WorldWideScience

Sample records for unit recognition management

  1. Facial Action Units Recognition: A Comparative Study

    NARCIS (Netherlands)

    Popa, M.C.; Rothkrantz, L.J.M.; Wiggers, P.; Braspenning, R.A.C.; Shan, C.

    2011-01-01

    Many approaches to facial expression recognition focus on assessing the six basic emotions (anger, disgust, happiness, fear, sadness, and surprise). Real-life situations proved to produce many more subtle facial expressions. A reliable way of analyzing the facial behavior is the Facial Action Coding

  2. Facial Action Units Recognition: A Comparative Study

    NARCIS (Netherlands)

    Popa, M.C.; Rothkrantz, L.J.M.; Wiggers, P.; Braspenning, R.A.C.; Shan, C.

    2011-01-01

    Many approaches to facial expression recognition focus on assessing the six basic emotions (anger, disgust, happiness, fear, sadness, and surprise). Real-life situations proved to produce many more subtle facial expressions. A reliable way of analyzing the facial behavior is the Facial Action Coding

  3. Neuroleptic malignant syndrome. Recognition, prevention and management.

    Science.gov (United States)

    Velamoor, V R

    1998-07-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia characterised by mental status changes, muscle rigidity, hyperthermia and autonomic dysfunction. Increased awareness and early recognition will lead to prompt management. The diagnosis of NMS presents a challenge because several medical conditions generate similar symptoms. The presentation and course of NMS can be quite variable ranging from a stormy and potentially fatal course to a relatively benign and self-limiting course. The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of suspected cases and prompt discontinuation of the offending agent. All patients with psychosis should be monitored daily for dehydration and elevated temperature, have vital signs checked and agitation should be watched for. Antipsychotics should be used conservatively with gradual titration of doses. The management of NMS should be based on a hierarchy of symptom severity. Following an episode of NMS, the patient should be reassessed for further treatment with antipsychotics and rechallenge should not be attempted at least 2 weeks following resolution of symptoms of NMS. The patient and family should be educated about the episode and consent for further medication use obtained after a clear explanation of the risk-benefit analysis.

  4. Battery thermal management unit

    Science.gov (United States)

    Sanders, Nicholas A.

    1989-03-01

    A battery warming device has been designed which uses waste heat from an operating internal combustion engine to warm a battery. A portion of the waste heat is stored in the sensible and latent heat of a phase change type material for use in maintaining the battery temperature after the engine is shut off. The basic design of the device consists of a Phase Change Material (PCM) reservoir and a simple heat exchanger connected to the engineer's cooling system. Two types of units were built, tested and field trialed. A strap-on type which was strapped to the side of an automotive battery and was intended for the automotive after-market and a tray type on which a battery or batteries sat. This unit was intended for the heavy duty truck market. It was determined that both types of units increased the average cranking power of the batteries they were applied to. Although there were several design problems with the units such as the need for an automatic thermostatically controlled bypass valve, the overall feeling is that there is a market opportunity for both the strap-on and tray type battery warming units.

  5. An Investigation of the Role of Grapheme Units in Word Recognition

    Science.gov (United States)

    Lupker, Stephen J.; Acha, Joana; Davis, Colin J.; Perea, Manuel

    2012-01-01

    In most current models of word recognition, the word recognition process is assumed to be driven by the activation of letter units (i.e., that letters are the perceptual units in reading). An alternative possibility is that the word recognition process is driven by the activation of grapheme units, that is, that graphemes, rather than letters, are…

  6. Ventricular arrhythmias. Clinical recognition and management.

    Science.gov (United States)

    Nestico, P F; DePace, N L; Morganroth, J

    1984-05-01

    The recognition that patients at high risk for sudden cardiac death can be identified raises our enthusiasm to eliminate some of these risk factors and thus our hope to prevent sudden cardiac death. Although this effect is yet to be shown in cooperative, well-controlled clinical trials, data exist to suggest that this result will be achieved. Thus, the use of antiarrhythmic agents in chronic ventricular ectopy, particularly in patients with left ventricular dysfunction, seems to be warranted, and new and more potent agents to be used for this end will be available in the future.

  7. Infectious Mononucleosis: Recognition and Management in Athletes.

    Science.gov (United States)

    Eichner, Edward R.

    1987-01-01

    Infectious mononucleosis strikes many young athletes. Considered here are its epidemiology, pathophysiology, diagnosis, natural course, complications, and management. The focus is on concerns of athletes with a perspective on personality, convalescence, and chronic fatigue. (Author/MT)

  8. Recognition and Management of Athletic Pubalgia

    Institute of Scientific and Technical Information of China (English)

    Paul R. Geisler; Ed.D; ATC

    2011-01-01

    Whether termed “sports hernias”,“hockey groin”,or “athletic pubalgia”,insidious onset and vague groin and hip maladies seem to be on the rise in the last few years,creating much confusion as to the best way to diagnosis and treat the multifaceted and complex conditions.Because of the vague nature of their clinical presentation,sports hernias and athletic pubalgia are complicated and multifaceted problems for clinicians and athletes to manage.

  9. Integrated Co-management of Lakes through Beach Management Units

    OpenAIRE

    Goverment of Uganda; Department for International Development (DFID) of the UK Government

    2007-01-01

    Metadata only record In 1999, the Integrated Co-management of Lakes through Beach Management Units project was started in an effort to implement a new approach to the management of lake resources in Uganda. The main components of this plan involved decentralization, local community management, and improving the livelihood of the poor. In order to finance the management of these areas, the Beach Management Units (BMU's) are charging user fees to those individuals who obtain benefit from the...

  10. Cervical spondylosis: recognition, differential diagnosis, and management.

    Science.gov (United States)

    Voorhies, R M

    2001-04-01

    In contemporary clinical practice, the prevalence of neck pain in the general population is approximately 15%. The challenge for the primary care specialist is to be able to recognize the more serious disorders that require early referral. Additionally, it is important to have the confidence to institute specific treatment for nonurgent conditions in order to avoid unnecessary referral of patients with generally self-limiting conditions.CERVICAL SPONDYLOSIS IS A GENERAL AND NONSPECIFIC TERM THAT ENCOMPASSES A BROAD SPECTRUM OF AFFLICTIONS BUT, FOR PURPOSES OF CLARITY, CAN BE ORGANIZED INTO THREE CLINICAL SYNDROMES: Type I Syndrome (Cervical Radiculopathy); Type II Syndrome (Cervical Myelopathy); and Type III Syndrome (Axial Joint Pain). It is important to remember that shoulder problems can masquerade as cervical problems, and vice versa (e.g. adhesive capsulitis, recurrent anterior subluxation, impingement syndrome, rotator cuff tear, etc.). A number of management options, including pharmaceutical, physical therapy, and psychological therapies, are available once a diagnosis has been made.

  11. Recognition and management of preoperative risk.

    Science.gov (United States)

    Nierman, E; Zakrzewski, K

    1999-08-01

    Internists are frequently asked to do preoperative consultations and to manage perioperative complications. Realistic goals are to identify patient factors that increase the risk of surgery, to quantify this risk in order to make decisions about the appropriateness of and timing of the surgery, to provide recommendations on how to minimize the risk, to identify and manage coexisting medical conditions and their associated medication requirements, to monitor the patient for perioperative problems, and to make recommendations to deal with these problems when they occur. With few exceptions, nonselective imaging and laboratory screening tests have repeatedly been shown to be of little value when the history and physical do not suggest a problem. The risk associated with the planned surgery can be estimated, with the most common serious complications being cardiac events. Updated versions of Goldman's risk indices are particularly helpful for this. Clinical variables are optimally combined with selective stress testing to discern which patients will benefit from preoperative revascularization. This has been studied best in the setting of vascular surgery. A critical guiding principle is that the value of revascularization must be judged in terms of long term gains rather than just immediate perioperative benefit. Other interventions include the selective use of beta blockers, adequate analgesia for all, control of hypertension, and appropriate volume management, especially in the settings of preexisting CHF or valvular disease. It must also be recognized that perioperative ischemia and CHF often present atypically. An approach that combines aspects of both the ACC/AHA and the ACP guidelines seems optimal. A variety of noncardiac issues must also be addressed. Postoperative pulmonary complications are common, especially with preexisting pulmonary disease, thoracic and upper abdominal surgery, and obesity. PFTs and ABGs are indicated in selected patients. Stopping

  12. Complications of decorative tattoos: recognition and management.

    Science.gov (United States)

    Simunovic, Carolina; Shinohara, Michi M

    2014-12-01

    Tattooing is an ancient practice that enjoys continued popularity. Although a modern, professionally performed tattoo is generally safe, complications can occur. A skin biopsy of all tattoo reactions is recommended as some tattoo reactions have systemic implications. Tattoo-related infections are seen days to decades after tattooing, and range from acute pyogenic infections to cutaneous tuberculosis. In particular, non-tuberculous mycobacterial infections happen in tattoos with increasing frequency and are introduced at the time of tattooing through contaminated ink or water used to dilute inks. Despite a transition in tattoo pigments from metal salts to industrial azo dyes, hypersensitivity reactions also persist, and include eczematous, granulomatous, lichenoid, and pseudoepitheliomatous patterns (among others). Granulomatous tattoo reactions can be a clue to cutaneous or systemic sarcoidosis, particularly in the setting of interferon use. Pseudoepitheliomatous tattoo reactions have substantial overlap with squamous cell carcinoma and keratoacanthoma, making diagnosis and management difficult. Other malignancies and their benign mimics can occur in tattoos, raising questions about the safety of tattoo ink and its role in carcinogenesis.

  13. Improving recognition and management of ADHD.

    Science.gov (United States)

    Forbes, Fiona

    2010-04-01

    ADHD covers a group of common, chronic neurodevelopmental disorders characterised by developmentally abnormal and disabling levels of restlessness and overactivity (usually combined with impulsiveness) and/or inattention. There are three subtypes of ADHD: predominantly inattentive; predominantly hyperactive-impulsive; and combined type. For a diagnosis of ADHD to be made: onset of symptoms has to occur before the age of seven, symptoms should have been present longer than 6 months and they must be causing significant impairment. The prevalence of ADHD is at least 5%. Two-thirds of children with ADHD continue to have symptoms in adolescence. At the age of 25, half will still have symptoms which continue to cause significant impairment. ADHD is associated with an increased rate of other disorders: mood disorders; anxiety; other behavioural disorders; autism spectrum disorders; tic disorders; specific learning difficulties; developmental co-ordination disorder and sleep disorders. The GP has an important role in identification of possible ADHD, and onward referral, and also in the management of ADHD post-diagnosis, particularly with respect to prescribing medication usually on a shared care basis with specialist services.

  14. New Public Management, Care and Struggles about Recognition

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene

    2009-01-01

    New Public Management (NPM) is usually perceived as a homogeneous discourse. However, when we examine it by looking at micro-politics in municipalities and understand its consequences drawing on the voices of home helpers, the picture is more complex and ambiguous. NPM is seen as disciplining paid...... of resistance. The analysis applies feminist theories of recognition and care, and its findings are based on focus group interviews and feminist discourse analysis...

  15. Energy Efficient Iris Recognition With Graphics Processing Units

    National Research Council Canada - National Science Library

    Rakvic, Ryan; Broussard, Randy; Ngo, Hau

    2016-01-01

    .... In the past few years, however, this growth has slowed for central processing units (CPUs). Instead, there has been a shift to multicore computing, specifically with the general purpose graphic processing units (GPUs...

  16. Childhood constipation: recognition, management and the role of the nurse.

    Science.gov (United States)

    Bruce, James Schuster; Bruce, Catherine Schuster; Short, Hayley; Paul, Siba Prosad

    2016-12-08

    Constipation is a common childhood condition that health professionals will encounter in many different settings. The majority of these cases of childhood constipation are idiopathic in nature. It is considered to exhibit the 'tip of the iceberg' phenomenon as a large number of cases remain undetected due to under-recognition by families, embarrassment regarding the condition, fear of receiving a negative response from health professionals, or parental belief there is actually something more seriously wrong and failure to accept the diagnosis. Prompt evaluation and management is likely to be associated with better outcomes. To ensure this, fast recognition of symptoms, with care taken to exclude any 'red flag' symptoms that could indicate an organic cause and subsequently a different treatment pathway, is essential. Nurses, given their regular contact with families in different settings, are suitably placed to detect these symptoms early and can play a vital role in successful management of the condition. Laxatives are the first line in management of constipation. Polyethylene glycol 3350 is the laxative that evidence-based guidelines from the National Institute for Health and Care Excellence (2010) recommend as the initial pharmacological management. Advice should also be given about supportive measures, including diet and lifestyle changes.

  17. Assessing the Performance of Business Unit Managers

    NARCIS (Netherlands)

    Bouwens, J.F.M.G.; van Lent, L.A.G.M.

    2006-01-01

    Using a sample of 140 managers, we investigate the use of various performance metrics in determining the periodic assessment, bonus decisions, and career paths of business unit managers.We show that the weight on accounting return measures is associated with the authority of these managers, and we d

  18. The role of familiarity in associative recognition of unitized compound word pairs.

    Science.gov (United States)

    Ahmad, Fahad N; Hockley, William E

    2014-01-01

    This study examined the effect of unitization and contribution of familiarity in the recognition of word pairs. Compound words were presented as word pairs and were contrasted with noncompound word pairs in an associative recognition task. In Experiments 1 and 2, yes-no recognition hit and false-alarm rates were significantly higher for compound than for noncompound word pairs, with no difference in discrimination in both within- and between-subject comparisons. Experiment 2 also showed that item recognition was reduced for words from compound compared to noncompound word pairs, providing evidence of the unitization of the compound pairs. A two-alternative forced-choice test used in Experiments 3A and 3B provided evidence that the concordant effect for compound word pairs was largely due to familiarity. A discrimination advantage for compound word pairs was also seen in these experiments. Experiment 4A showed that a different pattern of results is seen when repeated noncompound word pairs are compared to compound word pairs. Experiment 4B showed that memory for the individual items of compound word pairs was impaired relative to items in repeated and nonrepeated noncompound word pairs, and Experiment 5 demonstrated that this effect is eliminated when the elements of compound word pairs are not unitized. The concordant pattern seen in yes-no recognition and the discrimination advantage in forced-choice recognition for compound relative to noncompound word pairs is due to greater reliance on familiarity at test when pairs are unitized.

  19. Trigger recognition and management in poorly controlled asthmatics.

    Science.gov (United States)

    Rank, Matthew A; Wollan, Peter; Li, James T; Yawn, Barbara P

    2010-01-01

    Previous studies using cross-sectional designs suggest that asthma trigger recognition and management are suboptimal in clinical practice. The objective of this study was to assess gaps between asthma guideline recommendations and clinical practice regarding asthma trigger recognition and management by tracking poorly controlled asthma patients over a 2-year period. A retrospective cohort study of a representative sample of 102 children and adult residents of Olmsted County, MN, with poor asthma control in 2003-2004 was performed. All medical records from each asthma-related visit were examined for documented asthma trigger inquiries, specific trigger avoidance advice, and for adherence to the trigger avoidance advice. One hundred two subjects made 686 asthma-related visits that were included for analysis. At least 1 trigger inquiry occurred in 83% of visits, with an average of 2.0 triggers queried per visit. The most common trigger inquiries were for infection (47%), environmental tobacco smoke (41%), and allergens (29%). The mean number of triggers queried was higher during exacerbation visits versus nonexacerbation visits (2.1 versus 1.8; p < 0.001) and in the emergency care settings compared with outpatient settings (2.4 versus 1.7; p < 0.001). Advice for managing asthma triggers was given in 30% of visits and adherence to trigger advice was evaluated at 6% of visits. Future interventions for improving asthma trigger management should be targeted to routine asthma outpatient visits, where trigger avoidance advice is infrequent and rarely addressed in follow-up visits.

  20. Cimex lectularius ("Bed Bugs"): Recognition, Management, and Eradication.

    Science.gov (United States)

    McMenaman, Kathryn S; Gausche-Hill, Marianne

    2016-11-01

    Reports of bed bug infestations in major cities in the United States and abroad have been in the public press. Physicians and other clinicians who care for children need to be able to recognize bed bug bites and understand the social, psychological, and medical implications that this diagnosis will have on patients and their families. In this article, a case presentation serves to guide discussion regarding establishing the diagnosis, differential diagnosis, and the management of bed bug bites and their complications. Integrated pest management programs involving housing managers, residents, and professional pest exterminators provide both chemical and nonchemical solutions for eradication of bed bug infestations.

  1. Flyway Habitat Management Unit Project report no. 1: Introduction to the Flyway Habitat Management Unit Project

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — To reduce uncertainties and provide improved program guidance, we divided the coterminous United States into 164 management units, developed sets of key information...

  2. Hanford Site Waste Management Units Report

    Energy Technology Data Exchange (ETDEWEB)

    Shearer, Jeffrey P. [Hanford Site (HNF), Richland, WA (United States)

    2014-02-19

    The Hanford Site Waste Management Units Report (HSWMUR) has been created to meet the requirements of the Tri-Party Agreement (TPA) Action Plan, Section 3.5, which states: “The Hanford Site Waste Management Units Report shall be generated, in a format agreed upon by the Parties, as a calendar year report and issued annually by the DOE by the end of February of each year, and posted electronically for regulator and public access. This report shall reflect all changes made in waste management unit status during the previous year.” This February 2013 version of the HSWMUR contains a comprehensive inventory of the 3438 sites and 569 subsites in the Waste Information Data System (WIDS). The information for each site contains a description of each unit and the waste it contains, where applicable. The WIDS database provides additional information concerning the sites contained in this report and is maintained with daily changes to these sites.

  3. Hanford Site Waste Management Units Report

    Energy Technology Data Exchange (ETDEWEB)

    Shearer, Jeffrey P. [Hanford Site (HNF), Richland, WA (United States)

    2012-02-29

    The Hanford Site Waste Management Units Report (HSWMUR) has been created to meet the requirements of the Tri-Party Agreement (TPA) Action Plan, Section 3.5, which states: “The Hanford Site Waste Management Units Report shall be generated, in a format agreed upon by the Parties, as a calendar year report and issued annually by the DOE by the end of February of each year, and posted electronically for regulator and public access. This report shall reflect all changes made in waste management unit status during the previous year.” This February 2012 version of the HSWMUR contains a comprehensive inventory of the 3389 sites and 540 subsites in the Waste Information Data System (WIDS). The information for each site contains a description of each unit and the waste it contains, where applicable. The WIDS database provides additional information concerning the sites contained in this report and is maintained with daily changes to these sites.

  4. Hanford Site Waste Management Units Report

    Energy Technology Data Exchange (ETDEWEB)

    Shearer, Jeffrey P. [Hanford Site (HNF), Richland, WA (United States)

    2013-02-13

    The Hanford Site Waste Management Units Report (HSWMUR) has been created to meet the requirements of the Tri-Party Agreement (TPA) Action Plan, Section 3.5, which states: “The Hanford Site Waste Management Units Report shall be generated, in a format agreed upon by the Parties, as a calendar year report and issued annually by the DOE by the end of February of each year, and posted electronically for regulator and public access. This report shall reflect all changes made in waste management unit status during the previous year.” This February 2013 version of the HSWMUR contains a comprehensive inventory of the 3427 sites and 564 subsites in the Waste Information Data System (WIDS). The information for each site contains a description of each unit and the waste it contains, where applicable. The WIDS database provides additional information concerning the sites contained in this report and is maintained with daily changes to these sites.

  5. Stillwater Wildlife Management Area : Grasslands Management Plan : North Marsh Unit

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This plan is designed to serve as the initial Fish and Wildlife Service habitat management proposal for the North Marsh grazing unit of Stillwater National Wildlife...

  6. Nursing unit managers, staff retention and the work environment.

    Science.gov (United States)

    Duffield, Christine M; Roche, Michael A; Blay, Nicole; Stasa, Helen

    2011-01-01

    This paper examined the impact of leadership characteristics of nursing unit managers, as perceived by staff nurses, on staff satisfaction and retention. A positive work environment will increase levels of job satisfaction and staff retention. Nurse leaders play a critical role in creating a positive work environment. Important leadership characteristics of the front-line nurse manager include visibility, accessibility, consultation, recognition and support. Secondary analysis of data collected on 94 randomly selected wards in 21 public hospitals across two Australian states between 2004-2006. All nurses (n = 2488, 80·3% response rate) on the selected wards were asked to complete a survey that included the 49-item Nursing Work Index-Revised [NWI-R] together with measures of job satisfaction, satisfaction with nursing and intention to leave. Subscales of the NWI-R were calculated. Leadership, the domain of interest, consisted of 12 items. Wards were divided into those reporting either positive or negative leadership. Data were analysed at the nurse level using spss version 16. A nursing manager who was perceived to be a good leader, was visible, consulted with staff, provided praise and recognition and where flexible work schedules were available was found to distinguish the positive and negative wards. However, for a ward to be rated as positive overall, nurse leaders need to perform well on all the leadership items. An effective nursing unit manager who consults with staff and provides positive feedback and who is rated highly on a broad range of leadership items is instrumental in increasing job satisfaction and satisfaction with nursing. Good nurse managers play an important role in staff retention and satisfaction. Improved retention will lead to savings for the organisation, which may be allocated to activities such as training and mentorship to assist nurse leaders in developing these critical leadership skills. Strategies also need to be put in place to

  7. Recognition, Reification, and Practices of Forgetting: Ethical Implications of Human Resource Management

    OpenAIRE

    Islam, Gazi

    2012-01-01

    International audience; This article examines the ethical framing of employment in contemporary human resource management (HRM). Using Axel Honneth's theory of recognition and classical critical notions of reification, I contrast recognition and reifying stances on labor. The recognition approach embeds work in its emotive and social particu-larity, positively affirming the basic dignity of social actors. Reifying views, by contrast, exhibit a forgetfulness of recognition, removing action fro...

  8. Market Response toward Accrual Earnings Management, Real Transactions, and Strategic Revenue Recognition - Earnings Management1

    Directory of Open Access Journals (Sweden)

    Windy Puspita Dewi

    2015-01-01

    Full Text Available This study investigates how the capital market response to a variety of earnings management tools i.e., accrual-based earnings management, real transaction activities, and strategic revenue recognition. We measure the market response to the information content of earnings by the earnings response coefficient (ERC. By using pooled-OLS regression from 748 firm-years data of public listed companies on the Indonesian Stock Exchange (IDX in 2004-2009, we find some evidence of a negative association between earnings response coefficients and information content of earnings that contained earnings management. Our study find that real transactions earnings management in operating activities has negative association with earnings response coefficient, but we do not find any evidence from the other earnings management tools. The findings of this study imply that the market participants are able to capture a certain kind of earnings management behaviour that may reduce the earnings response coefficient.

  9. Managing nuclear weapons in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.

    1993-03-16

    This report discusses the management and security of nuclear weapons in the post-cold war United States. The definition of what constitutes security is clearly changing in the US. It is now a much more integrated view that includes defense and the economy. The author tries to bring some semblance of order to these themes in this brief adaptation of a presentation.

  10. Evidence for view-invariant face recognition units in unfamiliar face learning.

    Science.gov (United States)

    Etchells, David B; Brooks, Joseph L; Johnston, Robert A

    2017-05-01

    Many models of face recognition incorporate the idea of a face recognition unit (FRU), an abstracted representation formed from each experience of a face which aids recognition under novel viewing conditions. Some previous studies have failed to find evidence of this FRU representation. Here, we report three experiments which investigated this theoretical construct by modifying the face learning procedure from that in previous work. During learning, one or two views of previously unfamiliar faces were shown to participants in a serial matching task. Later, participants attempted to recognize both seen and novel views of the learned faces (recognition phase). Experiment 1 tested participants' recognition of a novel view, a day after learning. Experiment 2 was identical, but tested participants on the same day as learning. Experiment 3 repeated Experiment 1, but tested participants on a novel view that was outside the rotation of those views learned. Results revealed a significant advantage, across all experiments, for recognizing a novel view when two views had been learned compared to single view learning. The observed view invariance supports the notion that an FRU representation is established during multi-view face learning under particular learning conditions.

  11. H1N1 in dialysis units: Prevention and management

    Directory of Open Access Journals (Sweden)

    Karkar Ayman

    2010-01-01

    Full Text Available Dialysis patients are at increased risk of contracting influenza A H1N1 and deve-loping serious illness. Increasing the awareness of dialysis patients and continuous education and training of medical staff on early recognition and management of influenza A H1N1 can help in saving the life of patients. Antiviral drugs and influenza vaccines are effective in providing ade-quate immunity in dialysis patients with strict implementation of infection control policies and procedures can help in preventing and controlling the dissemination of influenza A H1N1 in dia-lysis units. We report a case of a patient who presented with HINI influenza and developed acute kidney injury during his hospitalization and his course with disease.

  12. Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management

    Directory of Open Access Journals (Sweden)

    Justin M. Oldham

    2017-08-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF, a fibrosing interstitial pneumonia of unknown etiology, primarily affects older adults and leads to a progressive decline in lung function and quality of life. With a median survival of 3–5 years, IPF is the most common and deadly of the idiopathic interstitial pneumonias. Despite the poor survivorship, there exists substantial variation in disease progression, making accurate prognostication difficult. Lung transplantation remains the sole curative intervention in IPF, but two anti-fibrotic therapies were recently shown to slow pulmonary function decline and are now approved for the treatment of IPF in many countries around the world. While the approval of these therapies represents an important first step in combatting of this devastating disease, a comprehensive approach to diagnosing and treating patients with IPF remains critically important. Included in this comprehensive assessment is the recognition and appropriate management of comorbid conditions. Though IPF is characterized by single organ involvement, many comorbid conditions occur within other organ systems. Common cardiovascular processes include coronary artery disease and pulmonary hypertension (PH, while gastroesophageal reflux and hiatal hernia are the most commonly encountered gastrointestinal disorders. Hematologic abnormalities appear to place patients with IPF at increased risk of venous thromboembolism, while diabetes mellitus (DM and hypothyroidism are prevalent metabolic disorders. Several pulmonary comorbidities have also been linked to IPF, and include emphysema, lung cancer, and obstructive sleep apnea. While the treatment of some comorbid conditions, such as CAD, DM, and hypothyroidism is recommended irrespective of IPF, the benefit of treating others, such as gastroesophageal reflux and PH, remains unclear. In this review, we highlight common comorbid conditions encountered in IPF, discuss disease-specific diagnostic

  13. Enhanced iris recognition method based on multi-unit iris images

    Science.gov (United States)

    Shin, Kwang Yong; Kim, Yeong Gon; Park, Kang Ryoung

    2013-04-01

    For the purpose of biometric person identification, iris recognition uses the unique characteristics of the patterns of the iris; that is, the eye region between the pupil and the sclera. When obtaining an iris image, the iris's image is frequently rotated because of the user's head roll toward the left or right shoulder. As the rotation of the iris image leads to circular shifting of the iris features, the accuracy of iris recognition is degraded. To solve this problem, conventional iris recognition methods use shifting of the iris feature codes to perform the matching. However, this increases the computational complexity and level of false acceptance error. To solve these problems, we propose a novel iris recognition method based on multi-unit iris images. Our method is novel in the following five ways compared with previous methods. First, to detect both eyes, we use Adaboost and a rapid eye detector (RED) based on the iris shape feature and integral imaging. Both eyes are detected using RED in the approximate candidate region that consists of the binocular region, which is determined by the Adaboost detector. Second, we classify the detected eyes into the left and right eyes, because the iris patterns in the left and right eyes in the same person are different, and they are therefore considered as different classes. We can improve the accuracy of iris recognition using this pre-classification of the left and right eyes. Third, by measuring the angle of head roll using the two center positions of the left and right pupils, detected by two circular edge detectors, we obtain the information of the iris rotation angle. Fourth, in order to reduce the error and processing time of iris recognition, adaptive bit-shifting based on the measured iris rotation angle is used in feature matching. Fifth, the recognition accuracy is enhanced by the score fusion of the left and right irises. Experimental results on the iris open database of low-resolution images showed that the

  14. Performance Recognition for Sulphur Flotation Process Based on Froth Texture Unit Distribution

    Directory of Open Access Journals (Sweden)

    Mingfang He

    2013-01-01

    Full Text Available As an important indicator of flotation performance, froth texture is believed to be related to operational condition in sulphur flotation process. A novel fault detection method based on froth texture unit distribution (TUD is proposed to recognize the fault condition of sulphur flotation in real time. The froth texture unit number is calculated based on texture spectrum, and the probability density function (PDF of froth texture unit number is defined as texture unit distribution, which can describe the actual textual feature more accurately than the grey level dependence matrix approach. As the type of the froth TUD is unknown, a nonparametric kernel estimation method based on the fixed kernel basis is proposed, which can overcome the difficulty when comparing different TUDs under various conditions is impossible using the traditional varying kernel basis. Through transforming nonparametric description into dynamic kernel weight vectors, a principle component analysis (PCA model is established to reduce the dimensionality of the vectors. Then a threshold criterion determined by the TQ statistic based on the PCA model is proposed to realize the performance recognition. The industrial application results show that the accurate performance recognition of froth flotation can be achieved by using the proposed method.

  15. Facial Action Unit Recognition under Incomplete Data Based on Multi-label Learning with Missing Labels

    KAUST Repository

    Li, Yongqiang

    2016-07-07

    Facial action unit (AU) recognition has been applied in a wild range of fields, and has attracted great attention in the past two decades. Most existing works on AU recognition assumed that the complete label assignment for each training image is available, which is often not the case in practice. Labeling AU is expensive and time consuming process. Moreover, due to the AU ambiguity and subjective difference, some AUs are difficult to label reliably and confidently. Many AU recognition works try to train the classifier for each AU independently, which is of high computation cost and ignores the dependency among different AUs. In this work, we formulate AU recognition under incomplete data as a multi-label learning with missing labels (MLML) problem. Most existing MLML methods usually employ the same features for all classes. However, we find this setting is unreasonable in AU recognition, as the occurrence of different AUs produce changes of skin surface displacement or face appearance in different face regions. If using the shared features for all AUs, much noise will be involved due to the occurrence of other AUs. Consequently, the changes of the specific AUs cannot be clearly highlighted, leading to the performance degradation. Instead, we propose to extract the most discriminative features for each AU individually, which are learned by the supervised learning method. The learned features are further embedded into the instance-level label smoothness term of our model, which also includes the label consistency and the class-level label smoothness. Both a global solution using st-cut and an approximated solution using conjugate gradient (CG) descent are provided. Experiments on both posed and spontaneous facial expression databases demonstrate the superiority of the proposed method in comparison with several state-of-the-art works.

  16. Institutional Development to Build a Succesfull Local Collective Action in Forest Management from Arau Watershed Unit

    Directory of Open Access Journals (Sweden)

    Nursidah Nursidah

    2012-04-01

    Full Text Available The study was aimed to build institution model of sustainable forest management, through analysis of action arena, community attributes and forest management rules in Arau Watershed Unit Management Area.  To achieve sustainable forest management, recognition and incorporation of local institutions in forest policy formulation is very important because it had great potential for collective action and had characteristics of common pools resources sustainable management needed.  To achieve a successful local collective action, the institution must be had: the rules in use suitable with local community norms; the organization has power to give reward and punishment as well as recognized and respected by society; specific management according location; rules of the game was made participatory; there are economic incentives for owners and users; there is an instrument for controlling sustainable use; and conflict resolution through negotiations to reach an concencus agreement.  The finding of institutional models  analysis  show  that  co-management  model  between government and local communities, called Nagari Forest Management Model is more suitable, because it gives greater opportunities for indigenous rights recognition to communal forest, until the capacity of villages get better, then the choice of forest management can be shifted into Nagari Community Based Forest Management Model.Keywords: sustainable forest management, institution, collective action, nagari

  17. Implementing a Nurse Manager Profile to Improve Unit Performance.

    Science.gov (United States)

    Krugman, Mary E; Sanders, Carolyn L

    2016-06-01

    Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

  18. 50 CFR 600.320 - National Standard 3-Management Units.

    Science.gov (United States)

    2010-10-01

    .... Wherever practicable, an FMP should seek to manage interrelated stocks of fish. (c) Unity of management... management exits or is planned for a separate geographic area or for a distinct use of the stocks, or if the... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false National Standard 3-Management Units....

  19. Analysis, Interpretation, and Recognition of Facial Action Units and Expressions Using Neuro-Fuzzy Modeling

    CERN Document Server

    Khademi, Mahmoud; Manzuri-Shalmani, Mohammad T; Kiaei, Ali A

    2010-01-01

    In this paper an accurate real-time sequence-based system for representation, recognition, interpretation, and analysis of the facial action units (AUs) and expressions is presented. Our system has the following characteristics: 1) employing adaptive-network-based fuzzy inference systems (ANFIS) and temporal information, we developed a classification scheme based on neuro-fuzzy modeling of the AU intensity, which is robust to intensity variations, 2) using both geometric and appearance-based features, and applying efficient dimension reduction techniques, our system is robust to illumination changes and it can represent the subtle changes as well as temporal information involved in formation of the facial expressions, and 3) by continuous values of intensity and employing top-down hierarchical rule-based classifiers, we can develop accurate human-interpretable AU-to-expression converters. Extensive experiments on Cohn-Kanade database show the superiority of the proposed method, in comparison with support vect...

  20. Recognition and management of children with protracted bacterial bronchitis.

    Science.gov (United States)

    Paul, Siba P; Sanapala, Swathi; Bhatt, Jayesh M

    2015-07-01

    Chronic moist cough in children can be associated with serious pathologies. Protracted bacterial bronchitis remains a clinical diagnosis causing persistent moist cough, disturbed sleep, exercise intolerance and significant levels of morbidity. Management involves minimal investigations and prolonged courses of antibiotics.

  1. The diabetic foot: recognition and principles of management

    African Journals Online (AJOL)

    laboratory tests. • skin temperature ... Full blood count for the exclusion of anaemia. ... as set out by the International Working. Group on ... The steps of successful management include the following: ... rehabilitation whenever possible. Surgery.

  2. Recognition and management of asthma in children and young people.

    Science.gov (United States)

    Pinfield, Jenny; Gaskin, Kerry; Bentley, Jackie; Rouse, Jo

    2015-09-16

    Asthma is a common childhood disorder that has global significance. Developing an understanding of the aetiology, effects, diagnosis and management of the disorder enables healthcare practitioners to reduce the physical, psychological and social effects of asthma on children, families and healthcare systems. This article refers to the Scottish Intercollegiate Guidelines Network and British Thoracic Society guideline on the management of asthma, and enables the reader to incorporate this guidance into their practice.

  3. Recognition and management of autonomic dysreflexia in pediatric spinal cord injury.

    Science.gov (United States)

    McGinnis, Katrina B; Vogel, Lawrence C; McDonald, Craig M; Porth, Susan; Hickey, Kathryn J; Davis, Monica; Bush, Pat; Jenkins, Diane

    2004-01-01

    Autonomic dysreflexia (AD) is a well-documented complication of spinal cord injury (SCI) at or above the T6 level. However, research into AD has focused primarily on the adult. Because research that involves children with SCI is scarce, current guidelines may not be appropriate for children. Therefore, many episodes of AD may be unrecognized or inappropriately treated. To address this issue, Shriners Hospitals for Children undertook the development of a protocol specific to children and adolescents. A task force was developed to look at current literature on AD and blood pressure in children. Utilizing this literature and consensus among the task force members, the tools necessary to treat children with SCI at risk for AD were developed. The task force developed several products intended to assist in the recognition and management of AD. These include an event flow sheet for recording incidents of AD, a letter for the child's school or primary care physician that provides a brief summary of AD and the child's baseline blood pressure, and a policy/protocol with 2 age-specific algorithms to standardize interventions across the 3 Shriners Hospitals in the United States with SCI programs (California, Illinois, and Pennsylvania). The Shriners Hospitals for Children Task Force on Autonomic Dysreflexia in Children with Spinal Cord Injury has developed several tools specific to children. However, many questions remain to be answered concerning blood pressure norms and the clinical presentation of AD in children.

  4. Management of inpatient aggression in forensic mental health nursing : the application of the Early Recognition Method

    NARCIS (Netherlands)

    Fluttert, F.A.J.

    2011-01-01

    Management of Inpatient Aggression in Forensic Mental Health Nursing. The application of the Early Recognition Method. Forensic mental health nurses take care of forensic patients convicted for an offense for which they were assessed not to be fully accountable due to their psychiatric disorder. For

  5. Risk Management: Earning Recognition with an Automated Safety Program

    Science.gov (United States)

    Lansberry, Linden; Strasburger, Tom

    2012-01-01

    Risk management is a huge task that requires diligent oversight to avoid penalties, fines, or lawsuits. Add in the burden of limited resources that schools face today, and the challenge of meeting the required training, reporting, compliance, and other administrative issues associated with a safety program is almost insurmountable. Despite an…

  6. Risk Management: Earning Recognition with an Automated Safety Program

    Science.gov (United States)

    Lansberry, Linden; Strasburger, Tom

    2012-01-01

    Risk management is a huge task that requires diligent oversight to avoid penalties, fines, or lawsuits. Add in the burden of limited resources that schools face today, and the challenge of meeting the required training, reporting, compliance, and other administrative issues associated with a safety program is almost insurmountable. Despite an…

  7. Recognition and management of seizures in children in emergency departments.

    Science.gov (United States)

    Caplan, Edward; Dey, Indranil; Scammell, Andrea; Burnage, Katy; Paul, Siba Prosad

    2016-09-01

    Seizure is defined as 'a sudden surge of electrical activity in the brain, which usually affects how a person appears or acts for a short time'. Children who have experienced seizures commonly present to emergency departments (EDs), and detailed history taking will usually help differentiate between epileptic and non-epileptic events. ED nurses are often the first health professionals to manage children with seizures, and this is best done by following the ABCDE approach. Treatment involves termination of seizures with anticonvulsants, and children may need other symptomatic management. Seizures in children can be an extremely distressing experience for parents, who should be supported and kept informed by experienced ED nurses. Nurses also play a vital role in educating parents on correct administration of anticonvulsants and safety advice. This article discusses the aetiology, clinical presentation, diagnosis and management of children with seizures, with particular emphasis on epilepsy. It includes two reflective case studies to highlight the challenges faced by healthcare professionals managing children who present with convulsions.

  8. Recognition and management of febrile convulsion in children.

    Science.gov (United States)

    Paul, Siba Prosad; Kirkham, Emily Natasha; Shirt, Bethany

    2015-08-26

    Febrile convulsion is characterised by convulsion associated with fever in an infant or child aged between six months and six years. The febrile illness causing the convulsion should not be secondary to an intracranial infection (meningitis or encephalitis) or acute electrolyte imbalance. Most cases of febrile convulsion are short lived and self-terminating. However, a few cases of prolonged febrile convulsion may need anticonvulsant medication to stop the seizure. Management is mainly symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion. Referral to paediatric neurologists may be necessary in cases of complex or recurrent febrile convulsion, or in those where a pre-existing neurological disorder exists. One third of children will develop a further febrile convulsion during subsequent febrile illness. Nurses have a vital role in managing children with febrile convulsion, educating parents about the condition and dispelling myths. This article outlines the presentation, management, investigations and prognosis for febrile convulsion, indicating how nurses working in different clinical areas can help to manage this common childhood condition.

  9. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-02-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  10. Biochemical recurrence of prostate cancer: the controversial recognition and management

    Institute of Scientific and Technical Information of China (English)

    XIA Shu-jie; JING Yi-feng

    2011-01-01

    @@ Over the past decaade, more and more patients diagnosed as prostate cancer have received radical management attributing to the advent of prostate-specific antigen (PSA) based medical screening.Radical prostatectomy (RP) and radiation therapy (RT) are the most commonly used forms of definitive therapy for clinically localized prostate cancer.However, despite these technique advances, biochemical recurrence (BCR),as determined by subsequent rises in the serum PSA level,is still a challenge that urologists face.

  11. Toxicities of chimeric antigen receptor T cells: recognition and management.

    Science.gov (United States)

    Brudno, Jennifer N; Kochenderfer, James N

    2016-06-30

    Chimeric antigen receptor (CAR) T cells can produce durable remissions in hematologic malignancies that are not responsive to standard therapies. Yet the use of CAR T cells is limited by potentially severe toxicities. Early case reports of unexpected organ damage and deaths following CAR T-cell therapy first highlighted the possible dangers of this new treatment. CAR T cells can potentially damage normal tissues by specifically targeting a tumor-associated antigen that is also expressed on those tissues. Cytokine release syndrome (CRS), a systemic inflammatory response caused by cytokines released by infused CAR T cells can lead to widespread reversible organ dysfunction. CRS is the most common type of toxicity caused by CAR T cells. Neurologic toxicity due to CAR T cells might in some cases have a different pathophysiology than CRS and requires different management. Aggressive supportive care is necessary for all patients experiencing CAR T-cell toxicities, with early intervention for hypotension and treatment of concurrent infections being essential. Interleukin-6 receptor blockade with tocilizumab remains the mainstay pharmacologic therapy for CRS, though indications for administration vary among centers. Corticosteroids should be reserved for neurologic toxicities and CRS not responsive to tocilizumab. Pharmacologic management is complicated by the risk of immunosuppressive therapy abrogating the antimalignancy activity of the CAR T cells. This review describes the toxicities caused by CAR T cells and reviews the published approaches used to manage toxicities. We present guidelines for treating patients experiencing CRS and other adverse events following CAR T-cell therapy.

  12. Research on Risks Recognition and Management of Contractor on the Design Construction Pattern of Contract

    Institute of Scientific and Technical Information of China (English)

    杨鹏飞

    2013-01-01

    By combining with the implementation in expressway of traffic branch’s test point of design construction pattern of contract,the paper illustrates the risks from the bidding,the design of the construction graphic,the process dynamic design and construction process,the recognition of the unpredictable risks,the risk recognition,the evaluation,the prevention and the control of the risk management,so as to seek for the method which can be favorable for improving the design construction contract.

  13. Women and Ischemic Heart Disease: Recognition, Diagnosis and Management.

    Science.gov (United States)

    Park, Seong-Mi; Merz, C Noel Bairey

    2016-07-01

    Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.

  14. Recognition and management of respiratory dysfunction in children with tetraplegia.

    Science.gov (United States)

    Porth, Susan C

    2004-01-01

    Children less than 15 years of age comprise approximately 3% to 5% of all new spinal injuries each year. Approximately one third of these children sustain injuries to the cervical spine. Respiratory complications of spinal cord injuries at the level of C5 and above may include diaphragm dysfunction, retained airway secretions, recurrent aspiration, nocturnal hypoventilation, and respiratory failure. Although most newly injured children with cervical injuries above the level of C5 will require mechanical ventilation acutely, many eventually will be able to be weaned from technology. Despite their ability to breathe without mechanical support, these children often develop ongoing issues associated with respiratory compromise, which interfere with daily activities and can negatively affect quality of life. Poor endurance, failure to thrive, recurrent pneumonia, and sleep-disordered breathing all may be indications of significant respiratory dysfunction. This article describes assessment tools and management strategies aimed at supporting optimal health and preventing recurrent complications associated with unrecognized or untreated respiratory dysfunction.

  15. The greatest recognition to the scientist Nikola Tesla: Award of the unit for magnetic induction (T in the international system of units (SI

    Directory of Open Access Journals (Sweden)

    Spaić Gordana

    2006-01-01

    Full Text Available The paper describes the reasons and results that led to the greatest recognition that a scientist can achieve, his name Tesla given to a unit in the field of electricity and magnetism in the International System of Units (SI. The difficulties on the way from a proposal to its final adoption through different Technical and Experts Committees of the International Electro technical Commission (IEC and of the International Committee on Weights and Measures are described. Some examples for the usage of the "tesla" unit are mentioned.

  16. Dual recognition unit strategy improves the specificity of the adenosine triphosphate (ATP) aptamer biosensor for cerebral ATP assay.

    Science.gov (United States)

    Yu, Ping; He, Xiulan; Zhang, Li; Mao, Lanqun

    2015-01-20

    Adenosine triphosphate (ATP) aptamer has been widely used as a recognition unit for biosensor development; however, its relatively poor specificity toward ATP against adenosine-5'-diphosphate (ADP) and adenosine-5'-monophosphate (AMP) essentially limits the application of the biosensors in real systems, especially in the complex cerebral system. In this study, for the first time, we demonstrate a dual recognition unit strategy (DRUS) to construct a highly selective and sensitive ATP biosensor by combining the recognition ability of aptamer toward A nucleobase and of polyimidazolium toward phosphate. The biosensors are constructed by first confining the polyimidazolium onto a gold surface by surface-initiated atom transfer radical polymerization (SI-ATRP), and then the aptamer onto electrode surface by electrostatic self-assembly to form dual-recognition-unit-functionalized electrodes. The constructed biosensor based on DRUS not only shows an ultrahigh sensitivity toward ATP with a detection limit down to the subattomole level but also an ultrahigh selectivity toward ATP without interference from ADP and AMP. The constructed biosensor is used for selective and sensitive sensing of the extracellular ATP in the cerebral system by combining in vivo microdialysis and can be used as a promising neurotechnology to probing cerebral ATP concentration.

  17. United nations Supported principles for Responsible Management Education

    DEFF Research Database (Denmark)

    Godemann, Jasmin; Moon, Jeremy; Haertle, Jonas

    2014-01-01

    and various ecological system crises. The United Nations supported Principles for Responsible Management Education (PRME) initiative is an important catalyst for the transformation of management education and a global initiative to change and reform management education in order to meet the increasing......The expectation that management education institutions should be leading thought and action on issues related to corporate responsibility and sustainability has been reinforced in the light of their association with business leaders' failings, including corporate corruption, the financial crisis...

  18. Complications of laparoscopic pelvic surgery: recognition, management and prevention.

    Science.gov (United States)

    Li, T C; Saravelos, H; Richmond, M; Cooke, I D

    1997-01-01

    Laparoscopic surgery has many advantages but it is not without complications. The complexity of the surgery significantly influences the complication rate. Laparoscopic surgeons ought to be aware of the possible complications and how they could be prevented, recognized without delay, and managed safely and efficiently. Important complications include injuries to the vessels, bowel and urinary tract. Incisional hernia ought to be reduced by careful closure of the fascia whenever a trocar > or =10 mm is used at the extraumbilical site. Gas embolism is a rare but potentially life threatening complication. Shoulder pain is a minor complication but is exceedingly common; it is less likely to occur if as much gas as possible is removed at the end of the operation while the patient is still in head down Trendelenburg position. Rare complications include pneumothorax, subcutaneous and pre-peritoneal emphysema, cardiac arrhythmia, nerve injury and venous thrombosis. Laparoscopic surgeons should also understand the principles of electrosurgery and how to avoid complications arising from the use of electrical energy including capacitative coupling, direct coupling and insulation failure.

  19. Small Unit Management Project : 1990 : Cooperator Report

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The goal of this project is to determine the recruitment potential of mallards and other dabbling ducks for use in assessing the effectiveness of management...

