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Sample records for challenges facing pediatric

  1. "Pedogeriatrics": a pediatric nephrologist's outlook on common challenges facing pediatric and geriatric nephrologists.

    PubMed

    Grünberg, Jose

    2010-03-01

    Dramatic demographic changes longevity and medical progress helped create a new population made up of the survivors of previously fatal diseases. These trends pose new major social and economic challenges that should be accounted for in health policy making. This paper discusses the similarities between the specialties of pediatrics and geriatrics, especially in the realm of patient care. Children and the elderly share a limited autonomy and dependence on the human environment (i.e., willing and able caregiving persons) due to age or disease. The long-term care of dependent patients (DP) requires caregiving persons who share with dependent persons the risk of losing autonomy, facing burnout, family disruption, and interference with work and educational activities. Families with DPs may face potential losses of income because both patients and caregivers are partially or completely unable to work, the former for medical reasons and the latter due to the new demands on their time and energy. Additionally, new expenses have to be met because while direct medical expenses might be covered by insurance or the State, other expenses have to be financed by the family, such as co-payments for medicines, new water or electricity home installations, and transport and eventual hotel costs if they have to stay overnight near a hospital outside of their town. The main objectives of long-term care should be to maximize patients' independence and prevent their physical and psychological deterioration while minimizing the social, economic and personal costs to caregivers. To achieve these goals, one needs a holistic approach, a multidisciplinary professional team (doctors, nurses, social workers, nutritionists and psychologists) and auxiliary staff (secretaries, electricians, administrators, messengers, cleaning staff, doormen, nursing aids and coordinators of medical appointments and medical procedures). Optimal management of DPs on chronic treatments such as chronic dialysis

  2. Pediatric Sedation: A Global Challenge

    PubMed Central

    Gozal, David; Mason, Keira P.

    2010-01-01

    Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established certification and credentials for sedation delivery whereas most have not. Some of the relevant sedation guidelines and recommendations of specialty organizations worldwide will be explored. The challenge facing sedation care providers moving forward in the 21st century will be to determine how to apply the local, regional and national guidelines to the individual sedation practices. A greater challenge, perhaps impossible, will be to determine whether the sedation community can come together worldwide to develop standards, guidelines and recommendations for safe sedation practice. PMID:20981309

  3. The interRAI Pediatric Home Care (PEDS HC) Assessment: Evaluating the Long-term Community-Based Service and Support Needs of Children Facing Special Healthcare Challenges

    PubMed Central

    Phillips, Charles D; Hawes, Catherine

    2015-01-01

    The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity—explaining significant proportions of the variance in parents’ perceptions of needs, case managers’ service authorizations, and Medicaid program expenditures for long-term community-based services and supports. In addition, PEDS HC items have been used to construct scales that summarize the strengths and needs of children facing special healthcare challenges. Versions of the PEDS HC are now being used in Medicaid programs in three states in the United States. PMID:26401100

  4. Unique challenges faced by pediatric neurosurgeon Harvey Cushing in 1909 at Johns Hopkins: a choroid plexus tumor of the lateral ventricle mimicking a cerebellar lesion

    PubMed Central

    Pendleton, Courtney; Olivi, Alessandro; Jallo, George I.

    2015-01-01

    Introduction At the turn of the twentieth century, diagnosis of pediatric intracranial lesions frequently relied exclusively on the subtle, nonspecific signs associated with these pathologies. In absence of detailed neuroimaging, erroneous diagnoses and misdirected operative explorations were common within pediatric populations. Methods Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the surgical files from the Johns Hopkins Hospital for the years 1896–1912. Harvey Cushing's neurosurgical cases were collected and further analyzed. Results A 9-year-old boy presented with a year-long history of headaches and blindness. His neurological examination was remarkable for focal cranial nerve deficits and cerebellar signs. Cushing diagnosed a cerebellar tumor with hydrocephalus and performed two suboccipital explorations with negative results. The patient died prior to further operative intervention, and the postmortem examination revealed a large choroid plexus tumor within the left lateral ventricle. Conclusions Early neurosurgical diagnosis and operative planning was fraught with difficulties, and surgeons relied solely on history and physical examination for localization of intracranial lesions. Here we report a case of a choroid plexus tumor of the lateral ventricle, which was misdiagnosed by Cushing. This case serves to emphasize the unique challenges faced by pediatric neurosurgeons at the turn of the twentieth century, who relied solely on history and examination to localize intracranial lesions. PMID:21494884

  5. Challenges Facing Special Education.

    ERIC Educational Resources Information Center

    Meyen, Edward L., Ed.; And Others

    This book presents 17 selected papers from recent issues of the journal, "Focus on Exceptional Children," concerning current and emerging challenges facing the field of special education. The book is organized in two parts. Part 1, "Contemporary Challenges," includes the following articles: "Transitions in Early Childhood Special Education: Issues…

  6. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    PubMed Central

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

  7. Challenges facing production grids

    SciTech Connect

    Pordes, Ruth; /Fermilab

    2007-06-01

    Today's global communities of users expect quality of service from distributed Grid systems equivalent to that their local data centers. This must be coupled to ubiquitous access to the ensemble of processing and storage resources across multiple Grid infrastructures. We are still facing significant challenges in meeting these expectations, especially in the underlying security, a sustainable and successful economic model, and smoothing the boundaries between administrative and technical domains. Using the Open Science Grid as an example, I examine the status and challenges of Grids operating in production today.

  8. Persistent pharmacokinetic challenges to pediatric drug development

    PubMed Central

    Sage, Daniel P.; Kulczar, Christopher; Roth, Wyatt; Liu, Wanqing; Knipp, Gregory T.

    2014-01-01

    The development of new therapeutic agents for the mitigation of pediatric disorders is largely hindered by the inability for investigators to assess pediatric pharmacokinetics (PK) in healthy patients due to substantial safety concerns. Pediatric patients are a clinical moving target for drug delivery due to changes in absorption, distribution, metabolism and excretion (ADME) and the potential for PK related toxicological (T) events to occur throughout development. These changes in ADMET can have profound effects on drug delivery, and may lead to toxic or sub-therapeutic outcomes. Ethical, economical, logistical, and technical barriers have resulted in insufficient investigation of these changes by industrial, regulatory, and academic bodies, leading to the classification of pediatric patients as therapeutic orphans. In response to these concerns, regulatory agencies have incentivized investigation into these ontogenic changes and their effects on drug delivery in pediatric populations. The intent of this review is to briefly present a synopsis of the development changes that occur in pediatric patients, discuss the effects of these changes on ADME and drug delivery strategies, highlight the hurdles that are still being faced, and present some opportunities to overcome these challenges. PMID:25221567

  9. Pediatric palliative care and pediatric medical ethics: opportunities and challenges.

    PubMed

    Feudtner, Chris; Nathanson, Pamela G

    2014-02-01

    The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions. PMID:24488535

  10. Facing Tomorrow's Challenges - An Overview

    USGS Publications Warehouse

    U.S. Geological Survey

    2008-01-01

    In 2007, the U.S. Geological Survey (USGS) developed a science strategy outlining the major natural-science issues facing the Nation in the next decade. The science strategy consists of six science directions of critical importance, focusing on areas where natural science can make a substantial contribution to the well-being of the Nation and the world. This fact sheet is an overview of the science strategy and describes how USGS research can strengthen the Nation with information needed to meet the challenges of the 21st century.

  11. Computer Face Scale for Measuring Pediatric Pain and Mood

    PubMed Central

    Gulur, Padma; Rodi, Scott W.; Washington, Tabitha A.; Cravero, Joseph P.; Fanciullo, Gilbert J.; McHugo, Gregory J.; Baird, John C.

    2009-01-01

    This investigation determined the psychometric properties and acceptability of an animated face scale presented on a hand-held computer as a means to measure pediatric pain and mood. In Study 1, seventy nine hospitalized, pediatric patients indicated their levels of pain by adjusting the expression of an animated cartoon face. The first objective was to determine feasibility, concurrent validity, and acceptability of the method. All patients were tested both with the Computer Face Scale and the poster format of the Wong-Baker Faces Scale. A second objective was to evaluate test-retest reliability of the method. In Study 2, fifty hospitalized, pediatric patients were tested on two occasions, but in this case the patients used the Computer Face Scale to indicate both their pain (how much they hurt) and their mood (how they felt). Children in Study 1 were able to use the Computer Face Scale to express relative amounts of pain/hurt; the method showed concurrent validity with the Wong-Baker Face Scale; and most children expressed a preference for the Computer Face Scale. The method also showed adequate test-retest reliability. In Study 2 adequate test-retest reliability was demonstrated for ratings of both pain and mood. Perspective The Computer Face Scale allows the health provider to obtain reliable and valid measures of pediatric pain and mood. The method can be understood and used by children as young as three years, and is also appropriate for use with adults. PMID:19010740

  12. Sponge systematics facing new challenges.

    PubMed

    Cárdenas, P; Pérez, T; Boury-Esnault, N

    2012-01-01

    Systematics is nowadays facing new challenges with the introduction of new concepts and new techniques. Compared to most other phyla, phylogenetic relationships among sponges are still largely unresolved. In the past 10 years, the classical taxonomy has been completely overturned and a review of the state of the art appears necessary. The field of taxonomy remains a prominent discipline of sponge research and studies related to sponge systematics were in greater number in the Eighth World Sponge Conference (Girona, Spain, September 2010) than in any previous world sponge conferences. To understand the state of this rapidly growing field, this chapter proposes to review studies, mainly from the past decade, in sponge taxonomy, nomenclature and phylogeny. In a first part, we analyse the reasons of the current success of this field. In a second part, we establish the current sponge systematics theoretical framework, with the use of (1) cladistics, (2) different codes of nomenclature (PhyloCode vs. Linnaean system) and (3) integrative taxonomy. Sponges are infamous for their lack of characters. However, by listing and discussing in a third part all characters available to taxonomists, we show how diverse characters are and that new ones are being used and tested, while old ones should be revisited. We then review the systematics of the four main classes of sponges (Hexactinellida, Calcispongiae, Homoscleromorpha and Demospongiae), each time focusing on current issues and case studies. We present a review of the taxonomic changes since the publication of the Systema Porifera (2002), and point to problems a sponge taxonomist is still faced with nowadays. To conclude, we make a series of proposals for the future of sponge systematics. In the light of recent studies, we establish a series of taxonomic changes that the sponge community may be ready to accept. We also propose a series of sponge new names and definitions following the PhyloCode. The issue of phantom species

  13. Challenges in pediatric renal transplantation

    PubMed Central

    Peruzzi, Licia; Amore, Alessandro; Coppo, Rosanna

    2014-01-01

    Transplantation in children is the best option to treat renal failure. Over the last 25 years the improvements in therapy have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Tolerance of the graft and minimization of side effects are the challenges for improving the outcome of children with a grafted kidney. Notwithstanding the difficulties in settling in children large multicenter trials to derive statistically useful data, many important contributions in the last years brought important modifications in the immunosuppressive therapy, including minimization protocols of steroids and calcineurin inhibitors and new induction drugs. New methods for diagnosis of anti HLA antibodies and some new protocols to improve both chance and outcome of transplantation in immunized subjects represent area of ongoing research of extreme interest for children. PMID:25540732

  14. An Emerging Field of Research: Challenges in Pediatric Decision Making

    PubMed Central

    Lipstein, Ellen A.; Brinkman, William B.; Fiks, Alexander G.; Hendrix, Kristin S.; Kryworuchko, Jennifer; Miller, Victoria A.; Prosser, Lisa A.; Ungar, Wendy J.; Fox, David

    2014-01-01

    There is growing interest in pediatric decision science, spurred by policies advocating for children’s involvement in medical decision making. Challenges specific to pediatric decision research include: the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this manuscript are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and establish a blueprint for future research that will contribute to high quality pediatric medical decision making. Much work has been done toward addressing gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum. PMID:25145576

  15. Challenges Facing Group Work Online

    ERIC Educational Resources Information Center

    Chang, Bo; Kang, Haijun

    2016-01-01

    Online group work can be complicated because of its asynchronous characteristics and lack of physical presence, and its requirements for skills in handling technology, human relationships, and content-related tasks. This study focuses on the administrative, logistical and relationship-related challenges in online group work. Challenges in areas…

  16. Pediatric dental sedation: challenges and opportunities

    PubMed Central

    Nelson, Travis M; Xu, Zheng

    2015-01-01

    High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of

  17. Facing Violence - A Global Challenge.

    PubMed

    Wenzel, Thomas; Kienzler, Hanna; Wollmann, Andreas

    2015-09-01

    Violence has been shown to be a global challenge resulting in long-lasting social, medical, and mental health sequelae. In this article, we focus on massive social violence, such as war and civil war. Social suffering and mental health problems related to violence as a global public health problem can be tackled only with a holistic approach that addresses the specific region, culture and group and the limited resources available in most countries. Research that can give a reliable assessment of complex long-term outcomes is still largely missing, and can be seen as a major and complex challenge for future study. PMID:26300037

  18. Gender-Specific Health Challenges Facing Women

    MedlinePlus

    ... Specific Health Challenges Facing Women Questions and Answers Science Advances Skip Website Tools Website Tools Print this page Get email updates Order publications Volunteer for Clinical Studies Help improve ...

