928 resultados para service level management


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The discipline of Enterprise Architecture Management (EAM) deals with the alignment of business and information systems architectures. While EAM has long been regarded as a discipline for IT managers this book takes a different stance: It explains how top executives can use EAM for leveraging their strategic planning and controlling processes and how EAM can contribute to sustainable competitive advantage. Based on the analysis of best practices from eight leading European companies from various industries the book presents crucial elements of successful EAM. It outlines what executives need to do in terms of governance, processes, methodologies and culture in order to bring their management to the next level. Beyond this, the book points how EAM might develop in the next decade allowing today's managers to prepare for the future of architecture management.

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Objectives: To develop European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis. Methods: An expert group (10 rheumatologists, 3 nephrologists, 2 immunolgists, 2 internists representing 8 European countries and the USA, a clinical epidemiologist and a representative from a drug regulatory agency) identified 10 topics for a systematic literature search through a modified Delphi technique. In accordance with standardised EULAR operating procedures, recommendations were derived for the management of large vessel vasculitis. In the absence of evidence, recommendations were formulated on the basis of a consensus opinion. Results: Seven recommendations were made relating to the assessment, investigation and treatment of patients with large vessel vasculitis. The strength of recommendations was restricted by the low level of evidence and EULAR standardised operating procedures. Conclusions: On the basis of evidence and expert consensus, management recommendations for large vessel vasculitis have been formulated and are commended for use in everyday clinical practice.

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The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland. A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included. At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome. This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.

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Performance-related pay within public organizations is continuing to spread. Although it can help to strengthen an entrepreneurial spirit in civil servants, its implementation is marred by technical, financial, managerial and cultural problems. This article identifies an added problem, namely the contradiction that exists between a managerial discourse that emphasizes the team and collective performance, on the one hand, and the use of appraisal and reward tools that are above all individual, on the other. Based on an empirical survey carried out within Swiss public organizations, the analysis shows that the team is currently rarely taken into account and singles out the principal routes towards an integrated system for the management and rewarding of civil servants.

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BACKGROUND: Pancreatic fistula (PF), which is a major complication of pancreaticoduodenectomy (PD), can be treated conservatively or by reoperation. The aim of this study was to evaluate conservative management of PF, which was attempted whenever possible as a first-intention treatment in a large series of PD. STUDY DESIGN: From 1990 to 2000, 242 patients underwent PD with pancreaticogastrostomy. PF was observed in 31 (13%) and was defined by an amylase-rich surgical drainage fluid (above fivefold serum amylase) after postoperative day 5, or by presence on CT scan of a fluid collection located close to the anastomosis or containing amylase-rich fluid, or by operative findings in case of reoperation. Conservative management included total parenteral nutrition, nasogastric suction, imaging-guided percutaneous drainage of collection when necessary, and somatostatin or its analogues. RESULTS: PF was symptomatic in 20 patients (65%). Amylase level on surgical drainage fluid was elevated in 23 patients (74%). Four patients (13%), including two with hemorrhage and two with intraabdominal collection not accessible by percutaneous approach, were not considered for conservative management and underwent early reoperation. Conservative management was successful in the 27 patients (100%) in whom it was attempted, including the 10 who required percutaneous drainage. The only death (3%) occurred after massive hemorrhage complicating misdiagnosed PF. Mean hospital stay was 36 +/- 12 days (range 18 to 71) after successful conservative management. CONCLUSIONS: Conservative management of PF complicating PD is feasible and successful in above 85% of patients.

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This Environmental Assessment documents the National Environmental Policy Act (NEPA) process for developing a Comprehensive Conservation Plan (CCP) for the Iowa Wetland Management District (WMD, district). In general, scoping reveals issues that drive alternative ways of managing the district. Implementation of each of those alternative management styles (including the No Action Alternative) may have different effects on the physical, biological, and socio-economic environment. Analysis of these effects reveals the “preferred” alternative, which constitutes the CCP. The CCP includes goals, objectives, and strategies for the district to guide overall management for the next 15 years. The Iowa WMD consists of scattered tracts of habitat (both wetland and upland grassland) known as Waterfowl Production Areas (WPAs). As of 2011, there are 75 WPAs in 18 counties in north-central Iowa totaling 24,712 acres in fee title primarily managed by the Iowa Department of Natural Resources (DNR). Even though district acquisition has only occurred in 18 counties to date, a larger 35-county boundary is approved. This boundary follows the historic range of the poorly drained Prairie Pothole Region (PPR) in Iowa, an area known for its waterfowl production. The district also includes 575 WPA acres and approximately 434 Farm Service Agency acres in conservation easements on private land. This plan was prepared with the intent that the strong partnership with the Iowa DNR will continue over the next 15 years.

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A study was undertaken by the Bituminous Research Laboratory of the Engineering Research Institute at Iowa State University, under the sponsorship of the Iowa Highway Research Board, project HR 100, to ascertain the effects of a number of characteristics and properties of asphaltic concrete mixes upon the service behavior of the mixes as evaluated by the Traffic Simulator and by field observations. The study included: Investigations of the relations, of gradation, fraction and resistance to wear of aggregates; of stability, cohesion, per cent voids and asphalt content: of a number of laboratory and field mixes to service behavior as indicated by the Traffic Simulator under various test conditions. Based upon the results of the tests and the relationships noted, tentative criteria for the Traffic Simulator test were devised, subject to verification by observations and measurements of field service behavior of the mixes.

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[spa] Asistimos, desde hace algunos años, a un proceso de profundos cambios en la Universidad. Reformas que no sólo están afectando, entre otros, a su financiación, a su gobierno y gestión o a la estructura de las enseñanzas que en ella se imparten. También, y de forma muy especial e intensa, se están proyectando en su profesorado modificando su proceso de selección y transformando su función docente. Precisamente, en relación con ésta última, el papel que está llamado a desempeñar el docente está garantizado por la Constitución que les reconoce el derecho fundamental a la libertad de cátedra. La proclamación al más alto nivel normativo de este derecho del profesor ha obligado a conjugarla con otros derechos, igualmente fundamentales, presentes en el sistema educativo, en especial, el de la educación, y con otras potestades que se encomiendan a poderes públicos y universidades derivadas de la concepción de la educación como un servicio público. No obstante, en la actualidad las amenazas que plantean las nuevas exigencias derivadas del EEES pueden suponer un paso más allá actuando en la misma esencia de contenido de la libertad de cátedra perdiendo su sentido originario y condicionando su ejercicio a límites no permitidos por el propio texto constitucional.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.

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Iowa Manure Matters: Odor and Nutrient Management is published by Iowa State University Extension, with funding support from the USDA Natural Resource Conservation Service.