  20. Difficult asthma in adults: recognition and approaches to management.

    Science.gov (United States)

    Harrison, B D W

    2005-09-01

    Difficult asthma must be distinguished from severe asthma. It is then important in patients with suspected difficult asthma to ensure that the diagnosis is correct, and that if the patient has asthma that the attributed symptoms are indeed all genuinely due to the asthma and not to coexisting physical or psychogenic respiratory conditions. It is also important to be alert when there is discordance between symptoms and objective lung function in order to recognize both poor perceivers and over-reactors. Difficult asthma can occur in patients with objectively mild, moderate or severe disease, but the consequences are most dramatic in patients with severe asthma. Asthma may be difficult for the patient, for the clinician or both because of disease factors, doctor or nurse therapist factors, and/or patient factors. Investigation requires access to the full range of respiratory, imaging and allergy tests. It also requires a multidisciplinary approach involving ear, nose and throat specialists and speech therapists, and access to psychiatric and psychological assessment and therapies. Poor compliance is associated with significantly poorer asthma and asthma-related health outcomes. Poor compliance can be recognized in two-thirds of such patients by their not attending scheduled appointments. Poor compliance is significantly associated with anxiety, social deprivation and adverse family circumstances, and these characteristics and adversities probably contribute to the poorly compliant behaviour. In difficult asthma it is important to identify and manage the condition causing the symptoms rather than prescribing more and more asthma therapy. Recognizing psychosocial adversity is essential. A structured approach is essential. There remains a small number of patients with genuine steroid-resistant asthma, some with predominately neutrophilic rather than eosinophilic airway inflammation, and others for whom the secondary gain of continuing symptoms is overwhelming. There is

  1. Electrophysiological Correlates of Familiarity and Recollection in Associative Recognition: Contributions of Perceptual and Conceptual Processing to Unitization.

    Science.gov (United States)

    Li, Bingcan; Mao, Xinrui; Wang, Yujuan; Guo, Chunyan

    2017-01-01

    It is generally accepted that associative recognition memory is supported by recollection. In addition, recent research indicates that familiarity can support associative memory, especially when two items are unitized into a single item. Both perceptual and conceptual manipulations can be used to unitize items, but few studies have compared these two methods of unitization directly. In the present study, we investigated the effects of familiarity and recollection on successful retrieval of items that were unitized perceptually or conceptually. Participants were instructed to remember either a Chinese two-character compound or unrelated word-pairs, which were presented simultaneously or sequentially. Participants were then asked to recognize whether word-pairs were intact or rearranged. Event-related potential (ERP) recordings were performed during the recognition phase of the study. Two-character compounds were better discriminated than unrelated word-pairs and simultaneous presentation was found to elicit better discrimination than sequential presentation for unrelated word-pairs only. ERP recordings indicated that the early intact/rearranged effects (FN400), typically associated with familiarity, were elicited in compound word-pairs with both simultaneous and sequential presentation, and in simultaneously presented unrelated word-pairs, but not in sequentially presented unrelated word-pairs. In contrast, the late positive complex (LPC) effects associated with recollection were elicited in all four conditions. Together, these results indicate that while the engagement of familiarity in associative recognition is affected by both perceptual and conceptual unitization, conceptual unitization promotes a higher level of unitization (LOU). In addition, the engagement of recollection was not affected by unitized manipulations. It should be noted, however, that due to experimental design, the effects presented here may be due to semantic rather than episodic memory and

  2. Refuge Management Plan: Sandstone Unit Rice Lake National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Part I of this management plan for the Sandstone Unit of Rice Lake NWR summarizes background information on the location, history, environment, resources,...

  3. The Holistic Leadership Model and the Nurse Unit Manager ...

    African Journals Online (AJOL)

    1Neonatal intensive care unit at Rwanda Military Hospital. 2University of ... Keywords: Nurse; nursing practice; leadership; management; caring; competencies; holistic nursing ... indicators of a profession's advancement or lack thereof.

  4. Initial Survey Instructions for management unit water monitoring : level

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Initial survey instructions for 1.08 management unit water monitoring (level) survey on Fish Springs National Wildlife Refuge. This survey is conducted weekly and is...

  5. The death of marriage? The effects of new forms of legal recognition on marriage rates in the United States.

    Science.gov (United States)

    Dillender, Marcus

    2014-04-01

    Some conservative groups argue that allowing same-sex couples to marry reduces the value of marriage to opposite-sex couples. This article examines how changes in U.S. legal recognition laws occurring between 1995 and 2010 designed to include same-sex couples have altered marriage rates in the United States. Using a difference-in-differences strategy that compares how marriage rates change after legal recognition in U.S. states that alter legal recognition versus states that do not, I find no evidence that allowing same-sex couples to marry reduces the opposite-sex marriage rate. Although the opposite-sex marriage rate is unaffected by same-sex couples marrying, it decreases when domestic partnerships are available to opposite-sex couples.

  6. Modeling words with subword units in an articulatorily constrained speech recognition algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Hogden, J.

    1997-11-20

    The goal of speech recognition is to find the most probable word given the acoustic evidence, i.e. a string of VQ codes or acoustic features. Speech recognition algorithms typically take advantage of the fact that the probability of a word, given a sequence of VQ codes, can be calculated.

  7. Identification of management units using population genetic data

    NARCIS (Netherlands)

    Palsboll, Per J.; Berube, Martine; Allendorf, Fred W.

    2007-01-01

    The identification of management units (MUs) is central to the management of natural populations and is crucial for monitoring the effects of human activity upon species abundance. Here, we propose that the identification of MUs from population genetic data should be based upon the amount of genetic

  8. Orchard Business Management. Unit II. Management and Analysis of the Orchard Operation.

    Science.gov (United States)

    Mullinix, Shauna K.

    This guide is intended for use in providing in-depth formal classroom and on-site instruction in the principles of business and financial management as they apply to operating and managing orchards. Designed to be used with an accompanying Orchard Business Management Record Book, this unit is devoted to management and analysis of an orchard…

  9. Orchard Business Management. Unit II. Management and Analysis of the Orchard Operation.

    Science.gov (United States)

    Mullinix, Shauna K.

    This guide is intended for use in providing in-depth formal classroom and on-site instruction in the principles of business and financial management as they apply to operating and managing orchards. Designed to be used with an accompanying Orchard Business Management Record Book, this unit is devoted to management and analysis of an orchard…

  10. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira

    2015-12-01

    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  11. Health care units and human resources management trends.

    Science.gov (United States)

    André, Adriana Maria; Ciampone, Maria Helena Trench; Santelle, Odete

    2013-02-01

    To identify factors producing new trends in basic health care unit management and changes in management models. This was a prospective study with ten health care unit managers and ten specialists in the field of Health in São Paulo, Southeastern Brazil, in 2010. The Delphi methodology was adopted. There were four stages of data collection, three quantitative and the fourth qualitative. The first three rounds dealt with changing trends in management models, manager profiles and required competencies, and the Mann-Whitney test was used in the analysis. The fourth round took the form of a panel of those involved, using thematic analysis. The main factors which are driving change in basic health care units were identified, as were changes in management models. There was consensus that this process is influenced by the difficulties in managing teams and by politics. The managers were found to be up-to-date with trends in the wider context, with the arrival of social health organizations, but they are not yet anticipating these within the institutions. Not only the content, but the professional development aspect of training courses in this area should be reviewed. Selection and recruitment, training and assessment of these professionals should be guided by these competencies aligned to the health service mission, vision, values and management models.

  12. Characteristics of the nurse manager's recognition behavior and its relation to sense of coherence of staff nurses in Japan.

    Science.gov (United States)

    Miyata, Chiharu; Arai, Hidenori; Suga, Sawako

    2015-01-01

    The recognition behaviors strongly influence the job satisfaction of staff nurses and an extremely important factor for the prevention of burnout and the promotion of retention. Additionally, among internal factors that may affect worker's mental health, a sense of coherence (SOC) is an important concept from the view of the salutogenic theory and stress recognition style. Individual's SOC increases in relation to recognition behavior. However, in Japan, few studies have examined the effect of recognition behaviors on the SOC of staff nurses. The purpose of this study was to investigate how staff nurses perceive recognition behaviors of the nurse manager and to determine the relationship between recognition behaviors and the staff nurses' SOC. This quantitative, cross-sectional study involved 10 hospitals in Japan. A total of 1425 nurses completed the questionnaire. As a result, the perceptions of nurse manager's recognition behaviors by staff nurses were evaluated by presentation and report, individual value and the transfer of responsibility, and professional development. The median score of staff nurse SOC-13 was 50 (IQR; 45-55). Significant differences in SOC scores were found in marital status, age, years of experience, and mental and physical health condition. In conclusion, recognition behaviors by the nurse manager can improve staff nurse's SOC and effectively support the mental health of the staff nurse.

  13. Crosstalk Suppression in Header Recognition Unit Using Time-Space Conversion

    Institute of Scientific and Technical Information of China (English)

    Hideaki Furukawa; Tsuyoshi Konishi; Yoshinori Oshita; Wanji Yu; Kazuyoshi Itoh; Yoshiki Ichioka

    2003-01-01

    We demonstrate a suppression effect of a crosstalk among a target and similar header signals using the header recognition filter designed by a design technique of the multiple-object discriminant filter.

  14. Genomic Relatedness Strengthens Genetic Connectedness Across Management Units.

    Science.gov (United States)

    Yu, Haipeng; Spangler, Matthew L; Lewis, Ronald M; Morota, Gota

    2017-08-31

    Genetic connectedness refers to a measure of genetic relatedness across management units (e.g., herds and flocks). With the presence of high genetic connectedness in management units, best linear unbiased prediction (BLUP) is known to provide reliable comparisons between genetic values. Genetic connectedness has been studied for pedigree-based BLUP; however, relatively little attention has been paid to using genomic information to measure connectedness. In this study, we assessed genome-based connectedness across management units by applying prediction error variance of difference (PEVD), coefficient of determination (CD), and prediction error correlation (r) to a combination of computer simulation and real data (mice and cattle). We found that genomic information (G) increased the estimate of connectedness among individuals from different management units compared to that based on pedigree (A). A disconnected design benefited the most. In both datasets, PEVD and CD statistics inferred increased connectedness across units when using G- rather than A-based relatedness suggesting stronger connectedness. With r once using allele frequencies equal to one-half or scaling G to values between 0 and 2, which is intrinsic to A, connectedness also increased with genomic information. However, PEVD occasionally increased, and r decreased when obtained using the alternative form of G, instead suggesting less connectedness. Such inconsistencies were not found with CD. We contend that genomic relatedness strengthens measures of genetic connectedness across units and has the potential to aid genomic evaluation of livestock species. Copyright © 2017, G3: Genes, Genomes, Genetics.

  15. Managing Highway Maintenance: Instructor's Manual for Management by Objectives Review, Unit 11, All Levels.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit is designed for the training group leader and contains selected highlights and suggested discussion questions from six units of training: maintenance activities, work units, and classifying work; maintenance feature inventories; how to conduct a maintenance feature inventory;…

  16. Target-context unitization effect on the familiarity-related FN400: a face recognition exclusion task.

    Science.gov (United States)

    Guillaume, Fabrice; Etienne, Yann

    2015-03-01

    Using two exclusion tasks, the present study examined how the ERP correlates of face recognition are affected by the nature of the information to be retrieved. Intrinsic (facial expression) and extrinsic (background scene) visual information were paired with face identity and constituted the exclusion criterion at test time. Although perceptual information had to be taken into account in both situations, the FN400 old-new effect was observed only for old target faces on the expression-exclusion task, whereas it was found for both old target and old non-target faces in the background-exclusion situation. These results reveal that the FN400, which is generally interpreted as a correlate of familiarity, was modulated by the retrieval of intra-item and intrinsic face information, but not by the retrieval of extrinsic information. The observed effects on the FN400 depended on the nature of the information to be retrieved and its relationship (unitization) to the recognition target. On the other hand, the parietal old-new effect (generally described as an ERP correlate of recollection) reflected the retrieval of both types of contextual features equivalently. The current findings are discussed in relation to recent controversies about the nature of the recognition processes reflected by the ERP correlates of face recognition.

  17. [Operational units for health risk management (patient safety)].

    Science.gov (United States)

    Pardo Hernández, A; Claveria Fontán, A; García Urbaneja, M; López Barba, J

    2008-12-01

    In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services.

  18. Practitioner Perceptions of Adaptive Management Implementation in the United States

    Directory of Open Access Journals (Sweden)

    Melinda Harm. Benson

    2013-09-01

    Full Text Available Adaptive management is a growing trend within environment and natural resource management efforts in the United States. While many proponents of adaptive management emphasize the need for collaborative, iterative governance processes to facilitate adaptive management, legal scholars note that current legal requirements and processes in the United States often make it difficult to provide the necessary institutional support and flexibility for successful adaptive management implementation. Our research explores this potential disconnect between adaptive management theory and practice by interviewing practitioners in the field. We conducted a survey of individuals associated with the Collaborative Adaptive Management Network (CAMNet, a nongovernmental organization that promotes adaptive management and facilitates in its implementation. The survey was sent via email to the 144 participants who attended CAMNet Rendezvous during 2007-2011 and yielded 48 responses. We found that practitioners do feel hampered by legal and institutional constraints: > 70% of respondents not only believed that constraints exist, they could specifically name one or more examples of a legal constraint on their work implementing adaptive management. At the same time, we found that practitioners are generally optimistic about the potential for institutional reform.

  19. Managing Highway Maintenance: Maintenance Management--by Objectives, Unit 10, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit deals with management by objectives--its definition, how it works, and necessary steps for application. It is designed for maintenance supervisors who are familiar with maintenance management systems. The format is a programed, self-instructional approach in which questions are…

  20. Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings.

    Science.gov (United States)

    Dowding, Dawn; Lichtner, Valentina; Allcock, Nick; Briggs, Michelle; James, Kirstin; Keady, John; Lasrado, Reena; Sampson, Elizabeth L; Swarbrick, Caroline; José Closs, S

    2016-01-01

    The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n=31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n=56) and informal open conversations with staff and carers (family members). Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour. We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the

  1. Facial Action Unit Recognition using Temporal Templates and Particle Filtering with Factorized Likelihoods

    NARCIS (Netherlands)

    Valstar, Michel; Pantic, Maja; Patras, Ioannis

    2005-01-01

    Automatic recognition of human facial expressions is a challenging problem with many applications in human-computer interaction. Most of the existing facial expression analyzers succeed only in recognizing a few basic emotions, such as anger or happiness. In contrast, the system we wish to demonstra

  2. Seminar on Sanitation for Restaurant Owners and Managers. Unit II.

    Science.gov (United States)

    Threlkeld, Joyce C.

    Intended for use in conducting short seminars on sanitation for restaurant owners and managers, unit two of the curriculum guide is organized to provide four hours of classroom instruction. Four major concepts are emphasized. The first concept, providing sanitary conditions in food service establishments, discusses safe use and storage of cleaning…

  3. Managing Highway Maintenance: Budget Preparation, Unit 9, Level 3.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit describes the essential steps in developing a maintenance budget, or performance budget, based on the work to be done. It is designed for field engineers and supervisors who assist department officials in preparing work programs and budgets. The format is a programed,…

  4. Managing a surgical unit using google drive - a feasibility study

    Directory of Open Access Journals (Sweden)

    Ashley Solomon C.

    2016-10-01

    Conclusions: It is feasible to use google drive as a patient management system by a surgical unit to organise work. This system is efficient, secure and cost effective. [Int J Res Med Sci 2016; 4(10.000: 4365-4369

  5. Management of mycetoma: major challenge in tropical mycoses with limited international recognition.

    Science.gov (United States)

    Ahmed, Abdalla A O; van de Sande, Wendy W J; Fahal, Ahmed; Bakker-Woudenberg, Irma; Verbrugh, Henri; van Belkum, Alex

    2007-04-01

    The present review highlights an orphan infectious disease in alarming need of international recognition. While money is being invested to develop new broad-spectrum antimicrobial drugs to treat infection in general, improvement in the management of complicated infections such as mycetoma receives little support. Many case presentations describe single-center experience in the management of mycetoma. Unfortunately, randomized and blinded clinical studies into the efficacy of antimicrobial treatment are desperately lacking. Response to medical treatment is usually better in actinomycetoma than eumycetoma. Eumycetoma is difficult to treat using current therapies. Surgery in combination with azole treatment is the recommended regimen for small eumycetoma lesions in the extremities. Bone involvement complicates clinical management, leaving surgical amputation as the only treatment option. Although clinical management has not received major attention recently, laboratory technology has improved in areas of molecular diagnosis and epidemiology. Management of mycetoma and laboratory diagnosis of its etiological agents need to be improved and better implemented in endemic regions. Optimized therapeutic approaches and more detailed epidemiological data are urgently needed. It is vital to initiate multicenter collaborations on national and international levels to develop consensus clinical score sheets and state-of-the-art treatment regimens for mycetoma patients.

  6. Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses.

    Science.gov (United States)

    Cho, Ok Min; Kim, Hwasoon; Lee, Young Whee; Cho, Insook

    2016-01-01

    The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 ± 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

  7. Rural nursing unit managers: education and support for the role.

    Science.gov (United States)

    Paliadelis, Penny S

    2005-01-01

    Nursing unit managers (NUMs) occupy the often unenviable position of first-line management in many health services in Australia. As such, their role is complex and multifaceted requiring an intertwining of their clinical and managerial responsibilities. While there is an abundance of studies that explore and describe the various management roles in many professions and industries, little is known about the experiences of nurses as managers, particularly in rural settings. This article focuses on the education and support needs of rural nursing unit managers. A qualitative study design was used to explore the stories of a number of nursing unit managers in rural New South Wales, Australia. Data was collected using semi-structured individual interviews. Data was analysed using a voice-relational method as a framework for more clearly hearing the voices of participants. This method of data analysis is particularly useful for hearing from those who do not usually have a 'strong' voice, for gaining an understanding of the context of the interviews, and for acknowledging the role of the researcher in the research process. All NUMs employed in a single regional health authority in rural Australia were invited to participate. Out of 42 NUMs in the region, 20 agreed to be interviewed. Nursing unit managers were asked to reflect on their experiences prior to and during the early days within the position. In summary, all the NUMs: believed they were promoted because of their clinical expertise; felt unprepared for the managerial and administrative aspects of their role; continued to identify as nurses rather than as managers; found the role isolated them from their former peer group. Those employed in small facilities had limited opportunities for education and peer support. Based on the NUMs' experiences and suggestions, the following information would have helped them to cope with the demands of their new role: information and discussions about the role expectations of

  8. Roles of mammalian structural units, ligand cluster and polyvalency in the Abrus precatorius agglutinin and glycoprotein recognition process.

    Science.gov (United States)

    Wu, Albert M; Wu, June H; Liu, Jia-Hau; Chen, Yuen-Yuen; Singha, Biswajit; Chow, Lu-Ping; Lin, Jung-Yaw

    2009-10-01

    Previous studies on one of the toxic type 2 ribosome inactivating proteins (RIP), Abrus precatorius agglutinin (APA), have shown that the recognition domains of APA are restricted to monomers of Galbeta1-3GalNAc (T, Thomsen-Friedenreich glycotope) and Galbeta1-3/4GlcNAc (blood group precursor type I/II sequences); which are essential but play a minor role in the recognition process. In this study, APA recognition factors were expanded to include ligand clusters and polyvalent glycotopes by enzyme-linked lectinosorbent binding and inhibition assays. Based on the results of molar relative potency, the essential mammalian structural units are Galbeta1-3GalNAcalpha/beta1- (T(alpha)/T(beta))>Galalpha1-4Gal (E)>Galbeta1-3/4GlcNAc (I/II) and avidity for tri-/di-antennary II(beta), T, E and II monomers was found to be 7.1 x 10(2), 4.0, 5.5, 3.7 and 2.4 times higher than monomeric Gal. Among natural polyvalent glycotopes or clusters, high-density polyvalent T(alpha) and complex multivalent I(beta)/II(beta) glycotopes greatly enhanced the affinity for APA over 10(4) times. Based on these results, it is concluded that contribution of monomeric T(alpha), II(beta), I(beta), E(beta) and their clusters and polyvalency play critical roles in this recognition process. The binding intensities of these factors in decreasing order are: polyvalent T(alpha), II(beta)/I(beta) and E(beta)>tri-antennary II(beta)>monomeric T(alpha), T(beta), I and II>Gal>GalNAc (weak). As one of type 2 RIP lectins, these recognition factors of the B chain are likely to be crucial for attachment and endocytosis. A comparison of the differential recognition factors and combining sites of APA with those of other lectins (Ricinus communis agglutinin, RCA(1) and ricin) is also illustrated.

  9. Managing Highway Maintenance: Maintenance Activities, Work Units, and Classifying Work, Unit 6, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit explains how maintenance work should be described, measured, and classified. It is designed for supervisors who need to know the mechanics of describing work. The format is a programed, self-instruction approach in which information is presented in progressive segments or…

  10. Using unitization as encoding strategy in associative recognition memory : behavioral, fMRI, and ERP evidence

    OpenAIRE

    2014-01-01

    Recognition memory is thought to depend on two processes. Whereas familiarity refers to a simple feeling of knowing a stimulus, recollection enables us to remember associative information such as the place of a particular episode in which the stimulus has occurred. Accordingly, recollection, which relies on the integrity of the hippocampus, is generally required to remember arbitrary associations. In contrast, a familiarity signal, presumably arising in the perirhinal cortex, is sufficient to...

  11. PMBOK® Application in project management in information units

    Directory of Open Access Journals (Sweden)

    Daniela Spudeit

    2017-04-01

    Full Text Available Introduction: The units of information are increasingly being seen as providing services organizations whose main input is the information that adds value to the company and the intellectual capital. Indicating a need for planning to meet the informational needs of its customers. Objective: The aim of this study is to recognize the project management as an alternative to improve from planning and implementation through solutions that meet these needs. Methodology: Was conduced a bibliographic research that pursuit to enhance the use of best practices in project management for helping, and supporting the management of information units. Results: As results, it is pointed out that all ten areas of PMBOK® are applicable to units of information and it is up to the librarian, promote the implementation, monitoring and completion of these processes. Conclusions: Information units is to promote access to information sources and so it is important that best practices are adopted the PMBOK ® as accelerate the launch of products and services, reduce costs, improve quality controls and optimize resources and efforts.

  12. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  13. The effectiveness of education in the recognition and management of deteriorating patients: A systematic review.

    Science.gov (United States)

    Connell, Clifford J; Endacott, Ruth; Jackman, Jennifer A; Kiprillis, Noelleen R; Sparkes, Louise M; Cooper, Simon J

    2016-09-01

    Survival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown. The aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness. A mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form. Twenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with >87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44h however one of the most educationally effective programs was based upon a 40min simulation program. Educational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes

  14. Difficult airway management from Emergency Department till Intensive Care Unit.

    Science.gov (United States)

    Pradhan, Debasis; Bhattacharyya, Prithwis

    2015-09-01

    We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  15. Formal verification of a set of memory management units

    Science.gov (United States)

    Schubert, E. Thomas; Levitt, K.; Cohen, Gerald C.

    1992-01-01

    This document describes the verification of a set of memory management units (MMU). The verification effort demonstrates the use of hierarchical decomposition and abstract theories. The MMUs can be organized into a complexity hierarchy. Each new level in the hierarchy adds a few significant features or modifications to the lower level MMU. The units described include: (1) a page check translation look-aside module (TLM); (2) a page check TLM with supervisor line; (3) a base bounds MMU; (4) a virtual address translation MMU; and (5) a virtual address translation MMU with memory resident segment table.

  16. Managing Training of Military Units: Development of a Management Information System.

    Science.gov (United States)

    Atwood, Nancy K.; Hiller, Jack H.

    An automated management information system was developed for planning and scheduling unit training in a U.S. Army infantry division. The primary goal of the project was to test the feasibility of the concept for a computer-based management information system. Specific objectives were to integrate information on personnel, training, and logistics…

  17. [Job satisfaction of nurses in the clinical management units].

    Science.gov (United States)

    Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia

    2013-01-01

    Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement [1] are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity [2]. Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU [3] but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are

  18. Surgical Management of Severe Colitis in the Intensive Care Unit.

    Science.gov (United States)

    Halaweish, Ihab; Alam, Hasan B

    2015-12-01

    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  19. [Management of maxillofacial injuries in an emergency unit: our experience].

    Science.gov (United States)

    Famà, Fausto; Beccaria, Antonio; Malara, Consolato; Placanica, Pantaleone; Cucinotta, Francesco; Caruso, Antonino; Estollere, Concetta; Versace, Giuseppina; Latorre, Nadia; Foti, Donatella; Falzea, Roberto; De Ponte, Francesco; Gioffrè-Florio, Maria Antonietta

    2009-01-01

    Maxillofacial injuries are relatively frequent. These may be complicated by cranioencephalic injuries or large facial wounds. We report our experience with the initial management of these lesions in an emergency unit setting. In 2007, we observed 105 patients with maxillofacial injuries. Maxillofacial injuries were associated with cranio-encephalic injuries in 69 patients (65.7%) and with polytrauma in 31(29.5%), while in 5 cases (4.8%) they were isolated. The main causes of trauma were motorcycle accidents (60%). All patients were treated in accordance with the Advanced Trauma Life Support guidelines and assessed by computed tomography. No mortality was observed after diagnosis in the emergency unit or in the month following the trauma. Seventy-seven patients (73.3%) were admitted and 28 (26.7%) were treated and discharged. Accurate diagnosis and appropriate initial management yield good clinical outcomes with functional restoration and fewer aesthetic complications.

  20. Design of Intelligent Parking Management System Based on License Plate Recognition

    Directory of Open Access Journals (Sweden)

    Qing Tian

    2014-06-01

    Full Text Available License Plate Recognition (LPR which has been extensively studied recently is becoming one important part of Intelligent Transportation Systems (ITS. It is not only applied to public security monitoring, but also applied to a red light shot, speeding violation paparazzi, parking system and so on. The present paper introduces an intelligent parking management system based on LPR, recognizing license plate automatically at the parking lot access and realizing vehicle information integrated management conveniently. The software part is developed with VC++, QT and Microsoft Office Access Database. In the system, LPR is carried out through video streaming frame by frame to choose the best result with a high speed. After accurate LPR, the vehicle information, such as LP number, LP color, car type and access time, will be stored in system database. In addition, the system interface is designed very friendly and simple for administrators to operate, which can largely improve the whole performance of LPR system. Experimental results show that this parking management system can achieve high correct rate at 95%, and can be applied to real-time implementation

  1. Phenology research for natural resource management in the United States.

    Science.gov (United States)

    Enquist, Carolyn A F; Kellermann, Jherime L; Gerst, Katharine L; Miller-Rushing, Abraham J

    2014-05-01

    Natural resource professionals in the United States recognize that climate-induced changes in phenology can substantially affect resource management. This is reflected in national climate change response plans recently released by major resource agencies. However, managers on-the-ground are often unclear about how to use phenological information to inform their management practices. Until recently, this was at least partially due to the lack of broad-based, standardized phenology data collection across taxa and geographic regions. Such efforts are now underway, albeit in very early stages. Nonetheless, a major hurdle still exists: phenology-linked climate change research has focused more on describing broad ecological changes rather than making direct connections to local to regional management concerns. To help researchers better design relevant research for use in conservation and management decision-making processes, we describe phenology-related research topics that facilitate "actionable" science. Examples include research on evolution and phenotypic plasticity related to vulnerability, the demographic consequences of trophic mismatch, the role of invasive species, and building robust ecological forecast models. Such efforts will increase phenology literacy among on-the-ground resource managers and provide information relevant for short- and long-term decision-making, particularly as related to climate response planning and implementing climate-informed monitoring in the context of adaptive management. In sum, we argue that phenological information is a crucial component of the resource management toolbox that facilitates identification and evaluation of strategies that will reduce the vulnerability of natural systems to climate change. Management-savvy researchers can play an important role in reaching this goal.

  2. Habitat Demonstration Unit Project Leadership and Management Strategies

    Science.gov (United States)

    Kennedy, Kriss J.

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project management team that put in place the key multi-center leadership skills and

  3. Syncope management unit: evolution of the concept and practice implementation.

    Science.gov (United States)

    Shen, Win K; Traub, Stephen J; Decker, Wyatt W

    2013-01-01

    Syncope, a clinical syndrome, has many potential causes. The prognosis of a patient experiencing syncope varies from benign outcome to increased risk of mortality or sudden death, determined by the etiology of syncope and the presence of underlying disease. Because a definitive diagnosis often cannot be established immediately, hospital admission is frequently recommended as the "default" approach to ensure patient's safety and an expedited evaluation. Hospital care is costly while no studies have shown that clinical outcomes are improved by the in-patient practice approach. The syncope unit is an evolving practice model based on the hypothesis that a multidisciplinary team of physicians and allied staff with expertise in syncope management, working together and equipped with standard clinical tools could improve clinical outcomes. Preliminary data have demonstrated that a specialized syncope unit can improve diagnosis in a timely manner, reduce hospital admission and decrease the use of unnecessary diagnostic tests. In this review, models of syncope units in the emergency department, hospital and outpatient clinics from different practices in different countries are discussed. Similarities and differences of these syncope units are compared. Outcomes and endpoints from these studies are summarized. Developing a syncope unit with a standardized protocol applicable to most practice settings would be an ultimate goal for clinicians and investigators who have interest, expertise, and commitment to improve care for this large patient population.

  4. Communication Management Unit : Single Solution of Voice and Data Routing Unit

    Directory of Open Access Journals (Sweden)

    Ravi Shankar

    2013-03-01

    Full Text Available Challenges faced by present avionics systems are low weight, less power, low volume, high mean time between failure and low mean time to repair. This paper is a feasibility study for single solution of voice and data switching/routing unit. This paper presents a new architecture for voice and data switching unit in the form of communication management unit.  The proposed solution is obtained on integrated modular avionics architecture using commercial-off-the-shelf  hardware. A single board computer is used as a processing engine with add-on audio boards to convert analog voice input and output signals into digital signals.Defence Science Journal, 2013, 63(2, pp.181-185, DOI:http://dx.doi.org/10.14429/dsj.63.4261

  5. Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons

    NARCIS (Netherlands)

    K.D. Strang; E.M.M. van Lieshout (Esther); R.A. Verhoeven (Roelof A.); O.J.F. van Waes (Oscar); M.H.J. Verhofstad (Michiel); Iah-Acs Study Group

    2017-01-01

    textabstractPurpose: Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) are relatively rare, but severe complications. Although many advances were made in recent years, the recognition and management remain subject of debate. The aim of this study was to determine the

  6. 76 FR 41525 - Hewlett Packard Global Parts Supply Chain, Global Product Life Cycles Management Unit Including...

    Science.gov (United States)

    2011-07-14

    ... Employment and Training Administration Hewlett Packard Global Parts Supply Chain, Global Product Life Cycles... Chain, Global Product Life Cycles Management Unit, including teleworkers reporting to Houston, Texas... Parts Supply Chain, Global Product Life Cycles Management Unit, including teleworkers reporting to...

  7. Operations research in intensive care unit management: a literature review.

    Science.gov (United States)

    Bai, Jie; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

    2016-08-12

    The intensive care unit (ICU) is a crucial and expensive resource largely affected by uncertainty and variability. Insufficient ICU capacity causes many negative effects not only in the ICU itself, but also in other connected departments along the patient care path. Operations research/management science (OR/MS) plays an important role in identifying ways to manage ICU capacities efficiently and in ensuring desired levels of service quality. As a consequence, numerous papers on the topic exist. The goal of this paper is to provide the first structured literature review on how OR/MS may support ICU management. We start our review by illustrating the important role the ICU plays in the hospital patient flow. Then we focus on the ICU management problem (single department management problem) and classify the literature from multiple angles, including decision horizons, problem settings, and modeling and solution techniques. Based on the classification logic, research gaps and opportunities are highlighted, e.g., combining bed capacity planning and personnel scheduling, modeling uncertainty with non-homogenous distribution functions, and exploring more efficient solution approaches.

  8. Integrated Waste Treatment Unit GFSI Risk Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    W. A. Owca

    2007-06-21

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP).

  9. Realization of Simply Connected Polygonal Linkages and Recognition of Unit Disk Contact Trees

    NARCIS (Netherlands)

    Bowen, Clinton; Durocher, Stephane; Löffler, Maarten; Rounds, Anika; Schulz, André; Tóth, Csaba

    2015-01-01

    We consider two variants of the fundamental question of determining whether a simply connected flexible combinatorial structure can be realized in Euclidean space. Two models are considered: body-and-joint frameworks and contact graphs of unit disks in the plane. (1) We show that it is strongly

  10. 7 CFR 275.18 - Project area/management unit corrective action plan.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Project area/management unit corrective action plan... SYSTEM Corrective Action § 275.18 Project area/management unit corrective action plan. (a) The State agency shall ensure that corrective action plans are prepared at the project area/management unit level...

  11. PLANNING THE WORK OF AVIATION UNITS USING PROJECT MANAGEMENT TOOLS

    Directory of Open Access Journals (Sweden)

    Dmitry Valerievich Bogomolov

    2017-01-01

    Full Text Available The article deals with the problematic issues of planning the work of aviation units and offers one of the possible variants of their solutions by means of project management tools implementation in aviation units.As a key concept in the theory of planning, the author proposes introducing the concept of a project as a complex, non-repeating one-time action, limited in time, budget, resources and in clear guidance throughout the process, followingthe customer requirements. In aviation engineering service work, this also includes such works as operational preparationstypes, routine maintenance, aviation technology improvements, military repair etc.The use of network models can also easily specify the sequence of some of the actions (events, to make process flow charts and organizational charts.The main advantage of linear graphs is their clarity and simplicity. Linear graphs make it possible to optimize the work on a variety of criteria, including the equability of labor force, machinery, building materials, etc. At the same time,the main drawback of linear graphs is that they are difficult to correct in case of non-compliance with the deadlines or a change in their arrangement. These drawbacks are eliminated by a different form of scheduling - network charts.The scheme of planning the work of units using project management tools is given. To carry out the scheme theauthor proposes to use modern tools of project management, which allow to structure the process of maintenance activities through its decomposition into phases, tasks and subtasks, then to identify critical path tasks, construct the chart of imple- mentation. The process model as a project allows to make the prognostic analysis and to improve the process according to it, for what a number of modern software packages that automate the functions of planning and planned types of work schedule control.

  12. Application of Business Process Management to drive the deployment of a speech recognition system in a healthcare organization.

    Science.gov (United States)

    González Sánchez, María José; Framiñán Torres, José Manuel; Parra Calderón, Carlos Luis; Del Río Ortega, Juan Antonio; Vigil Martín, Eduardo; Nieto Cervera, Jaime

    2008-01-01

    We present a methodology based on Business Process Management to guide the development of a speech recognition system in a hospital in Spain. The methodology eases the deployment of the system by 1) involving the clinical staff in the process, 2) providing the IT professionals with a description of the process and its requirements, 3) assessing advantages and disadvantages of the speech recognition system, as well as its impact in the organisation, and 4) help reorganising the healthcare process before implementing the new technology in order to identify how it can better contribute to the overall objective of the organisation.

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

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

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

  14. The effects of unitization on the contribution of familiarity and recollection processes to associative recognition memory: evidence from event-related potentials.

    Science.gov (United States)

    Zheng, Zhiwei; Li, Juan; Xiao, Fengqiu; Broster, Lucas S; Jiang, Yang; Xi, Mingjing

    2015-03-01

    Familiarity and recollection are two independent cognitive processes involved in recognition memory. It is traditionally believed that both familiarity and recollection can support item recognition, whereas only recollection can support associative recognition. Here, using a standard associative recognition task, we examined whether associative retrieval of unitized associations involved differential patterns of familiarity and recollection processes relative to non-unitized associations. The extent of engagement of familiarity and recollection processes during associative retrieval was estimated by using event-related potentials (ERPs). Twenty participants studied compound words and unrelated word pairs during encoding. Subsequently, they were asked to decide whether a presented word pair was intact, rearranged, or a new pair while electroencephalogram (EEG) was recorded. ERP results showed that compound words evoked a significant early frontal old/new effect (associated with familiarity) between ERPs to intact and rearranged word pairs, whereas this effect disappeared for the unrelated word pairs. In addition, the left parietal old/new effect (associated with recollection) between ERPs to intact and rearranged word pairs was greater for compounds than for unrelated word pairs. These findings suggest that unitization enhances the contribution of both familiarity and recollection processes to associative recognition.

  15. Produced water volumes and management practices in the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Clark, C. E.; Veil, J. A. (Environmental Science Division)

    2009-09-01

    Produced water volume generation and management in the United States are not well characterized at a national level. The U.S. Department of Energy (DOE) asked Argonne National Laboratory to compile data on produced water associated with oil and gas production to better understand the production volumes and management of this water. The purpose of this report is to improve understanding of produced water by providing detailed information on the volume of produced water generated in the United States and the ways in which produced water is disposed or reused. As the demand for fresh water resources increases, with no concomitant increase in surface or ground water supplies, alternate water sources, like produced water, may play an important role. Produced water is water from underground formations that is brought to the surface during oil or gas production. Because the water has been in contact with hydrocarbon-bearing formations, it contains some of the chemical characteristics of the formations and the hydrocarbons. It may include water from the reservoir, water previously injected into the formation, and any chemicals added during the production processes. The physical and chemical properties of produced water vary considerably depending on the geographic location of the field, the geologic formation, and the type of hydrocarbon product being produced. Produced water properties and volume also vary throughout the lifetime of a reservoir. Produced water is the largest volume by-product or waste stream associated with oil and gas exploration and production. Previous national produced water volume estimates are in the range of 15 to 20 billion barrels (bbl; 1 bbl = 42 U.S. gallons) generated each year in the United States (API 1988, 2000; Veil et al. 2004). However, the details on generation and management of produced water are not well understood on a national scale. Argonne National Laboratory developed detailed national-level information on the volume of produced

  16. Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives.

    Science.gov (United States)

    Guirgis, Faheem W; Jones, Lisa; Esma, Rhemar; Weiss, Alice; McCurdy, Kaitlin; Ferreira, Jason; Cannon, Christina; McLauchlin, Laura; Smotherman, Carmen; Kraemer, Dale F; Gerdik, Cynthia; Webb, Kendall; Ra, Jin; Moore, Frederick A; Gray-Eurom, Kelly

    2017-08-01

    Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Retrospective review of patients ≥18years treated for sepsis. There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p=0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p=0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39-0.99, p=0.046), mean intensive care unit LOS (2.12days before, 95%CI 1.97, 2.34; 1.95days after, 95%CI 1.75, 2.06; p<0.001), mean overall hospital LOS (11.7days before, 95% CI 10.9, 12.7days; 9.9days after, 95% CI 9.3, 10.6days, p<0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p=0.007), and total charges with a savings of $7159 per sepsis admission (p=0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p=0.18). A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Using supply chain management to enable GIS units to improve their response to their customers' needs

    CSIR Research Space (South Africa)

    Schmitz, Peter MU

    2008-09-01

    Full Text Available (2000) also indicated that there will be several management tools available to assist GIS units to enable them to manage themselves successfully. This paper discusses such a management tool, namely supply chain management. Supply chain management is used...

  18. Leadership development: an essential ingredient in supporting nursing unit managers

    Directory of Open Access Journals (Sweden)

    Wilson V

    2013-12-01

    Full Text Available Valerie Wilson,1,2 Sheree Paterson,3 Kelly Kornman1 1Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia; 2Faculty of Nursing Midwifery Health, The University of Technology, Sydney, Broadway, NSW, Australia; 3Formerly of the Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia Purpose: The aim of the leadership development program was to enhance participants’ understanding of person-centered leadership in the context of their nursing unit manager (NUM roles. Materials and methods: This article details the results of the NUM leadership development program (LDP. Twenty-one NUMs from an Australian pediatric hospital participated in the 8-month program. The evaluation encompassed a group claims/concerns/issues session, one-on-one interviews, and written feedback. Data were themed using a four-step sequential process. Results: The NUM LDP had a positive impact on the leadership practices of the participants. Six key themes were identified from the evaluation: “forming the group”; “being in the group”; “translating into practice”; “how we see ourselves; how do we want to be seen?”; “positive outcomes for me”; and “positive outcomes for others”. Conclusion: This study showed improvements in the leadership understanding and practice of NUMs who participated in the program. Further research, particularly into the transferability of skills and active participatory aspects of these types of evaluation studies, is required. Keywords: nurse, evaluation, person-centered care, experiential learning

  19. [Management control of cardiology: the experience of a departmental unit].

    Science.gov (United States)

    Boccanelli, A; Spandonaro, F

    2000-01-01

    In most Italian hospitals, sanitary reform is being applied, while at the same time a new organization of the National Health System is being planned. The director of the medical hospital (head doctor) is becoming more and more involved in management and this aspect has modified his professional attributes. Cardiology is a branch of medicine that, through its scientific preparatory work consisting in debates, management courses, ethics, and production of managerial software, is closer to applying the reform without risking improper administrative aspects. This, obviously, comes about after thoroughly reviewing past work methods and the need to have an administrative organization, which allocates efficient use of manpower and materials, helping to eliminate any sources of inefficiency. The logical procedure foresees an actual analysis in terms of sanitary needs and availability of resources, and so attempting to better balance and harmonize both aspects of the problem. Certainly, the acquisition of theoretical norms and practices, which today are present because of the upsurge in training courses for doctors, is not enough to guarantee the achievement of optimal results. Furthermore, we find that theoretical models need to be validated and adapted to real work situations in the public hospital sector. This paper proposes, therefore, to explain the managerial experiences achieved in actual work situations at the Cardiology Department Unit of the San Giovanni Addolorata Hospital in Rome. In particular, it shows that in order to reach its clinical and economical objectives, it is essential to make available correct informative support for strategic and operational decisions. We can observe that there is a continuing lack of computer support systems being integrated into the present organization of most cardiology units. The use of software distributed to cardiology units from the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) has enabled us to partially

  20. Nurses’ Experiences of Managing and Management in a Critical Care Unit

    Directory of Open Access Journals (Sweden)

    K. Robyn Ogle

    2014-05-01

    Full Text Available In this article, we describe the major findings of an ethnographic study undertaken to investigate nurses’ experiences of managing nurses and being managed by nurses in an Australian critical care unit. Our purpose was to valorize and make space for nurses to speak of their experiences and investigate the cultural practices and knowledges that comprised nursing management discourses. Subjugated practices, knowledges, and discourses were identified, revealing how nurses were inscribed by, or resisted, the discourses, including their multiple mobile subject positions. Informed by critical, feminist, and postmodern perspectives, nine mobile subject positions were identified. Direct participant observation, participant interviews, and reflective field notes were analyzed for dominant and subjugated discourses. The major finding described is the subject position of “junior novice.” Nurses informed by dominant patriarchal and organizational discourses participated in constructing and reinscribing their own submissive identity reflected in interprofessional relations that lacked individual valuing and undermined their self-esteem.

  1. Flyway Habitat Management Unit Project report no. 4: A 1965 waterfowl population model

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Complete estimates of waterfowl populations in each of 164 management units through the forty-eight coterminous United States were systematically developed for May...

  2. Defining management units for cetaceans by combining genetics, morphlogy, acoustics and satellite tracking

    DEFF Research Database (Denmark)

    Sveegaard, Signe; Galatius, Anders; Dietz, Rune

    2015-01-01

    Managing animal units is essential in biological conservation and requires spatial and temporal identification of such units. Since even neighbouring populations often have different conservation status and face different levels of anthropogenic pressure, detailed knowledge of population structur...

  3. [Prostate cancer unit for an optimal management of prostate cancer unit].

    Science.gov (United States)

    Sciarra, Alessandro; Salciccia, Stefano; Gentilucci, Alessandro; Innocenzi, Michele; Alfarone, Andrea; Cattarino, Susanna; Ravaziol, Michele; Panebianco, Valeria

    2012-01-01

    Prostate cancer (PC) is established as one of the most important medical problems affecting the male population. PC is the most common solid neoplasm (214 cases per 1000 men) and the second most common cause of cancer death in men. Its management involves several complex issues for both clinicians and patients. An early diagnosis is necessary to implement well-balanced therapeutic options, and the correct evaluation can reduce the risk of overtreatment with its consequential adverse effects. Breast and Prostate cancers, respectively, are the most common cancers in women and in men, and different similarities have been underlined. The paradigm of the patient consulting a multidisciplinary medical team has been an established standard approach in treating breast cancer. Such multidisciplinary approach can offer the same optional care for men with PC as it does for women with breast cancer. A multidisciplinary team (MDT) comprises healthcare professionals from different disciplines whose goal of providing optimal patient care is achieved through coordination and communication with one another. A Prostate Cancer Unit is a place where men can be cared for by specialists in PC, working together within a multi-professional team. The MTD approach guarantees a higher probability for the PC patient to receive adequate information on the disease and on all possible therapeutic strategies, balancing advantages and related side effects. The future of PC patients relies on a successful multidisciplinary collaboration between experienced physicians, which can lead to important advantages in all the phases and aspects of PC management.

  4. Water Management Program: Unit Three, 1987 Prime Hook National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Water management facilities in Unit Three at Prime Hook National Wildlife Refuge were completed in 1984, providing management capability of over 2500 acres of marsh....

  5. Water Management Program: Unit Three, 1986 Prime Hook National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Water management facilities in Unit Three at Prime Hook National Wildlife Refuge were completed in 1984, providing management capability of over 2500 acres of marsh....

  6. Two novel fluorescent calix[4]arene derivatives with benzoazole units in 1,3-alternate conformation for selective recognition to Fe~(3+) and Cr~(3+)

    Institute of Scientific and Technical Information of China (English)

    He Wen Wang; Ya Qing Feng; Chen Chen; Jin Qiang Xue

    2009-01-01

    Two novel fluorescent calix[4]arene derivatives 1a and 1b with benzoxazole or benzothiazole units in 1,3-alternate conformation have been synthesized and characterized by IR, ~1H NMR, ~(13)C NMR and MS. Their complexation properties to different heavy and transition metal ions have been studied by UV-vis spectroscopy and fluorescence spectrometer. Compounds la and lb show selective recognition to Fe~(3+) and Cr~(3+).

  7. Policy Adoption of Forest Management Unit: A Knowledge Diffusion Analysis

    Directory of Open Access Journals (Sweden)

    Julijanti

    2014-08-01

    Full Text Available Within the policy adoption process of Forest Management Unit (FMU concept, there has been disagreement of stakeholders on FMUs concept. This disagreement is caused by the exchange of knowledge, information, and perception among stakeholders involved. The results of these interactions could speed up, slow down, and prevent the adoption process of FMU policy. The study objective was analyzing process of knowledge diffusion of FMUs development policy and stakeholders interaction in PFMU Batutegi and PFMU Kotaagung Utara, Indonesia. Adoption process was analyzed by the logical diffusion technique based on knowledge time of FMUs concept received and its interaction space. Social interaction among stakeholders was analyzed using method developed by International Development Studies analysis, i.e. interaction among discourse/narrative, actors/networks and politics/interests. The results showed that knowledge diffusion of FMUs concept in both PFMU tends to cascade diffusion. Factors was affecting of it process were network, role of opinion leaders, willingness to know, and understand on FMUs concept. Indicative strategy is needed as anticipating and overcoming an obstacle in its internalization process, i.e. harmonization of legislative and executive relationship, building an opinion the importance of FMU, and optimalizing network for bureaucratic problems.

  8. Current Status of the United Kingdom Programme for Long-Term Radioactive Waste Management

    Energy Technology Data Exchange (ETDEWEB)

    Murray, C. H.; Hooper, A. J.; Mathieson, J.