  19. Challenge of pediatric oncology in Africa.

    PubMed

    Hadley, Larry G P; Rouma, Bankole S; Saad-Eldin, Yasser

    2012-05-01

    The care of children with malignant solid tumors in sub-Saharan Africa is compromised by resource deficiencies that range from inadequate healthcare budgets and a paucity of appropriately trained personnel, to scarce laboratory facilities and inconsistent drug supplies. Patients face difficulties accessing healthcare, affording investigational and treatment protocols, and attending follow-up. Children routinely present with advanced local and metastatic disease and many children cannot be offered any effective treatment. Additionally, multiple comorbidities, including malaria, tuberculosis, and HIV when added to acute on chronic malnutrition, compound treatment-related toxicities. Survival rates are poor. Pediatric surgical oncology is not yet regarded as a health care priority by governments struggling to achieve their millennium goals. The patterns of childhood solid malignant tumors in Africa are discussed, and the difficulties encountered in their management are highlighted. Three pediatric surgeons from different regions of Africa reflect on their experiences and review the available literature. The overall incidence of pediatric solid malignant tumor is difficult to estimate in Africa because of lack of vital hospital statistics and national cancer registries in most of countries. The reported incidences vary between 5% and 15.5% of all malignant tumors. Throughout the continent, patterns of malignant disease vary with an obvious increase in the prevalence of Burkitt lymphoma (BL) and Kaposi sarcoma in response-increased prevalence of HIV disease. In northern Africa, the most common malignant tumor is leukemia, followed by brain tumors and nephroblastoma or neuroblastoma. In sub-Saharan countries, BL is the commonest tumor followed by nephroblastoma, non-Hodgkin lymphoma, and rhabdomyosarcoma. The overall 5-years survival varied between 5% (in Côte d'Ivoire before 2001) to 34% in Egypt and up to 70% in South Africa. In many reports, the survival rate of

  20. Challenges and Changes Faced by Rural Superintendents

    ERIC Educational Resources Information Center

    Lamkin, Marcia L.

    2006-01-01

    This research study was designed to build grounded theory about the challenges faced by rural superintendents. Participating rural superintendents identified five areas that presented a challenge but that also applied to superintendents in other settings: school law, finance, personnel, government mandates, and district or board policies. Further,…

  1. Overcoming obstacles: challenges of caring for an urban pediatric population.

    PubMed

    Cuthbert-Allman, C; Burrows, K

    1998-05-01

    There are many challenges to working with pediatric patients at home, and they are complicated when the family lives in the inner city. The VNA of Boston has overcome many of the challenges through its unique Maternal Child Health team--a good model for any pediatric care team. PMID:10180154

  2. Exploring the challenges faced by polytechnic students

    NASA Astrophysics Data System (ADS)

    Matore, Mohd Effendi @ Ewan Mohd; Khairani, Ahmad Zamri

    2015-02-01

    This study aims to identify other challenges besides those already faced by students, in seven polytechnics in Malaysia as a continuation to the previous research that had identified 52 main challenges faced by students using the Rasch Model. The explorative study focuses on the challenges that are not included in the Mooney Problem Checklist (MPCL). A total of 121 polytechnic students submitted 183 written responses through the open questions provided. Two hundred fifty two students had responded from a students' perspective on the dichotomous questions regarding their view on the challenges faced. The data was analysed qualitatively using the NVivo 8.0. The findings showed that students from Politeknik Seberang Perai (PSP) gave the highest response, which was 56 (30.6%) and Politeknik Metro Kuala Lumpur (PMKL) had the lowest response of 2 (1.09%). Five dominant challenges were identified, which were the English language (32, 17.5%), learning (14, 7.7%), vehicles (13, 7.1%), information technology and communication (ICT) (13, 7.1%), and peers (11, 6.0%). This article, however, focus on three apparent challenges, namely, English language, vehicles, as well as computer and ICT, as the challenges of learning and peers had been analysed in the previous MPCL. The challenge of English language that had been raised was regarding the weakness in commanding the aspects of speech and fluency. The computer and ICT challenge covered the weakness in mastering ICT and computers, as well as computer breakdowns and low-performance computers. The challenge of vehicles emphasized the unavailability of vehicles to attend lectures and go elsewhere, lack of transportation service in the polytechnic and not having a valid driving license. These challenges are very relevant and need to be discussed in an effort to prepare polytechnics in facing the transformational process of polytechnics.

  3. Transitioning Challenges Faced by Chinese Graduate Students

    ERIC Educational Resources Information Center

    Huang, Ying

    2012-01-01

    This literature review examines transitioning challenges faced by Chinese international students who pursue graduate degrees in the United States. Based on existing research on adulthood in U.S. and Chinese contexts and the features of Chinese graduate students, Chinese adults, and international students as learners in Western countries, the…

  4. Challenges Beginning Teachers Face in Hong Kong

    ERIC Educational Resources Information Center

    Lam, Bick-Har

    2014-01-01

    By conducting in-depth interviews with new teachers who are about to become full-time teachers and then reinterviewing them two years later, the author of this article presents how beginning teachers think and feel about teaching and describes the challenges they face as beginning teachers in the context of Hong Kong. The stories of the teachers,…

  5. Challenges Facing Early Childhood Programs Worldwide

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2008-01-01

    In this article, the author presents the challenges faced by early childhood education in 29 countries, according to the World Forum National Representatives and Global Leaders for Young Children. The countries represented in these responses include: Azerbaijan, Bangladesh, Bolivia, Brazil, Canada, Denmark, Egypt, Fiji, India, Iran, Iraq, Japan,…

  6. Cultural Challenges Faced by Mexican Immigrant Students

    ERIC Educational Resources Information Center

    Zugel, Kevin

    2012-01-01

    This purpose of this investigation is to explore the cultural challenges faced by Mexican immigrant students through the study of current literature. Four themes emerged as a result of the investigation: dominant pedagogy, educational skills, deficit model, and student identities. The themes are discussed and suggestions are made as to how these…

  7. Anatomy Education Faces Challenges in Pakistan

    ERIC Educational Resources Information Center

    Memon, Ismail K.

    2009-01-01

    Anatomy education in Pakistan is facing many of the same challenges as in other parts of the world. Roughly, a decade ago, all medical and dental colleges in Pakistan emphasized anatomy as a core basic discipline within a traditional medical science curriculum. Now institutions are adopting problem based learning (PBL) teaching philosophies, and…

  8. Fiber quality challenges facing the cotton industry

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The cotton industry is in the midst of an exciting time with increased domestic consumption, but also facing pressure from other crops and the global marketplace. In order to ensure the US cotton crop remains the fiber of choice for the world it is important to keep an eye on the challenges to fibe...

  9. Pharmacogenetics in clinical pediatrics: challenges and strategies

    PubMed Central

    Van Driest, Sara L; McGregor, Tracy L

    2013-01-01

    The use of genetic information to guide medication decisions holds great promise to improve therapeutic outcomes through increased efficacy and reduced adverse events. As in many areas of medicine, pediatric research and clinical implementation in pharmacogenetics lag behind corresponding adult discovery and clinical applications. In adults, genotype-guided clinical decision support for medications such as clopidogrel, warfarin and simvastatin are in use in some medical centers. However, research conducted in pediatric populations demonstrates that the models and practices developed in adults may be inaccurate in children, and some applications lack any pediatric research to guide clinical decisions. To account for additional factors introduced by developmental considerations in pediatric populations and provide pediatric patients with maximal benefit from genotype-guided therapy, the field will need to develop and employ creative solutions. In this article, we detail some concerns about research and clinical implementation of pharmacogenetics in pediatrics, and present potential mechanisms for addressing them. PMID:24363766

  10. Supreme Court rejects challenge to FACE.

    PubMed

    1996-10-25

    On October 7, the US Supreme Court declined to hear Skott vs. US, a case challenging the Freedom of Access to Clinic Entrances Act (FACE). The 1994 law makes it a federal crime to use or attempt to use force, threat of force, or physical obstruction to injure, intimidate, or interfere with reproductive health care providers and their patients. The case came to the High Court after the US Court of Appeals for the Seventh Circuit overturned an earlier district court ruling and upheld the constitutionality of the federal statute in December 1995. Six Wisconsin anti-choice protestors, who had been arrested in September 1994 after participating in a blockade of a Milwaukee women's health facility, had successfully petitioned the US District Court for the Eastern District of Wisconsin to dismiss criminal charges based on FACE. While the district court held that Congress had no authority under the Commerce Clause or under the Fourteenth Amendment of the US Constitution to enact FACE, the appellate panel found that the lower court had not given sufficient consideration to congressional findings that the activities restricted by FACE substantially affect interstate commerce and are subject to the regulatory power of Congress. FACE has been upheld by the US Courts of Appeal for the Fourth, Eighth, and Eleventh Circuits and eleven federal district courts. Two district courts have found the law invalid. This marks the third time the High Court has refused to hear a challenge to the law. PMID:12320456

  11. Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge

    PubMed Central

    Ademuyiwa, Adesoji O; Usang, Usang E; Oluwadiya, Kehinde S; Ogunlana, Dare I; Glover-Addy, Hope; Bode, Chris O; Arjan, B Van A S

    2012-01-01

    All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge. PMID:22416156

  12. Challenges Facing Early Career Academic Cardiologists

    PubMed Central

    Tong, Carl W.; Ahmad, Tariq; Brittain, Evan L.; Bunch, T. Jared; Damp, Julie B.; Dardas, Todd; Hijar, Amalea; Hill, Joseph A.; Hilliard, Anthony A.; Houser, Steven R.; Jahangir, Eiman; Kates, Andrew M.; Kim, Darlene; Lindman, Brian R.; Ryan, John J.; Rzeszut, Anne K.; Sivaram, Chittur A.; Valente, Anne M.; Freeman, Andrew M.

    2014-01-01

    Early-career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology (ACC) completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: (1) definition of categories of early career academic cardiologists, (2) general challenges to all categories and specific challenges to each category, (3) obstacles as identified by a survey of current early career members of the ACC, (4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute (NIH/NHLBI) career development grants, (5) potential solutions, and (6) a call to action with specific recommendations. PMID:24703919

  13. Pediatric cataract: challenges and future directions

    PubMed Central

    Medsinge, Anagha; Nischal, Ken K

    2015-01-01

    Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract. PMID:25609909

  14. Pediatric cataract: challenges and future directions.

    PubMed

    Medsinge, Anagha; Nischal, Ken K

    2015-01-01

    Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract. PMID:25609909

  15. Key challenges facing American nurse leaders.

    PubMed

    Thompson, Pamela A

    2008-11-01

    What are the key challenges facing nurse leaders in the United States? To find out, I asked 20 prominent nurse leaders to respond to that question and tell me their top three issues. Their voices tell a compelling story on challenges faced by the nurse leaders in American healthcare. The focus is no longer just on the process of how care is delivered, but on the outcomes of that care. More attention is being given to documenting that the care is provided according to specific standards associated with better outcomes. Many of the standards are directly related to the care given by nurses, including some indicators that are specifically sensitive to nurse intervention. There is also a new focus on federal reporting of patient satisfaction with the services provide. Producing quality outcomes, high patient satisfaction and effective measurements of both are now a central theme for the entire hospital administrative team. For the nurse leader, however, it represents explicit accountability for managing and leading the staff responsible for providing the patient care. Safety and quality issues are directly linked to financial pressure. Reimbursement for hospital is being whittled away as financial accountability for services receives greater scrutiny from the federal government and private insurers. Close on the heels of the financial challenge is the ever present workforce shortage. The most troublesome challenge identified by these nurse leaders is the absence of an adequate pipeline for nursing leaders. It is an exciting time for nursing in the United States. Challenges to be sure, but these nurse leaders have identified the priorities that will create a successful future. PMID:19094102

