Akwa, Yvette; Lacomblez, Lucette; Lieury, Alain; Bentu?-Ferrer, Dani?le

    2007-01-01

    Cognitive psychology has provided clinicians with specific tools for analyzing the processes of cognition (memory, language) and executive functions (attention-concentration, abstract reasoning, planning). Neuropsychology, coupled with the neurosciences (including neuroimaging techniques), has authenticated the existence of early disorders affecting the ?superior or intellectual? functions of the human brain. The prevalence of cognitive and attention disorders is high in adults because all th...

  12. A Comprehensive Review of the Pharmacologic Management of Uterine Leiomyoma

    Directory of Open Access Journals (Sweden)

    Terrence D. Lewis

    2018-01-01

    Full Text Available Uterine leiomyomata are the most common benign tumors of the gynecologic tract impacting up to 80% of women by 50 years of age. It is well established that these tumors are the leading cause for hysterectomy with an estimated total financial burden greater than $30 billion per year in the United States. However, for the woman who desires future fertility or is a poor surgical candidate, definitive management with hysterectomy is not an optimal management plan. Typical gynecologic symptoms of leiomyoma include infertility, abnormal uterine bleeding (AUB/heavy menstrual bleeding (HMB and/or intermenstrual bleeding (IMB with resulting iron-deficiency anemia, pelvic pressure and pain, urinary incontinence, and dysmenorrhea. The morbidity caused by these tumors is directly attributable to increases in tumor burden. Interestingly, leiomyoma cells within a tumor do not rapidly proliferate, but rather the increase in tumor size is secondary to production of an excessive, stable, and aberrant extracellular matrix (ECM made of disorganized collagens and proteoglycans. As a result, medical management should induce leiomyoma cells toward dissolution of the extracellular matrix, as well as halting or inhibiting cellular proliferation. Herein, we review the current literature regarding the medical management of uterine leiomyoma.

  13. Effects of a pain program on nurses' pharmacological pain management

    NARCIS (Netherlands)

    Francke, AL; Dingemans, WA; Borg, PAJ; Luiken, JB; Grypdonck, M; Abu-Saad, HH

    1999-01-01

    Surgical nurses from five Dutch general hospitals participated in a continuing education program on pain assessment and management. Effects of the program were measured in a pretest-post-test control group design, in which nursing wards were randomly allocated to the experimental condition (program)

  14. Cognitive decline in normal aging and its prevention: a review on non-pharmacological lifestyle strategies

    Directory of Open Access Journals (Sweden)

    Klimova B

    2017-05-01

    Full Text Available Blanka Klimova,1,2 Martin Valis,2 Kamil Kuca3,4 1Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, 2Department of Neurology, 3Biomedical Research Centre, University Hospital Hradec Kralove, 4Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic Abstract: The purpose of this study is to examine the effects of the selected non-pharmacological lifestyle activities on the delay of cognitive decline in normal aging. This was done by conducting a literature review in the four acknowledged databases Web of Science, Scopus, MEDLINE, and Springer, and consequently by evaluating the findings of the relevant studies. The findings show that physical activities, such as walking and aerobic exercises, music therapy, adherence to Mediterranean diet, or solving crosswords, seem to be very promising lifestyle intervention tools. The results indicate that non-pharmacological lifestyle intervention activities should be intense and possibly done simultaneously in order to be effective in the prevention of cognitive decline. In addition, more longitudinal randomized controlled trials are needed in order to discover the most effective types and the duration of these intervention activities in the prevention of cognitive decline, typical of aging population groups. Keywords: cognitive impairment, healthy older individuals, intervention, benefits

  15. Clinical and pharmacological management of endodontic flare-up

    OpenAIRE

    Jayakodi, Harikaran; Kailasam, Sivakumar; Kumaravadivel, Karthick; Thangavelu, Boopathi; Mathew, Sabeena

    2012-01-01

    Knowledge of the causes of and mechanisms behind interappointment pain in endodontics is of utmost importance for the clinician to properly prevent or manage this undesirable condition. The causative factors of interappointment pain encompass mechanical, chemical, and microbial injuries to the pulp or periradicular tissues, which are induced or exacerbated during root canal treatment. This review article underlines the various treatment modalities for relief of pain and swelling in such situa...

  16. Clinical and pharmacological management of endodontic flare-up.

    Science.gov (United States)

    Jayakodi, Harikaran; Kailasam, Sivakumar; Kumaravadivel, Karthick; Thangavelu, Boopathi; Mathew, Sabeena

    2012-08-01

    Knowledge of the causes of and mechanisms behind interappointment pain in endodontics is of utmost importance for the clinician to properly prevent or manage this undesirable condition. The causative factors of interappointment pain encompass mechanical, chemical, and microbial injuries to the pulp or periradicular tissues, which are induced or exacerbated during root canal treatment. This review article underlines the various treatment modalities for relief of pain and swelling in such situations, including premedication, drainage establishment, relief of occlusion, and intracanal and systemic medication.

  17. Pharmacologic and nonpharmacologic options for the management of HIV infection during pregnancy

    Directory of Open Access Journals (Sweden)

    Carmen D Zorrilla

    2009-12-01

    Full Text Available Carmen D Zorrilla, Vivian Tamayo-AgraitDepartment of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, Maternal Infant Studies Center (CEMI, San Juan, Puerto RicoAbstract: Over the past decade, significant advances have been made in the treatment of HIV-1 infection using both pharmacologic and nonpharmacologic strategies to prevent mother-to-child transmission (MTCT. Optimal prevention of the MTCT of HIV requires antiretroviral drugs (ARV during pregnancy, during labor, and to the infant. ARVs reduce viral replication, lowering maternal plasma viral load and thus the likelihood of MTCT. Postexposure prophylaxis of ARV agents in newborns protect against infection following potential exposure to maternal HIV during birth. In general, the choice of an ARV for treatment of HIV-infected women during pregnancy is complicated by the need to consider the effectiveness of the therapy for the maternal disease as well as the teratogenic or teratotoxic potential of these drugs. Clinicians managing HIV in pregnancy need to discuss the potential risks and benefits of available therapy options so that mothers can make informed decisions in choosing the best treatment regimen for themselves and for their children.Keywords: HIV, pregnancy, acquired immunodeficiency syndrome, antiretroviral agents

  18. Non-pharmacological measures in the pain management in newborns: nursing care

    Directory of Open Access Journals (Sweden)

    Ana Paula da Silva Morais

    2016-01-01

    Full Text Available Objective: to analyze the evidence of the literature about pain management during arterial puncture, venous and capillary in the newborn that received non-pharmacological measures before the painful procedure. Methods: this is an integrative review performed in databases. Initially, 120 articles were selected being a sample composed of ten articles. Data were collected in forms. Results: orally glucose was the most used method followed by breast milk and contact measures and the use of glucose associated or not to breast milk and contact measures. Conclusion: the use of non-pharmacological methods has been proven effective to promote the relief of pain in newborns.

  19. Clinical and pharmacological management of endodontic flare-up

    Directory of Open Access Journals (Sweden)

    Harikaran Jayakodi

    2012-01-01

    Full Text Available Knowledge of the causes of and mechanisms behind interappointment pain in endodontics is of utmost importance for the clinician to properly prevent or manage this undesirable condition. The causative factors of interappointment pain encompass mechanical, chemical, and microbial injuries to the pulp or periradicular tissues, which are induced or exacerbated during root canal treatment. This review article underlines the various treatment modalities for relief of pain and swelling in such situations, including premedication, drainage establishment, relief of occlusion, and intracanal and systemic medication.

  20. MANAGEMENT OF INSOMNIA USING PHARMOCOLOGY OR NON- PHARMACOLOGY

    Directory of Open Access Journals (Sweden)

    Muammar Ghaddafi

    2013-11-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Insomnia is a symptom rather than a diagnosis that may lead to irritability, dissatisfaction and decrease individual productivity. Insomnia can be divided into primary and secondary symptom which cause by other condition, but the mechanism on how this happened still unclear. In addition, relation between insomnia and other clinical problem is always undefined because it is impossible to find out the relation between causes and consequences of this symptom. Practitioner can choose either pharmacotherapy or non-pharmacotherapy in management of insomnia patient. Side effects and efficacy of pharmacotherapy must be considered before we prescribe a medicine to de patient. We also can Choose non-pharmacotherapy which is without side effects, but can be same effective as pharmacotherapy and even more.

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

    African Journals Online (AJOL)

    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 ...

  2. Interaction between behavioral and pharmacological treatment strategies to decrease cocaine choice in rhesus monkeys.

    Science.gov (United States)

    Banks, Matthew L; Blough, Bruce E; Negus, S Stevens

    2013-02-01

    Behavioral and pharmacotherapeutic approaches constitute two prominent strategies for treating cocaine dependence. This study investigated interactions between behavioral and pharmacological strategies in a preclinical model of cocaine vs food choice. Six rhesus monkeys, implanted with a chronic indwelling double-lumen venous catheter, initially responded under a concurrent schedule of food delivery (1-g pellets, fixed-ratio (FR) 100 schedule) and cocaine injections (0-0.1 mg/kg/injection, FR 10 schedule) during continuous 7-day treatment periods with saline or the agonist medication phenmetrazine (0.032-0.1 mg/kg/h). Subsequently, the FR response requirement for cocaine or food was varied (food, FR 100; cocaine, FR 1-100; cocaine, FR 10; food, FR 10-300), and effects of phenmetrazine on cocaine vs food choice were redetermined. Decreases in the cocaine FR or increases in the food FR resulted in leftward shifts in the cocaine choice dose-effect curve, whereas increases in the cocaine FR or decreases in the food FR resulted in rightward shifts in the cocaine choice dose-effect curve. The efficacy of phenmetrazine to decrease cocaine choice varied systematically as a function of the prevailing response requirements, such that phenmetrazine efficacy was greatest when cocaine choice was maintained by relatively low unit cocaine doses. These results suggest that efficacy of pharmacotherapies to modulate cocaine use can be influenced by behavioral contingencies of cocaine availability. Agonist medications may be most effective under contingencies that engender choice of relatively low cocaine doses.

  3. Communication strategies for conflict management

    International Nuclear Information System (INIS)

    Schlange, L.E.

    1994-01-01

    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

  4. Pharmacologic Management of Type 2 Diabetes Mellitus: Available Therapies.

    Science.gov (United States)

    Thrasher, James

    2017-06-01

    Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin. Therapy choices are guided by glycemic efficacy, safety profiles, particularly effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost. Balancing management of hyperglycemia with the risk of hypoglycemia and consideration of the effects of pharmacotherapy on weight figure prominently in US-based T2DM recommendations, whereas less emphasis has been placed on the ability of specific medications to affect cardiovascular outcomes. This is likely because, until recently, specific glucose-lowering agents have not been shown to affect cardiorenal outcomes. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME), the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes 6 (SUSTAIN-6) recently showed a reduction in overall cardiovascular risk with empagliflozin, liraglutide, and semaglutide treatment, respectively. Moreover, empagliflozin has become the first glucose-lowering agent indicated to reduce the risk of cardiovascular death in adults with T2DM and established cardiovascular disease. Results from cardiovascular outcomes trials have prompted an update to the 2017 American Diabetes Association

  5. Pharmacologic Management of Type 2 Diabetes Mellitus: Available Therapies.

    Science.gov (United States)

    Thrasher, James

    2017-07-01

    Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin. Therapy choices are guided by glycemic efficacy, safety profiles, particularly effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost. Balancing management of hyperglycemia with the risk of hypoglycemia and consideration of the effects of pharmacotherapy on weight figure prominently in US-based T2DM recommendations, whereas less emphasis has been placed on the ability of specific medications to affect cardiovascular outcomes. This is likely because, until recently, specific glucose-lowering agents have not been shown to affect cardiorenal outcomes. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME), the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes 6 (SUSTAIN-6) recently showed a reduction in overall cardiovascular risk with empagliflozin, liraglutide, and semaglutide treatment, respectively. Moreover, empagliflozin has become the first glucose-lowering agent indicated to reduce the risk of cardiovascular death in adults with T2DM and established cardiovascular disease. Results from cardiovascular outcomes trials have prompted an update to the 2017 American Diabetes Association

  6. Recent pharmacological management of oral bleeding in hemophilic patient

    Directory of Open Access Journals (Sweden)

    Monica Widyawati Setiawan

    2011-09-01

    Full Text Available Background: Hemophilia is a hereditary bleeding disorder that can increase the risk of disease in oral cavity. Sometimes hemophilia is not always established already in a patient. The lack of awareness of hemophilia presence can cause serious problem. Purpose: The purpose of this review is to explain about dental bleeding manifestation and management in hemophilic patient. Reviews: Hemophilia can be manifested as dental bleeding that cannot stop spontaneously. It should be treated with factor VIIII either by giving whole blood, fresh plasma, fresh frozen plasma, cryoprecipitate, and factor VIII concentrate. Factor VIII dose for hemophilia treatment can be calculated based on factor VIII present in hemophilia patient’s body. Factor VIII can also be given as prophylaxis to prevent bleeding. Complications that can be caused by factor VIII replacement therapy are the presence of factor VIII inhibitor and transfusion related diseases. Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. Conclusion: Treatment of dental bleeding due to hemophilia consists of factor replacement therapy and supportive therapy. There are complications that can happen due to factor VIII replacement therapy that should be considered and anticipated.Latar belakang: Hemofilia adalah kelainan pembekuan darah yang diturunkan. Hemophilia dapat meningkatkan resiko penyakit rongga mulut. Hemofilia tidak selalu sudah terdiagnosa saat penderita melakukan kunjungan ke dokter gigi. Kurangnya kewaspadaan akan adanya hemofilia dapat menyebabkan masalah serius. Tujuan: Tujuan dari kajian pustaka ini adalah memaparkan tentang manifestasi dan penanganan perdarahan gigi pada penderita hemofilia. Tinjauan pustaka: hemofilia dapat bermanifestasi sebagai perdarahan gigi yang tidak dapat berhenti secara spontan. Pada keadaan perdarahan tersebut, pemberian faktor VIII yang diberikan sebagai whole blood, fresh plasma, fresh frozen plasma

  7. Deployment strategies of managed lanes on arterials.

    Science.gov (United States)

    2015-02-01

    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,...

  8. Managing service quality: Human resource management strategies

    Directory of Open Access Journals (Sweden)

    K. K. Govender

    2000-06-01

    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.

  9. Management Accounting and Supply Chain Strategy

    OpenAIRE

    Hald, Kim S.; Thrane, Sof

    2016-01-01

    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...

  10. Configuration Management Process Assessment Strategy

    Science.gov (United States)

    Henry, Thad

    2014-01-01

    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.*

  11. Clinically Relevant Pharmacological Strategies That Reverse MDMA-Induced Brain Hyperthermia Potentiated by Social Interaction.

    Science.gov (United States)

    Kiyatkin, Eugene A; Ren, Suelynn; Wakabayashi, Ken T; Baumann, Michael H; Shaham, Yavin

    2016-01-01

    MDMA-induced hyperthermia is highly variable, unpredictable, and greatly potentiated by the social and environmental conditions of recreational drug use. Current strategies to treat pathological MDMA-induced hyperthermia in humans are palliative and marginally effective, and there are no specific pharmacological treatments to counteract this potentially life-threatening condition. Here, we tested the efficacy of mixed adrenoceptor blockers carvedilol and labetalol, and the atypical antipsychotic clozapine, in reversing MDMA-induced brain and body hyperthermia. We injected rats with a moderate non-toxic dose of MDMA (9 mg/kg) during social interaction, and we administered potential treatment drugs after the development of robust hyperthermia (>2.5 °C), thus mimicking the clinical situation of acute MDMA intoxication. Brain temperature was our primary focus, but we also simultaneously recorded temperatures from the deep temporal muscle and skin, allowing us to determine the basic physiological mechanisms of the treatment drug action. Carvedilol was modestly effective in attenuating MDMA-induced hyperthermia by moderately inhibiting skin vasoconstriction, and labetalol was ineffective. In contrast, clozapine induced a marked and immediate reversal of MDMA-induced hyperthermia via inhibition of brain metabolic activation and blockade of skin vasoconstriction. Our findings suggest that clozapine, and related centrally acting drugs, might be highly effective for reversing MDMA-induced brain and body hyperthermia in emergency clinical situations, with possible life-saving results.

  12. Recovery of gait and other motor functions after stroke: novel physical and pharmacological treatment strategies.

    Science.gov (United States)

    Hesse, S

    2004-01-01

    The gait-lab at Klinik Berlin developed and evaluated novel physical and pharmacological strategies promoting the repetitive practise of hemiparetic gait in line with the slogan: who wants to relearn walking, has to walk. Areas of research are treadmill training with partial body weight support, enabling wheelchair-bound subjects to repetitively practice gait, the electromechanical gait trainer GT I reducing the effort on the therapists as compared to the manually assisted locomotor therapy, and the future HapticWalker which will allow the additional practise of stair climbing up and down and of perturbations. Further means to promote gait practice after stroke was the application of botulinum toxin A for the treatment of lower limb spasticity and the early use of walking aids. New areas of research are also the study of D-Amphetamine, which failed to promote motor recovery in acute stroke patients as compared to placebo, and the development of a computerized arm trainer, Bi-Manu-T rack, for the bilateral treatment of patients with a severe upper limb paresis.

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

    Science.gov (United States)

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

    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.

  14. Noradrenergic augmentation strategies in the pharmacological treatment of depression and schizophrenia : An experimental study

    OpenAIRE

    Linnér, Love

    2002-01-01

    The pharmacological treatment of depression and schizophrenia, two major psychiatric disorders, is largely based on modulation of central monoaminergic neurotransmission. However, currently available pharmacological treatment alternatives possess a relatively modest clinical efficacy, making them less than optimal. The present series of studies, using in vivo electrophysiological, biochemical and behavioral techniques in rats, aim at the disclosure of mechanisms whereby an ...

  15. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

    OpenAIRE

    Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

    2017-01-01

    Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also...

  16. Pharmacological strategies for blood conservation in cardiac surgery: erythropoietin and antifibrinolytics.

    Science.gov (United States)

    Hardy, J F

    2001-04-01

    We review the clinically important benefits of the two principal pharmacological strategies, erythropoietin (EPO) and antifibrinolytics (aprotinin and lysine analogues), to decrease transfusion of allogeneic blood products (ABP) during and after cardiac surgery. Articles were selected from an ongoing review of the literature, with special attention to meta-analyses dealing with EPO and/or antifibrinolytics and cardiac surgery. The few studies available include a number of patients insufficient to allow definitive conclusions on the benefits of EPO in cardiac surgery. Further studies are required to determine the optimal dose of EPO and to compare its cost-effectiveness with other blood sparing strategies in this context. Both aprotinin and lysine analogues effectively decrease ABP transfusions and the incidence of re-thoracotomy. In addition, high-dose aprotinin reduces cerebrovascular morbidity and mortality after cardiopulmonary bypass. Several mechanisms have been put forward to explain these beneficial effects, some of which could well be common to all antifibrinolytics. The clinical benefits of aprotinin's unique anti-inflammatory effect are not entirely clear but the finding that it reduces the incidence of stroke and death is certainly a major argument in favor of its utilization. Yet, we have to ensure that aprotinin's benefits are not offset by side-effects such as allergy. We still need large scale studies to definitely confirm the benefits and exclude the deleterious effects of these drugs on outcomes other than ABP requirements. At present, aprotinin is the only agent that has been shown to reduce the risk of cerebrovascular accident and mortality after cardiac surgery in adults.

  17. Management of Depression in Patients with Dementia: Is Pharmacological Treatment Justified?

    Science.gov (United States)

    Ford, Andrew H; Almeida, Osvaldo P

    2017-02-01

    Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia. Antidepressants are the mainstay of pharmacological treatment for clinically significant depression in the general population but evidence to support their use in dementia is mixed. Trials of antidepressants should generally be reserved for individuals with depression where the symptoms are distressing and surpass the threshold for major depression. Acetylcholinesterase inhibitors and memantine are effective in the symptomatic treatment of Alzheimer's disease but current evidence does not support their use to treat depressive symptoms in dementia. Similarly, antipsychotics and mood stabilizers have no proven efficacy for depression and the risk of adverse effects seems to outweigh any potential benefit. Pain can be a frequent problem in dementia and may have significant effects on behavior and mood. Preliminary evidence supports a role of adequate analgesia in improving mood in people with dementia.

  18. Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children.

    Science.gov (United States)

    Paul, Siba Prosad; Basude, Dharamveer

    2016-11-01

    Abdominal pain-related functional gastrointestinal disorder (AP-FGID) comprises of 4 main conditions: functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain. AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood. There is limited evidence for pharmacological therapies. This review article discusses nonpharmacological management of AP-FGID based on the current literature including systematic reviews, randomized controlled trials, cohort and case control studies. We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID. Managing AP-FGIDs can be challenging. This should follow a stepwise approach with focused history, identification of "red flag" signs and symptoms, physical examination and investigations done following initial consultation. Family needs explaining that there is nothing seriously wrong with the child's abdomen. This explanation and reassurance can achieve symptom control in large number of cases. Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies. Dietary interventions vary depending on the type of AP-FGID. Bio-psychosocial therapies such as hypnotherapy, cognitive behavioral therapy and yoga aim at stress reduction. There is increasing evidence for use of non-pharmacological interventions in children with APFGID.

  19. Management strategies for autoimmune pancreatitis.

    Science.gov (United States)

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

    2011-10-01

    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.

  20. Management strategies for idiopathic urethritis.

    Science.gov (United States)

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

    2016-02-01

    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.

