Physician perceptions of risk regarding mood disorders and pharmacological management during pregnancy: What is current practice?

Mood disorders are the most common form of mental illness and one of the leading causes of morbidity worldwide. Major depressive disorder and bipolar disorder have a lifetime prevalence of 16.2% and 4.4%, respectively. Women comprise a substantial proportion of this population, and an estimated 500,000 pregnancies each year involve women with a psychiatric condition. Management with psychotropic medications is considered standard of care for most patients with mood disorders. However, many of these medications are known human teratogens. Because pregnant women with mood disorders face a high risk of relapse if unmanaged, the obstetrician faces a unique challenge in providing the best care to both mother and baby. It has been suggested that many obstetricians overestimate the teratogenic risks associated with psychotropic medications, while concurrently underestimating the risks associated with unmanaged mood disorders. This may be due a knowledge gap regarding the most current teratogen information, and lack of official management guidelines. Therefore, the purpose of this study is to determine the current knowledge base of obstetricians regarding the teratogenic effects of common psychotropic medications, as wells as to capture current management practices for pregnant women with mood disorders. A total of 117 Texas obstetricians responded to a survey regarding teratogen knowledge and management practice. It was common for respondents to encounter women who disclose both having a mood disorder and taking a psychotropic medication during pregnancy. Many respondents did not utilize up-to-date drug counseling resources, and were unaware of or over-estimated the teratogenic risks of common medications used to treat mood disorders. Finally, many respondents reported wanting to refer pregnant patients with mood disorders to psychiatrists for co-management, but are reportedly restricted in doing so due to accessibility or insurance issues. This study demonstrates that there is a knowledge gap among obstetricians regarding the teratogenicity of common psychotropic medications utilized to manage a patient population they frequently encounter. Further, obstetricians have vastly different risk perceptions of these medications, resulting in various management approaches and recommendations. Future research should focus on establishing standard practice guidelines, as well as better accessibility to psychiatric services for pregnant women.

How much management is enough? Stakeholder views on forest management in fire-prone areas in central Portugal

With the increasing pressure to improve the contribution of forests to help dealing with global changes, it is critical to understand the different perceptions of those involved in the forest. How do forest owners, managers and members of local communities who often depend on the forest, value it and what are the problems affecting the forests in terms of being able to meet these new challenges? In Portugal, this task has taken on an even greater priority as more than 90% of the forest is private and forest management relies on the individual decisions of thousands of forest owners. To understand stakeholder views on forest and forest management, a transversal social perception survey was implemented in the form of a case study of central Portugal which included decision-makers, local technicians, forest owners and the general public. The results show that there is a consensus on the main issues affecting forests and forest management. A shift from classic forest owners to the emergence of indifferent forest owners was observed, although this shift has not been recognized by the forest owners in the survey, who maintain the individual management of their properties.

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Is Europe ready to provide a pan-European Identity Management System?

European public administrations must manage citizens' digital identities, particularly considering interoperability among different countries. Owing to the diversity of electronic identity management (eIDM) systems, when users of one such system seek to communicate with governments using a different system, both systems must be linked and understand each other. To achieve this, the European Union is working on an interoperability framework. This article provides an overview of eIDM systems' current state at a pan-European level. It identifies and analyzes issues on which agreement exists, as well as those that aren't yet resolved and are preventing the adoption of a large-scale model.

Major issues in business process management: An Australian perspective

Business Process Management (BPM) is widely seen as the top priority in organizations wanting to survive competitive markets. However, the current academic research agenda does not seem to map with industry demands. In this paper, we address the need to identify the actual issues that organizations face in their efforts to manage business processes. To that end, we report a number of critical issues identified by industry in what we consider to be the first steps towards an industry-driven research agenda for the BPM area. The reported issues are derived from a series of focus groups conducted with Australian organizations. The findings point to, among others, a need for more consolidated efforts in the areas of business process governance, systematic change management, developing BPM methodologies, and introducing appropriate performance measures.

On aggregation issues in spatial data management

Large amounts of information can be overwhelming and costly to process, especially when transmitting data over a network. A typical modern Geographical Information System (GIS) brings all types of data together based on the geographic component of the data and provides simple point-and-click query capabilities as well as complex analysis tools. Querying a Geographical Information System, however, can be prohibitively expensive due to the large amounts of data which may need to be processed. Since the use of GIS technology has grown dramatically in the past few years, there is now a need more than ever, to provide users with the fastest and least expensive query capabilities, especially since an approximated 80 % of data stored in corporate databases has a geographical component. However, not every application requires the same, high quality data for its processing. In this paper we address the issues of reducing the cost and response time of GIS queries by preaggregating data by compromising the data accuracy and precision. We present computational issues in generation of multi-level resolutions of spatial data and show that the problem of finding the best approximation for the given region and a real value function on this region, under a predictable error, in general is "NP-complete.

