846 resultados para Management objective
Resumo:
Objective: To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. Design: Retrospective, noncomparative, interventional case series. Patients: All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and orbital units. Methods: Clinical records of all patients were reviewed. Main Outcome Measures: Clinical presentation, radiological and histological findings, treatment modalities, and outcome. Results. The study included 24 patients (15 female, 9 male) with a mean age of 57 17 years. Nineteen cases were unilateral, and 5 were bilateral. Clinical signs and symptoms included a visible or palpable periocular mass or tissue infiltration (95.8%), ptosis (54.2%), periocular discomfort or pain (25%), proptosis or globe displacement (21%), limitations in ocular motility (16.7%), recurrent periocular subcutaneous hemorrhages (12.5%), and diplopia (8.3%). Seven cases had orbital involvement, and 17 were periocular. Immunohistochemistry in 7 patients showed B cells or plasma cells producing monoclonal immunoglobulin chains that were deposited as amyloid light chains. Only 1 patient was diagnosed with systemic amyloid light chain amyloidosis. Treatment modalities were mainly observation and surgical debulking. During a mean follow-up period of 39 months, 21% showed significant progression after treatment, whereas 79% were stable or showed no recurrence after treatment. Conclusion: Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Complete surgical excision is not feasible in many cases, and the goal of treatment is to preserve function and to prevent sight-threatening complications.
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Many populations have a negative impact on their habitat, or upon other species in the environment, if their numbers become too large. For this reason they are often managed using some form of control. The objective is to keep numbers at a sustainable level, while ensuring survival of the population.+Here we present models that allow population management programs to be assessed. Two common control regimes will be considered: reduction and suppression. Under the suppression regime the previous population is maintained close to a particular threshold through near continuous control, while under the reduction regime, control begins once the previous population reaches a certain threshold and continues until it falls below a lower pre-defined level. We discuss how to best choose the control parameters, and we provide tools that allow population managers to select reduction levels and control rates. Additional tools will be provided to assess the effect of different control regimes, in terms of population persistence and cost.In particular we consider the effects of each regime on the probability of extinction and the expected time to extinction, and compare the control methods in terms of the expected total cost of each regime over the life of the population. The usefulness of our results will be illustrated with reference to the control of a koala population inhabiting Kangaroo Island, Australia.
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Trees in plantations established for timber production are usually grown at a sufficiently high density that canopy closure occurs within a relatively short time after planting. The trees then shade and outcompete most herbs, shrubs or grasses growing at the site. The closer the spacing (i.e. the greater the density) the faster this will occur. Subsequently, as the trees grow larger, this between-species competition is replaced by within-species competition. If unmanaged, this competition can reduce the commercial productivity of the plantation. Thus, there are two management dilemmas. One is knowing the best initial planting density. The second is knowing how to management the subsequent between-tree competition in order to optimize overall plantation timber productivity. In this chapter we consider initial spacing and thinning for high value timber trees grown in single and mixed species plantations. From growth studies in stands of different ages recommendations are proposed for managing both types of plantations where the primary objective is timber production. It seems that many rainforest species will require more space to achieve optimal growth than most eucalypts and conifers. On the other hand many rainforest species do not have strong apical dominance. Care will be needed to balance these two attributes.
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Retention of sugarcane leaves and tops on the soil surface after harvesting has almost completely replaced pre- and post-harvest burning of crop residues in the Australian sugar industry. Since its introduction around 25 years ago, residue retention has increased soil organic matter to improve soil fertility as well as improve harvest flexibility and reduce erosion. However, in the wet tropics residue retention also poses potential problems of prolonged waterlogging, and late-season release of nitrogen which can reduce sugar content of the crop. The objective of this project is to examine the management of sugarcane residues in the wet tropics using a systems approach. Subsidiary objectives are (a) to improve understanding of nitrogen cycling in Australian sugarcane soils in the wet tropics, and (b) to identify ways to manage crop residues to retain their advantages and limit their disadvantages. Project objectives will be addressed using several approaches. Historic farm production data recorded by sugar mills in the wet tropics will be analysed to determine the effect of residue burning or retention on crop yield and sugar content. The impact of climate on soil processes will be highlighed by development of an index of nitrogen mineralisation using the Agricultural Production Systems Simulator (APSIM) model. Increased understanding of nitrogen cycling in Australian sugarcane soils and management of crop residues will be gained through a field experiment recently established in the Australian wet tropics. From this experiment the decomposition and nitrogen dynamics of residues placed on the soil surface and incorporated will be compared. The effect of differences in temperature, soil water content and pH will be further examined on these soils under glasshouse conditions. Preliminary results show a high ammonium to nitrate ratio in tropics soils, which may be due to low rates of nitrification that increase the retention of nitrogen in a form (ammonium) that is less subject to leaching. Further results will be presented at Congress.