    2002-02-27

    In 1997, the UK programme for the deep disposal of radioactive waste was ''stopped dead in its tracks'' with the refusal by the Secretary of State for the Environment to allow Nirex to go ahead with its plans for an underground Rock Characterisation Facility at Sellafield in north-west England. Since that time a House of Lords' Select Committee has held an inquiry into what went wrong and what the way ahead should be. In addition, Nirex and the nuclear industry players have also been analyzing the past with a view to learning from the experience in taking things forward. In Nirex's view this is essentially an ethical issue; the waste exists and we should deal with it in this generation. Three areas need to be better addressed if a successful program of management of the nation's radioactive waste is to be achieved: the process of how policy development and implementation can be achieved; the structure of the nuclear industry and its relationship to the waste management organization; and the behavior of the players in their interaction with stakeholders. All three are underpinned by the need for transparency. In recognition that developing a policy for managing radioactive waste has to be achieved with the support of all stakeholders, the Government instigated a consultation exercise in September 2001. The initial phase of this initiative is essentially a consultation about consultation and is intended to decide on how the next stages of a six year policy development program should be addressed. In addition to this exercise, the Government is undertaking a fundamental review of the structuring of the United Kingdom Atomic Energy Authority (UKAEA) and British Nuclear Fuels plc (BNFL). They are both shareholders in Nirex and in November 2001 the Government announced the setting up of a Liabilities Management Authority (LMA) to manage the long-term nuclear liabilities that are publicly owned, particularly through those organizations

  9. Current Status of the United Kingdom Programme for Long-Term Radioactive Waste Management

    Energy Technology Data Exchange (ETDEWEB)

    Murray, C. H.; Hooper, A. J.; Mathieson, J.

    2002-02-27

    In 1997, the UK programme for the deep disposal of radioactive waste was ''stopped dead in its tracks'' with the refusal by the Secretary of State for the Environment to allow Nirex to go ahead with its plans for an underground Rock Characterisation Facility at Sellafield in north-west England. Since that time a House of Lords' Select Committee has held an inquiry into what went wrong and what the way ahead should be. In addition, Nirex and the nuclear industry players have also been analyzing the past with a view to learning from the experience in taking things forward. In Nirex's view this is essentially an ethical issue; the waste exists and we should deal with it in this generation. Three areas need to be better addressed if a successful program of management of the nation's radioactive waste is to be achieved: the process of how policy development and implementation can be achieved; the structure of the nuclear industry and its relationship to the waste management organization; and the behavior of the players in their interaction with stakeholders. All three are underpinned by the need for transparency. In recognition that developing a policy for managing radioactive waste has to be achieved with the support of all stakeholders, the Government instigated a consultation exercise in September 2001. The initial phase of this initiative is essentially a consultation about consultation and is intended to decide on how the next stages of a six year policy development program should be addressed. In addition to this exercise, the Government is undertaking a fundamental review of the structuring of the United Kingdom Atomic Energy Authority (UKAEA) and British Nuclear Fuels plc (BNFL). They are both shareholders in Nirex and in November 2001 the Government announced the setting up of a Liabilities Management Authority (LMA) to manage the long-term nuclear liabilities that are publicly owned, particularly through those organizations

  10. The current acceptance, accessibility and recognition of Chinese and Ayurvedic medicine in the United States in the public, governmental, and industrial sectors.

    Science.gov (United States)

    Park, Jongbae J; Beckman-Harned, Selena; Cho, Gayoung; Kim, Duckhee; Kim, Hangon

    2012-06-01

    To assess the current level of acceptance in the United States of complementary and alternative medicine, recent research into the prevalence, acceptance, accessibility, and recognition of complementary and alternative therapies were reviewed. Several signs point to an increasing acceptance of complementary and alternative medicine in the United States; the use of complementary and alternative medicine is significantly increasing, many aspects of Chinese medicine and Ayurveda are becoming mainstream, practitioners in the United States are beginning to be licensed, and insurance companies are beginning to cover some complementary and alternative therapies. Remaining challenges to true acceptance include the restrictive Western mindset, the absence of published studies, a lack of consistent manufacturing processes and quality standards, and a fear of adulteration. Although the field still faces many challenges, alternative and complementary medicine, including Chinese medicine and Ayurvedic medicine, is becoming more accepted and accessible in the United States.

  11. Big Game Management Units, New Mexico Department of Game and Fish 2010

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — GMUs are based on New Mexico Department of Game and Fish Big Game Management Units and Game Management Sub-units as described in Title 19 Chapter 30 Part 4 ofThe New...

  12. Clinical teaching of student nurses by unit managers of selected hospitals in Limpopo Province

    Directory of Open Access Journals (Sweden)

    LA Murathi

    2005-09-01

    Full Text Available The comprehensive nature of nurse training needs the involvement of almost all health team personnel, including unit managers to gain practical experience and learn to correlate theory and practice. The overall aim of the study was to explore and describe the experiences of unit managers regarding teaching of student nurses in the clinical area and to develop recommendations that will enhance clinical teaching, for the production of competent future nurse practitioners who will render quality care to patients. A qualitative design, which is explorative, descriptive and contextual in nature, was employed, utilizing a phenomenological approach to capture the experiences of unit managers regarding teaching of student nurses at selected hospitals, where students are allocated for their clinical exposure. Ethical measures as well as measures to ensure trustworthiness were adhered to. In-depth phenomenological interviews were conducted with unit managers who shared their experiences regarding clinical teaching of student nurses. Data analysis was done according to Tesch’s (1990 open coding method. One major theme emerged, namely that unit managers experienced problems when doing clinical teaching of student nurses. Based on the findings the following recommendations were made: Colleges should open a two-way communication with unit managers, involvement of unit managers in the activities that take place at the college like courses, seminars and workshops on clinical teaching, learning contracts should be developed for the students and issues of clinical learning should be addressed and unit managers should be included in both summative and formative evaluations.

  13. 40 CFR 264.101 - Corrective action for solid waste management units.

    Science.gov (United States)

    2010-07-01

    ..., AND DISPOSAL FACILITIES Releases From Solid Waste Management Units § 264.101 Corrective action for solid waste management units. (a) The owner or operator of a facility seeking a permit for the treatment... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Corrective action for solid...

  14. WIPP Facility Work Plan for Solid Waste Management Units

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2001-02-25

    This 2001 Facility Work Plan (FWP) has been prepared as required by Module VII, Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Facility Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a), and incorporates comments from the New Mexico Environment Department (NMED) received on December 6, 2000 (NMED, 2000a). This February 2001 FWP describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. The permittees are evaluating data from previous investigations of the SWMUs and AOCs against the newest guidance proposed by the NMED. Based on these data, the permittees expect that no further sampling will be required and that a request for No Further Action (NFA) at the SWMUs and AOCs will be submitted to the NMED. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current NMED guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility’s Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to the NMED's guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit.

  15. Managing Highway Maintenance: Standards for Maintenance Work, Part 2, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit describes the ways maintenance standards are developed and some of the factors which are considered in setting standards; the preceding unit on standards (part 1) should be completed before reading this unit. The format is a programed, self-instruction approach in which…

  16. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    Science.gov (United States)

    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  17. Developing standardized strategic response categories for fire management units

    Science.gov (United States)

    Matthew P. Thompson; Crystal S. Stonesifer; Robert C. Seli; Marlena Hovorka

    2013-01-01

    Federal wildland fire policy requires that publicly owned lands with burnable vegetation have a fire management plan (FMP); this applies to the five primary Federal fire agencies (Bureau of Indian Affairs, Bureau of Land Management, National Park Service, U.S. Fish and Wildlife Service, and Forest Service). FMPs are based on land and resource management plans and are...

  18. The recognition unit of FIBCD1 organizes into a noncovalently linked tetrameric structure and uses a hydrophobic funnel (S1) for acetyl group recognition

    DEFF Research Database (Denmark)

    Thomsen, Theresa; Moeller, Jesper B; Schlosser, Anders

    2010-01-01

    We have recently identified FIBCD1 (Fibrinogen C domain containing 1) as a type II transmembrane endocytic receptor located primarily in the intestinal brush border. The ectodomain of FIBCD1 comprises a coiled coil, a polycationic region, and a C-terminal FReD (fibrinogen-related domain) that ass......We have recently identified FIBCD1 (Fibrinogen C domain containing 1) as a type II transmembrane endocytic receptor located primarily in the intestinal brush border. The ectodomain of FIBCD1 comprises a coiled coil, a polycationic region, and a C-terminal FReD (fibrinogen-related domain......) that assembles into disulfide-linked homotetramers. The FIBCD1-FReD binds Ca(2+) dependently to acetylated structures like chitin, N-acetylated carbohydrates, and amino acids. FReDs are present in diverse innate immune pattern recognition proteins including the ficolins and horseshoe crab TL5A. Here, we use...... combined with site-directed mutagenesis to define the binding site involved in the interaction of FIBCD1 with acetylated structures. We show that mutations of central residues (A432V and H415G) in the hydrophobic funnel (S1) abolish the binding of FIBCD1 to acetylated bovine serum albumin and chitin...

  19. Planning for a smooth transition: evaluation of a succession planning program for prospective nurse unit managers.

    Science.gov (United States)

    Manning, Vicki; Jones, Alan; Jones, Pamela; Fernandez, Ritin S

    2015-01-01

    The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

  20. WIPP Facility Work Plan for Solid Waste Management Units

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2000-02-25

    This Facility Work Plan (FWP) has been prepared as required by Module VII,Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a). This work plan describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current New Mexico Environment Department (NMED) guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility’s Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to NMED’s guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit. The scope of work for the RFI Work Plan or SAP is being developed by the Permittees. The final content of the RFI Work Plan or SAP will be coordinated with the NMED for submittal on May 24, 2000. Specific project-related planning information will be included in the RFI Work Plan or SAP. The SWMU program at WIPP began in 1994 under U.S. Environmental Protection Agency (EPA) regulatory authority. NMED subsequently received regulatory authority from EPA

  1. Forest management and water in the United States [Chapter 13

    Science.gov (United States)

    Daniel G. Neary

    2017-01-01

    This chapter outlines a brief history of the United States native forests and forest plantations. It describes the past and current natural and plantation forest distribution (map, area, main species), as well as main products produced (timber, pulp, furniture, etc.). Integrated into this discussion is a characterization of the water resources of the United States and...

  2. 75 FR 5849 - Financial Management Service; Proposed Collection of Information: Claim Against the United States...

    Science.gov (United States)

    2010-02-04

    ... Fiscal Service Financial Management Service; Proposed Collection of Information: Claim Against the United States for the Proceeds of a Government Check AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management Service, as part of...

  3. Orchard Business Management. Unit I. Establishing an Orchard Record Keeping System.

    Science.gov (United States)

    Mullinix, Shauna K.

    This guide is intended for use in providing in-depth formal classroom and on-site instruction in the principles of business and financial management as they apply to operating and managing orchards. Designed to be used with an accompanying Orchard Business Management Record Book, this unit (i.e., the first year) of the course deals with…

  4. 77 FR 4274 - Migratory Bird Permits; Double-Crested Cormorant Management in the United States

    Science.gov (United States)

    2012-01-27

    ... Environmental Assessment on the development of revised regulations governing the management of double- crested cormorants. Under current regulations, cormorant damage management activities are conducted annually at the... Management in the United States AGENCY: Fish and Wildlife Service, Interior. ACTION: Request for comments...

  5. Orchard Business Management. Unit I. Establishing an Orchard Record Keeping System.

    Science.gov (United States)

    Mullinix, Shauna K.

    This guide is intended for use in providing in-depth formal classroom and on-site instruction in the principles of business and financial management as they apply to operating and managing orchards. Designed to be used with an accompanying Orchard Business Management Record Book, this unit (i.e., the first year) of the course deals with…

  6. Phases of Recognition and Management of Financial Crisis in Public Organizations.

    Science.gov (United States)

    Jones, L. R.

    Based in part on interviews conducted in 32 municipalities, this paper is intended to provide information to public managers, policy analysts, and others on methods for improving the management of retrenchment. A model summarizes how public organizations recognize and attempt to manage financial crises and prolonged financial stress. Some cutback…

  7. Vendor Managed Inventory : Pilot for Fiskars Home Sourcing Unit

    OpenAIRE

    Kervinen, Minna

    2013-01-01

    Just in time principles and vendor managed inventory model are part of today’s supply chain management. These models are utilized in order to have successful and effective supply chain. This thesis concentrates on inbound logistics operations of supply chain. It describes the general theory of inbound supply chain logistics operations and dives into vendor managed inventory model and how this model can be utilized in a company where the suppliers are located far, lead times are long and deman...

  8. Fox management plan, Aleutian Islands Unit, AMNWR: Draft

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The presence or absence of arctic fox on islands in the Aleutian Islands Units is described as a decision tool for fox eradication. An effective chemical...

  9. Special Needs Dentistry: Interdisciplinary Management of Medically-Complex Patients at Hospital-Based Dental Units in Tasmania, Australia

    Directory of Open Access Journals (Sweden)

    Lim

    2017-06-01

    Full Text Available Background: Increasing awareness of the interactions between oral and general health has led to the establishment of Special Needs Dentistry as a dental specialty in many countries. This specialty assists with the interdisciplinary management of patients between the medical and dental professions particularly those with complex medical problems, intellectual and physical impairments, and psychiatric conditions that may affect their oral health or the manner in which they receive treatment. However, little is known about the utilisation of specialised services provided to facilitate individuals with these needs. Aim: The aim of this study was to understand current utilisation of hospital-based dental services established to provide medically-necessary dental care. Methods: A retrospective review of the demographics and medical status of patients treated at referral hospital-based dental clinics in the state of Tasmania was completed for the month of August 2015. Results: Patients treated at these units had a variety of medical backgrounds. Most (46.4% were referred from medical professionals within the hospital. On average, patients treated at these units had 2.56 medical conditions and were taking 3.59 medications each. Many of these were chronic medical conditions known to have an interaction with oral health. Conclusions: Our results demonstrate the growing recognition of dynamic interactions between oral and general health and the importance of these hospitalbased units and interprofessional relationships in providing timely and holistic health care to these patients.

  10. Intraurethral knot in a very-low-birth-weight infant: radiological recognition, surgical management and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Lodha, Abhay; Ly, Linh; McNamara, Patrick J. [Hospital for Sick Children, Division of Neonatology, Toronto (Canada); Brindle, Mary [Hospital for Sick Children, Department of Surgery, Toronto (Canada); Daneman, Alan [Hospital for Sick Children, Department of Radiology, Toronto (Canada)

    2005-07-01

    We report a case where a knot developed in a urinary catheter and became lodged within the urethra of a very-low-birth-weight (VLBW) preterm infant. The catheter was removed with the assistance of a urologist. We recommend using caution when placing urinary catheters in VLBW infants and question the appropriateness of feeding tubes as catheters. Recognition on radiographs of malpositioned bladder catheters is vital to the care of these patients. All staff involved in the insertion, maintenance or removal of these catheters should be suitably trained to minimize the risk of knots and related complications. (orig.)

  11. Prehospital airway management on rescue helicopters in the United Kingdom.

    Science.gov (United States)

    Schmid, M; Mang, H; Ey, K; Schüttler, J

    2009-06-01

    Adequate equipment is one prerequisite for advanced, out of hospital, airway management. There are no data on current availability of airway equipment on UK rescue helicopters. An internet search revealed all UK rescue helicopters, and a questionnaire was sent to the bases asking for available airway management items. We identified 27 helicopter bases and 26 (96%) sent the questionnaire back. Twenty-four bases (92%) had at least one supraglottic airway device; 16 (62%) helicopters had material for establishing a surgical airway (e.g. a cricothyroidotomy set); 88% of the helicopters had CO(2) detection; 25 (96%) helicopters carried automatic ventilators; among these, four (15%) had sophisticated ventilators and seven (27%) helicopters carried special face masks suitable for non-invasive ventilation. We found a wide variation in the advanced airway management equipment that was carried routinely on air ambulances. Current guidelines for airway management are not met by all UK air ambulances.

  12. Experimental Woodcock Habitat Management, Baring Unit, Moosehorn National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The overall objectives of this study were to develop woodcock habitat management techniques that: (1) small landowners can apply with a minimum of equipment and...

  13. Managed competition, governmentality and institutional response in the United Kingdom.

    Science.gov (United States)

    Light, D W

    2001-04-01

    This article traces the use of managed competition policy to transform the NHS from an administered public service to a set of interlocking markets and contracts. It reviews the overlooked origins of managed competition in the new managerialism and explains the relationship between managed competition and the cost crisis of the NHS by extending Foucault's concept of governmentality to revise the concept of the state. The paper then describes how the government structured health care markets, using managed competition as an instrument of governmentality. It summarises institutional responses by health authorities, hospital trusts, and GP fundholders. The terms "master institution", "dictated competition" and "coercive partnering" are introduced as new concepts for economic sociology and as strategies of governmentality. Implementation, however, led to resistance, opposition and eventual abandonment of managed competition as too disruptive and costly. Yet, this analysis contends, managed competition has left an enduring legacy of accountability to purchasers in economic terms such as efficiency, transaction costs, and cost effectiveness. The policies of the new government are based on coercive partnering and doctor-based "commissioning". This and the Internet imply revolutionary changes for the health professions and the delivery of health care services through networks of moebius-strip organisations interacting in flexible sequences and subject to communitarian pressures.

  14. 78 FR 51131 - Fisheries of the Northeastern United States; Atlantic Coastal Fisheries Cooperative Management...

    Science.gov (United States)

    2013-08-20

    ... National Oceanic and Atmospheric Administration 50 CFR Part 697 RIN 0648-BD45 Fisheries of the Northeastern United States; Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration...

  15. Moose Population Survey in the Upper Tanana Valley Game Management Unit 12, Alaska, 2008

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — We conducted an aerial moose (Alces alces) survey on Tetlin National Wildlife Refuge and the northeast corner of Game Management Unit (GMU) 12 from 6 – 22 November...

  16. Reconsidering information management roles and capabilities in disaster response decision-making units

    NARCIS (Netherlands)

    Bharosa, N.; Janssen, M.F.W.H.A.

    2009-01-01

    When disaster strikes, the emerging task environment requires relief agencies to transform from autonomous mono-disciplinary organizations into interdependent multidisciplinary decision-making units. Evaluation studies reveal that adaptation of information management to the changing task environment

  17. Final Environmental Assessment : Livestock Grazing Management Seven Blackfeet Habitat Unit : Charles M. Russell National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Final environmental assessment for the grazing management within the Seven Blackfeet Habitat Unit of the Charles M. Russell National Wildlife Refuge, in relation to...

  18. United States of America Department of Energy Environmental Management Advisory Committee Public Meeting

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    This reports contains documentation of presentations given at the United States of America Department of Energy Environmental Management Advisory Committee Public Meeting held December 14--15, 1993 in Alexandria, Virginia.

  19. Water Management Program: Unit Three, 1985 Prime Hook National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual program describes the results of the 1984 water management program for Unit Three at Prime Hook National Wildlife Refuge and outlines the water regimen...

  20. 40 CFR 63.7886 - What are the general standards I must meet for my affected remediation material management units?

    Science.gov (United States)

    2010-07-01

    ... meet for my affected remediation material management units? 63.7886 Section 63.7886 Protection of... meet for my affected remediation material management units? (a) For each remediation material... material management units exempted under paragraph (c) or (d) of this section. (b) For each affected...

  1. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Science.gov (United States)

    2010-07-01

    ... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101 What must I do to address corrective action for solid waste management units? (a) You must...

  2. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  3. Implications of stock recovery for a neighbouring management unit: experience from the Baltic cod

    DEFF Research Database (Denmark)

    Eero, Margit; Hansen, Jakob Hemmer; Hüssy, Karin

    2014-01-01

    Cod in the Baltic Sea is assessed and managed as two separate stocks, i.e. eastern and western Baltic cod. The eastern Baltic cod has recently started to recover after several decades of severe depletion. In the present study, we suggest that the recovery of the eastern Baltic cod population has...... also substantially increased cod abundance in a specific area of the adjacent western Baltic management unit. This is investigated through long time-series of spatially resolved stock assessment data supplemented by genetic analyses of origin of the cod currently found in the transition area between...... the two populations. Due to immigrating cod from the east, there are currently large spatial differences in cod abundance and mean weight in the western Baltic management unit that raise new management concerns. First, the high abundance of cod of eastern origin found in the western Baltic management unit...

  4. Science, Society, and America's Nuclear Waste: The Waste Management System, Unit 4. Teacher Guide. Second Edition.

    Science.gov (United States)

    Department of Energy, Washington, DC. Office of Civilian Radioactive Waste Management, Washington, DC.

    This guide is Unit 4 of the four-part series, Science, Society, and America's Nuclear Waste, produced by the U.S. Department of Energy's Office Civilian Radioactive Waste Management. The goal of this unit is to explain how transportation, a geologic repository, and the multi-purpose canister will work together to provide short-term and long-term…

  5. The Efficacy of a Three-Week Stress Management Unit for High School Students.

    Science.gov (United States)

    Richardson, Glenn E.; And Others

    1983-01-01

    A study used psychometric information to determine the efficacy of a stress management unit in a high school health class. Students who took the unit showed improvement in knowledge, attitudes, and the ability to relax, as demonstrated on tests of heart rate and muscular tension. (PP)

  6. Managing Highway Maintenance: Standards for Maintenance Work, Part 3, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit explains various uses of maintenance standards and how standards should be interpreted and communicated to formen and crew leaders. Several examples are given of the decisions made when applying the standards to routine work. The preceding units on standards (parts 1 and 2)…

  7. Business unit controller involvement in management : An empirical study in the Netherlands

    NARCIS (Netherlands)

    Rouwelaar, ten J.A. (Hans); Bots, J.M.

    2008-01-01

    In recent years there has been much debate on the new business-oriented role of management accountants, also called controllers. The purpose of this paper is to investigate to what extent the involvement of the business unit (BU) controller in the decision-making process of business units is impacte

  8. Low Energy Technology. A Unit of Instruction in Florida Agriculture. Crop Protection with Integrated Pest Management.

    Science.gov (United States)

    Florida Univ., Gainesville. Inst. of Food and Agricultural Sciences.

    This unit of instruction on integrated pest management was designed for use by agribusiness and natural resources teachers in Florida high schools and by agricultural extension agents as they work with adults and students. It is one of a series of 11 instructional units (see note) written to help teachers and agents to educate their students and…

  9. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

    Science.gov (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  10. Recognition of management structure and spatial planning in Tehran metropolitan area

    OpenAIRE

    Manijeh Lalehpour

    2016-01-01

    Metropolitan areas are concentrated and dense areas filled settlements and include a central urban region with its surrounding residences. Severity and complexity of issues in metropolitan areas along with intricacy and quantity of influential factors in these areas necessitate novel approaches and innovative solutions for comprehensive strategies and management coordination of land use in these regions. The present study has taken this approach to investigate management structure and spatial...

  11. Project Management Unit for decommissioning of NPP Bohunice VI (2003-2014); Project Management Unit para el desmantelamiento de CN Bohunice V1 (2003-2014)

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Fernandez-conde, A.; Brochet, I.; Ferreira, A.

    2015-07-01

    From October 2003 until december 2014 the Consortium consisting of Iberdrola Engineering and Construction (leader). Empresarios Agrupados Internacional, and Indra Sistemas has carried out the project Project Management Unit ((PMU) for the decommissioning of Bohunice V1 NPP (units 1 and 2), type VVER-440/V-230 in Slovakia. during the first phase (2003-2007) EdF was also part of the Consortium. The project is funded by the Bohunice International Decommissioning Support Fund (BIDSF) administered by the RBRD. The main objective of the project is to provide the necessary engineering and resources of project management for planning, execution, management, coordination and monitoring of all tasks in support of the decommissioning. (Author)

  12. Seminar On Sanitation for Restaurant Owners and Managers. Unit I.

    Science.gov (United States)

    Threlkeld, Joyce C.

    Intended for use in conducting short seminars on sanitation for restaurant owners and managers, the conceptual outline is organized to provide four hours of classroom instruction. Two major concepts are emphasized. The first concept, the effect of sanitary practices on the financial profits of food service, focuses on: (1) service and quality to…

  13. Management of Character-Based Curriculum in the Educational Unit

    OpenAIRE

    Agustinus Hermino Superma Putra

    2015-01-01

    Manajemen Kurikulum Berbasis Karakter pada Satuan Pendidikan Abstract: The purpose of this study to determine the character-based curriculum in the educational unit. The approach used is a multi-case study design using the constant comparative method. Data were collected through interviews, observation, and study documentation. Analysis using comparative analysis. The results showed that curriculum planning based on the needs of the school, the ability of the foundation, educational exper...

  14. Human Resources Management Practices in Japanese Organizations in the United States.

    Science.gov (United States)

    Dicle, Ulku; And Others

    1988-01-01

    This study examines human resource management practices in Japanese organizations in the United States, specifically those in the Fort Custer Industrial Park, Battle Creek, Michigan. It identifies characteristics of human resource management, compares them with those of their parent organizations, and looks at modifications needed because of a new…

  15. Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

    Science.gov (United States)

    Matthew Thompson; David Calkin; Joe H. Scott; Michael. Hand

    2017-01-01

    Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

  16. Corrective Action Management Unit Report of Post-Closure Care Activities Calendar Year 2016.

    Energy Technology Data Exchange (ETDEWEB)

    Ziock, Robert [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Little, Bonnie Colleen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-02-01

    The Corrective Action Management Unit (CAMU) at Sandia National Laboratories, New Mexico (SNL/NM) consisted of a containment cell, two treatment systems, four associated waste staging and storage areas, and support areas; all were used for management of remediation wastes between 1997 and 2003.

  17. Connectionist Reinforcement Learning for Intelligent Unit Micro Management in StarCraft

    NARCIS (Netherlands)

    Shantia, Amirhosein; Begue, Eric; Wiering, Marco

    2011-01-01

    Real Time Strategy Games are one of the most popular game schemes in PC markets and offer a dynamic environment that involves several interacting agents. The core strategies that need to be developed in these games are unit micro management, building order, resource management, and the game main tac

  18. Computers in hospital management and improvements in patients care--new trends in the United States.

    Science.gov (United States)

    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  19. Connectionist Reinforcement Learning for Intelligent Unit Micro Management in StarCraft

    NARCIS (Netherlands)

    Shantia, Amirhosein; Begue, Eric; Wiering, Marco

    2011-01-01

    Real Time Strategy Games are one of the most popular game schemes in PC markets and offer a dynamic environment that involves several interacting agents. The core strategies that need to be developed in these games are unit micro management, building order, resource management, and the game main

  20. Recognition and management of common acute conditions of the oral cavity resulting from tooth decay, periodontal disease, and trauma: an update for the family physician.

    Science.gov (United States)

    Edwards, Paul C; Kanjirath, Preetha

    2010-01-01

    This article presents an overview of common and/or significant diseases of the oral cavity that the family physician is likely to encounter, with an emphasis on pathogenesis, recognition, complications, and management. Topics reviewed include the sequelae of dental caries, periodontal disease, and trauma. Prevention and early intervention strategies are emphasized. Recent updates and practical issues for the family physician are highlighted.

  1. Management of offshore wastes in the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Veil, J. A.

    1998-10-22

    During the process of finding and producing oil and gas in the offshore environment operators generate a variety of liquid and solid wastes. Some of these wastes are directly related to exploration and production activities (e.g., drilling wastes, produced water, treatment workover, and completion fluids) while other types of wastes are associated with human occupation of the offshore platforms (e.g., sanitary and domestic wastes, trash). Still other types of wastes can be considered generic industrial wastes (e.g., scrap metal and wood, wastes paints and chemicals, sand blasting residues). Finally, the offshore platforms themselves can be considered waste materials when their useful life span has been reached. Generally, offshore wastes are managed in one of three ways--onsite discharge, injection, or transportation to shore. This paper describes the regulatory requirements imposed by the government and the approaches used by offshore operators to manage and dispose of wastes in the US.

  2. Global Geospatial Information Management: un'iniziativa delle Nazioni Unite

    Directory of Open Access Journals (Sweden)

    Mauro Salvemini

    2010-03-01

    Full Text Available What is Global Geospatial Information ManagementThere is general agreement of an urgent need for an inter-government consultative mechanism that can play a leadershiprole in setting the agenda for the development of global geospatial information and to promote its use to address key global challenges; to liaise and coordinate among Member States, and between Member States and international organizations.

  3. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.

  4. United States-Russia: Environmental management activities, Summer 1998

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-09-01

    A Joint Coordinating Committee for Environmental Restoration and Waste Management (JCCEM) was formed between the US and Russia. This report describes the areas of research being studied under JCCEM, namely: Efficient separations; Contaminant transport and site characterization; Mixed wastes; High level waste tank remediation; Transuranic stabilization; Decontamination and decommissioning; and Emergency response. Other sections describe: Administrative framework for cooperation; Scientist exchange; Future actions; Non-JCCEM DOE-Russian activities; and JCCEM publications.

  5. Intelligent Tutor with Emotion Recognition and Student Emotion Management for Math Performance

    Directory of Open Access Journals (Sweden)

    Mari­a Luci­a Barron Estrada

    2014-10-01

    Full Text Available This research presents the development, implementation, and testing of an Intelligent Tutoring System for math in third grade elementary students, it identifies and manages the emotional state of the student; it produces affective feedback for the student during the course that also it is part of a social network. Emotions are recognized via facial expressions by means of an artificial neural network. The social network and the intelligent tutoring system with affective management have been tested in public and private elementary schools with very satisfying results.

  6. Contribution of unit managers to the training of student nurses in the Cape Peninsula

    Directory of Open Access Journals (Sweden)

    R. Troskie

    1998-09-01

    Full Text Available The article is based on research conducted over the period 1993 to 1996 in the Cape Peninsula. The purpose of the study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practice. The sample consisted of student nurses training in the four nursing colleges in the Cape Peninsula, and the unit managers working in the health services accommodating students for clinical practice in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patient care plans, discussing patients’ treatment plans when handing over report, giving assistance regarding care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students’ training programme.

  7. Contribution of unit managers to the training of student nurses in the Cape Peninsula.

    Science.gov (United States)

    Troskie, R; Guwa, S N; Booyens, S W

    1998-12-01

    The article is based on research conducted over the period 1993 to 1996 in the Cape Peninsula. The purpose of the study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practica. The sample consisted of student nurses training in the four nursing colleges in the Cape Peninsula, and the unit managers working in the health services accommodating students for clinical practica in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patient care plans, discussing patients' treatment plans when handing over report, giving assistance regarding care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students' training programme.

  8. Novel approach to cardiac alarm management on telemetry units.

    Science.gov (United States)

    Whalen, Deborah A; Covelle, Patricia M; Piepenbrink, James C; Villanova, Karen L; Cuneo, Charlotte L; Awtry, Eric H

    2014-01-01

    General medical-surgical units struggle with how best to use cardiac monitor alarms to alert nursing staff to important abnormal heart rates (HRs) and rhythms while limiting inappropriate and unnecessary alarms that may undermine both patient safety and quality of care. When alarms are more often false than true, the nursing staff's sense of urgency in responding to alarms is diminished. In this syndrome of "clinical alarm fatigue," the simple burden of alarms desensitizes caregivers to alarms. Noise levels associated with frequent alarms may also heighten patient anxiety and disrupt their perception of a healing environment. Alarm fatigue experienced by nurses and patients is a significant problem and innovative solutions are needed. The purpose of this quality improvement study was to determine variables that would safely reduce noncritical telemetry and monitor alarms on a general medical-surgical unit where standard manufacturer defaults contributed to excessive audible alarms. Mining of alarm data and direct observations of staff's response to alarms were used to identify the self-reset warning alarms for bradycardia, tachycardia, and HR limits as the largest contributors of audible alarms. In this quality improvement study, the alarms for bradycardia, tachycardia, and HR limits were changed to "crisis," requiring nursing staff to view and act on the alarm each time it sounded. The limits for HR were HR low 45 bpm and HR high 130 bpm. An overall 89% reduction in total mean weekly audible alarms was achieved on the pilot unit (t = 8.84; P monitoring events, and the incidence of code blues decreased by 50%. Alarms with self-reset capabilities may result in an excess number of audible alarms and clinical alarm fatigue. By eliminating self-resetting alarms, the volume of audible alarms and associated clinical alarm fatigue can be significantly reduced without requiring additional resources or technology or compromising patient safety and lead to improvement in

  9. Nurse manager perspective of staff participation in unit level shared governance.

    Science.gov (United States)

    Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J

    2017-08-30

    To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.

  10. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh.

    Science.gov (United States)

    Mashreky, S R; Bari, S; Sen, S L; Rahman, A; Khan, T F; Rahman, F

    2010-09-01

    Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  11. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh

    Directory of Open Access Journals (Sweden)

    Mashreky S

    2010-10-01

    Full Text Available Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  12. Competence Management System Design in International Multicultural Environment: Registration, Transfer, Recognition and Transparency

    Science.gov (United States)

    Starcic, Andreja Istenic

    2012-01-01

    A competence management system (CMS) was devised to assist the registration of competencies in the textile and clothing sector, starting in the four EU countries of Portugal, Slovenia, the UK and Denmark, further leading to the European network. This paper presents the design and development framework assisting international multicultural…

  13. Metabolic syndrome in women of childbearing age and pregnancy: recognition and management of dyslipidemia.

    Science.gov (United States)

    Paramsothy, Pathmaja; Knopp, Robert H

    2005-01-01

    The obesity pandemic engenders the global threat of metabolic syndrome and its related disorders, including diabetes and coronary artery disease (CAD). The purpose of this review is to discuss the deleterious effects of metabolic syndrome on women of childbearing age, including pregnancy, with a discussion of lipid management. Treatment options will also be presented.

  14. Third-Party Certification of Forest Management In Indonesia: Analysing Stakeholders' Recognition and Preferences

    Directory of Open Access Journals (Sweden)

    Santi Pratiwi

    2015-08-01

    Full Text Available The existence of third-party forest and timber certification schemes in Indonesia has created benefits and challenges, mainly for forest industries. In the end, the interests and objectives of those industries will determine whether they decide to get certified and if so, what certification schemes they will use. This study analyses the stakeholder recognition of the competing forest legality and sustainability certification systems and describes the preferences for particular schemes based on stakeholder interests. Online questionnaires were distributed to relevant stakeholders, namely logging companies, wood processing industries, wood processing associations, auditors, academics, environmental organisations and government officials. The results indicate that there are different scheme preferences based on the stakeholder's interests. Sistem verifikasi legalitas kayu (SVLK is the most frequently preferred scheme due to the simplicity of its requirements and the low cost of its certifying process, while the forest stewardship council (FSC is valued for its reputation and very high standards. Furthermore, lembaga ekolabel Indonesia (LEI was least preferred because of its complexity and because it was unpopular with foreign end buyers, and the programme for the endorsement of forest certification (PEFC was identified as being a complex scheme that was expensive and subject to high standards, and also appeared to have the least demand. Each scheme should be improved based on stakeholders' expectations, that their popularity with end buyers of timber products should be improved, and that this should be done in a way that allows logging and wood processing industries to choose freely the scheme that is most advantageous to them.

  15. Recognition and management of palatogingival groove for tooth survival: a literature review.

    Science.gov (United States)

    Kim, Hee-Jin; Choi, Yoorina; Yu, Mi-Kyung; Lee, Kwang-Won; Min, Kyung-San

    2017-05-01

    Palatogingival groove (PGG) is an anomaly in the maxillary anterior teeth, often accompanied by the area of bony destruction adjacent to the teeth with no carious or traumatic history. The hidden trap in the tooth can harbor plaque and bacteria, resulting in periodontal destruction with or without pulpal pathologic change. Related diseases can involve periodontal destruction, combined endodontic-periodontal lesions, or separate endodontic and periodontal lesions. Disease severity and prognosis related to PGG depend on several factors, including location, range, depth, and type of the groove. Several materials have been used and recommended for cases of extensive periodontal destruction from PGG to remove and block the inflammatory source and recover the health of surrounding periodontal tissues. Even in cases of severe periodontal destruction, several studies have reported favorable treatment outcomes with proper management. With new options in diagnosis and treatment, clinicians need a detailed understanding of the characteristics, treatment, and prognosis of PGG to successfully manage the condition.

  16. Impression Management and the Problematic Self Online: Facebook, Friendship and Recognition

    OpenAIRE

    Flaxman, Kayleigh Louise Layla

    2014-01-01

    This thesis broadly addresses the issue of identity management and performance online. The social networking site Facebook has been used as the primary research site due to its dominance on the World Wide Web and in individuals’ lives. Specifically this thesis seeks to understand how people negotiate their identity in a social space where a multitude of different friendship groups and associations are simultaneously present. The thesis makes extensive use of the premise originally made by Erv...

  17. Improving cellular therapy for primary immune deficiency diseases: recognition, diagnosis, and management.

    Science.gov (United States)

    Griffith, Linda M; Cowan, Morton J; Notarangelo, Luigi D; Puck, Jennifer M; Buckley, Rebecca H; Candotti, Fabio; Conley, Mary Ellen; Fleisher, Thomas A; Gaspar, H Bobby; Kohn, Donald B; Ochs, Hans D; O'Reilly, Richard J; Rizzo, J Douglas; Roifman, Chaim M; Small, Trudy N; Shearer, William T

    2009-12-01

    More than 20 North American academic centers account for the majority of hematopoietic stem cell transplantation (HCT) procedures for primary immunodeficiency diseases (PIDs), with smaller numbers performed at additional sites. Given the importance of a timely diagnosis of these rare diseases and the diversity of practice sites, there is a need for guidance as to best practices in management of patients with PIDs before, during, and in follow-up for definitive treatment. In this conference report of immune deficiency experts and HCT physicians who care for patients with PIDs, we present expert guidance for (1) PID diagnoses that are indications for HCT, including severe combined immunodeficiency disease (SCID), combined immunodeficiency disease, and other non-SCID diseases; (2) the critical importance of a high degree of suspicion of the primary care physician and timeliness of diagnosis for PIDs; (3) the need for rapid referral to an immune deficiency expert, center with experience in HCT, or both for patients with PIDs; (4) medical management of a child with suspicion of SCID/combined immunodeficiency disease while confirming the diagnosis, including infectious disease management and workup; (5) the posttransplantation follow-up visit schedule; (6) antimicrobial prophylaxis after transplantation, including gamma globulin administration; and (7) important indications for return to the transplantation center after discharge. Finally, we discuss the role of high-quality databases in treatment of PIDs and HCT as an element of the infrastructure that will be needed for productive multicenter clinical trials in these rare diseases.

  18. [A new joint approach to drug management: clinical pharmacy services and risk management unit].

    Science.gov (United States)

    Schwartz, Vardit; Kravitz, Martine Szyper

    2015-04-01

    According to the "To Err is Human" report, medication-related errors are common in medicine and may have several and different effects. Clinical Pharmacy is a leading worldwide established pharmacy service which has been improving the quality of care for the last 30 years. The accumulated experience shows improved quality of care, improved patient safety and economic benefit. These understandings led to the definition and expansion of the Clinical Pharmacist Intervention Program and a joint project with the Risk Management Unit was created. A characterization process was conducted, parameters were defined for monitoring and surveillance and interventions were devised. The relevant data requiring pharmacist intervention was defined (e.g., dose adjustments, contraindications, side-effects); a report was devised, based on the patient's electronic medical record; daily follow-up included analysis, stratification, quantification and understanding of the different types of pharmacist interventions. The pharmacist interventions were summed up and assessed for performance and quality control. Between March 2013 and February 2014 the medical records of 14,499 patients were examined in our hospital Only in 16% of the records an active pharmacist intervention was performed, according to the parameters defined. Interventions for potentially high risk events such as therapeutic duplication, drug administration in spite of contraindication and in spite of documented allergy were very rare, less than 2% of all the pharmacist interventions. This joint venture, which is based on an existing platform, reflects an up-to-date view of an important facet of the clinical work performed at the hospital, helps identify trends, potential failures and vulnerabilities with regard to medication treatment and allows the formulation of intervention programs to improve the quality and safety of drug therapy.

  19. A Multi-Agent Mah Jong Playing System: Towards Real-Time Recognition of Graphic Units in Graphic Representations

    Directory of Open Access Journals (Sweden)

    H. Achten

    2003-01-01

    Full Text Available In architectural design, sketching is an important means to explore the first conceptual developments in the design process. It is necessary to understand the conventions of depiction and encoding in sketches and drawings if we want to support the architect in the sketching activity. The theory of graphic units provides a comprehensive list of conventions of depiction and encoding that are widely used among architects. These graphic units form useful building blocks to understand design drawings. We investigate whether it is possible to build a system that can recognize graphic units. The technology we are looking at is multi-agent systems. It was chosen for the following reasons: agents can specialize in graphic units, a multi-agent system can deal with ambiguity through negotiation and conflict resolution, and multi-agent systems function in dynamically changing environments. Currently there is no general approach or technology available for multi-agent systems. Therefore, in our research we first set out to make such a multi-agent system. In order to keep the complexity low, we first aim to make a system that can do something simple: playing Mah Jong solitary. The Mah Jong solitary system shares the following important features with a multi-agent system that can recognize graphic units: (1 specialized agents for moves; (2 negotiation between agents to establish the best move; (3 a dynamically changing environment; and (4 search activity for more advanced strategies. The paper presents the theoretical basis of graphic units and multi-agents systems, followed by a description of the multi-agent framework and its implementation. A number of systems that can play Mah Jong at various degrees of competence and accordingly degrees of complexity of multi-agent system, are distinguished. Finally, the paper demonstrates how the findings are informative for a system that can recognize graphic units.

  20. Process and structure: resource management and the development of sub-unit organisational structure.

    Science.gov (United States)

    Packwood, T; Keen, J; Buxton, M

    1992-03-01

    Resource Management (RM) requires hospital units to manage their work in new ways, and the new management processes affect, and are affected by, organisation structure. This paper is concerned with these effects, reporting on the basis of a three-year evaluation of the national RM experiment that was commissioned by the DH. After briefly indicating some of the major characteristics of the RM process, the two main types of unit structures existing in the pilot sites at the beginning of the experiment, unit disciplinary structure and clinical directorates, are analysed. At the end of the experiment, while clinical directorates had become more popular, another variant, clinical grouping, had replaced the unit disciplinary structure. Both types of structure represent a movement towards sub-unit organisation, bringing the work and interests of the service providers and unit managers closer together. Their properties are likewise analysed and their implications, particularly in terms of training and organisational development (OD), are then considered. The paper concludes by considering the causes for these structural changes, which, in the immediate time-scale, appear to owe as much to the NHS Review as to RM.

  1. The Development and Trial Evaluation of Alternate Programs for Unit Training Managers and Trainers. Appendix D. Directed Practice Program for the TO and E Unit Training Manager Course

    Science.gov (United States)

    1977-09-01

    APPENDIX P. DIRECTED PRACTICE PROGRAM FOR THE; TO&E UNIT TRAINING MANAGER COURSE! William H. Welching Mark F. Brennani Jacklyn E...Controlling Otllct) rjJ William H./Melching, Mark F./Brennan, [^ Jacklyn E./Hungerla.id, Morris/Showel,! : ei John E.; Taylor RE,\\D...obstacle Barbed wire obst £.ole w/noiser.akers attached Rifle and helmet for each student 1 instructor 1/2 hour Put a telephone TA 312/PT into

  2. Segmenting into Adequate Units for Automatic Recognition of Emotion-Related Episodes: A Speech-Based Approach

    Directory of Open Access Journals (Sweden)

    Anton Batliner

    2010-01-01

    Full Text Available We deal with the topic of segmenting emotion-related (emotional/affective episodes into adequate units for analysis and automatic processing/classification—a topic that has not been addressed adequately so far. We concentrate on speech and illustrate promising approaches by using a database with children's emotional speech. We argue in favour of the word as basic unit and map sequences of words on both syntactic and ‘‘emotionally consistent” chunks and report classification performances for an exhaustive modelling of our data by mapping word-based paralinguistic emotion labels onto three classes representing valence (positive, neutral, negative, and onto a fourth rest (garbage class.

  3. An Effective Security Management of Database through DNA Fingerprinting Recognition using Geometric Parameters

    Directory of Open Access Journals (Sweden)

    Radha Krishna Rambol

    2012-08-01

    Full Text Available History bears testimony to the fact that the march of any civilization has been on the shoulders of science and technology. Almost everything that distinguishes the modern world from earlier centuries is attributable to science specially information technology. With the rapid growth in computing technology and its application in all spheres of modern society, databases have become an integral component of our everyday life. Database management system manages all the information to our use. The database needs to ensure its security and make it personalized and secure. To make it personalized up to family or royalty, DNA fingerprinting is only the aspect that serve best. In this present article, the researcher has endeavored to make all possible attempts to clarify the DNA database as the tool for Database Security that maintain the hierarchy of family inheritance. In this work, we are going to recognize the DNA sample present in the database with a feature based approach. The approach here is mainly by using the histogram plot by this we are going to extract the characteristics of the image features. By comparing these image features with images present in the database, we can decide whether the test image is from among DNA sample already known or not. If the test image is find in the database then system is displaying the identity of the user as well as works as the password to access the particular database on the basis of biological inheritance.

  4. Doctors' recognition and management of melanoma patients' risk: An Australian population-based study.

    Science.gov (United States)

    Madronio, C M; Armstrong, B K; Watts, C G; Goumas, C; Morton, R L; Curtin, A; Menzies, S W; Mann, G J; Thompson, J F; Cust, A E

    2016-12-01

    Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices. A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management. Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state's cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care. Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients' risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (melanoma patients' risk and could be the focus of strategies for improving care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  6. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Mitchell, A L; Gandhi, A; Scott-Coombes, D; Perros, P

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines. Recommendations • Ultrasound scanning (USS) of the nodule or goitre is a crucial investigation in guiding the need for fine needle aspiration cytology (FNAC). (R) • FNAC should be considered for all nodules with suspicious ultrasound features (U3-U5). If a nodule is smaller than 10 mm in diameter, USS guided FNAC is not recommended unless clinically suspicious lymph nodes on USS are also present. (R) • Cytological analysis and categorisation should be reported according to the current British Thyroid Association Guidance. (R) • Ultrasound scanning assessment of cervical nodes should be done in FNAC-proven cancer. (R) • Magnetic resonance imaging (MRI) or computed tomography (CT) should be done in suspected cases of retrosternal extension, fixed tumours (local invasion with or without vocal cord paralysis) or when haemoptysis is reported. When CT with contrast is used pre-operatively, there should be a two-month delay between the use of iodinated contrast media and subsequent radioactive iodine (I131) therapy. (R) • Fluoro-deoxy-glucose positron emission tomography imaging is not recommended for routine evaluation. (G) • In patients with thyroid cancer, assessment of extrathyroidal extension and lymph node disease in the central and lateral neck compartments should be undertaken pre-operatively by USS and cross-sectional imaging (CT or MRI) if indicated. (R) • For patients with Thy 3f or Thy 4 FNAC a diagnostic hemithyroidectomy is recommended. (R) • Total thyroidectomy is recommended for patients with tumours greater than 4 cm in diameter or tumours of any size in association with any of the following characteristics: multifocal disease, bilateral disease, extrathyroidal

  7. A study on work life balance amongst managers of garment units in Tamilnadu State, India

    Directory of Open Access Journals (Sweden)

    Kalaiselvi Kandampalayam Thulasimani

    2010-07-01

    Full Text Available Work life balance plays an important role now a day. Employees want it, managers need it, and organization cannot afford to ignore it! Managers need to take work-life balance seriously particularly in garment units. The more overworked and overloaded, the higher the demands or the expectations on the department or the work unit, the more the managers have to rely on their employees to produce at the highest possible level of efficiency, effectiveness, and quality. If managers are out of balance or stressed or sick then they will be less committed to the outcomes, they will be less committed to the organization, they will be less committed to the client, the product or goods or service that they are producing. This research paper examined the work life balance amongst managers of garment units in Tamil nadu state. The methodology adopted for the study was descriptive research design. Data were collected from 480 managers through questionnaire method around Tamilnadu state, India. In the present study, stastical tools such as percentage analysis, mean value, chi-square, ANOVA, and correlation analysis were used for the analysis. The results indicated that the work life balance of managers are not completely successful due to their present working hours, working environment and increase in products prices, work load, responsibilities in work and  decrease of job security due to recession.