  1. Managing Conflict: 50 Strategies for School Leaders

    Science.gov (United States)

    Edmonson, Stacey; Combs, Julie; Harris, Sandra

    2008-01-01

    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…

  2. An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital.

    Science.gov (United States)

    Khalil, Viviane; Li, Matthew; Hua, Qiantong Amanda

    2015-02-01

    According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.

  3. Management strategies for problem behaviors in the patient with dementia.

    Science.gov (United States)

    Lehninger, F W; Ravindran, V L; Stewart, J T

    1998-04-01

    Psychiatric and behavioral problems are present in most patients with dementia and are usually the clinician's main focus of management. Differential diagnosis of these problems can be challenging, but the effort is essential for planning appropriate therapy. Pharmacologic interventions are available for treatment of depression, agitation, aggression, psychotic symptoms, wandering, and sleep disorders. Given the less than favorable risk-benefit ratio of most psychotropic drugs in the population of older patients with dementia, the importance of nonpharmacologic strategies and limiting treatment goals should not be overlooked.

  4. The Effects of Combined Treadmill Training and Pharmacological Treatment on Management of Multiple Sclerosis Female Patients

    Directory of Open Access Journals (Sweden)

    Ali Asghar Arastoo

    2013-04-01

    Full Text Available Objectives: To compare the effectiveness of two treatment methods of ‘combination pharmacological treatment and treadmill training’ and ‘pharmacological treatment’ on management of multiple sclerosis (MS female patients. Methods: In this quasi experimental and interventional study a sample of 20 MS patients (mean age: 36.75 years with Expanded Disability Status Scale scores (EDSS 1.0 to 4.0 were randomly assigned to a ‘pharmacologic treatment’ (Ph group and a combination group of ‘pharmacologic treatment& treadmill training’ (PhTT. All these individuals used the drugs of choice ‘Rebif’ and ‘Avonex’. The intervention consisted of 8-weeks (24 sessions of treadmill training (30 minutes each, at 40-75% of age-predicted maximum heart rate for the PhTT group. The Ph group followed their own routine treatment program. Balance, speed and endurance of walking, quality of life and fatigue were measured by Berg Balance Score, 10 meter timed walk test, 2 minute walk test, and Fatigue Severity Scale (FFS. Data were analyzed by paired t test and one way ANOVA. Results: Comparison of results indicated that pre and post intervention led to significant improvements in the balance score (P=0.001, 10m walk time (P=0.001, walking endurance (P=0.007, and FFS (P=0.04 in the PhTT group. In contrast, no significant changes were observed in the Ph group’s balance score, 10m timed walk and fatigue, while there was a significant decrease in the 2min walking distance (P=0.015 in this group. Discussion: These results suggest that treadmill training in combination with pharmacological treatment improve balance and walking capacity and level of fatigue in women with mild to moderate MS.

  5. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

    Science.gov (United States)

    Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

    2014-03-01

    Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

  6. Pharmacologic Approaches to Weight Management: Recent Gains and Shortfalls in Combating Obesity.

    Science.gov (United States)

    Saunders, Katherine H; Kumar, Rekha B; Igel, Leon I; Aronne, Louis J

    2016-07-01

    Obesity is a growing epidemic in the USA with over one third of adults presently classified as obese. Obesity-related comorbidities include many leading causes of preventable death such as heart disease, stroke, type 2 diabetes, and certain types of cancer. Modest weight loss of 5-10 % of body weight is sufficient to produce clinically relevant improvements in cardiovascular disease risk factors among patients with overweight and obesity. Until recently, there were limited pharmacologic options approved by the Food and Drug Administration to treat obesity. Phentermine/topiramate ER and lorcaserin were approved in 2012, and naltrexone SR/bupropion SR and liraglutide 3.0 mg were approved in 2014. This article reviews recent literature in the field of Obesity Medicine and highlights important findings from clinical trials. Future directions in the pharmacologic management of obesity are presented along with new diabetes medications that promote weight loss and reduce cardiovascular mortality.

  7. Maritime Domain Awareness Architecture Management Hub Strategy

    National Research Council Canada - National Science Library

    2008-01-01

    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...

  8. The impact of chronic kidney disease on medication choice and pharmacologic management in patients with heart failure.

    Science.gov (United States)

    Shah, Syed Raza; Winchester, David E

    2018-05-21

    In the past few years, medical community, including doctors, have become increasingly aware of the fact that chronic kidney disease (CK) and heart failure (HF) have common risk factors which impacts one another in terms of choice of therapy. Areas covered: Management of these two diseases has been a challenge for physicians. The treatment goals for HF patients in CK are very important. They serve as the end-point in using a specific treatment for management and treatment of CK patients hence, decreasing mortality rates. In this review, we discuss the pharmacological approaches to managing patients with HF and CK, discussing current evidence based uptodate management strategies and guidelines in the general population with HF and CK. Expert Commentary: Newer novel drugs targeting specific signaling pathways are approaching the stages of clinical investigation including the direct renin inhibitors. They have been a highly attractive concept for the future in the management of these patients. However, while advances in technology elucidated many aspects of these diseases, many mysteries still remain. With continued research, we can expect more cost- effective and patient-friendly drug therapies to be developed in the near future.

  9. A strategy model for management

    DEFF Research Database (Denmark)

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

    2016-01-01

    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....

  10. The notion of strategy in facility management

    DEFF Research Database (Denmark)

    Holzweber, Markus

    2013-01-01

    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...

  11. Selection of intellectual capital management strategies

    OpenAIRE

    Shcherbachenko Viktoriia Oleksiivna

    2016-01-01

    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.

  12. Selection of intellectual capital management strategies

    Directory of Open Access Journals (Sweden)

    Shcherbachenko Viktoriia Oleksiivna

    2016-02-01

    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.

  13. Nonpharmacologic strategies to manage exercise-induced bronchoconstriction

    DEFF Research Database (Denmark)

    Dickinson, John; Amirav, Israel; Hostrup, Morten

    2018-01-01

    Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to ...

  14. Containment severe accident management - selected strategies

    International Nuclear Information System (INIS)

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

    1994-01-01

    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)

  15. Linking corporate strategy and supply chain management

    OpenAIRE

    Hofmann, Erik

    2009-01-01

    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...

  16. Risk evaluation of accident management strategies

    International Nuclear Information System (INIS)

    Dingman, S.; Camp, A.

    1992-01-01

    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

  17. Strategies in Managing Rapport in Classroom Discussion

    OpenAIRE

    Reski Reski

    2018-01-01

    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...

  18. Managing regional innovation strategy projects

    OpenAIRE

    Wolf, Patricia; Hanisch, Christoph

    2014-01-01

    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...

  19. Recycling - Danish Waste Management Strategy

    DEFF Research Database (Denmark)

    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....

  20. Managing price risk - setting and implementing strategies

    International Nuclear Information System (INIS)

    Haines, D.

    1999-01-01

    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

  1. Management strategies in antithrombotic therapy

    National Research Council Canada - National Science Library

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

    2007-01-01

    ... 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...

  2. Evaluating risk management strategies in resource planning

    International Nuclear Information System (INIS)

    Andrews, C.J.

    1995-01-01

    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

  3. Project management strategies for prototyping breakdowns

    DEFF Research Database (Denmark)

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

    2009-01-01

    , 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...

  4. Comprehensive Self-Management Strategies.

    Science.gov (United States)

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

    2015-08-01

    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.

  5. Time management strategies for research productivity.

    Science.gov (United States)

    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

    2013-02-01

    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.

  6. Pharmacologically directed strategies in academic anticancer drug discovery based on the European NCI compounds initiative.

    Science.gov (United States)

    Hendriks, Hans R; Govaerts, Anne-Sophie; Fichtner, Iduna; Burtles, Sally; Westwell, Andrew D; Peters, Godefridus J

    2017-07-11

    The European NCI compounds programme, a joint initiative of the EORTC Research Branch, Cancer Research Campaign and the US National Cancer Institute, was initiated in 1993. The objective was to help the NCI in reducing the backlog of in vivo testing of potential anticancer compounds, synthesised in Europe that emerged from the NCI in vitro 60-cell screen. Over a period of more than twenty years the EORTC-Cancer Research Campaign panel reviewed ∼2000 compounds of which 95 were selected for further evaluation. Selected compounds were stepwise developed with clear go/no go decision points using a pharmacologically directed programme. This approach eliminated quickly compounds with unsuitable pharmacological properties. A few compounds went into Phase I clinical evaluation. The lessons learned and many of the principles outlined in the paper can easily be applied to current and future drug discovery and development programmes. Changes in the review panel, restrictions regarding numbers and types of compounds tested in the NCI in vitro screen and the appearance of targeted agents led to the discontinuation of the European NCI programme in 2017 and its transformation into an academic platform of excellence for anticancer drug discovery and development within the EORTC-PAMM group. This group remains open for advice and collaboration with interested parties in the field of cancer pharmacology.

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

    International Nuclear Information System (INIS)

    Haverkate, B.R.W.

    2003-01-01

    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

  8. Mitochondrial pharmacology: electron transport chain bypass as strategies to treat mitochondrial dysfunction.

    Science.gov (United States)

    Atamna, Hani; Mackey, Jeanette; Dhahbi, Joseph M

    2012-01-01

    Mitochondrial dysfunction (primary or secondary) is detrimental to intermediary metabolism. Therapeutic strategies to treat/prevent mitochondrial dysfunction could be valuable for managing metabolic and age-related disorders. Here, we review strategies proposed to treat mitochondrial impairment. We then concentrate on redox-active agents, with mild-redox potential, who shuttle electrons among specific cytosolic or mitochondrial redox-centers. We propose that specific redox agents with mild redox potential (-0.1 V; 0.1 V) improve mitochondrial function because they can readily donate or accept electrons in biological systems, thus they enhance metabolic activity and prevent reactive oxygen species (ROS) production. These agents are likely to lack toxic effects because they lack the risk of inhibiting electron transfer in redox centers. This is different from redox agents with strong negative (-0.4 V; -0.2 V) or positive (0.2 V; 0.4 V) redox potentials who alter the redox status of redox-centers (i.e., become permanently reduced or oxidized). This view has been demonstrated by testing the effect of several redox active agents on cellular senescence. Methylene blue (MB, redox potential ≅10 mV) appears to readily cycle between the oxidized and reduced forms using specific mitochondrial and cytosolic redox centers. MB is most effective in delaying cell senescence and enhancing mitochondrial function in vivo and in vitro. Mild-redox agents can alter the biochemical activity of specific mitochondrial components, which then in response alters the expression of nuclear and mitochondrial genes. We present the concept of mitochondrial electron-carrier bypass as a potential result of mild-redox agents, a method to prevent ROS production, improve mitochondrial function, and delay cellular aging. Thus, mild-redox agents may prevent/delay mitochondria-driven disorders. Copyright © 2012 International Union of Biochemistry and Molecular Biology, Inc.

  9. CLASSROOM MANAGEMENT STRATEGIES IN AN EFL CLASS

    OpenAIRE

    Eva Fitriani Syarifah; Raynesa Noor Emiliasari

    2017-01-01

    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 ...

  10. Control Strategies for Corridor Management

    Science.gov (United States)

    2016-06-28

    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...

  11. Informing Parents about the Pharmacological and Invasive Behavior Management Techniques Used in Pediatric Dentistry

    Directory of Open Access Journals (Sweden)

    Mehrysa Paryab

    2014-06-01

    Full Text Available Background and aims. Parental acceptance and consent are important parameters in selecting the required behavior management technique during pediatric dental treatment. The present study sought to assess the effect of three different informing methods on the parental acceptance, consent and concern regarding the pharmacological and invasive behavior management techniques used in pediatric dentistry. Materials and methods. Ninety mothers of 3-6-year-old uncooperative children were selected and randomly assigned to three study groups. The parents in each group were initially asked to answer three questions related to their levels of ‘acceptance’, ‘consent’, and ‘concern’ toward the five behavior management techniques. Then, the information about the techniques was presented through a piece of writing in group I, verbal presentation in group II and showing a film in group III. At last, the parents answered the same three questions again. Score changes were analyzed by using ANOVA, correlations, Mann-Whitney U and Kruskal-Wallis methods. Results. There were no statistically significant differences in score changes of parental acceptance, consent and concern between the three groups, overall and in relation to each behaviour management technique (P > 0.05. Mothers with academic education revealed more statistically significant concern following presentation of information by film (P < 0.05. Conclusion. None of the presentation methods had a significant preference over the others; in selecting the behavioral management techniques, it is advisable to observe individual factors, such as the level of education of the mothers.

  12. Preoperative anxiety in children risk factors and non-pharmacological management.

    Science.gov (United States)

    Ahmed, Mohammad I; Farrell, Maureen A; Parrish, Katie; Karla, Aman

    2011-06-01

    It is important for anesthesiologists to appreciate the impact of preoperative anxiety in children. Not only does it cause suffering in many children prior to their surgical experience, it has a negative impact on their postoperative recovery and possibly long afterwards. Because of these concerns, continued research is warranted to seek ways of minimizing their fears in the perioperative setting. In this review, we will examine the risk factors for preoperative anxiety, tools for quantifying children and parent's anxiety, and strategies that may play a part in decreasing preoperative anxiety. Variables, which influence preoperative anxiety in children, include their age, temperament, prior hospital experience and parent coping abilities. This review will also explore issues surrounding parental presence during a child's anesthesia induction and how understanding child development can enhance their cooperativeness during the preoperative period, especially during anesthesia induction. Non-pharmacological interventions as a means of decreasing pediatric anxiety will be explored. Finally recent trends and new directions will be touched upon.

  13. Rapid prototyping of energy management charging strategies

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-07-01

    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.)

  14. Developments in weather responsive traffic management strategies.

    Science.gov (United States)

    2011-06-01

    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...

  15. Psychological Strategies in Managing Television Commercial Efficacy

    African Journals Online (AJOL)

    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 ...

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

    African Journals Online (AJOL)

    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 ...

  17. Responsive Multimodal Transportation Management Strategies And IVHS

    Science.gov (United States)

    1995-02-01

    THE PURPOSE OF THIS STUDY WAS TO INVESTIGATE NEW AND INNOVATIVE WAYS TO INCORPORATE IVHS TECHNOLOGIES INTO MULTIMODAL TRANSPORTATION MANAGEMENT STRATEGIES. MUCH OF THE IVHS RESEARCH DONE TO DATE HAS ADDRESSED THE MODES INDIVIDUALLY. THIS PROJECT FOCU...

  18. Mild TBI Diagnosis and Management Strategies

    Data.gov (United States)

    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...

  19. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment

    Directory of Open Access Journals (Sweden)

    Aisanov Z

    2018-01-01

    Full Text Available Zaurbek Aisanov,1 Sergey Avdeev,2 Vladimir Arkhipov,3 Andrey Belevskiy,1 Alexander Chuchalin,1 Igor Leshchenko,4 Svetlana Ovcharenko,5 Evgeny Shmelev,6 Marc Miravitlles7 1Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia, 2Clinical Department, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia, 3Clinical Pharmacology Department, RUDN University, 4Department of Phthisiology, Pulmonology and Thoracic Surgery, Ural State Medical University, Healthcare Ministry of Russia, Ekaterinburg, 5Internal Medicine Department No.1, I.M. Sechenov First Moscow State Medical University, Healthcare Ministry of Russia, 6Department of Differential Diagnostics, Federal Central Research Institute of Tuberculosis, Moscow, Russia; 7Pneumology Department, University Hospital Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES, Barcelona, Spain Abstract: The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and

  20. Optimizing diabetes management: managed care strategies.

    Science.gov (United States)

    Tzeel, E Albert

    2013-06-01

    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.

  1. Management strategy 3: fixed rate fertilizer applications

    Science.gov (United States)

    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 ...

  2. Pharmacological options in the management of orthostatic hypotension in older adults.

    LENUS (Irish Health Repository)

    Kearney, Fiona

    2009-11-01

    Orthostatic hypotension (OH) is a common disorder in older adults with potentially serious clinical consequences. Understanding the key underlying pathophysiological processes that predispose individuals to OH is essential when making treatment decisions for this group of patients. In this article, we discuss the key antihypotensive agents used in the management of OH in older adults. Commonly, midodrine is used as a first-line agent, given its supportive data in randomized, controlled trials. Fludrocortisone has been evaluated in open-label trials and has long-established usage in clinical practice. Other agents are available and in clinical use, either alone or in combination, but larger randomized trial evaluations are yet to be published. It is important to bear in mind that a patient may be taking medications that predispose to or exacerbate the symptoms of OH. Withdrawal of such medications, where possible, should be considered before commencing other pharmacological agents that attenuate the symptoms of OH.

  3. Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management : Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

    NARCIS (Netherlands)

    Gant, Christina M.; Binnenmars, S. Heleen; van den Berg, Else; Bakker, Stephan J. L.; Navis, Gerjan; Laverman, Gozewijn D.

    2017-01-01

    Cardiovascular risk management is an integral part of treatment in Type 2 Diabetes Mellitus (T2DM), and requires pharmacological as well as nutritional management. We hypothesize that a systematic assessment of both pharmacological and nutritional management can identify targets for the improvement

  4. The Changing Career Strategies of Managers.

    Science.gov (United States)

    Wilson, Tony; Davies, Goronwy

    1999-01-01

    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)

  5. Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

    Directory of Open Access Journals (Sweden)

    DE Moulin

    2007-01-01

    Full Text Available Neuropathic pain (NeP, generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics and anticonvulsants (gabapentin and pregabalin. Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

  6. Role of management devices in enacting strategy

    DEFF Research Database (Denmark)

    Harritz, Daniel

    2016-01-01

    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...

  7. Hydrogen management strategy for the Loviisa NPP

    International Nuclear Information System (INIS)

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

    1997-01-01

    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)

  8. Risk impact of two accident management strategies

    International Nuclear Information System (INIS)

    Dingman, S.; Camp, A.

    1992-01-01

    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-

  9. The CEA's waste management strategy

    International Nuclear Information System (INIS)

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

    2011-01-01

    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

  10. The AREVA's waste management strategy

    International Nuclear Information System (INIS)

    Poncet, Ph.

    2011-01-01

    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)

  11. Management strategies for acne vulgaris

    Science.gov (United States)

    Whitney, Kristen M; Ditre, Chérie M

    2011-01-01

    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

  12. Information Technology Management Strategies to Implement Knowledge Management Systems

    Science.gov (United States)

    McGee, Mary Jane Christy

    2017-01-01

    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…

  13. Policies and strategies for radioactive waste management

    International Nuclear Information System (INIS)

    2009-01-01

    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

  14. Management strategies for acne vulgaris

    Directory of Open Access Journals (Sweden)

    Whitney KM

    2011-04-01

    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

  15. Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia.

    LENUS (Irish Health Repository)

    2017-08-23

    Critical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established.

  16. Challenges in the pharmacological management of epilepsy and its causes in the elderly.

    Science.gov (United States)

    Ferlazzo, Edoardo; Sueri, Chiara; Gasparini, Sara; Aguglia, Umberto

    2016-04-01

    Epilepsy represents the third most common neurological disorders in the elderly after cerebrovascular disorders and dementias. The incidence of new-onset epilepsy peaks in this age group. The most peculiar aetiologies of late-onset epilepsy are stroke, dementia, and brain tumours. However, aetiology remains unknown in about half of the patients. Diagnosis of epilepsy may be challenging due to the frequent absence of ocular witnesses and the high prevalence of seizure-mimics (i.e. transient ischemic attacks, syncope, transient global amnesia or vertigo) in the elderly. The diagnostic difficulties are even greater when patients have cognitive impairment or cardiac diseases. The management of late-onset epilepsy deserves special considerations. The elderly can reach seizure control with low antiepileptic drugs (AEDs) doses, and seizure-freedom is possible in the vast majority of patients. Pharmacological management should take into account pharmacokinetics and pharmacodynamics of AEDs and the frequent occurrence of comorbidities and polytherapy in this age group. Evidences from double-blind and open-label studies indicate lamotrigine, levetiracetam and controlled-release carbamazepine as first line treatment in late-onset epilepsy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Overview on spent fuel management strategies

    International Nuclear Information System (INIS)

    Dyck, P.

    2002-01-01

    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)

  18. Conflict Management Strategies for Rangeland Resources

    OpenAIRE

    Rasmussen, G.A.

    1995-01-01

    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...

  19. Negotiation strategies in Supply Chain Management

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2008-01-01

    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....

  20. Momentum management strategy during Space Station buildup

    Science.gov (United States)

    Bishop, Lynda; Malchow, Harvey; Hattis, Philip

    1988-01-01

    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.

  1. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

    Science.gov (United States)

    Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

    2017-01-01

    Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also target the periphery with minimal CNS effects. Evidence of Acquisition In this paper, reputable internet databases from 1960 - 2016 were searched including Pubmed and ClinicalTrials.org, and 97 original articles analyzed. Search was performed based on the following keywords and combinations: irritable bowel syndrome, clinical trial, pain, visceral pain, narcotics, opioid, chloride channel, neuropathy, primary afferent, intestine, microbiota, gut barrier, inflammation, diarrhea, constipation, serotonin, visceral hypersensitivity, nociceptor, sensitization, hyperalgesia. Results Certain conventional pain managing drugs do not effectively improve IBS symptoms, including NSAIDs, acetaminophen, aspirin, and various narcotics. Anxiolytic and antidepressant drugs (Benzodiazepines, TCAs, SSRI and SNRI) can attenuate pain in IBS patients with relevant comorbidities. Clonidine, gabapentin and pregabalin can moderately improve IBS symptoms. Lubiprostone relieves constipation predominant IBS (IBS-C) while loperamide improves diarrhea predominant IBS (IBS-D). Alosetron, granisetron and ondansetron can generally treat pain in IBS-D patients, of which alosetron needs to be used with caution due to cardiovascular toxicity. The optimal drugs for managing pain in IBS-D and IBS-C appear to be eluxadoline and linaclotide, respectively, both of which target peripheral GI tract. Conclusions Conventional pain managing drugs are in general not suitable for treating IBS pain. Medications that target

  2. CUSTOMER RELATIONSHIP MANAGEMENT AND BUSINESS STRATEGIES

    Directory of Open Access Journals (Sweden)

    Rozitta Chittaie

    2012-06-01

    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.