  16. Current challenges in pediatric pulmonary hypertension.

    PubMed

    Takatsuki, Shinichi; Ivy, David Dunbar

    2013-10-01

    Pulmonary arterial hypertension (PAH) in the pediatric population is associated with a variety of underlying diseases and causes, significantly morbidity and mortality. In the majority of patients, PAH in children is idiopathic or associated with congenital heart disease (CHD), with pulmonary hypertension (PH) associated with connective tissue disease, a rare cause in children. Classification of pediatric PH has generally followed the WHO classification, but recognition of the importance of fetal origins of PH and developmental abnormalities have led to the formation of a new pediatric-specific classification. Incidence data from the Netherlands has revealed an annual incidence and point prevalence of 0.7 and 4.4 for idiopathic PAH and 2.2 and 15.6 for associated pulmonary arterial hypertension-CHD cases per million children. Although the treatment with new selective pulmonary vasodilators offers hemodynamic and functional improvement in pediatric populations, the treatments in children largely depend on results from evidence-based adult studies and experience of clinicians treating children. A recent randomized clinical trial of sildenafil and its long-term extension has led to disparate recommendations in the United States and Europe. PMID:24037630

  17. Facing adolescence and adulthood: the importance of mental health care in the global pediatric AIDS epidemic.

    PubMed

    Domek, Gretchen J

    2009-04-01

    With the increasing global accessibility of antiretrovirals, many HIV-positive children now face a future once thought impossible. As these children grow, they face unique psychosocial stressors that differ from any previous chronic or incurable childhood illness. Studies have already described an increased prevalence of mental health disorders among this population. In addition, other studies have illustrated the known future health consequences of adverse childhood experiences, similar but not related to the HIV/AIDS epidemic. This article connects these studies and predicts the grave future health consequences likely to be faced if pediatric mental health care is not addressed. Practical solutions are described that often go hand-in-hand with the current global scale-up of antiretroviral accessibility. These include scaling-up mental health services, educating communities, supporting school-based programs, promoting the role of nongovernmental organizations, and strengthening families and the community to provide a safe and secure home environment for children. HIV-positive children are likely to face future physical and psychological health consequences related to the psychosocial challenges they face as children if mental health care is not made a priority in the current global fight against AIDS. PMID:19363366

  18. The challenges facing wearable sensor systems.

    PubMed

    McAdams, Eric; Gehin, Claudine; Massot, Bertrand; McLaughlin, James

    2012-01-01

    It has been pointed out that, in spite of significant national and international funding programmes, there is a dearth of successfully commercialised wearable monitoring systems. Although problems such as financial reimbursement, device interoperability and the present lack of the required connected healthcare infrastructure are major hurdles to the provision of remote clinical monitoring of home-based patients, the "Mount Everest" of monitoring applications, why are wearable systems not already commercialised and used in less demanding applications? The numerous wearable systems which appear on the Web and even in the literature are, for the most part, basic prototypes unsuited to the demands of real-life applications. SMEs which do seek to commercialise clinically promising systems are unfortunately faced with many challenges and few as yet have survived long enough to successfully commercialise their innovations. PMID:22942054

  19. Challenges in pediatric inflammatory bowel disease.

    PubMed

    Bousvaros, Athos; Sylvester, Francisco; Kugathasan, Subra; Szigethy, Eva; Fiocchi, Claudio; Colletti, Richard; Otley, Anthony; Amre, Devendra; Ferry, George; Czinn, Steven J; Splawski, Judy B; Oliva-Hemker, Maria; Hyams, Jeffrey S; Faubion, William A; Kirschner, Barbara S; Dubinsky, Marla C

    2006-09-01

    It is estimated that of the >1 million individuals in the United States with inflammatory bowel disease (IBD), approximately 100,000 are children. IBD that begins in childhood affects the individual at a critical period of growth and development. Children with Crohn's disease and ulcerative colitis may experience complications such as growth failure, school absence, and depression. In addition, because children with IBD have fewer environmental confounders such as smoking, children may be an excellent population to study microbial and immune interactions. Despite these opportunities, the discipline of pediatric IBD investigation is still in its infancy. In September of 2005, a group of investigators with expertise in pediatric IBD met in Boston (Massachusetts) to review the current status of childhood IBD research and to develop research priorities that warranted funding from the Crohn's and Colitis Foundation of America. The group included pediatricians, internists, basic scientists, clinical investigators, and members of the administrative staff and board of the Crohn's and Colitis Foundation of America. The research needs in respective areas were outlined by the heads of 10 focus groups, each with expertise in their respective fields (genetics, psychosocial issues, epidemiology, microbiology, immunology, quality improvement, pharmacogenomics, nutrition, growth and skeletal health, and clinical trials). Before the conference, heads of the research focus groups developed their proposals with experts in the field. At the end of the conference, members of the focus groups and members of the steering committee rated the proposed areas of study in terms of feasibility and importance. It was recommended that the Crohn's and Colitis Foundation of America focus its initial efforts in pediatric IBD in 5 areas: the effects of inflammation on growth and skeletal development, the genetics of early-onset IBD, the development of quality improvement interventions to standardize

  20. Challenges and Promises of Pediatric Psychopharmacology.

    PubMed

    Giles, Lisa L; Martini, D Richard

    2016-08-01

    Most prescriptions for psychotropic medications are written by primary care physicians, yet pediatricians, many of whom are teaching residents and medical students about pediatric psychopharmacology, often feel inadequately trained to treat mental health concerns. Over the past several decades, the number, size, and quality of psychopharmacologic studies in youth has greatly increased. Here we review the current evidence for efficacy and safety of each of the major pharmacologic drug classes in youth (psychostimulants, antidepressants, mood stabilizers, and antipsychotics). Psychostimulants have a robust body of literature supporting their evidence as first-line treatment for attention-deficit/hyperactivity disorder. Selective serotonin reuptake inhibitors (SSRIs) have documented efficacy for pediatric depression and multiple different anxiety disorders with childhood onset. Combining cognitive-behavioral therapy with SSRI treatment enhances treatment benefit and minimizes adverse events of medication. Mood stabilizers, including lithium and anticonvulsant medications, have a less robust strength of evidence and come with more problematic side effects. However, they are increasingly prescribed to youth, often to treat irritability, mood lability, and aggression, along with treatment of bipolar disorder. Antipsychotics have long been a mainstay of treatment for childhood-onset schizophrenia, and in recent years, the evidence base for providing antipsychotics to youth with bipolar mania and autistic disorder has grown. Most concerning with antipsychotics are the metabolic side effects, which appear even more problematic in youth than adults. By better understanding the evidence-based psychopharmacologic interventions, academic pediatricians will be able to treat patients and prepare future pediatrician to address the growing mental health care needs of youth. PMID:27064142

  1. Clinical and economic challenges facing pharmacogenomics.

    PubMed

    Cohen, J; Wilson, A; Manzolillo, K

    2013-08-01

    In this paper, we examine the clinical and economic challenges that face developers of and payers for personalized drugs and companion diagnostics. We review and summarize clinical, regulatory and reimbursement issues with respect to eight, high profile personalized medicines and their companion diagnostics. Subsequently, we determine Medicare parts B and D reimbursement of the eight drugs from publicly available databases. Finally, we utilize surveys-each tailored to three key stakeholders; payers, drug and diagnostic developers, and pharmacogenomic expert analysts-to assess reimbursement of diagnostics, analyze the role that different kinds of evidence have in informing prescribing and reimbursement decisions, as well as the specific clinical, regulatory and economic challenges that confront pharmacogenomics as it moves forward. We found that Medicare beneficiary access to physician-administered (Medicare part B) drugs is relatively unfettered, with a fixed patient co-insurance percentage of 20%. More reimbursement restrictions are placed on self-administered (Medicare part D) drugs, which translates into higher and more variable cost sharing, more use of prior authorization and quantity limits. There is a lack of comprehensive reimbursement of companion diagnostics, even in cases in which the diagnostic is on the label and recommended or required by the Food and Drug Administration. Lack of evidence linking diagnostic tests to health outcomes has caused payers to be skeptical about the clinical usefulness of tests. Expert analysts foresee moderate growth in post-hoc development of companion diagnostics to personalize already approved drugs, and limited growth in the concurrent co-development of companion diagnostics and personalized medicines. Lack of clinically useful diagnostics as well as an evidence gap in terms of knowledge of drug and diagnostic clinical effectiveness appear to be hindering growth in personalized medicine. An increase in comparative

  2. The Challenges of Interfacing between Face-To-Face and Online Instruction.

    ERIC Educational Resources Information Center

    Dabbagh, Nada H.

    2000-01-01

    Discussion of the development and use of Web-based instruction in higher education focuses on issues of course content; technological assumptions; logistical and implementation challenges; interfacing between face-to-face and online learning environments; and the use of a Web-based course management tool to support face-to-face instruction. (LRW)

  3. Droughts and water scarcity: facing challenges

    NASA Astrophysics Data System (ADS)

    Pereira, Luis S.

    2014-05-01

    Water scarcity characterizes large portions of the world, particularly the Mediterranean area. It is due to natural causes - climate aridity, which is permanent, and droughts, that are temporary - and to human causes - long term desertification and short term water shortages. Droughts aggravate water scarcity. Knowledge has well developed relative to all processes but management tools still are insufficient as well as the tools required to support appropriate planning and management. Particularly, new approaches on tools for assessing related impacts in agriculture and other economic and social activities are required. Droughts occur in all climates but their characteristics largely differ among regions both in terms frequency, duration and intensity. Research has already produced a large number of tools that allow appropriate monitoring of droughts occurrence and intensity, including dynamics of drought occurrence and time evolution. Advances in drought prediction already are available but we still are far from knowing when a drought will start, how it will evolve and when it dissipates. New developments using teleconnections and GCM are being considered. Climate change is a fact. Are droughts occurrence and severity changing with global change? Opinions are divided about this subject since driving factors and processes are varied and tools for the corresponding analysis are also various. Particularly, weather data series are often too short for obtaining appropriate answers. In a domain where research is producing improved knowledge and innovative approaches, research faces however a variety of challenges. The main ones, dealt in this keynote, refer to concepts and definitions, use of monitoring indices, prediction of drought initiation and evolution, improved assessment of drought impacts, and possible influence of climate change on drought occurrence and severity.

  4. Challenges Facing Design and Analysis Tools

    NASA Technical Reports Server (NTRS)

    Knight, Norman F., Jr.; Broduer, Steve (Technical Monitor)

    2001-01-01

    The design and analysis of future aerospace systems will strongly rely on advanced engineering analysis tools used in combination with risk mitigation procedures. The implications of such a trend place increased demands on these tools to assess off-nominal conditions, residual strength, damage propagation, and extreme loading conditions in order to understand and quantify these effects as they affect mission success. Advances in computer hardware such as CPU processing speed, memory, secondary storage, and visualization provide significant resources for the engineer to exploit in engineering design. The challenges facing design and analysis tools fall into three primary areas. The first area involves mechanics needs such as constitutive modeling, contact and penetration simulation, crack growth prediction, damage initiation and progression prediction, transient dynamics and deployment simulations, and solution algorithms. The second area involves computational needs such as fast, robust solvers, adaptivity for model and solution strategies, control processes for concurrent, distributed computing for uncertainty assessments, and immersive technology. Traditional finite element codes still require fast direct solvers which when coupled to current CPU power enables new insight as a result of high-fidelity modeling. The third area involves decision making by the analyst. This area involves the integration and interrogation of vast amounts of information - some global in character while local details are critical and often drive the design. The proposed presentation will describe and illustrate these areas using composite structures, energy-absorbing structures, and inflatable space structures. While certain engineering approximations within the finite element model may be adequate for global response prediction, they generally are inadequate in a design setting or when local response prediction is critical. Pitfalls to be avoided and trends for emerging analysis tools

  5. The carbon dioxide challenge facing aviation

    NASA Astrophysics Data System (ADS)

    Hileman, James I.; De la Rosa Blanco, Elena; Bonnefoy, Philippe A.; Carter, Nicholas A.

