888 resultados para Autonomic managers


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The purposes of this document are to:
• outline some processes in relation to the administration and/or handling of earth resources activities (particularly exploration and mining for minerals) on Crown land;
• provide Crown land managers with guidelines and procedures to assist in administration of exploration and mining cases;
• provide a broad framework within which regional or localised guidelines and procedures can be developed or utilised;
• provide guidance to proponents wishing to undertake exploration or mining for minerals on Crown land.

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Objectives:
To determine the effectiveness of 
collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers.

Design:
A two-arm open randomised cluster trial with wait-list control for 6 months. The intervention was followed over 12 months.
Setting:
Eleven Australian general practices, five randomly allocated to the intervention and six to the control.
Participants:
400 primary care patients (206 intervention, 194 control) with depression and type 2 diabetes, coronary heart disease or both.
Intervention:
The practice nurse acted as a case manager identifying depression, reviewing pathology results, lifestyle risk factors and patient goals and priorities. Usual care continued in the controls.
Main outcome measure:
A five-point reduction in depression scores for patients with moderate-to-severe depression. Secondary outcome was improvements in physiological measures.
Results:
Mean depression scores after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7±1.3 compared with 4.3±1.2 in control, a significant (p=0.012) difference. (The plus–minus is the 95% confidence range) Intervention practices demonstrated adherence to treatment guidelines and intensification of treatment for depression, where exercise increased by 19%, referrals to exercise programmes by 16%, referrals to mental health workers (MHWs) by 7% and visits to MHWs by 17%. Control-practice exercise did not change, whereas referrals to exercise programmes dropped by 5% and visits to MHWs by 3%. Only referrals to MHW increased by 12%. Intervention improvements were sustained over 12 months, with a significant (p=0.015) decrease in 10-year cardiovascular disease risk from 27.4±3.4% to 24.8±3.8%. A review of patients indicated that the study’s safety protocols were followed.
Conclusions:
TrueBlue participants showed significantly improved depression and treatment intensification, sustained over 12 months of intervention and reduced 10-year cardiovascular disease risk. Collaborative care using practice nurses appears to be an effective primary care intervention.

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Background:
Depression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship; however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia.

Methods:
Individuals (n = 53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score ≥20 and a Zung Self-Rating Depression Scale score > 53 were compared to 53 healthy individuals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals > 50 ms different from preceding interval (pNN50). Pearson’s correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)).

Results:
The values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group (P<.05). The mean value of the LF in the depression group was higher than the in control group (P<.05). Furthermore the ratio of LF/HF was higher among the depression group than the control group (P<.05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group (P<.05), particularly supraventricular arrhythmias.

Conclusions:
Our findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. Individuals with depression appear to be susceptible to premature atrial and/or ventricular disease.

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This article integrates typically separate SME research on e-commerce, business networking, and knowledge management into a model explaining factors influencing the willingness of SME owner-managers to share knowledge online in business networks in rural districts. This is important because e-commerce can assist owner-managers, often dispersed in rural districts, to share knowledge between face-to-face networking events. The main factors associated with willingness to share knowledge online were their willingness to share knowledge face-to-face and their intensity of Internet use. Entrepreneurial factors such as owner-managers' expectations of rapid growth, trading outside the district, and seeking information about customers/competitors were indirectly associated with online sharing via intensity of Internet use only. The model suggests network coordinators could encourage online knowledge sharing by assisting owner-managers to see the business value of e-commerce and by ensuring that networking events are suitable for owner-managers, whether or not they have entrepreneurial goals, to facilitate face-to-face knowledge sharing.

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Construction project managers normally need develop their professional knowledge and practical skills in construction technologies and management on the basis of long term work experience. Their organizational commitment and job satisfaction level significantly influence their performance attitudes and job achievements. Keeping construction project managers highly committed to and satisfied with the employed companies is extremely vital to employed construction companies but is really difficulty due to the non-attractive job circumstances. This research investigates the major demographic variables that affect the organizational commitment and job satisfaction of project managers in the construction industry. Based on an empirical study, the statistical results indicate that some demographical variables play a substantial role in construction project managers' organizational commitment and job satisfaction. With this knowledge, construction organizations can draw up operational strategies to retain their project managers.

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Self-assessment of support needs is a relatively new and under-researched phenomenon in domiciliary aged care. This article outlines the results of a comparative study focusing on whether a self-assessment approach assists clients to identify support needs and the degree to which self-assessed needs differ from an assessment conducted by community care professionals. A total of 48 older people and their case managers completed a needs assessment tool. Twenty-two semi-structured interviews were used to ascertain older people’s views and preferences regarding the self-assessment process. The study suggests that while a co-assessment approach as outlined in this article has the potential to assist older people to gain a better understanding of their care needs as well as the assessment process and its ramifications, client self-assessment should be seen as part of a co-assessment process involving care professionals. Such a co-assessment process allows older people to gain a better understanding of their support needs and the wider community aged care context. The article suggests that a co-assessment process involving both clients and care professionals contains features that have the capacity to enhance domiciliary aged care.

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This thesis examined the social ecological correlates of desk-based workers sedentary time and sitting-breaks.

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Purpose: Observational learning within the leadership development of managers is under-theorized thus far. The purpose of this paper is to develop a theoretical argument that builds out from a relational leadership perspective to center on processes affecting observational learning. Design/methodology/approach: The contribution is to draw together research to build a holistic model of observational learning. A further contribution is to apply this model to the context of leadership development. Findings: The paper examines processes associated with attention, availability, access, attainability, motivation and social comparison with significant others in particular contexts. The paper takes a temporal perspective to examine the ways that such interaction appears to be most prominent at particular times. Research limitations/implications: The paper concludes by outlining the opportunities for applying this understanding of observational leadership learning within management development arenas and explore future directions for research. Originality/value: Observational learning has been relatively overlooked. Though the authors often "know" that leaders develop through experience, the role of observational learning in this experience is not well understood. This paper is intended to provide a stimulus for exploring this important area in terms of shaping thinking and designs for management development interventions. © Emerald Group Publishing Limited.