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Management Challenge (management + challenge)
Selected AbstractsHow Many Brains Does It Take to Build a New Light: Knowledge Management Challenges of a Transdisciplinary ProjectMIND, BRAIN, AND EDUCATION, Issue 1 2009Bruno Della Chiesa ABSTRACT, The Organization for Economic Cooperation and Development's (OECD) Center for Educational Research and Innovation (CERI) carried out the Learning Sciences and Brain Research project (1999,2007) to investigate how neuroscience research can inform education policy and practice. This transdisciplinary project brought many challenges. Within the political community, participation in the project varied, with some countries resisting approval of the project altogether, in the beginning. In the neuroscientific community, participants struggled to represent their knowledge in a way that would be meaningful and relevant to educators. Within the educational community, response to the project varied, with many educational researchers resisting it for fear that neuroscience research might make their work obsolete. Achieving dialogue among these communities was even more challenging. One clear obstacle was that participants had difficulty recognizing tacit knowledge in their own field and making this knowledge explicit for partners in other fields. This article analyzes these challenges through a knowledge management framework. [source] Management challenges of small-scale fishing communities in a protected reef system of Veracruz, Gulf of MexicoFISHERIES MANAGEMENT & ECOLOGY, Issue 1 2008L. JIMÉNEZ-BADILLO Abstract, Socioeconomic characterisation of fishing activities in the Veracruz Reef System National Park was used to develop a management system which balances the community's livelihood, and the conservation needs of the protected area. A survey was applied to four sectors of the fishing community: the fishers, fishers' wives, retailers and local population. The survey determined their perceptions about: (1) fishing as a lifestyle; (2) economic alternatives; (3) perspectives about the future; (4) environment; and (5) knowledge of the National Park as a protected area. Fishers devoted an average of 27 years fishing, investing an average of 12 h per day giving a regular income of 15,20 US$. Most interviewed (60%) were full-time fishers, with fishing the only family income source. Fishers are predominately educated to primary school level (64%). The main problem faced by fishers and the communities were economic opportunities but 89% believed that mariculture could be an alternative income source. There was strong ecological awareness, with 75% aware of the decline in fisheries resource and 62% knowing about the role of protected areas. There was divided opinion about future perspectives. Inefficient organisation and communication between authorities and fishers were identified as obstacles to co-management. Discussion on alternative incomes and a proposal involve fishers in co-management initiatives are presented. [source] Advanced Heart Failure: Prognosis, Uncertainty, and Decision MakingCONGESTIVE HEART FAILURE, Issue 5 2007Jane G. Zapka ScD Heart failure is a serious clinical management challenge for both patients and primary care physicians. The authors studied the perceptions and practices of internal medicine residents and faculty at an academic medical center in the Southeast to guide design of strategies to improve heart failure care. Data were collected via a self-administered survey. Eighty-nine faculty and resident physicians in general internal medicine and geriatrics participated (74% response rate). Items measured perceived skills and barriers, adherence to guidelines, and physician understanding of patient prognosis. Case studies explored practice approaches. Clinical knowledge and related scales were generally good and comparable between physician groups. Palliative care and prognostic skills were self-rated with wide variance. Physicians rated patient noncompliance and low lifestyle change motivation as major barriers. Given the complexities of caring for elderly persons with heart failure and comorbid conditions, there are significant opportunities for improving physician skills in decision making, patient-centered counseling, and palliative care. [source] Prophylaxis of Hemicrania Continua: Two New Cases Effectively Treated With TopiramateHEADACHE, Issue 3 2007Filippo Brighina MD Hemicrania continua (HC) is an uncommon and under-recognized primary headache disorder characterized by a strictly unilateral continuous headache of moderate intensity with possible exacerbations and associated with ipsilateral autonomic features. HC has generally a prompt and enduring response to indomethacin although 25% to 50% of treated patients develop gastrointestinal side effects. These cases pose a difficult management challenge as no other drug is consistently effective in HC. Recently 2 HC patients responsive to topiramate treatment have been reported. Here we describe 2 more patients effectively treated with topiramate. Neither reported any side effects and one had persisting response for 6 months after drug withdrawal. [source] Creating social capital in MNCs: the international human resource management challengeHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 4 2007Sully Taylor Social capital has assumed a critical role in the successful implementation of global strategy for multinational companies (MNCs). The article focuses on the ways in which the international human resource management (IHRM) system and those responsible for it influence the creation and utilisation of social capital in MNCs. It examines the challenges posed to IHRM by the wide diversity of definitions and manifestations of social capital found in the multiple