Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

A comparison of labor and delivery management activities in two settings

Similarities and differences in management activities and patient health outcomes between a traditional physician staffed labor and delivery setting and a certified nurse-midwife staffed Birth Center within the same hospital were described. The 950 study subjects, low income, minority women, were classified as low obstetrical risk by a POPRAS score of 25 points or less at time of admission for labor and delivery. The study subjects were similar in demographic, antepartum and intrapartum characteristics; the labor course was problem free for the majority in both settings. There were no remarkable differences in health outcomes between the groups. Management activities varied between settings; these variations were policy related rather than health related. The POPRAS rating system was an accurate predictor for 93% of BC subjects and 85% of LDU subjects. Charge for service was approximately $600 less for BC women; length of stay did not contribute to the difference in charge. Overall, BC respondents to the attitude survey were more satisfied with their labor and delivery experience than L\&DU women. ^

Interview forms for integrating education for conservation in marine protected areas management in Colombia

Environmental Education (EE) is a key component in any marine protected area management. However, its visibility and action plans are still poorly developed and structured as a clear element in management procedures. The objective of this study is to contribute with a methodological route that integrates EE to the existing model of management planning and strategies, taking the Colombian National Natural Parks System as a case study. The creation of the route is proposed as a participatory research with different stakeholders in order to respond to the specific conservation needs and goals for the National Parks System. The EE national diagnosis has shown that its integration within the parks management structure is a first priority need, being a converging result on the two case studies on National Parks from the Pacific Coast of Colombia. The diagnosis also demonstrates that communication, participation, training and evaluation have to be reinforced, linking the community and stakeholders involved in the park management to the whole EE process. The proposed methodology route has been agreed upon by the National Parks staff and incorporates advice and recommendations from different stakeholders, in order to better include the park users. This step will help us to advance toward sustainable management in marine and coastal protected areas elsewhere, taking into account not only the biological but also the social-cultural prism. The main challenges in the management and conservation of coastal and marine ecosystems today are discussed.

The future obligations of "project manager" as construction integral director (DIPE) in the law of buildings construction in spain (LOE)

In the year 1999 approves the Law of Construction Building (LOE, in Spanish) to regulate a sector such as construction, which contained some shortcomings from the legal point of view. Currently, the LOE has been in force 12 years, changing the spanish world of the construction, due to influenced by internationalization. Within the LOE, there regulating the different actors involved in the construction building, as the Projects design, the Director of Construction, the developer, The builder, Director of execution of the construction (actor only in Spain, similar as construcion engineer and abroad in), control entities and the users, but lacks figure Project manager will assume the delegation of the promoter helping and you organize, direct and management the process. This figure assumes that the market and contracts are not legally regulated in Spain, then should define and establish its regulation in the LOE. (Spain Construction Law) The translation in spanish of the words "Project Manager is owed to Professor Rafael de Heredia in his book Integrated Project Management, as agent acting on behalf of the organization and promoter assuming control of the project, ie Integraded Project Management . Already exist in Spain, AEDIP (Spanish Association Integrated of Project Construction management) which comprises the major companies in “Project Management” in Spain, and MeDIP (Master in Integrated Construction Project) the largest and most advanced studies at the Polytechnic University of Madrid, in "Construction Project Management" they teach which is also in Argentina. The Integrated Project ("Project Management") applied to the construction process is a methodological technique that helps to organize, control and manage the resources of the promoters in the building process. When resources are limited (which is usually most situations) to manage them efficiently becomes very important. Well, we find that in this situation, the resources are not only limited, but it is limited, so a comprehensive control and monitoring of them becomes not only important if not crucial. The alternative of starting from scratch with a team that specializes in developing these follow directly intervening to ensure that scarce resources are used in the best possible way requires the use of a specific methodology (Manual DIP, Matrix Foreign EDR breakdown structure EDP Project, Risk Management and Control, Design Management, et ..), that is the methodology used by "Projects managers" to ensure that the initial objectives of the promoters or investors are met and all actors in process, from design to construction company have the mind aim of the project will do, trying to get their interests do not prevail over the interests of the project. Among the agents listed in the building process, "Project Management" or DIPE (Director Comprehensive building process, a proposed name for possible incorporation into the LOE, ) currently not listed as such in the LOE (Act on Construction Planning ), one of the agents that exist within the building process is not regulated from the legal point of view, no obligations, ie, as is required by law to have a project, a builder, a construction management, etc. DIPE only one who wants to hire you as have been advanced knowledge of their services by the clients they have been hiring these agents, there being no legal obligation as mentioned above, then the market is dictating its ruling on this new figure, as if it were necessary, he was not hired and eventually disappeared from the building process. As the aim of this article is regular the process and implement the name of DIPE in the Spanish Law of buildings construction (LOE)