  3. Current strategies for non-pharmacological therapy of long-standing persistent atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Teiichi Yamane, MD, PhD

    2012-06-01

    Full Text Available Non-pharmacological rhythm control of atrial fibrillation (AF is becoming increasingly important in our aging society. Advancement of catheter ablation techniques in the last decade has provided a cure for AF patients, with a nearly established efficiency for paroxysmal cases. However, since ablation of persistent/chronic AF cases is still challenging, early treatment of paroxysmal AF before transformation to the persistent/chronic form is mandatory. Although there is a consensus that pulmonary vein isolation is the first-line approach for ablation of long-standing persistent AF, similar to that for paroxysmal AF, there are still wide variations in the adjunctive approach to modify the atrial substrate of persistent AF (anatomical linear ablation, electrogram-based complex fractionated atrial electrogram ablation, ganglionated plexus ablation, etc.. Since data comparing the effectiveness of these adjunctive approaches are still lacking, large-scale controlled trials evaluating the effect of catheter ablation in diverse patient populations on a long-term basis are needed to establish the appropriate approach for long-standing persistent AF. Furthermore, the development of de novo ablation methods (new energies, new targets, etc. is expected to improve ablation outcome in patients with long-standing persistent AF.

  4. Prevention of bronchiolitis from the hospital to home: enviromental and pharmacological strategies

    Directory of Open Access Journals (Sweden)

    Andrea Dotta

    2015-10-01

    Full Text Available Bronchiolitis is one of the major cause of mortality and morbidity during infancy, with high hospitalization rate during epidemic season for high risk infants during the first year of life. There is no specific therapy with proven efficacy apart hydration and hypertonic saline. Mild forms can be treated in outpatient setting avoiding a useless hospitalization. Enviromental prevention is crucial in hospital setting, in outpatient ambulatory and at home: for this purpose hand hygiene, tobacco exposure, breastfeeding must be emphasized with families and caregivers. Pharmacological prophylaxis uses a humanized monoclonal antibody (palivizumab shown effective in reducing hospitalization rate in preterm infants < 35 weeks gestational age, infants with bronchopulmonary dysplasia and infants with congenital heart disease. During the last 2 years different recommandations and guidelines confirmed the importance of prophylaxis with palivizumab with some differences between Groups and Societies based on different healthcare systems. In any case it is important a good contact between hospital and all caregivers of these patients to reduce the viral exposure and increase the defense capability of high risk patients. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  5. Interrupting the natural history of diabetes mellitus: lifestyle, pharmacological and surgical strategies targeting disease progression.

    Science.gov (United States)

    Khavandi, Kaivan; Brownrigg, Jack; Hankir, Mohammed; Sood, Harpreet; Younis, Naveed; Worth, Joy; Greenstein, Adam; Soran, Handrean; Wierzbicki, Anthony; Goldsmith, David J

    2014-01-01

    In recent decades we have seen a surge in the incidence of diabetes in industrialized nations; a threat which has now extended to the developing world. Type 2 diabetes is associated with significant microvascular and macrovascular disease, with considerable impact on morbidity and mortality. Recent evidence has cast uncertainty on the benefits of very tight glycaemic goals in these individuals. The natural history of disease follows an insidious course from disordered glucose metabolism in a pre-diabetic state, often with metabolic syndrome and obesity, before proceeding to diabetes mellitus. In the research setting, lifestyle, pharmacological and surgical intervention targeted against obesity and glycaemia has shown that metabolic disturbances can be halted and indeed regressed if introduced at an early stage of disease. In addition to traditional anti-diabetic medications such as the glinides, sulphonylureas and the glitazones, novel therapies manipulating the endocannabinoid system, neurotransmitters, intestinal absorption and gut hormones have shown dual benefit in weight loss and glycaemic control normalisation. Whilst these treatments will not and should not replace lifestyle change, they will act as invaluable adjuncts for weight loss and aid in normalising the metabolic profile of individuals at risk of diabetes. Utilizing novel therapies to prevent diabetes should be the focus of future research, with the aim of preventing the challenging microvascular and macrovascular complications, and ultimately cardiovascular death.

  6. Strategies for successful software development risk management

    Directory of Open Access Journals (Sweden)

    Marija Boban

    2003-01-01

    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.

  7. Strategies for Managing a Multigenerational Workforce

    Science.gov (United States)

    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.

  8. Assessment of two BWR accident management strategies

    International Nuclear Information System (INIS)

    Hodge, S.A.; Petek, M.

    1991-01-01

    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

  9. Specification of data centre power management strategies

    NARCIS (Netherlands)

    Postema, Björn F.; Haverkort, Boudewijn R.

    2017-01-01

    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

  10. Essays in industrial organization and management strategy

    NARCIS (Netherlands)

    de Bijl, P.W.J.

    1996-01-01

    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

  11. INTEGRATION OF PROGRESS STRATEGY IN PROJECT MANAGEMENT

    OpenAIRE

    Дмитрий Георгиевич БЕЗУГЛЫЙ

    2015-01-01

    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.

  12. Management Strategies for Promoting Teacher Collective Learning

    Science.gov (United States)

    Cheng, Eric C. K.

    2011-01-01

    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…

  13. Electronic government: Rethinking channel management strategies

    NARCIS (Netherlands)

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

    2008-01-01

    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

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

    African Journals Online (AJOL)

    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) ...

  15. Product Portfolio Management: An Important Business Strategy

    Directory of Open Access Journals (Sweden)

    Doorasamy Mishelle

    2015-06-01

    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.

  16. Time management strategies in nursing practice.

    Science.gov (United States)

    Waterworth, Susan

    2003-09-01

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

  17. Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan

    Directory of Open Access Journals (Sweden)

    Al Sifri S

    2012-08-01

    Full Text Available Saud Al SifriEndocrinology Department, Alhada Armed Forces Hospital, Taif, Saudi ArabiaI read with great interest the recent review article by AlMaatouq regarding the pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan.1 This article stated that "A recent prospective study of more than 1000 patients with T2DMwho fasted during Ramadan found that the risk of hypoglycemia associated with a vildagliptin-based regimen (vildagliptin 100 mg once daily was lower than that of a sulfonylurea-based regimen (both with and without metformin."1 This statement needs to be corrected.Ramadan is the lunar month observed each year in which Muslim adults will fast. This fast includes abstinence from eating, drinking, and smoking from sunrise to sunset. Hypoglycemia during this period represents the greatest health risk for these patients. Recently introduced modulators of the incretin system are the dipeptidylpeptidase-4 inhibitors, which include sitagliptin, vildagliptin, alogliptin, saxagliptin, and linagliptin. These agents are not associated with hypoglycemia.View original paper by AlMaatouq

  18. Managing the Chronically Overworked Team: Twenty Strategies.

    Science.gov (United States)

    Hills, Laura

    2015-01-01

    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.

  19. Irritable bowel syndrome: contemporary nutrition management strategies.

    Science.gov (United States)

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

    2014-09-01

    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.

  20. Social Media Strategies and Destination Management

    DEFF Research Database (Denmark)

    Munar, Ana Maria

    2012-01-01

    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...

  1. An approach to and the rationale for the pharmacological management of behavioral and psychological symptoms of dementia

    Directory of Open Access Journals (Sweden)

    Tripathi Manjari

    2010-10-01

    Full Text Available The behavioral and psychological symptoms of dementia (BPSD have been a difficult management area for neurologists and psychiatrists alike. The correct identification of each symptom and the underlying precipitating cause is the key to proper management-nonpharmacological as well as pharmacological. BPSD has been well documented in all types of dementia in various stages of the disease and in all dementias at an advanced stage. The proper management is not only rewarding in terms of responsiveness in an otherwise "incurable" and progressive disease, but also improves the quality of life of the patients and the caregivers alike. The caregiver burden is greatly decreased by an efficient management of BPSD. This review discusses the implications and boundaries of the term BPSD and unravels each symptom and its identification. Manifestations of psychological symptoms such as delusion, hallucination, misidentification, psychosis, depression, apathy, and anxiety are briefly described. Correct identification of behavior symptoms such as wandering, agitation, catastrophic reaction, disinhibition, and delirium has been outlined. While the subtle differences in each entity make the precise identification difficult, the different therapeutics of each make the exercise necessary. Pharmacological recommendations and side effects of medications have been mentioned thereafter. The review will help in the identification and correct pharmacological management of BPSD.

  2. Assessment of two BWR accident management strategies

    International Nuclear Information System (INIS)

    Hodge, S.A.; Petek, M.

    1994-01-01

    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.))

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

    Directory of Open Access Journals (Sweden)

    Wojciech Machowiak

    2012-12-01

    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.

  4. Food Versus Pharmacy: Assessment of Nutritional and Pharmacological Strategies to Improve Bone Health in Energy-Deficient Exercising Women.

    Science.gov (United States)

    Southmayd, Emily A; Hellmers, Adelaide C; De Souza, Mary Jane

    2017-10-01

    The review aims to summarize our current knowledge surrounding treatment strategies aimed at recovery of bone mass in energy-deficient women suffering from the Female Athlete Triad. The independent and interactive contributions of energy status versus estrogen status on bone density, geometry, and strength have recently been reported, highlighting the importance of addressing both energy and estrogen in treatment strategies for bone health. This is supported by reports that have identified energy-related features (low body weight and BMI) and estrogen-related features (late age of menarche, oligo/amenorrhea) to be significant risk factors for low bone mineral density and bone stress injury in female athletes and exercising women. Nutritional therapy is the recommended first line of treatment to recover bone mass in energy-deficient female athletes and exercising women. If nutritional therapy fails after 12 months or if fractures or significant worsening in BMD occurs, pharmacological therapy may be considered in the form of transdermal estradiol with cyclic oral progestin (not COC).

  5. Strategy development management of Multimodal Transport Network

    Directory of Open Access Journals (Sweden)

    Nesterova Natalia S.

    2016-01-01

    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.

  6. Balancing energy strategies in electricity portfolio management

    International Nuclear Information System (INIS)

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

    2011-01-01

    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)

  7. Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction.

    Science.gov (United States)

    Dickinson, John; Amirav, Israel; Hostrup, Morten

    2018-05-01

    Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to patients and athletes with EIB. Copyright © 2018 Elsevier Inc. All rights reserved.

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

    OpenAIRE

    Wojciech Machowiak

    2012-01-01

    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: ...

  9. Flexible management: strategies for the changing workforce.

    Science.gov (United States)

    Michaels, B

    1994-01-01

    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.

  10. A case report of hypertensive bleed presenting with pathological laughter: Focus on neurobiological correlates and pharmacological management

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

    Full Text Available Pathological laughter and crying are episodes of either laughter or crying, which is intense and uncontrollable, usually lasting for brief periods and occurring in paroxysms. In the literature, pathological laughing and crying, emotionalism, pseudo-bulbar affect are synonymously used. Favorable evidences exist with regard to the use of antidepressants, mood stabilizers, and anti-glutaminergic agents for the management of pathological laughter and crying. In this case report, we highlight the clinical presentation of hypertensive bleed in the form of pathological laughter and its management with selective serotonin reuptake inhibitor - sertraline along with literature review regarding its neurobiological basis and pharmacological management.

  11. Development of multimodal imaging strategies for the pharmacology of anticancer agents

    International Nuclear Information System (INIS)

    Brulle, Laura

    2012-01-01

    Preclinical imaging in oncology is booming. It allows, using representative animal models of human cancers, to understand the mechanisms of development of pathologies and to assess the therapeutic efficiency of a new treatment. The main objective of this work was to develop two ortho-topic models of cancer (pancreas and colon) and to assess on them the reference treatments as well as a new therapeutic strategy by non-thermal plasma so called Plasma Gun. The two cancer models developed showed good representation in relation to human cancers, with the appearance of distant metastases and hypoxia. 5-fluorouracil for the HCT116-luc ortho-topic model of colorectal carcinoma and gemcitabine for the MIA PaCa2-luc pancreatic adenocarcinoma model, have induced discrete effects at low dose which can be detected thanks imaging modalities. After validation of our experimental steps, a new therapeutic strategy, Plasma Gun was evaluated and showed significant effects on tumor growth inhibition. The second objective was to carry out tools for the induction and the characterization of bone metastases and for high resolution imaging of the vasculature. On the one hand, bone metastases obtained by injection of PC3M-luc cells intracardially, was evaluated and quantified with different imaging modalities (bioluminescence, scintigraphy and Computed Tomography). And the other hand, the achievement of a high resolution imaging of vascularization, was possible by the casting method that restores the 3D structure of the vascular architecture following injection of a resin in the circulation. Developments makes during this thesis are new tools for preclinical evaluation of novel anticancer therapies. (author) [fr

  12. Strategy on radioactive waste management in Lithuania

    International Nuclear Information System (INIS)

    Poskas, P.; Adomaitis, J.E.

    2003-01-01

    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.)

  13. Spill management strategy for the Chesapeake Bay

    International Nuclear Information System (INIS)

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

    1990-01-01

    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

  14. Environmental Management Strategy: Four Forces Analysis

    Science.gov (United States)

    Doyle, Martin W.; Von Windheim, Jesko

    2015-01-01

    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.

  15. Environmental management strategy: four forces analysis.

    Science.gov (United States)

    Doyle, Martin W; Von Windheim, Jesko

    2015-01-01

    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.

  16. KNOWLEDGE MANAGEMENT STRATEGY TO IMPROVE BUSINESS SECTOR

    Directory of Open Access Journals (Sweden)

    Haradhan Kumar Mohajan

    2017-09-01

    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.

  17. Big Rock Point severe accident management strategies

    International Nuclear Information System (INIS)

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

    1996-01-01

    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

  18. Pain and pharmacologic pain management in long-stay nursing home residents.

    Science.gov (United States)

    Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L

    2017-06-01

    Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.

  19. Essays in industrial organization and management strategy

    OpenAIRE

    de Bijl, P.W.J.

    1996-01-01

    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...

  20. Strategy generation in accident management support

    International Nuclear Information System (INIS)

    Sirola, M.

    1995-01-01

    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

  1. Novel strategies in the management of polycystic ovary syndrome.

    Science.gov (United States)

    Spritzer, P M; Motta, A B; Sir-Petermann, T; Diamanti-Kandarakis, E

    2015-09-01

    Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting reproductive-aged women. PCOS has been recognized as a syndrome combining reproductive and metabolic abnormalities with lifelong health implications. Cardiometabolic alterations require regular screening and effective and targeted lifestyle advice to lose weight as well as to prevent weight gain. Pharmacological therapy includes insulin-sensitizer drugs and agents that act directly on metabolic comorbidities, such as statins and antiobesity drugs. Bariatric surgery may be an option for severely obese women with PCOS Regarding reproductive aspects, ovulation induction with antiestrogens such as clomiphene citrate or letrozole is the first-line medical treatment. Exogenous gonadotropins and in vitro fertilization (IVF) are recommended as second-line treatment for anovulatory infertility. Laparoscopic ovarian diathermy may be used in special cases and metformin is no longer recommended for ovulation induction. Combined oral contraceptives (OCs) are the first-line treatment for the management of menstrual irregularities in women not seeking pregnancy, also providing endometrial protection and contraception. Progestin-only pills or cyclical progestins are recommended for those with contraindications to OCs. Metformin is also considered a second-line choice for improving menstrual cycles in women presenting insulin-resistance and dysglicemia. Hirsutism requires cosmetic procedures and medical treatment with OCs. More severe cases may need anti-androgen drugs added to the OCs. In conclusion, strategies regarding the management of reproductive issues in PCOS encompass a tailored approach to individual needs of each patient.

  2. Pharmacological targeting of p53 through RITA is an effective antitumoral strategy for malignant pleural mesothelioma.

    Science.gov (United States)

    Di Marzo, Domenico; Forte, Iris Maria; Indovina, Paola; Di Gennaro, Elena; Rizzo, Valeria; Giorgi, Francesca; Mattioli, Eliseo; Iannuzzi, Carmelina Antonella; Budillon, Alfredo; Giordano, Antonio; Pentimalli, Francesca

    2014-01-01

    Malignant mesothelioma, a very aggressive tumor associated to asbestos exposure, is expected to increase in incidence, and unfortunately, no curative modality exists. Reactivation of p53 is a new attractive antitumoral strategy. p53 is rarely mutated in mesothelioma, but it is inactivated in most tumors by the lack of p14(ARF). Here, we evaluated the feasibility of this approach in pleural mesothelioma by testing RITA and nutlin-3, two molecules able to restore p53 function through a different mechanism, on a panel of mesothelioma cell lines representing the epithelioid (NCI-H28, NCI-H2452, IST-MES 2), biphasic (MSTO-211H), and sarcomatoid (NCI-H2052) histotypes compared with the normal mesothelial HMC-hTERT. RITA triggered robust caspase-dependent apoptosis specifically in epithelioid and biphasic mesothelioma cell lines, both through wild-type and mutant p53, concomitant to p21 downregulation. Conversely, nutlin-3 induced a p21-dependent growth arrest, rather than apoptosis, and was slightly toxic on HMC-hTERT.   Interestingly, we identified a previously undetected point mutation of p53 (p.Arg249Ser) in IST-MES 2, and showed that RITA is also able to reactivate this p53 mutant protein and its apoptotic function. RITA reduced tumor growth in a MSTO-211H-derived xenograft model of mesothelioma and synergized with cisplatin, which is the mainstay of treatment for this tumor. Our data indicate that reactivation of p53 and concomitant p21 downregulation effectively induce cell death in mesothelioma, a tumor characterized by a high intrinsic resistance to apoptosis. Altogether, our findings provide the preclinical framework supporting the use of p53-reactivating agents alone, or in combination regimens, to improve the outcome of patients with mesothelioma.

  3. Parking management : strategies, evaluation and planning

    International Nuclear Information System (INIS)

    Litman, T.A.

    2006-01-01

    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

  4. Nuclear knowledge management strategies in Canada

    International Nuclear Information System (INIS)

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

    2004-01-01

    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)

  5. Pharmacologic management of non-cancer pain among nursing home residents.

    Science.gov (United States)

    Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

    2013-01-01

    Pain is common in nursing home settings. To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use. We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics. Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19). Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  6. Management strategies for nuclear power plant outages

    International Nuclear Information System (INIS)

    2006-01-01

    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

  7. Assessment of two BWR accident management strategies

    International Nuclear Information System (INIS)

    Hodge, S.A.; Petek, M.

    1991-01-01

    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

  8. Diabetes benefit management: evolving strategies for payers.

    Science.gov (United States)

    Tzeel, Albert L

    2011-11-01

    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.

  9. Pharmacological Activation of Protein Phosphatase 2 A (PP2A): A Novel Strategy to Fight Against Human Malignancies?

    Science.gov (United States)

    Carratù, Maria Rosaria; Signorile, Anna; De Rasmo, Domenico; Reale, Antonia; Vacca, Angelo

    2016-01-01

    The serine-threonine protein phosphatase 2A (PP2A) regulates multiple cell signaling cascades and its inactivation by viral oncoproteins, mutation of specific structural subunits or upregulation of the cellular endogenous inhibitors may contribute to malignant transformation by regulating specific phosphorylation events. Pharmacological modulation of PP2A activity is becoming an attractive strategy for cancer treatment. Some compounds targeting PP2A are able to induce PP2A reactivation and subsequent cell death in several types of cancer. We undertook a search of bibliographic databases for peer-reviewed articles focusing on the main item of the review. We selected articles published in indexed journals. The quality of retrieved papers was appraised using the standard bibliometric indicators. One hundred and fourteen papers were included in the review. Twenty-seven papers gave an overview of structure and physiological role of PP2A. Twenty-five papers outlined the role of PP2A in tumor suppression. Forty papers analyzed the mechanism involved in PP2A reactivation by synthetic compounds, and twenty-two papers outlined the capability of natural compounds of restoring PP2A activity and how this could be beneficial. Findings analyzed in this review underline the central role of PP2A as a regulator of cell growth and survival, hence its function as tumor suppressor. The discovery that some compounds, either synthetic or natural, are capable of reactivating PP2A opens up new perspectives for future strategies to fully exploit therapeutic potential in human cancer. Thus, this review could also be of particular interest to pharmaceutical or biotechnology companies for drug design and targeted delivery.

  10. Hybrid electric vehicles energy management strategies

    CERN Document Server

    Onori, Simona; Rizzoni, Giorgio

    2016-01-01

    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...

  11. Method of assessing severe accident management strategies

    International Nuclear Information System (INIS)

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

    1991-01-01

    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

  12. Management strategies in hospitals: scenario planning

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2015-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ameneh Khadivar

    2014-12-01

    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.

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

    OpenAIRE

    Ameneh Khadivar; Shohreh Nasri Nasr Abadi; Elham Fallah

    2014-01-01

    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...

  15. TASKILLAN II - Pilot strategies for workload management

    Science.gov (United States)

    Segal, Leon D.; Wickens, Christopher D.