cultural contexts of the global business environment and provides a framework on how to approach the cultural influences on the definitions and behavioural expressions of social capital. It also critically assesses the recommendations that have been made regarding developing social capital in MNCs, the competencies most critical to the ability to develop social capital in multiple cultural settings, and provides a set of recommendations for future research in this area. [source] Post-cholecystectomy biliary strictures: Not always benignJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt2 2008Ajay Sharma Abstract Background:, Post-cholecystectomy malignant biliary obstruction masquerading as benign biliary stricture (BBS) has not been reported in the literature; it presents a diagnostic and management challenge. Methods:, Of the 349 post-cholecystectomy BBS managed at a tertiary care hospital in northern India between 1989 and 2004, 11 patients were found to have biliary malignancy. Records of these 11 patients were analyzed retrospectively for the purpose of this study. Results:, Mean age of patients with malignant biliary strictures was significantly higher (52 vs 38 years, P = 0.000); they were more likely to have jaundice (100% vs 78%, P = 0.008) and pruritus (82% vs 48%, P = 0.03). Unlike most patients with BBS referred from elsewhere to us, they had had a smooth postoperative course uncomplicated by bile leak, had a longer cholecystectomy-presentation interval, and were more likely to have high strictures ((Bismuth type III/IV) 91% vs 49%, P = 0.008). Conclusions:, Post-cholecystectomy biliary obstruction is not always benign. High bilirubin levels and hilar strictures, especially after an uneventful cholecystectomy, in a middle-aged patient should raise a suspicion of underlying missed malignancy. [source] A novel method of comparing the healing properties of two hydrogels in chronic leg ulcersJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2006M De La Brassinne Abstract Skin ulcers on the legs have a chronic, relapsing course and are often a significant management challenge. Novel methods of measuring and comparing the effects of different treatments can be of assistance in addressing this situation. A clinical pilot study using original methods was undertaken to compare the healing properties of the alginate gel Flaminal® (test) and the hydrocolloid gel Intrasite® (control) on chronic leg ulcers. The study was performed over a period of 28 days with two parallel groups of 10 patients. Both the surface (acetate tracing and planimetry) and the volume (Jeltrate® mould impression and weighting) of each wound were measured at baseline and after 7, 14 and 28 days of treatment. On both parameters results were superior with the test product compared to the control, with volume reduction being the first parameter to change. Between groups, difference in wound volume reduction was detected as early as day 7 whereas difference in surface reduction was clearly apparent only at day 28. Correlation between wound surface and volume reductions was also better in the test group (r = 0.843 vs. 0.421) than in the control. In conclusion, this pilot study suggests that combining wound surface and volume evaluations allows a more precise analysis of the healing process in venous leg ulcers and that this method is able to detect very early differences in treatments even with limited sample size. [source] Managing chronic hepatitis C in the difficult-to-treat patientLIVER INTERNATIONAL, Issue 10 2007Nyingi Kemmer Abstract Patients with chronic hepatitis C virus (HCV) infection and disease-related complications , among them cirrhosis and liver failure , pose a particular management challenge. Some of these patients may fail to respond to current therapy (non-responders), and some are affected so severely that treatment puts them at an unacceptable risk for complications. Treatment with pegylated interferon (peg-IFN) plus ribavirin improves hepatic enzyme levels and eradicates the virus in ,50% of patients; however, a significant number of patients do not respond to therapy or relapse following treatment discontinuation. Several viral, hepatic and patient-related factors influence response to IFN therapy; many of these factors cannot be modified to improve long-term outcomes. Identifying risk factors and measuring viral load early in the treatment can help to predict response to IFN therapy and determine the need to modify or discontinue treatment. Retreatment options for patients who have failed therapy are limited. Retreatment with peg-IFN has been successful in some patients who exhibit an inadequate response to conventional IFN treatment, particularly those who have relapsed. Consensus IFN, another option in treatment-resistant patients, has demonstrated efficacy in the retreatment of non-responders and relapsers. Although the optimal duration of retreatment and the benefits and safety of maintenance therapy have not been determined, an extended duration is likely needed. This article reviews the risk factors for HCV treatment resistance and discusses the assessment and management of difficult-to-treat patients. [source] Leprosy: Not always an easy diagnosis and often a management challengeAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2009Rachel Manifold SUMMARY Leprosy is rare in Australia, particularly in the southern states. We report two cases of leprosy in southern Australia that presented to the dermatology outpatients' department within a 4-month period. The presentation of the first case was complex, making the correct diagnosis difficult. Both cases involved immigrants from South-East Asia, were classified as multi-bacillary leprosy as defined by the World Health Organization, and were commenced on the recommended