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Risk and knowledge are two concepts and components of business management which have so far been studied almost independently. This is especially true where risk management (RM) is conceived mainly in financial terms, as for example, in the financial institutions sector. Financial institutions are affected by internal and external changes with the consequent accommodation to new business models, new regulations and new global competition that includes new big players. These changes induce financial institutions to develop different methodologies for managing risk, such as the enterprise risk management (ERM) approach, in order to adopt a holistic view of risk management and, consequently, to deal with different types of risk, levels of risk appetite, and policies in risk management. However, the methodologies for analysing risk do not explicitly include knowledge management (KM). This research examines the potential relationships between KM and two RM concepts: perceived quality of risk control and perceived value of ERM. To fulfill the objective of identifying how KM concepts can have a positive influence on some RM concepts, a literature review of KM and its processes and RM and its processes was performed. From this literature review eight hypotheses were analysed using a classification into people, process and technology variables. The data for this research was gathered from a survey applied to risk management employees in financial institutions and 121 answers were analysed. The analysis of the data was based on multivariate techniques, more specifically stepwise regression analysis. The results showed that the perceived quality of risk control is significantly associated with the variables: perceived quality of risk knowledge sharing, perceived quality of communication among people, web channel functionality, and risk management information system functionality. However, the relationships of the KM variables to the perceived value of ERM are not identified because of the low performance of the models describing these relationships. The analysis reveals important insights into the potential KM support to RM such as: the better adoption of KM people and technology actions, the better the perceived quality of risk control. Equally, the results suggest that the quality of risk control and the benefits of ERM follow different patterns given that there is no correlation between both concepts and the distinct influence of the KM variables in each concept. The ERM scenario is different from that of risk control because ERM, as an answer to RM failures and adaptation to new regulation in financial institutions, has led organizations to adopt new processes, technologies, and governance models. Thus, the search for factors influencing the perceived value of ERM implementation needs additional analysis because what is improved in RM processes individually is not having the same effect on the perceived value of ERM. Based on these model results and the literature review the basis of the ERKMAS (Enterprise Risk Knowledge Management System) is presented.
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Physical distribution plays an imporant role in contemporary logistics management. Both satisfaction level of of customer and competitiveness of company can be enhanced if the distribution problem is solved optimally. The multi-depot vehicle routing problem (MDVRP) belongs to a practical logistics distribution problem, which consists of three critical issues: customer assignment, customer routing, and vehicle sequencing. According to the literatures, the solution approaches for the MDVRP are not satisfactory because some unrealistic assumptions were made on the first sub-problem of the MDVRP, ot the customer assignment problem. To refine the approaches, the focus of this paper is confined to this problem only. This paper formulates the customer assignment problem as a minimax-type integer linear programming model with the objective of minimizing the cycle time of the depots where setup times are explicitly considered. Since the model is proven to be MP-complete, a genetic algorithm is developed for solving the problem. The efficiency and effectiveness of the genetic algorithm are illustrated by a numerical example.
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Purpose: The business process outsourcing (BPO) industry in India is evolving rapidly, and one of the key characteristics of this industry is the emergence of high-end services offered by knowledge processing outsourcing (KPO) organizations. These organizations are set to grow at a tremendous pace. Given the people-intensive nature of this industry, efficient employee management is bound to play a critical role. The literature lacks studies offering insights into the HR challenges involved and the ways in which they are addressed by KPOs. The purpose of this paper is to attempt to fill this gap by presenting findings from an in-depth case study of a KPO organization. Design/methodology/ approach: To achieve the research objective we adopted an in-depth case study approach. The research setting was that of a KPO organization in India, which specialises in offering complex analytics, accounting and support services to the real estate and financial services industries. Findings: The results of this study highlight the differences in the nature of work characteristics in such organizations as compared to call centres. The study also highlights some of the key people management challenges that these organizations face like attracting and retaining talent. The case company adopts formal, structured, transparent and innovative human resource practices. The study also highlights that such enlightened human resource practices stand on the foundations laid by an open work environment and facilitative leadership. Research limitations/implications: One of the key limitations is that the analysis is based on primary data from a single case study and only 18 interviews. The analysis contributes to the fields of KPO, HRM and India and has key messages for policy makers. Originality/value: The literature on outsourcing has in general focused on call centres established in the developed world. However, the booming BPO industry in India is also beginning to offer high-end services, which are far above the typical call centres. These KPOs and their people management challenges are relatively unexplored territories in the literature. By conducting this study in an emerging market (India) and focusing on people-related challenges in KPOs, this study attempts to provide a fresh perspective to the extant BPO literature. © Emerald Group Publishing Limited.
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Several parties (stakeholders) are involved in a construction project. The conventional Risk Management Process (RMP) manages risks from a single party perspective, which does not give adequate consideration to the needs of others. The objective of multi-party risk management is to assist decision-makers in managing risk systematically and most efficiently in a multi-party environment. Multi-party Risk Management Processes (MRMP) consist of risk identification, structuring, analysis and developing responses from all party perspectives. The MRMP has been applied to a cement plant construction project in Thailand to demonstrate its effectiveness.
