The Process of Writing a Case Study of the Third Kind to Teach the Management of Change

The Process of Writing a Case Study of the Third Kind to Teach the Management of Change This paper is about the process of writing a case study of the third kind to teach the management of change. The theoretical model I chose to structure my case study is the one proposed by John Kotter. After the first section where I explain the background to this project, the second section contains the pertinent literature and the third one the process plan I followed. While the fourth section contains the case study I wrote, the fifth summarizes my key learnings. Finally, this project ends with a sixth section where I conclude my project and propose directions for the students who will follow our path

Primitive model electrolytes. A comparison of the HNC approximation for the activity coefficient with Monte Carlo data

Accuracy of the mean activity coefficient expression (Hansen-Vieillefosse-Belloni equation), valid within the hypernetted chain (HNC) approximation, was tested in a wide concentration range against new Monte Carlo (MC) data for +1:-1 and +2:-2 primitive model electrolytes. The expression has an advantage that the excess chemical potential can be obtained directly, without invoking the time consuming Gibbs-Duhem calculation. We found the HNC results for the mean activity coefficient to be in good agreement with the machine calculations performed for the same model. In addition, the thermodynamic consistency of the HNC approximation was tested. The mean activity coefficients, calculated via the Gibbs-Duhem equation, seem to follow the MC data slightly better than the Hansen-Vieillefosse-Belloni expression. For completeness of the calculation, the HNC excess internal energies and osmotic coefficients are also presented. These results are compared with the calculations based on other theories commonly used to describe electrolyte solutions, such as the mean spherical approximation, Pitzer's extension of the Debye-H\"uckel theory, and the Debye-H\"uckel limiting law.Comment: 15 pages, 6 figure

Bird flight behavior, collision risk and mitigation options at high-speed railway viaducts

High-speed railway (HSR) networks are rapidly expanding and are predicted to continue to grow over coming decades. However, there is scant knowledge of their environmental impacts. Their possible effects on bird mortality, particularly at viaducts, gives especial cause for concern. This work presents the results of a nine-month monitoring of bird activity in the vicinity of three HSR viaducts in Central Spain. The study focused on the effects of the infrastructure regarding bird frequentation of the site and on bird flight activity in the danger zone for collision with passing trains. The findings show (i) that bird communities may differ markedly between sites and (ii) that bird activity increases near the railway together with changes in relative species abundances. Furthermore, (iii) birds show a significant tendency to avoid flying across the danger zone, but (iv) all kinds of birds are at a real risk of collisions with trains at viaducts. The greatest danger is at viaduct extremes rather than in their central section, particularly during gusts of wind and for small or medium-sized birds. It also appears that relatively low viaducts might pose greater risk. In practical terms, these results (i) emphasise the need for thorough prior prospection of bird species present, and their flight patterns, where new viaducts are to be built, (ii) show that there is a real risk of bird collisions with trains at viaducts, which should be mitigated, with particular attention due to viaduct extremes and areas where their height is not much above the surrounding vegetation and (iii) strongly indicate the need to minimise viaduct features that may attract birds to them, for example as potential nest sitesThis study is derived from research into the ecology and mortality of birds at highspeed railways done under project EU LIFE+ Impacto Cero (LIFE 12 BIO/ES/000660). JEM and JH form part of the REMEDINAL TE-CM research network, funded by the Comunidad de Madrid (P2018/ EMT-4338). Comments by two anonymous reviewers improved the final tex

Primary Care Physiciansʼ Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination

BACKGROUND: Expert recommendations do not recommend using Papanicolaou (Pap) or human papillomavirus (HPV) test results to determine whether unvaccinated women should receive HPV vaccine, nor do they recommend using vaccine receipt to inform cervical cancer screening practices. This study characterizes physicians' HPV vaccine recommendations and practices in the context of HPV and Pap testing. METHODS: We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to women (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated women. RESULTS: Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated women. About 41% reported recommendation-consistent practices with all 3 measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. CONCLUSIONS: Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately

Factors Related to Malaria in Pregnant Women in the Work Area of Kambaniru Health Center East Sumba District

Background: This disease is one of the major health problems in NTT province. Where the disease is still the cause of death for infants, toddlers and pregnant women.Nearly 90% of villages in NTT province make up almost 100% of malaria endemic villages. Pregnant women in malaria endemic areas have a high risk,because the impact of malaria will cause anemia and malaria treatment will affect the growth and development of the fetus it contains,the worst can also cause pain and death and fetus. Methods: This research metode is analytic observational research with cross sectional study design approach.The study was conducted from September to October 2017 in pregnant women in the working area of Puskesmas Kambaniru.The sampling technique used was random samplimg,66 samples of total population of 198 pregnant women.The instrument used in this study is a questionnaire. Results: The result of the research will be analyzed by univariate and bivariate analysis by using linear regression.The result of this research can be knowledge (0.017) and attitude (0.001).While the external factors of the incidence of malaria in pregnant women are related variable health care facilities (0.018)

Comparison of four-times-a-day and twice-a-day dosing regimens in subjects requiring 1200 μg or less of budesonide to control mild to moderate asthma