multiple drug therapy. The ensuing clinical course was complicated, with both cases developing Type 1 leprosy reactions. The first case also developed the rare but serious dapsone-induced delayed hypersensitivity reaction. [source] Using botulinum toxin for pelvic indications in womenAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Archana RAO Background: Botulinum toxin (BoNT) is a potent neurotoxin. Its ability to cause muscle paralysis is increasingly being utilised for the management of a number of conditions of interest to the gynaecologist. Aims: This review aims to give the reader an overview of the use of BoNT for conditions presenting a management challenge for the gynaecologist, such as chronic pelvic pain and idiopathic detrusor overactivity. Methods: The literature was reviewed regarding the use, side-effects and complications of BoNT in the pelvis, focussing on chronic pelvic pain, provoked vestibulodynia, conditions involving the lower gastrointestinal tract and detrusor overactivity. Results: In terms of pain caused by pelvic floor spasm, daily pelvic pain and dyspareunia are the symptoms most likely to be improved by BoNT. Limited data regarding use for provoked vestibulodynia indicate an improvement in pain scores. In the lower gastrointestinal tract, injection into puborectalis has been showed to objectively improve intravaginal pressures, though there are no randomised controlled trials (class I studies) validating its use in this setting. Class I studies demonstrate a role for BoNT in the management of idiopathic detrusor overactivity, though long-term follow-up data are lacking. Potential problems with BoNT injection include toxin reactions, urinary and faecal incontinence, urinary retention and secondary treatment failure due to antibody production. Conclusions: A single class I study supports the use of BoNT for refractory pelvic floor spasm; however, further adequately powered class I studies for this indication and for provoked vestibulodynia are warranted. [source] Benzofuran derivatives and the thyroidCLINICAL ENDOCRINOLOGY, Issue 1 2009T. S. Han Summary Amiodarone and dronedarone are two clinically important benzofuran derivatives. Amiodarone has been used widely for treating resistant tachyarrhythmias in the past three decades. However amiodarone and its main metabolically active metabolite desethylamiodarone can adversely affect many organs, including the thyroid gland. Amiodarone-induced thyroid disorders are common and often present as a management challenge for endocrinologists. The pathogenesis of amiodarone-induced thyroid dysfunction is complex but the inherent effects of the drug itself as well as its high iodine content appear to play a central role. The non-iodinated dronedarone also exhibits anti-arrhythmic properties but appears to be less toxic to the thyroid. This review describes the biochemistry of benzofuran derivatives, including their pharmacology and the physiology necessary for understanding the cellular mechanisms involved in their actions. The known effects of these compounds on thyroid action are described. Recommendations for management of amiodarone-induced hypothyroidism and thyrotoxicosis are suggested. Dronedarone appears to be an alternative but less-effective anti-arrhythmic agent and it does not have adverse effects on thyroid function. It may have a future role as an alternative agent in patients being considered for amiodarone therapy especially those at high risk of developing thyroid dysfunction but not in severe heart failure. [source] Identification of optimal poultry litter biorefinery location in Alabama through minimization of feedstock transportation costENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2008Burak Aksoy Abstract The estimated amount of poultry litter produced annually in Alabama is more than 1,250,000 tons. This large amount results in significant litter management challenges. Currently, poultry producers are facing many regulatory issues and challenges with respect to environmental impacts of litter management. Commercialization and implementation of environmentally benign biorefinery technologies have the potential to generate electric power (including on-site power) and heat as well as transportation fuels, hydrogen, valuable chemicals, and fertilizer from poultry litter economically while addressing environmental problems caused by traditional disposal practices. In this study, poultry litter generated annually in northern and southern Alabama was documented on the basis of published literature, and transportation cost of poultry litter is minimized for both north and south Alabama by the selection of the best large-scale biorefining facility location and optimal feedstock allocation using mathematical optimization techniques. The available portion of the existing poultry litter feedstock for a large scale biorefinery is found to be an important factor in determining transportation cost. Transportation cost increases several fold as the local feedstock availability for biorefining reduces from 100 to 50%. Optimum facility locations for both north and south Alabama were found within a 10 mile radius for three different poultry litter feedstock availabilities. © 2008 American Institute of Chemical Engineers Environ Prog, 2008 [source] Contrasting approaches to statistical regression in ecology and economicsJOURNAL OF APPLIED ECOLOGY, Issue 2 2009P. R. Armsworth Summary 1Conservation and natural resource management challenges are as much social problems as biological ones. In recognition of this fact, ecologists and economists work increasingly closely together. We discuss one barrier to effective integration of the two disciplines: put simply, many ecologists and economists approach statistical regression differently. 