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Innovation is part and parcel of any service in today's environment, so as to remain competitive. Quality improvement in healthcare services is a complex, multi-dimensional task. This study proposes innovation management in healthcare services using a logical framework. A problem tree and an objective tree are developed to identify and mitigate issues and concerns. A logical framework is formulated to develop a plan for implementation and monitoring strategies, potentially creating an environment for continuous quality improvement in a specific unit. We recommend logical framework as a valuable model for innovation management in healthcare services. Copyright © 2006 Inderscience Enterprises Ltd.
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Conventional project management techniques are not always sufficient for ensuring time, cost and quality achievement of large-scale construction projects due to complexity in planning and implementation processes. The main reasons for project non-achievement are changes in scope and design, changes in Government policies and regulations, unforeseen inflation) under-estimation and improper estimation. Projects that are exposed to such an uncertain environment can be effectively managed with the application of risk numagement throughout project life cycle. However, the effectiveness of risk management depends on the technique in which the effects of risk factors are analysed and! or quantified. This study proposes Analytic Hierarchy Process (AHP), a multiple attribute decision-making technique as a tool for risk analysis because it can handle subjective as well as objective factors in decision model that are conflicting in nature. This provides a decision support system (DSS) to project managenumt for making the right decision at the right time for ensuring project success in line with organisation policy, project objectives and competitive business environment. The whole methodology is explained through a case study of a cross-country petroleum pipeline project in India and its effectiveness in project1nana.gement is demonstrated.
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Purpose - To consider the role of technology in knowledge management in organizations, both actual and desired. Design/methodology/approach - Facilitated, computer-supported group workshops were conducted with 78 people from ten different organizations. The objective of each workshop was to review the current state of knowledge management in that organization and develop an action plan for the future. Findings - Only three organizations had adopted a strongly technology-based "solution" to knowledge management problems, and these followed three substantially different routes. There was a clear emphasis on the use of general information technology tools to support knowledge management activities, rather than the use of tools specific to knowledge management. Research limitations/implications - Further research is needed to help organizations make best use of generally available software such as intranets and e-mail for knowledge management. Many issues, especially human, relate to the implementation of any technology. Participation was restricted to organizations that wished to produce an action plan for knowledge management. The findings may therefore represent only "average" organizations, not the very best practice. Practical implications - Each organization must resolve four tensions: Between the quantity and quality of information/knowledge, between centralized and decentralized organization, between head office and organizational knowledge, and between "push" and "pull" processes. Originality/value - Although it is the group rather than an individual that determines what counts as knowledge, hardly any previous studies of knowledge management have collected data in a group context.
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Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.
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Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved.
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The starting point of the project was the observation that strategic management is absent in small businesses. The first objective of the project was to examine the reasons causing this situation in Greece, the second one, to examine the appropriateness of the contemporary models of strategic planning for the Greek S.M.E.s, and the third to examine the appropriateness of the alternative approaches to strategic management for the Greek S.M.E.s. The term appropriateness includes (a) the ability of managers to use the models and (b) the ability of the models to assist the managers. The results of the research indicate that none of the two above conditions exists, hence, it is suggested that the contemporary models of strategic management are inappropriate for the Greek S.M.E.s. Many previous research projects on the topic suggest that since the strategic decision making process in S.M.E.s is informal, the whole process is absent or ineffective. Current trends in S.M.E.s' strategic management do not consider the informality of the strategic decision making process as a kind of managerial illness, but as a managerial characteristic. The use of sophisticated data collection and analytical methods does not indicate successful strategic decisions, but it indicates the method large firms use to manage their strategy. According to the literature review, the S.M.E.s' managers avoid the use of the contemporary models of strategic management, because they do not have the knowledge, the resources or the time. Another thesis, expressed by some firms' specialists, suggests that small firms are different from large ones, hence their practice of strategic management should not follow the large firm's prototypes.
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In this thesis, I view the historical background of Zimbabwe to show the patterns of traditional life that existed prior to settlerism. The form, nature, pace and impact of settlerism and colonialism up to the time of independence are also discussed to show how they affected the health of the population and the pace of development of the country. The political, social and economic underdevelopment of the African people that occurred in Zimbabwe prior to independence was a result of deliberate, politically motivated and controlled policy initiatives. These led to inequatable, inadequate, inappropriate and inaccessible health care provision. It is submitted that since it was the politics that determined the pace of underdevelopment, it must be the politics that must be at the forefront of the development strategy adopted. In the face of the amed conflict that existed in Zimbabwe, existing frameworks of analyses are shown to be inadequate for planning purposes because of their inability to provide indications about the stability of future outcomes. The Metagame technique of analysis of options is proposed as a methology that can be applied in such situations. It rejects deterministic predicative models as misleading and advocates an interactive model based on objective and subjective valuation of human behaviour. In conclusion, the search for stable outcomes rather than optimal and best solutions strategies is advocated in decision making in organisations of all sizes.