A randomised controlled clinical trial of a post-discharge, nurse-led educational intervention to reduce anxiety and enhance self-efficacy in percutaneous coronary intervention (PCI) patients within the first week post-discharge: A pilot study

This research investigated the efficacy of a post-discharge nurse-led clinic, for patients who underwent a cardiovascular interventional procedure in Australia. A randomised controlled clinical trial measured the effects of the clinic on patient confidence to self-manage and minimise psychological distress given the strong link between anxiety, depression and coronary heart disease. Hospitalisation for the procedure is short and stressful, and patients may wait up to 7-64 days for post-discharge review. This study provides preliminary quantitative and qualitative evidence that nurse-led clinics undertaken within the first week post-percutaneous coronary intervention may fill a much-needed gap for patients during a potentially vulnerable period.

Conceptual model of salt marsh management on Merritt Island National Wildlife Refuge, Florida: final report

Diking and holding water on salt marshes ("impounding" the marsh) is a management technique used on Merritt Island National Wildlife Refuge (MINWR) and elsewhere in the Southeast to: a) prevent the reproduction of saltmarsh mosquitos, and b) attract wintertering waterfowl and other marsh, shore, and wading birds. Because of concern that diking and holding water may interfere with the production of estuarine fish and shellfish, impoundment managers are being asked to consider altering management protocol to reduce or eliminate any such negative influence. How to change protocol and preserve effective mosquito control and wildlife management is a decision of great complexity because: a) the relationships between estuarine organisms and the fringing salt marshes at the land-water interface are complex, and b) impounded marshes are currently good habitat for a variety of species of fish and wildlife. Most data collection by scientists and managers in the area has not been focused on this particular problem. Furthermore, collection of needed data may not be possible before changes in protocol are demanded. Therefore, the purpose of this document is two-fold: 1) to suggest management alternatives, given existing information, and 2) to help identify research needs that have a high probability of leading to improved simultaneous management of mosquitos, waterfowl, other wildlife, freshwater fish, and estuarine fish and shellfish on the marshland of the Merritt Island National Wildlife Refuge. (92 page document)

Community fisheries management of freshwater lakes in Bangladesh

The Oxbow Lakes Small Scale Fishermen Project in western Bangladesh is primarily a Social Fisheries Project. The project aims at self-management of the Oxbow lakes fishing and fish farming by members of the local communities and the sharing of the benefits in an equitable manner. Project emphasis is on social and institutional aspects of the community water resource management and on improving the fish yields through better fisheries practices.

Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Flexible self-adjustment of task deployment in dynamic environments

This paper presents an investigation into dynamic self-adjustment of task deployment and other aspects of self-management, through the embedding of multiple policies. Non-dedicated loosely-coupled computing environments, such as clusters and grids are increasingly popular platforms for parallel processing. These abundant systems are highly dynamic environments in which many sources of variability affect the run-time efficiency of tasks. The dynamism is exacerbated by the incorporation of mobile devices and wireless communication. This paper proposes an adaptive strategy for the flexible run-time deployment of tasks; to continuously maintain efficiency despite the environmental variability. The strategy centres on policy-based scheduling which is informed by contextual and environmental inputs such as variance in the round-trip communication time between a client and its workers and the effective processing performance of each worker. A self-management framework has been implemented for evaluation purposes. The framework integrates several policy-controlled, adaptive services with the application code, enabling the run-time behaviour to be adapted to contextual and environmental conditions. Using this framework, an exemplar self-managing parallel application is implemented and used to investigate the extent of the benefits of the strategy

Policy-based techniques for self-managing parallel applications

This paper presents an empirical investigation of policy-based self-management techniques for parallel applications executing in loosely-coupled environments. The dynamic and heterogeneous nature of these environments is discussed and the special considerations for parallel applications are identified. An adaptive strategy for the run-time deployment of tasks of parallel applications is presented. The strategy is based on embedding numerous policies which are informed by contextual and environmental inputs. The policies govern various aspects of behaviour, enhancing flexibility so that the goals of efficiency and performance are achieved despite high levels of environmental variability. A prototype self-managing parallel application is used as a vehicle to explore the feasibility and benefits of the strategy. In particular, several aspects of stability are investigated. The implementation and behaviour of three policies are discussed and sample results examined.