  8. 75 FR 13253 - Plan Revision for Lake Tahoe Basin Management Unit, Alpine, El Dorado, and Placer Counties, CA...

    Science.gov (United States)

    2010-03-19

    ... management plan (forest plan) and will also prepare an environmental impact statement (EIS) for this revised... Be Made The Lake Tahoe Basin Management Unit is preparing an EIS to revise the current forest plan... Forest Service Plan Revision for Lake Tahoe Basin Management Unit, Alpine, El Dorado, and Placer Counties...

  9. Characteristics of the nurse manager's recognition behavior and its relation to sense of coherence of staff nurses in Japan

    OpenAIRE

    Miyata, Chiharu; Arai, Hidenori; SUGA, Sawako

    2015-01-01

    The recognition behaviors strongly influence the job satisfaction of staff nurses and an extremely important factor for the prevention of burnout and the promotion of retention. Additionally, among internal factors that may affect worker's mental health, a sense of coherence (SOC) is an important concept from the view of the salutogenic theory and stress recognition style. Individual's SOC increases in relation to recognition behavior. However, in Japan, few studies have examined the effect o...

  10. Defining management units for cetaceans by combining genetics, morphology, acoustics and satellite tracking

    Directory of Open Access Journals (Sweden)

    Signe Sveegaard

    2015-01-01

    Full Text Available Managing animal units is essential in biological conservation and requires spatial and temporal identification of such units. Since even neighbouring populations often have different conservation status and face different levels of anthropogenic pressure, detailed knowledge of population structure, seasonal range and overlap with animals from neighbouring populations is required to manage each unit separately. Previous studies on genetic structure and morphologic separation suggests three distinct populations of harbour porpoises with limited geographic overlap in the North Sea (NS, the Belt Sea (BS and the Baltic Proper (BP region. In this study, we aim to identify a management unit for the BS population of harbour porpoises. We use Argos satellite data and genetics from biopsies of tagged harbour porpoises as well as acoustic data from 40 passive acoustic data loggers to determine management areas with the least overlap between populations and thus the least error when abundance and population status is estimated. Discriminant analysis of the satellite tracking data from the BS and NS populations showed that the best fit of the management unit border during the summer months was an east–west line from Denmark to Sweden at latitude 56.95°N. For the border between BS and BP, satellite tracking data indicate a sharp decline in population density at 13.5°E, with 90% of the locations being west of this line. This was supported by the acoustic data with the average daily detection rate being 27.5 times higher west of 13.5°E as compared to east of 13.5°E. By using this novel multidisciplinary approach, we defined a management unit for the BS harbour porpoise population. We recommend that these boundaries are used for future monitoring efforts of this population under the EU directives. The boundaries may also be used for conservation efforts during the summer months, while seasonal movements of harbour porpoises should be considered during

  11. The Development Strategies for the Management Models of the Electronic Documents and Records in the United States, United Kingdom and Australia

    Directory of Open Access Journals (Sweden)

    Chiu-Yen Lin

    2015-06-01

    Full Text Available The trend toward electronic government has espoused a large quantity of electronic records, which challenge the existing records management models in the modern countries. This paper describes and compares the development and transition toward electronic records management in the United States, United Kingdom, and Australia to show how the three advanced countries evolved the government records management practices. The analysis emphasized on the holistic policy initiative perspective and compared the directives and regulations, research and development programs and plans, the emerging structures of governance, staffing and professional training, and risk management provisions. The comparison may shed lights on the government electronic management in the other countries. [Article content in Chinese

  12. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries.

    Science.gov (United States)

    Hubert, Gordian J; Müller-Barna, Peter; Audebert, Heinrich J

    2014-12-01

    TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries.

  13. Development and testing of INSPIRE themes Addresses (AD and Administrative Units (AU managed by COSMC

    Directory of Open Access Journals (Sweden)

    Michal Med

    2013-12-01

    Full Text Available Main content of this article is to describe implementing INSPIRE themes Addresses and Administrative Units in Czech Republic. Themes were implemented by Czech Office for Surveying, Mapping and Cadastre. Implementation contains developing GML files with data and designing its structure, developing and testing of INSPIRE services and preparing metadata for data and services. Besides harmonised INSPIRE themes COSMC manages also non-harmonised themes Cadastral map (KM and Units eXtended (UX.

  14. Salamander chytrid fungus (Batrachochytrium salamandrivorans) in the United States—Developing research, monitoring, and management strategies

    Science.gov (United States)

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

    2016-01-20

    The recently (2013) identified pathogenic chytrid fungus, Batrachochytrium salamandrivorans (Bsal), poses a severe threat to the distribution and abundance of salamanders within the United States and Europe. Development of a response strategy for the potential, and likely, invasion of Bsal into the United States is crucial to protect global salamander biodiversity. A formal working group, led by Amphibian Research and Monitoring Initiative (ARMI) scientists from the U.S. Geological Survey (USGS) Patuxent Wildlife Research Center, Fort Collins Science Center, and Forest and Rangeland Ecosystem Science Center, was held at the USGS Powell Center for Analysis and Synthesis in Fort Collins, Colorado, United States from June 23 to June 25, 2015, to identify crucial Bsal research and monitoring needs that could inform conservation and management strategies for salamanders in the United States. Key findings of the workshop included the following: (1) the introduction of Bsal into the United States is highly probable, if not inevitable, thus requiring development of immediate short-term and long-term intervention strategies to prevent Bsal establishment and biodiversity decline; (2) management actions targeted towards pathogen containment may be ineffective in reducing the long-term spread of Bsal throughout the United States; and (3) early detection of Bsal through surveillance at key amphibian import locations, among high-risk wild populations, and through analysis of archived samples is necessary for developing management responses. Top research priorities during the preinvasion stage included the following: (1) deployment of qualified diagnostic methods for Bsal and establishment of standardized laboratory practices, (2) assessment of susceptibility for amphibian hosts (including anurans), and (3) development and evaluation of short- and long-term pathogen intervention and management strategies. Several outcomes were achieved during the workshop, including development

  15. Using Lean principles to manage throughput on an inpatient rehabilitation unit.

    Science.gov (United States)

    Chiodo, Anthony; Wilke, Ruste; Bakshi, Rishi; Craig, Anita; Duwe, Doug; Hurvitz, Edward

    2012-11-01

    Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.

  16. Management and marketing in health care. Some lessons for the United States from the British system.

    Science.gov (United States)

    Gumbiner, R; Frye, R

    1973-06-01

    The British health care system has been examined by sociologists, political scientists, and medical care specialists before, but in this presentation a section of the British health care system is viewed through the eyes of modern business management, particularly as to cost and consumer effectiveness. Examination of positive features as well as problems may be helpful in relation to some future health care delivery system in the United States. Cross fertilization between the disciplines of management and medicine has much to offer to the rapidly changing delivery of health care in the United States.

  17. Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities.

    Science.gov (United States)

    Dickey, Wayne; Arday, David R; Kelly, Joseph; Carnahan, Col David

    2017-02-01

    As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines. ©2016 American Association of Nurse Practitioners.

  18. Ability emotional intelligence of nurse managers in the Midwestern United States

    Directory of Open Access Journals (Sweden)

    Susan M Ohlson

    2015-01-01

    Full Text Available Objective: The aim of this study was to describe the emotional intelligence (EI and examine the corresponding demographic characteristics of front-line Nurse Managers in acute care settings. Methods: This quantitative descriptive study was conducted in eight acute care hospitals in the Midwestern United States. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT was used to measure the EI of 87 front-line Nurse Managers. Demographic characteristics of the participants were captured on a second tool, the Nurse Manager Demographic Characteristics questionnaire. Descriptive and inferential statistics were used for analysis. Results: Significant correlations were found between the perceiving and using branches of the model and total EI score and nurses certified in a specialty. No significant correlations were found between EI and graduate education, age, years in management, percentage of time in management or number of direct reports. Considerations for future research are discussed. Conclusions: Opportunity exists to develop EI in front-line Nurse Managers.

  19. The recognition and management of intrapartum fetal heart rate emergencies: beyond definitions and classification.

    Science.gov (United States)

    Fahey, Jenifer O

    2014-01-01

    The ongoing and well-documented debate about the value of electronic fetal monitoring has focused primarily on the fact that most variant fetal heart rate (FHR) patterns are poor predictors of fetal acid-base status. Most recently, much of this attention has been focused on the implications for clinical management of FHR patterns that the National Institute of Child Health and Human Development has classified as indeterminate: neither normal nor abnormal. Given that a majority of fetuses will have an FHR pattern considered indeterminate at some point in labor, this is an important and worthwhile discussion. It is also important, however, for providers to be able to recognize those patterns that signal the presence of developing acidemia and those that signal the potential presence of an acute obstetric complication that can quickly lead to acidemia and fetal asphyxia, such as a placental abruption or uterine rupture. Early identification of these FHR patterns, and immediate intervention to improve oxygenation or expedite birth, may help improve neonatal outcomes. The first part of this article presents descriptions of theses FHR patterns. The route and timing of birth during these emergencies is then discussed. The last part of the article presents an overview of strategies for optimizing the efficiency of providers, particularly teams of providers, in responding to FHR emergencies. The use of simulation-based training is reviewed, with specific focus on its potential application in the context of preparing for these emergencies. © 2014 by the American College of Nurse-Midwives.

  20. [Management of tobacco smoking in the prison service units - The effects of the health promotion program].

    Science.gov (United States)

    Puchalski, Krzysztof; Korzeniowska, Elżbieta

    In 2014 the health promotion program aimed at managing personnel smoking was implemented in the Polish prison service (PS) in cooperation with the Nofer Institute of Occupational Medicine (NIOM). It combined education of managers, encouraging them to implement good practices, with employees' education. This paper describes the process of implementation and its effects in 159 units of PS, against the data on the management of smoking in medium and large companies in Poland gathered in 2010. Situations concerning smoking management in PS units before and after a half-year program implementation were compared. Data were gathered using self-diagnosis questionnaires (initial and final assessments) collectively filled in by representatives of management and employees. Due to the program implementation there was an increase in the percentage of PS units with known number of smoking employees (19% vs. 61%), consultions on formal smoking regulations with personnel (14% vs. 57%), minimal antismoking medical interventions (46% vs. 59%), and assessments of effects of antismoking activities (14% vs. 55%). There was also increase in the number of PS units with personnel totally obeying smoking regulations (28% vs. 41%) and decrease in those where such rules are not completely met (9% vs. 7%). In 3/4 PS units there was an increase in employees' interest in quitting smoking and in 40% of them employees smoke less at work. Almost every second unit has set up a health promotion team. In many aspects the program has brought along satisfying effects and allowed for depicting areas of improvement. Its scheme and tools can be used, after adaptation, in interventions concerning other health problems in workplaces. Med Pr 2016;67(5):605-621.

  1. What can the postanesthesia care unit manager do to decrease costs in the postanesthesia care unit?

    Science.gov (United States)

    Macario, A; Glenn, D; Dexter, F

    1999-10-01

    The economic structure of the PACU dictates whether a cost-reducing intervention (e.g., reducing the length of time patients stay in the PACU) is likely to decrease hospital costs. Cost-reducing interventions, such as changes in medical practice patterns (e.g., to reduce PACU length of stay), only impact variable costs. How PACU nurses are paid (e.g., salaried v hourly) affects which strategies to decrease PACU staffing costs will actually save money. For example, decreases in PACU labor costs resulting from increases in the number of patients that bypass the PACU vary depending on how the staff is compensated. The choice of anesthetic drugs and the elimination of low morbidity side effects of anesthesia, such as postoperative nausea, are likely to have little effect on the peak numbers of patients in a PACU and PACU staffing costs. Because the major determinant of labor productivity in the PACU is hour-to-hour and day-to-day variability in the timing of admissions from the operating room, a more even inflow of patients into the PACU could be attained by appropriate sequencing of cases in the operating room suite (e.g., have long cases scheduled at the beginning of the day). However, this mathematically proven solution may not be desirable. Surgeons, for example, may not want to lose control over the order of their cases. Guidelines for analysis of past daily peak numbers of patients are provided that will provide data to predict the minimum adequate number of nurses needed. Though many managers already do this manually on an ad hoc basis statistical methods summarized in this article may increase the accuracy.

  2. Barriers to implementation of risk management for federal wildland fire management agencies in the United States

    Science.gov (United States)

    Dave Calkin; Matthew P. Thompson; Alan A. Ager; Mark Finney

    2010-01-01

    In this presentation we review progress towards the implementation of a risk-based management framework for U.S. Federal wildland fire policy and operations. We first describe new developments in wildfire simulation technology that catalyzed the development of risk-based decision support systems for strategic wildfire management. These systems include new analytical...

  3. Phragmites australis management in the United States: 40 years of methods and outcomes.

    Science.gov (United States)

    Hazelton, Eric L G; Mozdzer, Thomas J; Burdick, David M; Kettenring, Karin M; Whigham, Dennis F

    2014-01-01

    Studies on invasive plant management are often short in duration and limited in the methods tested, and lack an adequate description of plant communities that replace the invader following removal. Here we present a comprehensive review of management studies on a single species, in an effort to elucidate future directions for research in invasive plant management. We reviewed the literature on Phragmites management in North America in an effort to synthesize our understanding of management efforts, identify gaps in knowledge and improve the efficacy of management. Additionally, we assessed recent ecological findings concerning Phragmites mechanisms of invasion and integrated these findings into our recommendations for more effective management. Our overall goal is to examine whether or not current management approaches can be improved and whether they promote reestablishment of native plant communities. We found: (i) little information on community-level recovery of vegetation following removal of Phragmites; and (ii) most management approaches focus on the removal of Phragmites from individual stands or groups of stands over a relatively small area. With a few exceptions, recovery studies did not monitor vegetation for substantial durations, thus limiting adequate evaluation of the recovery trajectory. We also found that none of the recovery studies were conducted in a landscape context, even though it is now well documented that land-use patterns on adjacent habitats influence the structure and function of wetlands, including the expansion of Phragmites. We suggest that Phragmites management needs to shift to watershed-scale efforts in coastal regions, or larger management units inland. In addition, management efforts should focus on restoring native plant communities, rather than simply eradicating Phragmites stands. Wetlands and watersheds should be prioritized to identify ecosystems that would benefit most from Phragmites management and those where the

  4. Crew resource management training in the intensive care unit: a multisite controlled before-after study.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.

    2016-01-01

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non

  5. The Moral Reasoning of Sports Management Students in the United States and Italy

    Science.gov (United States)

    Forte, Almerinda

    2013-01-01

    The researcher analyzed the moral reasoning ability of Sports Management students in the United States and Italy. The researcher statistically analyzed data collected through a survey questionnaire designed to measure moral reasoning. The Defining Issues Test (DIT) developed by James Rest using Kohlberg's six stages of moral judgment was used in…

  6. Litter Control, Waste Management, and Recycling Resource Unit, K-6. Bulletin 1722.

    Science.gov (United States)

    Louisiana State Dept. of Education, Baton Rouge.

    This unit provides elementary teachers with ideas for assisting their students in developing an understanding and appreciation of sound resource use. It contains projects and activities that focus on both the litter problem and on waste management solutions. These materials can be adapted and modified to accommodate different grade levels and…

  7. 76 FR 34271 - Hewlett Packard, Global Parts Supply Chain, Global Product Life Cycles Management Unit, Including...

    Science.gov (United States)

    2011-06-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Hewlett Packard, Global Parts Supply Chain, Global Product Life Cycles... workers of Hewlett Packard, Global Parts Supply Chain, Global Product Life Cycles Management Unit...

  8. The Moral Reasoning of Sports Management Students in the United States and Italy

    Science.gov (United States)

    Forte, Almerinda

    2013-01-01

    The researcher analyzed the moral reasoning ability of Sports Management students in the United States and Italy. The researcher statistically analyzed data collected through a survey questionnaire designed to measure moral reasoning. The Defining Issues Test (DIT) developed by James Rest using Kohlberg's six stages of moral judgment was used in…

  9. Managing Highway Maintenance: Instructor's Manual for Work Programs and Budgets, Unit 9, Levels 1 and 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit covers the purpose of developing work programs and budgets; a review of the program and budget development process (activity descriptions, feature inventories and quality standards, estimated work quantities, and dollar requirements); and typical calculations for work programs,…

  10. Managing Highway Maintenance: Standards for Maintenance Work, Part 1, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit is about maintenance standards and is designed for superintendents and senior foremen who are responsible for scheduling and controlling routine maintenance. It describes different kinds of standards, why and how standards are developed, and how standards are to be used and…

  11. The Role of an Academic Development Unit in Supporting Institutional VET Learning and Teaching Change Management

    Science.gov (United States)

    Fotinatos, Nina

    2016-01-01

    The aim of this paper is to examine the role and impact of a central academic development unit (ADU) within an institutional strategic and operational change management project. The primary goal of this project was to improve vocational education and training (VET) learning and teaching practice in an Australian dual-sector regional university.…

  12. Why business unit controllers bias accounting figures: Involvement in management, social pressure and Machiavellianism

    NARCIS (Netherlands)

    Maas, V.S.; Hartmann, F.G.H.

    2009-01-01

    This paper investigates why some business unit controllers are more likely to deliberately bias accounting data than others. Different from the existing literature, we argue that involvement in management and social pressure are neither necessary, nor sufficient conditions for biasing behavior.

  13. A Methodology for Building Faculty Support for the United Nations Principles for Responsible Management Education

    Science.gov (United States)

    Maloni, Michael J.; Smith, Shane D.; Napshin, Stuart

    2012-01-01

    Evidence from extant literature indicates that faculty support is a critical driver for implementing the United Nations Principles for Responsible Management Education (PRME), particularly for schools pursuing an advanced, cross-disciplinary level of sustainability integration. However, there is limited existing research offering insight into how…

  14. Effect of Conceptual Change Texts for Overcoming Misconceptions in "People and Management" Unit

    Science.gov (United States)

    Dagdelen, Orhan; Kosterelioglu, Ilker

    2015-01-01

    This study aimed to investigate the effects of conceptual change texts in teaching concepts in the "People and Management" Unit of a Social Studies Course. The working group of the study was composed of 4th graders in a primary school in Çorum, assigned as control (n = 23) and experimental (n = 23) groups. Non-equivalent control group…

  15. Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

    Science.gov (United States)

    Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

    2010-01-01

    This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

  16. The Moral Reasoning of Sports Management Students in the United States and Italy

    Science.gov (United States)

    Forte, Almerinda

    2013-01-01

    The researcher analyzed the moral reasoning ability of Sports Management students in the United States and Italy. The researcher statistically analyzed data collected through a survey questionnaire designed to measure moral reasoning. The Defining Issues Test (DIT) developed by James Rest using Kohlberg's six stages of moral judgment was used…

  17. A Methodology for Building Faculty Support for the United Nations Principles for Responsible Management Education

    Science.gov (United States)

    Maloni, Michael J.; Smith, Shane D.; Napshin, Stuart

    2012-01-01

    Evidence from extant literature indicates that faculty support is a critical driver for implementing the United Nations Principles for Responsible Management Education (PRME), particularly for schools pursuing an advanced, cross-disciplinary level of sustainability integration. However, there is limited existing research offering insight into how…

  18. Smoke modeling in support of management of forest landscapes in the eastern United States

    Science.gov (United States)

    Gary L. Achtemeier

    2009-01-01

    The impact of smoke from forest burning on air quality is a threat to the use of prescribed fire to manage woodlands in the eastern United States. Population shifts from urban centers to the wildland/urban interface have increased human exposures to smoke. Tighter national ambient air quality standards restrict the amount of smoke released over an area. This article...

  19. [Analysis of the safety culture in a Cardiology Unit managed by processes].

    Science.gov (United States)

    Raso-Raso, Rafael; Uris-Selles, Joaquín; Nolasco-Bonmatí, Andreu; Grau-Jornet, Guillermo; Revert-Gandia, Rosa; Jiménez-Carreño, Rebeca; Sánchez-Soriano, Ruth M; Chamorro-Fernández, Carlos I; Marco-Francés, Elvira; Albero-Martínez, José V

    2017-04-03

    The safety culture is one of the requirements to prevent the occurrence of adverse effects, however has not been studied in the field of cardiology. The objective is to evaluate the safety culture in a cardiology unit has implemented and certified an integrated quality and risk management for patient safety system. A transversal observational study was made in 2 consecutive years using the survey "Hospital Survey on Patient Safety Culture" of the "Agency for Healthcare Research and Quality" in its Spanish version (42 items grouped into 12 dimensions) in all staff. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules. The overall assessment of a possible 5, was 4.5 in 2014 and 4.7 in 2015. We identified seven dimensions as a fortress. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions respect to national data, and 8 respect to American data. The safety culture in a Cardiology Unit with an integrated quality and risk management and patient safety system is high, higher than the national in all its dimensions and in most of them respect to the United States. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  20. ­­Estimating Forest Management Units from Road Network Maps in the Southeastern U.S.

    Science.gov (United States)

    Yang, D.; Hall, J.; Fu, C. S.; Binford, M. W.

    2015-12-01

    The most important factor affecting forest structure and function is the type of management undertaken in forest stands. Owners manage forests using appropriately sized areas to meet management objectives, which include economic return, sustainability, recreation, or esthetic enjoyment. Thus, the socio-environmental unit of study for forests should be the management unit. To study the ecological effects of different kinds of management activities, we must identify individual management units. Road networks, which provide access for human activities, are widely used in managing forests in the southeastern U.S. Coastal Plain and Piedmont (SEUS). Our research question in this study is: How can we identify individual forest management units in an entire region? To answer it, we hypothesize that the road network defines management units on the landscape. Road-caused canopy openings are not always captured by satellite sensors, so it is difficult to delineate ecologically relevant patches based only on remote sensing data. We used a reliable, accurate and freely available road network data, OpenStreetMap (OSM), and the National Land Cover Database (NLCD) to delineate management units in a section of the SEUS defined by Landsat Wprldwide Reference System (WRS) II footprint path 17 row 39. The spatial frequency distributions of forest management units indicate that while units Management units ≥ 0.5 Ha ranged from 0.5 to 160,770 Ha (the Okefenokee National Wildlife Refuge). We compared the size-frequency distributions of management units with four independently derived management types: production, ecological, preservation, and passive management. Preservation and production management had the largest units, at 40.5 ± 2196.7 (s.d.) and 41.3 ± 273.5 Ha, respectively. Ecological and passive averaged about half as large at 19.2 ± 91.5 and 22.4 ± 96.0 Ha, respectively. This result supports the hypothesis that the road network defines management units in SEUS. If this way

  1. Valorization/Recognition of Environmental Protection Qualifications in the Chemical and Metal Industries. Synthesis of the National Reports: Federal Republic of Germany, France, Italy, Spain, United Kingdom. CEDEFOP Panorama. First Edition.

    Science.gov (United States)

    Gay, Catherine

    Reports on the development and recognition of environmental protection qualifications in the chemical and metal industries in Germany, France, Italy, Spain, and the United Kingdom were synthesized. The synthesis focused on companies' and social partners' current and planned strategies and obligations of companies regarding recognizing…

  2. Closure of hazardous and mixed radioactive waste management units at DOE facilities. [Contains glossary

    Energy Technology Data Exchange (ETDEWEB)

    1990-06-01

    This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure of each of the following hazardous waste management units regulated under RCRA.

  3. Managing medical technology: lessons for the United States from Quebec and France.

    Science.gov (United States)

    Rosenau, P V

    2000-01-01

    Important modifications to technology assessment, diffusion, adoption, and utilization must take place if the United States is to better employ medical technology and save resources so as to assure access for the uninsured and underinsured. The United States can learn from other health systems that are more successful in achieving these goals. The author selects for comparison the health systems of France and Quebec. The discussion focuses on the differences between the three systems in the management of medical technology on a range of policy-relevant dimensions, including health system structure, attitudes about planning versus market competition, government regulation, the balance between decentralization and centralization, the needs of the individual and those of the society, linkages between technology assessment and policy-making, and the importance of medical technology assessment for medical practice. Seven specific recommendations are made for better managing medical technology in the United States, drawing on what can be observed from the experiences of Quebec and France.

  4. Molecular recognition at methyl methacrylate/n-butyl acrylate (MMA/nBA) monomer unit boundaries of phospholipids at p-MMA/nBA copolymer surfaces.

    Science.gov (United States)

    Yu, Min; Urban, Marek W; Sheng, Yinghong; Leszczynski, Jerzy

    2008-09-16

    Lipid structural features and their interactions with proteins provide a useful vehicle for further advances in membrane proteins research. To mimic one of potential lipid-protein interactions we synthesized poly(methyl methacrylate/ n-butyl acrylate) (p-MMA/nBA) colloidal particles that were stabilized by phospholipid (PLs). Upon the particle coalescence, PL stratification resulted in the formation of surface localized ionic clusters (SLICs). These entities are capable of recognizing MMA/nBA monomer interfaces along the p-MMA/nBA copolymer backbone and form crystalline SLICs at the monomer interface. By utilizing attenuated total reflectance Fourier transform infrared (ATR FT-IR) spectroscopy and selected area electron diffraction (SAD) combined with ab initio calculations, studies were conducted that identified the origin of SLICs as well as their structural features formed on the surface of p-MMA/nBA copolymer films stabilized by 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) PL. Specific entities responsible for SLIC formation are selective noncovalent bonds of anionic phosphate and cationic quaternary ammonium segments of DLPC that interact with two neighboring carbonyl groups of nBA and MMA monomers of the p-MMA/nBA polymer backbone. To the best of our knowledge this is the first example of molecular recognition facilitated by coalescence of copolymer colloidal particles and the ability of PLs to form SLICs at the boundaries of the neighboring MMA and nBA monomer units of the p-MMA/nBA chain. The dominating noncovalent bonds responsible for the molecular recognition is a combination of H-bonding and electrostatic interactions.

  5. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

    Science.gov (United States)

    Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

    2016-01-01

    To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  6. Sustainable Materials Management (SMM) - Materials and Waste Management in the United States Key Facts and Figures

    Data.gov (United States)

    U.S. Environmental Protection Agency — Each year EPA produces a report called Advancing Sustainable Materials Management: Facts and Figures. It includes information on municipal solid waste (MSW)...

  7. Notes on critical care-review of seminal management and leadership papers in the United Kingdom.

    Science.gov (United States)

    Coombs, Maureen

    2009-06-01

    Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.

  8. Risk Management in Csr Unit of Shams Hospital Using FMEA Technique -Tabriz

    Directory of Open Access Journals (Sweden)

    Mohammad Saadati

    2015-08-01

    Full Text Available Background and Objectives : Since one of the effective ways to prevent infections is the proper sterilization of instruments, CSR is one of the most important units in hospitals. Thus, risk management has a high priority in CSR. The aim of this study was to identify and prevent potential risks in CSR unit in Shams Hospital using FMEA technique. Material and Methods : This is a descriptive and interventional study. Using FMEA technique, potential risks were identified. Risks were prioritized and corrective interventions were implemented to reduce risks. Results : The current study identified 69 risks that 10 risks were marked as high priority. Corrective activities were suggested by risk management teams which were applied. Conclusion : The results showed that flaws in safety policies, equipment and physical conditions were the most important risk factors. Implementing risk management plan and clear safety policies could be useful. ​

  9. Integrated pest management and weed management in the United States and Canada.

    Science.gov (United States)

    Owen, Micheal D K; Beckie, Hugh J; Leeson, Julia Y; Norsworthy, Jason K; Steckel, Larry E

    2015-03-01

    There is interest in more diverse weed management tactics because of evolved herbicide resistance in important weeds in many US and Canadian crop systems. While herbicide resistance in weeds is not new, the issue has become critical because of the adoption of simple, convenient and inexpensive crop systems based on genetically engineered glyphosate-tolerant crop cultivars. Importantly, genetic engineering has not been a factor in rice and wheat, two globally important food crops. There are many tactics that help to mitigate herbicide resistance in weeds and should be widely adopted. Evolved herbicide resistance in key weeds has influenced a limited number of growers to include a more diverse suite of tactics to supplement existing herbicidal tactics. Most growers still emphasize herbicides, often to the exclusion of alternative tactics. Application of integrated pest management for weeds is better characterized as integrated weed management, and more typically integrated herbicide management. However, adoption of diverse weed management tactics is limited. Modifying herbicide use will not solve herbicide resistance in weeds, and the relief provided by different herbicide use practices is generally short-lived at best. More diversity of tactics for weed management must be incorporated in crop systems.

  10. EVOLUTION OF THE FOREST MANAGEMENT PHILOSOPHY IN TURKEY: A CASE STUDY OF ARTVIN PLANNING UNIT

    Directory of Open Access Journals (Sweden)

    Hacı Ahmet Yolasığmaz

    2006-04-01

    Full Text Available Forest management plans were firstly prepared and implemented in Turkey between 1963 and 1973. All forests in Turkey have been managed with timber oriented forest management philosophy; however, there have been some developments about inventory and silviculture techniques for approximately 40 years. Last decade, Turkey participated in Convention of Biological Diversity in Rio (1992 and included in both Pan – European and Near East Region Conventions. Nowadays, Turkish forest management philosophy has changed from timber management to ecosystem-based multiple-use forest planning with the principles of “sustainable forest management” criteria and indicators drafted in a few national and international agreements. Thus, Turkish forestry is underway in a restructuring process. This paper presents evolution of the traditional forest management philosophy in Turkey since 1963. This study was carried out in Artvin Planning Unit. Past two decade planning periods (managed under timber management approach was compared with current case study data used for forest multiple use management approach based on ecosystem in terms of distribution of age class, site class and change of volume and increment. In conclusion, former applications and techniques for adaptation of improvement must be analyzed and interpreted properly. Monetary resources and experts as well as legal, technique and scientific framework must be provided.

  11. Flyway Habitat Management Unit Project report no. 2: Important migration and wintering waterfowl habitat in the United States, 1965 and 2000, and trends

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Estimates of acreages of upland, wetland, and permanent water habitat important to migrating and wintering waterfowl were made for each of 164 management units in...

  12. Leadership skills for nursing unit managers to decrease intention to leave

    Directory of Open Access Journals (Sweden)

    Roche MA

    2015-05-01

    Full Text Available Michael A Roche,1 Christine Duffield,1,2 Sofia Dimitrelis,1 Belinda Frew1 1Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia Aim: To examine specific elements of nursing leadership linked to intention to leave, in public acute care hospitals. Background: Nurse turnover is a global issue receiving widespread attention due to prolonged and projected workforce shortages. Nurse management and leadership qualities have been associated with intention to leave and turnover of nurses. The role of the nurse unit managers in the retention of nurses is becoming increasingly important, particularly because of their strong influence on the quality and stability of the work environment. Methods: Data were collected from 62 medical, surgical, and mixed units across eleven public acute care hospitals in three Australian states (September 2008 to August 2010. A total of 1,673 nurses completed a nurse survey that included measures of intention to leave and leadership aspects of the practice environment. Analyses explored specific leadership characteristics that were associated with turnover intent. Results: The role of nursing unit managers was confirmed to be a major factor in nurses’ intention to remain or leave their current workplace. Nurses valued “human” skills more highly than other leadership characteristics, including their manager’s connection with nurses’ concerns, clarity, participation in decisions, and encouragement. Conclusion: Strong leadership qualities in the nursing unit manager have been associated with greater job satisfaction, reduced turnover intention among nursing staff, and improved patient outcomes. Nurse leaders need to be supported in an effort to retain nurses given ongoing workforce issues and to ensure high-quality patient care. Keywords: nurse

  13. Pattern recognition

    CERN Document Server

    Theodoridis, Sergios

    2003-01-01

    Pattern recognition is a scientific discipline that is becoming increasingly important in the age of automation and information handling and retrieval. Patter Recognition, 2e covers the entire spectrum of pattern recognition applications, from image analysis to speech recognition and communications. This book presents cutting-edge material on neural networks, - a set of linked microprocessors that can form associations and uses pattern recognition to ""learn"" -and enhances student motivation by approaching pattern recognition from the designer's point of view. A direct result of more than 10

  14. [Airway management in intensive care units in Rhineland-Palatinate : Evolution over five years].

    Science.gov (United States)

    Piepho, T; Härer, T; Ellermann, L; Noppens, R R

    2017-05-01

    Securing the airway in severely ill patients is associated with a high rate of complications. So far, no information exists about the equipment readily available for airway management in German intensive care units (ICUs). It is also unknown if the range of material has improved over time. In the present trial the availability of equipment for airway management in ICUs in Rhineland-Palatinate was evaluated at two different times. Using a structured questionnaire, all ICUs in the state were contacted in the years 2010 and 2015. The availability of different types of equipment for airway management, as well as the presence of a training program for airway management, was evaluated. For 2010 data from 64 ICUs were evaluated and for 2015 data sets from 63 ICUs were collected. In 2010 indirect laryngoscopes were available in eight ICUs; in 2015 these devices were directly accessible in 43 units (p airway procedures was available in nearly every ICU (n = 60). The availability of capnography increased significantly from 2010 (n = 12) to 2015 (n = 56; p airway management was performed in 23 and 32 units, respectively (p > 0.05). Most ICUs in Rhineland-Palatinate have a broad range of equipment for airway management available, and the range has significantly improved over the time period evaluated. The availability of indirect laryngoscopes and capnometers improved significantly. However, it is remarkable that in some ICU's there is still a lack of equipment for advanced airway management.

  15. The United Nations and Energy Management. Conference on the United Nations of the Next Decade (15th, Woodstock, Vermont, June 15-20, 1980).

    Science.gov (United States)

    Stanley Foundation, Muscatine, IA.

    The conference described in this report convened to provide a forum for exchanging ideas and opinions on the role of the United Nations in global energy management. The conference was one in a series of international meetings (14 have been held to date) to consider how to increase the effectiveness of the United Nations during the 1980s. The…

  16. Gharacteristics and management style of Mexican enterprises in the United States

    Directory of Open Access Journals (Sweden)

    Blanco, M.

    2005-07-01

    Full Text Available The United States and Mexico are two countries with vast cultural and economic differences, but their bilateral relations oftrade and Foreign Direct Investment (FDl are very close. Their geographic proximity and their membership to NAFTA have increased the US-Mexican goods trade and have multiplied the Foreign Direct Investment (FDl inflows into Mexico by seven folds during 1988-2000. Onthe other hand, the Mexican FDI inflows into the United States even though enjoyed a steady growth during last years, but without asubstantialncrease. Although, there are some outside ooliticalnd economical fctors that have influenced this evolution ofFDI in both countries, there are some managerial fctors that have made it difficult to integratehe Mexican enterprises with the US ones. Some researches confirm that in Mexico, cultural aspects influence in all possible ways to make business. These are different from the American management style, so the Mexican enterprises that wanto invest in the American market must adopt the American management system, in order to have a successful investment. This research aims to: 1 Demonstrate thgrowing mutual economic trade interdependence between Mexico and the United States, 2 ldentify in which sectors and what areas are most of the Mexican enterprises located in the United States and 3 Compare the Mexican management style with the American system.

  17. Neonatal nurses' perceptions of pain management: survey of the United States and China.

    Science.gov (United States)

    Cong, Xiaomei; McGrath, Jacqueline M; Delaney, Colleen; Chen, Hua; Liang, Shuang; Vazquez, Victoria; Keating, Laura; Chang, Kimberly; Dejong, Angela

    2014-12-01

    Despite growing knowledge, neonatal pain remains unrecognized, undertreated, and generally challenging. A cross-sectional survey study was conducted to investigate neonatal nurses' perceptions, knowledge, and practice of infant pain in the United States and China, including 343 neonatal nurses (American nurses [n = 237]; Chinese nurses [n = 106]). Nurses' responses regarding neonatal pain reflected adequate knowledge in general pain concepts, but knowledge deficits related to several topics were found (e.g., preterm infants are more sensitive to pain and long-term consequences of pain). Most reported regular use of pain assessment tools, but fewer agreed that the tool used was appropriate and accurate. More American nurses (83%) than Chinese nurses (58%) felt confident in the use of pain medications, while more Chinese nurses (78%) than American nurses (61%) acknowledged the effectiveness of nonpharmacologic interventions. About half reported that pain in their units was well managed (American: 44.3%; Chinese: 55.7%), and less than half felt that pain guidelines/protocols were research-based (American: 42.6%; Chinese: 34.9%). Nurses' perceptions of well-managed pain in their units were significantly correlated with adequate education/training, use of accurate tools, and use of research-based protocols. Barriers to effective pain management included resistance to change, lack of knowledge, lack of time, fear of side effects of pain medication, and lack of trust in the tools. The survey reflects concerns that pain has not been well managed in many neonatal intensive care units in the United States and China. Further actions are needed to solve the issues of inadequate training, lack of clinically feasible pain tools, and absence of evidence-based guidelines/protocols.

  18. Integrating genetic data and population viability analyses for the identification of harbour seal (Phoca vitulina) populations and management units.

    Science.gov (United States)

    Olsen, Morten T; Andersen, Liselotte W; Dietz, Rune; Teilmann, Jonas; Härkönen, Tero; Siegismund, Hans R

    2014-02-01

    Identification of populations and management units is an essential step in the study of natural systems. Still, there is limited consensus regarding how to define populations and management units, and whether genetic methods allow for inference at the relevant spatial and temporal scale. Here, we present a novel approach, integrating genetic, life history and demographic data to identify populations and management units in southern Scandinavian harbour seals. First, 15 microsatellite markers and model- and distance-based genetic clustering methods were used to determine the population genetic structure in harbour seals. Second, we used harbour seal demographic and life history data to conduct population viability analyses (PVAs) in the vortex simulation model in order to determine whether the inferred genetic units could be classified as management units according to Lowe and Allendorf's (Molecular Ecology, 19, 2010, 3038) 'population viability criterion' for demographic independence. The genetic analyses revealed fine-scale population structuring in southern Scandinavian harbour seals and pointed to the existence of several genetic units. The PVAs indicated that the census population size of each of these genetic units was sufficiently large for long-term population viability, and hence that the units could be classified as demographically independent management units. Our study suggests that population genetic inference can offer the same degree of temporal and spatial resolution as 'nongenetic' methods and that the combined use of genetic data and PVAs constitutes a promising approach for delineating populations and management units.

  19. Management of behavioral and psychological symptoms of dementia in a dedicated psychogeriatric unit: a pilot experience.

    Science.gov (United States)

    Koskas, Pierre; Feugeas, Marie Cécile Henry; Saad, Sawsan; Belqadi, Sana; Daraux, Jacques; Drunat, Olivier

    2011-01-01

    The French government gave a consensual definition of reinforced care units for Behavioral and Psychological Symptoms in Dementia (BPSD) within the project "Plan Alzheimer 2008/2012." These Cognitive and Behavioral Units (CBU) differ in resources from the traditional reference units for BPSD management, the Acute Psychogeriatric Units (APU). However, a better understanding of their operational specificities may enhance the CBU and APU synergies. To describe one of the first CBU experiments, with regard to preexisting BPSD management in an APU in the same geriatric hospital. A total of 129 patients with BPSD, 35 from the CBU and 94 admitted to the APU before opening the colocated CBU. Patients from the CBU often showed comorbidities and a lower nutritional status, but these conditions were more frequent in the APU (P ≤ 10(-4)). Severe dementia, night time and aberrant motor behavior, and agitation were more frequent in the CBU (P ≤ 0.0015). In both the units, about 80% of patients were improved without increased use of psychotropic medications and there was a high discharge rate back home of about 30%. These findings that are still preliminary support a particular role for the CBU for elderly patients showing the most advanced dementia and disruptive BPSD. Colocated APU and CBU may allow for more effective integration of medical and psychiatric care in elderly patients with BPSD with frequent comorbidities.

  20. [Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard].

    Science.gov (United States)

    Lorenzo Torrent, R; Sánchez Palacios, M; Santana Cabrera, L; Cobian Martinez, J L; García del Rosario, C

    2010-10-01

    The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel.

  1. United States Local Government Reform: The Emergence of the City Manager

    Directory of Open Access Journals (Sweden)

    Robert McEVOY

    2002-06-01

    Full Text Available City Managers came into being in the early 1900.s because of the corruption, waste, and lack of responsiveness of local governments in the United States. Business leaders in large cities had begun to recognise that major changes in their local governments were desperately needed for their businesses to grow and prosper. Andrew Carnegie, a founder of United States Steel, had indicated that business needed a stable society to prosper. Local government had to become responsive to the changing needs of the poor, abused and neglected children, the mentally ill and the elderly, to cite a few examples.

  2. Development of Advanced In core Management Codes for Ulchin Unit 1, 2

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hee; Park, Moon Gyu [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1996-12-31

    As the first case of FRAMATOME`s plants, Ulchin Unit 1 Cycle 8 core was loaded with V5H fuel. Because of the heterogeneity in the axial enrichment of the V5H fuel, FRAMATOME`s 2-D in core management codes, CEDRIC-CARIN-ESTHER, are no longer valid to be used for in core management. In order to analyze Ulchin Unit 1 an 2 cores loaded with V5H fuel exactly, this study substituted them with WH`s In core-3D and Tote code. The previous IN CORE-Tote codes have been utilized on the HP workstation or the IBM mainframe which are not easily accessible by the site engineers and require the complicated manipulation in the computer network system. This study developed the PC-version of IN CORE-3D and Tote codes available in plants, including an interface code linking the data measured by the in core instrument system (RIC-KIT system) to IN CORE code. These codes reduce the time to manage in core and increase the economic benefits. We installed the developed codes in Ulchin Unit 1 and 2 and actually applied them to the core power distribution measurement performed during Cycle 8 power escalation tests. The results satisfied all limits of Technical Specification very well. The major contents of this study can be categorized as follows. 1. Analysis of the in core management codes. (a) Analysis of flux mapping system and measurement reduction algorithm. (b) Analysis of the methodology of in core management codes. 2. Development and verification of PC-version in core management codes. (a) Development of the measured-data processing code (C2I). (b) Development of PC-version IN CORE code. (c) Development of PC-version Tote code (d) Verification of the developed codes. 3. Application to core physics test of Ulchin until cycle 8. (a) Power distribution measurement at 75% and 100%. (author). 14 refs., figs., tabs.

  3. The Need To Reposition The Insurance Logistics Management In M.A.I. Units

    Directory of Open Access Journals (Sweden)

    Paul Gheorghe

    2017-03-01

    Full Text Available Logistics, considered by some authors as "a science of the future, has the aim ofof study dimensioning and correlation optimal flow of information and goods, in order to continuously adapt the organization to the environment" and is an essential component of management entity, especially in the context propagation production concept JIT (just in time, extended to financial security. Providing specialized management and structural compatibility between M.A.I. units components and greater specialization of staff with similar tasks are achievable when the uniformity of the organization structure of the existing logistics structures subordinated M. A.I.

  4. [Organizational context and care management by nurses at emergency care units].

    Science.gov (United States)

    dos Santos, José Luis Guedes; Pestanab, Aline Lima; Higashi, Giovana Dorneles Callegaro; de Oliveira, Roberta Juliane Tono; Cassetari, Sônia da Silva Reis; Erdmann, Alacoque Lorenzini

    2014-12-01

    The purpose of this study was to understand the meanings attributed to the organizational context and the role of nurses in care management at emergency care units.This study was based on qualitative research and the Grounded Theory methodological framework. Data were collected from September 2011 to June 2012 by means of semi-structured interviews with 20 participants from two emergency care units (UPA) in southern Brazil, divided into three sample groups. The context is marked by constraints that hinder communication and interaction between professionals and the search of assistance by patients with demands that are not resolved at other levels of care. This scenario highlights the performance of nurses in the managerial dimension of their work, who assume the responsibility for managing care and coordinating professional actions in favour of improved care practices.

  5. United States Air Force Summer Faculty Research Program. 1980 Program Management Report.

    Science.gov (United States)

    1980-10-01

    Command, United States Air Force, and is conduted by the South- eastern Center for Electrical Engineering Education, Inc. UNCLASS I FIED SECURITY...Tolin Human Resource Management in the Air Force 76 Proton Induced Nuclear Events in Silicon Dr. William P. Tucker 77 A Model for the Thermal ...particularly the specific heat and thermal conductivity of the coatings, the thickness of the coating, and the properties of the superconductor. A comparison of

  6. SafeNet - fleet management network for ships and offshore units

    Energy Technology Data Exchange (ETDEWEB)

    Bereicoa, Sidney; Noble, Peter [American Bureau of Shipping (United States)

    1998-07-01

    This paper will provide an overview of the SafeNet system and its core fleet management modules as well as discuss the special features implemented, such as mooring analysis, for application to MODU's, FPSO's and other offshore units. In addition, the techniques for assessing the condition of the structure represented by its corrosion scenario, coating breakdown, structural stresses and fatigue will also be described. (author)

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

    Science.gov (United States)

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

    2016-07-01

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

  8. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Ismail, Ahmad

    2016-12-01

    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  9. Failures of foreseeability: Risk management considerations in reducing allegations of sexual violence in psychiatric units.

    Science.gov (United States)

    Banja, John D

    2017-01-01

    This article begins with a brief discussion of findings on causal factors leading to allegations of sexual violence in health care facilities and then offers the author's account of 4 such cases that he reviewed, 3 of which occurred in psychiatric units. These cases show remarkably similar variables, especially involving decisions to allow male and female patients to commingle, the inadequate physical layout of the units, poor or absent video surveillance, and staff unacquainted with institutional policies on patient safety or refusing to enforce relevant rules. These variables arguably amount to "failures of foreseeability" that reasonably cautious health care personnel should recognize as facilitating or enabling sexual violence. As such, the proactive message of this article for health care risk management urges critical and robust attention paid to a unit's environmental/physical design as well as to performance factors among personnel so as to prevent sexual attacks and diminish the probability of malpractice actions.

  10. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries...... and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance...

  11. Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardebil, Iran

    Directory of Open Access Journals (Sweden)

    Nasrin Mehrnoush

    2016-12-01

    Full Text Available Background: This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units. Methods: A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013, including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.Results: Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%. Less than half felt that the pain tool used in their unit was an accurate measure (44.2%. Fewer than half reported that pain was well managed (28.3% , that their pain protocols were research evidence based (34.2% and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%. Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.Conclusions: proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision.