Challenges for expatriate managers:an exploration of cross-cultural management, adjustment, and training issues faced by Anglo-American managers in Hong Kong

This field work study furthers understanding about expatriate management, in particular, the nature of cross-cultural management in Hong Kong involving Anglo-American expatriate and Chinese host national managers, the important features of adjustment for expatriates living and working there, and the type of training which will assist them to adjust and to work successfully in this Asian environment. Qualitative and quantitative data on each issue was gathered during in-depth interviews in Hong Kong, using structured interview schedules, with 39 expatriate and 31 host national managers drawn from a cross-section of functional areas and organizations. Despite the adoption of Western technology and the influence of Western business practices, micro-level management in Hong Kong retains a cultural specificity which is consistent with the norms and values of Chinese culture. There are differences in how expatriates and host nationals define their social roles, and Hong Kong's recent colonial history appears to influence cross-cultural interpersonal interactions. The inability of the spouse and/or family to adapt to Hong Kong is identified as a major reason for expatriate assignments to fail, though the causes have less to do with living away from family and friends, than with Hong Kong's highly urbanized environment and the heavy demands of work. Culture shock is not identified as a major problem, but in Hong Kong micro-level social factors require greater adjustment than macro-level societal factors. The adjustment of expatriate managers is facilitated by a strong orientation towards career development and hard work, possession of technical/professional expertise, and a willingness to engage in a process of continuous 'active learning' with respect to the host national society and culture. A four-part model of manager training suitable for Hong Kong is derived from the study data. It consists of a pre-departure briefing, post-arrival cross-cultural training, language training in basic Cantonese and in how to communicate more effectively in English with non-native speakers, and the assignment of a mentor to newly arrived expatriate managers.

"Ignorance was bliss, now I'm ignorant and that is far more difficult":transdisciplinary learning and reflexivity in responsible management education

Purpose – The collapse of world economic systems brought the interconnectedness between business and global events sharply into focus. As Starkey points out: “leading business schools need to overcome their fascination with a particular form of finance and economics […] to broaden their intellectual horizons […] (and to) look at the lessons of history and other disciplines”. The purpose of this paper is to provide evidence from three years of research on the Aston MBA suggesting that an emphasis on developing capabilities within a far broader, connected and reflexive business curriculum is what business students and practitioners now recognise as an essential way forward for responsible management education. Design/methodology/approach – This research paper examines the reflective accounts of 300 MBA students undertaking a transdisciplinary Business Ethics, Responsibility and Sustainability core module. Findings – As Klein argues, transdisciplinarity is simultaneously an attitude and a form of action. The student reflections provide powerful discourses of individual learning and report a range of outcomes from finding “the vocabulary or the confidence” to raise issues to acting as “change agents” in the workplace. Originality/value – As responsibility and sustainability requires learners, researchers and educators to engage with real world complexity, uncertainty and risk, conventional disciplinary study, especially within business, often proves inadequate and partial. This paper demonstrates that creative and exploratory frames need to be developed to facilitate the development of more connected knowledge – informed by multiple stakeholders, able to contribute heterogeneous skills, perspectives and expertise.

Current issues in international HRM:alternative forms of assignments, careers and talent management in a global context

This special issue is dedicated to examining some current issues in international HRM; it contributes mainly to the field of HRM in the multinational enterprise. However, it clearly also draws on knowledge from cross-cultural IHRM. The guest editors have identified three topics that have gained tremendous importance due to the increasing globalisation of the world economy and the war for internationally qualified talent. This not only applies to multinational enterprises, but also to small and medium-sized enterprises, as senior managers are challenged to attract, retain, and motivate global talent: global assignments, global careers and global talent management. While all fields are not new and have partly been subject to prominent publications (e.g., Scullion & Collings, 2011; Cascio, 2013) new and highly relevant research questions continue to emerge and there is still a lack of empirical research in these areas.

