Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

A MANAGEMENT INFORMATION SYSTEM AND EVALUATION SCHEME FOR THE UNIVERSITY OF TEXAS EMPLOYEE ASSISTANCE PROGRAMS

Early Employee Assistance Programs (EAPs) had their origin in humanitarian motives, and there was little concern for their cost/benefit ratios; however, as some programs began accumulating data and analyzing it over time, even with single variables such as absenteeism, it became apparent that the humanitarian reasons for a program could be reinforced by cost savings particularly when the existence of the program was subject to justification.^ Today there is general agreement that cost/benefit analyses of EAPs are desirable, but the specific models for such analyses, particularly those making use of sophisticated but simple computer based data management systems, are few.^ The purpose of this research and development project was to develop a method, a design, and a prototype for gathering managing and presenting information about EAPS. This scheme provides information retrieval and analyses relevant to such aspects of EAP operations as: (1) EAP personnel activities, (2) Supervisory training effectiveness, (3) Client population demographics, (4) Assessment and Referral Effectiveness, (5) Treatment network efficacy, (6) Economic worth of the EAP.^ This scheme has been implemented and made operational at The University of Texas Employee Assistance Programs for more than three years.^ Application of the scheme in the various programs has defined certain variables which remained necessary in all programs. Depending on the degree of aggressiveness for data acquisition maintained by program personnel, other program specific variables are also defined. ^

A Student Manual for Venture Consulting

This manual is written to provide students taking the venture consulting class a better understanding of how to consult a small or medium sized business. It covers topics such as how to find a client, how to determine the business problem, how to collect data from customers as well as managers and employees, and how to come up with solution recommendations. By reading the manual, students will gain a better understanding of the consulting industry and will have a guide to help them through the project.

Standardization of data collection for the Lifetime Surveillance of Astronaut Health (LSAH)

Problems due to the lack of data standardization and data management have lead to work inefficiencies for the staff working with the vision data for the Lifetime Surveillance of Astronaut Health. Data has been collected over 50 years in a variety of manners and then entered into a software. The lack of communication between the electronic health record (EHR) form designer, epidemiologists, and optometrists has led to some level to confusion on the capability of the EHR system and how its forms can be designed to fit all the needs of the relevant parties. EHR form customizations or form redesigns were found to be critical for using NASA's EHR system in the most beneficial way for its patients, optometrists, and epidemiologists. In order to implement a protocol, data being collected was examined to find the differences in data collection methods. Changes were implemented through the establishment of a process improvement team (PIT). Based on the findings of the PIT, suggestions have been made to improve the current EHR system. If the suggestions are implemented correctly, this will not only improve efficiency of the staff at NASA and its contractors, but set guidelines for changes in other forms such as the vision exam forms. Because NASA is at the forefront of such research and health surveillance the impact of this management change could have a drastic improvement on the collection of and adaptability of the EHR. Accurate data collection from this 50+ year study is ongoing and is going to help current and future generations understand the implications of space flight on human health. It is imperative that the vast amount of information is documented correctly.^