    2013-11-01

    This paper investigates the challenge that U.S. aviation would face in meeting future Greenhouse Gas (GHG) reduction goals to mitigate global climate change via technological options. This investigation is done within a framework that considers aviation GHG emissions as a function of aviation growth, aircraft efficiency, operational efficiency, and life cycle GHG emissions of aviation fuels. The concept of life cycle GHG intensity (LGI) with units of grams carbon dioxide equivalent per payload distance traveled is used for this purpose as it can be decomposed into components that quantify improvements in aircraft design, operations, and alternative fuels. For example, the life cycle GHG intensity of U.S. aviation in 2005 was 1.37 g CO2e/kg km. If U.S. aviation is to meet the IATA 2050 goal of a 50% reduction in CO2 relative to a 2005 baseline while allowing for a 3.2% annual growth rate in payload-distance traveled, it will need to decrease to 0.22 g CO2e/kg km in 2050, an 84% reduction. The analysis framework that is developed in this manuscript was used to compare the improvements in life cycle GHG intensity that could accompany the use of advanced aircraft designs, operational improvements, and alternative fuels to those required on a fleet-wide basis to meet the future GHG reduction goals under varied aviation growth scenarios. The results indicate that the narrow body segment of the fleet could indeed meet ambitious goals of reducing GHG emissions by 50%, relative to 2005 levels, with a 3.2% annual growth rate; however, it would require relatively rapid adoption of innovative aircraft designs and the widespread use of alternative fuels with relatively low life cycle GHG emissions.

  6. Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge

    PubMed Central

    Pacifico, Lucia; Poggiogalle, Eleonora; Cantisani, Vito; Menichini, Guendalina; Ricci, Paolo; Ferraro, Flavia; Chiesa, Claudio

    2010-01-01

    The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determining the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nature of the study design. The natural history of pediatric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk population, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninvasive alternatives that will allow the prognosis of pediatric NAFLD to be followed in large community or population-based studies. PMID:21161009

  7. Psychosocial challenges facing physicians of today.

    PubMed

    Arnetz, B B

    2001-01-01

    Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the

  8. Challenges Facing Teachers New to Working in Schools Overseas

    ERIC Educational Resources Information Center

    Halicioglu, Margaret L.

    2015-01-01

    This article considers the potential challenges facing teachers moving abroad for the first time, both professional challenges in their school and personal challenges in their private life. It suggests that such teachers embarking on a professional adventure overseas would benefit from careful consideration of the kind of school they will thrive…

  9. Facing Multiculturalism's Challenges in Korean Education and Society

    ERIC Educational Resources Information Center

    Olneck, Michael R.

    2011-01-01

    Multicultural policy in South Korea faces variants of challenges endemic to multiculturalism. These challenges are "dilemmas of difference," "variable terms of inclusion," and "legitimacy." In Korea, these challenges arise in a setting in which ethnic diversity is of relatively recent origin, an ideology of ethnic homogeneity is prevalent, and…

  10. An Exploration of Challenges Facing Division III Athletic Directors

    ERIC Educational Resources Information Center

    Engbers, Jeffrey L.

    2011-01-01

    The purpose of this study was to establish a basic understanding of the challenges associated with directing athletic programs at NCAA Division III Institutions. Specifically, this study identified the frequency, intensity, and time allocated to common challenges facing the position of the NCAA Division III AD. The challenges were examined using…

  11. CHALLENGES FACING HIGH POWER PROTON ACCELERATORS

    SciTech Connect

    Plum, Michael A

    2013-01-01

    This presentation will provide an overview of the challenges of high power proton accelerators such as SNS, J-PARC, etc., and what we have learned from recent experiences. Beam loss mechanisms and methods to mitigate beam loss will also be discussed.

  12. Early sex -- early motherhood: facing the challenge.

    PubMed

    1996-01-01

    This article reviews the causes and consequences of adolescent sex behavior and adolescent pregnancy and motherhood. The article opens by noting that adolescents give birth to 15 million babies annually despite their increased risk resulting from biological and social vulnerability. Risky sex behavior is seen to result from gender power imbalances and from "clustering" of high-risk behaviors. Lack of contraceptives, particularly condoms, increases risk of acquiring a sexually transmitted disease or HIV infection as well as the risk of pregnancy. Adolescent sexual activity also doubles the lifetime risk of acquiring cervical cancer. Pregnant adolescents are more likely than mature women to have eclampsia or obstructed labor with its attendant complication of obstetric fistula. Adolescents are also less likely to seek prenatal care and face a higher risk of death during delivery. Adolescents also account for a large proportion of abortion complications because they undergo illegal or late procedures. Babies born to adolescents risk low birth weight, prematurity, and a higher rate of perinatal mortality. Adolescent mother also face social ostracism and reduced ability to acquire a job or education. Research into adolescent sexuality is best undertaken with the input of adolescents themselves (an example is the World Health Organization's narrative research method). Adolescent health can be promoted by creation of a safe and supportive environment and by provision of 1) information, 2) opportunities for adolescents to develop skills to negotiate sexual encounters, 3) counseling, and 4) youth-friendly adolescent health services. PMID:12292434

  13. The Challenges Facing Staff Development in Promoting Quality Online Teaching

    ERIC Educational Resources Information Center

    Weaver, Debbi

    2006-01-01

    This article describes the evolution of an academic professional development program, related to the use of WebCT in teaching programs, and discusses the challenges that have arisen for the members of the staff development team since the original implementation of the program. The training program begins with face-to-face workshops, covering…

  14. Children at Risk: Global Views on Challenges Facing Children

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2011-01-01

    Members of the World Forum community were invited to respond to the question: "What is the most urgent challenge facing young children in your country?" Here are some of their responses. Jamils Richard Achunji Anguaseh mentions that in Cameroon, young children face lots of insecurity, both from health hazards and poor parenting practices. There…

  15. Issues and challenges facing rechargeable lithium batteries.

    PubMed

    Tarascon, J M; Armand, M

    2001-11-15

    Technological improvements in rechargeable solid-state batteries are being driven by an ever-increasing demand for portable electronic devices. Lithium-ion batteries are the systems of choice, offering high energy density, flexible and lightweight design, and longer lifespan than comparable battery technologies. We present a brief historical review of the development of lithium-based rechargeable batteries, highlight ongoing research strategies, and discuss the challenges that remain regarding the synthesis, characterization, electrochemical performance and safety of these systems. PMID:11713543

  16. Emotional Face Processing in Pediatric Bipolar Disorder: Evidence for Functional Impairments in the Fusiform Gyrus

    PubMed Central

    Perlman, Susan B.; Fournier, Jay C.; Bebko, Genna; Bertocci, Michele A.; Hinze, Amanda K.; Bonar, Lisa; Almeida, Jorge R. C.; Versace, Amelia; Schirda, Claudiu; Travis, Michael; Gill, Mary Kay; Demeter, Christine; Diwadkar, Vaibhav A.; Sunshine, Jeffrey L.; Holland, Scott K.; Kowatch, Robert. A.; Birmaher, Boris; Axelson, David; Horwitz, Sarah M.; Arnold, L. Eugene; Fristad, Mary. A; Youngstrom, Eric A.; Findling, Robert L.; Phillips, Mary L.

    2013-01-01

    Objective Pediatric bipolar disorder involves poor social functioning, but the neural mechanisms underlying these deficits are not well understood. Previous neuroimaging studies have found deficits in emotional face processing localized to emotional brain regions. However, few studies have examined dysfunction in other regions of the face processing circuit. This study assessed hypoactivation in key face processing regions of the brain in pediatric bipolar disorder. Method Youth with a bipolar spectrum diagnosis (n=20) were matched to a nonbipolar clinical group (n=20), with similar demographics and comorbid diagnoses, and a healthy control group (n=20). Youth participated in a functional magnetic resonance imaging (fMRI) scanning which employed a task-irrelevant emotion processing design in which processing of facial emotions was not germane to task performance. Results Hypoactivation, isolated to the fusiform gyrus, was found when viewing animated, emerging facial expressions of happiness, sadness, fearfulness, and especially anger in pediatric bipolar participants relative to matched clinical and healthy control groups. Conclusions The results of the study imply that differences exist in visual regions of the brain’s face processing system and are not solely isolated to emotional brain regions, such as the amygdala. Findings are discussed in relation to facial emotion recognition and fusiform gyrus deficits previously reported in the autism literature. Behavioral interventions targeting attention to facial stimuli might be explored as possible treatments for bipolar disorder in youth. PMID:24290464

  17. Challenges Faced by Project Competition Participants and Recommended Solutions

    ERIC Educational Resources Information Center

    Demirel, Turgay; Baydas, Ozlem; Yilmaz, Rabia M.; Goktas, Yuksel

    2013-01-01

    The numbers of project competitions and interest in this kind of competition have been steadily increasing in Turkey. Accordingly, it is important to determine what challenges teachers and students may face while preparing themselves for project competitions, so that recommendations may be made to overcome these challenges. This study investigated…

  18. Deans' Balancing Acts: Education Leaders and the Challenges They Face.

    ERIC Educational Resources Information Center

    Gmelch, Walter H., Ed.

    This collection of papers addresses the personal challenges academics face in successfully responding to "the call" to academic leadership, focusing on who academic deans are, unique challenges to women deans, stress impacting deans' ability to lead, keys to successful entry into the deanship, organizational strategies for leading successfully,…

  19. More Realistic Face Model Surface Improves Relevance of Pediatric In-Vitro Aerosol Studies

    PubMed Central

    Amirav, Israel; Halamish, Asaf; Gorenberg, Miguel; Omar, Hamza; Newhouse, Michael T.

    2015-01-01

    Background Various hard face models are commonly used to evaluate the efficiency of aerosol face masks. Softer more realistic “face” surface materials, like skin, deform upon mask application and should provide more relevant in-vitro tests. Studies that simultaneously take into consideration many of the factors characteristic of the in vivo face are lacking. These include airways, various application forces, comparison of various devices, comparison with a hard-surface model and use of a more representative model face based on large numbers of actual faces. Aim To compare mask to “face” seal and aerosol delivery of two pediatric masks using a soft vs. a hard, appropriately representative, pediatric face model under various applied forces. Methods Two identical face models and upper airways replicas were constructed, the only difference being the suppleness and compressibility of the surface layer of the “face.” Integrity of the seal and aerosol delivery of two different masks [AeroChamber (AC) and SootherMask (SM)] were compared using a breath simulator, filter collection and realistic applied forces. Results The soft “face” significantly increased the delivery efficiency and the sealing characteristics of both masks. Aerosol delivery with the soft “face” was significantly greater for the SM compared to the AC (p< 0.01). No statistically significant difference between the two masks was observed with the hard “face.” Conclusions The material and pliability of the model “face” surface has a significant influence on both the seal and delivery efficiency of face masks. This finding should be taken into account during in-vitro aerosol studies. PMID:26090661

  20. Heart transplantation: challenges facing the field.

    PubMed

    Tonsho, Makoto; Michel, Sebastian; Ahmed, Zain; Alessandrini, Alessandro; Madsen, Joren C

    2014-05-01

    There has been significant progress in the field of heart transplantation over the last 45 years. The 1-yr survival rates following heart transplantation have improved from 30% in the 1970s to almost 90% in the 2000s. However, there has been little change in long-term outcomes. This is mainly due to chronic rejection, malignancy, and the detrimental side effects of chronic immunosuppression. In addition, over the last decade, new challenges have arisen such as increasingly complicated recipients and antibody-mediated rejection. Most, if not all, of these obstacles to long-term survival could be prevented or ameliorated by the induction of transplant tolerance wherein the recipient's immune system is persuaded not to mount a damaging immune response against donor antigens, thus eliminating the need for chronic immunosuppression. However, the heart, as opposed to other allografts like kidneys, appears to be a tolerance-resistant organ. Understanding why organs like kidneys and livers are prone to tolerance induction, whereas others like hearts and lungs are tolerance-resistant, could aid in our attempts to achieve long-term, immunosuppression-free survival in human heart transplant recipients. It could also advance the field of pig-to-human xenotransplantation, which, if successful, would eliminate the organ shortage problem. Of course, there are alternative futures to the field of heart transplantation that may include the application of total mechanical support, stem cells, or bioengineered whole organs. Which modality will be the first to reach the ultimate goal of achieving unlimited, long-term, circulatory support with minimal risk to longevity or lifestyle is unknown, but significant progress in being made in each of these areas. PMID:24789875

  1. Heart Transplantation: Challenges Facing the Field

    PubMed Central

    Tonsho, Makoto; Michel, Sebastian; Ahmed, Zain; Alessandrini, Alessandro; Madsen, Joren C.