Towards policy-based self-configuration of embedded systems

This paper describes work towards the deployment of flexible self-management into real-time embedded systems. A challenging project which focuses specifically on the development of a dynamic, adaptive automotive middleware is described, and the specific self-management requirements of this project are discussed. These requirements have been identified through the refinement of a wide-ranging set of use cases requiring context-sensitive behaviours. A sample of these use-cases is presented to illustrate the extent of the demands for self-management. The strategy that has been adopted to achieve self-management, based on the use of policies is presented. The embedded and real-time nature of the target system brings the constraints that dynamic adaptation capabilities must not require changes to the run-time code (except during hot update of complete binary modules), adaptation decisions must have low latency, and because the target platforms are resource-constrained the self-management mechanism have low resource requirements (especially in terms of processing and memory). Policy-based computing is thus and ideal candidate for achieving the self-management because the policy itself is loaded at run-time and can be replaced or changed in the future in the same way that a data file is loaded. Policies represent a relatively low complexity and low risk means of achieving self-management, with low run-time costs. Policies can be stored internally in ROM (such as default policies) as well as externally to the system. The architecture of a designed-for-purpose powerful yet lightweight policy library is described. A suitable evaluation platform, supporting the whole life-cycle of feasibility analysis, concept evaluation, development, rigorous testing and behavioural validation has been devised and is described.

Flexible and robust run-time configuration for self-managing systems

This paper describes a methodology for deploying flexible dynamic configuration into embedded systems whilst preserving the reliability advantages of static systems. The methodology is based on the concept of decision points (DP) which are strategically placed to achieve fine-grained distribution of self-management logic to meet application-specific requirements. DP logic can be changed easily, and independently of the host component, enabling self-management behavior to be deferred beyond the point of system deployment. A transparent Dynamic Wrapper mechanism (DW) automatically detects and handles problems arising from the evaluation of self-management logic within each DP and ensures that the dynamic aspects of the system collapse down to statically defined default behavior to ensure safety and correctness despite failures. Dynamic context management contributes to flexibility, and removes the need for design-time binding of context providers and consumers, thus facilitating run-time composition and incremental component upgrade.

A run-time configurable software architecture for self-managing systems

This paper describes a highly flexible component architecture, primarily designed for automotive control systems, that supports distributed dynamically- configurable context-aware behaviour. The architecture enforces a separation of design-time and run-time concerns, enabling almost all decisions concerning runtime composition and adaptation to be deferred beyond deployment. Dynamic context management contributes to flexibility. The architecture is extensible, and can embed potentially many different self-management decision technologies simultaneously. The mechanism that implements the run-time configuration has been designed to be very robust, automatically and silently handling problems arising from the evaluation of self- management logic and ensuring that in the worst case the dynamic aspects of the system collapse down to static behavior in totally predictable ways.

Clinical pharmacy-led disease and medicine management programme for patients with COPD

center dot The concept of self-management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management.

The influence of health education on family management of childhood asthma

The purpose of this study was to examine differences in asthma management among families with a child who has moderate to severe asthma. Half of the 50 families chosen for study had participated in an intensive in-patient asthma treatment program and half had participated in an out-patient day camp. Two broad categories of outcome were examined - illness and self-management skills. Families who participated in the in-patient program exhibited a pattern of illness behaviours which indicated asthma symptoms were better managed in comparison to those families that participated in the out-patient program. It was also observed that children who participated in the in-patient program had a tendency to feel more positive about having asthma with the more self-management behaviours they practised. On the other hand, children from the out-patient program reported a more negative attitude about having asthma with the more self-management behaviours they practised.

Self-healing systems and virtual structures

Modern networks are large, highly complex and dynamic. Add to that the mobility of the agents comprising many of these networks. It is difficult or even impossible for such systems to be managed centrally in an efficient manner. It is imperative for such systems to attain a degree of self-management. Self-healing i.e. the capability of a system in a good state to recover to another good state in face of an attack, is desirable for such systems. In this paper, we discuss the self-healing model for dynamic reconfigurable systems. In this model, an omniscient adversary inserts or deletes nodes from a network and the algorithm responds by adding a limited number of edges in order to maintain invariants of the network. We look at some of the results in this model and argue for their applicability and further extensions of the results and the model. We also look at some of the techniques we have used in our earlier work, in particular, we look at the idea of maintaining virtual graphs mapped over the existing network and assert that this may be a useful technique to use in many problem domains.

Adhésion thérapeutique aux traitements oncologiques oraux et prise en charge interdisciplinaire [Therapeutic adherence to oral cancer therapy and interdisciplinary management].

Medication adherence is a well-known risk factor in internal medicine. However in oncology this dimension is emerging due to the increasing number of oral formulations. First results in the oral oncology literature suggest that patients' ability to cope with medical prescription decreases with time. This might preclude patients from reaching clinical outcomes. Factors impacting on medication adherence to oral oncology treatments have not been yet extensively described neither strategies to address them and support patient's needs. Oncologists and pharmacists in our University outpatient settings performed a pilot study which aimed at measuring and facilitating adherence to oral oncology treatments and at understanding determinants of patient's adherence. The ultimate purpose of such a patient-centered and interdisciplinary collaboration would be to promote patient self-management and complement the standard medical follow-up.