Academic medical centers: A framework for strategic repositioning

This study sought to understand the elements affecting the success or failure of strategic repositioning efforts by academic medical centers (AMC). The research question was: What specific elements in the process appear to be most important in determining the success or failure of an AMC.s strategic repositioning? Where success is based on the longterm sustainability of the new position.^ "An organization's strategic position is its perceptual location relative to others" (Gershon, 2003). Hence, strategic repositioning represents a shift from one strategic position within an environment to another (H. Mintzberg, 1987a). A deteriorating value proposition coupled with an unsustainable national health care financing system is forcing AMCs to change their strategic position. Where the value proposition is defined as the health outcome per dollar spent. ^ AMCs are of foundational importance to our health care system. They educate our new physicians, generate significant scientific breakthroughs, and care for our most difficult patients. Yet, their strategic, financial and business acumen leaves them particularly vulnerable in a changing environment. ^ After a literature review revealed limited writing on this subject, the research question was addressed using three separate but parallel exploratory case study inquiries of AMCs that recently underwent a strategic repositioning. Participating in the case studies were the Baylor College of Medicine, the University of Texas M. D. Anderson Cancer Center, and the University of Texas Medical Branch.^ Each case study consisted of two major research segments; a thorough documentation review followed by semi-structured interviews of selected members of their governance board, executive and faculty leadership teams. While each case study.s circumstances varied, their response to the research question, as extracted through thematic coding and analysis of the interviews, had a high degree of commonality.^ The results identified managing the strategic risk surrounding the repositioning and leadership accountability as the two foundational elements of success or failure. Metrics and communication were important process elements. They both play a major role in managing the strategic repositioning risk communication loop. Sustainability, the final element, was the outcome sought.^ Factors leading to strategic repositioning included both internal and external pressures and were primarily financial or mission based. Timing was an important consideration as was the selection of the strategic repositioning endpoint.^ In conclusion, a framework for the strategic repositioning of AMCs was offered that integrates the findings of this study; the elements of success, the factors leading to strategic repositioning, and the risk communication loop. ^

An analysis of the revenue policy -making process of the Texas Legislature

The purpose of this dissertation was to develop a conceptual framework which can be used to account for policy decisions made by the House Ways and Means Committee (HW&MC) of the Texas House of Representatives. This analysis will examine the actions of the committee over a ten-year period with the goal of explaining and predicting the success of failure of certain efforts to raise revenue.^ The basis framework for modelling the revenue decision-making process includes three major components--the decision alternatives, the external factors and two competing contingency theories. The decision alternatives encompass the particular options available to increase tax revenue. The options were classified as non-innovative or innovative. The non-innovative options included the sales, franchise, property and severance taxes. The innovative options were principally the personal and corporate income taxes.^ The external factors included political and economic constraints that affected the actions of the HW&MC. Several key political constraints on committee decision-making were addressed--including public attitudes, interest groups, political party strength and tradition and precedents. The economic constraints that affected revenue decisions included court mandates, federal mandates and the fiscal condition of the nation and the state.^ The third component of the revenue decision-making framework included two alternative contingency theories. The first alternative theory postulated that the committee structure, including the individual member roles and the overall committee style, resulted in distinctive revenue decisions. This theory will be favored if evidence points to the committee acting autonomously with less concern for the policies of the Speaker of the House. The Speaker assignment theory, postulated that the assignment of committee members shaped or changed the course of committee decision-making. This theory will be favored if there was evidence that the committee was strictly a vehicle for the Speaker to institute his preferred tax policies.^ The ultimate goal of this analysis is to develop an explanation for legislative decision-making about tax policy. This explanation will be based on the linkages across various tax options, political and economic constraints, member roles and committee style and the patterns of committee assignment. ^

European legislation and implementation measures in the management of construction and demolition waste.

The intense activity in the construction sector during the last decade has generated huge volumes of construction and demolition (C&D) waste. In average, Europe has generated around 890 million tonnes of construction and demolition waste per year. Although now the activity has entered in a phase of decline, due to the change of the economic cycle, we don’t have to forget all the problems caused by such waste, or rather, by their management which is still far from achieving the overall target of 70% for C&D waste --excludes soil and stones not containing dangerous substances-- should be recycled in the EU Countries by 2020 (Waste Framework Directive). But in fact, the reality is that only 50% of the C&D waste generated in EU is recycled and 40% of it corresponds to the recycling of soil and stones not containing dangerous substances. Aware of this situation, the European Countries are implementing national policies as well as different measures to prevent the waste that can be avoidable and to promote measures to increase recycling and recovering. In this aspect, this article gives an overview of the amount of C&D waste generated in European countries, as well as the amount of this waste that is being recycled and the different measures that European countries have applied to solve this situation.