    2014-01-01

    There has been significant progress in the field of heart transplantation over the last 45 years. The 1-yr survival rates following heart transplantation have improved from 30% in the 1970s to almost 90% in the 2000s. However, there has been little change in long-term outcomes. This is mainly due to chronic rejection, malignancy, and the detrimental side effects of chronic immunosuppression. In addition, over the last decade, new challenges have arisen such as increasingly complicated recipients and antibody-mediated rejection. Most, if not all, of these obstacles to long-term survival could be prevented or ameliorated by the induction of transplant tolerance wherein the recipient’s immune system is persuaded not to mount a damaging immune response against donor antigens, thus eliminating the need for chronic immunosuppression. However, the heart, as opposed to other allografts like kidneys, appears to be a tolerance-resistant organ. Understanding why organs like kidneys and livers are prone to tolerance induction, whereas others like hearts and lungs are tolerance-resistant, could aid in our attempts to achieve long-term, immunosuppression-free survival in human heart transplant recipients. It could also advance the field of pig-to-human xenotransplantation, which, if successful, would eliminate the organ shortage problem. Of course, there are alternative futures to the field of heart transplantation that may include the application of total mechanical support, stem cells, or bioengineered whole organs. Which modality will be the first to reach the ultimate goal of achieving unlimited, long-term, circulatory support with minimal risk to longevity or lifestyle is unknown, but significant progress in being made in each of these areas. PMID:24789875

  2. Pediatric intraoral high-flow arteriovenous malformation: a diagnostic challenge.

    PubMed

    Petel, Roy; Ashkenazi, Malka

    2014-01-01

    Arteriovenous malformations (AVMs) are rarely reported in the dental pediatric literature. They may develop adjacent to primary molars and can be life-threatening due to their potential for massive bleeding. The most common symptom associated with documented cases of AVMs is spontaneous gingival bleeding. Other clinical signs include pain, erythematous gingiva, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic lesions. The purpose of this report was to describe the challenge of diagnosis of a high-flow arteriovenous malformation located in the primary maxillary molar region, which was misdiagnosed as a dentoalveolar abscess adjacent to previously treated primary molars. A decision to extract a tooth with gingival swelling and associated spontaneous bleeding should be made after the differential diagnosis of a vascular malformation has been ruled out. PMID:25303512

  3. Challenges and Opportunities Facing Technology Education in Taiwan

    ERIC Educational Resources Information Center

    Lee, Lung-Sheng Steven

    2009-01-01

    The technology education in Taiwan is prescribed in the national curriculum and provided to all students in grades 1-12. However, it faces the following challenges: (1) Lack of worthy image, (2) Inadequate teachers in elementary schools, (3) Deficient teaching vitality in secondary schools, and (4) Diluted technology teacher education programs. In…

  4. Challenges Facing Higher Educational Administrators Down Under in the Eighties.

    ERIC Educational Resources Information Center

    Seagren, Alan T.; Doyle, Ken J.

    The changing perspectives of higher educational administration in Australia are traced from the growth of the 1960s and early 1970s to the period of contraction, since 1975. Three major challenges facing administrators in the period ahead are identified: problems of continuing institutional viability with the threat of government intervention;…

  5. Challenges Facing Principals in the First Year at Their Schools

    ERIC Educational Resources Information Center

    Bayar, Adem

    2016-01-01

    The aim of this study is to identify key challenges of practice that principals face. In line with this purpose, the researcher has employed a qualitative research methodology, interviewing principals working in Amasya district, over and above doing document analysis to collect detailed information concerning leadership and administration…

  6. Strategies for the Challenges Facing Women in Higher Education Administration.

    ERIC Educational Resources Information Center

    Rehnke, Mary Ann

    Women administrators in higher education must deal not only with the usual challenges facing administrators (decision-making, resolving conflict, and advancing professionally), but also with the effects of sex stereotyping. Women are not seen as decision-makers, nor as conflict-resolvers, and are often viewed as supporting personnel rather than…

  7. Challenges School Principals Facing in the Context of Technology Leadership

    ERIC Educational Resources Information Center

    Sincar, Mehmet

    2013-01-01

    The purpose of this study is to determine the challenges school principals facing in the context of technology leadership. This is a qualitative case study guided by the National Educational Technology Standards for Administrators (NETS*A). Six elementary school principals working in a large city in southeastern Turkey participated into the study.…

  8. The Challenges of Blending a Face-to-Face Laboratory Experience with a Televised Distance Education Course

    ERIC Educational Resources Information Center

    LeDrew, June; Cummings-Vickaryous, Bonnie

    2010-01-01

    This article describes the practical challenges faced by instructors who must blend a face-to-face laboratory experience into a distance education course. This issue is discussed in the context of an ongoing kinesiology and health course that includes a mandatory physical activity laboratory experience. The challenges that have arisen around this…

  9. Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting.

    PubMed

    Mixer, Sandra J; Carson, Emily; McArthur, Polly M; Abraham, Cynthia; Silva, Krystle; Davidson, Rebecca; Sharp, Debra; Chadwick, Jessica

    2015-01-01

    Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients. PMID:26072213

  10. Solutions to Challenges Facing a University Digital Library and Press

    PubMed Central

    D'Alessandro, Michael P.; Galvin, Jeffrey R.; Colbert, Stephana I.; D'Alessandro, Donna M.; Choi, Teresa A.; Aker, Brian D.; Carlson, William S.; Pelzer, Gay D.

    2000-01-01

    During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses. PMID:10833161

  11. Challenges Facing Healthwatch, a New Consumer Champion in England

    PubMed Central

    Carter, Pam; Martin, Graham

    2016-01-01

    This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people’s views. PMID:27239869

  12. Challenges Facing Healthwatch, a New Consumer Champion in England.

    PubMed

    Carter, Pam; Martin, Graham

    2016-01-01

    This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people's views. PMID:27239869

  13. Quo Vadis 2010? – Carpe Diem: Challenges and Opportunities in Pediatric Traumatic Brain Injury

    PubMed Central

    Kochanek, Patrick M.; Bell, Michael J.; Bayır, Hülya

    2011-01-01

    Traumatic brain injury (TBI) in infants and children remains a public health problem of enormous magnitude. It is a complex and heterogeneous condition that presents many diagnostic, therapeutic and prognostic challenges. A number of investigative teams are studying pediatric TBI both in experimental models and in clinical studies at the bedside. This review builds on work presented in a prior supplement to Developmental Neuroscience that was published in 2006, and addresses several active areas of research on this topic, including (1) the application of novel imaging methods, (2) the use of serum and/or CSF biomarkers of injury, (3) advances in neuromonitoring, (4) the development and testing of novel therapies, (5) developments in modeling pediatric TBI, (6) the consideration of a new approach to classification of pediatric TBI, and (7) assessing the potential impact of the development of pediatric and neonatal neurocritical care services on the management and outcome of pediatric TBI. PMID:21252553

  14. Objective 3D face recognition: Evolution, approaches and challenges.

    PubMed

    Smeets, Dirk; Claes, Peter; Vandermeulen, Dirk; Clement, John Gerald

    2010-09-10

    Face recognition is a natural human ability and a widely accepted identification and authentication method. In modern legal settings, a lot of credence is placed on identifications made by eyewitnesses. Consequently these are based on human perception which is often flawed and can lead to situations where identity is disputed. Therefore, there is a clear need to secure identifications in an objective way based on anthropometric measures. Anthropometry has existed for many years and has evolved with each advent of new technology and computing power. As a result of this, face recognition methodology has shifted from a purely 2D image-based approach to the use of 3D facial shape. However, one of the main challenges still remaining is the non-rigid structure of the face, which can change permanently over varying time-scales and briefly with facial expressions. The majority of face recognition methods have been developed by scientists with a very technical background such as biometry, pattern recognition and computer vision. This article strives to bridge the gap between these communities and the forensic science end-users. A concise review of face recognition using 3D shape is given. Methods using 3D shape applied to data embodying facial expressions are tabulated for reference. From this list a categorization of different strategies to deal with expressions is presented. The underlying concepts and practical issues relating to the application of each strategy are given, without going into technical details. The discussion clearly articulates the justification to establish archival, reference databases to compare and evaluate different strategies. PMID:20395086

  15. Challenges Facing 3-D Audio Display Design for Multimedia

    NASA Technical Reports Server (NTRS)

    Begault, Durand R.; Null, Cynthia H. (Technical Monitor)

    1998-01-01

    The challenges facing successful multimedia presentation depend largely on the expectations of the designer and end user for a given application. Perceptual limitations in distance, elevation and azimuth sound source simulation differ significantly between headphone and cross-talk cancellation loudspeaker listening and therefore must be considered. Simulation of an environmental context is desirable but the quality depends on processing resources and lack of interaction with the host acoustical environment. While techniques such as data reduction of head-related transfer functions have been used widely to improve simulation fidelity, another approach involves determining thresholds for environmental acoustic events. Psychoacoustic studies relevant to this approach are reviewed in consideration of multimedia applications

  16. Challenges and considerations for development of therapeutic proteins in pediatric patients.

    PubMed

    Zhang, Yi; Wei, Xiaohui; Bajaj, Gaurav; Barrett, Jeffrey S; Meibohm, Bernd; Joshi, Amita; Gupta, Manish

    2015-03-01

    Target specificity and generally good tolerability of therapeutic proteins (TPs) present desirable treatment opportunities for pediatric patients. However, little is known on the ontogeny of processes related to the pharmacokinetics (PK) and disposition of TPs. The science, regulatory requirements and strategy of developing TPs for children are evolving. Our current review of TPs, (with focus on monoclonal antibodies and fusion proteins) that were approved for pediatric use indicates that dose-selection for pediatric pivotal studies is often based on adult PK information alone. This approach might not be sufficient if more complex PK properties than simple linear PK are present. Body weight-based dosing for pediatric patients directly scaled down from adult dosing can lead to under-exposure in young pediatric patients who are usually in the lowest body-weight range. Tiered-fixed dosing can be reasonably effective for TPs in achieving comparable exposure in children over a wide age range. The uniqueness of the pediatric population, the practical challenges in conducting clinical studies in this population, as well as regulations from health authorities warrant including pharmacometrics as an integral component of pediatric drug development. We propose a framework distinct from previous proposals, to guide clinical pharmacology strategy for pediatric drug development specifically for TPs. PMID:25707958

  17. Pediatric Malignant Bone Tumors: A Review and Update on Current Challenges, and Emerging Drug Targets.

    PubMed

    Jackson, Twana M; Bittman, Mark; Granowetter, Linda

    2016-07-01

    Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common malignant bone tumors in children and adolescents. While significant improvements in survival have been seen in other pediatric malignancies the treatment and prognosis for pediatric bone tumors has remained unchanged for the past 3 decades. This review and update of pediatric malignant bone tumors will provide a general overview of osteosarcoma and the Ewing sarcoma family of tumors, discuss bone tumor genomics, current challenges, and emerging drug targets. PMID:27265835

  18. [Systemic sarcoidosis: a diagnostic challenge in pediatrics. Case report].

    PubMed

    Díaz Angarita, Tomás; Morales Camacho, William; Lozano Neira, Laura; Plata Ortiz, Jessica; Zárate Taborda, Linda

    2016-10-01

    Sarcoidosis is a granulomatous inflammatory disease of unknown etiology, evidenced most often in young adults, which can compromise several organs, mainly lung, lymph nodes, eyes and skin. The presence of the disease in pediatric population is rare. Denomination in pediatrics is made based on age and clinical manifestations of the patient. The aim of this report is to present a case of systemic sarcoidosis in a pediatric patient without lung involvement with severe extrapulmonary manifestations. Fifteen year old patient who debuted with nonspecific symptoms (emesis, weight loss). Radiographic studies without lung involvement but with findings suggestive of Langerhans cell histiocytosis; however, histopathological report (bone and lymph) showed the presence of chronic granulomatous nonnecrotizing disease, sarcoidosis type. Childhood sarcoidosis is a rare and difficult entity to diagnose, mainly by the lack of specific biomarkers for diagnosis. PMID:27606655

  19. The Challenges Faced by New Science Teachers in Saudi Arabia

    NASA Astrophysics Data System (ADS)

    Alsharari, Salman

    Growing demand for science teachers in the Kingdom of Saudi Arabia, fed by increasing numbers of public school students, is forcing the Saudi government to attract, recruit and retain well-qualified science teachers. Beginning science teachers enter the educational profession with a massive fullfilment and satisfaction in their roles and positions as teachers to educating children in a science classroom. Nevertheless, teachers, over their early years of practice, encounter numerous challenges to provide the most effective science instruction. Therefore, the current study was aimed to identify academic and behavioral classroom challenges faced by science teachers in their first three years of teaching in the Kingdom of Saudi Arabia. In addition, new science teacher gender, school level and years of teaching experience differences in perceptions of the challenges that they encountered at work were analyzed. The present study also investigated various types of support that new science teachers may need to overcome academic and behavioral classroom challenges. In order to gain insights about ways to adequately support novice science teachers, it was important to examine new science teachers' beliefs, ideas and perceptions about effective science teaching. Three survey questionnaires were developed and distributed to teachers of both sexes who have been teaching science subjects, for less than three years, to elementary, middle and high school students in Al Jouf public schools. A total of 49 novice science teachers responded to the survey and 9 of them agreed to participate voluntarily in a face-to-face interview. Different statistical procedures and multiple qualitative methodologies were used to analyze the collected data. Findings suggested that the top three academic challenges faced by new science teachers were: poor quality of teacher preparation programs, absence of appropriate school equipment and facilities and lack of classroom materials and instructional

  20. 77 FR 2556 - Ethical and Regulatory Challenges in the Development of Pediatric Medical Countermeasures; Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... HUMAN SERVICES Food and Drug Administration Ethical and Regulatory Challenges in the Development of... announcing a public workshop entitled ``Ethical and Regulatory Challenges in the Development of Pediatric... scientific, ethical, and regulatory issues confronting FDA and other stakeholders in the area of...