Autonomes Performance-Management in dienstorientierten Architekturen

Die Bedeutung des Dienstgüte-Managements (SLM) im Bereich von Unternehmensanwendungen steigt mit der zunehmenden Kritikalität von IT-gestützten Prozessen für den Erfolg einzelner Unternehmen. Traditionell werden zur Implementierung eines wirksamen SLMs Monitoringprozesse in hierarchischen Managementumgebungen etabliert, die einen Administrator bei der notwendigen Rekonfiguration von Systemen unterstützen. Auf aktuelle, hochdynamische Softwarearchitekturen sind diese hierarchischen Ansätze jedoch nur sehr eingeschränkt anwendbar. Ein Beispiel dafür sind dienstorientierte Architekturen (SOA), bei denen die Geschäftsfunktionalität durch das Zusammenspiel einzelner, voneinander unabhängiger Dienste auf Basis deskriptiver Workflow-Beschreibungen modelliert wird. Dadurch ergibt sich eine hohe Laufzeitdynamik der gesamten Architektur. Für das SLM ist insbesondere die dezentrale Struktur einer SOA mit unterschiedlichen administrativen Zuständigkeiten für einzelne Teilsysteme problematisch, da regelnde Eingriffe zum einen durch die Kapselung der Implementierung einzelner Dienste und zum anderen durch das Fehlen einer zentralen Kontrollinstanz nur sehr eingeschränkt möglich sind. Die vorliegende Arbeit definiert die Architektur eines SLM-Systems für SOA-Umgebungen, in dem autonome Management-Komponenten kooperieren, um übergeordnete Dienstgüteziele zu erfüllen: Mithilfe von Selbst-Management-Technologien wird zunächst eine Automatisierung des Dienstgüte-Managements auf Ebene einzelner Dienste erreicht. Die autonomen Management-Komponenten dieser Dienste können dann mithilfe von Selbstorganisationsmechanismen übergreifende Ziele zur Optimierung von Dienstgüteverhalten und Ressourcennutzung verfolgen. Für das SLM auf Ebene von SOA Workflows müssen temporär dienstübergreifende Kooperationen zur Erfüllung von Dienstgüteanforderungen etabliert werden, die sich damit auch über mehrere administrative Domänen erstrecken können. Eine solche zeitlich begrenzte Kooperation autonomer Teilsysteme kann sinnvoll nur dezentral erfolgen, da die jeweiligen Kooperationspartner im Vorfeld nicht bekannt sind und – je nach Lebensdauer einzelner Workflows – zur Laufzeit beteiligte Komponenten ausgetauscht werden können. In der Arbeit wird ein Verfahren zur Koordination autonomer Management-Komponenten mit dem Ziel der Optimierung von Antwortzeiten auf Workflow-Ebene entwickelt: Management-Komponenten können durch Übertragung von Antwortzeitanteilen untereinander ihre individuellen Ziele straffen oder lockern, ohne dass das Gesamtantwortzeitziel dadurch verändert wird. Die Übertragung von Antwortzeitanteilen wird mithilfe eines Auktionsverfahrens realisiert. Technische Grundlage der Kooperation bildet ein Gruppenkommunikationsmechanismus. Weiterhin werden in Bezug auf die Nutzung geteilter, virtualisierter Ressourcen konkurrierende Dienste entsprechend geschäftlicher Ziele priorisiert. Im Rahmen der praktischen Umsetzung wird die Realisierung zentraler Architekturelemente und der entwickelten Verfahren zur Selbstorganisation beispielhaft für das SLM konkreter Komponenten vorgestellt. Zur Untersuchung der Management-Kooperation in größeren Szenarien wird ein hybrider Simulationsansatz verwendet. Im Rahmen der Evaluation werden Untersuchungen zur Skalierbarkeit des Ansatzes durchgeführt. Schwerpunkt ist hierbei die Betrachtung eines Systems aus kooperierenden Management-Komponenten, insbesondere im Hinblick auf den Kommunikationsaufwand. Die Evaluation zeigt, dass ein dienstübergreifendes, autonomes Performance-Management in SOA-Umgebungen möglich ist. Die Ergebnisse legen nahe, dass der entwickelte Ansatz auch in großen Umgebungen erfolgreich angewendet werden kann.

Higher Education Quality and Guidance : efficacy of a career celf-management seminar for undergraduates

Monogr??fico con el t??tulo: "Calidad en la Educaci??n Superior: una visi??n en perspectiva"