Legal Aspects which Implement Good Practice Measures in the Management of Construction and Demolition Waste

The construction industry, one of the most important ones in the development of a country, generates unavoidable impacts on the environment. The social demand towards greater respect for the environment is a high and general outcry. Therefore, the construction industry needs to reduce the impact it produces. Proper waste management is not enough; we must take a further step in environmental management, where new measures need to be introduced for the prevention at source, such as good practices to promote recycling. Following the amendment of the legal frame applicable to Construction and Demolition Waste (C&D waste), important developments have been incorporated in European and International laws, aiming to promote the culture of reusing and recycling. This change of mindset, that is progressively taking place in society, is allowing for the consideration of C&D waste no longer as an unusable waste, but as a reusable material. The main objective of the work presented in this paper is to enhance C&D waste management systems through the development of preventive measures during the construction process. These measures concern all the agents intervening in the construction process as only the personal implication of all of them can ensure an efficient management of the C&D waste generated. Finally, a model based on preventive measures achieves organizational cohesion between the different stages of the construction process, as well as promoting the conservation of raw materials through the use and waste minimization. All of these in order to achieve a C&D waste management system, whose primary goal is zero waste generation

Proposal for the Management of temporal and semantic components of Geographic Information

This poster raises the issue of a research work oriented to the storage, retrieval, representation and analysis of dynamic GI, taking into account The ultimate objective is the modelling and representation of the dynamic nature of geographic features, establishing mechanisms to store geometries enriched with a temporal structure (regardless of space) and a set of semantic descriptors detailing and clarifying the nature of the represented features and their temporality. the semantic, the temporal and the spatiotemporal components. We intend to define a set of methods, rules and restrictions for the adequate integration of these components into the primary elements of the GI: theme, location, time [1]. We intend to establish and incorporate three new structures (layers) into the core of data storage by using mark-up languages: a semantictemporal structure, a geosemantic structure, and an incremental spatiotemporal structure. Thus, data would be provided with the capability of pinpointing and expressing their own basic and temporal characteristics, enabling them to interact each other according to their context, and their time and meaning relationships that could be eventually established

Proposal for the Management of temporal and semantic components of Geographic Information

This poster raises the issue of a research work oriented to the storage, retrieval, representation and analysis of dynamic GI, taking into account the semantic, the temporal and the spatiotemporal components. We intend to define a set of methods, rules and restrictions for the adequate integration of these components into the primary elements of the GI: theme, location, time [1]. We intend to establish and incorporate three new structures (layers) into the core of data storage by using mark-up languages: a semantictemporal structure, a geosemantic structure, and an incremental spatiotemporal structure. The ultimate objective is the modelling and representation of the dynamic nature of geographic features, establishing mechanisms to store geometries enriched with a temporal structure (regardless of space) and a set of semantic descriptors detailing and clarifying the nature of the represented features and their temporality. Thus, data would be provided with the capability of pinpointing and expressing their own basic and temporal characteristics, enabling them to interact each other according to their context, and their time and meaning relationships that could be eventually established

Air Traffic Management - Historic background and present situation

Ponencia invitada sobre gestion de trafico aereo en el curso de verano de la UPM Research in Decision Support Systems for future Air Traffic Management

AUTOFLY-Aid: Flight Deck Automation Support with Dynamic 4D Trajectory Management for Responsive and Adaptive Airborne Collision Avoidance

AUTOFLY-Aid Project aims to develop and demonstrate novel automation support algorithms and tools to the flight crew for flight critical collision avoidance using “dynamic 4D trajectory management”. The automation support system is envisioned to improve the primary shortcomings of TCAS, and to aid the pilot through add-on avionics/head-up displays and reality augmentation devices in dynamically evolving collision avoidance scenarios. The main theoretical innovative and novel concepts to be developed by AUTOFLY-Aid project are a) design and development of the mathematical models of the full composite airspace picture from the flight deck’s perspective, as seen/measured/informed by the aircraft flying in SESAR 2020, b) design and development of a dynamic trajectory planning algorithm that can generate at real-time (on the order of seconds) flyable (i.e. dynamically and performance-wise feasible) alternative trajectories across the evolving stochastic composite airspace picture (which includes new conflicts, blunder risks, terrain and weather limitations) and c) development and testing of the Collision Avoidance Automation Support System on a Boeing 737 NG FNPT II Flight Simulator with synthetic vision and reality augmentation while providing the flight crew with quantified and visual understanding of collision risks in terms of time and directions and countermeasures.

