Management Plan
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Yalda Afshar ◽  
Whitnee J. Hogan ◽  
Charlotte Conturie ◽  
Sherzana Sunderji ◽  
Jennifer Y. Duffy ◽  

Background Prenatal diagnosis of congenital heart disease has been associated with early‐term delivery and cesarean delivery (CD). We implemented a multi‐institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal‐Maternal Consortium. Our objective was to decrease early‐term (37–39 weeks) delivery and CD in pregnancies complicated by fetal congenital heart disease using a SCAMP methodology to improve practice in a high‐risk and clinically complex setting. Methods and Results University of California Fetal‐Maternal Consortium site‐specific management decisions were queried following SCAMP implementation. This contemporary intervention group was compared with a University of California Fetal‐Maternal Consortium historical cohort. Primary outcomes were early‐term delivery and CD. A total of 496 maternal–fetal dyads with prenatally diagnosed congenital heart disease were identified, 185 and 311 in the historical and intervention cohorts, respectively. Recommendation for later delivery resulted in a later gestational age at delivery (38.9 versus 38.1 weeks, P =0.01). After adjusting for maternal age and site, historical controls were more likely to have a CD (odds ratio [OR],1.8; 95% CI, 2.1–2.8; P =0.004) and more likely (OR, 2.1; 95% CI, 1.4–3.3) to have an early‐term delivery than the intervention group. Vaginal delivery was recommended in 77% of the cohort, resulting in 61% vaginal deliveries versus 50% in the control cohort ( P =0.03). Among pregnancies with major cardiac lesions (n=373), vaginal birth increased from 51% to 64% ( P =0.008) and deliveries ≥39 weeks increased from 33% to 48% ( P =0.004). Conclusions Implementation of a SCAMP decreased the rate of early‐term deliveries and CD for prenatal congenital heart disease. Development of clinical pathways may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce healthcare costs.

2021 ◽  
Vol 22 (1) ◽  
Hui Xing Lau ◽  
Ser Lin Celine Lee ◽  
Yusuf Ali

Abstract Background Institutions, funding agencies and publishers are placing increasing emphasis on good research data management (RDM). RDM lapses in medical science can result in questionable data and cause the public’s confidence in the scientific community to crumble. A fledgling medical school in a young university in Singapore has mandated every funded research project to have a data management plan (DMP). However, researchers’ adherence to their DMPs was unknown until the school embarked on routine data auditing. We hypothesize that research data auditing improves RDM awareness, compliance and reception in the school. Methods We conducted surveys with research PIs and researchers before and after data auditing to evaluate differences in self-reported RDM awareness, compliance and reception. As it is mandatory to deposit research data in a central data repository system in the school, we tracked data deposition by each laboratory from 2 weeks before to 3 months after data auditing as a marker of actual RDM compliance. Results Research data auditing had an overall positive effect on self-reported RDM awareness, compliance and reception for both research PIs and researchers. Research PIs agreed more that RDM was important to scientific reproducibility, were more aware of proper RDM, had higher RDM strength in their laboratories and were more compliant with the DMP. Both research PIs and researchers believed data auditing helped them to be more compliant with data deposition in the repository. However, data auditing had no significant impact on laboratories’ data deposition rates over time, which could be due to the short sampling period. Conclusions Research PIs and researchers generally felt that data auditing was effective in improving RDM practices. It helped to evaluate their RDM practices objectively, propose corrective actions for RDM lapses and spread awareness of the university’s data management policies. Our findings corroborated other studies in medical research, geosciences, engineering and ethics that data auditing promotes good RDM practices. Hence, we recommend research institutions worldwide to adopt data auditing as a tool to reinforce research integrity.

Wen-Xia Lan ◽  
Zhe Li

IntroductionTo investigate the effect of nurse-led multidisciplinary cooperation in the early screening and protection of fecal water dermatitis in hospitalized patients with enterostomy.Material and methodsAn enterostomy management team led by nurses with multidisciplinary cooperation was established to investigate the current situation of fecal water dermatitis in patients with enterostomy in our hospital, and the causes of fecal water dermatitis were analyzed. Based on the evidence-based results, the management plan for the prevention of fecal water dermatitis in patients with enterostomy was implemented.ResultsThe incidence of fecal water dermatitis in patients with enterostomy decreased from 45.56% to 20.73%, the screening rate of nutritional risk for patients with enterostomy increased from 45.57% to 97.56%, the accuracy of stoma positioning by nurses was increased from 65.82% to 98.78%, the incidence of basement warping in enterostomy was decreased from 29.80% to 1.95%, the incidence of fecal water leakage decreased from 50.76% to 22.53%, the one-hour leakage rate of stoma basement increased from 4.48% to 97.29%, the awareness rate of patients' related knowledge increased from 43.03% to 80.48%, and the average score of self-care ability of patients (family members) increased from 99.5 to 126.7, Patients' mean quality of life scores increased from 80.73 to 98.57, and patients' mean self-efficacy scores increased from 78.34 to 99.26.The differences in the above indicators were statistically significant (P < 0.01).ConclusionsNurse-led multidisciplinary cooperation can improve early screening and protection of fecal water dermatitis in hospitalized patients with enterostomy and improve the quality of life of patients.