    1990-01-01

    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.

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

    Science.gov (United States)

    Schwartz, Steven

    2003-11-15

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

  17. The strategy of radwaste management in Slovenia

    International Nuclear Information System (INIS)

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

    1994-01-01

    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

  18. Management Strategies for CLN2 Disease.

    Science.gov (United States)

    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

    2017-04-01

    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.

  19. Management strategies in hospitals: scenario planning.

    Science.gov (United States)

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

    2015-01-01

    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.

  20. An Overview of Pharmacological Approaches for Management and Repair of Spinal Cord Injuries

    Directory of Open Access Journals (Sweden)

    Azam Mardani

    2010-11-01

    Full Text Available "nSpinal cord injury (SCI leads to loss of nervous tissue and consequently to catastrophic neurological deficits. Up to now there is no definite treatment available that restores the loss of function to a degree that an independent life can be guaranteed. "nThis justifies the cost of research into the new modalities for a treatment of SCIs. In current paper, recent developments and new approaches in pharmacological therapy have been reviewed

  1. Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials.

    Science.gov (United States)

    Mesa-Jiménez, Juan A; Lozano-López, Cristina; Angulo-Díaz-Parreño, Santiago; Rodríguez-Fernández, Ángel L; De-la-Hoz-Aizpurua, Jose L; Fernández-de-Las-Peñas, Cesar

    2015-12-01

    Manual therapies are generally requested by patients with tension type headache. To compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials. PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their inception until June 2014. All randomized controlled trials comparing any manual therapy vs. medication care for treating tension type headache adults were included. Data were extracted and methodological quality assessed independently by two reviewers. We pooled headache frequency as the main outcome and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was used to determine effect sizes. Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis. Pooled analyses found that manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference -0.8036, 95% confidence interval -1.66 to -0.44; three trials), intensity (weighted mean difference -0.5974, 95% confidence interval -0.8875 to -0.3073; five trials) and duration (weighted mean difference -0.5558, 95% confidence interval -0.9124 to -0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference -0.3498, 95% confidence interval -1.106 to 0.407; three trials). Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care. However, due to the heterogeneity of the interventions, these results should be considered with caution at this stage. © International Headache

  2. Current Approaches and New Developments in the Pharmacological Management of Tourette Syndrome.

    Science.gov (United States)

    Quezada, Julio; Coffman, Keith A

    2018-01-01

    Tourette syndrome (TS) is a neurodevelopmental disorder of unknown etiology characterized by spontaneous, involuntary movements and vocalizations called tics. Once thought to be rare, TS affects 0.3-1% of the population. Tics can cause physical discomfort, emotional distress, social difficulties, and can interfere with education and desired activities. The pharmacologic treatment of TS is particularly challenging, as currently the genetics, neurophysiology, and neuropathology of this disorder are still largely unknown. However, clinical experience gained from treating TS has helped us better understand its pathogenesis and, as a result, derive treatment options. The strongest data exist for the antipsychotic agents, both typical and atypical, although their use is often limited in children and adolescents due to their side-effect profiles. There are agents in a variety of other pharmacologic categories that have evidence for the treatment of TS and whose side-effect profiles are more tolerable than the antipsychotics; these include clonidine, guanfacine, baclofen, topiramate, botulinum toxin A, tetrabenazine, and deutetrabenazine. A number of new agents are being developed and tested as potential treatments for TS. These include valbenazine, delta-9-tetrahydrocannabidiol, and ecopipam. Additionally, there are agents with insufficient data for efficacy, as well as agents that have been shown to be ineffective. Those without sufficient data for efficacy include clonazepam, ningdong granule, 5-ling granule, omega-3 fatty acids, and n-acetylcysteine. The agents that have been shown to be ineffective include pramipexole and metoclopramide. We will review all of the established pharmacologic treatments, and discuss those presently in development.

  3. Research on Energy Management Strategy of Hybrid Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Deng Tao

    2015-01-01

    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.

  4. A Knowledge Management Strategy To Achieve Organisation Competitiveness

    Directory of Open Access Journals (Sweden)

    Dr. St. Sukmawati.

    2015-08-01

    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.

  5. Adaptation of the Pharmacological Management of Delirium in ICU Patients in Iran: Introduction and Definition

    Directory of Open Access Journals (Sweden)

    mohammad arbabi

    2018-02-01

    Full Text Available Objective: Delirium is a brain dysfunction syndrome. In most cases, this syndrome is neither diagnosed accurately nor treated properly. The incidence of delirium by itself increases hospitalization period, mortality rate and the cost in health spectrum. If appropriate attempts are not made to treat this complication, the outcomes could become worse. Thus, the present study aimed at conducting a review on medications which are prescribed to treat delirium and establishing a general view on their advantages and disadvantages.Method: By searching Google Scholar, PsycINFO, Scopus, and PubMed databases as well as hand searching in key journals, data were collected without time and language limitation. After collecting the data, comparing the similar or contradictory information, and sorting them, the views of specialists were inquired and duly received via email. By acquiring consensus of opinions, the secondary manuscript was written in a narrative review form.Discussion: This narrative review paper aimed at providing a general view on defining delirium, the pathologic factors that create it, and treating this syndrome based on its development. Authentic evidence regarding delirium management was reviewed and a treatment strategy was suggested for Iranian patients.

  6. Facilities Management a new strategy at CERN

    CERN Document Server

    Nonis, M; CERN. Geneva. ST Division

    2002-01-01

    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...

  7. Radioactive waste management strategies: setting the scene

    International Nuclear Information System (INIS)

    Allan, C.J.

    1994-01-01

    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

  8. Pyroprocessing as a waste management strategy

    International Nuclear Information System (INIS)

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

    1991-01-01

    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

  9. Performance management vital in implementing new strategies

    International Nuclear Information System (INIS)

    Kruzner, D.; Trollinger, R.

    1996-01-01

    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

  10. Healthcare management strategies: interdisciplinary team factors.

    Science.gov (United States)

    Andreatta, Pamela; Marzano, David

    2012-12-01

    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.

  11. Strategy of image management in retail shops

    Directory of Open Access Journals (Sweden)

    Sandra Soče Kraljević

    2007-12-01

    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

  12. Effectiveness of alternative management strategies in meeting conservation objectives

    Science.gov (United States)

    Richards S. Holthausen; Carolyn Hull Sieg

    2007-01-01

    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...

  13. Emergency management: Concepts and strategies for effective programs

    OpenAIRE

    Lucus, Valerie

    2007-01-01

    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.

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

    Science.gov (United States)

    Nields, Allison N.

    2014-01-01

    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…

  15. A holistic strategy for adaptive land management

    Science.gov (United States)

    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...

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

    Science.gov (United States)

    2015-06-01

    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...

  17. ADMINISTRATIVE INSTRUMENTS IN IMPLEMENTING FUNCTIONAL STRATEGIES COMPETITIVENESS MANAGEMENT

    OpenAIRE

    Stankovska, Iryna

    2017-01-01

    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...

  18. AN EVALUATION OF RISK MANAGEMENT STRATEGIES FOR DAIRY FARMS

    OpenAIRE

    Bosch, Darrell J.; Johnson, Christian J.

    1992-01-01

    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...

  19. Evolutionary space station fluids management strategies

    Science.gov (United States)

    1989-01-01

    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.

  20. Strategy-driven talent management a leadership imperative

    CERN Document Server

    Silzer, Rob

    2009-01-01

    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

  1. Towards an Effective Management Strategy for Passive RFID Implementation

    National Research Council Canada - National Science Library

    Fisch, John N; Koch, David M

    2004-01-01

    .... 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...

  2. Integrated Weed Management Strategies for Control of Hydrilla

    National Research Council Canada - National Science Library

    Nelson, Linda S; Shearer, Judy F

    2009-01-01

    ...), 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...

  3. High-dose buprenorphine: perioperative precautions and management strategies.

    Science.gov (United States)

    Roberts, D M; Meyer-Witting, M

    2005-02-01

    Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.

  4. Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management: Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT

    Directory of Open Access Journals (Sweden)

    Christina M. Gant

    2017-07-01

    Full Text Available Cardiovascular risk management is an integral part of treatment in Type 2 Diabetes Mellitus (T2DM, and requires pharmacological as well as nutritional management. We hypothesize that a systematic assessment of both pharmacological and nutritional management can identify targets for the improvement of treatment quality. Therefore, we analysed blood pressure (BP management in the DIAbetes and LifEstyle Cohort Twente (DIALECT. DIALECT is an observational cohort from routine diabetes care, performed at the ZGT Hospital (Almelo and Hengelo, The Netherlands. BP was measured for 15 minutes with one minute intervals. Sodium and potassium intake was derived from 24-hour urinary excretion. We determined the adherence to pharmacological and non-pharmacological guidelines in patients with BP on target (BP-OT and BP not on target (BP-NOT. In total, 450 patients were included from August 2009 until January 2016. The mean age was 63 ± 9 years, and the majority was male (58%. In total, 53% had BP-OT. In those with BP-NOT, pharmacological management was suboptimal (zero to two antihypertensive drugs in 62% of patients, and nutritional guideline adherence was suboptimal in 100% of patients (only 8% had a sodium intake on target, 66% had a potassium intake on target, 3% had a sodium-to-potassium ratio on target, and body mass index was <30 kg/m2 in 35%. These data show pharmacological undertreatment and a low adherence to nutritional guidelines. Uncontrolled BP is common in T2DM, and our data show a window of opportunity for improving BP control, especially in nutritional management. To improve treatment quality, we advocate to incorporate the integrated monitoring of nutritional management in quality improvement cycles in routine care.

  5. Screening asymptomatic patients with diabetes for unknown coronary artery disease: does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?).

    Science.gov (United States)

    Turrini, Fabrizio; Messora, Roberto; Giovanardi, Paolo; Tondi, Stefano; Magnavacchi, Paolo; Cavani, Rita; Tosoni, Giandomenico; Cappelli, Carlo; Pellegrini, Elisa; Romano, Stefania; Baldini, Augusto; Zennaro, Romeo Giulietto; Bondi, Marco

    2009-12-23

    Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart) will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery.The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. (ClinicalTrials.gov): NCT00547872.

  6. Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?

    Directory of Open Access Journals (Sweden)

    Romano Stefania

    2009-12-01

    Full Text Available Abstract Background Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. Methods/Design In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery. The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. Discussion The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. Trial registration (ClinicalTrials.gov: NCT00547872

  7. ADMINISTRATIVE INSTRUMENTS IN IMPLEMENTING FUNCTIONAL STRATEGIES COMPETITIVENESS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Iryna Stankovska

    2017-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Enea, C.

    2010-12-01

    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.

  9. The notion of strategy in facility management

    DEFF Research Database (Denmark)

    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....

  10. Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Claudia Caminha Escosteguy

    Full Text Available CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2. 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4. The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0. Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9 of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6; beta-blockers in 49.0% (95% CI 43.8 to 54.1; angiotensin-converting enzyme (ACE inhibitors in 63.3% (95% CI 58.2 to 68.1; nitrates in 82.0% (95% CI 82.4 to 89.6; heparin in 81.3% (95% CI 76.9 to 85.0; calcium antagonists in 30.5% (95% CI 26.0 to 35.4. There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and

  11. DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES.

    Science.gov (United States)

    Ysa, Tamyko; Sierra, Vicenta; Esteve, Marc

    2014-09-01

    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.

  12. Interventions for the management of dry mouth: non-pharmacological interventions.

    Science.gov (United States)

    Furness, Susan; Bryan, Gemma; McMillan, Roddy; Worthington, Helen V

    2013-08-30

    Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. Sjogren's Syndrome) and radiotherapy treatment for head and neck cancers. Non-pharmacological techniques such as acupuncture or mild electrostimulation may be used to improve symptoms. To assess the effects of non-pharmacological interventions administered to stimulate saliva production for the relief of dry mouth. We searched the Cochrane Oral Health Group's Trials Register (to 16th April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE via OVID (1948 to 16th April 2013), EMBASE via OVID (1980 to 16th April 2013), AMED via OVID (1985 to 16th April 2013), CINAHL via EBSCO (1981 to 16th April 2013), and CANCERLIT via PubMed (1950 to 16th April 2013). The metaRegister of Controlled Clinical Trials (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov) were also searched to identify ongoing and completed trials. References lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status. We included parallel group randomised controlled trials of non-pharmacological interventions to treat dry mouth, where participants had dry mouth symptoms at baseline. At least two review authors assessed each of the included studies to confirm eligibility, assess risk of bias and extract data using a piloted data extraction form. We calculated mean difference (MD) and 95% confidence intervals (CI) for continuous outcomes or where different scales were used to assess an outcome, we calculated standardised mean differences (SMD) together with 95% CIs. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information. There were nine studies (total 366

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

    Science.gov (United States)

    Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon

    2017-03-15

    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. Vocal local versus pharmacological treatments for pain management in tubal ligation procedures in rural Kenya: a non-inferiority trial.

    Science.gov (United States)

    Keogh, Sarah C; Fry, Kenzo; Mbugua, Edwin; Ayallo, Mark; Quinn, Heidi; Otieno, George; Ngo, Thoai D

    2014-02-04

    Vocal local (VL) is a non-pharmacological pain management technique for gynecological procedures. In Africa, it is usually used in combination with pharmacological analgesics. However, analgesics are associated with side-effects, and can be costly and subject to frequent stock-outs, particularly in remote rural settings. We compared the effectiveness of VL + local anesthesia + analgesics (the standard approach), versus VL + local anesthesia without analgesics, on pain and satisfaction levels for women undergoing tubal ligations in rural Kenya. We conducted a site-randomised non-inferiority trial of 884 women receiving TLs from 40 Marie Stopes mobile outreach sites in Kisii and Machakos Districts. Twenty sites provided VL + local anesthesia + analgesics (control), while 20 offered VL + local anesthesia without additional analgesics (intervention). Pain was measured using a validated 11-point Numeric Rating Scale; satisfaction was measured using 11-point scales. A total of 461 women underwent tubal ligations with VL + local anesthesia, while 423 received tubal ligations with VL + local anesthesia + analgesics. The majority were aged ≥30 years (78%), and had >3 children (99%). In a multivariate analysis, pain during the procedure was not significantly different between the two groups. The pain score after the procedure was significantly lower in the intervention group versus the control group (by 0.40 points; p = 0.041). Satisfaction scores were equally high in both groups; 96% would recommend the procedure to a friend. VL + local anesthesia is as effective as VL + local anesthesia + analgesics for pain management during tubal ligation in rural Kenya. Avoiding analgesics is associated with numerous benefits including cost savings and fewer issues related to the maintenance, procurement and monitoring of restricted opioid drugs, particularly in remote low-resource settings where these systems are weak. Pan-African Clinical Trials Registry PACTR201304000495942.

  15. Evaluation of Advanced Data Centre Power Management Strategies

    NARCIS (Netherlands)

    Postema, Björn F.; Haverkort, Boudewijn R.

    2018-01-01

    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

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

    Science.gov (United States)

    Michael Nisengard; Miklos Gratzer

    1998-01-01

    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...

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

    Science.gov (United States)

    Allen, Myria Watkins; Caillouet, Rachel H.

    1994-01-01

    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)

  18. Strategy Maps in University Management: A Comparative Study

    Science.gov (United States)

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    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…

  19. PERFORMANCE ACHIEVEMENT OF TOURISM ENTERPRISE BY IMPLEMENTING MANAGEMENT STRATEGIES

    Directory of Open Access Journals (Sweden)

    Nicolae PLATON

    2017-04-01

    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.

  20. Knowledge and Attitude Towards Pharmacological Management of Acute Agitation: A Survey of Psychiatrists, Psychiatry Residents, and Psychiatric Nurses.

    Science.gov (United States)

    Tangu, KeumbÔh; Ifeanyi, Adaora; Velusamy, Mayurapriya; Dar, Sara; Shah, Nurun; Ezeobele, Ifeoma E; Okusaga, Olaoluwa O

    2017-06-01

    The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.

  1. Barriers to Use of Non-pharmacological Pain Management Methods in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Y Zahedpasha

    2017-09-01

    CONCLUSION: According to the results of this study, inadequate nursing staff and insufficient knowledge about pain complications were the most important causes for lack of application of pain management methods for neonates

  2. Assessment of uncertainties in severe accident management strategies

    International Nuclear Information System (INIS)

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

    1990-01-01

    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

  3. Management of Irritable Bowel Syndrome: Novel Approaches to the Pharmacology of Gut Motility

    Directory of Open Access Journals (Sweden)

    Carmelo Scarpignato

    1999-01-01

    receptors on GI smooth muscle and, therefore, act as motilin agonists. This antibiotic accelerates gastric emptying and shortens orocecal transit time. In the large bowel a significant decrease in transit is observed only in the right colon, which suggests a shift in fecal distribution. Several ‘motilinomimetics’ have been synthesized. Their development depends on the lack of antimicrobial activity and the absence of fading of the prokinetic effect during prolonged administration. 5-hydroxytryptamine (5-HT4 agonists with significant pharmacological effects on the mid- and distal gut (such as prucalopride and tegaserod are available for human use. These ‘enterokinetic’ compounds are useful for treating constipation- predominant IBS patients. 5-HT3 receptor antagonists also possess a number of interesting pharmacological properties that may make them suitable for treatment of IBS. Besides decreasing colonic sensitivity to distension, these drugs prolong intestinal transit and may be particularly useful in diarrhea-predominant IBS. Finally, when administered in small pulsed doses, octreotide, besides reducing the perception of rectal distension, accelerates intestinal transit, although other evidence disputes such an effect.

  4. Pharmacologic Management of Duchenne Muscular Dystrophy: Target Identification and Preclinical Trials

    Science.gov (United States)

    Kornegay, Joe N.; Spurney, Christopher F.; Nghiem, Peter P.; Brinkmeyer-Langford, Candice L.; Hoffman, Eric P.; Nagaraju, Kanneboyina

    2014-01-01

    Duchenne muscular dystrophy (DMD) is an X-linked human disorder in which absence of the protein dystrophin causes degeneration of skeletal and cardiac muscle. For the sake of treatment development, over and above definitive genetic and cell-based therapies, there is considerable interest in drugs that target downstream disease mechanisms. Drug candidates have typically been chosen based on the nature of pathologic lesions and presumed underlying mechanisms and then tested in animal models. Mammalian dystrophinopathies have been characterized in mice (mdx mouse) and dogs (golden retriever muscular dystrophy [GRMD]). Despite promising results in the mdx mouse, some therapies have not shown efficacy in DMD. Although the GRMD model offers a higher hurdle for translation, dogs have primarily been used to test genetic and cellular therapies where there is greater risk. Failed translation of animal studies to DMD raises questions about the propriety of methods and models used to identify drug targets and test efficacy of pharmacologic intervention. The mdx mouse and GRMD dog are genetically homologous to DMD but not necessarily analogous. Subcellular species differences are undoubtedly magnified at the whole-body level in clinical trials. This problem is compounded by disparate cultures in clinical trials and preclinical studies, pointing to a need for greater rigor and transparency in animal experiments. Molecular assays such as mRNA arrays and genome-wide association studies allow identification of genetic drug targets more closely tied to disease pathogenesis. Genes in which polymorphisms have been directly linked to DMD disease progression, as with osteopontin, are particularly attractive targets. PMID:24936034

  5. Effective strategies for comprehensive corridor management

    Science.gov (United States)

    2004-10-01

    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...

  6. Developing management strategies for riparian areas.

    Science.gov (United States)

    D.E. Hibbs; S. Chan

    2001-01-01

    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...

  7. A national cohesive wildland fire management strategy

    Science.gov (United States)

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

    2011-01-01

    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...

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

    African Journals Online (AJOL)

    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 ...

  9. Strategies for Managing a Multigenerational Workforce

    Science.gov (United States)

    Iden, Ronald

    2016-01-01

    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…

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

    African Journals Online (AJOL)

    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 ...

  11. A holistic strategy for adaptive land management

    Science.gov (United States)

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

    2012-01-01

    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).

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

    Directory of Open Access Journals (Sweden)

    Palika Wannawilai

    2017-04-01

    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.

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

    Science.gov (United States)

    Andrew B. Carey

    2000-01-01

    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 (

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

    Science.gov (United States)

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

    2007-01-01

    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.…

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

    Science.gov (United States)

    Liu, Hong-cheng

    2005-07-01

    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.

  16. Evidence and consensus recommendations for the pharmacological management of pain in India

    Directory of Open Access Journals (Sweden)

    Dureja GP

    2017-03-01

    Full Text Available Gur Prasad Dureja,1 Rajagopalan N Iyer,2 Gautam Das,3 Jaishid Ahdal,4 Prashant Narang4 On behalf of the Pain Working Group 1Delhi Pain Management Centre, New Delhi, Delhi, 2Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka, 3Daradia Pain Clinic, Kolkata, West Bengal, 4Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India Abstract: Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease

  17. Anesthetic pharmacology

    National Research Council Canada - National Science Library

    Evers, Alex S; Maze, M; Kharasch, Evan D

    2011-01-01

    ...: Section 1 introduces the principles of drug action, Section 2 presents the molecular, cellular and integrated physiology of the target organ/functional system and Section 3 reviews the pharmacology...

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

    African Journals Online (AJOL)

    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 ...

  19. Environmental factors and health information technology management strategy.

    Science.gov (United States)

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

    2011-01-01

    : 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.

  20. CHANGE MANAGEMENT STRATEGIES RELATED TO THE GLOBAL ENVIRONMENT COMPLEXITY

    Directory of Open Access Journals (Sweden)

    Elena DOVAL

    2016-12-01

    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.

