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.

Opportunistic Control Over Shared Wireless Channels

© 2015 IEEE.We consider a wireless control architecture with multiple control loops over a shared wireless medium. A scheduler observes the random channel conditions that each control system experiences over the shared medium and opportunistically selects systems to transmit at a set of non-overlapping frequencies. The transmit power of each system also adapts to channel conditions and determines the probability of successfully receiving and closing the loop. We formulate the optimal design of channel-aware scheduling and power allocation that minimize the total power consumption while meeting control performance requirements for all systems. In particular, it is required that for each control system a given Lyapunov function decreases at a specified rate in expectation over the random channel conditions. We develop an offline algorithm to find the optimal communication design, as well as an online protocol which selects scheduling and power variables based on a random observed channel sequence and converges almost surely to the optimal operating point. Simulations illustrate the power savings of our approach compared to other non-channel-aware schemes.

International guidelines for management of metastatic breast cancer: Can metastatic breast cancer be cured?

A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology-Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatment. © 2010. Published by Oxford University Press.

A qualitative temporal information system for process control

A general system is presented in this paper which supports the expression of relative temporal knowledge in process control and management. This system allows knowledge of Allen's temporal relations over time elements, which may be both intervals and points. The objectives and characteristics of two major temporal attributes, i.e. ‘transaction time’ and ‘valid time’, are described. A graphical representation for the temporal network is presented, and inference over the network may be made by means of a consistency checker in terms of the graphical representation. An illustrative example of the system as applied to process control and management is provided.

An architectural approach to autonomics and self-management of automotive embedded electronic systems

Embedded electronic systems in vehicles are of rapidly increasing commercial importance for the automotive industry. While current vehicular embedded systems are extremely limited and static, a more dynamic configurable system would greatly simplify the integration work and increase quality of vehicular systems. This brings in features like separation of concerns, customised software configuration for individual vehicles, seamless connectivity, and plug-and-play capability. Furthermore, such a system can also contribute to increased dependability and resource optimization due to its inherent ability to adjust itself dynamically to changes in software, hardware resources, and environment condition. This paper describes the architectural approach to achieving the goals of dynamically self-configuring automotive embedded electronic systems by the EU research project DySCAS. The architecture solution outlined in this paper captures the application and operational contexts, expected features, middleware services, functions and behaviours, as well as the basic mechanisms and technologies. The paper also covers the architecture conceptualization by presenting the rationale, concerning the architecture structuring, control principles, and deployment concept. In this paper, we also present the adopted architecture V&V strategy and discuss some open issues in regards to the industrial acceptance.

Multiple attractors of host-parasitoid models with integrated pest management strategies: eradication, persistence and outbreak

Host-parasitoid models including integrated pest management (IPM) interventions with impulsive effects at both fixed and unfixed times were analyzed with regard to host-eradication, host-parasitoid persistence and host-outbreak solutions. The host-eradication periodic solution with fixed moments is globally stable if the host's intrinsic growth rate is less than the summation of the mean host-killing rate and the mean parasitization rate during the impulsive period. Solutions for all three categories can coexist, with switch-like transitions among their attractors showing that varying dosages and frequencies of insecticide applications and the numbers of parasitoids released are crucial. Periodic solutions also exist for models with unfixed moments for which the maximum amplitude of the host is less than the economic threshold. The dosages and frequencies of IPM interventions for these solutions are much reduced in comparison with the pest-eradication periodic solution. Our results, which are robust to inclusion of stochastic effects and with a wide range of parameter values, confirm that IPM is more effective than any single control tactic.

Strategies for water pollution control in Dhaka, Bangladesh: an institutional and economic analysis

This paper presents primary data based on research carried out as part of a large World Bank project. Results from our survey show that water pollution in Dhaka watershed has reached alarming levels and is posing significant threats to health and economic activity, particularly among the poor and vulnerable. Rice productivity in the watershed area, for example, has declined by 40% in recent years and vegetable cultivation in the riverbeds has been severely damaged. We also found significant correlation between water pollution and diseases such as jaundice, diarrhoea and skin problems. It was reported that the cost of treatment of skin diseases for one episode could be as high as 29% of the weekly earnings of poor households. Given the magnitude of the contamination problem, a multi-agent stakeholder approach was necessary to analyse the institutional and economic constraints that would need to be addressed in order to improve environmental management. This approach, in turn, enabled core strategies to be developed. The strategies were better understood around three types of actors in industrial pollution, i.e. (1) principal actors, who contribute directly to industrial pollution; (2) stakeholders, who exacerbate the situation by inaction; and (3) the potential actors in mitigation of water contamination. Within a carrot-and-stick framework, nine strategies leading to the strengthening of environmental management were explored. They aim at improving governance and transparency within public agencies and private industry through the setting up of incentive structures to advance compliance and enforcement of environmental standards. Civil society and the population at large are, on the other hand, encouraged to contribute actively to the mitigation of water pollution by improving the management of environmental information and by raising public awareness.