  1. Challenges facing European agriculture and possible biotechnological solutions.

    PubMed

    Ricroch, Agnès; Harwood, Wendy; Svobodová, Zdeňka; Sági, László; Hundleby, Penelope; Badea, Elena Marcela; Rosca, Ioan; Cruz, Gabriela; Salema Fevereiro, Manuel Pedro; Marfà Riera, Victoria; Jansson, Stefan; Morandini, Piero; Bojinov, Bojin; Cetiner, Selim; Custers, René; Schrader, Uwe; Jacobsen, Hans-Joerg; Martin-Laffon, Jacqueline; Boisron, Audrey; Kuntz, Marcel

    2016-10-01

    Agriculture faces many challenges to maximize yields while it is required to operate in an environmentally sustainable manner. In the present study, we analyze the major agricultural challenges identified by European farmers (primarily related to biotic stresses) in 13 countries, namely Belgium, Bulgaria, the Czech Republic, France, Germany, Hungary, Italy, Portugal, Romania, Spain, Sweden, UK and Turkey, for nine major crops (barley, beet, grapevine, maize, oilseed rape, olive, potato, sunflower and wheat). Most biotic stresses (BSs) are related to fungi or insects, but viral diseases, bacterial diseases and even parasitic plants have an important impact on yield and harvest quality. We examine how these challenges have been addressed by public and private research sectors, using either conventional breeding, marker-assisted selection, transgenesis, cisgenesis, RNAi technology or mutagenesis. Both national surveys and scientific literature analysis followed by text mining were employed to evaluate genetic engineering (GE) and non-GE approaches. This is the first report of text mining of the scientific literature on plant breeding and agricultural biotechnology research. For the nine major crops in Europe, 128 BS challenges were identified with 40% of these addressed neither in the scientific literature nor in recent European public research programs. We found evidence that the private sector was addressing only a few of these "neglected" challenges. Consequently, there are considerable gaps between farmer's needs and current breeding and biotechnology research. We also provide evidence that the current political situation in certain European countries is an impediment to GE research in order to address these agricultural challenges in the future. This study should also contribute to the decision-making process on future pertinent international consortia to fill the identified research gaps. PMID:26133365

  2. Pediatric HIV Infection: A Neuropsychological and Educational Challenge.

    ERIC Educational Resources Information Center

    Armstrong, F. Daniel; And Others

    1993-01-01

    This article reviews the effects of human immunodeficiency virus (HIV) on the central nervous system and the educational implications of increasing numbers of students with perinatal HIV infection and pediatric acquired immunodeficiency syndrome (AIDS). Studies on the relationship between HIV and child development are urged. (Author/DB)

  3. Pediatric hypertension: recent trends and accomplishments, future challenges.

    PubMed

    Flynn, Joseph T

    2008-06-01

    Publication of the Fourth Report on high blood pressure (BP) in children and adolescents by the National High BP Education Program (NHBPEP) in 2004 has been followed by a remarkable increase in interest in pediatric hypertension. New data have emerged on the epidemiology of hypertension in the young, the influence of the childhood obesity epidemic on BP, how ambulatory BP monitoring (ABPM) can be used in evaluating elevated BP and the extent of hypertensive target-organ damage in the pediatric age group. Exciting new information on drug treatment of pediatric hypertension has been produced by industry-sponsored clinical trials of antihypertensive medications spurred by the FDA Modernization Act (FDAMA) and successor legislation. Despite these trends, recognition of elevated BP in children and adolescents by primary care providers remains problematic. This article will highlight these and other aspects of pediatric hypertension, hopefully providing a snapshot of where we are in early 2008, and pointing out areas where further work is needed in order to reduce the future burden of adult cardiovascular disease. PMID:18437129

  4. 48 CFR 1480.903 - Award in the face of challenge.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Award in the face of challenge. 1480.903 Section 1480.903 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR... Award in the face of challenge. (a) Award of a contract in the face of challenge may be made on...

  5. 48 CFR 1480.903 - Award in the face of challenge.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Award in the face of challenge. 1480.903 Section 1480.903 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR... Award in the face of challenge. (a) Award of a contract in the face of challenge may be made on...

  6. Commentary: Progress and Challenges in Evidence-based Family Assessment in Pediatric Psychology

    PubMed Central

    2008-01-01

    It is widely accepted that families are integral to biopsychosocial, social ecological, and other systemic approaches for understanding families and pediatric health. Pediatric psychologists are among the strongest advocates for families. At the same time, families pose challenges that we (pediatric psychology as a field) struggle with in terms of theoretical conceptualizations, assessment and intervention approaches, and training. We primarily use individual frameworks in our practice and research. In this brief commentary, prompted by the report of accomplishments in evidence-based family assessment in pediatric psychology (Alderfer et al., 2007), I outline some of the background for an implicit “challenge” to our field to advance our family orientation and provide some concrete ideas about next steps.

  7. Pediatric liver diseases: current challenges and future perspectives.

    PubMed

    Della Corte, Claudia; Mosca, Antonella; Vania, Andrea; Alterio, Arianna; Alisi, Anna; Nobili, Valerio

    2016-01-01

    Chronic liver diseases in children represent a rising problem with significant effects on public health. In fact, several pediatric liver diseases are precursors of adult chronic hepatopathies, cirrhosis and hepatocellular carcinoma. The prevalence of liver diseases in children is unknown. In the USA, every year, 15,000 children are hospitalized for liver diseases, but these disorders continue to be under-recognized or diagnosed late. The main reason is due to the frequent absence of symptoms in the vast majority of liver diseases, especially in the early stages. In the last few decades several advances have been made in understanding the pathogenesis of liver diseases, permitting the discovery of new therapeutic targets to treat liver diseases, thus improving the natural history of these disorders. In this article we discuss the most recent advances in the understanding of the pathogenesis, diagnosis and treatment of the most frequent pediatric liver diseases. PMID:26641319

  8. Pediatric Hemophagocytic Syndromes: A Diagnostic and Therapeutic Challenge

    PubMed Central

    2005-01-01

    Pediatric hemophagocytic syndrome (HS) is a severe and often fatal clinical disorder. This syndrome is frequently unrecognized, and thus, affected children may receive suboptimal management, leading to an increase in mortality. The purpose of this review is to provide a clinical guide to (1) the recognition of HS based on clinical, biologic, and pathologic features; (2) the identification of the primary cause of HS in a given affected child; and (3) the initiation of effective treatment in a timely manner. PMID:20529219

  9. Next-generation proteomics faces new challenges in environmental biotechnology.

    PubMed

    Armengaud, Jean

    2016-04-01

    Environmental biotechnology relies on the exploration of novel biological systems and a thorough understanding of the underlying molecular mechanisms. Next-generation proteomics based on the latest generation of mass analyzers currently allows the recording of complete proteomes from any microorganism. Interpreting these data can be straightforward if the genome of the organism is established, or relatively easy to perform through proteogenomics approaches if a draft sequence can be obtained. However, next-generation proteomics faces new, interesting challenges when the organism is distantly related to previously characterized organisms or when mixtures of organisms have to be analyzed. New mass spectrometers and innovative bioinformatics tools are reshaping the possibilities of homology-based proteomics, proteogenomics, and metaproteomics for the characterization of biological systems. Novel time- and cost-effective screening strategies are also possible with this methodology, as exemplified by whole proteome thermal profiling and subpopulation proteomics. The complexity of environmental samples allows for unique developments of approaches and concepts. PMID:26950175

  10. Lautenbacher will face challenges as new NOAA Head

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    With a non-controversial confirmation hearing on November 8 before the U.S. Senate Commerce Committee, retired U.S. Navy Vice Admiral Conrad Lautenbacher, Jr. is gearing up to soon take over the helm at the National Oceanic and Atmospheric Administration (NOAA). His nomination by the Bush administration also includes serving as undersecretary of commerce for oceans and atmosphere.A number of sources familiar with Lautenbacher indicated that his Navy and managerial skills will be useful in these posts, as he likely will face a number of science, budget, and administrative challenges in running this $3.2-billion agency, which comprises 63% of the Commerce Department budget. These sources also sited Lautenbacher's integrity; his ability to listen to different sides of issues and to consult broadly; his connections to both the scientific and political worlds; and his persuasive ability to get things done.

  11. Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): design and methods.

    PubMed

    Dallas, Ronald H; Wilkins, Megan L; Wang, Jichuan; Garcia, Ana; Lyon, Maureen E

    2012-09-01

    As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-month post-intervention. The primary outcome measures will be in congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice. PMID:22664645

  12. Electronic health systems: challenges faced by hospital-based providers.

    PubMed

    Agno, Christina Farala; Guo, Kristina L

    2013-01-01

    The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed. PMID:23903942

  13. Facing up to the Challenges of Advancing Craniofacial Research

    PubMed Central

    Trainor, Paul A.; Richtsmeier, Joan T.

    2015-01-01

    Craniofacial anomalies are among the most common human birth defects and have considerable functional, aesthetic, and social consequences. The early developmental origin as well as the anatomical complexity of the head and face render these tissues prone to genetic and environmental insult. The establishment of craniofacial clinics offering comprehensive care for craniofacial patients at a single site together with international research networks focused on the origins and treatment of craniofacial disorders has led to tremendous advances in our understanding of the etiology and pathogenesis of congenital craniofacial anomalies. However, the genetic, environmental, and developmental sources of many craniofacial disorders remain unknown. To overcome this problem and further advance craniofacial research, we must recognize current challenges in the field and establish priority areas for study. We still need (i) a deeper understanding of variation during normal development and within the context of any disorder, (ii) improved genotyping and phenotyping and understanding of the impact of epigenetics, (iii) continued development of animal models and functional analyses of genes and variants, and (iv) integration of patient derived cells and tissues together with 3D printing and quantitative assessment of surgical outcomes for improved practice. Only with fundamental advances in each of these areas will we be able to meet the challenge of translating potential therapeutic and preventative approaches into clinical solutions and reduce the financial and emotional burden of craniofacial anomalies. PMID:25820983

  14. Communicating with the New Generations. The Challenge for Pediatric Dentists.

    PubMed

    Saadia, Marc; Valencia, Roberto

    2015-01-01

    Most of the children and parents are virtuous and will give us plenty of reasons to enjoy what we do. Unfortunately, we all know that something is somehow wrong with these new generations. Parents and children sometimes place Pediatric dentists in a dilemma. The social structure changes every few years causing a burden on how to deal with these families. For this reason, dentists might decide to sedate or go to the operating room when these children might be potentially good dental patients. Deciding this course of action, does not allow us to bond with them. Bonding with children must be worked and nurtured. This is part of what pediatric dentists are trained for. This manuscript will illustrate the major changes seen with the new generations of parents and children and how it affects us the way we work in our offices. We will show the importance of bonding with parents and children, moving beyond the biological aspects and venturing into the psycho-socio and cultural issues. Knowing our children and adolescents will allow us to detect potential physical or emotional hazardous behavior. PMID:26161598

  15. Interview: challenges faced by the modern bioanalytical laboratory.

    PubMed

    Sangster, Timothy; Oliver, Mike

    2012-10-01

    Timothy Sangster (Charles River Laboratories) and Mike Oliver (Thermo Fisher Scientific) speak to Thomas Payne at Bioanalysis in September 2012 about the challenges faced by the modern bioanalytical laboratory. Timothy Sangster has been with Charles River Laboratories since September 2009. Having worked for Quintiles, Pharmacia, Astrazeneca and Huntingdon Life Sciences, he has gained experience over 17 years in both CRO and pharmaceutical environments, and also in both Europe and the USA. Specific areas of interest over the past years have been microchromatography, sample preparation and matrix effects, to name a few. Mike Oliver has held the position of Global Product Manager for sample preparation at Thermo Fisher Scientific since 2010, being responsible for the development and introduction of new innovative technologies such as SOLA™ to the market place. Prior to this role, Mike has worked for two leading MS vendors over a 9‑year period, being responsible for biotechnology sales within the UK and providing application solutions for proteomic and metabolic workflows based on high-resolution LC-MS platforms, respectively. Mike holds a PhD in MS and Biochemistry from the MS Research Unit, University of Wales, Swansea, UK. PMID:23088459