Looking for business models in digital media and content industries

International Conference on Dynamics of the Media and Content Industry. European Forum for Science and Industry.

A Cost-Benefit analysis model for technical debt management considering uncertainty and time

In the last few years, technical debt has been used as a useful means for making the intrinsic cost of the internal software quality weaknesses visible. This visibility is made possible by quantifying this cost. Specifically, technical debt is expressed in terms of two main concepts: principal and interest. The principal is the cost of eliminating or reducing the impact of a, so called, technical debt item in a software system; whereas the interest is the recurring cost, over a time period, of not eliminating a technical debt item. Previous works about technical debt are mainly focused on estimating principal and interest, and on performing a cost-benefit analysis. This cost-benefit analysis allows one to determine if to remove technical debt is profitable and to prioritize which items incurring in technical debt should be fixed first. Nevertheless, for these previous works technical debt is flat along the time. However the introduction of new factors to estimate technical debt may produce non flat models that allow us to produce more accurate predictions. These factors should be used to estimate principal and interest, and to perform cost-benefit analysis related to technical debt. In this paper, we take a step forward introducing the uncertainty about the interest, and the time frame factors so that it becomes possible to depict a number of possible future scenarios. Estimations obtained without considering the possible evolution of the interest over time may be less accurate as they consider simplistic scenarios without changes.

Improving the management of water and nitrogen resources in cropping systems by using simulation models