2021 ◽  
Sarah VL Hodge ◽  
Beata Mickiewicz ◽  
Matthew Lau ◽  
Craig N Jenne ◽  
Graham C Thompson

Reliable and efficient diagnosis of pediatric appendicitis is essential for the establishment of a clinical management plan and improvement of patient outcomes. Current strategies used to diagnose a child presenting with a suspected appendicitis include laboratory studies, clinical scores and diagnostic imaging. Although these modalities work in conjunction with each other, one optimal diagnostic strategy has yet to be agreed upon. The recent introduction of precision medicine techniques such as genomics, transcriptomics, proteomics and metabolomics has increased both the diagnostic sensitivity and specificity of appendicitis. Using these novel strategies, the integration of precision medicine into clinical practice via point-of-care technologies is a plausible future. These technologies would assist in the screening, diagnosis and prognosis of pediatric appendicitis.

2021 ◽  
Vol 3 (1) ◽  
pp. 132-134
Dayang Nur Sakinah Musa ◽  
Ahmad Ainuddin Nuruddin

Information on calorific value is very important factor in fuel evaluation. The objective of the study was to investigate the calorific values of the leaves of five (5) selected trees species of dipterocarp in Piah Forest Reserve, Perak, Malaysia. The species are Hopea sp., Shorea parvifolia, Shorea leprosula, Shorea macroptera and Dipterocarpus sp. The calorific values were determined using the Adiabatic Bomb Calorimeter. The difference of calorific value between the five species were also examined. It was found that, the mean calorific value for the dipterocarp species were within the range of 4041.28 Cal g-1 to 4820.78 Cal g-1. The leaves of the Shorea macroptera contain higher calorific value compared to other four species. The findings will be useful in the preparation of forest fire management plan, and also in the development of bioenergy project of wood-based biomass from forest species.

Land ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 747
Marlene Marques ◽  
Keith M. Reynolds ◽  
Susete Marques ◽  
Marco Marto ◽  
Steve Paplanus ◽  

Forest management planning can be challenging when allocating multiple ecosystem services (ESs) to management units (MUs), given the potentially conflicting management priorities of actors. We developed a methodology to spatially allocate ESs to MUs, according to the objectives of four interest groups—civil society, forest owners, market agents, and public administration. We applied a Group Multicriteria Spatial Decision Support System approach, combining (a) Multicriteria Decision Analysis to weight the decision models; (b) a focus group and a multicriteria Pareto frontier method to negotiate a consensual solution for seven ESs; and (c) the Ecosystem Management Decision Support (EMDS) system to prioritize the allocation of ESs to MUs. We report findings from an application to a joint collaborative management area (ZIF of Vale do Sousa) in northwestern Portugal. The forest owners selected wood production as the first ES allocation priority, with lower priorities for other ESs. In opposition, the civil society assigned the highest allocation priorities to biodiversity, cork, and carbon stock, with the lowest priority being assigned to wood production. The civil society had the highest mean rank of allocation priority scores. We found significant differences in priority scores between the civil society and the other three groups, highlighting the civil society and market agents as the most discordant groups. We spatially evaluated potential for conflicts among group ESs allocation priorities. The findings suggest that this approach can be helpful to decision makers, increasing the effectiveness of forest management plan implementation.

2021 ◽  
Vol 11 (14) ◽  
pp. 6538
Justin J. Merrigan ◽  
Jason D. Stone ◽  
Joel R. Martin ◽  
William Guy Hornsby ◽  
Scott M. Galster ◽  

Force plate assessments, such as countermovement jumps and isometric mid-thigh pulls, examine performances (e.g., jump height, force, power) and movement strategies (e.g., asymmetries, durations), and are best suited to characterize and monitor physical capabilities, not predict injuries. To begin applying force plate technologies, users must first; (1) develop a data management plan to visualize and capture data over time; (2) select appropriate force plates for their scenario; (3) design appropriate testing protocols to ensure valid and reliable data. Force plate assessments may be added to existing testing, serve as separate testing batteries for annual profile testing to compare individuals and understand initial physical capabilities, or for more frequent testing (i.e., monthly or weekly) to monitor training-related adaptations or neuromuscular fatigue. Although these assessments inform evidence-based program designs, human performance practitioners must understand the considerations for conducting appropriate force plate testing, as well as proper visualizations and management of force plate data. Thus, the aim of this review is to provide evidence-based practices for utilizing force plates in tactical populations (e.g., military, firefighters, police). This includes best practices to implement testing for performance profiling, training adaptations, and monitoring neuromuscular fatigue and force asymmetries. Of note, due to the large amount of force-time metrics to choose from, this article provides general examples of important metrics to monitor and training recommendations based on changes to these force-time metrics, followed by specific examples in three case studies.