2Regression techniques provide the most commonly used approach for empirical analyses of land management decisions. Researchers from each discipline attribute differing importance to a range of possibly conflicting design criteria when formulating regression analyses. 3Ecologists commonly attribute greater importance to spatial autocorrelation and parsimony than do economists when designing regressions. Economists often attribute greater importance than ecologists to concerns about endogeneity and conformance with a priori theoretical expectations. 4Synthesis and applications. The differing importance attributed to different design characteristics may reflect a process of cultural drift within each discipline. Greater interdisciplinary collaboration can counteract this process by stimulating the flow of ideas and techniques across disciplinary boundaries. [source] Models, Assumptions, and Stakeholders: Planning for Water Supply Variability in the Colorado River Basin,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 2 2008Dustin Garrick Abstract:, Declining reservoir storage has raised the specter of the first water shortage on the Lower Colorado River since the completion of Glen Canyon and Hoover Dams. This focusing event spurred modeling efforts to frame alternatives for managing the reservoir system during prolonged droughts. This paper addresses the management challenges that arise when using modeling tools to manage water scarcity under variable hydroclimatology, shifting use patterns, and institutional complexity. Assumptions specified in modeling simulations are an integral feature of public processes. The policymaking and management implications of assumptions are examined by analyzing four interacting sources of physical and institutional uncertainty: inflow (runoff), depletion (water use), operating rules, and initial reservoir conditions. A review of planning documents and model reports generated during two recent processes to plan for surplus and shortage in the Colorado River demonstrates that modeling tools become useful to stakeholders by clarifying the impacts of modeling assumptions at several temporal and spatial scales. A high reservoir storage-to-runoff ratio elevates the importance of assumptions regarding initial reservoir conditions over the three-year outlook used to assess the likelihood of reaching surplus and shortage triggers. An ensemble of initial condition predictions can provide more robust initial conditions estimates. This paper concludes that water managers require model outputs that encompass a full range of future potential outcomes, including best and worst cases. Further research into methods of representing and communicating about hydrologic and institutional uncertainty in model outputs will help water managers and other stakeholders to assess tradeoffs when planning for water supply variability. [source] Chronic Pain in the Cancer Survivor: A New FrontierPAIN MEDICINE, Issue 2 2007Allen W. Burton MD ABSTRACT Objective., This monograph is intended to clarify the clinical problem of chronic pain in cancer patients. Design., A pertinent literature review on chronic pain syndromes in cancer patients was undertaken using Medline. Further, the treatment strategies for cancer versus chronic pain are contrasted and clarified. Results., With increasing cancer survivorship come new challenges in patient care. In the United States, the cancer-related death rate has dropped by 1.1% per year from 1993,2002. Seventy-five percent of children and two out of three adults will survive cancer, whereas 50 years ago just one out of four survived. The net effect of these trends and opportunities is a large and rapidly growing population of persons living longer with cancer and/or as cancer survivors. While agreement exists on the best strategies for assessment and treatment of most acute cancer pain syndromes, little consensus exists on the treatment of chronic pain in the patient with slowly progressive cancer or the cancer survivor. Conclusions., The landscape of "cancer pain" is shifting quickly into a chronic pain situation in many instances, thereby blurring previous lines of distinction in treatment strategies most suited for "chronic" versus "malignant" pain. Adopting chronic pain treatment strategies including pharmacologic and other pain control techniques, rehabilitation care, and psychological coping strategies may lead to optimal outcomes. Lastly, as cancer evolves into a chronic illness, with co-morbid conditions, recurrent cancer, and treatment toxicities from repeated antineoplastic therapies, pain management challenges in the oncologic patient continue to increase in complexity. [source] The Modern Call Center: A Multi-Disciplinary Perspective on Operations Management ResearchPRODUCTION AND OPERATIONS MANAGEMENT, Issue 6 2007Zeynep Aksin Call centers are an increasingly important part of today's business world, employing millions of agents across the globe and serving as a primary customer-facing channel for firms in many different industries. Call centers have been a fertile area for operations management researchers in several domains, including forecasting, capacity planning, queueing, and personnel scheduling. In addition, as telecommunications and information technology have advanced over the past several years, the operational challenges faced by call center managers have become more complicated. Issues associated with human resources management, sales, and marketing have also become increasingly relevant to call center operations and associated academic research. In this paper, we provide a survey of the recent literature on call center operations management. Along with traditional research areas, we pay special attention to new management challenges that have been caused by emerging