  12. Integrating genetic data and population viability analyses for the identification of harbour seal (Phoca vitulina) populations and management units

    DEFF Research Database (Denmark)

    Olsen, Morten Tange; Andersen, Liselotte Wesley; Dietz, Rune

    2014-01-01

    present a novel approach, integrating genetic, life-history and demographic data to identify populations and management units in southern Scandinavian harbour seals. First, 15 microsatellite markers and model- and distance-based genetic clustering methods were used to determine the population genetic...... structure in harbour seals. Second, we used harbour seal demographic and life-history data to conduct population viability analyses (PVAs) in the VORTEX simulation model in order to determine whether the inferred genetic units could be classified as management units according to Lowe and Allendorf's (2010......Identification of populations and management units is an essential step in the study of natural systems. Still, there is limited consensus regarding how to define populations and management units, and whether genetic methods allow for inference at the relevant spatial and temporal scale. Here, we...

  13. Geographic variation in social acceptability of wildland fuels management in the western United States

    Science.gov (United States)

    Brunson, M.; Schindler, Bruce A.

    2004-01-01

    Contemporary natural resource management requires consideration of the social acceptability of management practices and conditions. Agencies wishing to measure, respond to, and influence social acceptability must understand the nuances of public perception regarding controversial issues. This study explores social acceptability judgments about one such issue: reduction of wildland fuel hazards on federal lands in the western United States. Citizens were surveyed in four locations where fire has been a significant ecological disturbance agent and public land agencies propose to reduce wildland fuel levels and wildfire hazards via prescribed burning, thinning, brush removal, and/or livestock grazing. Respondents in different locations differed in their knowledge about fire and fuel issues as well in their acceptability judgments. Differences are associated with location-specific social and environmental factors as well as individual beliefs. Results argue against using a??one-size-fits-alla?? policies or information strategies about fuels management.

  14. Development of a Carbon Management Geographic Information System (GIS) for the United States

    Energy Technology Data Exchange (ETDEWEB)

    Howard Herzog; Holly Javedan

    2009-12-31

    In this project a Carbon Management Geographical Information System (GIS) for the US was developed. The GIS stored, integrated, and manipulated information relating to the components of carbon management systems. Additionally, the GIS was used to interpret and analyze the effect of developing these systems. This report documents the key deliverables from the project: (1) Carbon Management Geographical Information System (GIS) Documentation; (2) Stationary CO{sub 2} Source Database; (3) Regulatory Data for CCS in United States; (4) CO{sub 2} Capture Cost Estimation; (5) CO{sub 2} Storage Capacity Tools; (6) CO{sub 2} Injection Cost Modeling; (7) CO{sub 2} Pipeline Transport Cost Estimation; (8) CO{sub 2} Source-Sink Matching Algorithm; and (9) CO{sub 2} Pipeline Transport and Cost Model.

  15. Habitat Demonstration Unit Project: Leadership and Management Strategies for a Rapid Prototyping Project

    Science.gov (United States)

    Kennedy, Kriss J.; Toup, Larry; Gill, Tracy; Tri, Terry; Howe, Scott; Smitherman, David

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies being used by the NASA HDU team for a rapid prototyping project. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team rapid prototyping approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project

  16. Rivers as borders, uniting or dividing? The effect of topography and implications for catchment management.

    Science.gov (United States)

    Smedley, D A; Rowntree, K M

    2012-01-01

    South Africa's water resources are unequally distributed over space and time and an already stressed water resource situation will only be exacerbated by climate change if current predictions are correct. The potential for conflict over increasingly strained water resources in South Africa is thus very real. In order to deal with these complex problems, national legislation is demanding that water resource management be decentralized to the local level where active participation can take place in an integrated manner in accordance with the principles of Integrated Water Resource Management (IWRM). However, administrative and political boundaries rarely match those of catchments as, throughout South Africa, rivers have been employed extensively to delineate administrative and political boundaries at a number of spatial scales. The aim of this research is to determine if rivers act as dividing or uniting features in a socio-political landscape and whether topography will influence their role in this context. The Orange-Senqu River is used as a case study. This paper goes on to consider the implications of this for catchment management in South Africa. No study known to the authors has explored the effect of the river itself, and its topographic setting, on the drivers that foster either conflict or cooperation, and allow for participatory management. This study presents evidence that the topography of a catchment has the ability to aggravate or reduce the impact of the variables considered by water managers and thereby influence the role of a river as a dividing or uniting feature. South Africa's proposed form of decentralized water management will have to contend with the effects of different topographies on the way in which rivers are perceived and utilized.

  17. Work and Recognition

    DEFF Research Database (Denmark)

    Willig, Rasmus

    2004-01-01

    individual and collective identity formation and has led to an increase in social pathological illnesses such as stress and depression. By juxtaposing these analyses with Honneth’s theory on recognition, we conclude that the contemporary logic of work is unable to provide adequate forms of recognition......The article deals with the relationship between work and recognition, taking Axel Honneth’s social-philosophical theory of the struggle for recognition as its point of departure. In order to give sociological substance to Honneth’s theory, we turn to three contemporary social theorists - Jean......-Pierre Le Goff, Christophe Dejours and Emmanuel Renault. In spite of many differences, their work is united by a critical description of the logic of work and its consequences for individual individuation. These theorists agree that the growth of autonomy, flexibility and mobility has destabilised...

  18. Work and Recognition

    DEFF Research Database (Denmark)

    Willig, Rasmus

    2004-01-01

    individual and collective identity formation and has led to an increase in social pathological illnesses such as stress and depression. By juxtaposing these analyses with Honneth’s theory on recognition, we conclude that the contemporary logic of work is unable to provide adequate forms of recognition......The article deals with the relationship between work and recognition, taking Axel Honneth’s social-philosophical theory of the struggle for recognition as its point of departure. In order to give sociological substance to Honneth’s theory, we turn to three contemporary social theorists - Jean......-Pierre Le Goff, Christophe Dejours and Emmanuel Renault. In spite of many differences, their work is united by a critical description of the logic of work and its consequences for individual individuation. These theorists agree that the growth of autonomy, flexibility and mobility has destabilised...

  19. Management units radio physics hospital clinic: New management model; Unidades de gestion clinica de radiofisica hospitalaria, ¿nuevo modelo de gestion?

    Energy Technology Data Exchange (ETDEWEB)

    Iborra Oquendo, M.; Angulo Pain, E.; Castro Ramirez, I.; Quinones Rodriguez, L. A.; Urena Llinares, A.; Richarter Reina, J. M.; Lupiani Castellanos, J.; Ramos Caballero, L. I.

    2011-07-01

    Clinical management in the Andalusian Health Service is a process of organizational design that allows professionals to incorporate the management of resources used in their own clinical practice. In the Clinical Management Units activity develops according to different objectives, among them: encourage the involvement of health professionals in managing the centers, enhance continuity of care between the two levels of care, improve work organization and raise patient satisfaction.

  20. Development of certified environmental management in hospital and outpatient haemodialysis units.

    Science.gov (United States)

    García Vicente, Sergio; Morales Suárez-Varela, María; Martí Monrós, Anna; Llopis González, Agustín

    2015-01-01

    The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Face Recognition Technology Application Study in Prison Management%人脸识别技术在监狱管理中的应用研究

    Institute of Scientific and Technical Information of China (English)

    陈书光

    2011-01-01

    本文重点结合监狱管理中门禁系统对人脸识别的需求,详细分析了监狱管理中的门禁系统对人脸识别的业务需求、功能需求、性能需求和高级接口需求等,并对每一个需求点设定了优先级,为实现一个有效的具有人脸识别功能的门禁系统打下了基础。%This paper focuses on access control system with the prison administration's demand for face recognition, a detailed analysis of prison management in the face recognition access control system of business requirements,functional requirements,performance requirements and other high-level interface requirements,and each needs point set priorities,to achieve an effective access control system with face recognition features lay the foundation.

  2. The identification and description of the management units of the Goegap Nature Reserve

    Directory of Open Access Journals (Sweden)

    Helga Rosch

    2001-07-01

    Full Text Available Goegap Nature Reserve, near Springbok, is situated in the floral paradise of Namaqualand. This 15 000 ha reserve falls within the Namaqualand Broken Veld and in the transition zone between this Veld type and the False Succulent Karoo. Otherwise, it could be said that the reserve falls within the Upland Succulent Karoo and the transition zone between this vegetation type and the Bushmanland vegetation type. With the use of stratified aerial photographs of the reserve, random sample plots were placed within each homogeneous physiographic-physionomic unit and 284 releves were compiled in September 1998. With the use of the BBPC computer program, the resulting TWINSPAN split the data into two tables, one predominantly for the Plains and one for the Rocky Hills. After refining these tables, 13 plant communities were identified. These communities, together with the stratified aerial photographs, land type and habitat information were used to determine ten management units for the reserve. These units will be used in effective management and monitoring on the reserve. Table 1 and 2 will be uploaded as a supplementary file in due course.

  3. Theory of Infants' Transition Management from the Neonatal Intensive Care Unit to Home: a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Mahboobeh Namnabati

    2017-01-01

    Full Text Available Background: Infant's transition is a challenge for parents and the health system that requires ongoing assessment and management to improve each newborn`s growth and development. The purpose of this study was to explore the management of infant` transition from neonatal intensive care unit (NICU to home.Materials and Methods: We used a grounded theory study to explore and describe the management of infants’ transition from the NICU to the home. Interviews were conducted with 31 professionals and 20 family members, and participant observations were made in hospitals, clinics, and one physician office. MAXQDA was utilized for coding and categorizing data.Results: The theory illustrated six phenomena: An unexpected separation; A crisis situation; Mother-infant rebonding; Protection of the infant’s health; Promotion of growth and development; and Inadequate management causing disability. Together, these formed a three-phase process consisting of: A threat to the infant's life, Efforts to save the infant's life, and Continuation of life. Conclusion: Development of the theory of  infants transition provides a three phases process ( A threat to the infant’s life, Efforts to save the infant’s life, and Continuation of life, that  can yield   guidelines to  manage  the infant` transition in prevent mother–infant separation, support parents in their role as primary caregivers, and follow up with individual home visits by nurses.

  4. RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

    Science.gov (United States)

    Zapatero-Gaviria, Antonio; Javier Elola-Somoza, Francisco; Casariego-Vales, Emilio; Fernandez-Perez, Cristina; Gomez-Huelgas, Ricardo; Bernal, José Luis; Barba-Martín, Raquel

    2017-08-01

    To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

  5. A postal survey of hydrosalpinx management prior to IVF in the United Kingdom.

    Science.gov (United States)

    Hammadieh, N; Afnan, M; Evans, J; Sharif, K; Amso, N; Olufowobi, O

    2004-04-01

    In the last decade, numerous studies have demonstrated concern about the presence of hydrosalpinx and its management in patients undergoing IVF. We evaluated the current management of hydrosalpinx prior to IVF treatment in the UK. A total of 117 postal survey, anonymous, sealed questionnaires were sent to all IVF centres in the UK, to determine the policy for the management of hydrosalpinx in infertile women prior to IVF treatment. There were 88 (75%) responders, of which 80 (91%) indicated that they discussed the effect of hydrosalpinx on IVF outcome. Ten (12%) units did not recommend treatment of hydrosalpinx prior to IVF treatment, while 30 (36%), 27 (33%) and 16 (19%) recommended treatment weakly, strongly and very strongly respectively. The treatment options offered by clinicians were laparoscopic salpingectomy (75%), open salpingectomy (45%), salpingostomy (40%), proximal tubal occlusion (34%), transvaginal songraphic (TVS) aspiration during oocyte collection (23%) and TVS aspiration before oocyte collection (10%). The frequency of use varied from one option of treatment to another. Only 28% of the responders had a protocol or guidelines for the management of hydrosalpinx. More attention should be given to patients with hydrosalpinx prior to IVF treatment and patients should be counselled about the negative effect of hydrosalpinx on IVF outcome. There is a wide variation in the management of hydrosalpinx prior to IVF treatment in the UK and many treatment options may be questionable, as they are not yet based on evidence.

  6. Sustainable water management in the southwestern United States: reality or rhetoric?

    Directory of Open Access Journals (Sweden)

    Robert M Marshall

    Full Text Available BACKGROUND: While freshwater sustainability is generally defined as the provisioning of water for both people and the environment, in practice it is largely focused only on supplying water to furnish human population growth. Symptomatic of this is the state of Arizona, where rapid growth outside of the metropolitan Phoenix-Tucson corridor relies on the same groundwater that supplies year-round flow in rivers. Using Arizona as a case study, we present the first study in the southwestern United States that evaluates the potential impact of future population growth and water demand on streamflow depletion across multiple watersheds. METHODOLOGY/PRINCIPAL FINDINGS: We modeled population growth and water demand through 2050 and used four scenarios to explore the potential effects of alternative growth and water management strategies on river flows. Under the base population projection, we found that rivers in seven of the 18 study watersheds could be dewatered due to municipal demand. Implementing alternative growth and water management strategies, however, could prevent four of these rivers from being dewatered. CONCLUSIONS/SIGNIFICANCE: The window of opportunity to implement water management strategies is narrowing. Because impacts from groundwater extraction are cumulative and cannot be immediately reversed, proactive water management strategies should be implemented where groundwater will be used to support new municipal demand. Our approach provides a low-cost method to identify where alternative water and growth management strategies may have the most impact, and demonstrates that such strategies can maintain a continued water supply for both people and the environment.

  7. The effect of nursing management development program on clinical competency in coronary care unit

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

    Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.

  8. Nurse managers' strategies for the integration of newly graduated nurses into clinical units in Japan: a qualitative exploratory study.

    Science.gov (United States)

    Gregg, Misuzu F; Wakisaka, Toyomi; Hayashi, Chifuyu

    2013-01-01

    The purpose of this study was to explore the strategies used by nurse managers in Japan to facilitate the integration of newly graduate nurses (NGNs) into their clinical units. The integration of NGNs into clinical units is an important issue for both NGNs and nurse managers because the first year of practice plays a vital role in a NGN's career. Data were generated through semi-structured interviews with 9 nurse managers in 9 acute care hospitals. Data analysis was conducted using a qualitative content analysis method. Nurse managers used a total of 6 strategies: understanding the circumstances of NGNs, providing opportunities for experience and learning, supporting nurses who teach NGNs, facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. Three of these strategies were particularly important for NGNs' integration into clinical units: facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. These strategies were described in this study. The strategies adopted by nurse managers should be aimed at all nurses, not just NGNs, in order to strengthen the sense of comradeship in clinical units. This approach would create a supportive environment for the integration of NGNs into clinical units. The strategies presented in this study can be utilized not just by nurse managers but all senior nurses in the unit. NGNs can use these strategies to help them understand what they need to do to become a full member of their unit.

  9. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  10. [Barriers and challenges of the functional healthcare risk management units in hospitals of Madrid health service].

    Science.gov (United States)

    Pardo-Hernández, A; Navarro-Royo, C; Arguedas-Sanz, R; Albeniz-Lizarraga, C; Morón-Merchante, J

    2014-01-01

    To identify the barriers and challenges for the effective development of risk management units in hospitals of the Madrid Health Service. Descriptive cross-sectional study aimed at the management teams and members of the functional units of 31 hospitals in the Madrid Health Service. A self-administered questionnaire requesting answers in free text was used, identifying up to five barriers and challenges, and their prioritization by awarding from 1-5 points according to their importance. A discourse analysis was then conducted, grouping common themes and sorting them according to their score. The overall response rate was 94%. The most frequently identified barriers were lack of time (21%), inadequate safety culture (13%), lack of publication of their activities (10%), and lack of training (10%). The most important challenge was developing the training (18%), followed by improving the culture (17%), communication of safety activities (11%), and achieve leadership from the managers of the services (11%). According to the study conditions, the main identified barrier identified was the lack of available time, and the principal challenge found was promoting a proactive learning culture. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  11. Status of adolescent pelvic inflammatory disease management in the United States.

    Science.gov (United States)

    Trent, Maria

    2013-10-01

    Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

  12. Survey of 2014 behavioral management programs for laboratory primates in the United States.

    Science.gov (United States)

    Baker, Kate C

    2016-07-01

    The behavioral management of laboratory nonhuman primates in the United States has not been thoroughly characterized since 2003. This article presents the results of a survey behavioral management programs at 27 facilities and covering a total of 59,636 primates, 27,916 housed in indoor cages and 31,720 in group enclosures. The survey included questions regarding program structure, implementation, and methodology associated with social housing, positive reinforcement training, positive human interaction, exercise enclosures, and several categories of inanimate enrichment. The vast majority of laboratory primates are housed socially (83%). Since 2003, the proportion of indoor-housed primates reported to be housed singly has fallen considerably, from 59% to 35% in the facilities surveyed. The use of social housing remains significantly constrained by: 1) research protocol requirements, highlighting the value of closely involved IACUCs for harmonizing research and behavioral management; and 2) the unavailability of compatible social partners, underscoring the necessity of objective analysis of the methods used to foster and maintain compatibility. Positive reinforcement training appears to have expanded and is now used at all facilities responding to the survey. The use of enrichment devices has also increased in the participating facilities. For most behavioral management techniques, concerns over the possibility of negative consequences to animals are expressed most frequently for social housing and destructible enrichment, while skepticism regarding efficacy is limited almost exclusively to sensory enrichment. Behavioral management program staffing has expanded over time in the facilities surveyed, due not only to increased numbers of dedicated behavioral management technicians but also to greater involvement of animal care technicians, suggesting an increase in the integration of behavioral care into animal husbandry. Broad awareness of common practice may assist

  13. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Hong-chen ZHAO; Kong-han PAN; Qiu-ping XU

    2011-01-01

    This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission,ICU length of stay, acute physiology and chronic health evaluation (APACHE) Ⅱ score, and mortality were 18.2 beds,764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over-whelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab-domen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were "third-spacing from massive volume resuscitation in different settings" (88%), "intra-abdominal bleed-ing", and "liver failure with ascites" (52% for both). Though 60% respondents would recommend surgical decompres-sion when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re-spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physi

  14. THE INFORMATION CONTENT OF THE FARM AND UNIT LEVEL NUTRIENT BALANCES FOR THE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    T SOMOGYI

    2007-07-01

    Full Text Available The farm gate balance is well known from the environmental literature. This method is not suitable in every case to show the nutrient load for the environment of agricultural companies that is the reason why unit level internal nutrient balances are applied to express the level of nutrient pollution on the environment. These also help to determine the source of the pollution. With the survey of the nutrient flows within the farm we determine the keystones of nutrient management to control the nutrient load of the pollution sources. On the basis of the results and the controlled data of the unit level internal balances we make recommendations for the most appropriate environmental policy instrument to reduce the nutrient pollution.

  15. The Application of the lris Recognition System Security Management%虹膜识别安全管理系统的应用

    Institute of Scientific and Technical Information of China (English)

    张召华; 牛宁; 丁红; 惠庆华

    2014-01-01

    随着人们对社会安全要求的增加,基于生物特征识别的智能身份鉴别方法逐渐受到广泛的关注。由于虹膜识别具有高可靠性和非侵犯性,它正成为生物特征识别领域中的一个研究热点。看守所关押人员安全监控正从安全性较低的口令、门禁卡等传统方式向安全性更高的生物特征识别认证技术发展。虹膜识别以其超群的安全性、可靠性成为新型看守所关押人员安全管理认证系统的首选。%With the increasing demand for security ,biometrics based personal identification methods are being paid more attention. Due to its high reliability and non-invasiveness ,iris recognition is now a hot research and application topic. Passwords and cards based security management in detention houses is be-ing upgraded to biometrics based approaches. Iris recognition is the most suitable choice for the security management of modern detention houses.

  16. Best management practices plan for the Lower East Fork Poplar Creek Operable Unit, Oak Ridge, Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-04-01

    This plan was prepared in support of the Phase II Remedial Design Report (DOE/OR/01-1449&D1) and in accordance with requirements under CERCLA to present the plan for best management practices to be followed during the remediation. This document provides the Environmental Restoration Program with information about spill prevention and control, water quality monitoring, good housekeeping practices, sediment and erosion control measures, and inspections and environmental compliance practices to be used during Phase II of the remediation project for the Lower East Fork Poplar Creek Operable Unit.

  17. Retiree health benefits in the United States: a strategic critical management review.

    Science.gov (United States)

    Asubonteng, P; Bumpus, M; Munchus, G

    1997-01-01

    This article provides a critical review of studies associated with retiree health benefits in the United States. An attempt is made to determine if logical conclusions or trends could be identified regarding this issue of health care policy debate. The forms of retiree health benefits are covered, as is a discussion of Medigap policies and insurance coverage for the elderly. Employer-sponsored retiree benefits and the effects of supplemental coverage on the use of services are also reviewed. Lastly, a discussion and conclusion regarding this research agenda is presented with a critical analysis of the health care policy management debate for the future.

  18. Design of Central Management & Control Unit for Onboard High-Speed Data Handling System

    Institute of Scientific and Technical Information of China (English)

    LI Yan-qin; JIN Sheng-zhen; NING Shu-nian

    2007-01-01

    The Main Optical Telescope (MOT) is an important payload of the Space Solar Telescope (SST) with various instruments and observation modes. Its real-time data handling and management and control tasks are arduous. Based on the advanced techniques of foreign countries, an improved structure of onboard data handling systems feasible for SST, is proposed. This article concentrated on the development of a Central Management & Control Unit (MCU) based on FPGA and DSP. Through reconfigurating the FPGA and DSP programs, the prototype could perform different tasks.Thus the inheritability of the whole system is improved. The completed dual-channel prototype proves that the system meets all requirements of the MOT. Its high reliability and safety features also meet the requirements under harsh conditions such as mine detection.

  19. Top 40 priorities for science to inform conservation and management policy in the United States

    Science.gov (United States)

    Fleishman, Erica; Blockstein, David E.; Hall, John A.; Mascia, Michael B.; Rudd, Murray A.; Scott, J. Michael; Sutherland, William J.; Bartuska, Ann M.; Brown, A. Gordon; Christen, Catherine A.; Clement, Joel P.; DellaSala, Dominick; Duke, Clifford D.; Fiske, Shirley J.; Gosnell, Hannah; Haney, J. Chris; Hutchins, Michael; Klein, Mary L.; Marqusee, Jeffrey; Noon, Barry R.; Nordgren, John R.; Orbuch, Paul M.; Powell, Jimmie; Quarles, Steven P.; Saterson, Kathryn A.; Stein, Bruce A.; Webster, Michael S.; Vedder, Amy

    2011-01-01

    To maximize the utility of research to decisionmaking, especially given limited financial resources, scientists must set priorities for their efforts. We present a list of the top 40 high-priority, multidisciplinary research questions directed toward informing some of the most important current and future decisions about management of species, communities, and ecological processes in the United States. The questions were generated by an open, inclusive process that included personal interviews with decisionmakers, broad solicitation of research needs from scientists and policymakers, and an intensive workshop that included scientifically oriented individuals responsible for managing and developing policy related to natural resources. The process differed from previous efforts to set priorities for conservation research in its focus on the engagement of decisionmakers in addition to researchers. The research priorities emphasized the importance of addressing societal context and exploration of trade-offs among alternative policies and actions, as well as more traditional questions related to ecological processes and functions.

  20. When do business units benefit more from collective citizenship behavior of management teams? An upper echelons perspective.

    Science.gov (United States)

    Liu, Wu; Gong, Yaping; Liu, Jun

    2014-05-01

    Drawing upon the notion of managerial discretion from upper echelons theory, we theorize which external contingencies moderate the relationship between collective organizational citizenship behavior (COCB) and unit performance. Focusing on business unit (BU) management teams, we hypothesize that COCB of BU management teams enhances BU performance and that this impact depends on environmental uncertainty and BU management-team decision latitude, 2 determinants of managerial discretion. In particular, the positive effect of COCB is stronger when environmental uncertainty or the BU management-team decision latitude is greater. Time-lagged data from 109 BUs of a telecommunications company support the hypotheses. Additional exploratory analysis shows that the positive moderating effect of environmental uncertainty is further amplified at higher levels of BU management-team decision latitude. Overall, this study extends the internally focused view in the micro OCB literature by introducing external contingencies for the COCB-unit-performance relationship.

  1. Management and Climate Controls on Fire Trends in the Continental United States

    Science.gov (United States)

    Lin, H.; McCarty, J. L.; Wang, D.; Rogers, B. M.; Morton, D. C.; Collatz, G. J.; Randerson, J. T.

    2012-12-01

    Fires in croplands, plantations, and rangelands contribute significantly to fire emissions in the United States, yet are often overshadowed by forest fires in both scale and in the resources invested for management. Here we quantified decadal trends, interannual variability, and seasonality of satellite observations of active fires as a function of management type in the continental U.S. during 2001-2010. We used the Monitoring Trends in Burn Severity Database (MTBS) to identify the location of large wildland fires and the MODIS Land Cover Type Product (MCD12Q1) to identify agricultural burning in croplands. A third class of fires, defined as prescribed or other fires included all residual fires not attributed to wildland or cropland fire types. Wildland fires dominated the interannual variation for U.S. active fires; however, there were no significant trends by region over the last decade. Agricultural and other/prescribed fires were responsible for 70% of total active fires, 50% of which were in the south and southeastern United States where contributions from wildland fires was relatively small. In the west, agricultural fires had a decreasing trend at a rate of 6% per year, mainly during the harvest season of October. Except for the west, prescribed fires were in-phase with agricultural fires on both seasonal and interannual timescales, possibly reflecting the similar management strategies. We also performed correlation analysis between fires and potential evapotranspiration (PE) to examine how climate controls varied by fire type. While climate is the dominant factor for wildland fires, agricultural and other non-wildland fires show no direct relationship to PE. Our result suggests that by targeting agricultural and prescribed fire management, there is potential to significantly reduce landscape fire emissions within the U.S., despite expected changes in climate over the next several decades. The trends (p < 0.01) in annual active fire detections across the

  2. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  3. Relating management practices and nutrient export in agricultural watersheds of the United States

    Science.gov (United States)

    Sprague, Lori A.; Gronberg, Jo Ann M.

    2012-01-01

    Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.

  4. Lumbar puncture for suspected meningitis after intensive care unit admission is likely to change management.

    Science.gov (United States)

    Khasawneh, Faisal A; Smalligan, Roger D; Mohamad, Tammam N; Moughrabieh, Mohamad K; Soubani, Ayman O

    2011-02-01

    The aim of this study was to determine the outcome of lumbar punctures (LPs) in critically ill medical patients and how likely the results were to change case management. A retrospective review was conducted on the medical records of all 168 patients who underwent LP during their medical intensive care unit (MICU) admission at a university hospital during a 4.5-year period beginning in January 2000. Lumbar puncture was performed a mean of 2.8 days after MICU admission. The most common symptoms that prompted LP were changes in mental status and fever. Seventy-four percent of patients were on antibiotics at the time of LP, and 98% of patients had a computed tomography scan of the head performed before the procedure. Lumbar puncture confirmed meningitis in 47 (30%) patients and provided a specific bacteriologic diagnosis in 5 (3%) patients. The results of the procedure led to a change in management in 50 (30%) patients. The presence of meningeal signs and use of antibiotics at the time of the procedure were the factors that predicted change in management. Although the likelihood that LP will yield a specific bacteriologic diagnosis in critically ill patients is low, the procedure frequently provides important information that can lead to a change in case management, most commonly de-escalation of antibiotic therapy.

  5. Impact of a risk management plan on Legionella contamination of dental unit water.

    Science.gov (United States)

    Leoni, Erica; Dallolio, Laura; Stagni, Francesca; Sanna, Tiziana; D'Alessandro, Giovanni; Piana, Gabriela

    2015-02-23

    The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

  6. Genetic specificity of face recognition.

    Science.gov (United States)

    Shakeshaft, Nicholas G; Plomin, Robert

    2015-10-13

    Specific cognitive abilities in diverse domains are typically found to be highly heritable and substantially correlated with general cognitive ability (g), both phenotypically and genetically. Recent twin studies have found the ability to memorize and recognize faces to be an exception, being similarly heritable but phenotypically substantially uncorrelated both with g and with general object recognition. However, the genetic relationships between face recognition and other abilities (the extent to which they share a common genetic etiology) cannot be determined from phenotypic associations. In this, to our knowledge, first study of the genetic associations between face recognition and other domains, 2,000 18- and 19-year-old United Kingdom twins completed tests assessing their face recognition, object recognition, and general cognitive abilities. Results confirmed the substantial heritability of face recognition (61%), and multivariate genetic analyses found that most of this genetic influence is unique and not shared with other cognitive abilities.

  7. A historical context of municipal solid waste management in the United States.

    Science.gov (United States)

    Louis, Garrick E

    2004-08-01

    Municipal solid waste management (MSWM) in the United States is a system comprised of regulatory, administrative, market, technology, and social subcomponents, and can only be understood in the context of its historical evolution. American cities lacked organized public works for street cleaning, refuse collection, water treatment, and human waste removal until the early 1800s. Recurrent epidemics forced efforts to improve public health and the environment. The belief in anticontagionism led to the construction of water treatment and sewerage works during the nineteenth century, by sanitary engineers working for regional public health authorities. This infrastructure was capital intensive and required regional institutions to finance and administer it. By the time attention turned to solid waste management in the 1880s, funding was not available for a regional infrastructure. Thus, solid waste management was established as a local responsibility, centred on nearby municipal dumps. George Waring of New York City organized solid waste management around engineering unit operations; including street sweeping, refuse collection, transportation, resource recovery and disposal. This approach was adopted nationwide, and was managed by City Departments of Sanitation. Innovations such as the introduction of trucks, motorized street sweepers, incineration, and sanitary landfill were developed in the following decades. The Resource Conservation and Recovery Act of 1976 (RCRA), is the defining legislation for MSWM practice in America today. It forced the closure of open dumps nationwide, and required regional planning for MSWM. The closure of municipal dumps caused a 'garbage crisis' in the late 1980s and early 1990s. Private companies assumed an expanded role in MSWM through regional facilities that required the transportation of MSW across state lines. These transboundary movements of MSW created the issue of flow control, in which the US Supreme Court affirmed the protection

  8. Biodiversity and management of the Madrean Archipelago: The Sky Islands of southwestern United States and northwestern Mexico

    Science.gov (United States)

    Leonard H. DeBano; Peter H. Ffolliott; Alfredo Ortega-Rubio; Gerald J. Gottfried; Robert H. Hamre; Carleton B. Edminster

    1995-01-01

    This conference brought together scientists and managers from government, universities, and private organizations to examine the biological diversity and management challenges of the unique "sky island" ecosystems of the mountains of the southwestern United States and northwestern Mexico. Session topics included: floristic resources, plant ecology,...

  9. Broadening GHG accounting with LCA: application to a waste management business unit.

    Science.gov (United States)

    Fallaha, Sophie; Martineau, Geneviève; Bécaert, Valérie; Margni, Manuele; Deschênes, Louise; Samson, Réjean; Aoustin, Emmanuelle

    2009-11-01

    In an effort to obtain the most accurate climate change impact assessment, greenhouse gas (GHG) accounting is evolving to include life-cycle thinking. This study (1) identifies similarities and key differences between GHG accounting and life-cycle assessment (LCA), (2) compares them on a consistent basis through a case study on a waste management business unit. First, GHG accounting is performed. According to the GHG Protocol, annual emissions are categorized into three scopes: direct GHG emissions (scope 1), indirect emissions related to electricity, heat and steam production (scope 2) and other indirect emissions (scope 3). The LCA is then structured into a comparable framework: each LCA process is disaggregated into these three scopes, the annual operating activities are assessed, and the environmental impacts are determined using the IMPACT2002+ method. By comparing these two approaches it is concluded that both LCA and GHG accounting provide similar climate change impact results as the same major GHG contributors are determined for scope 1 emissions. The emissions from scope 2 appear negligible whereas emissions from scope 3 cannot be neglected since they contribute to around 10% of the climate change impact of the waste management business unit. This statement is strengthened by the fact that scope 3 generates 75% of the resource use damage and 30% of the ecosystem quality damage categories. The study also shows that LCA can help in setting up the framework for a annual GHG accounting by determining the major climate change contributors.

  10. Effect of different water management strategies on water and contaminant fluxes in Doncaster, United Kingdom.

    Science.gov (United States)

    Rueedi, J; Cronin, A A; Moon, B; Wolf, L; Hoetzl, H

    2005-01-01

    In Europe, large volumes of public water supply come from urban aquifers and so efficient urban water management and decision tools are essential to maintain quality of life both in terms of health, personal freedom and environment. In the United Kingdom, this issue gained increased importance with the last year's low volumes of groundwater replenishment that resulted in increased water shortages all over the country. An urban water volume and quality model (UVQ) was applied to a suburb of Doncaster (United Kingdom) to assess the current water supply system and to compare it with new potential scenarios of water management. The initial results show considerable changes in both water and solute fluxes for some scenarios and rather limited changes for others. Changing impermeable roads and paved areas to permeable areas, for example, would lead to higher infiltration rates that may be welcome from a water resources viewpoint but less so from a water quality point of view due to high concentrations of heavy metals. The biggest impact on water quality and quantity leaving the system through sewer, storm water and infiltration system was clearly obtained by re-using grey water from kitchen, bathroom and laundry for irrigation and toilet flush. The testing of this strategy led to lower volumes and higher concentrations of sewerage, a considerable decrease in water consumption and an increase in groundwater recharge. The scenarios were tested neither in terms of costs nor social acceptance for either water supplier or user.

  11. Tuberculosis genotyping information management system: enhancing tuberculosis surveillance in the United States.

    Science.gov (United States)

    Ghosh, Smita; Moonan, Patrick K; Cowan, Lauren; Grant, Juliana; Kammerer, Steve; Navin, Thomas R

    2012-06-01

    Molecular characterization of Mycobacterium tuberculosis complex isolates (genotyping) can be used by public health programs to more readily identify tuberculosis (TB) transmission. The Centers for Disease Control and Prevention's National Tuberculosis Genotyping Service has offered M. tuberculosis genotyping for every culture-confirmed case in the United States since 2004. The TB Genotyping Information Management System (TB GIMS), launched in March 2010, is a secure online database containing genotype results linked with case characteristics from the national TB registry for state and local TB programs to access, manage and analyze these data. As of September 2011, TB GIMS contains genotype results for 89% of all culture-positive TB cases for 2010. Over 400 users can generate local and national reports and maps using TB GIMS. Automated alerts on geospatially concentrated cases with matching genotypes that may represent outbreaks are also generated by TB GIMS. TB genotyping results are available to enhance national TB surveillance and apply genotyping results to conduct TB control activities in the United States.

  12. Book review: Biology and management of invasive quagga and zebra mussels in the western United States

    Science.gov (United States)

    Benson, Amy J.

    2017-01-01

    Water is a precious and limited commodity in the western United States and its conveyance is extremely important. Therefore, it is critical to do as much as possible to prevent the spread of two species of dreissenid mussels, both non-native and highly invasive aquatic species already well-established in the eastern half of the United States. This book addresses the occurrences of the two dreissenid mussels in the West, the quagga mussel and the zebra mussel, that are both known to negatively impact water delivery systems and natural ecosystems. It is edited by two researchers whom have extensive experience working with the mussels in the West and is composed of 34 chapters, or articles, written by a variety of experts.Book information: Biology and Management of Invasive Quagga and Zebra Mussels in the Western United States. Edited by Wai Hing Wong and Shawn L. Gerstenberger. Boca Raton (Florida): CRC Press (Taylor & Francis Group). $149.95. xx + 545 p.; ill.; index. ISBN: 978-1-4665-9561-3. [Compact Disc included.] 2015.

  13. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  14. Implementing the Corrective Action Management Unit at Sandia National Laboratories, New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    MOORE,DARLENE R.; SCHRADER,SCOTT A.; KING,GABRIEL G.; CORMIER,JOHN

    2000-01-26

    In September 1997, following significant public and regulator interaction, Sandia Corporation (Sandia) was granted a Resource Conservation and Recovery Act (RCRA) and Hazardous Solid Waste Amendment (HSWA) permit modification allowing construction and operation of a Correction Action Management Unit (CAMU). The CAMU follows recent regulatory guidance that allows for cost-effective, expedient cleanup of contaminated sites and management of hazardous remediation wastes. The CAMU was designed to store, treat, and provide long-term management for Environmental Restoration (ER) derived wastes. The 154 square meter CAMU site at Sandia National Laboratories, New Mexico (SNL/NM), includes facilities for storing bulk soils and containerized wastes, for treatment of bulk soils, and has a containment cell for long-term disposition of waste. Proposed treatment operations include soil washing and low temperature thermal desorption. The first waste was accepted into the CAMU for temporary storage in January 1999. Construction at the CAMU was completed in March 1999, and baseline monitoring of the containment cell has commenced. At completion of operations the facility will be closed, the waste containment cell will be covered, and long-term post-closure monitoring will begin. Sandia's CAMU is the only such facility within the US Department of Energy (DOE) complex. Implementing this innovative approach to ER waste management has required successful coordination with community representatives, state and federal regulators, the DOE, Sandia corporate management, and contractors. It is expected that cost savings to taxpayers will be significant. The life-cycle CAMU project cost is currently projected to be approximately $12 million.

  15. Reforming state-level chemicals management policies in the United States: status, challenges, and opportunities.

    Science.gov (United States)

    Geiser, Ken; Tickner, Joel; Torrie, Yve

    2009-01-01

    During the last several years there has been increasing public concern about chemicals in everyday products. Scientific studies are increasingly revealing the build-up of some substances in ecosystems and in our bodies and new findings are linking exposures to hazardous chemicals to a range of adverse human health effects. Despite these trends, there has been little federal initiative in the United States on reforming chemicals management policies for well over two decades, even though a variety of analyses have identified significant gaps in the regulatory structure. As has historically been the case, states are beginning to fill the holes in federal leadership. This article explores this emerging state leadership and establishes a vision for and elements of policies to reduce hazardous chemicals in the products we buy and the places we go. It examines international efforts to reform chemicals management policies, such as the European REACH legislation and corporate leadership in advancing safer products. Finally, it outlines specific challenges states face in developing integrated, comprehensive chemicals management policies. We conclude that while there are plenty of challenges to implementation of chemicals policy reforms, it is a propitious time for states to become leaders in policy innovation that can help achieve safer production systems and products for future generations. This article is part of a Lowell Center for Sustainable Production report entitled "Options for State Chemicals Policy Reform" that provides in-depth analysis of the pros and cons of policy options to address a range of aspects of state-level chemicals policy reform. The article has been edited slightly for use in New Solutions. The report has been widely distributed to policy-makers, advocates, and others across the United States.

  16. A descriptive survey of management and operations at selected sports medicine centers in the United States.

    Science.gov (United States)

    Olsen, D

    1996-11-01

    No uniform guidelines for operations or accreditation standards for sports medicine center were available and, at the time of this study, little information on the management and operation of sports medicine centers was available in the literature. The purpose of the study was to determine the management structure and function of selected sports medicine centers in the United States. Questionnaires were mailed to 200 randomly selected centers throughout the United State from a directory of sports medicine centers published in Physician and Sportsmedicine (1992) to gather descriptive information on eight areas, including 1) general background, 2) staffing, 3) services, facilities, and equipment, 4) billing, collections, and revenue, 5) clientele, caseloads, and referrals, 6) ownership and financing, 7) school and club outreach contracts, and 8) marketing strategies and future trends. A total of 71 surveys (35.5%) were returned in the allotted time frame. Data were analyzed using ranges, means, medians, modes, and percentages. Results yielded several conclusions about sports medicine centers. Nearly all (93%) of the centers employed physical therapists; physical therapists were clinical directors at 70.2% of centers; orthopaedists were most often medical directors; rehabilitation was the most frequently offered service (93%); physical therapy produced the highest revenue; sports injuries accounted for a mean 34.5% of patients, who were mostly recreational or high school athletes between 13-60 years of age; primary shareholders were most often physical therapists or physicians; most were involved in outreach services for schools; marketing strategies primarily involved communication with referral sources; and managed care was identified most frequently as a trend affecting the future of sports medicine centers. Findings identified common aspects of sports medicine centers and may assist in establishing guidelines for operations or accreditation of sports medicine

  17. Adaptive management of large aquatic ecosystem recovery programs in the United States.

    Science.gov (United States)

    Thom, Ronald; St Clair, Tom; Burns, Rebecca; Anderson, Michael

    2016-12-01

    Adaptive management (AM) is being employed in a number of programs in the United States to guide actions to restore aquatic ecosystems because these programs are both expensive and are faced with significant uncertainties. Many of these uncertainties are associated with prioritizing when, where, and what kind of actions are needed to meet the objectives of enhancing ecosystem services and recovering threatened and endangered species. We interviewed nine large-scale aquatic ecosystem restoration programs across the United States to document the lessons learned from implementing AM. In addition, we recorded information on ecological drivers (e.g., endangered fish species) for the program, and inferred how these drivers reflected more generic ecosystem services. Ecosystem services (e.g., genetic diversity, cultural heritage), albeit not explicit drivers, were either important to the recovery or enhancement of the drivers, or were additional benefits associated with actions to recover or enhance the program drivers. Implementing programs using AM lessons learned has apparently helped achieve better results regarding enhancing ecosystem services and restoring target species populations. The interviews yielded several recommendations. The science and AM program must be integrated into how the overall restoration program operates in order to gain understanding and support, and effectively inform management decision-making. Governance and decision-making varied based on its particular circumstances. Open communication within and among agency and stakeholder groups and extensive vetting lead up to decisions. It was important to have an internal agency staff member to implement the AM plan, and a clear designation of roles and responsibilities, and long-term commitment of other involved parties. The most important management questions and information needs must be identified up front. It was imperative to clearly identify, link and continually reinforce the essential

  18. Incontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation units.

    Science.gov (United States)

    McCarthy, Geraldine; McCormack, Brendan; Coffey, Alice; Wright, Jayne; Slater, Paul

    2009-03-01

    Background.  Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims.  To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method.  An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results.  Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67).

  19. The influence of impression management scales on the Personality Assessment Inventory in the epilepsy monitoring unit.

    Science.gov (United States)

    Purdom, Catherine L; Kirlin, Kristin A; Hoerth, Matthew T; Noe, Katherine H; Drazkowski, Joseph F; Sirven, Joseph I; Locke, Dona E C

    2012-12-01

    The Somatic Complaints scale (SOM) and Conversion subscale (SOM-C) of the Personality Assessment Inventory perform best in classifying psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES); however, the impact of positive impression management (PIM) and negative impression management (NIM) scales on SOM and SOM-C classification has not been examined. We studied 187 patients from an epilepsy monitoring unit with confirmed PNES or ES. On SOM, the best cut score was 72.5 T when PIM was elevated and 69.5 T when there was no bias. On SOM-C, when PIM was elevated, the best cut score was 67.5 T and 76.5 T when there was no bias. Negative impression management elevations (n=9) were too infrequent to analyze separately. Despite similarities in classification accuracy, there were differences in sensitivity and specificity with and without PIM, impacting positive and negative predictive values. The presence of PIM bias generally increases positive predictive power of SOM and SOM-C but decreases negative predictive power.

  20. Biosimilar competition in the United States: statutory incentives, payers, and pharmacy benefit managers.

    Science.gov (United States)

    Falit, Benjamin P; Singh, Surya C; Brennan, Troyen A

    2015-02-01

    Widespread adoption of generic medications, made possible by the Hatch-Waxman Act of 1984, has contained the cost of small-molecule drugs in the United States. Biologics, however, have yet to face competition from follow-on products and represent the fastest-growing sector of the US pharmaceutical market. We compare the legislative framework governing small-molecule generics to that which regulates follow-on biologics, and we examine management tools that are likely to be most successful in promoting biosimilars' adoption. The Biologics Price Competition and Innovation Act established an abbreviated pathway for follow-on biologics, but weak statutory incentives create barriers to entry. Many authors have raised concerns that competition under the biologics act may be weaker than that posed by small-molecule generics under Hatch-Waxman, in part because of legislative choices such as the absence of market exclusivity for the first biosimilar approved and a requirement that follow-on manufacturers disclose their manufacturing processes to the manufacturer of the reference product. Provider skepticism and limited competition from biosimilars will challenge payers and pharmacy benefit managers to reduce prices and maximize uptake of follow-on biologics. Successful payers and pharmacy benefit managers will employ various strategies, including tiered formularies and innovative fee schedules, that can control spending by promoting uptake of biosimilars across both the pharmacy and medical benefits. Project HOPE—The People-to-People Health Foundation, Inc.

  1. CONCEPTUAL BASES OF THE ENERGY EFFICIENT SYSTEM OF MANAGEMENT OF COMBINED UNITS OF WASTEWATER TREATMENT

    Directory of Open Access Journals (Sweden)

    V. N. Shtepa

    2016-01-01

    Full Text Available A critical analysis of the shortcomings of the existing water purification systems is conducted. In order to ensure environmental safety and energy savings it is proposed to use the combined units, including physical, chemical, physical-and-chemical and biological methods. The attention is driven to the fact that the most effective way to maintain current water purification is an adaptive control system. The shortcomings of the management of water treatment units were revealed and it was proposed to produce their synthesis based on the mathematical apparatus of artificial intelligence systems. Taking into account the requirements of the environmental safety and the need in the energy savings, the energy efficiency criteria of combined system functioning has been developed. At an industrial plant (slaughterhouse wastewater treatment the compliance of the production conditions of the criterion has been undertaken that confirmed the criterion relevance and usefulness as applied to the synthesis of energy-efficient control systems. A synthetic control system combined the water treatment plants. Having based on the preliminary research and analysis of the current work in the subject area the architecture of a control system of combined water treatment units that use intelligent technology was developed. The key functional of the unit – information-analytical subsystem of the formation control actions including: multilayer perceptrons self-organization Kohonen network, fuzzy cognitive map. The basic difference between the developed design and its analogues is the ability to adjust the settings of equipment adaptively on the basis of processing sensor data, information on the price of consumables, volley discharges of pollutants, a sudden change in the flow and other force majeure. Adjustment of the parameters of the control system is carried out with the use of experimental and analytical data stored in the knowledge base of technological

  2. Facial Recognition

    National Research Council Canada - National Science Library

    Mihalache Sergiu; Stoica Mihaela-Zoica

    2014-01-01

    .... From birth, faces are important in the individual's social interaction. Face perceptions are very complex as the recognition of facial expressions involves extensive and diverse areas in the brain...

  3. Words from spontaneous conversational speech can be recognized with human-like accuracy by an error-driven learning algorithm that discriminates between meanings straight from smart acoustic features, bypassing the phoneme as recognition unit.

    Science.gov (United States)

    Arnold, Denis; Tomaschek, Fabian; Sering, Konstantin; Lopez, Florence; Baayen, R Harald

    2017-01-01

    Sound units play a pivotal role in cognitive models of auditory comprehension. The general consensus is that during perception listeners break down speech into auditory words and subsequently phones. Indeed, cognitive speech recognition is typically taken to be computationally intractable without phones. Here we present a computational model trained on 20 hours of conversational speech that recognizes word meanings within the range of human performance (model 25%, native speakers 20-44%), without making use of phone or word form representations. Our model also generates successfully predictions about the speed and accuracy of human auditory comprehension. At the heart of the model is a 'wide' yet sparse two-layer artificial neural network with some hundred thousand input units representing summaries of changes in acoustic frequency bands, and proxies for lexical meanings as output units. We believe that our model holds promise for resolving longstanding theoretical problems surrounding the notion of the phone in linguistic theory.