  16. Family Medicine in Iran: Facing the Health System Challenges

    PubMed Central

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2015-01-01

    Background: In response to the current fragmented context of health systems, it is essential to support the revitalization of primary health care in order to provide a stronger sense of direction and integrity. Around the world, family medicine recognized as a core discipline for strengthening primary health care setting. Objective: This study aimed to understand the perspectives of policy makers and decision makers of Iran’s health system about the implementation of family medicine in Iran urban areas. Materials/Patients and Methods: This study is a qualitative study with framework analysis. Purposive semi-structured interviews were conducted with Policy and decision makers in the five main organizations of Iran health care system. The codes were extracted using inductive and deductive methods. Results: According to 27 semi-structured interviews were conducted with Policy and decision makers, three main themes and 8 subthemes extracted, including: The development of referral system, better access to health care and the management of chronic diseases. Conclusion: Family medicine is a viable means for a series of crucial reforms in the face of the current challenges of health system. Implementation of family medicine can strengthen the PHC model in Iran urban areas. Attempting to create a general consensus among various stakeholders is essential for effective implementation of the project. PMID:25948450

  17. Understanding Leadership in Schools Facing Challenging Circumstances: A Chilean Case Study

    ERIC Educational Resources Information Center

    Ahumada, Luis; Galdames, Sergio; Clarke, Simon

    2016-01-01

    During the last 10 years, research into schools facing challenging circumstances has attracted the attention of researchers around the world. The aim of this study was to understand the challenges that school leaders face as they per form their work, the nature of the context in which these challenges arise, the strategies school leaders adopt to…

  18. Pediatrics

    NASA Technical Reports Server (NTRS)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  19. Ethical challenges and interpretive difficulties with non-clinical applications of pediatric FMRI.

    PubMed

    Fenton, Andrew; Meynell, Letitia; Baylis, Francoise

    2009-01-01

    In this article, we critically examine some of the ethical challenges and interpretive difficulties with possible future non-clinical applications of pediatric fMRI with a particular focus on applications in the classroom and the courtroom - two domains in which children come directly in contact with the state. We begin with a general overview of anticipated clinical and non-clinical applications of pediatric fMRI. This is followed by a detailed analysis of a range of ethical challenges and interpretive difficulties that trouble the use of fMRI and are likely to be especially acute with non-clinical uses of the technology. We conclude that knowledge of these challenges and difficulties should influence policy decisions regarding the non-clinical uses of fMRI. Our aim is to encourage the development of future policies prescribing the responsible use of this neuroimaging technology as it develops both within and outside the clinical setting. PMID:19132609

  20. A personal perspective on challenges that face women scientists

    NASA Astrophysics Data System (ADS)

    Cashman, Katharine

    2016-04-01

    Gender equality has been a topic of discussion throughout my long (now three decade) career. This alone illustrates the complex nature of the issue, and the lack of a simple solution, particularly as many of the daily challenges that women face are institution or discipline-specific. For this reason, I will summarize some of the issues that appear to me to be more general, and therefore ones that may have general solutions. The first and foremost relates to demands on women's time. One way that academic institutions have sought to overcome gender bias has been to require that every university committee have a female member; in departments, schools and faculties where women represent a minority, this necessarily means that women shoulder an inequitable share of the service duties. I have experienced this myself, seen it in promotion files at all levels, and observed it with regard to my female colleagues. Clearly time spent doing service is time not spent doing science. There is also an easy solution to this problem, which is to re-think the underlying assumption that men are necessarily gender-biased if they don't have a woman sitting in the room! Additional time demands can come from informal mentoring of both students and younger colleagues, particularly in cases where senior male colleagues are viewed as too important, or too intimidating, to be consulted on personal issues. Although I suspect that this problem may also be widespread, it is more difficult to quantify, and is therefore more difficult to factor into time allotments of departmental duties. A final thought relates to hiring practices. I have now worked in both the US and UK educational systems, which have very different interview and hiring protocols. I will review both, highlighting components that I think are most likely to promote equitable hiring practices.

  1. Resistant pediatric priapism: A real challenge for the urologist

    PubMed Central

    Sekerci, Cagri Akin; Akbal, Cem; Sener, Tarik Emre; Sahan, Ahmet; Sahin, Bahadir; Baltacioglu, Feyyaz; Simsek, Ferruh

    2015-01-01

    Priapism in pediatric patients is a rare entity. We present an 8-year-old boy with known cerebral palsy. He came to the emergency department with sustained painful erection for 12 hours. Physical examination showed rigid penis. Blood count and biochemical analysis were normal. Although penile Doppler ultrasound revealed normal arterial and venous flow, cavernosal blood gas was hypoxic. A total of 50 mL of dark blood was aspirated, and 2 mL of 0.001% adrenalin solution was applied to both corpus cavernosum, twice within 20 minutes, which eventually did not achieve detumescence. A distal Winter shunt was performed at the end of which the penis was semi-flaccid. By the 18th hour of surgery, the penis re-gained painful erection status, so an Al-Ghorab shunt was performed. After the Al-Ghorab shunt, the penis was still in the semi-flaccid state. The next day, an angiography was performed and an arteriovenous fistula was discovered and treated by embolization. The flaccid state was achieved and the patient was discharged the day after the embolization. PMID:26609335

  2. Fronto-limbic-striatal dysfunction in pediatric and adult patients with bipolar disorder: impact of face emotion and attentional demands

    PubMed Central

    Brotman, M. A.; Tseng, W.-L.; Olsavsky, A. K.; Fromm, S. J.; Muhrer, E. J.; Rutenberg, J.G.; Deveney, C. M.; Adleman, N. E.; Zarate, C. A.; Pine, D. S.; Leibenluft, E.

    2013-01-01

    Background Research in bipolar disorder (BD) implicates fronto-limbic-striatal dysfunction during face emotion processing but it is unknown how such dysfunction varies by task demands, face emotion and patient age. Method During functional magnetic resonance imaging (fMRI), 181 participants, including 62 BD (36 children and 26 adults) and 119 healthy comparison (HC) subjects (57 children and 62 adults), engaged in constrained and unconstrained processing of emotional (angry, fearful, happy) and non-emotional (neutral) faces. During constrained processing, subjects answered questions focusing their attention on the face; this was processed either implicitly (nose width rating) or explicitly (hostility; subjective fear ratings). Unconstrained processing consisted of passive viewing. Results Pediatric BD rated neutral faces as more hostile than did other groups. In BD patients, family-wise error (FWE)-corrected region of interest (ROI) analyses revealed dysfunction in the amygdala, inferior frontal gyrus (IFG), anterior cingulate cortex (ACC) and putamen. Patients with BD showed amygdala hyperactivation during explicit processing (hostility ratings) of fearful faces and passive viewing of angry and neutral faces but IFG hypoactivation during implicit processing of neutral and happy faces. In the ACC and striatum, the direction of dysfunction varied by task demand: BD demonstrated hyperactivation during unconstrained processing of angry or neutral faces but hypoactivation during constrained processing (implicit or explicit) of angry, neutral or happy faces. Conclusions Findings suggest amygdala hyperactivation in BD while processing negatively valenced and neutral faces, regardless of attentional condition, and BD IFG hypoactivation during implicit processing. In the cognitive control circuit involving the ACC and putamen, BD neural dysfunction was sensitive to task demands. PMID:23930595

  3. Challenges Faced by Maine School Districts in Providing High Quality Public Education. Research Brief

    ERIC Educational Resources Information Center

    Silvernail, David L.; Linet, Sarah R.

    2014-01-01

    The goal of this study was to: (1) identify challenges faced by Maine school districts in providing high quality public education; (2) describe the magnitude of the challenges; and (3) identify areas where school districts were experiencing some success in meeting these challenges. The School Districts Challenge Survey was distributed online to…

  4. Persistence in the Face of Academic Challenge for Economically Disadvantaged Children

    ERIC Educational Resources Information Center

    Brown, Eleanor D.

    2009-01-01

    This study examined persistence in the face of academic challenge for economically disadvantaged children. Participants included 103 children attending Head Start preschools, as well as their caregivers and teachers. Child tasks measured persistence in the face of academic challenge as well as emergent implicit theories of intelligence. Caregiver…

  5. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

    PubMed Central

    2011-01-01

    For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier. Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care. A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills. Changing demographics and persistent reimbursement disparities will require workplace innovation

  6. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics.

    PubMed

    Henrickson, Michael

    2011-01-01

    For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier.Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care.A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills.Changing demographics and persistent reimbursement disparities will require workplace innovation

  7. Tolerance for distorted faces: challenges to a configural processing account of familiar face recognition.

    PubMed

    Sandford, Adam; Burton, A Mike

    2014-09-01

    Face recognition is widely held to rely on 'configural processing', an analysis of spatial relations between facial features. We present three experiments in which viewers were shown distorted faces, and asked to resize these to their correct shape. Based on configural theories appealing to metric distances between features, we reason that this should be an easier task for familiar than unfamiliar faces (whose subtle arrangements of features are unknown). In fact, participants were inaccurate at this task, making between 8% and 13% errors across experiments. Importantly, we observed no advantage for familiar faces: in one experiment participants were more accurate with unfamiliars, and in two experiments there was no difference. These findings were not due to general task difficulty - participants were able to resize blocks of colour to target shapes (squares) more accurately. We also found an advantage of familiarity for resizing other stimuli (brand logos). If configural processing does underlie face recognition, these results place constraints on the definition of 'configural'. Alternatively, familiar face recognition might rely on more complex criteria - based on tolerance to within-person variation rather than highly specific measurement. PMID:24853629

  8. The Benefits and Challenges of Preconsent in a Multisite, Pediatric Sickle Cell Intervention Trial.

    PubMed

    Nimmer, Mark; Czachor, Jason; Turner, Laura; Thomas, Bobbe; Woodford, Ashley L; Carpenter, Karli; Gonzalez, Victor; Liem, Robert I; Ellison, Angela; Casper, T Charles; Brousseau, David C

    2016-09-01

    Enrollment of patients in sickle cell intervention trials has been challenging due to difficulty in obtaining consent from a legal guardian and lack of collaboration between emergency medicine and hematology. We utilized education and preconsent in a pediatric multisite sickle cell intervention trial to overcome these challenges. Overall, 48 patients were enrolled after being preconsented. Variable Institutional Review Board policies related to preconsent validity and its allowable duration decreased the advantages of preconsent at some sites. The utility of preconsent for future intervention trials largely depends on local Institutional Review Board policies. Preeducation may also benefit the consent process, regardless of site differences. PMID:27081930

  9. Standing by Their Principles: Two Librarians Who Faced Challenges

    ERIC Educational Resources Information Center

    Adams, Helen; Leu, DaNae; Venuto, Dee Ann

    2015-01-01

    What do school librarians fear most? Hands down, their biggest fear is a formal challenge to a resource in the school library. There are no accurate statistics about the number of challenges to school library resources. The staff of ALA's Office for Intellectual Freedom estimates that only about 20 percent are reported to ALA annually. For the…

  10. Faculty and Student Challenges in Facing Cultural and Linguistic Diversity.

    ERIC Educational Resources Information Center

    Clark, Lynne W., Ed.; Waltzman, Dava E., Ed.

    This volume on strategies for meeting the challenges of cultural and linguistic diversity is designed to help faculty and administration in the professional education programs of the allied health professionals. The book's 11 chapters are divided among 3 main parts. The first section offers an introduction to the challenges before faculty and…

  11. Facing Today's Exploration Challenges in the Gulf of Mexico

    NASA Astrophysics Data System (ADS)

    Detomo, R.

