DHS Targeted Case Management 2002 Annual Report, February 2003

Report of 2002 annual activity by the Department of Human Services Targeted Case Management Unit. The DHS Targeted Case Management Unit is designed to help consumers with mental retardation, chronic mental illness or developmental disabilities gain access to appropriate living environments, needed medical services, and interrelated social, vocational and educational service.

Case Management Program for the Frail Elderly, June 2005

The Case Management Program for the Frail Elderly (CMPFE) is a coordinated comprehensive system that strives to provide Iowa’s frail elderly clients with the opportunity to make their own choices regarding long-term care and to receive services in the home and community setting.

Hierarchical management of carbon sources is regulated similarly by the CbrA/B systems in Pseudomonas aeruginosa and Pseudomonas putida.

The CbrA/B system in pseudomonads is involved in the utilization of carbon sources and carbon catabolite repression (CCR) through the activation of the small RNAs crcZ in Pseudomonas aeruginosa, and crcZ and crcY in Pseudomonas putida. Interestingly, previous works reported that the CbrA/B system activity in P. aeruginosa PAO1 and P. putida KT2442 responded differently to the presence of different carbon sources, thus raising the question of the exact nature of the signal(s) detected by CbrA. Here, we demonstrated that the CbrA/B/CrcZ(Y) signal transduction pathway is similarly activated in the two Pseudomonas species. We show that the CbrA sensor kinase is fully interchangeable between the two species and, moreover, responds similarly to the presence of different carbon sources. In addition, a metabolomics analysis supported the hypothesis that CCR responds to the internal energy status of the cell, as the internal carbon/nitrogen ratio seems to determine CCR and non-CCR conditions. The strong difference found in the 2-oxoglutarate/glutamine ratio between CCR and non-CCR conditions points to the close relationship between carbon and nitrogen availability, or the relationship between the CbrA/B and NtrB/C systems, suggesting that both regulatory systems sense the same sort or interrelated signal.

The politics of contaminated sites management : institutional regime change and actor's mode of participation in the environmental management of the Bonfol Chemical Waste Landfill in Switzerland

By the end of the 1970s, contaminated sites had emerged as one of the most complex and urgent environmental issues affecting industrialized countries. The authors show that small and prosperous Switzerland is no exception to the pervasive problem of sites contamination, the legacy of past practices in waste management having left some 38,000 contaminated sites throughout the country. This book outlines the problem, offering evidence that open and polycentric environmental decision-making that includes civil society actors is valuable. They propose an understanding of environmental management of contaminated sites as a political process in which institutions frame interactions between strategic actors pursuing sometimes conflicting interests. In the opening chapter, the authors describe the influences of politics and the power relationships between actors involved in decision-making in contaminated sites management, which they term a "wicked problem." Chapter Two offers a theoretical framework for understanding institutions and the environmental management of contaminated sites. The next five chapters present a detailed case study on environmental management and contaminated sites in Switzerland, focused on the Bonfol Chemical Landfill. The study and analysis covers the establishment of the landfill under the first generation of environmental regulations, its closure and early remediation efforts, and the gambling on the remediation objectives, methods and funding in the first decade of the 21st Century. The concluding chapter discusses the question of whether the strength of environmental regulations, and the type of interactions between public, private, and civil society actors can explain the environmental choices in contaminated sites management. Drawing lessons from research, the authors debate the value of institutional flexibility for dealing with environmental issues such as contaminated sites.

Supply chain management: An opportunity for metaheuristics

In today s highly competitive and global marketplace the pressure onorganizations to find new ways to create and deliver value to customersgrows ever stronger. In the last two decades, logistics and supply chainhas moved to the center stage. There has been a growing recognition thatit is through an effective management of the logistics function and thesupply chain that the goal of cost reduction and service enhancement canbe achieved. The key to success in Supply Chain Management (SCM) requireheavy emphasis on integration of activities, cooperation, coordination andinformation sharing throughout the entire supply chain, from suppliers tocustomers. To be able to respond to the challenge of integration there isthe need of sophisticated decision support systems based on powerfulmathematical models and solution techniques, together with the advancesin information and communication technologies. The industry and the academiahave become increasingly interested in SCM to be able to respond to theproblems and issues posed by the changes in the logistics and supply chain.We present a brief discussion on the important issues in SCM. We then arguethat metaheuristics can play an important role in solving complex supplychain related problems derived by the importance of designing and managingthe entire supply chain as a single entity. We will focus specially on theIterated Local Search, Tabu Search and Scatter Search as the ones, but notlimited to, with great potential to be used on solving the SCM relatedproblems. We will present briefly some successful applications.

Creative accounting: Some ethical issues of macro- and micro-manipulation

This paper examines two principal categories of manipulative behaviour. The term'macro-manipulation' is used to describe the lobbying of regulators to persuadethem to produce regulation that is more favourable to the interests of preparers.'Micro-manipulation' describes the management of accounting figures to produce abiased view at the entity level. Both categories of manipulation can be viewed asattempts at creativity by financial statement preparers. The paper analyses twocases of manipulation which are considered in an ethical context. The paperconcludes that the manipulations described in it can be regarded as morallyreprehensible. They are not fair to users, they involve an unjust exercise ofpower, and they tend to weaken the authority of accounting regulators.