  1. Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression.

    Science.gov (United States)

    Ahmadpanah, Mohammad; Nazaribadie, Marzieh; Aghaei, Elham; Ghaleiha, Ali; Bakhtiari, Azade; Haghighi, Mohammad; Bahmani, Dena Sadeghi; Akhondi, Amineh; Bajoghli, Hafez; Jahangard, Leila; Holsboer-Trachsler, Edith; Brand, Serge

    2018-02-01

    Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

  2. Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder.

    Science.gov (United States)

    Kerins, Carolyn A; McWhorter, Alton G; Seale, N Sue

    2007-01-01

    The purpose of this study was to conduct a survey of Texas pediatric dentists to determine: (1) the percentage of patients they treat with attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD); (2) the behavior management techniques that are utilized to treat their patients who suffer from ADD/ADHD; and (3) the relative success rates of these techniques in their practices. A 17-question, single-answer, multiple choice survey was mailed to 343 Texas pediatric dentists. The mailing list was obtained from American Academy of Pediatric Dentistry and Texas Academy of Pediatric Dentistry member rosters. One mailing was sent, including a self-addressed stomped envelope, for returned responses. A 54% response rate (186 surveys) revealed that nitrous oxide was the most frequently used pharmacologic behavior management technique; however, demerol/promethazine/nitrous oxide was rated as effective most often for treating ADD/ADHD patients. Practitioners believe the incidence of attention deficit disorder/attention deficit hyperactivity disorder is increasing, and they are familiar with the medications used to treat the conditions. Texas pediatric dentists are using a variety of sedation techniques and are interested in developing guidelines for sedation of these patients.

  3. Benchmarking Outdoor Expeditionary Program Risk Management Strategies

    Science.gov (United States)

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

    2017-01-01

    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…

  4. 10 Budget-Savvy Content Management Strategies

    Science.gov (United States)

    Hillis, David J.

    2004-01-01

    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…

  5. Strategies of management of the nuclear fuel

    International Nuclear Information System (INIS)

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

    1996-01-01

    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)

  6. Strategies of smallholder irrigation management in Zimbabwe

    NARCIS (Netherlands)

    Manzungu, E.

    1999-01-01

    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

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

    Science.gov (United States)

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

    2015-10-01

    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.

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

    DEFF Research Database (Denmark)

    Friis, Ole Uhrskov

    2014-01-01

    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...

  9. Hypoglycaemia in anesthesiology practice: Diagnostic, preventive, and management strategies

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2013-01-01

    Full Text Available Diabetes mellitus has emerged as one of the fastest growing non communicable diseases worldwide. Management of diabetic patients during surgical and critically illness is of paramount challenge to anesthesiologist and intensivist. Among its major acute complications, hypoglycemia has been given lesser attention as compared to other major acute complications; diabetic ketoacidosis and hyperosmolar non ketotic coma. However, newer studies and literary evidence have established the serious concerns of morbidity and mortality, both long- and short-term, related to hypoglycemia. basis. Invariably, diabetic patients are encountered in our daily routine practice of anesthesia. During fasting status as well as the perioperative period, it is hypoglycemia that is of high concern to anesthesiologist. Management has to be based on clinical, pharmacological, social, and psychological basis, so as to completely prevent the complications arising from an acute episode of hypoglycemia. This review aims to highlight various aspects of hypoglycemia and its management both from endocrine and anesthesia perspective.

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

    Directory of Open Access Journals (Sweden)

    Michael Mutingi

    2013-06-01

    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.

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

    OpenAIRE

    Schroeder, Amanda

    2017-01-01

    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...

  12. SUPPLY CHAIN MANAGEMENT AS AN ELEMENT OF COMPANY STRATEGY

    OpenAIRE

    SEBASTIAN KOT; DANUTA PLUTA; IWONA STASIAK; WIOLETTA STRUZIK

    2014-01-01

    : 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...

  13. [PHARMACOLOGICAL TREATMENT IN PALLIATIVE CARE. DRUG ADMINISTRATION ROUTE, CONTINUOUS SUBCUTANEOUS INFUSION, ADVERSE SIDE EFFECTS, SYMPTOM MANAGEMENT].

    Science.gov (United States)

    Dominguez Álvarez, Rocío; Calderón Carrasco, Justo; García Colchero, Francisco; Postigo Mota, Salvador; Alburquerque Medina, Eulalia

    2015-01-01

    To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. Management interventions drugs for nurses in Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a possible decompensation of it needing extra dose of medication. Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and nccocc rocnnnco t thocm

  14. Emphysematous pyelonephritis with calculus: Management strategies

    Directory of Open Access Journals (Sweden)

    Tanmaya Goel

    2007-01-01

    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.

  15. Emphysematous pyelonephritis with calculus: Management strategies.

    Science.gov (United States)

    Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

    2007-07-01

    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.

  16. Management strategy for unicameral bone cyst.

    Science.gov (United States)

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

    2003-06-01

    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.

  17. Fibromyalgia: management strategies for primary care providers.

    Science.gov (United States)

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

    2016-02-01

    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.

  18. Management Strategy for Unicameral Bone Cyst

    OpenAIRE

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

    2003-01-01

    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...

  19. WEALTH MANAGEMENT STRATEGIES IN THE ERA OF E-COMMERCE

    Directory of Open Access Journals (Sweden)

    Mohammed Shahedul QUADER

    2011-06-01

    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.

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

    African Journals Online (AJOL)

    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.

  1. Managing consumer disengagement through green advertising strategies

    OpenAIRE

    Loh, E-Jian

    2017-01-01

    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...

  2. Negotiation Strategies in Supply Chain Management

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2008-01-01

    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...

  3. Energy management strategies for vehicle power nets

    NARCIS (Netherlands)

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

    2004-01-01

    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.

  4. Managing Reward Strategy to Enhance Employee Performance

    African Journals Online (AJOL)

    Prof

    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.

  5. Burden, Determinants, and Pharmacological Management of Hypertension in HIV-Positive Patients and Populations: A Systematic Narrative Review.

    Science.gov (United States)

    Nguyen, Kim Anh; Peer, Nasheeta; Mills, Edward J; Kengne, Andre Pascal

    2015-01-01

    Hypertension among HIV-positive populations has emerged as a new threat to the health and well being of people living with HIV, particularly among those receiving antiretroviral therapy. We reviewed the global evidence on the burden of disease (including prevalence and incidence), determinants of hypertension among HIV-positive populations, and the pharmacological management of hypertension in HIV-positive patients. We systematically searched PubMed-MEDLINE and EMBASE from January 2000 through February 2015 for relevant studies and traced their citations through the ISI Web of Science. We also searched the websites of the World Health Organisation, the International Society of Hypertension, and the International AIDS Society and constructed a narrative data synthesis. Hypertension is common in HIV-positive populations, with prevalence estimates ranging from 4.7 to 54.4% in high-income countries, and from 8.7 to 45.9% in low- and middle-income countries. The role of HIV-specific factors including disease severity, duration of disease, and treatments on the presence of hypertension in HIV-positive patients is reported, but patterns remain unclear. The clinical management of hypertension in HIV-positive patients is similar to those with hypertension in the general population; however, additional considerations should be given to potential drug interactions between antihypertensive agents and antiretroviral drugs to inform the clinician's selection of these therapies. Hypertension is common in HIV-positive populations and remains an important comorbidity affecting mortality outcomes. Further research examining the development of hypertension and its associated care in HIV-positive patients is required to optimize management of the dual conditions.

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

    International Nuclear Information System (INIS)

    Orlowski, S.

    1986-01-01

    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)

  7. 118 cognitive –behavioural strategies for the management of ...

    African Journals Online (AJOL)

    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 ...

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

    Science.gov (United States)

    2010-10-01

    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...

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

    African Journals Online (AJOL)

    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 ...

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

    African Journals Online (AJOL)

    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.

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

    DEFF Research Database (Denmark)

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

    2018-01-01

    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...

  12. Pharmacological management of binge eating disorder: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    McElroy SL

    2012-05-01

    Full Text Available Susan L McElroy, Anna I Guerdjikova, Nicole Mori, Anne M O'MeliaLindner Center of HOPE, Mason, and Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USAAbstract: Growing evidence suggests that pharmacotherapy may be beneficial for some patients with binge eating disorder (BED, an eating disorder characterized by repetitive episodes of uncontrollable consumption of abnormally large amounts of food without inappropriate weight loss behaviors. In this paper, we provide a brief overview of BED and review the rationales and data supporting the effectiveness of specific medications or medication classes in treating patients with BED. We conclude by summarizing these data, discussing the role of pharmacotherapy in the BED treatment armamentarium, and suggesting future areas for research.Keywords: binge eating disorder, pharmacotherapy, medication management

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

    Institute of Scientific and Technical Information of China (English)

    Chen Huarong; Wang Xiaoming

    2012-01-01

    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.

  14. Spatial strategies for managing visitor impacts in National Parks

    Science.gov (United States)

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

    1999-01-01

    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

  15. Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

    Science.gov (United States)

    Fernández-González, Felipe José; Cañigral, Aránzazu; Balbontín-Ayala, Felipe; Gonzalo-Orden, José Manuel; de Carlos, Felix; Cobo, Teresa; Fernández-Vázquez, Jose Pedro; Sánchez-Lasheras, Fernando; Vega, José Antonio

    2015-01-01

    Introduction: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed. Objectives: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage. Methods: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed. Results: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs). Conclusions: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements. PMID:26560822

  16. Accidental oil spills - project management strategy

    International Nuclear Information System (INIS)

    Bobic, V.; Benkovic, Z.

    2009-01-01

    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

  17. Understanding the relationship between livelihood strategy and soil management

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...

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

    OpenAIRE

    Iyi, Obiora

    2015-01-01

    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...

  19. A survey of managed care strategies for pregnant smokers

    OpenAIRE

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

    2000-01-01

    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...

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

    OpenAIRE

    Luis C. Ortigueira

    2007-01-01

    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...

  1. Optimal energy management strategy for self-reconfigurable batteries

    International Nuclear Information System (INIS)

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

    2017-01-01

    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.

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

    African Journals Online (AJOL)

    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 ...

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

    OpenAIRE

    Zhang, Chen; Han, Xingyong

    2009-01-01

    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.

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

    African Journals Online (AJOL)

    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 ...

  5. Knowledge Management and the Competitive Strategy of the Firm

    Science.gov (United States)

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

    2006-01-01

    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…

  6. Conditions for developing a successful Talent Management Strategy

    OpenAIRE

    Naulleau , Mickaël

    2015-01-01

    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...

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

    International Nuclear Information System (INIS)

    Bartlett, J.W.

    1988-01-01

    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

  8. Respiratory Strategies and Airway Management in Patients with Pulmonary Alveolar Proteinosis: A Review

    Directory of Open Access Journals (Sweden)

    Tomas Vymazal

    2015-01-01

    Full Text Available Background. Pulmonary alveolar proteinosis is a rare disorder characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Treatment methods include noninvasive pharmacological approaches and invasive procedures, such as whole-lung lavage under general anesthesia. Methods. Based on the literature search using free-term key words, we have analyzed published articles concerning the perioperative management of adult and pediatric patients with pulmonary alveolar proteinosis. Results and Discussion. In total, 184 publications were analyzed. Only a few manuscripts were related to anesthetic, respiratory, and airway management in patients suffering from pulmonary alveolar proteinosis. Airway should be strictly separated using a double-lumen tube. Respiratory strategies involve the use of manual clapping, continuous positive airway pressure, high-frequency jet ventilation of the affected lung, and employment of venovenous extracorporeal membrane oxygenation in the most serious of cases. Conclusion. The goal of this review is to summarize the current published information about an anesthetic management strategy with a focus on airway management, ventilation, and oxygenation techniques in PAP patients.

  9. Epoetin zeta in the management of anemia associated with chronic kidney disease, differential pharmacology and clinical utility

    Directory of Open Access Journals (Sweden)

    Davis-Ajami ML

    2014-04-01

    Full Text Available Mary Lynn Davis-Ajami,1 Jun Wu,2 Katherine Downton,3 Emilie Ludeman,3 Virginia Noxon4 1Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA; 2South Carolina College of Pharmacy, University of South Carolina, Greenville, SC, USA; 3Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA; 4Department of Clinical Pharmacy and Outcomes Science, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA Abstract: Epoetin zeta was granted marketing authorization in October 2007 by the European Medicines Agency as a recombinant human erythropoietin erythropoiesis-stimulating agent to treat symptomatic anemia of renal origin in adult and pediatric patients on hemodialysis and adults on peritoneal dialysis, as well as for symptomatic renal anemia in adult patients with renal insufficiency not yet on dialysis. Currently, epoetin zeta can be administered either subcutaneously or intravenously to correct for hemoglobin concentrations ≤10 g/dL (6.2 mmol/L or with dose adjustment to maintain hemoglobin levels at desired levels not in excess of 12 g/dL (7.5 mmol/L. This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and discusses its pharmacology and clinical utility. Keywords: biosimilar, chronic kidney disease, epoetin alfa, erythropoiesis, renal anemia, Retacrit®

  10. Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review.

    Science.gov (United States)

    Lopes-Júnior, L C; Bomfim, E O; Nascimento, L C; Nunes, M D R; Pereira-da-Silva, G; Lima, R A G

    2016-11-01

    Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress. © 2015 John Wiley & Sons Ltd.

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

    African Journals Online (AJOL)

    Simon Bhekimuzi Khoza

    2016-11-05

    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 ...

  12. Strategy development for enterprise content management

    NARCIS (Netherlands)

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

    2014-01-01

    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

  13. Quantitative investment strategies and portfolio management

    NARCIS (Netherlands)

    Guo, J.

    2012-01-01

    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

  14. Management Strategy for Unicameral Bone Cyst

    Directory of Open Access Journals (Sweden)

    Chin-Yi Chuo

    2003-06-01

    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.

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

    African Journals Online (AJOL)

    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.

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

    African Journals Online (AJOL)

    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 ...

  17. Weed management strategies for castor bean crops

    Directory of Open Access Journals (Sweden)

    Augusto Guerreiro Fontoura Costa

    2014-04-01

    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.

  18. Knowledge Management: The Bedrock of Enterprise Strategy.

    Science.gov (United States)

    Stevens, George H.; Krasner, Scott M.

    2001-01-01

    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…

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

    Science.gov (United States)

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

    2017-01-01

    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…

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

    OpenAIRE

    Pitcher, GS

    2014-01-01

    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...

  1. Pharmacologic management of bone-related complications and bone metastases in postmenopausal women with hormone receptor-positive breast cancer

    Directory of Open Access Journals (Sweden)

    Yardley DA

    2016-05-01

    Full Text Available Denise A Yardley1,2 1Sarah Cannon Research Institute, Nashville, TN, USA; 2Tennessee Oncology, Nashville, TN, USA Abstract: There is a high risk for bone loss and skeletal-related events, including bone metastases, in postmenopausal women with hormone receptor-positive breast cancer. Both the disease itself and its therapeutic treatments can negatively impact bone, resulting in decreases in bone mineral density and increases in bone loss. These negative effects on the bone can significantly impact morbidity and mortality. Effective management and minimization of bone-related complications in postmenopausal women with hormone receptor-positive breast cancer remain essential. This review discusses the current understanding of molecular and biological mechanisms involved in bone turnover and metastases, increased risk for bone-related complications from breast cancer and breast cancer therapy, and current and emerging treatment strategies for managing bone metastases and bone turnover in postmenopausal women with hormone receptor-positive breast cancer. Keywords: breast cancer, bone metastases, hormone receptor-positive, bone-related complications, interventions, management and management strategies, estrogen receptor-positive

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

    OpenAIRE

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2014-10-01

    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).

  4. LINKING PROJECTS TO BUSINESS STRATEGY THROUGH PROJECT PORTFOLIO MANAGEMENT

    Directory of Open Access Journals (Sweden)

    A.J. Buys

    2012-01-01

    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

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

    African Journals Online (AJOL)

    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 ...

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

    NARCIS (Netherlands)

    H.M.S. Dietz (Bart)

    2009-01-01

    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

  7. Toward effective strategies for energy efficient network management

    NARCIS (Netherlands)

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

    2010-01-01

    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

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

    Science.gov (United States)

    Lisa K. Crone; Richard W. Haynes

    2001-01-01

    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...

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

    Science.gov (United States)

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

    1990-06-01

    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.

  10. A strategy for optimizing item-pool management

    NARCIS (Netherlands)

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

    2006-01-01

    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

  11. Strategies for job creation through national forest management

    Science.gov (United States)

    Susan Charnley

    2014-01-01

    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...

  12. A Candidate Army Energy and Water Management Strategy

    National Research Council Canada - National Science Library

    Fournier, Donald F; Westervelt, Eileen T

    2004-01-01

    .... 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.

  13. Effective Strategies for Enhancing Waste Management at University Campuses

    Science.gov (United States)

    Ebrahimi, Kianoosh; North, Leslie A.

    2017-01-01

    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…

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

    Science.gov (United States)

    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.

  15. Data management strategies for nuclear training

    International Nuclear Information System (INIS)

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

    1993-01-01

    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

  16. Customer Relationship Management : Strategy Process Evaluation

    OpenAIRE

    Din, Fazal

    2014-01-01

    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...

  17. Epilepsy during pregnancy: focus on management strategies

    Directory of Open Access Journals (Sweden)

    Borgelt LM

    2016-09-01

    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

  18. Strategy plan for management of Hanford tank wastes

    International Nuclear Information System (INIS)

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

    1993-01-01

    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

  19. PATTERNS FOR IDENTIFYING APPROPRIATE KNOWLEDGE MANAGEMENT STRATEGIES IN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Khadijeh Salmani

    2012-06-01

    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.

  20. Anchorage strategies in geriatric hip fracture management

    Directory of Open Access Journals (Sweden)

    Knobe Matthias

    2016-12-01

    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.

  1. Effective managed care marketing strategies for evolving markets.

    Science.gov (United States)

    Conlon, M K

    1997-11-01

    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.

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

    International Nuclear Information System (INIS)

    2012-01-01

    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.

  3. Integrated management system implementation strategy for PUSPATI TRIGA Reactor

    International Nuclear Information System (INIS)

    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

    2012-01-01

    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)

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

    Science.gov (United States)

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

    2008-12-01

    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.

  5. 20 strategies for marketing your managed care plan.

    Science.gov (United States)

    Firshein, J

    1996-01-01

    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.

  6. The development and implementation of a waste management strategy

    International Nuclear Information System (INIS)

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

    1999-01-01

    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)

  7. GLOBAL TEAM MANAGEMENT: AN ESSENTIAL COMPONENT OF FIRMS’ INNOVATION STRATEGY

    Directory of Open Access Journals (Sweden)

    AZİM ÖZTÜRK

    2013-05-01

    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.

  8. Risk management: a proposal for communication strategies

    Directory of Open Access Journals (Sweden)

    Michele Fontana

    2012-07-01

    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.

  9. Non-pharmacological nurse-led interventions to manage anxiety in patients with advanced cancer : A systematic literature review

    NARCIS (Netherlands)

    Zweers, D; de Graaf, E; Teunissen, SCCM

    Background Anxiety is a common symptom in patients with advanced cancer. Although pharmacological and psychosocial interventions are recommended, it remains unclear which role nurses can play in supporting patients with anxiety. Objective The objective was to provide an inventory of

  10. ''In-house'' pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation

    International Nuclear Information System (INIS)

    Maffei, Erica; Tedeschi, Carlo; Seitun, Sara; Ruffini, Livia; Aldrovandi, Annachiara; Palumbo, Alessandro A.; Martini, Chiara; Tarantini, Giuseppe; Weustink, Annick C.; Meijboom, Willem B.; Mollet, Nico R.; Krestin, Gabriel P.; Feyter, Pim J. de; Cademartiri, Filippo

    2009-01-01

    We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CA we enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p < 0.01). Group 4 showed the best (-16 ± 8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p < 0.05). Average time required for preparation was 44 ± 25 min. Groups 4 and 5 showed the most effective timing (8 ± 9 min and 8 ± 8 min, respectively; p < 0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers. (orig.)

  11. ''In-house'' pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation

    Energy Technology Data Exchange (ETDEWEB)

    Maffei, Erica; Tedeschi, Carlo; Seitun, Sara; Ruffini, Livia; Aldrovandi, Annachiara [Azienda Ospedaliero - Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Palumbo, Alessandro A.; Martini, Chiara [Azienda Ospedaliero - Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Tarantini, Giuseppe [Azienda Ospedaliero - Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); University of Padua, Department of Cardiology, Padua (Italy); Weustink, Annick C.; Meijboom, Willem B.; Mollet, Nico R.; Krestin, Gabriel P.; Feyter, Pim J. de [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Cademartiri, Filippo [Azienda Ospedaliero - Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria - Parma, Department of Radiology c/o Piastra Tecnica - Piano 0, Parma (Italy)

    2009-12-15

    We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CA we enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p < 0.01). Group 4 showed the best (-16 {+-} 8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p < 0.05). Average time required for preparation was 44 {+-} 25 min. Groups 4 and 5 showed the most effective timing (8 {+-} 9 min and 8 {+-} 8 min, respectively; p < 0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers. (orig.)