Los modelos de simulación de cultivos permiten analizar varias combinaciones de laboreo-rotación y explorar escenarios de manejo. El modelo DSSAT fue evaluado bajo condiciones de secano en un experimento de campo de 16 años en la semiárida España central. Se evaluó el efecto del sistema de laboreo y las rotaciones basadas en cereales de invierno, en el rendimiento del cultivo y la calidad del suelo. Los modelos CERES y CROPGRO se utilizaron para simular el crecimiento y rendimiento del cultivo, mientras que el modelo DSSAT CENTURY se utilizó en las simulaciones de SOC y SN. Tanto las observaciones de campo como las simulaciones con CERES-Barley, mostraron que el rendimiento en grano de la cebada era mas bajo para el cereal continuo (BB) que para las rotaciones de veza (VB) y barbecho (FB) en ambos sistemas de laboreo. El modelo predijo más nitrógeno disponible en el laboreo convencional (CT) que en el no laboreo (NT) conduciendo a un mayor rendimiento en el CT. El SOC y el SN en la capa superficial del suelo, fueron mayores en NT que en CT, y disminuyeron con la profundidad en los valores tanto observados como simulados. Las mejores combinaciones para las condiciones de secano estudiadas fueron CT-VB y CT-FB, pero CT presentó menor contenido en SN y SOC que NT. El efecto beneficioso del NT en SOC y SN bajo condiciones Mediterráneas semiáridas puede ser identificado por observaciones de campo y por simulaciones de modelos de cultivos. La simulación del balance de agua en sistemas de cultivo es una herramienta útil para estudiar como el agua puede ser utilizado eficientemente. La comparación del balance de agua de DSSAT , con una simple aproximación “tipping bucket”, con el modelo WAVE más mecanicista, el cual integra la ecuación de Richard , es un potente método para valorar el funcionamiento del modelo. Los parámetros de suelo fueron calibrados usando el método de optimización global Simulated Annealing (SA). Un lisímetro continuo de pesada en suelo desnudo suministró los valores observados de drenaje y evapotranspiración (ET) mientras que el contenido de agua en el suelo (SW) fue suministrado por sensores de capacitancia. Ambos modelos funcionaron bien después de la optimización de los parámetros de suelo con SA, simulando el balance de agua en el suelo para el período de calibración. Para el período de validación, los modelos optimizados predijeron bien el contenido de agua en el suelo y la evaporación del suelo a lo largo del tiempo. Sin embargo, el drenaje fue predicho mejor con WAVE que con DSSAT, el cual presentó mayores errores en los valores acumulados. Esto podría ser debido a la naturaleza mecanicista de WAVE frente a la naturaleza más funcional de DSSAT. Los buenos resultados de WAVE indican que, después de la calibración, este puede ser utilizado como "benchmark" para otros modelos para periodos en los que no haya medidas de campo del drenaje. El funcionamiento de DSSAT-CENTURY en la simulación de SOC y N depende fuertemente del proceso de inicialización. Se propuso como método alternativo (Met.2) la inicialización de las fracciones de SOC a partir de medidas de mineralización aparente del suelo (Napmin). El Met.2 se comparó con el método de inicialización de Basso et al. (2011) (Met.1), aplicando ambos métodos a un experimento de campo de 4 años en un área en regadío de España central. Nmin y Napmin fueron sobreestimados con el Met.1, ya que la fracción estable obtenida (SOC3) en las capas superficiales del suelo fue más baja que con Met.2. El N lixiviado simulado fue similar en los dos métodos, con buenos resultados en los tratamientos de barbecho y cebada. El Met.1 subestimó el SOC en la capa superficial del suelo cuando se comparó con una serie observada de 12 años. El crecimiento y rendimiento del cultivo fueron adecuadamente simulados con ambos métodos, pero el N en la parte aérea de la planta y en el grano fueron sobreestimados con el Met.1. Los resultados variaron significativamente con las fracciones iniciales de SOC, resaltando la importancia del método de inicialización. El Met.2 ofrece una alternativa para la inicialización del modelo CENTURY, mejorando la simulación de procesos de N en el suelo. La continua emergencia de nuevas variedades de híbridos modernos de maíz limita la aplicación de modelos de simulación de cultivos, ya que estos nuevos híbridos necesitan ser calibrados en el campo para ser adecuados para su uso en los modelos. El desarrollo de relaciones basadas en la duración del ciclo, simplificaría los requerimientos de calibración facilitando la rápida incorporación de nuevos cultivares en DSSAT. Seis híbridos de maiz (FAO 300 hasta FAO 700) fueron cultivados en un experimento de campo de dos años en un área semiárida de regadío en España central. Los coeficientes genéticos fueron obtenidos secuencialmente, comenzando con los parámetros de desarrollo fenológico (P1, P2, P5 and PHINT), seguido de los parámetros de crecimiento del cultivo (G2 and G3). Se continuó el procedimiento hasta que la salida de las simulaciones estuvo en concordancia con las observaciones fenológicas de campo. Después de la calibración, los parámetros simulados se ajustaron bien a los parámetros observados, con bajos RMSE en todos los casos. Los P1 y P5 calibrados, incrementaron con la duración del ciclo. P1 fue una función lineal del tiempo térmico (TT) desde emergencia hasta floración y P5 estuvo