Policy-Oriented Learning Among National Forest Stakeholders in the Pacific Northwest: Changes in Policy Beliefs Since Adoption of the Northwest Forest Plan

Thesis (Master's)--University of Washington, 2016-06

Allozyme electrophoresis still represents a powerful technique in the management of coral reefs

Understanding genetic variability and gene flow between populations of scleractinian corals separated by one to several hundred kilometers is crucially important as we head into a century of climate change in which an understanding of the connectivity of populations is a critically important question in management. Genetic methods that directly use molecular variance in the DNA should offer greater precision in detecting differences among individuals and populations than the more traditional allozyme electrophoresis. However, this paper highlights the point that the limited number of DNA markers that have been identified for scleractinian coral genetic studies do not necessarily offer greater precision than that offered by allozymes. In fact, at present allozyme electrophoresis yields greater information than the eight different DNA markers used in this study. Given the relative ease of use of allozymes and the wealth of comparable data sets from numerous previously published studies, allozyme electrophoresis should not be dismissed for population structure and connectivity studies on coral reefs. While continued effort should be placed into searching for new DNA markers, until a more sensitive DNA marker becomes available for scleractinian corals, allozyme electrophoresis remains a powerful and relevant technique for understanding the connectivity of coral population studies.

Sense of place: A tool to assist the meaningful engagement of communities in protected area management

This study used ‘sense of place’ as a research tool to help understand the relationship between a community and their local protected area, Brisbane Forest Park. To establish an indication of the community’s relative degree of sense of place, we considered and measured both the strength (intensity) and orientation (focus) of sense of place. We developed a new method to measure sense of place that considers and measures the elements constituting sense of place, independent of one another, utilising qualitative data collected in in-depth semi-structured interviews. Exploring both the strength and orientation of an individual's sense of place provides a way of exploring the desired nature of community involvement in the management of the Park. It was found that the stronger an individuals’ sense of place, the greater their place dependence and commitment, and the greater their desire to be involved in management. Analysing the strength and orientation of sense of place illustrated that there is a high degree of diversity in how individuals perceive and feel about area, and their desire to be involved in management. The type of information obtained in this study is important and useful to the management agencies if they are to successfully engage the community in meaningful ways.

Business education in operations management

This paper examines trends in the practice of Operations Management and in teaching the field in major Business Schools. Operations Management has been defined as the design and management of transformation processes that create value for society. The operations function is the one function directly involved in that transformation, and hence is directly responsible for the activities that justify the existence of the firm, both economically and as a value-creating organization in society. The top rated schools in Operations Management are the top-rated research-intensive Business Schools in the world. Operations Management is an area that has been undergoing rapid change in response to changes in business practices worldwide. It is at the heart of changes of which the AACSB report Management Education at Risk, August 2002 (p 20), comments of Business Schools in general: ‘With regard to global relevance (of Business Schools), the complex opportunities and challenges that emanate from the world scope of operations, outsourcing, supply chains, partnerships, and financial and consumer markets – all linked in real time through the Internet – are not reflected adequately in curricula and learning approaches.’ Products, and even services, depend increasingly on advanced technology. This is true globally and especially so for countries in South East and East Asia, from which Australian Universities draw a significant number of students. Services operations management has become much more important, while there are both educational and industrial needs in management science or operations research.