  12. Patient empowerment--a strategy for pain management in endodontics.

    Science.gov (United States)

    Selden, H S

    1993-10-01

    In order to promote rapid resolution of symptoms associated with root canal treatment, a multifaceted program was implemented. One-visit endodontics was performed universally, antibiotics were prescribed when infection was detected within the root canal, and nonsteroidal anti-inflammatory drugs were widely used at the time of treatment. The centerpiece of the program was the integration of various behavioral strategies designed to strengthen the patient's inherent coping capacity. The combination of clinical, pharmacological, and psychological approaches was collectively called patient empowerment. Five hundred forty patients were asked to contact the office the day after treatment. Four hundred twenty (78%) called and 390 (93%) reported a reduction in symptoms. Twenty of the 30 (7%) who were not relieved within the first 24 h reported significant improvement 1 day later. No patients experienced a flare-up or a worsening of symptoms.

  13. Severe accident management. Optimized guidelines and strategies

    International Nuclear Information System (INIS)

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

    2014-01-01

    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

  14. Management of craniopharyngiomas: Role of conservative strategies

    Directory of Open Access Journals (Sweden)

    Shibu Pillai

    2013-01-01

    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.

  15. Dust limit management strategy in tokamaks

    International Nuclear Information System (INIS)

    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.

    2009-01-01

    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.

  16. Dust limit management strategy in tokamaks

    Science.gov (United States)

    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.

    2009-06-01

    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.

  17. Sustainability: orthopaedic surgery wait time management strategies.

    Science.gov (United States)

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

    2015-01-01

    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.

  18. Care management actions in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Marcelo Costa Fernandes

    2015-11-01

    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.

  19. Strategies to manage patients with dental anxiety and dental phobia: literature review

    Directory of Open Access Journals (Sweden)

    Appukuttan DP

    2016-03-01

    Full Text Available Deva Priya Appukuttan Department of Periodontics, Sri Ramakrishna Mission Dental College and Hospital, Chennai, India Abstract: Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy

  20. Selection of a management strategy for depleted uranium

    International Nuclear Information System (INIS)

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

    1995-01-01

    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)

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

    Science.gov (United States)

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

    2009-01-01

    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.

  2. Features of the Development Strategy Customer Relationship Management

    Directory of Open Access Journals (Sweden)

    I. M. Gurova

    2017-01-01

    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

  3. Reflex epilepsy: triggers and management strategies

    Directory of Open Access Journals (Sweden)

    Okudan ZV

    2018-01-01

    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

  4. Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia (FTD): A call for randomised controlled studies

    Science.gov (United States)

    O'Connor, Claire M.; Clemson, Lindy; da Silva, Thaís Bento Lima; Piguet, Olivier; Hodges, John R.; Mioshi, Eneida

    2013-01-01

    FTD is a unique condition which manifests with a range of behavioural symptoms, marked dysfunction in activities of daily living (ADL) and increased levels of carer burden as compared to carers of other dementias. No efficacious pharmacological interventions to treat FTD currently exist, and research on pharmacological symptom management is variable. The few studies on non-pharmacological interventions in FTD focus on either the carer or the patients' symptoms, and lack methodological rigour. This paper reviews and discusses current studies utilising non-pharmacological approaches, exposing the clear need for more rigorous methodologies to be applied in this field. Finally, a successful randomised controlled trial helped reduce behaviours of concern in dementia, and through implementing participation in tailored activities, the FTD-specific Tailored Activities Program (TAP) is presented. Crucially, this protocol has scope to target both the person with FTD and their carer. This paper highlights that studies in this area would help to elucidate the potential for using activities to reduce characteristic behaviours in FTD, improving quality of life and the caregiving experience in FTD. PMID:29213832

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

    Science.gov (United States)

    Fine, R P

    1998-11-01

    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.

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

    International Nuclear Information System (INIS)

    Sekimura, Naoto; Kanno, Masanori

    2008-01-01

    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.)

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

    International Nuclear Information System (INIS)

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

    1993-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Afshar Mirzaei-Aghsaghali

    2015-06-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    1993-09-01

    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.

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

    International Nuclear Information System (INIS)

    Haverkate, B.R.W.

    2002-01-01

    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)

  11. Comparison of pharmacological and nonpharmacological treatment strategies in promotion of infertility self-efficacy scale in infertile women: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hajar Pasha

    2013-06-01

    Full Text Available Background: The infertility is associated with psychological consequence including depression, and lack of self-efficacy. Objective: The aim of this study was to compare the pharmacological and no pharmacological strategies in promotion of self-efficacy of infertile women. Materials and Methods: A randomized controlled clinical trial was conducted on 89 infertile women who were recruited from Fatemeh Zahra Infertility and Reproductive Health Research Center and were randomized into three groups; cognitive behavioral therapy (CBT, antidepressant therapy with flouxetine 20 mg daily for 3 month, and a control group. All participants completed Infertility Self-efficacy Inventory (ISE and the Beck Depression Inventory (BDI at the beginning and end of the study. Results: The means ISE scores among the CBT, fluoxetine, and control groups at the beginning and end of the study were 6.1±1.6 vs. 7.2±0.9, 6.4±1.4 vs. 6.9±1.3 and 6.1±1.1 vs. 5.9±1.4 respectively. Both CBT and fluoxetine increased the mean of ISE scores more than control group after intervention (p<0.0001, p=0.033; respectively, but increase in the CBT group was significantly greater than flouxetine group. Finally, there was evidence of high infertility self-efficacy for women exposed to the intervention compared with those in the control group. Also, there was an improvement in depression. Both fluoxetine and CBT decreased significantly the mean of BDI scores more than the control group; decrease in the CBT group was significantly more than that in the fluoxetine group. Conclusion: CBT can serve as an effective psychosocial intervention for promoting self-efficacy of infertile women

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

    Directory of Open Access Journals (Sweden)

    Emanoil MUSCALU

    2013-07-01

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

  13. Strategies in the Surgical Management of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Leanne Harling

    2011-01-01

    Full Text Available Atrial fibrillation (AF is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.

  14. SECONDARY WASTE MANAGEMENT STRATEGY FOR EARLY LOW ACTIVITY WASTE TREATMENT

    Energy Technology Data Exchange (ETDEWEB)

    TW, CRAWFORD

    2008-07-17

    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.

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

    Science.gov (United States)

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

    2015-02-01

    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.

  16. Selection of a management strategy for depleted uranium hexafluoride

    International Nuclear Information System (INIS)

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

    1995-01-01

    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

  17. The Role of Knowledge Management in E-Business Strategy

    Directory of Open Access Journals (Sweden)

    Ali Khalouei

    2014-09-01

    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.

  18. Reflection of Strategic Thinking in Activating Organizational Conflict Management Strategies

    Directory of Open Access Journals (Sweden)

    Ahmed Abed Mahmood Al-Janabi

    2018-05-01

    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.

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

    DEFF Research Database (Denmark)

    Kolko, Miriam

    2015-01-01

    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...

  20. Managing scientists leadership strategies in research and development

    CERN Document Server

    Sapienza, Alice M

    1995-01-01

    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...

  1. Improving nuclear plant management effectiveness: Aligning strategy, systems, and people

    International Nuclear Information System (INIS)

    Price, K.F.

    1991-01-01

    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

  2. Roles of managers in academic health centers: strategies for the managed care environment.

    Science.gov (United States)

    Guo, Kristina L

    2002-03-01

    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.

  3. A systematic critical appraisal for non-pharmacological management of osteoarthritis using the appraisal of guidelines research and evaluation II instrument.

    Science.gov (United States)

    Brosseau, Lucie; Rahman, Prinon; Toupin-April, Karine; Poitras, Stéphane; King, Judy; De Angelis, Gino; Loew, Laurianne; Casimiro, Lynn; Paterson, Gail; McEwan, Jessica

    2014-01-01

    Clinical practice CPGs (CPGs) have been developed to summarize evidence related to the management of osteoarthritis (OA). CPGs facilitate uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of the present review were: 1) to assess the quality of the CPGs on non-pharmacological management of OA; using a standardized and validated instrument--the Appraisal of Guidelines Research and Evaluation (AGREE II) tool--by three pairs of trained appraisers; and 2) to summarize the recommendations based on only high-quality existing CPGs. Scientific literature databases from 2001 to 2013 were systematically searched for the state of evidence, with 17 CPGs for OA being identified. Most CPGs effectively addressed only a minority of AGREE II domains. Scope and purpose was effectively addressed in 10 CPGs on the management of OA, stakeholder involvement in 12 CPGs, rigour of development in 10 CPGs, clarity/presentation in 17 CPGs, editorial independence in 2 CPGs, and applicability in none of the OA CPGs. The overall quality of the included CPGs, according to the 7-point AGREE II scoring system, is 4.8 ± 0.41 for OA. Therapeutic exercises, patient education, transcutaneous electrical nerve stimulation, acupuncture, orthoses and insoles, heat and cryotherapy, patellar tapping, and weight control are commonly recommended for the non-pharmacological management of OA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs, although interventions addressed varied. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. For CPGs to be standardized uniform creators should use the AGREE II criteria when developing CPGs. Innovative and effective methods of CPG implementation to users are needed to ultimately enhance the quality of life of arthritic individuals.

  4. Efficiency of Management and Marketing Strategies within The Dental Office

    OpenAIRE

    Oprea Valentin BUSU; Elena Cristina ANDREI

    2017-01-01

    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/...

  5. Risk management strategies by Australian farmers: two case studies

    OpenAIRE

    Nguyen, Nam C.; Wegener, Malcolm K.; Russell, Iean W.; Cameron, Donald; Coventry, David; Cooper, Ian M.

    2007-01-01

    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...

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

    Science.gov (United States)

    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

    2017-03-01

    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.

  7. Strategy-oriented display concept to assist severe accident management

    International Nuclear Information System (INIS)

    Jeong, Kwangsub; Ha, Jaejoo

    2000-01-01

    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.

    Science.gov (United States)

    Başoğul, Ceyda; Özgür, Gönül

    2016-09-01

    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.

    Science.gov (United States)

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

    2000-01-01

    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

    Science.gov (United States)

    Li, Ji-Zu; Zhang, Ya-Ping; Liu, Xiao-Guang; Liu, Yao-Long; Wang, Tian-Ri

    2017-01-01

    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. Human pharmacology for addiction medicine: From evidence to clinical recommendations.

    Science.gov (United States)

    Quednow, Boris B; Herdener, Marcus

    2016-01-01

    Substance use disorders (SUD) are complex and often chronic diseases with negative health outcomes and social consequences. Pharmacological treatment options for SUD can be separated in medications for (i) intoxication, (ii) withdrawal, and (iii) reduction of use together with relapse prevention. This chapter will focus on approved or clinically established pharmacological strategies suited to manage symptoms of withdrawal, and to reduce substance use or to promote abstinence. Hereby SUD involving alcohol, nicotine, stimulants, and opioids are primarily discussed as these substances are considered most harmful for both the individual and the society. Moreover, the pharmacotherapy of SUD related to the use of cannabis, benzodiazepines, and gamma-hydroxybutyrate is also briefly reviewed. Since most approved pharmacological treatment options show only moderate effect sizes especially in the long term, the development of new treatment strategies including new drugs, new combinations of available compounds, and biomarkers for response prediction is still warranted. © 2016 Elsevier B.V. All rights reserved.

  12. [Pharmacological treatment].

    Science.gov (United States)

    Arriola Manchola, Enrique; Álaba Trueba, Javier

    2016-06-01

    Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made. Copyright © 2016 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. An evaluation of management strategies for Atlantic tuna stocks

    Directory of Open Access Journals (Sweden)

    L. T. Kell

    2003-04-01

    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.

  14. How Managers' everyday decisions create or destroy your company's strategy.

    Science.gov (United States)

    Bower, Joseph L; Gilbert, Clark G

    2007-02-01

    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.

  15. Generating optimized stochastic power management strategies for electric car components

    Energy Technology Data Exchange (ETDEWEB)

    Fruth, Matthias [TraceTronic GmbH, Dresden (Germany); Bastian, Steve [Technische Univ. Dresden (Germany)

    2012-11-01

    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.)

  16. Risk management strategies utilized by small scale poultry farmers ...

    African Journals Online (AJOL)

    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 ...

  17. Coping Strategies for Managing Acculturative Stress among Asian International Students

    Science.gov (United States)

    Ra, Young-An; Trusty, Jerry

    2015-01-01

    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…

  18. Rule-based energy management strategies for hybrid vehicles

    NARCIS (Netherlands)

    Hofman, T.; Druten, van R.M.; Serrarens, A.F.A.; Steinbuch, M.

    2007-01-01

    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

  19. Managing Work and Family: Do Control Strategies Help?

    Science.gov (United States)

    Versey, H. Shellae

    2015-01-01

    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…

  20. San Francisco Bay Long Term Management Strategy for Dredging

    Science.gov (United States)

    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.

  1. How differential management strategies affect Ips typographus L. dispersal

    Czech Academy of Sciences Publication Activity Database

    Montano, V.; Bertheau, C.; Doležal, Petr; Krumböck, S.; Okrouhlík, Jan; Stauffer, CH.; Moodley, Y.

    2016-01-01

    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 http://www.sciencedirect.com/science/article/pii/S0378112715005940

  2. Strategies to improve clinical management of community-acquired pneumonia

    NARCIS (Netherlands)

    Meijvis, S.C.A.

    2012-01-01

    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

  3. GFC-Robust Risk Management Strategies under the Basel Accord

    NARCIS (Netherlands)

    M.J. McAleer (Michael); J.A. Jiménez-Martín (Juan-Ángel); T. Pérez-Amaral (Teodosio)

    2010-01-01

    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

  4. Gender Differences in Strategy and Human Resource Management

    NARCIS (Netherlands)

    Verheul, I.; Risseeuw, P.A.; Bartelse, G.

    2002-01-01

    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

  5. University Students' Views of Obesity and Weight Management Strategies

    Science.gov (United States)

    Okonkwo, Ononuju; While, Alison

    2010-01-01

    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…

  6. Maintenance management sourcing strategies and the condition of ...

    African Journals Online (AJOL)

    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 ...

  7. Clothing for Elderly Persons: Management and Caring Strategies ...

    African Journals Online (AJOL)

    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.

  8. Coping strategies for managing occupational stress for improved ...

    African Journals Online (AJOL)

    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 ...

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

    NARCIS (Netherlands)

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

    2010-01-01

    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

  10. National strategies in managing radioactive wastes in the Philippines

    International Nuclear Information System (INIS)

    Cabalfin, Edilberto A.

    2001-01-01

    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)

  11. MANAGEMENT OF ECONOMIC AND FINANCIAL STRATEGY INDUSTRIAL CORPORATION

    Directory of Open Access Journals (Sweden)

    K. B. Dobrova

    2010-01-01

    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.

  12. Need for a new skin cancer management strategy

    NARCIS (Netherlands)

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

    2010-01-01

    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

  13. Should Cost: A Strategy for Managing Military Systems Money

    Science.gov (United States)

    2016-03-01

    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

  14. Use of Participatory Forest Management as a Strategy for ...

    African Journals Online (AJOL)

    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 ...

  15. Board and Senior Management Alignment on School Strategy

    Science.gov (United States)

    Sarros, James C.; Sarros, Anne M.; Cooper, Brian K.; Santora, Joseph C.; Baker, Robin

    2016-01-01

    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…

  16. Strategies for Talent Management: Greater Philadelphia Companies in Action

    Science.gov (United States)

    Council for Adult and Experiential Learning (NJ1), 2008

    2008-01-01

    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…

  17. Efficiency of Management and Marketing Strategies within The Dental Office

    Directory of Open Access Journals (Sweden)

    Oprea Valentin BUSU

    2017-12-01

    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.

  18. Accident management strategy in Sweden - implementation and verification

    International Nuclear Information System (INIS)

    Loewenhielm, Gustaf; Engqvist, Alf; Espefaelt, Ralf

    1994-01-01

    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.))

  19. Radwaste Management in Small Nuclear Country - National Policy and Strategy

    International Nuclear Information System (INIS)

    Zagar, Tomaz

    2014-01-01

    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)

  20. Program strategies for maintenance management, organization and planning

    International Nuclear Information System (INIS)

    Czegeny, J.I.

    2003-01-01

    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)

  1. Current Management Strategy for Active Surveillance in Prostate Cancer.

    Science.gov (United States)

    Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C

    2017-02-01

    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.

  2. Formation of strategy and policy of banking credit operations management

    Directory of Open Access Journals (Sweden)

    O.V. Lysenok

    2016-03-01

    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.

  3. Did the introduction of a prospective payment system for nursing home stays reduce the likelihood of pharmacological management of secondary ischaemic stroke?

    Science.gov (United States)

    Lapane, Kate L; Hughes, Carmel M

    2006-01-01

    Since 1998, a prospective payment system (PPS) for Medicare services provided by nursing homes in the US has been in operation. Concerns have been expressed that the PPS may affect the quality of care delivered to residents. This study evaluates the impact of the PPS on pharmacological secondary ischaemic stroke prevention in nursing homes. The nationally mandated Minimum Data Set and Online Survey Certification and Automated Record data system from 1997 and 2000 for four states were used. We conducted a quasi-experimental study comparing the pharmacological treatment rates for secondary stroke prevention in the pre-PPS period (1997) with those in the post-PPS period (2000) in residents who experienced an ischaemic stroke within 6 months (n1997 = 5008; n2000 = 5243) of living in nursing facilities (n1997 = 1226; n2000 = 1092) in Kansas, Maine, Mississippi or Ohio. The sample was stratified according to recommendations for use of warfarin. Logistic regression models adjusting for clustering effects of residents residing in homes using generalised estimating equations provided estimates of the PPS effect on use of antiplatelets and the use of warfarin. The unadjusted proportion of use of pharmacological agents for the secondary prevention of stroke was similar for warfarin in both time periods and increased for antiplatelets in 2000. Relative to the pre-PPS era, the likelihood of use of antiplatelets increased in the post-PPS era (adjusted odds ratio 1.26; 95% CI 1.15, 1.38); there was no effect on the use of warfarin. Although the lack of a PPS effect on pharmacological management of secondary ischaemic stroke is encouraging, there is still room for improvement in overall stroke management.

  4. Forty project management strategies for the medical practice staff.

    Science.gov (United States)

    Hills, Laura Sachs

    2010-01-01

    Most every medical practice will embark at one time or another on a large and complex new project. The practice may, for instance, undertake a project in office construction or renovation, practice expansion, new technology, or a new large-scale event. The medical practice staff may find itself creating the project plan, overseeing its execution, and working through the plan day to day until its completion. In short, the staff may find itself responsible for project management. This article contains 40 specific, easy-to-implement project management strategies medical practice employees can use to manage both the large and small projects they undertake on behalf of the practice. It suggests effective project management strategies the staff can use before the onset of a new project as well as strategies to help define the project, to deliver the project, and to close and review the project. This article also describes five reasons medical practices often fail at project management and suggests more effective approaches that will ensure that the projects the medical practice undertakes are completed well, on time, and within budget.

  5. Comparison of Conflict Management Strategies of Physical Education Office Managers Based on some Demographic Characteristics

    OpenAIRE

    Fatemeh Ghorbanalizadeh Ghaziani; Mohsen Moadi; Siavash Khodaparast Sareshkeh

    2013-01-01

    The purpose of study was comparison of conflict management strategies of physical education office managers based on their some demographic characteristics. All of managers of physical education office of Mazandaran (n = 15) and Guilan (n = 16) province and their assistant [(n = 15) and (n =16) respectively] response to Putnam and Wilson’s “organizational communication conflict instrument (OCCI)”.Analysis showed that Mazandaran’s and Guilan’s managers and their assistant hadn’t differences to...

  6. A Water Demand Management Strategy For The Namibian Tourism Sector

    Science.gov (United States)

    Schachtschneider, K.; Winter, K.

    The arid conditions of Namibia are forcing its decision-makers to resort to new wa- ter resource management approaches, including Water Demand Management (WDM). When Namibia achieved its independence from South Africa 1990, a new opportunity arose to rewrite certain restrictive laws and policies in order to bring about redress, development and transformation. The new Water Policy is one example in which the mindset is changed from a supply to a demand oriented water management ap- proach. Legal support for WDM within the new Water Act is a critical component that will support the implementation of WDM in all economic sectors, such as agri- culture, mining and tourism. It is argued that an appropriate WDM strategy should be designed specifically for each sector, once the typical water use patterns in a sec- tor are understood and key water resource managers at all levels are identified. The Namibian tourism sector is geographically dispersed and control over its operations is compounded by the fact that it is frequently located in extremely remote areas that are arid and ecologically sensitive. In general, WDM is rarely practised, because it is not yet supported by law and there are currently no institutional arrangements to con- trol water use in this geographically dispersed industrial sector through which WDM could be enforced either through metering and/or payments. Managers of tourist en- terprises undertake most of the water management themselves, and have been identi- fied as being crucial to the implementation of WDM strategies. A study of six tourist facilities determined the willingness and motivation of these managers to undertake various WDM initiatives. The study identified three factors which appear to influence the actions of managers, namely external controls, economics and company ethics. It is recommended that a tourism sector WDM strategy should focus on these three factors in order to transform the WDM aims and objectives on the policy level into

  7. Strategies for knowledge management in law firms in Botswana

    Directory of Open Access Journals (Sweden)

    M.C. Fombad

    2009-02-01

    Full Text Available This article formulates a route map on how law firms in Botswana may utilise knowledge management to enhance their competitive edge amidst the changing legal environment. It draws from the multiple definitions and perspectives of knowledge management, several frameworks and models together with the empirical findings to recommend a strategy for knowledge management in law firms in Botswana. It underscores the fact that knowledge management is becoming an imperative for the survival of law firms as knowledge intensive organisations. Law firms in Botswana can no longer afford to rely on the traditional methods of managing knowledge because there is a need for the 'best minds' and the best knowledge in their area of practice. It is recommended that lawyers should be proactive, adaptive, innovative, effective and competitive in the provision of outstanding, cost-efficient and effective services to clients. Most previous studies in this area have been carried out in developed countries with large law firms.