Fenntartható fejlődés = Sustainability issues in purchasing and supply management

A fenntarthatóság kérdését a vállalati működésben számos kutatás elemzi. A vizsgálatokat azonban érdemes kiterjeszteni a vállalatokat beszállítóikkal összekötő kapcsolatrendszerre és az annak menedzseléséért felelős beszerzésre is, hiszen a nagy vállalatok beszerzési döntései jelentős értékükön keresztül fontos motiváló erőt jelentenek a beszállító vállalatok egy sokkal szélesebb hálózata számára. Tanulmányunk célja áttekinteni a fenntarthatóság három pillérjének beszerzési értelmezésének lehetőségeit, ehhez kapcsolódva bemutatni azokat a motivációs tényezőket, amelyek biztosíthatják azt, hogy a beszerzés a gyakorlatban is kezelni tudja a fenntarthatóság szempontjait. A bemutatott eredmények az irodalom feltérképezésén alapszanak, és egy olyan kutatás részét képezik, melynek során vállalati beszerzési szakembereket kérdezünk a fenntartható beszerzéssel kapcsolatos vállalati gyakorlatról és tapasztalataikról. A kutatás a Budapesti Corvinus Egyetemen folyó „Versenyben a világgal” kutatási program keretében készült. = Sustainability issues in literature are getting more and more attention. In this study the focus is extended to purchasing and supplier relationships as companies influence their supply base by the priorities of their sourcing decision. This paper addresses sustainability in purchasing in a comprehensive way including green, social responsibility and corporate growth issues. The results of a research project which aims to reveal and structure the meaning of sustainable purchasing and the motivating forces leading companies to make efforts in purchasing for sustainability and means applied to attain achievements at some fields of sustainability. After presenting the results of literature review, some theory development was done to create a framework in which it is possible to describe the sustainability means applied and the motivating force behind. This framework serves as a basis of an empirical investigation among Hungarian companies. The empirical results validated the theoretical framework: the number and the characteristics of sustainability activities were determined by the type of motivation (to avoid negative effects, compliance to expectations, to attain positive effects). Our research project was part of the research project “In Global Competition”.

Customer relationship management: A content analysis of issues and best practices

This dissertation is a study of customer relationship management theory and practice. Customer Relationship Management (CRM) is a business strategy whereby companies build strong relationships with existing and prospective customers with the goal of increasing organizational profitability. It is also a learning process involving managing change in processes, people, and technology. CRM implementation and its ramifications are also not completely understood as evidenced by the high number of failures in CRM implementation in organizations and the resulting disappointments. ^ The goal of this dissertation is to study emerging issues and trends in CRM, including the effect of computer software and the accompanying new management processes on organizations, and the dynamics of the alignment of marketing, sales and services, and all other functions responsible for delivering customers a satisfying experience. ^ In order to understand CRM better a content analysis of more than a hundred articles and documents from academic and industry sources was undertaken using a new methodological twist to the traditional method. An Internet domain name (http://crm.fiu.edu) was created for the purpose of this research by uploading an initial one hundred plus abstracts of articles and documents onto it to form a knowledge database. Once the database was formed a search engine was developed to enable the search of abstracts using relevant CRM keywords to reveal emergent dominant CRM topics. The ultimate aim of this website is to serve as an information hub for CRM research, as well as a search engine where interested parties can enter CRM-relevant keywords or phrases to access abstracts, as well as submit abstracts to enrich the knowledge hub. ^ Research questions were investigated and answered by content analyzing the interpretation and discussion of dominant CRM topics and then amalgamating the findings. This was supported by comparisons within and across individual, paired, and sets-of-three occurrences of CRM keywords in the article abstracts. ^ Results show that there is a lack of holistic thinking and discussion of CRM in both academics and industry which is required to understand how the people, process, and technology in CRM impact each other to affect successful implementation. Industry has to get their heads around CRM and holistically understand how these important dimensions affect each other. Only then will organizational learning occur, and overtime result in superior processes leading to strong profitable customer relationships and a hard to imitate competitive advantage. ^

Acculturation and Diabetes Self-management of Cuban Americans: Is Age a Protective Factor?

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.

Taxonomy of Institutional Issues that Act as Barriers to the Implementation of Pavement Management Systems, 1994

The benefits of pavement management system when fully implemented are well known and the history of successful implementation is rich. Implementation occurs, for purposes of this paper, when the pavement management system is the critical component for making pavement decisions. This paper addresses the issues that act as barriers to full implementation of pavement management systems. Institutional barriers, not technical and financial barriers, are more commonly responsible for a pavement management systems falling short of full implementation. The paper groups these institutional issues into a general taxonomy. In general, more effort needs to be put forth by highway agencies to overcome institutional issues. Most agencies approach pavement management as a technical process, but more commonly, institutional issues become more problematic and thus require more attention paid to institutional issues. The paper concludes by summarizing the implementation process being taken by the Iowa Department of Transportation. The process was designed to overcome institutional barriers and facilitate the complete and full implementation of their pavement management system.

Key Issues In Inhibitor Management In Patients With Haemophilia.

12 Suppl 1