Management role in employee participation:a comparative study of multi-national enterprises in India and the U.K.

This research is an Anglo-Indian comparative case study. It studies managerial action in the participation arena of two British multi-nationals i.e. Cadbury Limited and ICI plc. The research was carried out in matched pairs of factories of the above named companies, located in the Midlands of the UK and in Bombay in India. The data for this research was collected through semi-structured interviews with managers and non-management actors, study of company documents and non-participant observation of some participation forums. The research conceptualises the idea of a `participation arena' consisting of the structures, processes, purposes and dynamics of participation. This arena is visualised as broadly reflecting the organisation structure and can be divided into corporate, unit and shopfloor level. Managerial action in this arena is examined in terms of interaction between three sets of factors i.e. company business objectives, strategies and policies; managerial values of power and control; and the responses of unions. Similarities and differences between management action in the home and host plants of the two multi-national companies are also examined. The major findings of the research are as follows. There is significant difference between the participation arena of the parent and the subsidiary company. The latter is marked by absence of higher level participation forums and lack of opportunity for employees to discuss, let alone influence, key decisions. This results from parent company control over key activities of the subsidiary. The similarities in management action in the participation arenas of the two companies in both countries can be attributed to the operation of the three sets of factors mentioned above. Nevertheless, the particular circumstances of each company are a greater influence on managerial action than the national context. Finally, future areas of research in this field are explored.

Performance management in the United States and France:four case studies in the retail and airline industries

The profusion of performance measurement models suggested by Management Accounting literature in the 1990’s is one illustration of the substantial changes in Management Accounting teaching materials since the publication of “Relevance Lost” in 1987. At the same time, in the general context of increasing competition and globalisation it is widely thought that national cultural differences are tending to disappear, meaning that management techniques used in large companies, including performance measurement and management instruments (PMS), tend to be the same, irrespective of the company nationality or location. North American management practice is traditionally described as a contractually based model, mainly focused on financial performance information and measures (FPMs), more shareholder-focused than French companies. Within France, literature historically defined performance as being broadly multidimensional, driven by the idea that there are no universal rules of management and that efficient management takes into account local culture and traditions. As opposed to their North American brethren, French companies are pressured more by the financial institutions that fund them rather than by capital markets. Therefore, they pay greater attention to the long-term because they are not subject to quarterly capital market objectives. Hence, management in France should rely more on long-term qualitative information, less financial, and more multidimensional data to assess performance than their North American counterparts. The objective of this research is to investigate whether large French and US companies’ practices have changed in the way the textbooks have changed with regards to performance measurement and management, or whether cultural differences are still driving differences in performance measurement and management between them. The research findings support the idea that large US and French companies share the same PMS features, influenced by ‘universal’ PM models.

Diabetes management in care homes:steps in the right direction?

Aims: Previous research has identified several inadequacies in management of diabetes within care homes many of which were highlighted in Diabetes UK’s report Diabetes in care homes:awareness, screening, training. The aim of this study was to see if this was still the case and to identify specific areas for improvement. Methods: Thirty care homes in Birmingham were invited to participate in the study. Data were collected using a standard questionnaire based on the Diabetes UK national survey of care homes comprising questions relating to screening, self-management, care planning and local authority support. All returned responses were analysed. Results: Responses were received from 20 of the 30 care homes approached. The mean percentage of residents with diabetes in the care homes sampled was 13.7%. None of the homes screened for diabetes on admission and only 5% screened residents annually.80% of homes acknowledged providing diabetes-specific training to staff. Residents in 95% of homes had a medical review in the last 12 months: 70% with a GP, 20% with a diabetes specialist nurse/nurse. 65% of homes provided support for self-management.45% of care homes did not have individualised care plans for residents with diabetes. 35% of managers reported poor support and guidance from their local authority.Conclusions: Improvements were noted in the care provided to individuals with diabetes living in care homes in Birmingham. Aspects relating to screening, individualised care plans and support to care home staff still need attention.