linealmente relacionada con el TT desde floración a madurez. No hubo diferencias significativas en PHINT entre híbridos de FAO-500 a 700 , ya que tuvieron un número de hojas similar. Como los coeficientes fenológicos estuvieron directamente relacionados con la duración del ciclo, sería posible desarrollar rangos y correlaciones que permitan estimar dichos coeficientes a partir de la clasificación del ciclo. ABSTRACT Crop simulation models allow analyzing various tillage-rotation combinations and exploring management scenarios. DSSAT model was tested under rainfed conditions in a 16-year field experiment in semiarid central Spain. The effect of tillage system and winter cereal-based rotations on the crop yield and soil quality was evaluated. The CERES and CROPGRO models were used to simulate crop growth and yield, while the DSSAT CENTURY was used in the SOC and SN simulations. Both field observations and CERES-Barley simulations, showed that barley grain yield was lower for continuous cereal (BB) than for vetch (VB) and fallow (FB) rotations for both tillage systems. The model predicted higher nitrogen availability in the conventional tillage (CT) than in the no tillage (NT) leading to a higher yield in the CT. The SOC and SN in the top layer, were higher in NT than in CT, and decreased with depth in both simulated and observed values. The best combinations for the dry land conditions studied were CT-VB and CT-FB, but CT presented lower SN and SOC content than NT. The beneficial effect of NT on SOC and SN under semiarid Mediterranean conditions can be identified by field observations and by crop model simulations. The simulation of the water balance in cropping systems is a useful tool to study how water can be used efficiently. The comparison of DSSAT soil water balance, with a simpler “tipping bucket” approach, with the more mechanistic WAVE model, which integrates Richard’s equation, is a powerful method to assess model performance. The soil parameters were calibrated by using the Simulated Annealing (SA) global optimizing method. A continuous weighing lysimeter in a bare fallow provided the observed values of drainage and evapotranspiration (ET) while soil water content (SW) was supplied by capacitance sensors. Both models performed well after optimizing soil parameters with SA, simulating the soil water balance components for the calibrated period. For the validation period, the optimized models predicted well soil water content and soil evaporation over time. However, drainage was predicted better by WAVE than by DSSAT, which presented larger errors in the cumulative values. That could be due to the mechanistic nature of WAVE against the more functional nature of DSSAT. The good results from WAVE indicate that, after calibration, it could be used as benchmark for other models for periods when no drainage field measurements are available. The performance of DSSAT-CENTURY when simulating SOC and N strongly depends on the initialization process. Initialization of the SOC pools from apparent soil N mineralization (Napmin) measurements was proposed as alternative method (Met.2). Method 2 was compared to the Basso et al. (2011) initialization method (Met.1), by applying both methods to a 4-year field experiment in a irrigated area of central Spain. Nmin and Napmin were overestimated by Met.1, since the obtained stable pool (SOC3) in the upper layers was lower than from Met.2. Simulated N leaching was similar for both methods, with good results in fallow and barley treatments. Method 1 underestimated topsoil SOC when compared with a 12-year observed serial. Crop growth and yield were properly simulated by both methods, but N in shoots and grain were overestimated by Met.1. Results varied significantly with the initial SOC pools, highlighting the importance of the initialization procedure. Method 2 offers an alternative to initialize the CENTURY model, enhancing the simulation of soil N processes. The continuous emergence of new varieties of modern maize hybrids limits the application of crop simulation models, since these new hybrids should be calibrated in the field to be suitable for model use. The development of relationships based on the cycle duration, would simplify the calibration requirements facilitating the rapid incorporation of new cultivars into DSSAT. Six maize hybrids (FAO 300 through FAO 700) were grown in a 2-year field experiment in a semiarid irrigated area of central Spain. Genetic coefficients were obtained sequentially, starting with the phenological development parameters (P1, P2, P5 and PHINT), followed by the crop growth parameters (G2 and G3). The procedure was continued until the simulated outputs were in good agreement with the field phenological observations. After calibration, simulated parameters matched observed parameters well, with low RMSE in most cases. The calibrated P1 and P5 increased with the duration of the cycle. P1 was a linear function of the thermal time (TT) from emergence to silking and P5 was linearly related with the TT from silking to maturity . There were no significant differences in PHINT between hybrids from FAO-500 to 700 , as they had similar leaf number. Since phenological coefficients were directly related with the cycle duration, it would be possible to develop ranges and correlations which allow to estimate such coefficients from the cycle classification.