The Atlantic Meridional Transect (AMT) data management experience

As the UK's national marine data centre, a key responsibility of the British Oceanographic Data Centre (BODC) is to provide data management support for the scientific activities of complex multi-disciplinary long-term research programmes. Since the initial cruise in 1995, the NERC funded Atlantic Meridional Transect (AMT) project has undertaken 18 north–south transects of the Atlantic Ocean. As the project has evolved there has been a steady growth in the number of participants, the volume of data, its complexity and the demand for data. BODC became involved in AMT in 2002 at the beginning of phase II of this programme and since then has provided continuous support to the AMT and the wider scientific community through the rescue, quality control, processing and access to the data. The data management is carried out by a team of specialists using a sophisticated infrastructure and hardware to manage, integrate and serve physical, biological and chemical data. Here, we discuss the approach adopted, techniques applied and some guiding principles for management of large multi-disciplinary programmes.

Ownership Patterns and Control in Turkish Listed Companies

The purpose of this paper is to document the prevalent ownership concentration, structure and control in the top 100 companies listed on the Istanbul Stock Exchange. The results are discussed in the context of emerging corporate governance trends in Turkey. Where appropriate, comparisons with other countries are provided. The results of the study indicate that ownership of Turkish companies is highly concentrated, families being the dominant shareholders. The separation of ownership and control among Turkish companies is mainly achieved through pyramidal ownership structures and the presence of big business groups. However, the cash flow and voting rights in Turkish companies are relatively more aligned compared to other family–ownership–dominated insider–system countries.

Using CORBA's advanced services to enhance the integrity of QoS management programmable networks

The development of wideband network services and the new network infrastructures to support them have placed much more requirements on current network management systems. Issues such as scalability, integrity and interoperability have become more important. Existing management systems are not flexible enough to support the provision of Quality of Service (QoS) in these dynamic environments. The concept of Programmable Networks has been proposed to address these requirements. Within this framework, CORBA is regarded as a middleware technology that can enable interoperation among the distributed entities founds in Programmable Networks. By using the basic CORBA environment in a heterogeneous network environment, a network manager is able to control remote Network Elements (NEs) in the same way it controls its local resources. Using this approach both the flexibility and intelligence of the overall network management can be improved. This paper proposes the use of two advanced features of CORBA to enhance the QoS management in a Programmable Network environment. The Transaction Service can be used to manage a set of tasks, whenever the management of elements in a network is correlated; and the Concurrency Service can be used to coordinate multiple accesses on the same network resources. It is also shown in this paper that proper use of CORBA can largely reduce the development and administration of network management applications.

Identification of dynamic systems under closed-loop control

This paper introduces a novel modelling framework for identifying dynamic models of systems that are under feedback control. These models are identified under closed-loop conditions and produce a joint representation that includes both the plant and controller models in state space form. The joint plant/controller model is identified using subspace model identification (SMI), which is followed by the separation of the plant model from the identified one. Compared to previous research, this work (i) proposes a new modelling framework for identifying closed-loop systems, (ii) introduces a generic structure to represent the controller and (iii) explains how that the new framework gives rise to a simplified determination of the plant models. In contrast, the use of the conventional modelling approach renders the separation of the plant model a difficult task. The benefits of using the new model method are demonstrated using a number of application studies.

The importance of stakeholder engagement in invasive species management: A cross-jurisdictional perspective in Ireland

The management of invasive non-native species is a frequent cause of conflict in the field of biodiversity conservation because perceptions of their costs and benefits differ among stakeholder groups. A lack of cohesion between scientific researchers, the commercial sector and policy makers lies at the root of a widespread failure to develop and implement sustainable management practices for invasive species. The crisis of this situation is intensified by drivers stemming from international conventions and directives to address invasive species issues. There are further direct conflicts between legislative instruments promoting biodiversity conservation on the one hand while liberalizing trade at the national, European and global level on the other. The island of Ireland provides graphic illustration of the importance of cross-jurisdictional approaches to biological invasions. Using primarily Irish examples in this review, we emphasize the importance of approaching risk assessment, risk reduction and control or eradication policies from a cost-efficient, highly flexible perspective, incorporating linkages between environmental, economic and social objectives. The need for consolidated policies between Northern Ireland and the Republic of Ireland is particularly acute, though few model cross-border mechanisms for such consolidation are available. The importance of engaging affected stakeholders through positive interactions is discussed with regard to reducing the currently fragmented nature of invasive species management between the two jurisdictions.