AbstractThe aim of this study was to compare the efficacy, compliance and side-effects of budesonide administered twice daily (b.d.) and four times a day (q.d.) with a Turbuhaler® device in asthmatic subjects requiring ≤ 1200 μg daily. The randomized, parallel group study design included a 2-week baseline period followed by a 6–12-month treatment period. Subjects were assessed at regular intervals in hospital through FEV1, PC20 methacholine, adrenal function and throat swabs. They were asked to record their symptoms and PEF values morning and evening at home. An asthmatic flare-up, which was the main outcome resulting in a patient's termination of the study, was defined beforehand as (a) 25% or greater diurnal variability in PEF for 2 consecutive days, and/or (b) nocturnal awakenings due to asthma symptoms 2 days or more in the same week and/or (c) an increase (doubling or more) in the need for inhaled bronchodilator 2 days in the same week.Fifty-eight adult asthmatic subjects (20 males and 38 females) entered the study, one-half being randomly assigned to the b.d. regimen and one-half to the q.d. regimen. Fourteen subjects were on 400 μg, 15 subjects on 800 μg and 29 subjects on 1200 μg of budesonide daily. Seventeen flare-ups were recorded in the b.d. regimen group as opposed to 11 in the q.d. regimen (P=0·05), significant differences being found in the 800 and 1200 μg groups (a total of 13 flare-ups in the b.d. group and eight flare-ups in the q.d. group for the two doses, P=0·01). Kaplan-Meier survival analysis yielded similar results. There was no significant difference in FEV1, PC20 or cortisol levels during the study on either regimen. Throat symptoms and growth of Candida albicans were more common in the q.d. group. Compliance assessed by the number of times the Turbuhaler® device was actuated was significantly better in the b.d. group (95%) as compared with the q.d. group (83%). To conclude, administering inhaled budesonide with a Turbuhaler® device on a q.d. basis results in fewer flare-ups in spite of less satisfactory compliance and more common, local side-effects than on a b.d. regimen at daily doses of 800 and 1200 μg

Postharvest heat treatments to inhibit Penicillium digitatum growth and maintain quality of Mandarin (Citrus reticulata blanco)

Use of fungicides is a common practice as a postharvest treatment to control fruit decay. Nowadays, environment-friendly technologies, such as heat treatments, are viable replacements. This study evaluated the effects of post-harvest heat treatments (traditional and microwave-assisted) on mandarins intentionally inoculated with Penicillium digitatum. For the studied heat treatments, the target temperature was 50C, which was held for 2.5 min. After heating, mandarins were cooled and stored at 25C for 13 days. MW treatments effectively prevented mold growth during storage, while HW only delayed it. Control mandarins (without treatment) showed the highest significant weight loss. Neither thermal treatment nor storage affected fruit juice pH (p \u3e 0.05). Treated mandarins had a significantly lower vitamin C content than control fruits throughout storage, and all mandarins lost firmness by the 13th day (p \u3c 0.05). Control and MW-treated mandarins had lower citric acid content; however, they retained color, total soluble solids (TSS) and had a higher maturity index. While HW mandarins did not have changes in citric acid content, they had higher TSS, and lower maturity index. MW-assisted treatments were effective at inactivating molds and helped retain some nutritional and physical-chemical characteristics of mandarins. However, juice of MW-treated mandarins was not preferred by judges in the sensory tests, the juice was rated lower than that obtained from the other treatment. Postharvest heat treatments may constitute a helpful application to control mandarin’ fungal decay

Messages to Motivate Human Papillomavirus Vaccination: National Studies of Parents and Physicians

Physician communication about human papillomavirus (HPV) vaccine is a key determinant of uptake. To support physician communication, we sought to identify messages that would motivate HPV vaccination

Co-prescription patterns of cardiovascular preventive treatments: A cross-sectional study in the Aragon worker' health study (Spain)

Objectives: To identify cardiovascular disease (CVD) preventive treatments combinations, among them and with other drugs, and to determine their prevalence in a cohort of Spanish workers. Design: Cross-sectional study. Setting Aragon Workers'' Health Study (AWHS) cohort in Spain. Participants 5577 workers belonging to AWHS cohort. From these subjects, we selected those that had, at least, three prescriptions of the same therapeutic subgroup in 2014 (n=4605). Primary and secondary outcome measures Drug consumption was obtained from the Aragon Pharmaceutical Consumption Registry (Farmasalud). In order to know treatment utilisation, prevalence analyses were conducted. Frequent item set mining techniques were applied to identify drugs co-prescription patterns. All the results were stratified by sex and age. Results: 42.3% of men and 18.8% of women in the cohort received, at least, three prescriptions of a CVD preventive treatment in 2014. The most prescribed CVD treatment were antihypertensives (men: 28.2%, women 9.2%). The most frequent association observed among CVD preventive treatment was agents acting on the renin-angiotensin system and lipid-lowering drugs (5.1% of treated subjects). Co-prescription increased with age, especially after 50 years old, both in frequency and number of associations, and was higher in men. Regarding the association between CVD preventive treatments and other drugs, the most frequent pattern observed was lipid-lowering drugs and drugs used for acid related disorders (4.2% of treated subjects). Conclusions: There is an important number of co-prescription patterns that involve CVD preventive treatments. These patterns increase with age and are more frequent in men. Mining techniques are a useful tool to identify pharmacological patterns that are not evident in the individual clinical practice, in order to improve drug prescription appropriateness

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive “announcements” or participatory “conversations.