2021 ◽  
Vol 10 (14) ◽  
pp. 3101
Massimo Micocci ◽  
Simone Borsci ◽  
Viral Thakerar ◽  
Simon Walne ◽  
Yasmine Manshadi ◽  

Artificial Intelligence (AI) systems could improve system efficiency by supporting clinicians in making appropriate referrals. However, they are imperfect by nature and misdiagnoses, if not correctly identified, can have consequences for patient care. In this paper, findings from an online survey are presented to understand the aptitude of GPs (n = 50) in appropriately trusting or not trusting the output of a fictitious AI-based decision support tool when assessing skin lesions, and to identify which individual characteristics could make GPs less prone to adhere to erroneous diagnostics results. The findings suggest that, when the AI was correct, the GPs’ ability to correctly diagnose a skin lesion significantly improved after receiving correct AI information, from 73.6% to 86.8% (X2 (1, N = 50) = 21.787, p < 0.001), with significant effects for both the benign (X2 (1, N = 50) = 21, p < 0.001) and malignant cases (X2 (1, N = 50) = 4.654, p = 0.031). However, when the AI provided erroneous information, only 10% of the GPs were able to correctly disagree with the indication of the AI in terms of diagnosis (d-AIW M: 0.12, SD: 0.37), and only 14% of participants were able to correctly decide the management plan despite the AI insights (d-AIW M:0.12, SD: 0.32). The analysis of the difference between groups in terms of individual characteristics suggested that GPs with domain knowledge in dermatology were better at rejecting the wrong insights from AI.

2021 ◽  
Matthew D. Palumbo ◽  
Jacob N. Straub ◽  
Mohammed A. Al-Saffar ◽  
Gregory J. Soulliere ◽  
Jason L. Fleener ◽  

Abstract Context The North American Waterfowl Management Plan and the Upper Mississippi River/Great Lakes Joint Venture waterfowl habitat conservation strategy provide continental and regional guidance, respectively, for waterfowl habitat conservation planning. They were not designed to guide watershed- scale waterfowl habitat delivery. Objective Our goal was to develop a waterfowl habitat decision support framework for the state of Wisconsin using biological and social criteria to guide state and local-scale practitioners with an explicit link to larger scale objectives. Methods We engaged a core group of wetland and waterfowl experts to decide upon decision support layers relevant to biological and social objectives, evaluate variables, establish weights, and review model outputs for reasonableness and accuracy. We used spatial analyst tools, kernel density estimators, and weighted sums to create spatially explicit models to identify landscapes and watersheds important for waterfowl. We identified habitat resources that exist currently (Conservation Capital) and considered potential resources (Conservation Opportunities) which could enhance wetland restoration efforts. Results We developed a transparent framework to identify and prioritize landscapes for conserving waterfowl habitat at the Hydrologic Unit Code 12 watershed scale in Wisconsin, by maintaining continental and regional priorities, and including local landscape characteristics, biological criteria, and researcher, manager, and biologist expertise. Conclusions Local detail is critical for implementing waterfowl habitat delivery and making efficient use of limited funds for conservation but can be more abstract in larger regional or continental conservation planning. Our models are science-based, transparent, defensible, and can be modified as social, political, biological, and environmental forces change.

2021 ◽  
Robert Aquino

Concept/needs of user -- Planning context -- Support services -- Organizations involved -- Design process -- Regulatory framework & community interaction -- Management process -- Appendix A: Typical case study: "Group home in North York" -- Appendix B: Questionnaire: client information profile -- Appendix C: Problem identification matrix -- Appendix D: Group homes, Metropolitan Toronto, 1987 -- Appendix E: Group home operator's neighbourhood dialogue guidelines -- Appendix F: Solicitor's certificate #1 -- Appendix G: Initial project submission "560" -- Appendix H: Project application "1414" -- Appendix I: Standard budget package (Ministry of Community & Social Services) -- Appendix J: Design illustrations -- Appendix K: Metropolitan Toronto Draft Official Plan; Policies -- Appendix L: Management plan (city of Toronto Fire Department) -- Appendix M: Housing types.

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