  4. Fingerprint recognition

    OpenAIRE

    Diefenderfer, Graig T.

    2006-01-01

    The use of biometrics is an evolving component in today's society. Fingerprint recognition continues to be one of the most widely used biometric systems. This thesis explores the various steps present in a fingerprint recognition system. The study develops a working algorithm to extract fingerprint minutiae from an input fingerprint image. This stage incorporates a variety of image pre-processing steps necessary for accurate minutiae extraction and includes two different methods of ridge thin...

  5. The Relationship Between the Occurrence of Conflicts in the Work Unit, the Conflict Management Styles in the Work Unit and Workplace Bullying

    Directory of Open Access Journals (Sweden)

    Elfi Baillien

    2010-12-01

    Full Text Available The current study examines the relationship between the occurrence of conflicts in the work unit and conflict management styles in the work unit, and workplace bullying. First, we assume a positive relationship between the occurrence of conflicts and bullying; and that the conflict management styles 'fighting', 'avoiding' and 'yielding' associate positively and 'problem solving' associates negatively with bullying. Second, we expect that the work unit's conflict management styles moderate the relationship between the occurrence of conflicts and bullying. Results ('N' = 942 revealed a positive association between the occurrence of conflicts and bullying, as well as between fighting and bullying. Problem solving related negatively with bullying. Unexpectedly, we found no moderation. Our findings suggest that particularly the occurrence of conflicts relate to bullying, which may be owed to a strong negative connotation associated with (many conflicts at work or to its negative impact on the work unit's social climate. Organisations may also encourage problem solving and discourage fighting to prevent bullying.

  6. Out-of-hospital pediatric airway management in the United States.

    Science.gov (United States)

    Hansen, Matthew; Lambert, William; Guise, Jeanne-Marie; Warden, Craig R; Mann, N Clay; Wang, Henry

    2015-05-01

    The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset. In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Success and complication rates were analyzed and compared across pediatric age groups, by race, ethnicity, clinical condition, and geographic region. We identified a total of 949,301 pediatric patient care events in the NEMSIS 2012 dataset. 4.5% had airway management procedures (42,936 events). Invasive airway management or ventilation (ETI, cricothyroidotomy, alternate airway, CPAP/BiPAP, BVM and other ventilation) took place in 1.5% of patient care events (14,107). Of those who had invasive airway management, 29.9% were less than 1 year of age, 58.1% were male, 42.3% were white, and 83.6% were in urban areas. ETI occurred in 3124 of patient care events (329 per 100,000; 95% CI 318-341). Overall success of ETI was 81.1% (95% CI 79.7-82.6). Lower success was noted in patients with cardiac arrest (75.5%, 95% CI 72.6-78.3) and those aged 1-12 months (72.1%, 95% CI 68.3-75.6). Out-of-hospital pediatric advanced airway procedures were infrequently performed. Success rates are lowest in patients aged 1-12 months. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Analysis of social recognition and disposal time for the long-term management scenario of high-level waste

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Myong; Jeong, Jin Yeop; Ha, Gyu Man [Korea Energy Technology and Emergency Management Institute, Seoul (Korea, Republic of)

    2009-02-15

    Recently, the need of high-level radioactive waste policy including spent fuel management becomes serious due to the rapid increase in oil price, the nationalism of natural resources, and the environmental issues such as Tokyo protocol. Also, the policy should be established urgently to prepare the saturation of on-site storage capacity of spent fuel, the revision of 'Agreement for Cooperation-Concerning Civil Uses of Atomic Energy' between Korea and US, the anxiety for nuclear weapon proliferation, and R and D to reduce the amount of waste to be disposed. In this study, we performed case study of US, Japan, Canada and Finland, which have special laws and plans/roadmaps for high-level waste management, to draw the policy requirements to be considered in HLW management. Also, we reviewed social conflict issues experienced in our society, and summarized the factors affecting the political and social environment. These policy requirements and factors summarized in this study should be considered seriously in the process for public consensus and the policy making regarding HLW management. Finally, the following 4 action items were drawn to manage HLW successfully : - Continuous and systematic R and D activities to obtain reliable management technology - Promoting companies having specialty in HLW management - Nurturing experts and workforce - Drive the public consensus process

  8. Science Roles and Interactions in Adaptive Management of Large River Restoration Projects, Midwest United States

    Science.gov (United States)

    Jacobson, R. B.; Galat, D. L.; Smith, C. B.

    2010-12-01

    Most large-river restoration projects include formal or informal implementations of adaptive management strategies which acknowledge uncertainty and use scientific inquiry to learn and refine management options. Although the central role of science in reducing uncertainty is acknowledged in such projects, specific roles and interactions can vary widely, including how science relates to decision-making within the governance of these projects. Our objective is to present some structured generalizations about science roles and interactions as developed from the authors’ experiences in adaptive management of large river restoration in the Midwest United States. Scientific information may be introduced into decision making by scientists acting in any of the three roles common to adaptive management -- action agency representative, stakeholder, or science provider. We have observed that confusion and gridlock can arise when it is unclear if a scientist is acting as an advocate for a stakeholder or management position, or instead as an independent, “honest broker” of science. Although both advocacy and independence are proper and expected in public decision making, it is useful when scientists unambiguously identify their role. While complete scientific independence may be illusory, transparency and peer review can promote the ideal. Transparency comes from setting clear directions and objectives at the decision-making level and defining at the outset how learning will help assess progress and inform decisions. Independent peer reviews of proposals, study plans, and publications serve as a powerful tool to advance scientific independence, even if funding sources present a potential conflict of interest. Selection of experts for scientific advice and review often requires consideration of the balance between benefits of the “outside” expert (independent, knowledgeable but with little specific understanding of the river system), compared to those provided by the

  9. Management of Gonorrhea in Adolescents and Adults in the United States.

    Science.gov (United States)

    Kidd, Sarah; Workowski, Kimberly A

    2015-12-15

    Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited. This article summarizes the key questions and data that were discussed at the Sexually Transmitted Diseases (STD) Treatment Guidelines Expert Consultation meeting in April 2013, and the rationale for the 2015 Centers for Disease Control and Prevention STD treatment guidelines for gonococcal infections in adolescents and adults. Key issues addressed include whether to change the dosage of ceftriaxone and azithromycin used in the recommended dual treatment regimen, whether to continue to list dual treatment with cefixime and azithromycin as an alternative treatment regimen, and management of gonococcal infections in persons with severe cephalosporin allergy or suspected treatment failure.

  10. Design of RF energy harvesting platforms for power management unit with start-up circuits

    Science.gov (United States)

    Costanzo, Alessandra; Masotti, Diego

    2013-12-01

    In this contribution we discuss an unconventional rectifier design dedicated to RF energy harvesting from ultra-low sources, such as ambient RF sources which are typically of the order of few to few tens of μW. In such conditions unsuccessful results may occur if the rectenna is directly connected to its actual load since either the minimum power or the minimum activation voltage may not be simultaneously available. For this reason a double-branch rectifier topology is considered for the power management unit (PMU), instead of traditional single-branch one. The new PMU, interposed between the rectenna and application circuits, allows the system to operate with significantly lower input power with respect to the traditional solution, while preserving efficiency during steady-state power conversion.

  11. Blood component recalls and market withdrawals: frequency, reasons, and management in the United States.

    Science.gov (United States)

    Ramsey, Glenn

    2013-04-01

    In a previous article, we reviewed the management of blood component recalls and withdrawals (G. Ramsey. Transfusion Med Rev 2004;18:36-45). Since then, US rates of recall and biological product deviation for blood components have improved significantly, particularly with regard to reduced recalls for donor infectious disease risks or testing. However, analysis of the current data from the US Food and Drug Administration suggests that 1 (0.4%) in 250 blood components is involved in market withdrawals and quarantines, with 1 in 5800 components formally recalled. Most of these units, unfortunately, had already have been transfused. The U.S. Food and Drug Administration has issued several recent guidances that address transfusion service actions for dealing with specific infectious disease problems. This present article updates our 2004 recommendations as to when to notify physicians about transfused nonconforming blood components. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Optimizing energy management of decentralized photovoltaic. Fuel cell - direct storage - power supply units

    Energy Technology Data Exchange (ETDEWEB)

    Bocklisch, Thilo; Schufft, Wolfgang; Bocklisch, Steffen [Chemnitz Univ. of Technology (TUC) (Germany)

    2010-07-01

    This paper presents a new optimizing energy management concept for decentralized power supply units. Main goal is the coordinated utilization of dynamically controllable combined-heat-and-power-plants (e.g. fuel cell cogeneration plants) and electrochemical direct storages (e.g. future electric car batteries) for the active balancing of fluctuating renewable energy generation (e.g. building integrated photovoltaics) and fluctuation electricity consumption. The self-utilization and partial storage of renewable energy helps to stabilize the grid in a ''bottom-up'' approach. The new energy mangement concept features a three-layer control structure, which aims for the optimization of the power flows, minimizing the fuel consumption and the dynamic stress imposed onto the fuel cell. (orig.)

  13. Data structures, computer graphics, and pattern recognition

    CERN Document Server

    Klinger, A; Kunii, T L

    1977-01-01

    Data Structures, Computer Graphics, and Pattern Recognition focuses on the computer graphics and pattern recognition applications of data structures methodology.This book presents design related principles and research aspects of the computer graphics, system design, data management, and pattern recognition tasks. The topics include the data structure design, concise structuring of geometric data for computer aided design, and data structures for pattern recognition algorithms. The survey of data structures for computer graphics systems, application of relational data structures in computer gr

  14. Recognition and management of overweight and obese children: A questionnaire survey of general practitioners and parents in England

    OpenAIRE

    Gage, H; Erdal, E.; Saigal, P; Raats, MM; Williams, P.; Qiao, Y.

    2012-01-01

    Aims: To (i) compare the views of general practitioners (GPs) and parents about the causes, consequences and management of childhood overweight/obesity; and (ii) explore the extent to which they can identify overweight/obesity in children. Methods: A questionnaire was mailed to all GPs in one Primary Care Trust and all parents in one primary school in southern England, 2008. Information was gathered on socio-demographic background, views about causes, consequences and management of childhood ...

  15. HEART UK statement on the management of homozygous familial hypercholesterolaemia in the United Kingdom.

    Science.gov (United States)

    France, Michael; Rees, Alan; Datta, Dev; Thompson, Gilbert; Capps, Nigel; Ferns, Gordon; Ramaswami, Uma; Seed, Mary; Neely, Dermot; Cramb, Robert; Shoulders, Carol; Barbir, Mahmoud; Pottle, Alison; Eatough, Ruth; Martin, Steven; Bayly, Graham; Simpson, Bill; Halcox, Julian; Edwards, Ray; Main, Linda; Payne, Jules; Soran, Handrean

    2016-12-01

    This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and bile acid sequestrants. Two new classes of drug, effective in lowering cholesterol in HoFH, are now licensed in the United Kingdom. Lomitapide is restricted to use in HoFH but, may cause fatty liver and is very expensive. PCSK9 inhibitors are quite effective in receptor defective HoFH, are safe and are less expensive. Lower treatment targets for lipid lowering in HoFH, in line with those for the general FH population, have been proposed to improve cardiovascular outcomes. HEART UK presents a strategy combining Lp apheresis with pharmacological treatment to achieve these targets in the United Kingdom (UK). Improved provision of Lp apheresis by use of existing infrastructure for extracorporeal treatments such as renal dialysis is promoted. The clinical management of adults and children with HoFH including advice on pregnancy and contraception are addressed. A premise of the HEART UK strategy is that the risk of early use of drug treatments beyond their licensed age restriction may be balanced against risks of liver transplantation or ineffective treatment in severely affected patients. This may be of interest beyond the UK.

  16. Tuberculosis management continues to utilize a large amount of hospital resources in the United States.

    Science.gov (United States)

    Allareddy, Veerasathpurush; Rampa, Sankeerth; Allareddy, Veerajalandhar; Nalliah, Romesh P

    2017-01-01

    The objective of this study is to examine longitudinal trends in hospital admissions attributed to tuberculosis and resulting hospitalization outcomes in the United States for the years 2000-2010. We used the Nationwide Inpatient Sample, which is the largest all-payer and nationally representative in-hospital dataset in the United States. All hospitalizations that had a primary diagnosis for tuberculosis were selected for analysis. Patient characteristics and outcomes including discharge status following hospitalization, length of stay in hospital and hospitalization charges were examined. During the study period, a total of 96 431 hospitalizations occurred due to tuberculosis. The mean age of hospitalizations was 48.6 years. Males comprised 64.2% of all hospitalizations; 24.8% were Whites, 25.5% Blacks, 26.5% Hispanics, 14.3% Asians/Pacific Islanders, 1% Native Americans, and 7.9% other/mixed races. Following hospitalization, 72.1% were discharged routinely, 3.4% were transferred to another acute-care hospital, 10.7% to long-term care facilities including skilled nursing facilities, 7.6% to home health care, and 2.1% were discharged against medical advice. There were 3815 patients who died (4% of hospitalizations). The total hospitalization charge for this cohort of patients admitted due to tuberculosis across the United States was $6.96 billion and the total hospitalization days over study period was 1 419 605 days. High-risk cohorts who are likely to be hospitalized due to tuberculosis included Blacks and Hispanics. Majority of hospitalization comprised of males. Even though the annual number of hospitalizations reduced over the study period, substantial amounts of resources are used in hospital settings to manage tuberculosis. © 2015 John Wiley & Sons Ltd.

  17. Corrective action management unit application for the Environmental Restoration Disposal Facility

    Energy Technology Data Exchange (ETDEWEB)

    Evans, G.C.

    1994-06-01

    The Environmental Restoration Disposal Facility (ERDF) is to accept both CERCLA (EPA-regulated) and RCRA (Ecology-regulated) remediation waste. The ERDF is considered part of the overall remediation strategy on the Hanford Site, and as such, determination of ERDF viability has followed both RCRA and CERCLA decision making processes. Typically, determination of the viability of a unit, such as the ERDF, would occur as part of record of decision (ROD) or permit modification for each remediation site before construction of the ERDF. However, because construction of the ERDF may take a significant amount of time, it is necessary to begin design and construction of the ERDF before final RODs/permit modifications for the remediation sites. This will allow movement of waste to occur quickly once the final remediation strategy for the RCRA and CERCLA past-practice units is determined. Construction of the ERDF is a unique situation relative to Hanford Facility cleanup, requiring a Hanford Facility specific process be developed for implementing the ERDF that would satisfy both RCRA and CERCLA requirements. While the ERDF will play a significant role in the remediation process, initiation of the ERDF does not preclude the evaluation of remedial alternatives at each remediation site. To facilitate this, the January 1994 amendment to the Tri-Party Agreement recognizes the necessity for the ERDF, and the Tri-Party Agreement states: ``Ecology, EPA, and DOE agree to proceed with the steps necessary to design, approve, construct, and operate such a ... facility.`` The Tri-Party Agreement requires the DOE-RL to prepare a comprehensive ``package`` for the EPA and Ecology to consider in evaluating the ERDF. The package is to address the criteria listed in 40 CFR 264.552(c) for corrective action management unit (CAMU) designation and a CERCLA ROD. This CAMU application is submitted as part of the Tri-Party Agreement-required information package.

  18. Firewater Storage, Treatment, Recycling and Management: New Perspectives Based on Experiences from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Miklas Scholz

    2014-02-01

    Full Text Available Smart firewater management and recycling helps reduce water use and protect the environment from pollution. However, contamination of recycled water may pose a health risk to fire fighters. This review assesses international literature to identify best practices, and to recommend new technologies and methods on firewater management and recycling. The literature assessment indicates that this is a new research area where insufficient findings have been published in Web of Science-referenced journals. Therefore, informally published materials (a.k.a. grey literature were also assessed. Findings indicate the need for practical decision support tools to estimate consumption rates, predict “bottlenecks” and bund capacity, assess water quality and determine pump requirements. This article recommends that cost-efficient and rapid on-site treatment methods, such as compact and mobile filtration units for firewater recycling should be researched in the future. The filters should be based on compartments with different media. The empty pore space should decrease from inflow to outflow. A light plastic media should be positioned near the inflow to retain large particles, such as a grid. Activated carbon media could be placed near the outlet to remove fine suspended solids and dissolved contaminants. This should address concerns by fire fighters dealing with contaminated water, spray and foam.

  19. Financial management skills are associated with food insecurity in a sample of households with children in the United States.

    Science.gov (United States)

    Gundersen, Craig G; Garasky, Steven B

    2012-10-01

    Food insecurity is one of the leading public health challenges facing children in the United States today. Reducing food insecurity and its attendant consequences requires an understanding of the determinants of food insecurity. Although previous work has greatly advanced our understanding of these determinants, the role of one of the oft-speculated important determinants of food insecurity, household financial management skills, has not been considered. To address this research lacuna, we use a recently conducted survey, the Survey of Household Finances and Childhood Obesity, that has information on specific financial management practices, impressions of financial management skills, and households' food insecurity. The sample included 904 households with children. Within this sample, 19.3% were food insecure and, for our central financial management skill variable, the mean value was 3.55 on a 5-point scale. Probit regression models estimated the probability of a household being food insecure as conditional on financial management skills and other covariates. We found a large and significant inverse relationship between a respondent's use of specific financial management practices and food insecurity and between a respondent's confidence in his or her financial management skills and food insecurity. That is, households with greater financial management abilities are less likely to be food insecure. This finding also holds when the sample is restricted to households with incomes poverty line. These results suggest that improving households' financial management skills has the potential to reduce food insecurity in the United States.

  20. Reservoirs and water management influence fish mercury concentrations in the western United States and Canada

    Science.gov (United States)

    Willacker, James J.; Eagles-Smith, Collin A.; Lutz, Michelle A.; Tate, Michael T.; Lepak, Jesse M.; Ackerman, Josh

    2016-01-01

    Anthropogenic manipulation of aquatic habitats can profoundly alter mercury (Hg) cycling and bioaccumulation. The impoundment of fluvial systems is among the most common habitat manipulations and is known to increase fish Hg concentrations immediately following impoundment. However, it is not well understood how Hg concentrations differ between reservoirs and lakes at large spatial and temporal scales or how reservoir management influences fish Hg concentrations. This study evaluated total Hg (THg) concentrations in 64,386 fish from 883 reservoirs and 1387 lakes, across the western United States and Canada, to assess differences between reservoirs and lakes, as well as the influence of reservoir management on fish THg concentrations. Fish THg concentrations were 1.4-fold higher in reservoirs (0.13 ± 0.011 μg/g wet weight ± standard error) than lakes (0.09 ± 0.006), though this difference varied among ecoregions. Fish THg concentrations were 1.5- to 2.6-fold higher in reservoirs than lakes of the North American Deserts, Northern Forests, and Mediterranean California ecoregions, but did not differ between reservoirs and lakes in four other ecoregions. Fish THg concentrations peaked in three-year-old reservoirs then rapidly declined in 4–12 year old reservoirs. Water management was particularly important in influencing fish THg concentrations, which were up to 11-times higher in reservoirs with minimum water storage occurring in May, June, or July compared to reservoirs with minimum storage occurring in other months. Between-year changes in maximum water storage strongly influenced fish THg concentrations, but within-year fluctuations in water levels did not influence fish THg concentrations. Specifically, fish THg concentrations increased up to 3.2-fold over the range of between-year changes in maximum water storage in all ecoregions except Mediterranean California. These data highlight the role of reservoir creation and management in influencing fish

  1. Understanding Carbon Sequestration Options in the United States: Capabilities of a Carbon Management Geographic Information System

    Energy Technology Data Exchange (ETDEWEB)

    Dahowski, Robert T.; Dooley, James J.; Brown, Daryl R.; Mizoguchi, Akiyoshi; Shiozaki, Mai

    2001-04-03

    While one can discuss various sequestration options at a national or global level, the actual carbon management approach is highly site specific. In response to the need for a better understanding of carbon management options, Battelle in collaboration with Mitsubishi Corporation, has developed a state-of-the-art Geographic Information System (GIS) focused on carbon capture and sequestration opportunities in the United States. The GIS system contains information (e.g., fuel type, location, vintage, ownership, rated capacity) on all fossil-fired generation capacity in the Untied States with a rated capacity of at least 100 MW. There are also data on other CO2 sources (i.e., natural domes, gas processing plants, etc.) and associated pipelines currently serving enhanced oil recovery (EOR) projects. Data on current and prospective CO2 EOR projects include location, operator, reservoir and oil characteristics, production, and CO2 source. The system also contains information on priority deep saline aquifers and coal bed methane basins with potential for sequestering CO2. The GIS application not only enables data storage, flexible map making, and visualization capabilities, but also facilitates the spatial analyses required to solve complex linking of CO2 sources with appropriate and cost-effective sinks. A variety of screening criteria (spatial, geophysical, and economic) can be employed to identify sources and sinks most likely amenable to deployment of carbon capture and sequestration systems. The system is easily updateable, allowing it to stay on the leading edge of capture and sequestration technology as well as the ever-changing business landscape. Our paper and presentation will describe the development of this GIS and demonstrate its uses for carbon management analysis.

  2. Cultural Landscapes as a Methodology for Understanding Natural Resource Management Impacts in the Western United States

    Directory of Open Access Journals (Sweden)

    Rebecca S. Toupal

    2003-07-01

    Full Text Available Multicultural demands on public lands in the United States continue to challenge federal land managers to address social and cultural concerns in their planning efforts. Specifically, they lack adequate knowledge of cultural concerns, as well as a consistent strategy for acquiring that knowledge for use in decision-making. Current federal approaches to understanding such issues as access, use, and control of resources include public participation, conservation partnerships, government-to-government consultations with American Indian tribes, cultural resource inventories, and landscape analysis. Given that cultural knowledge arises from human-nature relationships and shared perceptions of natural environments, and that landscapes are the ultimate expression of such knowledge, an exploratory methodology was developed to provide a different approach to understanding cultural concerns through landscape perceptions. Using cultural landscape theories and applications from the natural and social sciences, this study examines the landscape perceptions of four groups concerned with management planning of the Baboquivari Wilderness Area in southern Arizona: the Bureau of Land Management, the landowners of the Altar Valley, recreationists, and members of the Tohono O'odham Nation. The methodology is based on a human-nature relationship rather than cultural aspects or features. It takes a holistic approach that differs from other perception studies in that it includes: emic aspects of data collection and analysis; a spatial component (triangulation of data collection through narrative and graphic descriptions; ethnographic, on-site interviews; and cultural consensus analysis and small-sample theory. The results include: verification of four cultural groups; two levels of consensus (in the population of concern, and in each group that overlap in some aspects of landscape perception; descriptions of four cultural landscapes that illustrate similarities and

  3. Management of wastestreams in United States; Jaetevirtojen hallinta USA:ssa

    Energy Technology Data Exchange (ETDEWEB)

    Itaevaara, M. [VTT Biotekniikka, Espoo (Finland)

    2001-07-01

    International markets are advancing waste management practices more than the legislation. The instructions and guidelines issued by the US EPA are not being implemented in practice. Restrictions designed to minimise the impacts of industrial activities are also scarce. Recycling and reuse of materials vary locally, and have recently increased considerably in some states. The goal of the US EPA is to keep the amount of waste generated per capita at the same level, in spite of increasing amounts of waste. Recycling goals have been set at levels that prevent the amounts of waste from increasing. Former US President Clinton signed the Kioto Agreement concerning global restrictions on impacts to the environment. However, the agreement has never been ratified by the Congress, and has therefore not even been started. European legislation and restrictions that effect international trade and exports are carefully followed, and changes in waste management practices in the US will probably be driven more by the international markets than by local legislation. Many companies in the US still consider environmental aspects to be a luxury which they cannot afford. In Europe, and especially in Scandinavia, environmentally friendly industrial products are considered to be marketing tools because of the high environmental awareness in these countries; in contrast, no such benefits are seen in the United States. In addition to national and international legislation, the cultural habits of the population strongly affect reuse, recycling and treatment efficiency. These cultural and national aspects should be taken into account when developing collection technologies and other waste management technologies for the US markets. (orig.)

  4. Recognition and Survey the Productive Residues of the Curing Centers and Presenting the Management Methods. (The case study: the 7th zone of Karaj municipality

    Directory of Open Access Journals (Sweden)

    P. Gohari Mokammel

    2016-06-01

    Full Text Available The high risk of residues of curing centre and extensive use of them endangered all over the world. According to the reports of the world health organization (WHO 75-90% of productive residue of curing centre is usual kind and is out of danger and management of them is like the urban waste material. On the basis of this reports 10 to 25% (percent of the mentioned residues are placed in the group of dangerous residues, and it needs a precise and wise management program. The aim of this research in the first step is to recognize and survey the sources of productive hospital residues and in the next step physical analysis of them. Finally, by considering the taken results, the suitable management methods for the zone would be presentable. On the basis of the available statistics, the seventh zone of Karaj municipality has 174280 per population (89059 per men and 85221 per women.In this zone totally one hospital with 316 beds Approval and 278 beds are used, 14 clinic 35 Medical recognition laboratory 69 Drugstore and there are nine rehabilitate centre, the way of study is descriptive interruptive. In this research recognition of productive source of hospital residue taken and process, sampling, analyzing of the data and presenting appropriate management methods suitable with the zone. At last after the taken data analysis, the results are described as follows: The average of infectious and disinfections residue of Alborz hospital, clinics and medical recognition laboratory by order 55, 45 and 23 , 77 and 15.7, 84.3 percent are obtained. The average of plastic and paper in productive residues of Alborz hospital, drugstores and rehabilitate centre by order 43.8, 8.4 and17.2, 67.6 and 0.2, 20.3 percent are calculated. Daily economical benefit in the case of performing the recovery plan for the Alborz hospital, 69 drugstores and 9 health centre totally 1369355 Rials calculated, and of this rate plastic with 923211 Rials is placed on the first grade. The

  5. Beyond Ebola treatment units: severe infection temporary treatment units as an essential element of Ebola case management during an outbreak.

    Science.gov (United States)

    Janke, Christian; Heim, Katrin Moira; Steiner, Florian; Massaquoi, Moses; Gbanya, Miatta Zenabu; Frey, Claudia; Froeschl, Guenter

    2017-02-06

    In the course of the Ebola outbreak in West Africa that was witnessed since early 2014, the response mechanisms showed deficits in terms of timeliness, volume and adequacy. The authors were deployed in the Ebola campaign in the West African country Liberia, where by September 2014 the changing epidemiological pattern made reconsiderations of guidelines and adopted procedures necessary. A temporary facility set up as a conventional Ebola Treatment Unit in the Liberian capital Monrovia was re-dedicated into a Severe Infections Temporary Treatment Unit. This facility allowed for stratification based on the nosocomial risk of exposure to Ebola virus for a growing subgroup of admitted patients that in the end would turn out as Ebola negative cases. At the same time, adequate diagnostic measures and treatment for the non-Ebola conditions of these patients could be provided without compromising work safety of the employed staff. The key elements of the new unit comprised a Suspect Cases Area similar to that of conventional Ebola treatment units for newly arriving patients, an Unlikely Cases Area for patients with a first negative Ebola PCR result, and a Confirmed Negative Cases Area for patients in whom Ebola could be ruled out. The authors, comprising representatives of the Liberian Ministry of Health and Social Welfare, as well as infectious disease specialists from the German Ebola Task Force are presenting key features of the adapted concept, and are highlighting its relevance in raising acceptance for outbreak counter-measures within the population at stake.

  6. Trimethoxybenzene- and trimethylbenzene-based compounds bearing imidazole, indole and pyrrole groups as recognition units: synthesis and evaluation of the binding properties towards carbohydrates.

    Science.gov (United States)

    Rosien, Jan-Ruven; Seichter, Wilhelm; Mazik, Monika

    2013-10-14

    The aim of the study was to evaluate the potential of trimethoxybenzene- and trimethylbenzene-based compounds bearing imidazole or indole groups as recognition sites in the complexation of carbohydrates. Representatives of these compounds were prepared and their binding properties toward selected carbohydrates evaluated. The results of the binding studies were compared with those obtained for the prepared pyrrole bearing analogues and for the previously described triethylbenzene-based receptors.

  7. Establishing a quality management system for unit-use testing based on NCCLS proposed guideline (EP18-P).

    Science.gov (United States)

    Whitley, R J; Santrach, P J; Phillips, D L

    2001-05-01

    Point of care tests often employ unit-use test devices. By their very nature (single use, disposable, self-contained) such devices present unique challenges for quality assurance (QA) and quality control (QC). The proposed NCCLS guideline (EP18-P) recommends a quality management system for unit-use testing. The document addresses regulatory considerations, proposes the development of a partnership between users and manufacturers, provides a source of error matrix, and suggests practical approaches to quality monitoring, identification and management of these potential problems. The key to the success of this guideline is cooperation and open exchange of information among manufacturers, users, regulators, and accrediting agencies.

  8. Impact of role-, job- and organizational characteristics on Nursing Unit Managers' work related stress and well-being.

    Science.gov (United States)

    Van Bogaert, Peter; Adriaenssens, Jef; Dilles, Tinne; Martens, Daisy; Van Rompaey, Bart; Timmermans, Olaf

    2014-11-01

    To study the impact of role, job- and organizational characteristics on nurse managers' work related stress and well-being such as feelings of emotional exhaustion, work engagement, job satisfaction and turnover intention. Various studies investigated role-, job- and organizational characteristics influencing nurse-related work environments. Research on nurse managers' related work environments define influencing factors, but, a clear understanding of the impact of nurse-managers' work-environment characteristics on their work related stress and well-being is limited. A cross-sectional design with a survey. A cross-sectional survey (N = 365) was carried out between December 2011-March 2012. The questionnaire was based on various validated measurement instruments identified by expert meetings (e.g. staff nurses, nurse managers and executives and physicians). Hierarchical regression analyses were performed using emotional exhaustion, work engagement, job satisfaction and turnover intentions as outcome variables. Study results showed one out of six nursing unit managers have high to very high feelings of emotional exhaustion and two out of three respondents have high to very high work engagement. Hierarchical regression models showed that role conflict and role meaningfulness were strong predictors of nursing unit managers' work related stress and well-being, alongside with job- and organizational characteristics. Several risk factors and stimulating factors influencing nurse unit managers' work related stress and well-being were identified. Further challenges will be to develop proper interventions and strategies to support nursing unit managers and their team in daily practice to deliver the best and safest patient care. © 2014 John Wiley & Sons Ltd.

  9. Addressing the Elephant in the Room: Nurse Manager Recognition of and Response to Nurse-to-Nurse Bullying.

    Science.gov (United States)

    Gilbert, Rebecca T; Hudson, John S; Strider, David

    2016-01-01

    Health care bullying is a pervasive, underestimated, and underreported problem that results in poor outcomes for staff, patients, and health care organizations. The most common form of health care bullying occurs between nurses. Nurse managers hold an important role in the prevention and elimination of frontline nurse-to-nurse bullying. An anonymous Web-based survey was conducted to uncover what behaviors nurse managers perceive as bullying and how they respond to bullying acts. Respondents who had witnessed or been victimized by bullying were more apt to identify bullying and those who had been victimized or supervised nurses for more than 20 years were more prone to act upon bullying behaviors. There was only a moderate correlation between the identification of and response to bullying behaviors. Finally, overt bullying elicited a stronger response for intervention than covert bullying. Although nurse managers are well positioned to prevent and eliminate nurse-to-nurse bullying, they may not recognize it and often lack the skills and support necessary to address it. Decreases in nurse-to-nurse bullying reduce health care costs, improve nurse and patient satisfaction, and enhance patient outcomes. Therefore, nurse managers at all levels need education and support to ensure proper identification of bullying and, furthermore, to prevent and eliminate the behaviors.

  10. Flyway Habitat Management Unit Project report no. 5: A target waterfowl population model: estimates of populations for individual species at maximum foreseeable levels

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Complete estimates of waterfowl populations in each of 164 management units through the forty-eight coterminous United States were systematically developed for May...

  11. Pseudocirrhosis in a pancreatic cancer patient with liver metastases: a case report of complete resolution of pseudocirrhosis with an early recognition and management.

    Science.gov (United States)

    Kang, Soonmo Peter; Taddei, Tamar; McLennan, Bruce; Lacy, Jill

    2008-03-14

    We report a case of pseudocirrhosis arising in the setting of regression of liver metastases from pancreatic cancer. A 55-year-old asymptomatic woman presented to our clinic with newly diagnosed metastatic pancreatic cancer with extensive liver metastases. She underwent systemic chemotherapy with gemcitabine and oxaliplatin (GEMOX). After 8 cycles of therapy, she had a remarkable response to the therapy evidenced by decline of carcinoembryonic antigen (CEA) and CA19 by > 50% and nearly complete resolution of hepatic metastases in computed tomography (CT) scan. Shortly after, she developed increasing bilateral ankle edema and ascites, associated with dyspnea, progressive weight gain, and declining performance status. Gemcitabine and oxaliplatin were discontinued as other causes of her symptoms such as congestive heart disease or venous thrombosis were ruled out. CT scan 6 mo after the initiation of GEMOX revealed worsening ascites with a stable pancreatic mass. However, it also revealed a lobular hepatic contour, segmental atrophy, and capsular retraction mimicking the appearance of cirrhosis. She was managed with aggressive diuresis and albumin infusions which eventually resulted in a resolution of the above-mentioned symptoms as well as complete resolution of pseudocirrhotic appearance of the liver and ascites in CT scan. This case demonstrates that pancreatic cancer patients can develop pseudocirrhosis. Clinicians and radiologist should be well aware of this entity as early recognition and management can lead to a near complete recovery of liver function and much improved quality of life as illustrated in this case.

  12. Management of tobacco smoking in the prison service units – The effects of the health promotion program

    Directory of Open Access Journals (Sweden)

    Krzysztof Puchalski

    2016-10-01

    Full Text Available Background: In 2014 the health promotion program aimed at managing personnel smoking was implemented in the Polish prison service (PS in cooperation with the Nofer Institute of Occupational Medicine (NIOM. It combined education of managers, encouraging them to implement good practices, with employees’ education. This paper describes the process of implementation and its effects in 159 units of PS, against the data on the management of smoking in medium and large companies in Poland gathered in 2010. Material and Methods: Situations concerning smoking management in PS units before and after a half-year program implementation were compared. Data were gathered using self-diagnosis questionnaires (initial and final assessments collectively filled in by representatives of management and employees. Results: Due to the program implementation there was an increase in the percentage of PS units with known number of smoking employees (19% vs. 61%, consultions on formal smoking regulations with personnel (14% vs. 57%, minimal antismoking medical interventions (46% vs. 59%, and assessments of effects of antismoking activities (14% vs. 55%. There was also increase in the number of PS units with personnel totally obeying smoking regulations (28% vs. 41% and decrease in those where such rules are not completely met (9% vs. 7%. In 3/4 PS units there was an increase in employees’ interest in quitting smoking and in 40% of them employees smoke less at work. Almost every second unit has set up a health promotion team. Conclusions: In many aspects the program has brought along satisfying effects and allowed for depicting areas of improvement. Its scheme and tools can be used, after adaptation, in interventions concerning other health problems in workplaces. Med Pr 2016;67(5:605–621

  13. Staff satisfaction and retention and the role of the nursing unit manager.

    Science.gov (United States)

    Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine

    2009-01-01

    Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.

  14. UHF-RFID solutions for logistics units management in the food supply chain

    Directory of Open Access Journals (Sweden)

    Paolo Barge

    2013-09-01

    Full Text Available The availability of systems for automatic and simultaneous identification of several items belonging to a logistics unit during production, warehousing and delivering can improve supply chain management and speed traceability controls. Radio frequency identification (RFID is a powerful technique that potentially permits to reach this goal, but some aspects as, for instance, food product composition (e.g. moisture content, salt or sugar content and some peculiarities of the production environment (high moisture, high/low temperatures, metallic structures have prevented, so far, its application in food sector. In the food industry, composition and shape of items are much less regular than in other commodities sectors. In addition, a wide variety of packaging, composed by different materials, is employed. As material, size and shape of items to which the tag should be attached strongly influence the minimum power requested for tag functioning, performance improvements can be achieved only selecting suitable RF identifier for the specific combination of food product and packaging. When dealing with logistics units, the dynamic reading of a vast number of tags originates simultaneous broadcasting of signals (tag-to-tag collisions that could affect reading rates and the overall reliability of the identification procedure. This paper reports the results of an extensive analysis of the reading performance of UHF RFID systems for multiple dynamic electronic identification of food packed products in controlled conditions. Products were considered singularly or arranged on a logistics pallet. The effects on reading rate and reading zone of different factors, among which the type of product, the number and position of antennas, the field polarization, the reader RF power output, the interrogation protocol configuration as well as the transit speed, the number of tags and their interactions were analysed and compared.

  15. Are Australian and United States Farmers Using Soil Information for Soil Health Management?

    Directory of Open Access Journals (Sweden)

    Lisa Lobry de Bruyn

    2016-03-01

    Full Text Available Soil health is an essential requirement of a sustainable, functioning agroecosystem. Tracking soil health to determine sustainability at the local level largely falls to farmers, even though they often lack access to critical information. We examine farmers’ participation in gathering soil information at the farm and paddock scale over the last two decades in Australia and the United States, by reviewing national-level reporting of farmer use of soil testing and farm planning as well as qualitative research on farmer perspectives. The level of participation in soil testing and farm planning has remained stable in the last two decades, with only 25% and 30% of landholders, respectively, participating nationally, in either country. The review revealed national-level reporting has a number of limitations in understanding farmers’ use of soil information and, in particular, fails to indicate the frequency and intensity of soil testing as well as farmer motivation to test soil or what they did with the soil information. The main use of soil testing is often stated as “determining fertilizer requirements”, yet data show soil testing is used less commonly than is customary practice. In Australia and in the United States, customary practice is three and half times more likely for decisions on fertilizer application levels. The rhetoric is heavy on the use of soil testing as a decision tool, and that it guides best practices. However, given that only a quarter of farmers are soil testing, and doing so infrequently and in low densities, the level of information on soil health is poor. While farmers report consistent monitoring of soil conditions, few have consistent records of such. In contrast to the information on the poor state of soil health, there is strong farmer interest in procuring soil health benefits through changes in farm practices such as conservation tillage or cover crops, even if they are unable to demonstrate these soil health

  16. Hot Topics in Primary Care: Update on the Recognition and Management of Gout: More Than the Great Toe.

    Science.gov (United States)

    Doghramji, Paul P

    2015-12-01

    Gout is a chronic inflammatory condition that is increasing in prevalence and commonly associated with other chronic diseases such as obesity, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, cardiovascular disease, and thromboembolic disorders. These associations make the management of patients with gout more complex. Although identification of MSU crystals in synovial fluid is diagnostic, a presumptive diagnosis of gout can be made clinically based on the presence of hyperuricemia, rapid development of pain, tenderness, and swelling in a single toe (male) or elbow or finger joint (female), and family history. Gout is increasingly recognized as a heterogeneous disease requiring individualized treatment. A healthy lifestyle is always recommended and patient education is critical to support self-management and long-term adherence. Antiinflammatory therapy, typically colchicine or an NSAID, is recommended for management of an acute gout flare, while ULT may be used in patients with frequent or severe acute gout, tophi, urolithiasis, renal function impairment, or other complications of gout. Allopurinol is first-line ULT for most patients, although febuxostat and probenecid are effective options and pegloticase is useful in selected patients. New medications, such as lesinurad, are on the horizon.

  17. Public roads in the opening of forests in forest management units of Sarajevo canton

    Directory of Open Access Journals (Sweden)

    Sokolović Dževada

    2015-01-01

    Full Text Available The primary network of forest roads consists of public and forest truck roads. Public roads in one forest area have been mainly built due to needs of local communities, access to rural areas, the development of tourism, recreation and so on. Forest truck roads have been built and maintained by those who manage forests (the forest management, while public roads have been managed by the Directorate for Roads of the Federation of B&H and cantonal and local governments. In the last twenty years, the sector for wood assortments transport in the Federation of B&H is in charge of the private transport operators which use vehicles of large capacities and high axle loads for the purpose of transport of as large as possible quantities of wooden mass per time unit. Due to this fact, the roads have deteriorated faster. The accelerated deterioration of the roads used for the transport of wooden assortments imposes the need for the allocation of larger funds for their maintenance. Due to the increasing damages on the roads the prohibitions of use of some public roads for wooden assortments transport occur more frequently. The aim of the research is to determine the total length of public roads which open Forest Management Units of Sarajevo Canton (FMU of SC and to investigate the possibility of using these categories of roads for forestry. For examination and analysis possibilities of using public roads for wooden assortments transport qualitative research - polls methods have been applied within the framework of the key representatives of the target groups such as forestry and the local community. In the questionnaire, two sets of questions were specified, the first one which is designed to determine the possible existence of problems of using public roads for transport of wooden assortments and possible causes of occurrence of the problems. The second group of questions gives some of the possible solutions for solving the problems of using public roads for

  18. Ecology, Planning, and River Management in the United States: Some Historical Reflections

    Directory of Open Access Journals (Sweden)

    Martin Reuss

    2005-06-01

    Full Text Available River ecologists are also river-basin planners. However, their role in planning has developed slowly over the decades since the beginning of the 20th century. Three major factors explain this phenomenon. First, ecologists focused on plant and animal communities rather than on broader policy issues related to land settlement and water development. Second, the federal government, and most state and local governments as well, used mainly economic criteria to justify projects. Intangible benefits, including the value of species or an aesthetically pleasing landscape, drew relatively little attention. Third, the public generally favored development, especially during the Great Depression of the 1930s. Only after World War II did the public's position shift in favor of more preservation, as ecologists developed the concept of the ecosystem, large dam projects forced basin inhabitants from their homes, and chemical and nuclear pollutants threatened the environment. Also, urbanization increased support for the preservation of recreation sites and of streams undisturbed by human intervention. Meanwhile, partly through important advances in geomorphology and hydrology, ecologists acquired new tools to understand the land-water relationship within river basins. Neverthless, benefit-cost analysis continued to dominate federal water-resources planning, and organizational culture and competing or overlapping bureaucracies hampered rational water resources administration. Environmental groups and physical, natural, and even social scientists began to promote alternative ways to develop rivers. Today, the ideas of integrated water resources management, sustainable development, and comprehensive river-basin management dominate much of the thinking about the future course of river planning in the United States. Any future planning must include ecologists who can help their planning colleagues choose from among rational choices that balance ecological and human

  19. [Invasive candidiasis in non-neutropenic adults : Guideline-based management in the intensive care unit].

    Science.gov (United States)

    Glöckner, A; Cornely, O A

    2013-12-01

    Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in

  20. Spinal stab injury with retained knife blades: 51 Consecutive patients managed at a regional referral unit.

    Science.gov (United States)

    Enicker, Basil; Gonya, Sonwabile; Hardcastle, Timothy C

    2015-09-01

    Spinal stab wounds presenting with retained knife blades (RKB) are uncommon, often resulting in spinal cord injury (SCI) with catastrophic neurological consequences. The purpose of this study is to report a single unit's experience in management of this pattern of injury at this regional referral centre. Retrospective review of medical records identified 51 consecutive patients with spinal stabs presenting with a RKB at the Neurosurgery Department at Inkosi Albert Luthuli Central Hospital between January 2003 and February 2015. The data was analyzed for patient characteristics, level of the RKB, neurological status using the ASIA impairment scale, associated injuries, radiological investigations, management, hospital length of stay, complications and mortality. The mean age was 28±10.9 years (range 14-69), with 45 (88%) males (M: F=7.5:1). The median Injury Severity Score was 16 (range 4-26). RKB were located in the cervical [9,18%], thoracic [38,74%], lumbar [2,4%] and sacral [2,4%] spine. Twelve patients (24%) sustained complete SCI (ASIA A), while 21 (41%) had incomplete (ASIA B, C, D), of which 17 had features of Brown-Sequard syndrome. Eighteen (35%) patients were neurologically intact (ASIA E). There were 8 (16%) associated pneumothoraces and one vertebral artery injury. Length of hospital stay was 10±7.1 days (range 1-27). One patient (2%) died during this period. Stab injuries to the spine presenting with RKB are still prevalent in South Africa. Resources should be allocated to prevention strategies that decrease the incidence of inter-personal violence. All RKBs should be removed in the operating theatre by experienced surgeons to minimise complications. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Management and climate contributions to satellite-derived active fire trends in the contiguous United States

    Science.gov (United States)

    Lin, Hsiao-Wen; McCarty, Jessica L.; Wang, Dongdong; Rogers, Brendan M.; Morton, Douglas C.; Collatz, G. James; Jin, Yufang; Randerson, James T.

    2014-04-01

    Fires in croplands, plantations, and rangelands contribute significantly to fire emissions in the United States, yet are often overshadowed by wildland fires in efforts to develop inventories or estimate responses to climate change. Here we quantified decadal trends, interannual variability, and seasonality of Terra Moderate Resolution Imaging Spectroradiometer (MODIS) observations of active fires (thermal anomalies) as a function of management type in the contiguous U.S. during 2001-2010. We used the Monitoring Trends in Burn Severity database to identify active fires within the perimeter of large wildland fires and land cover maps to identify active fires in croplands. A third class of fires defined as prescribed/other included all residual satellite active fire detections. Large wildland fires were the most variable of all three fire types and had no significant annual trend in the contiguous U.S. during 2001-2010. Active fires in croplands, in contrast, increased at a rate of 3.4% per year. Cropland and prescribed/other fire types combined were responsible for 77% of the total active fire detections within the U.S and were most abundant in the south and southeast. In the west, cropland active fires decreased at a rate of 5.9% per year, likely in response to intensive air quality policies. Potential evaporation was a dominant regulator of the interannual variability of large wildland fires, but had a weaker influence on the other two fire types. Our analysis suggests it may be possible to modify landscape fire emissions within the U.S. by influencing the way fires are used in managed ecosystems.

  2. Economic Screening of Geologic Sequestration Options in the United States with a Carbon Management Geographic Information System

    Energy Technology Data Exchange (ETDEWEB)

    Dahowski, Robert T.(BATTELLE (PACIFIC NW LAB)); Dooley, James J.(BATTELLE (PACIFIC NW LAB)); Brown, Daryl R.(BATTELLE (PACIFIC NW LAB)); Stephan, Alex J.(BATTELLE (PACIFIC NW LAB)); Badie I. Morsi

    2001-10-19

    Developing a carbon management strategy is a formidable task for nations as well as individual companies. It is often difficult to understand what options are available, let alone determine which may be optimal. In response to the need for a better understanding of complex carbon management options, Battelle has developed a state-of-the-art Geographic Information System (GIS) model with economic screening capability focused on carbon capture and geologic sequestration opportunities in the United States. This paper describes the development of this GIS-based economic screening model and demonstrates its use for carbon management analysis.

  3. Identification and management of women with inherited bleeding disorders: a survey of obstetricians and gynaecologists in the United Kingdom.