Creative accounting: Nature, incidence and ethical issues

This paper explores the nature and incidence of creative accounting practiceswithin the context of ethical considerations.It explores several definitionsof creative accounting and the potential and the range of reasons for acompany's directors to engage in creative accounting. Later the paperconsiders the various ways in which creative accounting can be undertaken andsummarizes some empirical research on the nature and incidence of creativeaccounting. The ethical dimension of creative accounting is discussed, drawingevidence from several empirical studies. The paper concludes with the analysisof possible solutions for the creative accounting problem.

Centralised versus Decentralised Management of Patients's Medical Records

For more than 20 years, many countries have been trying to set up a standardised medical record at the regional or at the national level. Most of them have not reached this goal, essentially due to two main difficulties related to patient identification and medical records standardisation. Moreover, the issues raised by the centralisation of all gathered medical data have to be tackled particularly in terms of security and privacy. We discuss here the interest of a noncentralised management of medical records which would require a specific procedure that gives to the patient access to his/her distributed medical data, wherever he/she is located.

A reflection about the social and technological aspects in flood risk management - the case of the Italian Civil Protection

The right of a person to be protected from natural hazards is a characteristic of the social and economical development of the society. This paper is a contribution to the reflection about the role of Civil Protection organizations in a modern society. The paper is based in the inaugural conference made by the authors on the 9th Plinius Conference on Mediterranean Storms. Two major issues are considered. The first one is sociological; the Civil Protection organizations and the responsible administration of the land use planning should be perceived as reliable as possible, in order to get consensus on the restrictions they pose, temporary or definitely, on the individual free use of the territory as well as in the entire warning system. The second one is technological: in order to be reliable they have to issue timely alert and warning to the population at large, but such alarms should be as "true" as possible. With this aim, the paper summarizes the historical evolution of the risk assessment, starting from the original concept of "hazard", introducing the concepts of "scenario of event" and "scenario of risk" and ending with a discussion about the uncertainties and limits of the most advanced and efficient tools to predict, to forecast and to observe the ground effects affecting people and their properties. The discussion is centred in the case of heavy rains and flood events in the North-West of Mediterranean Region.

Case Management Program For Frail Elders Manual, August 2008

The purpose of this manual is to guide operation of the Case Management Program for Frail Elders. After Background, Program Administration, Definitions, Consumer Eligibility, and Program Standards, the order follows the flow of a consumer entering the pro-gram from referral through ongoing case activities. The manual is written assuming the reader is the Case Manager. The effective date will appear in the bottom left hand corner of each page. This manual will be updated as needed via Iowa Aging Program Instructions (IAPI). This manual is used in conjunction with the Department of Human Services’ manuals which provide more detail about policies and procedures within the Medicaid elderly waiver program.

Why Objective Monitoring of Compliance is Important in the Management of Hypertension.

Hypertensive patients often experience poor adherence to treatment, a frequent cause of uncontrolled blood pressure. In this study, we have evaluated whether or not the use of electronic monitoring for drug adherence is a useful approach to identify and correct compliance problems in hypertensive patients, which may ultimately enhance the effect of antihypertensive therapy. Sixty-nine treated patients with an office blood pressure greater than 140/90 mm Hg were enrolled in this study. With patient consent, current antihypertensive therapy was dispensed in electronic pillboxes that record the time and date of each opening without changing the drug regimen. The intention was to provide physicians with objective measurements of drug compliance. The monitoring of compliance per se without any other intervention induced a marked decrease of blood pressure in the whole group (from 159/104Â+/-23/12 mm Hg to 143/92Â+/-20/15, meansÂ+/-standard deviation, p less than 0.001). A complete normalization of blood pressure (less than 140/90 mm Hg) was obtained in one third of the patients (group 1, n=23) during the monitoring period. A significant improvement of blood pressure control was found in another third (group 2, n=23), whereas in the remaining patients (group 3, n=23) no change in blood pressure was observed. The distribution of individual compliance values, as well as the mean compliances was comparable in the three subgroups. Conversely, the compliance reports have identified several potentially overtreated patients in group 1, a large number of patients with a poor adherence to the prescribed therapy in all groups, and patients who clearly needed a change in pharmacotherapy mainly in group 3. Thus, our results suggest that electronic monitoring of compliance can considerably enhance the efficacy of antihypertensive therapy in patients with uncontrolled hypertension. This procedure should be used more extensively in clinical practice whenever the blood pressure response to therapy appears insufficient. (c)2000 by Le Jacq Communications, Inc.

Ownership structure and innovation: Is there a real link?

This work focuses on the study of the relationship between ownership and control structure of the company and its innovative activity. Its aim consists of analysing the role that may be played by determinants within the company related to ownership structure when the decision to incur research and development activities is taken as well as on the output of this innovate process. Among these determinants we may think of issues such as who owns the firm and how the control of decision-making is distributed, the nature of this control and the level of concentration of ownership, among others. The study is carried out for the year 2001 using a representative sample of Spanish manufacturing industries.

Ownership structure and innovation: Is there a real link?

This work focuses on the study of the relationship between ownership and control structure of the company and its innovative activity. Its aim consists of analysing the role that may be played by determinants within the company related to ownership structure when the decision to incur research and development activities is taken as well as on the output of this innovate process. Among these determinants we may think of issues such as who owns the firm and how the control of decision-making is distributed, the nature of this control and the level of concentration of ownership, among others. The study is carried out for the year 2001 using a representative sample of Spanish manufacturing industries.