  8. Third-Party Incentive Strategies and Conflict Management in Africa

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2016-01-01

    Dr. Nikolas Emmanuel's examines the use of an incentives approach in managing intrastate conflict in Africa because in many cases, risks and costs make applications of hard power alone unfeasible. Furthermore, simply ignoring episodes of civil conflict in the hope that they will "burn themselves...... out"� does not appear to be a viable alternative. That said, both noncoercive and coercive incentive strategies exist and have been deployed by third parties in a variety of conflict situations. Such incentives seek to manage conflict by encouraging political bargaining. The clear intention...... parties can help manage conflicts. Second, it offers a typology of the available incentive strategies, classifying them along noncoercive and coercive lines. Thus, the article outlines the possibilities offered by an incentives approach, focusing on examples drawn from recent African cases....

  9. Strategy for managing mixed waste at a plant site

    International Nuclear Information System (INIS)

    Fentiman, A.

    1991-01-01

    No waste disposal site is currently accepting mixed waste, but facilities across the country continue to generate it. The waste manager at each site is faced with two problems: how to manage the mixed waste already on-site and how to minimize the amount of new waste generated. A strategy has been developed to address each problem. A key element of the strategy is a building-by-building survey of the site. The survey provides information on how and where mixed waste is generated and stored. This paper describes a method for planning and conducting a site-wide mixed-waste survey. It then outlines approaches to managing existing mixed waste and to minimizing mixed-waste generation using information from the survey

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

    Science.gov (United States)

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

    2010-02-01

    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 instruction cards, treatment plans, checklists and software were developed following an argument-based comprehensive "central route." These tools were used during on-farm study group meetings for farmers organized by veterinarians and also during individual veterinarian-farmer interactions. The second strategy aimed at adopting a single management practice to increase the use of milking gloves during milking. This approach followed a straightforward "peripheral" route that used implicit persuasion techniques. Results of an online survey of 374 Dutch dairy farmers showed that most farmers were able and willing to use the educational management tools to increase udder health on their farms. They evaluated the tools positively regardless of the mastitis problems on their farms. This seems to indicate that the central route of communication is most effective when farmers are motivated to work on udder health in general. Results of repeated random telephone surveys before, during, and after the campaign on the use of milking gloves showed that the use of gloves increased from 20.9 to 42.0% of the respondents. Respondents' opinions about milking gloves also changed favorably, indicating that a relatively short peripheral campaign on a single action can have a sustained effect on farmers' behavior. Both communication strategies seem to be potentially successful in disseminating knowledge to a specific target group of farmers and in changing that group's behavior. However, to reach as many farmers as possible, the strategies should be combined. When optimizing these strategies, both the farmers' motivation to work on udder health and the aim of the campaign should be considered

  11. Management Strategies in Basic Education and Participation of Parents

    Directory of Open Access Journals (Sweden)

    Johel Furguerle-Rangel

    2016-05-01

    Full Text Available In the educational process it is necessary to use management paradigms and active participation of parents. The objective was to determine the use of management strategies by the director of basic education and participation of parents in the educational process. It is a descriptive, transversal and field study, whose instrument was a questionnaire of 26 closed-questions.   The sample comprised 16 directors, 52 teachers and 62 parents. For most managers and faculty the technique of brainstorming, involvement in decision-making, continues knowledge management and radical change are crucial in the educational process of children.   But mothers and fathers believe that managerial groups do not use strategies properly except for reengineering.   The mother and fathers are mainly involved in education management but not in the learning process. It is recommended the deepening of policy management training teaching force, through continuous training provided by the government and the promotion of family participation in the teaching-learning process of children.

  12. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017.

    Science.gov (United States)

    Fan, Arthur Yin; Miller, David W; Bolash, Bonnie; Bauer, Matthew; McDonald, John; Faggert, Sarah; He, Hongjian; Li, Yong Ming; Matecki, Amy; Camardella, Lindy; Koppelman, Mel Hopper; Stone, Jennifer A M; Meade, Lindsay; Pang, John

    2017-11-01

    The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.

  13. Strategy for management of investigation-derived waste

    International Nuclear Information System (INIS)

    Russell, Laura E.; Hopkins, Gregory G.; Smith, Edward H.; Innis, Pamela S.; Stewart, Robert K.

    1992-01-01

    Large quantities of wastes containing hazardous and/or radiological constituents are being generated as part of the field investigations at the U.S. Department of Energy's Hanford Site in Richland, Washington. A problem exists with the integration of regulations under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, the Resource Conservation and Recovery Act of 1976, the Washington Hazardous Waste Management Act of 1976, and the Washington Administrative Code Waste management criteria under these regulations need to be consolidated into a single, acceptable management approach that can reasonably be applied to the Hanford Site cleanup effort. In response to this need, a Technical Task Team of representatives from the Washington Department of Ecology, U.S. Environmental Protection Agency, U.S. Department of Energy, and Westinghouse Hanford Company was organized. As a result of nearly two years of negotiations the Technical Task Team produced a specific waste management plan which is presented in the paper as the Strategy for Management of Investigation-Derived Waste. The paper outlines the strategy for handling and storing investigation-derived waste within a given operable unit until a waste unit-specific Record of Decision can be issued. To date, the Strategy for Management of Investigation-Derived Waste has not been finalized. However, formal approval by the U.S. Environmental Protection Agency is expected soon and will result in implementation of the management strategy at waste sites in which they have been identified as the lead regulatory agency. Negotiations with the Washington State Department of Ecology are ongoing. At the time of this writing, it is uncertain what the Washington State Department of Ecology's position will be regarding investigation-derived waste. Both the U.S. Environmental Protection Agency and the U.S. Department of Energy believe the Strategy for Management of Investigation-Derived Waste to be

  14. Management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures.

    Science.gov (United States)

    Saleh, Anas; Hegde, Vishal V; Potty, Anish G; Schneider, Robert; Cornell, Charles N; Lane, Joseph M

    2012-07-01

    Long-term bisphosphonate use has often been associated with atypical femoral fractures. These fractures evolve from incomplete femoral fractures. A previous study demonstrated that the presence of a radiolucent line in an incomplete fracture can indicate a high risk of progression to complete fracture. The aim of this study is to present a management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures. Specific study questions include the following: (1) Is there a difference in the prognosis of these fractures based on the presence or absence of a radiolucent fracture line? (2) Can treatment with teriparatide assist in clinical/radiographic healing of these incomplete fractures? (3) Is there a characteristic biochemical profile in these patients? We retrospectively examined all femur radiographs ordered by the metabolic bone disease service at our hospital between July 1, 2006 and July 1, 2011 and identified 10 patients with a total of 14 incomplete fractures. Nine patients received bisphosphonates for a mean duration of 10 ± 5 years (range, 4-17). The mean follow-up since the time of diagnosis was 20 ± 11 months (range, 6-36 months). Five fractures did not have a radiolucent fracture line and were treated conservatively with partial weight-bearing restrictions and pharmacologic therapy. All five of these fractures healed with conservative management. Nine fractures had a radiolucent fracture line, and only two of these were treated successfully with conservative management including teriparatide. Six of the eight patients with a radiolucent line elected for surgical prophylaxis after 3 months of conservative management, whereas one patient underwent surgical prophylaxis without a trial of conservative management. Regarding the biochemical profiles, bone turnover markers for our patient cohort were in the lower quartile. Fractures without a radiolucent line appear to respond to conservative management and not

  15. Managing burned landscapes: Evaluating future management strategies for resilient forests under a warming climate

    Science.gov (United States)

    K. L. Shive; P. Z. Fule; C. H. Sieg; B. A. Strom; M. E. Hunter

    2014-01-01

    Climate change effects on forested ecosystems worldwide include increases in drought-related mortality, changes to disturbance regimes and shifts in species distributions. Such climate-induced changes will alter the outcomes of current management strategies, complicating the selection of appropriate strategies to promote forest resilience. We modelled forest growth in...

  16. Relationship Between Strategy Shaping and Management Control Systems

    Directory of Open Access Journals (Sweden)

    Marcia Athayde Moreira

    2017-04-01

    Full Text Available This research analyzed the interactions between strategy shaping and management control systems, having as parameter of analysis the system of levers of control recommended by Simons (1995. A multiple case study was carried out of two companies in the construction sector in Brazil. It was found that these companies use generic niche strategies to sell the properties they have built. One of these companies uses long-term planning while the other is guided by short-term perspectives and perceptions. Both companies employ various formal control tools. It was noted, however, that some of these tools exist for the purpose of meeting the requirements of standards and audits established by certifying bodies and are not being used as tools for decision making. It was thus concluded that the relationship between managerial controls and the shaping of strategy in these organizations occurs in a passive way, with the management control systems serving as guarantors of the accomplishment of organizational strategies and goals, but not being used effectively to identify opportunities or as a source for shaping new strategies.

  17. Identification and assessment of containment and release management strategies

    International Nuclear Information System (INIS)

    Lehner, J.R.; Lin, C.C.; Neogy, P.

    1990-01-01

    Brookhaven National Laboratory, under the auspices of the U.S. Nuclear Regulatory Commission, is investigating accident management strategies which could help preserve containment integrity or minimize releases during a severe accident. The objective is to make use of existing plant systems and equipment in innovative ways to reduce the likelihood of containment failure or to mitigate the release of fission products to the environment if failure cannot be prevented. Many of these strategies would be implemented during the later stages of a severe accident (i.e., after vessel breach) and sizeable uncertainties exist regarding some of the phenomena involved. A majority of the strategies identified go well beyond existing procedures and often depend on the specific containment type. Strategies for all of the five different containments used in the U.S. are being considered: BWR Mark I, Mark II, and Mark III, as well as PWR ice condenser and large dry containments. Accident management strategies related to the in-vessel phase of a severe core melt accident are being dealt with under another NRC program. For each containment type the most likely challenges are identified and existing emergency guidelines and procedures are reviewed as to how they address these challenges

  18. Assessment of Solid Waste Management Strategies in Camarines Norte, Philippines

    Directory of Open Access Journals (Sweden)

    Maria Cristina C. Azuelo

    2016-11-01

    Full Text Available The Ecological Solid Waste Management Act of 2000 or RA 9003 mandates the local government units to take initiatives in managing their daunting problems on ecological solid waste disposal. Consequently, compliance of Camarines Norte, Philippines on this mandate needs assessment to determine the existing solid waste management (SWM strategies, the effectiveness and the possibility of adoption in each municipality. This study utilized the descriptive method using questionnaire as the main tool supplemented by interview. Results showed that the existing SWM strategies with the highest percentages of existence in the twelve (12 municipalities were provision of number of trucks in transporting solid wastes and knowledge on waste segregation conducted at every household/establishment. Varying levels were observed. However, high level of effectiveness is still required for significant impact, seeing that from the six areas assessed only four municipalities were identified to have more and highly effective SWM strategies. Generally, only availability of technology for composting was considered more effective and can be adopted in all municipalities. Better solid waste management may be fully attained through the involvement, political will and commitment of the implementers in the implementation of politically passed resolutions and undertaking of their initiatives that will stimulate active participation of the community. All these measures may bring change in health and environment in the province.

  19. A framework for assessing severe accident management strategies

    International Nuclear Information System (INIS)

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

    1991-01-01

    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. Together with risk management (changes in plant operation and/or addition of equipment) and emergency planning (off-site actions), accident management provides an extension of the defense-in-depth safety philosophy for severe accidents. A significant number of probabilistic safety assessments (PSA) have been completed which yield the principal plant vulnerabilities. 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 uncertainty in key phenomena, uncertainty in operator behavior, uncertainty in system availability and behavior, and uncertainty in available information (i.e., instrumentation). The objective of this project is to develop a methodology for assessing severe accident management strategies given the key uncertainties mentioned above. Based on Decision Trees and Influence Diagrams, the methodology is currently being applied to two case studies: cavity flooding in a PWR to prevent vessel penetration or failure, and drywell flooding in a BWR to prevent containment failure

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

    International Nuclear Information System (INIS)

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

    1992-01-01

    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. Together with risk management (changes in plant operation and/or addition of equipment) and emergency planning (off-site actions), accident management provides an extension of the defense-in-depth safety philosophy for severe accidents. A significant number of probabilistic safety assessments (PSA) have been completed which yield the principal plant vulnerabilities. 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 uncertainty in key phenomena, uncertainty in operator behavior, uncertainty in system availability and behavior, and uncertainty in available information (i.e., instrumentation). The objective of this project is to develop a methodology for assessing severe accident management strategies given the key uncertainties mentioned above. Based on decision trees and influence diagrams, the methodology is currently being applied to two case studies: cavity flooding in a pressurized water reactor to prevent vessel penetration or failure, and drywell flooding in a boiling water reactor to prevent containment failure

  1. Strategies for risk management using the paper markets

    International Nuclear Information System (INIS)

    Annesley, M.

    1992-01-01

    This paper briefly describes the significant milestones in the evolution of the oil markets, with emphasis on the reasons for the changing structures of the markets, and the roles of different types of participant. After explaining the current structure of the oil markets - futures - forwards - options and derivatives the paper then explains some basic strategies. Finally some of the favourite strategies of refiners, producers and end users will be explored. Some cautionary comments on deal tracking, control systems and other associated risk management requirements will round off this paper. (author)

  2. Managerial Stress Management as an Asset in People Management Being a Marketing Strategy Element

    Directory of Open Access Journals (Sweden)

    Branislav Radnović

    2013-07-01

    Full Text Available Any service organization operating under turbulent market conditions must have a successful marketing strategy. A successful marketing strategy implies proper management of all elements within a marketing mix: service package, price, distribution channels, promotion, service process, service ambience and people. People, i.e. primarily the employed within an organization are one of the elements that must be appropriately considered when drawing up and implementing a marketing strategy. Proper personnel management must nowadays include good management of managerial stress. Adequate managerial stress management is preconditioned by successful identification of sources of managerial stress. The aim of this paper is to present the importance of proper and timely identification of sources of managerial stress. The paper demonstrates the carried out scientific research based on a method that is universal for all types of organizations, regardless of their type and activity, in order to precisely identify the sources of managerial stress and define its proper management, as an asset in people management, which is an element of marketing strategy. The research was conducted using a survey, sampling 100 employees in 13 organizations throughout Serbia. Survey results indicated that the most important sources of managerial stress are: participation in decision-making, selection process, earnings, and time and deadlines pressure. Therefore, recommendations are provided for directing identified sources of managerial stress towards successful management of people as an element of marketing strategy.

  3. A Scheme for Evaluating Feral Horse Management Strategies

    Directory of Open Access Journals (Sweden)

    L. L. Eberhardt

    2012-01-01

    Full Text Available Context. Feral horses are an increasing problem in many countries and are popular with the public, making management difficult. Aims. To develop a scheme useful in planning management strategies. Methods. A model is developed and applied to four different feral horse herds, three of which have been quite accurately counted over the years. Key Results. The selected model has been tested on a variety of data sets, with emphasis on the four sets of feral horse data. An alternative, nonparametric model is used to check the selected parametric approach. Conclusions. A density-dependent response was observed in all 4 herds, even though only 8 observations were available in each case. Consistency in the model fits suggests that small starting herds can be used to test various management techniques. Implications. Management methods can be tested on actual, confined populations.

  4. Leadership Strategies of Performance Measures Impacts in Public Sector Management: A National Content Analysis.

    Science.gov (United States)

    Kubala, James Joseph

    A quantitative and qualitative study examined three leadership strategies found in performance-based management (human resource, scientific management and political strategies used in public sector management); a framework by which performance measurement (PM) supports leadership strategies; and how the strategies impact PM. It examined leadership…

  5. Identification and assessment of containment and release management strategies

    International Nuclear Information System (INIS)

    Lehner, J.R.; Lin, C.C.; Neogy, P.

    1993-01-01

    Brookhaven National Laboratory, under the auspices of the U.S. Nuclear Regulatory Commission, is investigating accident management strategies which could help preserve containment integrity or minimize the release of radioactivity during a severe accident in a nuclear reactor. The objective is to make use of existing plant systems and equipment in innovative ways to reduce the likelihood of containment failure or to mitigate the release of fission products to the environment if failure cannot be prevented. Many of these strategies would be implemented during the later stages of a severe accident, i.e. after the molten core penetrates the reactor vessel. Significant uncertainties exist regarding some of the phenomena involved with this phase of a severe accident. The identification and assessment process for containment and release strategies is described, and some insights derived from its application to a BWR Mark I plant are presented. A station blackout accident for this kind of plant is considered. The challenges encountered are identified and existing emergency guidelines are reviewed, where needed and when possible, new strategies are devised. The feasibility and effectiveness of these new strategies are assessed, making due allowances for the complicated phenomena and associated uncertainties involved. Both beneficial and adverse effects of the suggested strategies are considered. (orig.)

  6. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies

    Science.gov (United States)

    Scruggs, Caroline E.; Van Buren, Harry J.

    2014-01-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. PMID:27471326

  7. Forest management strategies for reducing carbon emissions, the French case

    Science.gov (United States)

    Valade, Aude; Luyssaert, Sebastiaan; Bellassen, Valentin; Vallet, Patrick; Martin, Manuel

    2015-04-01

    International agreements now recognize the role of forest in the mitigation of climate change through the levers of in-situ sequestration, storage in products and energy and product substitution. These three strategies of carbon management are often antagonistic and it is still not clear which strategy would have the most significant impact on atmospheric carbon concentrations. With a focus on France, this study compares several scenarios of forest management in terms of their effect on the overall carbon budget from trees to wood-products. We elaborated four scenarios of forest management that target different wood production objectives. One scenario is 'Business as usual' and reproduces the current forest management and wood production levels. Two scenarios target an increase in bioenergy wood production, with either long-term or short-term goals. One scenario aims at increasing the production of timber for construction. For this, an empirical regression model was developed building on the rich French inventory database. The model can project the current forest resource at a time horizon of 20 years for characteristic variables diameter, standing volume, above-ground biomass, stand age. A simplified life-cycle analysis provides a full carbon budget for each scenario from forest management to wood use and allows the identification of the scenario that most reduces carbon emissions.

  8. Water resource management : a strategy for Nova Scotia

    International Nuclear Information System (INIS)

    Theakston, J.

    1998-01-01

    Since 1995, the Nova Scotia Department of the Environment has been the lead agency responsible for water resource management in the province. The agency's mandate has been to establish a water resource management strategy and to report periodically to the people of the province on the state of the environment, including air, water and waste resource management. One of the Department's goals is to ensure that surface and groundwater resources are being adequately protected. This paper summarizes issues related to dams and how they will be addressed. The Department allocates water through approvals and regulates use and alteration of watercourses. The construction of a dam and water withdrawal for municipal, industrial, hydroelectric or other purposes requires an approval. The major concerns with these activities are flows to sustain downstream habitat, competing demand for water, public safety, and water quality impacts. The main water management actions established under the water strategy involve: (1) geo-referencing water resource use and allocation, (2) protecting water quality, (3) integrating management of natural resources, and (4) promoting partnership in stewardship

  9. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies.

    Science.gov (United States)

    Scruggs, Caroline E; Van Buren, Harry J

    2016-05-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood.

  10. Emergency strategies and trends in the management of liver trauma.

    Science.gov (United States)

    Jiang, Hongchi; Wang, Jizhou

    2012-09-01

    The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma.

  11. The Effectiveness of Time Management Strategies Instruction on Students' Academic Time Management and Academic Self Efficacy

    Science.gov (United States)

    Kader, Fathi Abdul Hamid Abdul; Eissa, Mourad Ali

    2015-01-01

    This study investigated the effect of using time management strategies instruction on improving first year learning disabled students' academic time management and academic self efficacy. A total of 60 students identified with LD participated. The sample was divided into two groups; experimental (n = 30 boys) and control (n = 30 boys). ANCOVA and…

  12. The contribution of disaster management to integrated flood risk management strategies: lessons learned from the Netherlands

    NARCIS (Netherlands)

    Kolen, B.; van Alphen, J

    2017-01-01

    An integrated flood risk management (IFRM) strategy consist of a comprehensive set of measures to reduce the risk: protective measures (to reduce the probability of a flood), and land use planning and disaster management (to reduce the consequences of a flood. In the Netherlands this is called a

  13. Financial coping strategies of mental health consumers: managing social benefits.

    Science.gov (United States)

    Caplan, Mary Ager

    2014-05-01

    Mental health consumers depend on social benefits in the forms of supplemental security income and social security disability insurance for their livelihood. Although these programs pay meager benefits, little research has been undertaken into how this population makes ends meet. Using a qualitative approach, this study asks what are the financial coping strategies of mental health consumers? Seven approaches were identified: subsidies, cost-effective shopping, budgeting, prioritizing, technology, debt management, and saving money. Results illustrate the resourcefulness of mental health consumers in managing meager social benefits and highlight the need to strengthen community mental health efforts with financial capabilities education.

  14. Self-managing teams: a strategy for quality improvement.

    Science.gov (United States)

    Feifer, Chris; Nocella, Kiki; DeArtola, Ignacio; Rowden, Suzanne; Morrison, Stephen

    2003-01-01

    Organizations are impacted by their environments, and health care settings are no different. Individuals charged with improving a practice are often impeded by environmental barriers, including incomplete information for decision making. One strategy to empower an organization for change is to form a self-managing team. This paper discusses the self-managing team concept and uses a case study to illustrate its application in primary care. Factors contributing to team success are presented as a guide, and a reminder--there is more to an effective team than gathering people in a room.