    Science.gov (United States)

    Chi, C; Shiltagh, N; Kingman, C E C; Economides, D L; Lee, C A; Kadir, R A

    2006-07-01

    A mail survey of members and fellows of Royal College of Obstetricians and Gynaecologists was carried out to determine current practices of obstetricians and gynaecologists in the United Kingdom in the management of women with inherited bleeding disorders. In total, 3929 questionnaires were sent, 707 returned and analysis was limited to 545 valid questionnaires. In the past 5 years, 91% have managed women with inherited bleeding disorders. The majority (83%) considered inherited bleeding disorders to be under diagnosed in obstetrics and gynaecology. More than 80% considered the prevalence of von Willebrand's disease (VWD) to be management guidelines are essential in minimizing haemorrhagic complications and improving quality of care of these women.

  4. Do United States’ Teachers Know and Adhere to the National Guidelines on Asthma Management in the Classroom? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Yudilyn Jaramillo

    2015-01-01

    Full Text Available Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s,” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US. From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  5. Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review.

    Science.gov (United States)

    Jaramillo, Yudilyn; Reznik, Marina

    2015-01-01

    Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms "asthma management," "teacher(s)," "school teacher," and "public school." The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

  6. The Meaning of Work and Performance-Focused Work Attitudes among Midlevel Managers in the United States and Brazil

    Science.gov (United States)

    Kuchinke, K. Peter; Cornachione, Edgard B., Jr.

    2010-01-01

    This survey-based study investigated work meaning and performance-focused work attitudes of some 315 midlevel managers in diverse industries in the United States and Brazil to determine similarities, differences, and relationships among absolute and relative meaning of work, work role identification, desired work outcomes, and job satisfaction,…

  7. Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; Wagner, C.

    2011-01-01

    Background: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizationa

  8. The Management of Change in Universities: Universities, State and Economy in Australia, Canada and the United Kingdom.

    Science.gov (United States)

    Miller, Henry D. R.

    This book explores the varying meanings and impacts of management and market on higher education. The book gives an historical account of the main characteristics of higher education systems in Australia, Canada, and the United Kingdom, focusing on developments in governance since World War II. There follows a discussion of the relationships of…

  9. Attitudes toward Business Ethics and Degree of Opinion Leadership of Future Managers In the United States, Finland, and China

    Science.gov (United States)

    Comegys, Charles; Vaisanen, Jaani; Lupton, Robert A.; Rawlinson, David R.

    2013-01-01

    The purpose of this study was to compare the attitudes towards business ethics of future managers in three countries: the United State, Finland, and China, and determine whether business ethics attitudes differed by the student's major, class year, GPA, gender, age, and the number of ethics and religious studies courses completed. Additionally the…

  10. Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; Wagner, C.

    2011-01-01

    Background: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and

  11. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review

  12. Attitudes toward Business Ethics and Degree of Opinion Leadership of Future Managers In the United States, Finland, and China

    Science.gov (United States)

    Comegys, Charles; Vaisanen, Jaani; Lupton, Robert A.; Rawlinson, David R.

    2013-01-01

    The purpose of this study was to compare the attitudes towards business ethics of future managers in three countries: the United State, Finland, and China, and determine whether business ethics attitudes differed by the student's major, class year, GPA, gender, age, and the number of ethics and religious studies courses completed. Additionally the…

  13. Attitudes toward Business Ethics and Degree of Opinion Leadership of Future Managers In the United States, Finland, and China

    Science.gov (United States)

    Comegys, Charles; Vaisanen, Jaani; Lupton, Robert A.; Rawlinson, David R.

    2013-01-01

    The purpose of this study was to compare the attitudes towards business ethics of future managers in three countries: the United State, Finland, and China, and determine whether business ethics attitudes differed by the student's major, class year, GPA, gender, age, and the number of ethics and religious studies courses completed.…

  14. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review o

  15. Discuss the Project Management of Construction Unit%浅谈建设单位项目管理

    Institute of Scientific and Technical Information of China (English)

    李洪桥

    2014-01-01

    建筑项目管理人员要重点关注工程施工的质量水平,并且作为各个建筑单位总的组织者和管理者,不但要参与和监督各个单位的实际工作,还要促进各个单位之间的相互协调与合作,保证建筑项目的顺利完工。%Construction project management staff should foc-us on the quality level of engineering construction, and as the overal organizer and manager of various construction units sh-ould not only participate and supervise the actual work of eve-ry unit, but also promote the coordination and cooperation am-ong the various units so as to ensure the successful completion of the construction project.

  16. Conflicts and natural disaster management: a comparative study of flood control in the Republic of Korea and the United States.

    Science.gov (United States)

    Chung, Jibum

    2016-07-01

    The purpose of this research is to analyse the conflicts that arise among major stakeholders during the process of disaster management and to suggest policy recommendations for improving disaster management systems. It describes several important conflict cases that have occurred among major stakeholders, such as governments, private-sector entities, and non-governmental organisations, during natural disaster management. In addition, it probes the similarities and the differences between such conflicts in the Republic of Korea and the United States. The differences between them may originate from a range of factors, such as the disaster itself, cultural features, management practices, and government organisation. However, the conflicts also are very similar in some ways, as the motivations and the behaviour of stakeholders during a disaster are alike in both countries. Based on this comparison, the study presents some common and important implications for successful disaster management practices in Korea and the US, as well as in many other nations around the world.

  17. [The implementation of an independent and differentiated pain management SOP (Standard Operating Procedure) for the interdisciplinary intensive care unit].

    Science.gov (United States)

    Aust, Hansjörg; Wulf, Hinnerk; Vassiliou, Timon

    2013-03-01

    Up to the present day, pain management in the ICU (Intensive Care Units) is a unresolved clinical problem due to patient heterogeneity with complex variation in etiopathology and treatment of the underlying diseases. Therefore, therapeutic strategies in terms of standard operating procedure (SOP) are a necessary to improve the pain management for intensive care patients. Common guidelines for analgosedation are often inadequate to reflect the clinical situation. In particular, for an ICU setting without permanent presence of a physician a missing pain management SOP resulting in delayed pain therapy caused by a therapeutic uncertainty of the nurse staff. In addition to our pre-existing SOP for analgosedation we implemented a pain management SOP for our interdisciplinary, anaesthesiologic ICU. A exploratory survey among the nurse staff was conducted to assess the efficacy of the SOP. The results of the evaluation after a 6 month follow-up indicated a faster onset of pain management and good acceptance by the nursing staff.

  18. Use of febuxostat in the management of gout in the United Kingdom

    Science.gov (United States)

    Waller, Arabella; Jordan, Kelsey M.

    2016-01-01

    Gout is the most common cause of inflammatory arthritis worldwide. Despite clinical cure being achievable and multiple evidence-based guidelines having been published, the incidence and prevalence continues to increase and the condition remains undertreated. Concerns regarding allopurinol have limited its use in those with renal impairment. Febuxostat, a novel xanthine oxidase inhibitor requiring no dose adjustment in mild−moderate renal impairment was launched in the United Kingdom (UK) in 2010. We review published data on the efficacy, safety and tolerability of febuxostat and provide an opinion on its place in the management of gout in the UK in the context of other published guidelines. One phase II trial, multiple phase III trials [febuxostat versus allopurinol controlled trial (FACT), APEX, CONFIRMS] and two open-label extension trials have demonstrated febuxostat given at the doses commonly used in UK practice (80 mg, 120 mg) to reduce serum urate more effectively than those receiving fixed-dose allopurinol. Overall adverse event rates were comparable across treatment groups aside from gout flare (more common in febuxostat-treated patients) and concerns regarding cardiovascular toxicity are being further evaluated in two large trials. If the outcomes of these are favourable, we would anticipate a marked increase in the use of febuxostat in the UK market. We would advocate the use of febuxostat to target a serum urate gouty flare with colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or Cyclo-oxygenase-2 selective NSAID (COXIB) after febuxostat initiation. PMID:28255339

  19. Strengthening the nursing and midwifery unit manager role: an interim programme evaluation.

    Science.gov (United States)

    Clarke, Elizabeth; Diers, Donna; Kunisch, Judith; Duffield, Christine; Thoms, Debra; Hawes, Sue; Stasa, Helen; Fry, Margaret

    2012-01-01

    An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health 'take the lead' ('ttl') programme, an initiative aimed at enhancing nursing/midwifery unit managers' (N/MUM) skills. Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the 'ttl' programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Semi-structured interviews were conducted with 17 participants who had completed components of the 'ttl' programme. The interviews explored participants' perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the 'ttl' workshops. The results suggest that the studied components of the 'ttl' programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Leadership programmes such as 'ttl' may provide an effective tool for improving N/MUM performance and role confidence. © 2011 Blackwell Publishing Ltd.

  20. Chest Pain Units: A Modern Way of Managing Patients with Chest Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Roberto Bassan

    2002-08-01

    Full Text Available It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS. This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI, and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.

  1. Phylogeography, Genetic Diversity, and Management Units of Hawksbill Turtles in the Indo-Pacific.

    Science.gov (United States)

    Vargas, Sarah M; Jensen, Michael P; Ho, Simon Y W; Mobaraki, Asghar; Broderick, Damien; Mortimer, Jeanne A; Whiting, Scott D; Miller, Jeff; Prince, Robert I T; Bell, Ian P; Hoenner, Xavier; Limpus, Colin J; Santos, Fabrício R; FitzSimmons, Nancy N

    2016-05-01

    Hawksbill turtle (Eretmochelys imbricata) populations have experienced global decline because of a history of intense commercial exploitation for shell and stuffed taxidermied whole animals, and harvest for eggs and meat. Improved understanding of genetic diversity and phylogeography is needed to aid conservation. In this study, we analyzed the most geographically comprehensive sample of hawksbill turtles from the Indo-Pacific Ocean, sequencing 766 bp of the mitochondrial control region from 13 locations (plus Aldabra, n = 4) spanning over 13500 km. Our analysis of 492 samples revealed 52 haplotypes distributed in 5 divergent clades. Diversification times differed between the Indo-Pacific and Atlantic lineages and appear to be related to the sea-level changes that occurred during the Last Glacial Maximum. We found signals of demographic expansion only for turtles from the Persian Gulf region, which can be tied to a more recent colonization event. Our analyses revealed evidence of transoceanic migration, including connections between feeding grounds from the Atlantic Ocean and Indo-Pacific rookeries. Hawksbill turtles appear to have a complex pattern of phylogeography, showing a weak isolation by distance and evidence of multiple colonization events. Our novel dataset will allow mixed-stock analyses of hawksbill turtle feeding grounds in the Indo-Pacific by providing baseline data needed for conservation efforts in the region. Eight management units are proposed in our study for the Indo-Pacific region that can be incorporated in conservation plans of this critically endangered species.

  2. WIPP Sampling and Analysis Plan for Solid Waste Management Units and Areas of Concern

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2000-05-23

    This Sampling and Analysis Plan (SAP) has been prepared to fulfill requirements of Module VII, Section VII.M.2 and Table VII.1, requirement 4 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Permit, NM4890139088-TSDF (the Permit); (NMED [New Mexico Environment Department], 1999a). This SAP describes the approach for investigation of the Solid Waste Management Units (SWMU) and Areas of Concern (AOC) specified in the Permit. This SAP addresses the current Permit requirements for a RCRA Facility Investigation(RFI) investigation of SWMUs and AOCs. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the RFI specified in Module VII of the Permit, current NMED guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI work plan and report sequence with a more flexible decision-making approach. The ACAA process allows a facility to exit the schedule of compliance contained in the facility's Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can beentered either before or after a RFI work plan. According to NMED's guidance, a facility can prepare a RFI work plan or SAP for any SWMU or AOC (NMED, 1998).

  3. The influence of capacity management on the unit cost of production: a case study in a flexible plastic packaging company

    Directory of Open Access Journals (Sweden)

    Tálita Floriano Goulart Silva

    2013-08-01

    Full Text Available This article presents the relationship between capacity management and cost management in determining the unit cost. The objective was to show how the use of effective capacity decreases the unit cost of manufacturing. For this, follow these steps: 1 Knowledge and analysis of production process and PPPC; 2 Data Collection; 3 Application of the Method Cost Center; 4Verification of the relationship between the Capacity Management and Cost Management. Through the company’s accounting reports, observations and interviews, the following results was possible: knowledge of the production process and functioning of PPCP, measuring the cost of each step of the production process and the unit cost of each product. Subsequently, we compared the unit cost using the effective capacity and normal capacity. The results showed that the unit costs decrease with the use of effective capacity, while increasing the margin for each product, even with the lower sale price, thus establishing a virtuous circle: effective capacity utilization, reduced unit cost, most competitive prices and increase in the number of requests.

  4. Expanded public notice: Washington State notice of intent for corrective action management unit, Hanford Environmental Restoration Disposal

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This document is to serve notice of the intent to operate an Environmental Restoration Disposal Facility (ERDF), adjacent to the 200 West Area of the Hanford Facility, Richland, Washington, as a Corrective Action Management Unit (CAMU), in accordance with 40 Code of Federal Regulation (CFR) 264.552. The ERDF CAMU will serve as a management unit for the majority of waste (primarily soil) excavated during remediation of waste management sites on the Hanford Facility. Only waste that originates from the Hanford Facility can be accepted in this ERDF CAMU. The waste is expected to consist of dangerous waste, radioactive waste, and mixed waste. Mixed waste contains radioactive and dangerous components. The primary features of the ERDF could include the following: one or more trenches, rail and tractor/trailer container handling capability, railroads, an inventory control system, a decontamination building, and operational offices.

  5. Facial Recognition

    Directory of Open Access Journals (Sweden)

    Mihalache Sergiu

    2014-05-01

    Full Text Available During their lifetime, people learn to recognize thousands of faces that they interact with. Face perception refers to an individual's understanding and interpretation of the face, particularly the human face, especially in relation to the associated information processing in the brain. The proportions and expressions of the human face are important to identify origin, emotional tendencies, health qualities, and some social information. From birth, faces are important in the individual's social interaction. Face perceptions are very complex as the recognition of facial expressions involves extensive and diverse areas in the brain. Our main goal is to put emphasis on presenting human faces specialized studies, and also to highlight the importance of attractiviness in their retention. We will see that there are many factors that influence face recognition.

  6. Turnover of professional nurses at Mokopane Hospital in the Limpopo Province, South Africa: Experiences of nursing unit managers

    Directory of Open Access Journals (Sweden)

    Mogale L. Mmamma

    2015-07-01

    Full Text Available Background: Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care.Objectives: The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision.Method: A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9 and those working night duty (n = 3 who were at work on the anticipated days for data collection.Results: The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented.Conclusion: It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.

  7. Help for heroes? Evaluating a case management programme for ex-service personnel in the United Kingdom.

    Science.gov (United States)

    Warren, Jon; Garthwaite, Kayleigh; Bambra, Clare

    2015-01-01

    There is increasing recognition of the health and social needs of ex-service personnel, but the UK evidence base on interventions is small. This article presents the findings from an evaluation of a vocational case management programme co-funded by the National Health Service (NHS) to prevent ill health among ex-service personnel. Qualitative, semi-structured interviews with 15 ex-service personnel were conducted. Five interviews with case management staff were also undertaken. Data were transcribed, thematically coded and analysed using NVivo. Ex-service personnel valued the service and consistently highlighted 'being listened to', 'being made to feel valued by programme staff', 'having their problems taken seriously' and 'being treated as an individual' as the most valuable aspects of the programme. Respondents particularly valued the personal support that case managers provided and the environment in which the service was delivered. Case management is a viable way in which the military, health professionals and support services can provide ongoing support for ex-service personnel in transitioning successfully to civilian life. © Royal Society for Public Health 2014.

  8. Breast lesions of uncertain malignant nature and limited metastatic potential: Proposals to improve their recognition and clinical management

    Science.gov (United States)

    Rakha, Emad A.; Badve, Sunil; Eusebi, Vincenzo; Reis-Filho, Jorge S.; Fox, Stephen B.; Dabbs, David J.; Decker, Thomas; Hodi, Zsolt; Ichihara, Shu; Lee, Andrew HS.; Palacios, José; Richardson, Andrea L.; Vincent-Salomon, Anne; Schmitt, Fernando C.; Tan, Puay-Hoon; Tse, Gary M.; Ellis, Ian O.

    2016-01-01

    Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are traditionally classified into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey-zone between benign and malignant as their behaviour cannot be predicted reliably. Defined pathological categorisation of such lesions is challenging and for some entities is recognised to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over-treatment or under-treatment. The rarity of these lesions makes acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification, behaviour and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions remain of uncertain malignant nature such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of 1) breast lesions of uncertain malignant nature and 2) breast lesions of limited metastatic potential, are proposed with details of which histological entities could be included in each category, and their management implications are discussed. PMID:26348644

  9. Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management.

    Science.gov (United States)

    Rakha, Emad A; Badve, Sunil; Eusebi, Vincenzo; Reis-Filho, Jorge S; Fox, Stephen B; Dabbs, David J; Decker, Thomas; Hodi, Zsolt; Ichihara, Shu; Lee, Andrew H S; Palacios, José; Richardson, Andrea L; Vincent-Salomon, Anne; Schmitt, Fernando C; Tan, Puay-Hoon; Tse, Gary M; Ellis, Ian O

    2016-01-01

    Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over- or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision-making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.

  10. Fire Management Plan North Tract Unit 8 Patuxent Research Refuge 2005

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — North Tract Unit 8 (NT -8, Drop Zone) is a grassland unit composed of a mixture of dense, cool season grass dominated by Tall Fescue and a woody legume, Korean...

  11. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach.

    Science.gov (United States)

    Molter, G; Seifert, H; Mandraka, F; Kasper, G; Weidmann, B; Hornei, B; Öhler, M; Schwimmbeck, P; Kröschel, P; Higgins, P G; Reuter, S

    2016-02-01

    An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAb) occurred in an interdisciplinary intensive care unit, affecting 10 patients. Within hours of recognition of the spread of CRAb an intervention team was instituted for collection of available data, decision-making, communication and monitoring of all interventions performed, including cohorting, temporary stop of admissions, staff education, and enforcement of infection control measures. An area was defined for cohortation of patients colonized with CRAb, with a separate nursing team and a second set of mobile equipment. New transmissions were no longer observed after only four days into the institution of enhanced infection control measures. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  12. Pseudocirrhosis in a pancreatic cancer patient with liver metastases:A case report of complete resolution of pseudocirrhosis with an early recognition and management

    Institute of Scientific and Technical Information of China (English)

    Soonmo Peter Kang; Tamar Taddei; Bruce McLennan; Jill Lacy

    2008-01-01

    We report a case of pseudocirrhosis arising in the setting of regression of liver metastases from pancreatic cancer.A 55-year-old asymptomatic woman presented to ourclinic with newly diagnosed metastatic pancreatic cancer with extensive liver metastases.She underwent systemic chemotherapy with gemcitabine and oxaliplatin (GEHOX).After 8 cycles of therapy,she had a remarkable response to the therapy evidenced by decline of carcinoembryonic antigen (CEA) and CA19 by>50% and nearlycomplete resolution of hepatic metastases in computed tomography (CT) scan.Shortly after,she developed increasing bilateral ankle edema and ascites,associated with dyspnea,progressive weight gain,and declining performance status.Gemcitabine and oxaliplatin were discontinued as other causes of her symptoms such as congestive heart disease or venous thrombosis were ruled out.CT scan 6 mo after the initiation of GEHOX revealed worsening ascites with a stable pancreatic mass.However,it also revealed a Iobular hepatic contour,segmental atrophy,and capsular retraction mimicking the appearance of cirrhosis.She was managed with aggressive diuresis and albumin infusions which eventually resulted in a resolution of the abovementioned symptoms as well as complete resolution of pseudocirrhotic appearance of the liver and ascites in CT scan.This case demonstrates that pancreatic cancer patients can develop pseudocirrhosis.Clinicians and radiologist should be well aware of this entity as early recognition and management can lead to a near complete recovery of liver function and much improved quality of life as illustrated in this case.

  13. Knowledge, attitudes and practices of trained traditional birth attendants in the Gambia in the prevention, recognition and management of postpartum haemorrhage.

    Science.gov (United States)

    bij de Vaate, Annelies; Coleman, Rosalind; Manneh, Hawa; Walraven, Gijs

    2002-03-01

    to assess the knowledge, attitudes, practices and the potential role of trained Gambian traditional birth attendants (TBAs) in the prevention, recognition and management of postpartum haemorrhage (PPH). a qualitative, reflective approach using semi-structured interviews followed by group discussions. poorly-resourced rural villages in The Gambia, West Africa. 22 trained TBAs and their supervisors from 12 villages. the TBAs recognised complications such as retained placenta and excessive blood loss and were well aware of the need to refer these women to a health facility quickly. Delay in referral was often due to late call-out of the TBA or lack of transport. Although the TBAs did not know the causes of excessive blood loss, they knew that anaemia was a risk factor for dying from PPH. The TBAs were keen to improve their knowledge and to participate in further training. although all the TBAs were illiterate, information from training programmes had usually been incorporated into their knowledge and practice. While the local infrastructure remains poor, home deliveries and delayed referrals will continue and interventions for PPH need to be effective at the site of delivery i.e. in the woman's home. These Gambian TBAs have the potential to contribute to the management of PPH in these situations. these Gambian TBAs could be trained to implement other practices relevant to prevention of PPH in the primary care setting. Linking together and maximising the skills of all health workers is important to reduce PPH mortality in home births in this setting. Copyright 2002 Published by Elsevier Science Ltd.

  14. Recognition and management of BPPV for an elderly female patient referred for low back pain: a resident's case study.

    Science.gov (United States)

    Massey, B James; Osborne, Raine; Beneciuk, Jason M; Rowe, Robert H

    2014-08-01

    Benign paroxysmal positional vertigo (BPPV) is common among older adults and frequently misdiagnosed or unidentified. Undiagnosed BPPV has been associated with depression, falls and ADL limitations. This case study describes the diagnostic process and management of BPPV for a 65-year-old patient with a primary complaint of chronic low back pain (LBP) in an outpatient orthopedic physical therapy setting. Following routine screening performed on initial evaluation, the patient was educated about examination findings that indicated the potential for BPPV and given the option to proceed with further assessment or defer until LBP was under control. The patient attended 16 visits over the course of care and the complaint of vertigo, described as a true spinning sensation, was assessed further on the visit 5. Continued assessment confirmed BPPV and the canalith repositioning procedure was administered. Following positive response to this intervention, the maneuver was re-administered on visit 6. Complete resolution of symptoms was reported on visit 7 and for the remainder of physical therapy services over the following month. Physical therapists may play a vital role in reducing healthcare expenses associated with cost to arrive at the diagnosis of BPPV, as well as improving the quality of life and safety of the older adult population affected by BPPV.

  15. Protocol management of severe traumatic brain injury in intensive care units: a systematic review.

    Science.gov (United States)

    English, Shane W; Turgeon, Alexis F; Owen, Elliott; Doucette, Steve; Pagliarello, Giuseppe; McIntyre, Lauralyn

    2013-02-01

    To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6 months (odds ratio [OR] and 95 % confidence interval [CI] 3.84 (2.47-5.96)) but not 12 months (OR, 95 % CI 0.87 (0.56-1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6 months (OR and 95 % CI 0.72 (0.45-1.14) and 0.33 (0.13-0.82) respectively), but not 12 months (OR, 95 % CI 0.79 (0.5-1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI.

  16. Adoption of anesthesia information management systems by academic departments in the United States.

    Science.gov (United States)

    Egger Halbeis, Christoph B; Epstein, Richard H; Macario, Alex; Pearl, Ronald G; Grunwald, Zvi

    2008-10-01

    Information technology has been promoted as a way to improve patient care and outcomes. Whereas information technology systems for ancillary hospital services (e.g., radiology, pharmacy) are deployed commonly, it has been estimated that anesthesia information management systems (AIMS) are only installed in a small fraction of United States (US) operating rooms. In this study, we assessed the adoption of AIMS at academic anesthesia departments and explored the motivations for and resistance to AIMS adoption. Members of the Society of Academic Anesthesiology Chairs and the Association of Anesthesiology Program Directors were solicited by e-mail to participate in an online survey of AIMS adoption. Two months after closing the survey, another e-mail was sent with a single question asking for an update to their AIMS implementation status. Surveys were fully completed by 48 (34%) of the 140 Society of Academic Anesthesiology Chairs and Association of Anesthesiology Program Directors departments surveyed, with 72 (51%) providing AIMS status information. Twenty of these 72 departments have an AIMS installed, 12 are currently implementing, 11 have selected but not yet installed, and 18 are planning to purchase an AIMS in 2008 or 2009. Therefore, at least 61 (44%) of all 140 US academic anesthesia departments have committed to AIMS. This estimated adoption rate is conservative because the numerator equals the affirmative responses, whereas the denominator equals the total population of academic departments. Among adopters, the top ranked anticipated benefits from installing an AIMS included improved clinical documentation, improved data collection for clinical research, enhancement of quality improvement programs, and compliance with requirements of regulatory authorities. The hospital provided funding in almost all facilities (90%), with co-funding by the anesthesia group in 35%. At least 61 or 44% of the 140 US academic departments surveyed in this study have already

  17. Recognition of endophytic Trichoderma species by leaf-cutting ants and their potential in a Trojan-horse management strategy

    Science.gov (United States)

    Rocha, Silma L.; Evans, Harry C.; Jorge, Vanessa L.; Cardoso, Lucimar A. O.; Pereira, Fernanda S. T.; Rocha, Fabiano B.; Barreto, Robert W.; Hart, Adam G.

    2017-01-01

    Interactions between leaf-cutting ants, their fungal symbiont (Leucoagaricus) and the endophytic fungi within the vegetation they carry into their colonies are still poorly understood. If endophytes antagonistic to Leucoagaricus were found in plant material being carried by these ants, then this might indicate a potential mechanism for plants to defend themselves from leaf-cutter attack. In addition, it could offer possibilities for the management of these important Neotropical pests. Here, we show that, for Atta sexdens rubropilosa, there was a significantly greater incidence of Trichoderma species in the vegetation removed from the nests—and deposited around the entrances—than in that being transported into the nests. In a no-choice test, Trichoderma-infested rice was taken into the nest, with deleterious effects on both the fungal gardens and ant survival. The endophytic ability of selected strains of Trichoderma was also confirmed, following their inoculation and subsequent reisolation from seedlings of eucalyptus. These results indicate that endophytic fungi which pose a threat to ant fungal gardens through their antagonistic traits, such as Trichoderma, have the potential to act as bodyguards of their plant hosts and thus might be employed in a Trojan-horse strategy to mitigate the negative impact of leaf-cutting ants in both agriculture and silviculture in the Neotropics. We posit that the ants would detect and evict such ‘malign’ endophytes—artificially inoculated into vulnerable crops—during the quality-control process within the nest, and, moreover, that the foraging ants may then be deterred from further harvesting of ‘Trichoderma-enriched’ plants. PMID:28484603

  18. Analysis of perception and community participation in forest management at KPHP model unit VII-Hulu Sarolangun, Jambi Province

    Science.gov (United States)

    Purnomo, B.; Anggoro, S.; Izzati, M.

    2017-06-01

    The concept of forest management at the site level in the form of forest management units (KPH) implemented by the government in an effort to improve forest governance in Indonesia. Forest management must ensure fairness for all stakeholders, especially indigenous and local communities that have been the most marginalized groups. Local communities have become an important part in the efforts to achieve sustainable forest management. Public perception as one of the stakeholders in forest management need to be analyzed to determine their perspectives on the forest. This study aimed to analyze the perception and the level of community participation in forest management activities in KPHP Model Unit VII-Hulu Sarolangun, as well as examine the relationship between these two variables. Perception variables are divided into three categories: good, moderate and bad, while the participation variable is also divided into three categories: high, medium, and low. Data was obtained through semi-structured interviews with the key informants and questionnaires to randomly selected respondents. Statistical analysis was conducted to determine whether there are differences of perception and participation between the two villages and the relationship between perceptions of participation or not. The results showed 90,16 % of people have a good perception and the remaining 9,84% have a moderate perception. In general, community participation is at a low level that is as much as 76,17 % and only 1,55% had a high participation rate. The analysis showed differences in levels of participation between the two villages and there is no relationship between the perception and the level of community participation in forest management. The results of this study can be taken into consideration for KPHP and other stakeholders in forest management policy in the region KPHP.

  19. Speaker Recognition

    DEFF Research Database (Denmark)

    Mølgaard, Lasse Lohilahti; Jørgensen, Kasper Winther

    2005-01-01

    Speaker recognition is basically divided into speaker identification and speaker verification. Verification is the task of automatically determining if a person really is the person he or she claims to be. This technology can be used as a biometric feature for verifying the identity of a person...... in applications like banking by telephone and voice mail. The focus of this project is speaker identification, which consists of mapping a speech signal from an unknown speaker to a database of known speakers, i.e. the system has been trained with a number of speakers which the system can recognize....

  20. Total Water Management: A Research Project of the United States Environmental Protection Agency

    Science.gov (United States)

    Total Water Management (TWM) examines urban water systems in an interconnected manner. It encompasses reducing water demands, increasing water recycling and reuse, creating water supply assets from stormwater management, matching water quality to end-use needs, and achieving envi...

  1. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Jordi Ferrer

    2014-12-01

    Conclusions: Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.

  2. Regulatory Lessons for Internet Traffic Management from Japan, the European Union, and the United States: Toward Equity, Neutrality and Transparency

    Directory of Open Access Journals (Sweden)

    John Harris Stevenson

    2010-01-01

    Full Text Available As network neutrality has been one of the most contentious Internet public policy issues of the past decade, this article provides a comparative overview of events, policies, and legislation surrounding Internet traffic management practises (ITMPs (e.g., network neutrality in Japan, the European Union, the United States, and Canada. Using the frame provided by Richard Rose of “hybrid lessons”to create a policy synthesis, the paper details the telecom policy environment, Internet Service provider competition, legislative jurisdiction, remedies for ITMPs, consumer transparency, and adherence to privacy protection in each country. The analysis focuses on Canada’s first significant regulatory effort to address network neutrality, which came during the Canadian Radio-television and Telecommunications Commission 2009 process on Internet traffic management. This paper presents a brief overview of the Canadian regulatory environment and the specific questions which were the subject of the CRTC review. Employing Richard Rose’s methods for comparative public policy analysis, we offer a number of regulatory “lessons” from Japan, the European Union, and the United States based on their experiences with traffic management issues. Applying these lessons to the Canadian context, we make several specific policy recommendations, among them that competition be encouraged within the Internet service provider space, that network management practises be reasonable and limited, and that ISPs provide full disclosure of network management policies and practises.

  3. Turning Diversity into Competitive Advantage: A Case Study of Managing Diversity in the United States of America

    Directory of Open Access Journals (Sweden)

    Eddy M. Sutanto

    2009-01-01

    Full Text Available Esty, Griffin, and Hirsch (1995 state that today’s workforce is truly a mosaic of different races, ages, genders, ethnic groups, religions, and lifestyles. As a manager or a supervisor, it is your job to make sure that the desperate pieces of a mosaic fit together in a harmonious, coordinated way, maximally utilizing the talents and abilities of each employee. If skillfully managed, this diversity can bring a competitive advantage to an organization. If not, however, the bottom line can be negatively affected, and the work environment can become unwelcoming. Dealing with a diverse work group is new terrain for most managers and supervisors. The United States rose to the top using a-one-size-fits-all approach to managing employees. This work in past because, historically, most of the work force was white, and male. This has all changed. The following parts will clearly provide a description about diversity, changes in the United States work force, challenges and opportunities of the changes for organizations, and how managers and supervisors as front liners deal with diversity and to turn diversity into a competitive advantage.

  4. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada.

    Science.gov (United States)

    Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema

    2012-10-01

    Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards.

  5. Stockless Medical Materials Management: Applications for the United States Air Force Medical Service

    Science.gov (United States)

    1991-09-01

    percent would agree with the following stockless materials management definition . This research effort will adopt the following stockless materials... management definition : In a stockless program, the distributor takes over the hospitals central distribution function (i.e., the "pick-and-pack" operation...study developed a generally accepted stockless materials management definition . It defines stockless materials management as an inventory system where

  6. Institutional Arrangements for River Basin Management: A Case Study of Comparison between the United States and China

    Institute of Scientific and Technical Information of China (English)

    ZHOU Gang-yan

    2007-01-01

    This note compares institutional arrangements for water resources management in two river basins, namely, those of the Susquehanna River in the United States and the Yangtze River in China. The Susquehanna River Basin Commission is composed of the US federal government and the three states of New York, Pennsylvania, and Maryland through which the Susquehanna River passes. Under the authority of the Susquehanna River Basin Compact, the Commission deals with water resources problems throughout its vast drainage area. In contrast, the Changjiang(Yangtze River) Water Resources Commission (CWRC) lacks relative effectiveness in mobilizing provincial governments in transboundary water resources management.

  7. Four Generations of Maintenance Resource Management Programs in the United States: An Analysis of the Past, Present, and Future

    Science.gov (United States)

    Taylor, James C.; Patankar, Manoj S.

    2001-01-01

    This paper analyzes four generations of Maintenance Resource Management (MRM) programs implemented by aviation maintenance organizations in the United States. Data collected from over ten years of survey research and field observations are used for this analysis; they are presented in a case-study format. The first three generations of MRM programs were episodic efforts to increase safety through teamwork, focus group discussions, and awareness courses, respectively. Now, the fourth generation programs, characterized by a commitment to long-term communication and behavioral changes in maintenance, are set to build on those earlier generations, toward a culture of mutual trust between mechanics, their managers, and regulators.

  8. International Space Station United States Laboratory Module Water Recovery Management Subsystem Verification from Flight 5A to Stage ULF2

    Science.gov (United States)

    Williams, David E.; Labuda, Laura

    2009-01-01

    The International Space Station (ISS) Environmental Control and Life Support (ECLS) system comprises of seven subsystems: Atmosphere Control and Supply (ACS), Atmosphere Revitalization (AR), Fire Detection and Suppression (FDS), Temperature and Humidity Control (THC), Vacuum System (VS), Water Recovery and Management (WRM), and Waste Management (WM). This paper provides a summary of the nominal operation of the United States (U.S.) Laboratory Module WRM design and detailed element methodologies utilized during the Qualification phase of the U.S. Laboratory Module prior to launch and the Qualification of all of the modification kits added to it from Flight 5A up and including Stage ULF2.

  9. Wolf Management Operational Plan Game Management Unit 15A Northern Portion of the Kenai National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of this operational plan is to establish a wolf management strategy for the Kenai National Wildlife Refuge that will be jointly implemented by the Fish...

  10. The recognition of work

    OpenAIRE

    Nierling, Linda

    2007-01-01

    The following article argues that recognition structures in work relations differ significantly in the sphere of paid work in contrast to unpaid work in private spheres. According to the systematic approach on recognition of Axel Honneth three different levels of recognition are identified: the interpersonal recognition, organisational recognition and societal recognition. Based on this framework it can be stated that recognition structures in the sphere of paid work and in private spheres di...

  11. 76 FR 28954 - International Conservation and Management Measures Recognized by the United States

    Science.gov (United States)

    2011-05-19

    ... National Oceanic and Atmospheric Administration RIN 0648-XA324 International Conservation and Management... publish from time to time in the Federal Register a list of international conservation and management... international conservation and management measures was first published in the Federal Register in 1996....

  12. Diabetes management patterns in a palliative care unit in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Sami Ayed Alshammary

    2016-01-01

    Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients' individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

  13. Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions.

    Science.gov (United States)

    Rolin-Gilman, Cheryl; Fournier, Bonnie; Cleverley, Kristin

    2017-06-01

    Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  14. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit.

    Science.gov (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M

    2012-02-01

    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  15. Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit.

    Science.gov (United States)

    Ryu, Jeong Am; Yang, Jeong Hoon; Chung, Chi Ryang; Suh, Gee Young; Hong, Seung Chyul

    2017-06-01

    Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients. © 2017 The Korean Academy of Medical Sciences.

  16. Analysis of Project Management for Construction Unit%建设方工程管理分析

    Institute of Scientific and Technical Information of China (English)

    杨音

    2013-01-01

      建设工程项目的全寿命周期包括决策阶段、实施阶段和使用或运营阶段,项目的顺利推进需要依赖建设方、设计方、施工方、供货方等多个参与方的共同配合,而建设方作为项目的总的管理者,其管理作用贯穿于建设工程项目的全寿命周期中,对整个项目的进展及质量起着至关重要的作用。  本文从建设方工程管理的主要工作内容出发,首先提出了工程项目的“投资管理、进度管理、质量管理”等三项管理重点,并详细分析了上述三项重点工作的体现阶段、管理权限、工作重点等方面的内容。其次,针对工程项目的分阶段实施特性,分别阐述了规划和项目管理阶段、工程实施管理阶段的重要性及主要工作内容,以及如何开展应急响应项目管理。最后分析了项目信息管理的必要性并提出信息管理系统的搭建方案。本文所提出的管理理念及工作方法已经部分应用于工作中并取得了良好的效果,因此具有一定的实际意义。%The life cycle of the construction project, including decision-making phase, implementation phase, and the use, or the operational phase. The smooth progress of the project depends on the co-ordination of the construction unit, the design unit, the construction unit, the supply unit, and other participants.As the general manager of the project, the construction unit plays a vital role in the progress and quality of the entire project, while its effect throughout the whole life cycle of the construction project. The thesis starts from the mainproject management work of construction unit,and then proposes the three management priorities which is "investment management, schedule management, quality management" with detailed analysis of their stage, administrative privileges and the focus of the work. Secondly, for projects phased implementation characteristics, it describes the

  17. Neglected infections of poverty in Texas and the rest of the United States: management and treatment options.

    Science.gov (United States)

    Barry, M A; Bezek, S; Serpa, J A; Hotez, P J; Woc-Colburn, L

    2012-08-01

    In the poorest regions of the United States, especially along the Gulf Coast and in South Texas, are a group of endemic parasitic and related infections known as the neglected infections of poverty. Such infections are characterized by their chronicity, disabling features, and disproportionate impact on the estimated 46 million people who live below the U.S. poverty line. Today more Americans live in poverty than ever before in the half-century that the Census Bureau has been recording poverty rates. In association with that poverty, a group of major neglected infections of poverty have emerged in the United States. Here we describe the major neglected infections of poverty in the United States, with a brief overview of their significant epidemiological features, their links with poverty, and our approaches to their diagnosis, management, and treatment.

  18. Acidic deposition in the northeastern United States: Sources and inputs, ecosystem effects, and management strategies

    Science.gov (United States)

    Driscoll, C.T.; Lawrence, G.B.; Bulger, A.J.; Butler, T.J.; Cronan, C.S.; Eagar, C.; Lambert, K.F.; Likens, G.E.; Stoddard, J.L.; Weathers, K.C.

    2001-01-01

    North America and Europe are in the midst of a large-scale experiment. Sulfuric and nitric acids have acidified soils, lakes, and streams, thereby stressing or killing terrestrial and aquatic biota. It is therefore critical to measure and to understand the recovery of complex ecosystems in response to decreases in acidic deposition. Fortunately, the NADP, CASTNet, and AIRMoN-dry networks are in place to measure anticipated improvements in air quality and in atmospheric deposition. Unfortunately, networks to measure changes in water quality are sparse, and networks to monitor soil, vegetation, and fish responses are even more limited. There is an acute need to assess the response of these resources to decreases in acid loading. It would be particularly valuable to assess the recovery of aquatic biota - which respond directly to acid stress - to changes in surface water chemistry (Gunn and Mills 1998). We used long-term research from the HBEF and other sites across the northeastern United States to synthesize data on the effects of acidic deposition and to assess ecosystem responses to reductions in emissions. On the basis of existing data, it is clear that in the northeastern United States ??? reductions of SO2 emissions since 1970 have resulted in statistically significant decreases in SO42- in wet and bulk deposition and in surface waters ??? emissions of NOX and concentrations of NO3- in wet and bulk deposition and in surface waters have shown no increase or decrease since the 1980s ??? estimates of NH3 emissions are uncertain, although atmospheric deposition of NH4+ remains important for forest management and stream NO3- loss ??? acidic deposition has accelerated the leaching of base cations from soils, thus delaying the recovery of ANC in lakes and streams from decreased emissions of SO2 (at the HBEF the available soil Ca pool appears to have declined 50% over the past 50 years) ???sulfur and N from atmospheric deposition have accumulated in forest soils across

  19. Demonstration of a Novel, Integrated, Multi-Scale Procedure for High-Resolution 3D Reservoir Characterization and Improved CO2-EOR/Sequestration Management, SACROC Unit

    Energy Technology Data Exchange (ETDEWEB)

    Scott R. Reeves

    2007-09-30

    The primary goal of this project was to demonstrate a new and novel approach for high resolution, 3D reservoir characterization that can enable better management of CO{sub 2} enhanced oil recovery (EOR) projects and, looking to the future, carbon sequestration projects. The approach adopted has been the subject of previous research by the DOE and others, and relies primarily upon data-mining and advanced pattern recognition approaches. This approach honors all reservoir characterization data collected, but accepts that our understanding of how these measurements relate to the information of most interest, such as how porosity and permeability vary over a reservoir volume, is imperfect. Ideally the data needed for such an approach includes surface seismic to provide the greatest amount of data over the entire reservoir volume of interest, crosswell seismic to fill the resolution gap between surface seismic and wellbore-scale measurements, geophysical well logs to provide the vertical resolution sought, and core data to provide the tie to the information of most interest. These data are combined via a series of one or more relational models to enable, in its most successful application, the prediction of porosity and permeability on a vertical resolution similar to logs at each surface seismic trace location. In this project, the procedure was applied to the giant (and highly complex) SACROC unit of the Permian basin in West Texas, one of the world's largest CO{sub 2}-EOR projects and a potentially world-class geologic sequestration site. Due to operational scheduling considerations on the part of the operator of the field, the crosswell data was not obtained during the period of project performance (it is currently being collected however as part of another DOE project). This compromised the utility of the surface seismic data for the project due to the resolution gap between it and the geophysical well logs. An alternative approach was adopted that utilized a

  20. Managing national forests of the eastern United States for non-timber forest products

    Science.gov (United States)

    James L. Chamberlain; Robert J. Bush; A.L. Hammett; Philip A. Araman

    2000-01-01

    Over the last decade, there has been a growing interest in the economic and ecological potential of non-timber forest products. In the United States, much of this increased interest stems from drastic changes in forest practices and policies in the Pacific Northwest region, a region that produces many non-timber forest products. The forests of the eastern United States...

  1. Management and Oversight of Services Acquisition Within the United States Air Force

    Science.gov (United States)

    2008-12-01

    47 Figure 14. Training Received............................................................................................48 Figure 15. QAP ...Surveillance Plan QAP Quality Assurance Personnel PSC Product Service Code SOO Statement of Objectives USA United States Army USN United States...Assurance Personnel ( QAP ), and the multi-functional teams (USAF, 2005). This policy has established clear guidelines and responsibilities for the USAF in

  2. Operative and technological management of super-large united power grids: lessons of major world's blackouts

    Science.gov (United States)

    Brinkis, K.; Kreslins, V.; Mutule, A.

    2014-02-01

    Power system (PS) blackouts still persist worldwide, evidencing that the existing protective structures need to be improved. The discussed requirements and criteria to be met for joint synchronous operation of large and super-large united PSs should be based on close co-ordination of operative and technological management of all PSs involved in order to ensure secure and stable electricity supply and minimise or avoid the threat of a total PS blackout. The authors analyse the July 2012 India blackout - the largest power outage in history, which affected over 620 million people, i.e. half of India's population and spread across its 22 states. The analysis is of a general character, being applicable also to similar blackouts that have occurred in Europe and worldwide since 2003. The authors summarise and develop the main principles and methods of operative and technological management aimed at preventing total blackouts in large and super-large PSs. Neskatoties uz sasniegumiem elektroenerģētikas jomā un energosistēmu nepārtrauktu modernizāciju, pasaulē regulāri notiek sabrukumu avārijas. Rakstā apskatīti lielu un superlielu energosistēmu apvienību savstarpējas sinhronas darbības nodrošinājuma prasības un kritēriji, kas pamatojas uz operatīvās un tehnoloģiskās vadības ciešu koordināciju starp energosistēmām. Savstarpējas sinhronas darbības nodrošinājuma prasībām un kritērijiem ir izšķiroša nozīme, lai panāktu elektroapgādes drošumu un stabilitāti katrā energosistēmā, kas darbojas apvienotas energosistēmas sastāvā. Šo prasību un kritēriju ievērošana sekmē totālo avāriju izcelšanās iespēju samazināšanu un to novēršanu. Indijas 2012.gada totālo avāriju un citu analogo avāriju Eiropā un Amerikā analīze un izvērtējums laika posmā no 2003.gada, deva iespēju apkopot un izstrādāt lielu un superlielu energosistēmu operatīvās un tehnoloģiskās vadības principus un metodoloģiju, lai novērstu vai

  3. Intensive care unit versus hospital floor: a comparative study of postoperative management of patients with adolescent idiopathic scoliosis.

    Science.gov (United States)

    Shan, Le-Qun; Skaggs, David L; Lee, Christopher; Kissinger, Catherine; Myung, Karen S

    2013-04-03

    Patients undergoing posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis were admitted to the intensive care unit until two years ago, at which time we changed our protocol to admit these patients to the general hospital floor following a brief stay in a postanesthesia care unit. This study compared postoperative management on a hospital floor with that in the intensive care unit for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. A retrospective review of 124 consecutive patients with adolescent idiopathic scoliosis treated with spinal fusion from August 2007 to August 2010 was performed. Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis and posterior spinal instrumentation and fusion surgery. Of 124 patients, sixty-six were managed postoperatively in the intensive care unit and fifty-eight, on the hospital floor. The mean age at the time of surgery was fourteen years. A mean of eleven vertebral levels (range, six to fifteen levels) were fused. No significant difference between the groups was found with respect to the mean age at the time of surgery, mean weight, mean preoperative and postoperative Cobb angles, and mean number of levels fused (p ≥ 0.12). However, the use of analgesic and antianxiety medication, number of postoperative blood tests, days of hospital stay, and number of physical therapy sessions were significantly decreased in the floor group compared with the intensive care unit group (p ≤ 0.05). No patient from the floor group had to be admitted to the intensive care unit. The mean charge was $33,121 for the floor group and $39,252 for the intensive care unit group (p floor, rather than in an intensive care unit, was associated with a shorter hospital stay, fewer blood tests, less analgesic and antianxiety medication usage, and fewer physical therapy sessions at this high-volume, academic, tertiary-care children's hospital. In addition to improved patient

  4. Management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve implantation: the United Kingdom TAVI Registry.

    Science.gov (United States)

    Snow, Thomas M; Ludman, Peter; Banya, Winston; DeBelder, Mark; MacCarthy, Philip M; Davies, Simon W; Di Mario, Carlo; Moat, Neil E

    2015-11-15

    The management and impact of concomitant coronary artery disease in patients referred for TAVI remains contentious. We describe the prevalence, clinical impact and management of coronary artery disease (CAD) in patients in the United Kingdom TAVI Registry. All-inclusive study of patients undergoing TAVI in the United Kingdom (excluding Northern Ireland) from January 2007 to December 2011. Coronary artery disease at the time of TAVI was demonstrated on invasive angiography. 2588 consecutive patients were entered in the U.K. TAVI Registry. CAD was reported in 1171 pts with left main stem involvement in 12.4% of this cohort (n=145). Most patients were free of chest pain, but limited by dyspnoea (NYHA Class III & IV 81.9%). Angina was however more prevalent in those patients with CAD (pdisease management in an "all-comers" patient population undergoing TAVI demonstrates that whilst often an indicator of significant underlying comorbidity coronary artery disease is not associated with decreased short or long-term survival. The majority of patients with aortic stenosis and concomitant CAD can be managed effectively by TAVI alone. However, the importance of the Heart Team in making decisions on individual patients must not be underestimated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Phoneme vs Grapheme Based Automatic Speech Recognition

    OpenAIRE

    Magimai.-Doss, Mathew; Dines, John; Bourlard, Hervé; Hermansky, Hynek

    2004-01-01

    In recent literature, different approaches have been proposed to use graphemes as subword units with implicit source of phoneme information for automatic speech recognition. The major advantage of using graphemes as subword units is that the definition of lexicon is easy. In previous studies, results comparable to phoneme-based automatic speech recognition systems have been reported using context-independent graphemes or context-dependent graphemes with decision trees. In this paper, we study...