technologies, to behavioral issues associated with both call center agents and customers, and to the interface between call center operations and sales and marketing. We identify a handful of broad themes for future investigation while also pointing out several very specific research opportunities. [source] Bauxite Mining Restoration by Alcoa World Alumina Australia in Western Australia: Social, Political, Historical, and Environmental ContextsRESTORATION ECOLOGY, Issue 2007John H. Gardner Abstract Alcoa World Alumina Australia mines bauxite under lease agreements with the Government of Western Australia. The leases lie in the Darling Range to the east of Perth, the capital and major population center. In addition to bauxite and other mineral ores, the Darling Range is a major potable water source and harbors a species-rich forest dominated by Jarrah (Eucalyptus marginata), a significant commercial timber. Conservation and recreation are important land uses in the region. Social and political pressures have led to stringent governmental requirements for restoration. In addition, a summer drought period, a soil deficient in most nutrients, water management challenges, an introduced disease, caused by Phytophthora cinnamomi Rands, and a post-mining ecosystem that must be conducive to the prescribed burning management of the region pose significant challenges to successful restoration. Alcoa presently mines and restores approximately 550 ha per annum. Although the "footprint" at the end of the life of the mining operations represents only about 4% of the total forest estate, Alcoa is committed to restoring the forest values of the region of all lands impacted by mining. The major objective of restoration is to enhance or maintain forest values by restoring habitat and structural characteristics of the native forest environment. Completion criteria for Alcoa's mine restoration have been developed. The original Alcoa mine at Jarrahdale has been rehabilitated, and in 2005, a 975-ha area received a "certificate of completion" and was returned to the management control of the State of Western Australia. [source] The mouth in HIV/AIDS: markers of disease status and management challenges for the dental professionAUSTRALIAN DENTAL JOURNAL, Issue 2010NW Johnson Abstract There are over 30 million people in the world with HIV infection and, whilst the rate of new infections is slowing, this number continues to grow. Although in Australia the overall prevalence of HIV infection in adults aged 15,49 is officially estimated at only 0.2%, representing less than 20 000 people living with HIV and AIDS, our geographical area contains populations with prevalences exceeding 10 times this. Oral health professionals must therefore practise safe, standard infection control at all times and be aware of the oral manifestations of HIV disease. These are predominantly opportunistic infections with fungi such as Candida albicans or with viruses of the herpes family, particularly herpes simplex, herpes zoster and Epstein-Barr virus infections. Warts or papillomas may arise due to human papilloma viruses , even in individuals on effective antiretroviral therapy. Rare types of fungal infection can occur, and severe bacterial infections, notably tuberculosis, are an ever-present risk. Susceptibility to periodontal breakdown is somewhat enhanced by the effects of HIV disease itself, and caries activity may increase because the patient neglects attention to diet and oral hygiene. Restorative and periodontal care need, therefore, to be maintained at a high level. Oral opportunistic infections cause much distress and the diagnosis and management of these is the responsibility of our profession. [source] Strategies for the endodontic management of concurrent endodontic and periodontal diseasesAUSTRALIAN DENTAL JOURNAL, Issue 2009PV Abbott Abstract Endodontic and periodontal diseases can provide many diagnostic and management challenges to clinicians, particularly when they occur concurrently. As with all diseases, a thorough history combined with comprehensive clinical and radiographic examinations are all required so an accurate diagnosis can be made. This is essential since the diagnosis will determine the type and sequence of treatment required. This paper reviews the relevant literature and proposes a new classification for concurrent endodontic and periodontal diseases. This classification is a simple one that will help clinicians to formulate management plans for when these diseases occur concurrently. The key aspects are to determine whether both types of diseases are present, rather than just having manifestations of one disease in the alternate tissue. Once it is established that both diseases are present and that they are as a result of infections of each tissue, then the clinician must determine whether the two diseases communicate via the periodontal pocket so that appropriate management can be provided using the guidelines outlined. In general, if the root canal system is infected, endodontic treatment should be commenced prior to any periodontal therapy in order to remove the intracanal infection before any cementum is removed. This avoids several complications and provides a more favourable environment for periodontal repair. The endodontic treatment can be completed before periodontal treatment is provided when there is no communication between the disease processes. However, when there is communication between the two disease processes, then the root canals should be medicated until the periodontal treatment has been completed and the overall prognosis of the tooth has been reassessed as being favourable. The use of non-toxic intracanal therapeutic medicaments is essential to destroy bacteria and to help encourage tissue repair. [source] | ||||||||||||||||