  15. Dental Emergencies: Management Strategies That Improve Outcomes [Digest].

    Science.gov (United States)

    Pedigo, Ryan Anthony; Zaurova, Milana

    2017-06-22

    Points & Pearls is a digest of Emergency Medicine Practice . Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

  16. Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens.

    Science.gov (United States)

    Lahiri, Sharon W

    2017-12-01

    IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.

  17. Strategy for the development and management of deserts

    Energy Technology Data Exchange (ETDEWEB)

    1978-02-01

    Recommendations from the June 1977 Conference on Alternative Strategies for Desert Development and Management apply primarily to arid lands, although some can be applied to true desert with no vegetation as well. The causes of desertification are reviewed and corrective measures suggested for both developed and developing countries. A range of strategies is proposed, but all are based on the efficient use of water and most are concerned with water used for agricultural purposes. The conference papers also addressed water management, agricultural development, field crops versus animal husbandry, grazing, land use and allocation, wild life resources, industry coastal resources, tourism, energy and minerals, and establishing the infrastructure needed to improve and retain desert health.

  18. Intermediate Collaborative Adaptive Management Strategies Build Stakeholder Capacity

    Directory of Open Access Journals (Sweden)

    Martha C. Monroe

    2013-06-01

    Full Text Available Efforts to implement collaborative adaptive management (CAM often suffer from challenges, such as an unwillingness of managers to share power, unresolved conflicts between stakeholders, and lack of capacity among stakeholders. Some aspects considered essential to CAM, e.g., trust and stakeholder capacity, may be more usefully viewed as goals for intermediate strategies rather than a set of initial conditions. From this perspective, intermediate steps that focus on social learning and building experience could overcome commonly cited barriers to CAM. An exploration of Springs Basin Working Groups, organized around major clusters of freshwater springs in north Florida, provides a case study of how these intermediate steps enable participants to become more reasonable and engaged. This strategy may be easily implemented by agencies beginning a CAM process.

  19. Aircrew Discourse: Exploring Strategies of Information and Action Management

    Science.gov (United States)

    Irwin, Cheryl M.; Veinott, Elizabeth S.; Shafto, Michael G. (Technical Monitor)

    1995-01-01

    This paper explores methodology issues encountered in the analysis of flightcrew communications in aviation simulation research. Examples are provided by two recent studies which are compared on three issues: level of analysis, data definition, and interpretation of the results. The data discussed were collected in a study comparing two levels of aircraft automation. The first example is an investigation of how pilots' information transfer strategies differed as a function of automation during low and high-workload flight phases. The second study focuses on how crews managed actions in the two aircraft during a ten minute, high-workload flight segment. Results indicated that crews in the two aircraft differed in their strategies of information and action management. The differences are discussed in terms of their operational and research significance.

  20. Accident management strategies for VVER-1000 reactors. Part 1: text

    International Nuclear Information System (INIS)

    Sdouz, G.; Sonneck, G.; Pachole, M.

    1994-10-01

    This report describes the effect of different accident management strategies on the onset, development and end of the core-concrete-interaction as well as on the containment integrity for a TMLB'-type sequence in a Pressurized Water Reactor of the type VVER- 1000. Using the computer code MARCH3 the following strategies were investigated: (1) One or more Spray and LP ECC Systems available with and without coolers after 10 hours (2) Inclusion of the reactor pressure vessel testing facility room to the cavity (3) Containment venting (4) External water supply and (5) Different electric power restoration times. The results show that some of these accident management measures will maintain the containment integrity and reduce the source term drastically, others will reduce the source term rate. For some measures final conclusions can only be given after complete source term calculations have been performed. (authors)

  1. PERFORMANCE IMPROVEMENT STRATEGIES USED BY MANAGERS IN THE PRIVATE SECTOR

    Directory of Open Access Journals (Sweden)

    Raþiu Patricia

    2013-07-01

    Full Text Available Abstract: There are many situations in professional life when for various reasons we are employed in jobs that do not meet our emotional expectations our professional capabilities, our passions and therefore performance on that job will not be high. Analysis of the causes of under-utilization of human potential and adoption of appropriate strategies according to employee needs help reduce staff turnover costs. The main objective of the present paper consists in identifying managerial strategies which contribute to the improvement of the employees’ performances by stimulating their motivation, and the extent to which they are used in the managerial practice. Based on literature review we realized an integrated model and developed a classification, that present our own vision regarding performance improvement strategies. Our classification divides strategies for improving employees’ performances into four main groups: by employees’ development, by rewarding employees, by modifying the job description, by employee involvement in the organization. Starting from this model, through two types of questionnaires we have made an empirical research among managers as well as among office personnel, in order to capture both perspectives regarding the pursued objectives. For the present paper we will present only research results obtained for performance improvement strategies by employees’ development because support a higher degree of generality and do not depend on the organization characteristics. A quantitative data analize from the two samples show that there are differences between managers and employees perception when it comes to strategies used in their organizations and also manager did not know which determines employees to strive in order to improve their performance and obtain better results. The strategies to improve the employee’s performances, proposed within this article have the role to show the fact that managers cannot

  2. The Impact of changed organizational structures- on middle managers' perception of strategy and people management

    DEFF Research Database (Denmark)

    Madsen, Mona Toft; Madsen, Henning

    Much research on organizational change and middle management has emphasized the idea of flatter more performance- and customer focused organizations, in which middle managers’ main responsibilities concern elements of organizational change and development such as strategy involvement, and managing...... people. An important condition for this is, however, that middle managers also perceive such responsibilities as important. This paper is based on a survey of Managers in Danish organizations. Findings with different but related angels are highlighted here. First, only a small percentage of participating...... managers reported that the amount of managerial levels had actually been reduced in the last three years. Secondly, middle managers who had experienced such a reduction perceived aspects of strategy and organizational development as more important. Thirdly, such a reduction did not introduce significant...

  3. Identification and assessment of containment and release management strategies

    International Nuclear Information System (INIS)

    Lehner, J.R.; Lin, C.C.; Neogy, P.

    1990-01-01

    Brookhaven National Laboratory, under the auspices of the US Nuclear Regulatory Commission, is investigating accident management strategies which could help preserve containment integrity or minimize releases during a severe accident. The objective is to make use of existing plant systems and equipment in innovative ways to reduce the likelihood of containment failure or to mitigate the release of fission products to the environment if failure cannot be prevented. Many of the strategies would be implemented during the later stages of a severe accident. The identification and assessment process for containment and release strategies is described, and some insights derived from its application to a BWR Mark 1 plant are presented here. 13 refs., 2 figs

  4. MANAGING RISK BY COORDINATING INVESTMENT, MARKETING, AND PRODUCTION STRATEGIES

    OpenAIRE

    Johnson, Donald A.; Boehlje, Michael

    1983-01-01

    This study of the farm firm integrates long run investment and financial decisions, and short-run production and marketing decisions into a single decision framework that includes both time and risk. The results suggest that the use of various strategies for managing market risks allow the entrepreneur to accept mores risk in investing and producing; and that an integrated analysis of production, marketing and investment-financing alternatives is essential to make accurate recommendations abo...

  5. Evolution in Clinical Knowledge Management Strategy at Intermountain Healthcare

    Science.gov (United States)

    Hulse, Nathan C.; Galland, Joel; Borsato, Emerson P.

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309

  6. International Border Management Systems (IBMS) Program : visions and strategies.

    Energy Technology Data Exchange (ETDEWEB)

    McDaniel, Michael; Mohagheghi, Amir Hossein

    2011-02-01

    Sandia National Laboratories (SNL), International Border Management Systems (IBMS) Program is working to establish a long-term border security strategy with United States Central Command (CENTCOM). Efforts are being made to synthesize border security capabilities and technologies maintained at the Laboratories, and coordinate with subject matter expertise from both the New Mexico and California offices. The vision for SNL is to provide science and technology support for international projects and engagements on border security.

  7. PROCESS OF INNOVATION IN PRODUCT LIFECYCLE MANAGEMENT BUSINESS STRATEGY

    OpenAIRE

    VALENTINA GECEVSKA; FRANC CUS; RADMIL POLENAKOVIC; PAOLO CHABERT

    2011-01-01

    This article proposes a scenario of Product Lifecycle Management (PLM), as a innovative business strategy based on the analysis of business drivers, industry requirements, limit of current solution, and recent state-of-the-art review in the domain related to PLM. Potential industrial impact of the developed PLM technology solutions is analyzed. It is hoped that the proposed PLM technology solutions will form the frontier basis for further research, development, and application of PLM systems ...

  8. Capital Structure, Environmental Dynamism, Innovation Strategy, and Strategic Risk Management

    DEFF Research Database (Denmark)

    Juul Andersen, Torben

    2005-01-01

    Previous research found that capital structure affects performance when it is adapted to the level of environmental dynamism and pursuit of an innovation strategy. The current study reproduces some of these relationships in a more recent dataset but also identifies significant nuances across...... industrial environments. Analyses of a large cross sectional sample and various industry sub-samples suggest that other factors have influenced capital structure effects in recent years including flexibilities in multinational organization and effective strategic risk management capabilities....

  9. Managing strategic change--strategy, culture and action.

    Science.gov (United States)

    Johnson, G

    1992-02-01

    One of the major problems facing senior executives is that of effecting significant strategic change in their organizations. This paper develops a number of explanatory frameworks which address the links between the development of strategy in organizations, dimensions of corporate culture and managerial action. In considering such linkages, and by illustrating them with examples from work undertaken in companies, the paper also seeks to advance our understanding of the problems and means of managing strategic change.

  10. CONSIDERATIONS REGARDING THE MANAGEMENT STRATEGIES OF BANK RISKS

    Directory of Open Access Journals (Sweden)

    NICOLETA GEORGETA PANAIT

    2015-12-01

    Full Text Available The study summarizes what it means banking risks, the main risk management strategies. The complexity of the business environment, liberalization and internationalization of financial flows, brings rapid innovation, diversified financial markets, new opportunities but multiplied risks. Banks establish the types of risks they are prepared to take and the threshold at which risk is considered significant. The process of determining the risks that are taken includes the nature, the scale and the complexity of banks.

  11. DESIGNING STRATEGIES FOR IMPROVING TOTAL QUALITY MANAGEMENT IN MANUFACTURING INDUSTRIES

    Directory of Open Access Journals (Sweden)

    Alfian Nur Ubay

    2017-05-01

    Full Text Available This research was aimed at designing strategies for improving total quality management at CV XYZ and PT HIJ. The research locations were selected intentionally with the consideration that the company is a middle class company that started to apply a study in line with the research topic. The experts were chosen using an approach method. This research used a descriptive approach and quantitative analysis through questionnaires using purposive sampling. The stages began with data processing, i.e. testing the questionnaire quality through validity and reliability tests, making a causality diagram, evaluating the implementation levels of each company by giving evaluation scales based on the existing condition, making House of Quality (HOQ using QFD methods, and then analyzing the problem solutions produced from the QFD methods with 5W + IH analysis, and finally determining the improvement priorities using Fuzzy AHP methods. The results were the strategies for improving total quality management /TQM of CV XYZ, namely the factor that plays the most important role was improving the quality management performance. The actor that has the competence to carry out the TQM improvement is the director. The prioritized goal to be achieved is a commitment to improve the quality of goods and services.  The prioritized strategy used in improving TQM is carrying out SOP consistently.Keywords: strategies, improvement, TQM, manufacturing company, fuzzy AHPABSTRAKPenelitian ini bertujuan merancang strategi peningkatan manajemen mutu terpadu pada CV XYZ dan PT HIJ. Pemilihan lokasi penelitian dilakukan secara sengaja dengan pertimbangan bahwa perusahaan tersebut merupakan perusahaan kelas menengah yang mulai menerapkan kajian sesuai dengan topik penelitian. Penentuan pakar dilakukan dengan metode pendekatan secara sengaja. Adapun penelitian ini menggunakan pendekatan deskriptif dan analisa kuantitatif dengan menyebarkan kuesioner secara sengaja (purposive sampling

  12. STRATEGY IMPLEMENTATION STYLES OF MALAYSIAN, THAI AND HUNGARIAN MIDDLE MANAGERS

    Directory of Open Access Journals (Sweden)

    Maheshkumar P. Joshi

    2004-01-01

    Full Text Available There is a need for more comparative empirical research that examines middle manager roles in strategic change. This paper reports a study of middle managers in two dynamic settings: the Asia/Pacific region – Malaysia and Thailand; and Central/Eastern Europe – Hungary. Results of 213 respondents across three countries indicate that middle managers from all three tend toward use of authoritarian management styles even in proactive strategic change situations. However, Hungarians are less likely to use these styles than Thai and Malaysian middle managers. For all three countries, managers with less work experience were found to have lower tendencies to use an authoritarian style of implementation. When top managers exhibit an aggressive strategic posture, middle-managers from all three countries are also less likely to use an authoritarian style.Firms that want to stay competitive in the global market place must continuously evolve by successfully accomplishing strategic change (Struckman & Yammarino 2003. Although senior managers are critical in leading the strategic change process, even the best-planned strategic changes will not achieve their full potential unless they are well implemented. Part of the strategic leadership responsibility, therefore, includes establishing a climate in which the organization's rank and file will experience both a positive attitude about change and the confidence to actively seek change opportunities (Kanter 2003. Research attention is bringing more insight into the important roles of middle-managers in this process of implementing strategic change (Balogun & Jenkins 2003; Floyd & Wooldridge, 1992, 1994; Wooldridge & Floyd 1990. Although there is little doubt that active support by middle managers is critical for the strategies to be well implemented (Guth & MacMillan 1986, there remain many important questions with regard to how middle managers participate in this process (Balogun 2003.The need for research

  13. LINKING HUMAN RESOURCES STRATEGY WITH KNOWLEDGE MANAGEMENT STRATEGY TO DRIVE MEASURABLE RESULTS

    Directory of Open Access Journals (Sweden)

    Otilia‐Maria\tBORDEIANU

    2015-06-01

    Full Text Available Today the human resources are seen as a very valuable asset to achieve long-term performance. Today we understand that every employee is required to learn throughout life, so to acquire new knowledge, to process such knowledge and possibly disseminate expertise with other members of the organization. The theory on human resources in various organizations has changed over time; recommendations have become more numerous, but there is no consensus on the subject. In other words, the permanent change which defines the competitive environment of business remains a type of constant when analysing the efficiency of human resources within companies; inter-individual relations (formal and informal and the values to which each employee relates remains crucial for any theoretical construction in this area. Principles and strategies applied by organizations yesterday could prove their inefficiency today; human resource strategies in organizations today should include a separate subcomponent, we believe, i.e. knowledge management (KM strategy. This is because the competitive advantage obtained or maintained by the company depends today, in large proportion, on the type, quality and value of knowledge possessed by the organization. Therefore, organizational strategy and thus the strategy of acquisition, developing and rewarding of human resources (HR should take into account this reality from the global environment. Moreover, in the current knowledge-driven economy, organizations must know how to develop and implement knowledge-based strategies to drive measurable business results. The goal of this paper is to describe a potential relation between the overall company strategy, HR strategy and KM strategy.

  14. Managing the Transformation: A Change Management Strategy for U.S. Marine Corps Expeditionary Energy Initiatives

    Science.gov (United States)

    2017-12-01

    sensegiving in transformational change processes from the bottom up. Higher Education , 65(6), 761–780. doi:10.1007/s10734-012-9575-7 Kezar, A...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. MANAGING THE TRANSFORMATION : A...DATE December 2017 3. REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE MANAGING THE TRANSFORMATION : A CHANGE MANAGEMENT STRATEGY

  15. Strategy and management of network security at KEK

    International Nuclear Information System (INIS)

    Kiyoharu Hashimoto; Teiji Nakamura; Hitoshi Hirose, Yukio Karita; Youhei Morita; Soh Suzuki; Fukuko Yuasa

    2001-01-01

    Recently the troubles related to the network security have often occurred at KEK. According to their security policy, the authors have started the strategy against the daily attacks. It consists of two fundamental things; the monitoring and the access control. To monitor the network, the authors have installed the intrusion detection system and have managed it since 1998. For the second thing, the authors arranged three categories to classify all hosts (about 5000 hosts) at KEK according to their security level. To realize these three categories, the authors filter the incoming packet from outside KEK whether it has a SYN flag or not. The network monitoring and the access control produced good effects in keeping the security level high. Since 2000 the authors have started the transition of LAN from shared-media network to switched network. Now almost part of LAN was re-configured and in this new LAN 10 Mbps 100 Mbps/1Gbps Ethernet are supported. Currently the authors are planning further speedup (10 Gbps) and redundancy of network. Not only LAN but also WAN, network speed will be upgraded to 10 Gbps thanks to the strong promotion of IT by Japanese government. In this very high speed network, the authors' current strategy will be affected and again the network security becomes a big issue. The authors describe the experiences in practice of the current strategy and management know-how together with the discussion on the new strategy

  16. Strategy generator in computerized accident management support system

    International Nuclear Information System (INIS)

    Sirola, M.

    1994-02-01

    An increased interest for research in the field of accident management of nuclear power plants 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 accidents 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 idea 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 from the plant will help the strategy planning. (orig.). (40 refs., 20 figs.)

  17. Optimal energy management strategy for battery powered electric vehicles

    International Nuclear Information System (INIS)

    Xi, Jiaqi; Li, Mian; Xu, Min

    2014-01-01

    Highlights: • The power usage for battery-powered electrical vehicles with in-wheel motors is maximized. • The battery and motor dynamics are examined emphasized on the power conversion and utilization. • The optimal control strategy is derived and verified by simulations. • An analytic expression of the optimal operating point is obtained. - Abstract: Due to limited energy density of batteries, energy management has always played a critical role in improving the overall energy efficiency of electric vehicles. In this paper, a key issue within the energy management problem will be carefully tackled, i.e., maximizing the power usage of batteries for battery-powered electrical vehicles with in-wheel motors. To this end, the battery and motor dynamics will be thoroughly examined with particular emphasis on the power conversion and power utilization. The optimal control strategy will then be derived based on the analysis. One significant contribution of this work is that an analytic expression for the optimal operating point in terms of the component and environment parameters can be obtained. Owing to this finding, the derived control strategy is also rendered a simple structure for real-time implementation. Simulation results demonstrate that the proposed strategy works both adaptively and robustly under different driving scenarios

  18. A framework for assessing hydrogen management strategies involving multiple decisions

    International Nuclear Information System (INIS)

    Lee, S.D.; Suh, K.Y.; Park, G.C.; Jae, M.

    2000-01-01

    An accident management framework consisting of multiple and sequential decisions is developed and applied to a hydrogen control strategy for a reference plant. The compact influence diagrams including multiple decisions are constructed and evaluated with MAAP4 calculations. Each decision variable, represented by a node in the influence diagrams, has an uncertainty distribution. Using the values from the IPE (Individual Plant Examinations) report for the reference plant (UCN 3 and 4), the hydrogen control and accident management strategies are assessed. In this paper, a problem with two decisions is modeled for a simple illustration of the process involved. One decision is whether or not to actuate igniters at the time of core uncovery. Another decision is whether or not to turn on the containment sprays. We chose a small-break loss-of-coolant accident (LOCA) sequence, which was one of the dominant accident sequences in the reference plant. The framework involves the modeling of the decision problem by using decision-making tools, data analysis, and the MAAP4 calculations. It is shown that the proposed framework with a new measure for assessing hydrogen control is flexible enough to be applied to various accident management strategies. (author)

  19. Including environmental concerns in management strategies for depleted uranium hexafluoride

    International Nuclear Information System (INIS)

    Goldberg, M.; Avci, H.I.; Bradley, C.E.

    1995-01-01

    One of the major programs within the Office of Nuclear Energy, Science, and Technology of the US Department of Energy (DOE) is the depleted uranium hexafluoride (DUF 6 ) management program. The program is intended to find a long-term management strategy for the DUF 6 that is currently stored in approximately 46,400 cylinders at Paducah, KY; Portsmouth, OH; and Oak Ridge, TN, USA. The program has four major components: technology assessment, engineering analysis, cost analysis, and the environmental impact statement (EIS). From the beginning of the program, the DOE has incorporated the environmental considerations into the process of strategy selection. Currently, the DOE has no preferred alternative. The results of the environmental impacts assessment from the EIS, as well as the results from the other components of the program, will be factored into the strategy selection process. In addition to the DOE's current management plan, other alternatives continued storage, reuse, or disposal of depleted uranium, will be considered in the EIS. The EIS is expected to be completed and issued in its final form in the fall of 1997

  20. Investigating the role of conflict management strategy on development of cooperative management

    Directory of Open Access Journals (Sweden)

    Hosseinali Aziziha

    2014-03-01

    Full Text Available This paper presents an empirical study to investigate the effect of conflict management strategies on development of cooperative culture in one of Iranian auto industries. The proposed study adopts a Putnam and Wilson’s questionnaire (1982 [Putnam, L. L., & Wilson, C. E. (1982. Communication strategies in organizational conflicts: Reliability and validity of a measurement scale. Communication Yearbook, 6, 629-652.] for measuring different components of conflict management. In addition, the study also designs a questionnaire for measuring cooperative culture. Cronbach alphas are calculated for conflict management and cooperative cultures as 0.76 and 0.79, respectively. Using Spearman correlation ratio as well as regression technique, the study has determined that three components of conflict management strategies including cooperation, competition and compromise could significantly contribute of development of cooperative culture.