Change of composition and diversity of species and grassland management between different grazing intensity in Pannonian dry and wet grasslands

Investigations were carried out in wet and dry pasture. Coenological recordings were taken in three zones. The first zone (“A”) located 0-50 m near the stable, second zone (“B”) located 50-150 m from the stable, while the third zone (“C”) located farther than 150 m. We have carried out analyses of ecological and environmental factors and life form types. Based on our results for both dry and wet grasslands, quadrates of “A” zone were well isolated from the rest of the zones. Overgrazing, which involves considerable trampling, vanishes differences among vegetations, thereby promotes weed and disturbance tolerant rich vegetation. The lowest species number and diversity could be found here. Due to the nitrogen enrichment due to the constant presence of livestock, drier and less heat demanding habitat developed in the “A” zones, according to the environmental indicators. Because of the change in management, conservation and diversity values of “C” zone increased, however, according to nature protection values it underperformed compared to “B” zone. According to the sample area, wet grasslands from the sandy areas of Kiskunság, preserve nature protection values and grass composition better moving away from stables, due to less grazing pressure. Drier backgrounds tolerate stronger grazing pressure.

An Institutional, Socio-economic, and Legal Analysis of Fisheries Co-management and Regulation in the Gulf of Nicoya, Costa Rica

Marine Areas for Responsible Artisanal Fishing (AMPR) have emerged as a new model for co-managing small-scale fisheries in Costa Rica, one that involves collaboration between fishers, government agencies and NGOs. This thesis aims to examine the context for collective action and co-management by small-scale fishers; evaluate the design, implementation, and enforcement of AMPRs; and conduct a linguistic analysis of fisheries legislation. The present work relies on the analysis of several types of qualitative data, including interviews with 23 key informants, rapid rural assessments, and legal documents. Findings demonstrate the strong influence of economic factors for sustaining collective action, as well as the importance of certain types of external organizations for community development and co-management. Additionally, significant enforcement gaps and institutional deficiencies were identified in the work of regulating agencies. Legal analysis suggests that mechanisms for government accountability are unavailable and that legal discourse reflects some of the most salient problems in management.

The effects of conflict in driving forward innovation in shared leadership management consultant teams

It is argued in this study that current investigations of the role of conflict in shared leadership teams and, thus, teams in which all members have the opportunity to participate in its decision-making process are insufficient as they have focused on the downsides of these conflicts. This study demonstrates that task conflict is beneficial in that it can have positive effects on innovation in teams. It shows that particularly in shared leadership management consultant teams task conflict can stimulate innovation. Therefore, this research investigates the relationships among shared leadership, conflict and innovation. The research develops and empirically tests a conceptual model which demonstrates the relationships between these concepts and for which the inclusion of multiple research methods was essential. The sequential explanatory approach included a combination of quantitative and qualitative methods, the order of which can be adapted for other domains of application. The conceptual model was first tested with a sample of 329 management consultants. This was followed by 25, in-depth, face-to-face interviews conducted with individual survey respondents. In addition, weekly meetings of a management consultant team in action were video recorded over several months. This allowed for an in-depth explanation of the findings from the survey by providing an understanding of the underlying processes. The inclusion of observational methods provided a validating role and explained how and why conflicts contributed to the development of team innovation, through the analysis of subtleties and fleeting disagreements in a real-life management consultant team. The results deliver an assessment of the theoretical model and demonstrate that task conflict can allow for additional innovation in management consultant teams operating under a shared leadership structure. A practical model and guidelines for management consultant teams wanting to enhance their innovatory capacities are provided. In addition, a novel-user methodology which includes video observations is developed, with recommendations and steps aiding researchers aiming to employ a similar combination of methods. An original contribution to knowledge is made regarding the positive effects that task conflict can have towards innovation in shared leadership teams. Collaboration and trust are identified as important mediators between shared leadership and task conflict and significant regarding the development of innovation. The effectiveness of shared leadership in reducing negative relationship conflict and the benefits of both shared leadership and task conflict in enhancing innovation are demonstrated.