  6. Management of Complications of End-Stage Liver Disease in the Intensive Care Unit.

    Science.gov (United States)

    DellaVolpe, Jeffrey D; Garavaglia, Jeffrey M; Huang, David T

    2016-02-01

    The management of critically ill patients with end-stage liver disease can be challenging due to the vulnerability of this population and the wide-ranging complications of the disease. This review proposes an approach based on the major organ systems affected, to provide a framework for managing the most common complications. Although considerable practice variation exists, a focus on the evidence behind the most common practices will ensure the development of the optimal skillset to appropriately manage this disease.

  7. United States Department of Energy Environmental Management Advisory Board: Public meeting

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-15

    This meeting of the Environmental Management Advisory Board was held to discuss environmental concerns that everybody has and to provide a strategy for dealing with the problems. Plans for the Environmental Management Programmatic Environmental Impact Statement are presented. A report is included of the subcommittee on institutional barriers to advanced technology use. The subcommittee on environmental restoration cost effectiveness also presents a report. The status of public involvement activities is evaluated. A presentation on the status of spent fuel management is included.

  8. [Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)].

    Science.gov (United States)

    Leroy, J E; Bensouda, C; Durand, E; Greffet, A; Scemama, A; Carli, P; Danchin, N; Sauval, P

    2005-03-01

    More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.

  9. The evolution of groundwater rights and groundwater management in New Mexico and the western United States

    Science.gov (United States)

    DuMars, Charles T.; Minier, Jeffrie D.

    Historically, rights in water originated as public property and only later became individualized rights to utilize the public resource, in a manner consistent with the public welfare needs of society, but protected by principles of property law. Five basic regulatory systems for rights in groundwater in the United States have evolved to date. The problems raised by the hydrologic differences between groundwater hydraulically connected to stream systems and groundwater in non-replenished aquifers have been resolved to some extent by a couple of leading court cases. Numerical modeling and other technical methodologies have also evolved to evaluate the scientific issues raised by the different hydrologic conditions, but these are not immune from criticism. The current role of aquifers is evolving into that of storage facilities for recycled water, and their utilization in this manner may be expanded even further in the future. The policy implications of the choices relating to joint management of ground and surface water cannot be overstated. As this paper demonstrates, proactive administration of future groundwater depletions that affect stream systems is essential to the ultimate ability to plan for exploitation, management and utilization of water resources in a rational way that coordinates present and future demand with the reality of scarcity of supply. The examples utilized in this paper demonstrate the need for capacity building, not just to develop good measurement techniques, or to train talented lawyers and judges to write good laws, but also for practical professional water managers to keep the process on a rational course, avoiding limitless exploitation of the resource as well as conservative protectionism that forever precludes its use. Historiquement, les droits d'eau étaient à l'origine un bien public; ils sont devenus plus tard des droits individualisés pour utiliser la ressource publique conformément aux besoins de salut public de la soci

  10. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    Science.gov (United States)

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  11. Communication barriers to applying federal research in support of land management in the United States

    Science.gov (United States)

    Vita Wright

    2007-01-01

    Barriers to effective communication between researchers and managers can ultimately result in barriers to the application of scientific knowledge and technology for land management. Both individual and organizational barriers are important in terms of how they affect the first three stages of the innovation-decision process: 1) knowledge, where an individual is exposed...

  12. Managing United States public lands in response to climate change: a view from the ground up.

    Science.gov (United States)

    Ellenwood, Mikaela S; Dilling, Lisa; Milford, Jana B

    2012-05-01

    Federal land managers are faced with the task of balancing multiple uses and goals when making decisions about land use and the activities that occur on public lands. Though climate change is now well recognized by federal agencies and their local land and resource managers, it is not yet clear how issues related to climate change will be incorporated into on-the-ground decision making within the framework of multiple use objectives. We conducted a case study of a federal land management agency field office, the San Juan Public Lands Center in Durango, CO, U.S.A., to understand from their perspective how decisions are currently made, and how climate change and carbon management are being factored into decision making. We evaluated three major management sectors in which climate change or carbon management may intersect other use goals: forests, biofuels, and grazing. While land managers are aware of climate change and eager to understand more about how it might affect land resources, the incorporation of climate change considerations into everyday decision making is currently quite limited. Climate change is therefore on the radar screen, but remains a lower priority than other issues. To assist the office in making decisions that are based on sound scientific information, further research is needed into how management activities influence carbon storage and resilience of the landscape under climate change.

  13. Implementation of crew resource management: a qualitative study in 3 intensive care units.

    NARCIS (Netherlands)

    Kemper, P.F.; Dyck, C. van; Wagner, C.; Bruijne, M. de

    2014-01-01

    Objectives: Classroom-based crew resource management (CRM) training has been increasingly applied in health care to improve safe patient care. Crew resource management aims to increase participants' understanding of how certain threats can develop as well as provides tools and skills to respond to

  14. Enrollment or "Enrolment": Strategic Enrollment Management in the United States and Canada

    Science.gov (United States)

    Smith, Clayton; Gottheil, Susan

    2008-01-01

    Since the early 1990s, Canadian registrars, admissions officers and student affairs professionals have traveled to U.S.-based conferences in search of the holy grail of enrollment management, finding it at the AACRAO Annual Meeting, AACRAO Strategic Enrollment Management (SEM) Conference, and other meetings sponsored by Noel-Levitz, SEM Works, the…

  15. Sports Management Faculty External Grant-Writing Activities in the United States

    Science.gov (United States)

    DeVinney, Timothy P.

    2012-01-01

    This study was conducted to fill a void in information, provide relevant, current data for faculty members related to external grant-writing activities related to the academic field of sport management and serve as a tool that may aid in the advancement of external grant-writing efforts within the field of sport management. All data is specific to…

  16. Evaluating Interactive Fatigue Management Workshops for Occupational Health Professionals in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Sheila Ali

    2014-12-01

    Conclusion: Fatigue can lead to severe functional impairment with adverse workplace outcomes. One-day workshops can be effective in training OH professionals in how to diagnose and manage fatigue and CFS. Training may increase general knowledge of fatigue and confidence in fatigue management in an OH setting.

  17. Development of certified environmental management in hospital and outpatient haemodialysis units

    Directory of Open Access Journals (Sweden)

    Sergio García Vicente

    2015-11-01

    Discussion: There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact.

  18. Impact of a risk management plan on Legionella contamination of dental unit water

    National Research Council Canada - National Science Library

    Leoni, Erica; Dallolio, Laura; Stagni, Francesca; Sanna, Tiziana; D'Alessandro, Giovanni; Piana, Gabriela

    2015-01-01

    The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination...

  19. An Automated Individual Training Record Management System (Prototype) United States Marine Corps

    Science.gov (United States)

    1984-03-01

    F OM A:CRNGQIAS ADDITIVE CASE I(MUNIT) = ID RESTORE F CM A:DRNGQIAS ADDITIVE CASE I( UNIT) = ’’ RESTORE F BCM A:BNRNGQTA ADDITIVE IECASE ERASE a 2,15...ADDITIVE CASE IR(UNIT) E RES TOEE F FCM A:BNENGQTA ADDITIVE IECAS E ERASE a 2,15 SAY "BIFLE RANGE QUOTA SCRATCH PAD"l 2 a4 5 SAY I"SFACE BELCW THIS

  20. Data Base Design with GIS in Ecosystem Based Multiple Use Forest Management in Artvin, Turkey: A Case Study in Balcı Forest Management Planning Unit

    Directory of Open Access Journals (Sweden)

    Hacı Ahmet Yolasığmaz

    2009-03-01

    Full Text Available In Turkey, the understanding of planning focused on timber production has given its place on Multiple Use Management (MUM. Because the whole infrastructure of forestry with inventory system leading the way depends on timber production, some cases of bottle neck are expected during the transition period. Database design, probably the most important stage during the transition to MUM, together with the digital basic maps making up the basis of this infrastructure constitute the main point of this article. Firstly, the forest management philosophy of Turkey in the past was shortly touched upon in the article. Ecosystem Based Multiple Use Forest Management (EBMUFM approaches was briefly introduced. The second stage of the process of EBMUFM, database design was described by examining the classical planning infrastructure and the coverage to be produced and consumed were suggested in the form of lists. At the application stage, two different geographical databases were established with GIS in Balcı Planning Unit of the years 1984 and 2006. Following that the related basic maps are produced. Timely diversity of the planning unit of 20 years is put forward comparatively with regard to the stand parameters such as tree types, age class, development stage, canopy closure, mixture, volume and increment.

  1. Isoniazid overdose: recognition and management.

    Science.gov (United States)

    Romero, J A; Kuczler, F J

    1998-02-15

    Since isoniazid is increasingly being used to control the spread of tuberculosis, physicians must be aware of its potentially fatal effects. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5 g of isoniazid. Doses larger than 30 mg per kg often produce seizures. When ingested in amounts of 80 to 150 mg per kg or more, isoniazid can be rapidly fatal. The first signs and symptoms of isoniazid toxicity usually appear 30 minutes to two hours after ingestion and include nausea, vomiting, slurred speech, dizziness, tachycardia and urinary retention, followed by stupor, coma and recurrent grand mal seizures. The seizures produced by isoniazid toxicity are often refractory to anticonvulsant therapy. Given in gram-per-gram amounts of the isoniazid ingested, pyridoxine (vitamin B6) usually eliminates seizure activity and helps to correct the patient's metabolic acidosis. Isoniazid toxicity should be suspected in any patient who presents with refractory seizures and metabolic acidosis.

  2. Study on the Upgrading and Recognition of Qualifications in the Field of the Restoration and Rehabilitation of the Architectural Heritage. Summary Report. National Reports: Federal Republic of Germany, Belgium Dutch-Speaking Region, France, Italy, United Kingdom. CEDEFOP Panorama. First Edition.

    Science.gov (United States)

    Paulet, Jean-Louis; And Others

    Five studies assessed the impact on systems and jobs of the recognition of qualifications in the field of the restoration and rehabilitation of the architectural heritage in five countries: Germany, Belgium Dutch-speaking region, France, Italy, and the United Kingdom. A striking feature in all five countries was the insignificant share of initial…

  3. Activity Recognition in Social Media

    Science.gov (United States)

    2015-12-29

    activity is splitting. 6 Crowd video classification Ability to identify crowd behavior enables crowd management systems to design and manage public...characterize group activities . We then showed the effectiveness of group level features in crowd video classification . 9 List of Publications 1. N. Bhargava, S...AFRL-AFOSR-JP-TR-2016-0044 Activity Recognition in Social Media Subhasis Chaudhuri INDIAN INSTITUTE OF TECHNOLOGY BOMBAY Final Report 05/09/2016

  4. Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit.

    Science.gov (United States)

    Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina

    2015-03-01

    Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management.

  5. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Emiliana Motta

    Full Text Available Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU, in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

  6. Challenges and opportunities of health care supply chain management in the United States.

    Science.gov (United States)

    Elmuti, Dean; Khoury, Grace; Omran, Omar; Abou-Zaid, Ahmed S

    2013-01-01

    This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.

  7. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  8. Biology, Ecology, and Evolving Management of Helicoverpa zea (Lepidoptera: Noctuidae) in Sweet Corn in the United States.

    Science.gov (United States)

    Olmstead, Daniel L; Nault, Brian A; Shelton, Anthony M

    2016-08-01

    The corn earworm, Helicoverpa zea (Boddie), is a polyphagous pest found throughout the United States, where it attacks many field and vegetable crops. Although H. zea has long been a traditional pest of sweet corn, its importance to this crop has increased dramatically over the past two decades. In this review, we summarize information critical for current and future management of H. zea in sweet corn production in the United States. First, we discuss the pest status of H. zea and its life history, including migration, infestation and larval development, diapause, overwintering, and abiotic factors that affect its biology. Next we describe monitoring methods, crop protection decision-making processes, chemical control options, and the use of genetic technologies for control of H. zea Alternative H. zea management options including biological control, cultural controls, host plant resistance, and pheromone disruption are also reviewed. The role of climate change and its effects on H. zea and its ecology are discussed, as well as the recent invasion of its relative, Helicoverpa armigera (Hübner), which is a major pest of corn in other parts of the world. To conclude, we suggest future research opportunities for H. zea and H. armigera management in sweet corn.

  9. Nontraditional Use of Biomass at Certified Forest Management Units: Forest Biomass for Energy Production and Carbon Emissions Reduction in Indonesia

    Directory of Open Access Journals (Sweden)

    Asep S. Suntana

    2012-01-01

    Full Text Available Biomass conversion technologies that produce energy and reduce carbon emissions have become more feasible to develop. This paper analyzes the potential of converting biomass into biomethanol at forest management units experiencing three forest management practices (community-based forest management (CBFM, plantation forest (PF, and natural production forest (NPF. Dry aboveground biomass collected varied considerably: 0.26–2.16 Mg/ha/year (CBFM, 8.08–8.35 Mg/ha/year (NPF, and 36.48–63.55 Mg/ha/year (PF. If 5% of the biomass was shifted to produce biomethanol for electricity production, the NPF and PF could provide continuous power to 138 and 2,762 households, respectively. Dedicating 5% of the biomass was not a viable option from one CBFM unit. However, if all biomasses were converted, the CBFM could provide electricity to 19–27 households. If 100% biomass from two selected PF was dedicated to biomethanol production: (1 52,200–72,600 households could be provided electricity for one year; (2 142–285% of the electricity demand in Jambi province could be satisfied; (3 all gasoline consumed in Jambi, in 2009, would be replaced. The net carbon emissions avoided could vary from 323 to 8,503 Mg when biomethanol was substituted for the natural gas methanol in fuel cells and from 294 to 7,730 Mg when it was used as a gasoline substitute.

  10. Research on a Power Management System for Thermoelectric Generators to Drive Wireless Sensors on a Spindle Unit

    Directory of Open Access Journals (Sweden)

    Sheng Li

    2014-07-01

    Full Text Available Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle.

  11. Research on a power management system for thermoelectric generators to drive wireless sensors on a spindle unit.

    Science.gov (United States)

    Li, Sheng; Yao, Xinhua; Fu, Jianzhong

    2014-07-16

    Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle.

  12. Technology Diffusion of Anesthesia Information Management Systems into Academic Anesthesia Departments in the United States

    National Research Council Canada - National Science Library

    Stol, Ilana S; Ehrenfeld, Jesse M; Epstein, Richard H

    2014-01-01

    BACKGROUND:Anesthesia information management systems (AIMS) are electronic health records that automatically import vital signs from patient monitors and allow for computer-assisted creation of the anesthesia record...

  13. Coastal Zone Management Act Boundary for the United States and US Territories as of December 2013

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data represents the extent of the nation's coastal zone, as defined by the individual states and territories under the Coastal Zone Management Act of 1972...

  14. Forest Management Plan Sugar Lake Area and Seneca Unit Erie National Wildlife Refuge 1985

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary timber management objective is to provide and improve the existing habitat for all indigenous species with primary consideration on migratory birds...

  15. Marsh and Water Management and Moist Soil Unit Plan: Louisa National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Louisa National Wildlife Refuge Water Management Plan has been developed to meet the station objectives set forth in the Master Plan. The purpose of this plan is...

  16. A Study of United States Army Product Support Manager (PSM) Training

    Science.gov (United States)

    2016-03-25

    relevant policy and data associated with Product Support Manager (PSM) responsibilities, measure the current status of PSM training and selection, and...conduct an analysis of the effectiveness of that PSM training in relation to weapon system acquisition support. PRODUCT SUPPORT MANAGER (PSM...review, a written survey to measure the effectiveness was sent to current PMs, Deputy PMs (DPMs), and PSMs within the Redstone Arsenal community. The

  17. Cultural Resources Management in the United States Air Force: Development of a Planning Primer.

    Science.gov (United States)

    1992-09-01

    1991a:11-5). The 1870’s and 1880’s saw significant efforts to preserve battlefields from the Civil War and also the Revolutionary War. The Casa Grande...directive requires each Air Force insallation to prelpe and adopt a Cultura Resources Management Plan. This plan will incude an inventoy of all cultual...geophysical components of the Legacy program. Specific to cultura resources, the task areas were developed as a general program for improving management of all

  18. Study on Intelligent Parking Management System for Stereo Garage Based on License Plate Automatic Recognition Technology%基于车牌自动识别立体车库智能停车管理系统研究

    Institute of Scientific and Technical Information of China (English)

    胡清明; 李西兵; 郭建华; 王世刚; 林颖

    2011-01-01

    An intelligent parking management system based on license plate automatic recognition technology was proposed to resolve the defects of current stereo garage parking management system. The master-slave structure was adopted in the system, namely the host management & control computer and the subordinate license plate automatic recognition system and car saving system. The hardware and software of the system were designed. The test between the host management software and the subordinate MCU was done. It is proved the system is reliable.%针对立体车库现有停车管理系统所存在的缺陷,提出一种基于车牌自动识别技术的智能停车管理系统.系统采用主从式结构,分别为用作管理控制的上位机和车牌识别系统与车辆存取系统的下位机,并完成了系统的软硬件设计.通过对上位机管理软件与下位机单片机显示控制之间的调试,证明了系统的实用性和可靠性.

  19. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses.

    Science.gov (United States)

    Byrd, Patricia J; Gonzales, Irene; Parsons, Virgil

    2009-12-01

    To explore barriers that NICU nurses face when attempting to optimally manage newborn pain. Ninety California NICU nurses with current membership in the National Association of Neonatal Nurses (NANN) voluntarily participated. A descriptive survey study. A researcher-developed survey consisting of 37 questions was mailed to 300 NICU nurses; 102 were returned and 90 were usable. Probability sampling from a listing of California registered nurses with current membership in the NANN was used to obtain the study's sampling frame. Less than half of the nurses felt that newborn pain is well managed within the NICUs where they are employed. Barriers identified related to physicians' pain management practices, lack of evidence-based pain management protocols, nurses' and physicians' resistance to change practice, infant pain assessment tools, and inadequate staff training regarding pain assessment and management. A knowledge-practice gap still exists within newborn pain management. Increased caregiver education remains a necessity, but strategies that address resistance to change practice within healthcare settings must also be considered.

  20. [Behavioral and psychological symptoms of dementia in a pilot psychogeriatric unit: management and outcomes].

    Science.gov (United States)

    Koskas, P; Belqadi, S; Mazouzi, S; Daraux, J; Drunat, O

    2011-03-01

    Behavioral and psychological symptoms in dementia (BPSD) are a major concern. The French government gave a consensual definition of reinforced intermediate-term care units for BPSD within the project "Plan Alzheimer 2008/2012". Our aim was to report one of the first experiences of this unit in France. Fifty-two patients (38 females, 14 males) were included, mean age 82.07±7.84 (73-97). About 80% of patients were improved and there was a high discharge rate to home of about 30%. Night-time behaviors, aberrant motor behaviors and agitation were the most frequent symptoms. Our study confirms that demented elderly patients greatly benefit from a specific BPSD care unit in agreement with the objective of Plan Alzheimer 2008/2012. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  1. Water matters: An assessment of opinion on water management and community engagement in the Republic of Ireland and the United Kingdom

    National Research Council Canada - National Science Library

    Alec Rolston; Eleanor Jennings; Suzanne Linnane

    2017-01-01

    ... in significant public disquiet and protest movements against the national government. In April 2015 we undertook a survey of current opinion on water management and community engagement initiatives in the Republic of Ireland and the United Kingdom...

  2. ANNUAL UPDATE OF THE SOLID WASTE MANAGEMENT UNIT (SWMU) LIST FOR THE OAK RIDGE Y-12 PLANT.

    Energy Technology Data Exchange (ETDEWEB)

    Deakin, J.M.

    1997-01-01

    In accordance with the terms of Paragraph II.A.8 of the Resource Conservation and Recovery Act (RCRA), 1984 Hazardous and Solid Waste Amendments (HSWA) Permit TN 001, and the Tennessee Department of Environment and Conservation (TDEC), RCRA Permit TN1 890 090 003 for Building 7652 at the Oak Ridge National Laboratory, the list of the solid waste management units (SWMUs) for the Oak Ridge Reservation, including the Oak Ridge Y-12 Plant, must be updated and submitted to personnel at the Environmental Protection Agency, Region IV, and TDEC by January 30, 1997. This report includes information satisfying the {section}II.A.8 requirements, to update the SWMU list for the Y-12 Plant. Newly identified SWMUs include discernible units which have accumulated, treated, stored, or disposed of waste; areas contaminated by routine, deliberate, or systematic releases from process components; RCRA 90-day accumulation areas; and TSCA one-year areas.

  3. Assessment of alternative management practices and policies affecting soil carbon in agroecosystems of the central United States

    Energy Technology Data Exchange (ETDEWEB)

    Donigian, A.S.; Barnwell, T.O.; Jackson, R.B.; Patwardhan, A.S.; Weinrich, K.B.

    1994-04-01

    The goal of the U.S. EPA BIOME Agroecosystems Assessment Project is to evaluate the degree to which agroecosystems can be technically managed, on a sustainable basis, to conserve and sequester carbon, reduce the accumulation of carbon dioxide in the atmosphere, and provide reference datasets and methodologies for agricultural assessment. The report provides preliminary estimates of carbon sequestration potential for the central United States including the Corn Belt, the Great Lakes, and portions of the Great Plains. This study region comprises 44% of the land area and 60% to 70% of the agricultural cropland of the conterminous United States. The assessment methodology includes the integration of the RAMS economic model, the Century soil carbon model, meteorologic and soils data bases, and GIS display and analysis capabilities in order to assess the impacts on soil carbon of current agricultural trends and conditions, alternative tillage practices, use of cover crops, and Conservation Reserve Program policy.

  4. Identifying management units in non-endangered species: the example of the sloth Bradypus variegatus Schinz, 1825.

    Science.gov (United States)

    Moraes-Barros, N; Miyaki, C Y; Morgante, J S

    2007-12-01

    In this study we propose the analysis of genetic diversity of the common three-toed sloth, Bradypus variegatus, in an attempt to understand population structure, identify divergent intraspecific units, and contribute to the knowledge of biodiversity in the neotropical forests. We analyzed a 387 bp segment of the mitochondrial DNA control region in 28 individuals distributed in different localities of both Atlantic and Amazon forests. Our results demonstrated that the genetic diversity of B. variegatus is distributed in six management units, MUs. The observed MUs encompass six phylogenetic lineages and represent respectively north and south regions of Atlantic forest, three regions within the Amazon forest, and a transition region between these two biomes. Considering the fact that these MUs are concordant with phylogroups and endemism areas already described for other vertebrate species, we can say that the study of B. variegatus, a widely distributed and not endangered species, can help to identify areas for conservation biology purposes in neotropical rain forests.

  5. Why farmers adopt best management practice in the United States: A meta-analysis of the adoption literature

    Science.gov (United States)

    Baumgart-Getz, Adam; Stalker Prokopy, Linda; Floress, Kristin

    2012-01-01

    This meta-analysis of both published and unpublished studies assesses factors believed to influence adoption of agricultural Best Management Practices in the United States. Using an established statistical technique to summarize the adoption literature in the United States, we identified the following variables as having the largest impact on adoption: access to and quality of information, financial capacity, and being connected to agency or local networks of farmers or watershed groups. This study shows that various approaches to data collection affect the results and comparability of adoption studies. In particular, environmental awareness and farmer attitudes have been inconsistently used and measured across the literature. This meta-analysis concludes with suggestions regarding the future direction of adoption studies, along with guidelines for how data should be presented to enhance the adoption of conservation practices and guide research.

  6. [Vocal recognition in dental and oral radiology].

    Science.gov (United States)

    La Fianza, A; Giorgetti, S; Marelli, P; Campani, R

    1993-10-01

    Speech reporting benefits by units which can recognize sentences in any natural language in real time. The use of this method in the everyday practice of radiology departments shows its possible application fields. We used the speech recognition method to report orthopantomographic exams in order to evaluate the advantages the method offers to the management and quality of reporting the exams which are difficult to fit in other closed computed reporting systems. Both speech recognition and the conventional reporting method (tape recording and typewriting) were used to report 760 orthopantomographs. The average time needed to make the report, the legibility (or Flesch) index, as adapted for the Italian language, and finally a clinical index (the subjective opinion of 4 odontostomatologists) were evaluated for each exam, with both techniques. Moreover, errors in speech reporting (crude, human and overall errors) were also evaluated. The advantages of speech reporting consisted in the shorter time needed for the report to become available (2.24 vs 2.99 minutes) (p < 0.0005), in the improved Flesch index (30.62 vs 28.9) and in the clinical index. The data obtained from speech reporting in odontostomatologic radiology were useful not only to reduce the mean reporting time of orthopantomographic exams but also to improve report quality by reducing both grammar and transmission mistakes. However, the basic condition for such results to be obtained is the speaker's skills to make a good report.

  7. Regional Management Units for Marine Turtles: A Novel Framework for Prioritizing Conservation and Research across Multiple Scales

    Science.gov (United States)

    Wallace, Bryan P.; DiMatteo, Andrew D.; Hurley, Brendan J.; Finkbeiner, Elena M.; Bolten, Alan B.; Chaloupka, Milani Y.; Hutchinson, Brian J.; Abreu-Grobois, F. Alberto; Amorocho, Diego; Bjorndal, Karen A.; Bourjea, Jerome; Bowen, Brian W.; Dueñas, Raquel Briseño; Casale, Paolo; Choudhury, B. C.; Costa, Alice; Dutton, Peter H.; Fallabrino, Alejandro; Girard, Alexandre; Girondot, Marc; Godfrey, Matthew H.; Hamann, Mark; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Mortimer, Jeanne A.; Musick, John A.; Nel, Ronel; Pilcher, Nicolas J.; Seminoff, Jeffrey A.; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B.

    2010-01-01

    Background Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques — including site-based monitoring, genetic analyses, mark-recapture studies and telemetry — can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. Methodology/Principal Findings To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. Conclusions/Significance The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition

  8. Regional management units for marine turtles: a novel framework for prioritizing conservation and research across multiple scales.

    Directory of Open Access Journals (Sweden)

    Bryan P Wallace

    Full Text Available BACKGROUND: Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques--including site-based monitoring, genetic analyses, mark-recapture studies and telemetry--can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. METHODOLOGY/PRINCIPAL FINDINGS: To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs, for marine turtles globally. CONCLUSIONS/SIGNIFICANCE: The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities

  9. Clinical management issues of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit

    NARCIS (Netherlands)

    Hemels, M.A.C.

    2011-01-01

    Nosocomial sepsis is a major cause of morbidity in the neonatal intensive care unit (NICU), with coagulase-negative staphylococci (CONS) generally reported to be the most frequent causative micro-organisms. There is substantial evidence for the association between CONS sepsis and indwelling intravas

  10. Hydrologic resources management program and underground test area operable unit fy 1997

    Energy Technology Data Exchange (ETDEWEB)

    Smith, D. F., LLNL

    1998-05-01

    This report present the results of FY 1997 technical studies conducted by the Lawrence Livermore National Laboratory (LLNL) as part of the Hydrology and Radionuclide Migration Program (HRMP) and Underground Test Area Operable Unit (UGTA). The HRMP is sponsored by the US Department of Energy to assess the environmental (radiochemical and hydrologic) consequences of underground nuclear weapons testing at the Nevada Test Site.

  11. Management characteristics of beef cattle production in the western United States

    Science.gov (United States)

    A comprehensive life cycle assessment (LCA) of beef in the United States is being conducted to provide benchmarks and identify opportunities for improvement of the beef value chain. Region-specific data are being collected to accurately characterize cattle production practices. This study reports pr...

  12. Traffic Information Unit, Traffic Information System, Vehicle Management System, Vehicle, and Method of Controlling a Vehicle

    NARCIS (Netherlands)

    Papp, Z.; Doodeman, G.J.N.; Nelisse, M.W.; Sijs, J.; Theeuwes, J.A.C.; Driessen, B.J.F.

    2010-01-01

    A traffic information unit (MD1, MD2, MD3) according to the invention comprises a facility (MI) for tracking vehicle state information of individual vehicles present at a traffic infrastructure and a facility (T) for transmitting said vehicle state information to a vehicle (70B, 70E). A traffic

  13. Climate change and wildlife in the southern United States: potential effects and management options

    Science.gov (United States)

    Cathryn H. Greenberg; Roger W. Perry; Kathleen E. Franzreb; Susan C. Loeb; Daniel Saenz; D. Craig Rudolph; Eric Winters; E.M. Fucik; M.A. Kwiatkowski; B.R. Parresol; J.D. Austin; G.W. Tanner

    2014-01-01

    In the southeastern United States, climate models project a temperature increase of 2-10°C by 2100 (Intergovernmental Panel on Climate Change 2007). Climate change is already evident. Since the 1970s, average temperature has risen by about 1°C, with the greatest seasonal temperature increase during winter. Average precipitation during autumn has increased by 30% since...

  14. The effect of inclement weather on ankle fracture management in an Irish trauma unit.

    LENUS (Irish Health Repository)

    O'Neill, B J

    2013-09-01

    Ireland is unfamiliar with extreme weather conditions. Such conditions occurred in winter 2009-2010 and 2010-2011, with much of the country being affected by snow and ice. We reviewed the effect that these conditions had on the treatment of ankle fractures in our trauma unit.

  15. Parkinson’s disease permanent care unit: managing the chronic-palliative interface

    Directory of Open Access Journals (Sweden)

    Lökk J

    2011-04-01

    Full Text Available Johan LökkDepartment of Neurobiology, Caring Sciences, and Society, Karolinska Institutet; Geriatric Department, Karolinska University Hospital Huddinge, Stockholm, SwedenBackground: Parkinson’s disease (PD eventually leads to severe functional decline and dependence. Specialized care units for PD patients in need of permanent care are lacking.Methods: Patients with severe PD are referred to the PD permanent care unit harboring 30 patients with specialized medical and health care provided by trained staff. Patients need to have intensive medical and care needs, and be no longer able to stay at home or at an ordinary institution. A written and continuously reviewed care plan is made for each patient at admission, with the overriding aim to preserve quality of life and optimize functionality.Results: After five years, the PD permanent care unit has cared for 70 patients (36 men and 34 women with a mean age of 76.6 years and a mean duration of Parkinsonism of 11.8 years. Hoehn and Yahr severity of disease was 3.7, cognition was 25.3 (Mini-Mental State Examination, and the mean daily levodopa dose was 739 mg. The yearly fatality rate was seven, and the mean duration of stay was 26.9 months. Only five patients moved out from the unit.Conclusion: A specially designed and staffed care unit for Parkinsonism patients seems to fill a need for patients and caregivers, as well as for social and health care authorities. This model is sensitive to the changing needs and capacities of patients, ensuring that appropriate services are available in a timely manner. There was a rather short duration of patient stay and remaining life span after admission to the unit. Despite the chronic/palliative state of patients at the PD permanent care unit, there are many therapeutic options, with the overriding objective being to allow the patients to end their days in a professional and comfortable environment.Keywords: Parkinsonism, palliative care, end-stage disease

  16. Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.

    Science.gov (United States)

    Fitzner, Karen; Fox, Kathe; Schmidt, Joseph; Roberts, Mark; Rindress, Donna; Hay, Joel

    2005-08-01

    Despite widespread adoption of disease management (DM) programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to 292 appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey. Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction. More respondents were highly satisfied with clinical results than with utilization or cost outcomes of their programs (46%, 17%, and 13%, respectively). Detailed results were analyzed for 57 DM programs with over 230,000 enrollees. Most responding plans offered DM programs for diabetes and asthma, with return on investment (ROI) ranging from 0.16:1 to 4:1. Weighted by number of enrollees per DM program, average ROI was 2.56:1 for asthma (n = 1,136 enrollees) and 1.98:1 for diabetes (n = 25,364). Most (but not all) respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes. Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement.

  17. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

    Science.gov (United States)

    2014-01-01

    Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs

  18. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units.

    Science.gov (United States)

    McCann, Terence V; Baird, John; Muir-Cochrane, Eimear

    2014-03-19

    In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative

  19. Current status of coral reefs in the United Arab Emirates: Distribution, extent, and community structure with implications for management.

    Science.gov (United States)

    Grizzle, Raymond E; Ward, Krystin M; AlShihi, Rashid M S; Burt, John A

    2016-04-30

    Coral reefs of the United Arab Emirates were once extensive, but have declined dramatically in recent decades. Marine management and policy have been hampered by outdated and inaccurate habitat maps and habitat quality information. We combined existing recent datasets with our newly mapped coral habitats to provide a current assessment of nation-wide extent, and performed quantitative surveys of communities at 23 sites to assess coral cover and composition. Over 132 km(2) of coral habitat was mapped, averaging 28.6 ± 3.8% live coral cover at surveyed sites. In the Arabian Gulf low cover, low richness Porites dominated communities characterized western Abu Dhabi, while reefs northeast of Abu Dhabi city generally contained higher richness and cover, and were dominated by merulinids (formerly faviids). Distinct communities occur in the Sea of Oman, where cover and richness were low. We provide management recommendations to enhance conservation of vulnerable coral reefs in the UAE.

  20. Decentralized Method for Load Sharing and Power Management in a Hybrid Single/Three-Phase Islanded Microgrid Consisting of Hybrid Source PV/Battery Units

    DEFF Research Database (Denmark)

    Karimi, Yaser; Oraee, Hashem; Guerrero, Josep M.

    2017-01-01

    This paper proposes a new decentralized power management and load sharing method for a photovoltaic based, hybrid single/three-phase islanded microgrid consisting of various PV units, battery units and hybrid PV/battery units. The proposed method is not limited to the systems with separate PV...... and battery units, and power flow among different phases is performed automatically through three-phase units. The proposed method takes into account the available PV power and battery conditions of the units to share the load among them. To cover all possible conditions of the microgrid, the operation...... in different load, PV generation and battery conditions is validated experimentally in a microgrid lab prototype consisted of one three-phase unit and two single-phase units....

  1. THE CRITICALITY DEFINITIONS OF INFORMATION MANAGEMENT NETWORK UNITS IN VIEW OF CHECKING PROCEDURES

    Directory of Open Access Journals (Sweden)

    Mr. Sergey A. Sherstobitov

    2016-09-01

    Full Text Available The problem of improving quality of work of a complex system, depending on system components that have the greatest influence on its performance is being analyzed in the paper. The author justifies the urgency of solving the problem of determining the critical elements of the system under certain probabilistic performance of their work. The probable model of information management system is considered, the effect of checking procedures at different stages of the management cycle is investigated. The article discusses an approach to the definition of critical components of information management network in view of checking its parameters at different stages. The sensitivity of the probable error-free system operation in relation to the probabilities of stage checking is adopted as an indicator of the criticality. Finally, a numerical example of the sensitivity calculation of probable error-free system operation in relation to the probable checking of stages based on the proposed model is submitted.

  2. Healthcare costs and outcomes of managing β-thalassemia major over 50 years in the United Kingdom.

    Science.gov (United States)

    Weidlich, Diana; Kefalas, Panos; Guest, Julian F

    2016-05-01

    The objective was to estimate the incidence-based costs of treating β-thalassemia major (BTM) to the United Kingdom's National Health Service (NHS) over the first 50 years of a patient's life in terms of healthcare resource use and corresponding costs and the associated health outcomes. This was a modeling study based on information obtained from a systematic review of published literature and clinicians involved in managing BTM in the United Kingdom. A state transition model was constructed depicting the management of BTM over a period of 50 years. The model was used to estimate the incidence-based health economic impact that BTM imposes on the NHS and patients' health status in terms of the number of quality-adjusted life-years (QALYs) over 50 years. The expected probability of survival at 50 years is 0.63. Of patients who survive, 33% are expected to be without any complication and the other 67% are expected to experience at least one complication. Patients' health status over this period was estimated to be a mean of 11.5 discounted QALYs per patient. Total healthcare expenditure attributable to managing BTM was estimated to be £483,454 ($720,201) at 2013/14 prices over 50 years. The cost of managing BTM could be potentially reduced by up to 37% if one in two patients had a bone marrow transplant, with an ensuing improvement in health-related quality of life. This analysis provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to this rare disease. © 2016 AABB.

  3. Recognition & Reconstruction

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    AS Libya rolls on toward its new destiny without former leader Muammar Gaddafi,the legitimacy of the National Transitional Council(NTC) is no longer in doubt. The United Nations has put its full force behind Libya’s former rebels,with the news that the NTC has occupied their nation’s seat at the world body and that certain sanctions imposed on the previous government will be lifted. The UN General Assembly vote of 114 nations to 17,with 15 abstentions,is a clear indication that the world is eager to get Libya’s economy moving and

  4. Factors driving the development of healthcare waste management in the United Kingdom over the past 60 years.

    Science.gov (United States)

    Townend, William K; Cheeseman, Christopher; Edgar, Jen; Tudor, Terry

    2009-06-01

    Since the creation of the National Health Service (NHS) in the United Kingdom in 1948 there have been significant changes in the way waste materials produced by healthcare facilities have been managed due to a number of environmental, legal and social drivers. This paper reviews the key changes in legislation and healthcare waste management that have occurred in the UK between 1948 and the present time. It investigates reasons for the changes and how the problems associated with healthcare wastes have been addressed. The reaction of the public to offensive disposal practices taking place locally required political action by the UK government and subsequently by the European legislature. The relatively new UK industry of hazardous healthcare waste management has developed rapidly over the past 25 years in response to significant changes in healthcare practices. The growth in knowledge and appreciation of environmental issues has also been fundamental to the development of this industry. Legislation emanating from Europe is now responsible for driving change to UK healthcare waste management. This paper examines the drivers that have caused the healthcare waste management to move forward in the 60 years since the NHS was formed. It demonstrates that the situation has moved from a position where there was no overall strategy to the current situation where there is a strong regulatory framework but still no national strategy. The reasons for this situation are examined and based upon the experience gained; suggestions are made for the benefit of countries with systems for healthcare waste management still in the early stages of development or without any provisions at all.

  5. Criteria and indicators for sustainable forestry under Mediterranean conditions applicable in Spain at the forest management unit scale

    Directory of Open Access Journals (Sweden)

    Pablo Valls-Donderis

    2015-04-01

    Full Text Available Aim of study: to identify criteria and indicators (C&I of sustainable forest management (SFM under Mediterranean conditions. The indicators are meant to monitor changes in the provision of ecosystem services at a local scale (forest management unit, FMU. We support that if a forest provides a bundle of ecosystem services its management can be considered sustainable; thus, we adjust C&I to an ecosystem services classification. Area of study: La Hunde y La Palomera, a public FMU in the region of Valencia (east of Spain, 100km southwest of the city of Valencia. Material and methods: first, a literature review of the following themes took part: SFM, features of Mediterranean forests, ecosystem services and C&I. Some C&I were proposed and, later on, a participatory process in Ayora, the municipality where the mentioned FMU is located, was carried out with different stakeholders (forestry professionals, users for recreation, hunters, environmentalists and professionals of cultural and rural development activities in order for them to value the C&I proposed according to their management preferences for La Hunde y La Palomera. Research highlights: 15 criteria and 133 indicators were identified: a balance has been achieved among economic, social and ecological concerns. People value the ecological issues associated to forestry on top and the economic ones at the bottom. Results suggest that SFM under Mediterranean conditions is based on more than one product and on the provision of several ecosystem services.

  6. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2013-01-01

    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  7. The United Nations Global Compact Progress Reports as Management Control Instruments for Social Responsibility at Spanish Universities

    Directory of Open Access Journals (Sweden)

    Amber Wigmore-Álvarez

    2014-04-01

    Full Text Available Sustainability and social responsibility (SR have emerged as a new way of managing all types of organizations. It is necessary that the resulting policy be integrated transversely in the control processes. The environment is especially demanding of higher education institutions (HEIs and universities when it comes to behaving in a socially responsible manner due to their great influence in society. Many universities have adhered to the United Nations Global Compact (UNGC principles to prove their commitment and gain legitimacy. The Communication on Progress (COP is a management tool that helps to understand the level of implementation of the principles. Furthermore, COP analysis aids in establishing a process of continuous improvement in the management of the impacts that institutions have on their stakeholders. The aim of this study was to analyze the Spanish universities that have joined the Global Compact. Through a descriptive methodology, we identified the aspects that reflect this commitment and how this is integrated into their operational and educational processes. The results have shown that it is necessary to promote the integration of different international initiatives to guide the SR of universities. There are deficiencies in their SR management systems that prevent them from being more transparent, and it was found that in some cases, they are not aware of the implications the commitment can have in developed countries.

  8. Impediments and solutions to sustainable, watershed-scale urban stormwater management: lessons from Australia and the United States.

    Science.gov (United States)

    Roy, Allison H; Wenger, Seth J; Fletcher, Tim D; Walsh, Christopher J; Ladson, Anthony R; Shuster, William D; Thurston, Hale W; Brown, Rebekah R

    2008-08-01

    In urban and suburban areas, stormwater runoff is a primary stressor on surface waters. Conventional urban stormwater drainage systems often route runoff directly to streams and rivers, thus exacerbating pollutant inputs and hydrologic disturbance, and resulting in the degradation of ecosystem structure and function. Decentralized stormwater management tools, such as low impact development (LID) or water sensitive urban design (WSUD), may offer a more sustainable solution to stormwater management if implemented at a watershed scale. These tools are designed to pond, infiltrate, and harvest water at the source, encouraging evaporation, evapotranspiration, groundwater recharge, and re-use of stormwater. While there are numerous demonstrations of WSUD practices, there are few examples of widespread implementation at a watershed scale with the explicit objective of protecting or restoring a receiving stream. This article identifies seven major impediments to sustainable urban stormwater management: (1) uncertainties in performance and cost, (2) insufficient engineering standards and guidelines, (3) fragmented responsibilities, (4) lack of institutional capacity, (5) lack of legislative mandate, (6) lack of funding and effective market incentives, and (7) resistance to change. By comparing experiences from Australia and the United States, two developed countries with existing conventional stormwater infrastructure and escalating stream ecosystem degradation, we highlight challenges facing sustainable urban stormwater management and offer several examples of successful, regional WSUD implementation. We conclude by identifying solutions to each of the seven impediments that, when employed separately or in combination, should encourage widespread implementation of WSUD with watershed-based goals to protect human health and safety, and stream ecosystems.

  9. The application of a telemedicine management system: the case of a Moroccan hospital unit.

    Science.gov (United States)

    Bennani Othmani, M; Diouny, S; Boumalif, O

    2012-01-01

    This study is a contribution to the ongoing debate on the application of informatics in medicine. It attempts to outline a theoretical framework supported by a software application of a telemedicine management system. The proposed model is based on a detailed benchmarking of Telecom environments, hardware environments, and content management systems. This approach, which uses open source technologies, helps to create an interface with two entities: web and medical care USB. In sum, for the proposed telemedicine model to be successful, health professionals, telecom operators and research medical informatics laboratories must play an active role in the conception and implementation of telemedicine applications.

  10. Design and testing of recognition unit for Unknown protocols in network intrusion%网络入侵中未知协议识别单元的设计与测试

    Institute of Scientific and Technical Information of China (English)

    芦彩林; 邹恒; 何淑贤

    2015-01-01

    identification unit in the whole network intrusion. the information received by traffic scheduling module is matched with the protocol characteristic library by means of the rule matching module,so as to realize the identification of unknown protocol. In the process of software design,the recognition unit of unknown protocol in network intrusion are analyzed in detail. The program code for unknown protocol recognition in network intrusion is offered. The feasibility and practicability of the system were verified by simulation experiment.

  11. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    Science.gov (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  12. 76 FR 38307 - Fisheries of the Northeastern United States; Recreational Management Measures for the Summer...

    Science.gov (United States)

    2011-06-30

    ... to enable greater commercial and recreational harvest opportunities while preventing overfishing on the scup stock. Recreational management measures are similarly intended to ensure that overfishing the... the overfishing level (OFL) and any other scientific uncertainty and, as such, is designed to...

  13. 76 FR 22350 - Fisheries of the Northeastern United States; Recreational Management Measures for the Summer...

    Science.gov (United States)

    2011-04-21

    ... objectives of the FMP and would have higher socio-economic impacts on fishery participants. Table 1 contains... management measures document, including the Environmental Assessment, Regulatory Impact Review, and Initial... 603 of the Regulatory Flexibility Act (RFA). The IRFAs describe the economic impact this proposed...

  14. Clinical management of ebola virus disease in the United States and Europe

    NARCIS (Netherlands)

    Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L.; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie

    2016-01-01

    Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data fro

  15. Knowledge Management, Innovation and Intellectual Capital for Corporate Value in the United States

    DEFF Research Database (Denmark)

    Bleoca, Lavinia

    2014-01-01

    dynamics of managerial decision-making and create new knowledge about time lags in returns on innovation and intellectual capital management. From the accounting perspective, the findings are highly relevant for knowledge productivity. The results indicate that innovation and intellectual capital...

  16. Continuous EEG monitoring in the intensive care unit: beta scientific and management scientific aspects

    NARCIS (Netherlands)

    Sanders, P.M.H.; van Putten, M.J.A.M.; Jarm, T.; Kramar, P.; Zupanic, A.

    2007-01-01

    Due to various technological advances, it is now possible to continuously monitor critically ill patients using EEG, including the extraction of various quantitative features. In this study, several beta scientific and management scientific aspects of the implementation and use of cEEg on the ICU wi

  17. Summary of Characteristics and Energy Efficiency Demand-side Management Programs in the Southeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Glatt, Sandy [BCS Inc., Laurel, MD (United States)

    2010-04-01

    This report is the first in a series that seeks to characterize energy supply and industrial sector energy consumption, and summarize successful industrial demand-side management (DSM) programs within each of the eight North American Electric Reliability Corporation (NERC) regions.

  18. Continuous EEG monitoring in the intensive care unit: beta scientific and management scientific aspects

    NARCIS (Netherlands)

    Sanders, P.M.H.; van Putten, Michel Johannes Antonius Maria; Jarm, T.; Kramar, P.; Zupanic, A.

    2007-01-01

    Due to various technological advances, it is now possible to continuously monitor critically ill patients using EEG, including the extraction of various quantitative features. In this study, several beta scientific and management scientific aspects of the implementation and use of cEEg on the ICU

  19. Clinical management of ebola virus disease in the United States and Europe

    NARCIS (Netherlands)

    Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L.; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M|info:eu-repo/dai/nl/074382160; Gutman, Julie

    2016-01-01

    Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data fro

  20. Clinical management of ebola virus disease in the United States and Europe

    NARCIS (Netherlands)

    Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L.; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie

    2016-01-01

    Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data