    2005-05-01

    The Gulf of Mexico represents one of the most intensively explored basins in the world, and yet it still delivers significant new material oil and gas discoveries every year. Because of it high productivity, geologic complexity, competitive acreage access and large profitability margins, the Gulf of Mexico presents many industry-leading challenges to Exploration today. For major companies exploring for oil and gas in the Gulf of Mexico today, their challenge is to "safely, responsibly and profitably find and produce reduced accumulations in increasingly hostile settings." The GoM serves as the sportsman's playground for a significant population located in and around its waters, and therefore, operating safely and responsibly are unassailable moral and operational standards by which we sustain future development, and maintain our license to operate. With that as a backdrop, today's challenges are driven by the nature of where the business is looking for new reserves in this extremely mature basin. These "Opportunities" encompass the following: 1) large, under-explored, sub-salt areas, characterized by poor seismic imaging, uncertain geologic regimes and potentially dangerous overpressures, 2) deep true-vertical-depth opportunities in older rocks that challenge our understanding of reservoir quality prediction and hydrocarbon systems, and are at the edge of today's drilling technologies, 3) access to sensitive areas including the eastern GoM-Florida shelf, coastal areas and international borders, 4) challenging "small accumulation" discoveries that cannot support expensive appraisal or development options, are remote to infrastructure or inefficiently produce the reservoir, and finally 5) new play development, which is challenged by long maturation cycles, small acreage blocks, intense international competition, and rapid lease rolls. This talk will consider what Shell and the Oil & Gas Industry does today to succeed in this arena, and specifically will show examples

  12. Pharmacotherapy Challenges of Fontan-Associated Plastic Bronchitis: A Rare Pediatric Disease

    PubMed Central

    Brooks, Kristina; Caruthers, Regine L.; Schumacher, Kurt R.; Stringer, Kathleen A.

    2013-01-01

    Pediatric pharmacotherapy is often challenging due to the paucity of available clinical data on the safety and efficacy of medications that are commonly used in children. This quandary is even more prevalent in children with rare diseases. Although extrapolations for dosing and administration are often made from available adult data with similar disease states, this translation becomes even more problematic in rare pediatric diseases. Understanding of disease pathophysiology is typically poor, and few, if any, effective therapies have been studied and identified. One condition that illustrates these issues is plastic bronchitis, a rare, most often pediatric disease that is characterized by the production of obstructive bronchial airway casts. This illness primarily occurs in children with congenital heart disease, often after palliative surgery. Plastic bronchitis is a highly clinically relevant and therapeutically challenging problem with a high mortality rate, and, to date, a generally accepted effective pharmacotherapy regimen has not been identified. Furthermore, the disease is ill defined, which makes timely identification and treatment of children with plastic bronchitis difficult. The pharmacotherapies currently used to manage this disease are largely anecdotal and vary between the use of macrolide antibiotics, mucolytics, bronchodilators, and inhaled fibrinolytics in a myriad of combinations. The purpose of this review is twofold: first, to highlight the dilemma of treating plastic bronchitis, and second, to bring attention to the continuing need for studies of drug therapies used in children so that safe and effective drug regimens can be established, particularly for rare diseases, which often have no treatment options. PMID:23686915

  13. Pediatric cardiac surgery: a challenge and outcome analysis of the Guatemala effort.

    PubMed

    Leon-Wyss, Juan R; Veshti, Altin; Veras, Oscar; Gaitán, Guillermo A; O'Connell, Mauricio; Mack, Ricardo A; Calvimontes, Gonzalo; Garcia, Flor; Hidalgo, Amilcar; Reyes, Alfredo; Castañeda, Aldo R

    2009-01-01

    A large underserved population of children with congenital cardiac malformation (CCM) exists in many developing countries. In recent years, several strategies have been implemented to supplement this need. These strategies include transferring children to first-world countries for surgical care or the creation of local pediatric cardiovascular surgical programs. In 1997, an effort was made to create a comprehensive pediatric cardiac care program in Guatemala. The objective of this study is to examine the outcome analysis of the Guatemala effort. The goals of our new and first pediatric cardiac care program were to: 1) provide diagnosis and treatment to all children with a CCM in Guatemala; 2) train of local staff surgeons, 3) established a foundation locally and in the United States in 1997 to serve as a fundraising instrument to acquire equipment and remodeling of the pediatric cardiac unit and also to raise funds to pay the hospital for the almost exclusively poor pediatric cardiac patients. The staff now includes 3 surgeons from Guatemala, trained by the senior surgeon (A.R.C.), seven pediatric cardiologists, 3 intensivists, and 2 anesthesiologists, as well as intensive care and ward nurses, respiratory therapists, echocardiography technicians, and support personnel. The cardiovascular program expanded in 2005 to 2 cardiac operating rooms, 1 cardiac catheterization laboratory, 1 cardiac echo lab, 4 outpatients clinics a 6-bed intensive care unit and a 4-bed stepdown unit, a 20 bed general ward (2 beds/room) and a genetics laboratory. Our center has become a referral center for children from Central America. A total of 2,630 surgical procedures were performed between February 1997 and December 2007, increasing the number of operations each year. Postoperative complication occurred in 523 of 2,630 procedures (20%). A late follow-up study was conducted of all the patients operated from 1997 to 2005. Late mortality was 2.7%. Development of a sustainable pediatric

  14. Principal Challenges Facing Electronic Records Management in Federal Agencies Today.

    ERIC Educational Resources Information Center

    Patterson, Giovanna; Sprehe, J. Timothy

    2002-01-01

    Discusses electronic records management in the federal government. Highlights include managing electronic mail; information technology planning, systems design, and architecture; updating conventional records management; integrating electronic records management with other information technology systems; challenges of end-user training; business…

  15. Present state and future challenges in pediatric abdominal pain therapeutics research: Looking beyond the forest

    PubMed Central

    Friesen, Craig A; Schurman, Jennifer V; Abdel-Rahman, Susan M

    2015-01-01

    At the present time, it is nearly impossible to treat pediatric functional gastrointestinal disorders associated with pain in an evidence based fashion. This is due to the overall lack of controlled studies and, even more importantly, the complexity of the contributors to disease phenotype which are not controlled or accounted for in most therapeutic trials. In this manuscript, we review the challenges of defining entry criteria, controlling for the large number of biopsychosocial factors which may effect outcomes, and understanding pharmacokinetic and pharmacodynamic factors when designing therapeutic trials for abdominal pain in children. We also review the current state of pediatric abdominal pain therapeutics and discuss trial design considerations as we move forward. PMID:26558142

  16. The Challenges Facing School Governing Bodies in England: A "Perfect Storm"?

    ERIC Educational Resources Information Center

    James, Chris; Brammer, Steve; Connolly, Michael; Spicer, David Eddy; James, Jane; Jones, Jeff

    2013-01-01

    The governing bodies of publicly funded schools in England are currently facing a number of substantive challenges of various kinds. Many of the challenges are long-standing, while others relate to the current context for governing wrought by recent education policy developments initiated by central government. A number of the challenges are…

  17. A Challenging Giant Dermatofibrosarcoma Protuberans on the Face

    PubMed Central

    Pérez, Gimena Castro; Arias, Cintia; Luna, Paula; Sorín, Irene

    2016-01-01

    Dermatofibrosarcoma protuberans (DFSP) is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth. PMID:27437151

  18. Gender-Equity Advocates Face Looming Challenges in Women's Sports

    ERIC Educational Resources Information Center

    Lipka, Sara

    2007-01-01

    Gender-equity advocates gathered at a conference in Cleveland last month to discuss looming challenges in women's sports. Next month the U.S. Commission on Civil Rights is scheduled to hold a hearing on Title IX of the Education Amendments of 1972. The meeting will focus on the most controversial means of compliance with the law. Institutions can…

  19. Lives of Quality in the Face of Challenge in Israel

    ERIC Educational Resources Information Center

    Neikrug, S.; Roth, D.; Judes, J.

    2011-01-01

    Purpose: The purpose of this study is to describe and analyse the quality of life of Israeli families raising a child with a disability while challenged with all the usual demands of family life. Methods: Respondents were main caregivers of 103 children with disability receiving services at Beit Issie Shapiro, a service agency in Israel. The…

  20. Issues and Challenges Facing the Minority Woman Dentist.

    ERIC Educational Resources Information Center

    Sinkford, Jeanne C.

    1992-01-01

    The status of minority women dentists is reviewed, and initiatives to improve it are noted. Issues and challenges for African-American female dentists are outlined, including negative racial/gender stereotypes, lack of advancement opportunities, difficulties in starting practices and securing professional and social support systems, lack of…

  1. Facing the Issues: Challenges, Censorship, and Reflection through Dialogue

    ERIC Educational Resources Information Center

    Lent, ReLeah Cossett

    2008-01-01

    ReLeah Cossett Lent provides practical advice for ensuring that books are kept on shelves and in classrooms for students to read. She outlines steps for creating professional learning communities that engage with censorship issues and prepare schools to deal with book challenges in thoughtful, supportive ways. (Contains 4 figures.)

  2. Challenges Faced by Korean Transnational Students in the United States

    ERIC Educational Resources Information Center

    Jung, Adrian; Nam, Sang; Han, Shini

    2015-01-01

    The purpose of this study was to help parents, educators, and policymakers understand how to help transnational children adjust to their psychological challenges at school in the United States. A total of 109 Korean transnational adolescents aged 11 to 19 participated in this study. They had been staying in the country alone or with one of their…

  3. Challenges faced by Thai families when a loved one has a traumatic brain injury.

    PubMed

    Piyakong, Duangporn

    2014-06-01

    The purpose of this study were to explore challenges and approaches for resolving challenges that Thai family members face when engaging with their loved one with severe traumatic brain injury in the critical care setting. This pilot study used an exploratory design. Nine family members were interviewed at a hospital in Thailand. Story-inquiry method guided data collection and analysis. Three challenges themes were identified: facing the uncertainty of their loved one's illness, dealing with personal sufferings, and changing everyday life patterns. Attending to their loved one and attending to self were two themes that family members used to manage challenges. PMID:24856277

  4. Challenges Faced by Undergraduate Military Students at American Public University System

    ERIC Educational Resources Information Center

    Machuca, Ana; Torres, Karin; Morris, Pamela; Whitley, William

    2014-01-01

    This paper will summarize some of challenges faced by military students enrolled in an associate and bachelors online program at American Public University System (APUS). The survey results on which the study is based exposed the following problems faced by military personnel: 48.7% had difficulties working around military obligations, 33.3%…

  5. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    PubMed Central

    2011-01-01

    The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career choice decision-making process

  6. Challenges facing providers caring for HIV/HCV-coinfected patients

    PubMed Central

    Lekas, Helen-Maria; Siegel, Karolynn; Leider, Jason

    2015-01-01

    Despite the high prevalence of Hepatitis C virus (HCV) infection among injection drug users also infected with Human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, the research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance. PMID:21825278

  7. Facing and Overcoming Sensitivity Challenges in Biomolecular NMR Spectroscopy.

    PubMed

    Ardenkjaer-Larsen, Jan-Henrik; Boebinger, Gregory S; Comment, Arnaud; Duckett, Simon; Edison, Arthur S; Engelke, Frank; Griesinger, Christian; Griffin, Robert G; Hilty, Christian; Maeda, Hidaeki; Parigi, Giacomo; Prisner, Thomas; Ravera, Enrico; van Bentum, Jan; Vega, Shimon; Webb, Andrew; Luchinat, Claudio; Schwalbe, Harald; Frydman, Lucio

    2015-08-01

    In the Spring of 2013, NMR spectroscopists convened at the Weizmann Institute in Israel to brainstorm on approaches to improve the sensitivity of NMR experiments, particularly when applied in biomolecular settings. This multi-author interdisciplinary Review presents a state-of-the-art description of the primary approaches that were considered. Topics discussed included the future of ultrahigh-field NMR systems, emerging NMR detection technologies, new approaches to nuclear hyperpolarization, and progress in sample preparation. All of these are orthogonal efforts, whose gains could multiply and thereby enhance the sensitivity of solid- and liquid-state experiments. While substantial advances have been made in all these areas, numerous challenges remain in the quest of endowing NMR spectroscopy with the sensitivity that has characterized forms of spectroscopies based on electrical or optical measurements. These challenges, and the ways by which scientists and engineers are striving to solve them, are also addressed. PMID:26136394

  8. Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

    PubMed Central

    Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

    2014-01-01

    Objective To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. PMID:24816766

  9. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge.

    PubMed

    Nguyen, Nguyenvu; Pezzella, A Thomas

    2015-04-01

    A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas. PMID:25870347

  10. Today's New dentists face professional challenges and opportunities.

    PubMed

    Barichello, Teri

    2005-01-01

    The substantial debt load of new dentists is part of the recent trend toward beginning practice as an associate, in a postdoctoral general dentistry program, or in the military. Other reasons include an opportunity to build clinical speed, learning practice management skills, and earning a guaranteed income. While today's new dentists value the same goals of quality, service, and autonomy that motivate established practitioners, they bring new dimensions to the profession. Diversity and a desire for a balanced lifestyle (among both men and women) affect practice decisions and participation in organized dentistry. The new dentist will look for flexibility and responsiveness to personal and social challenges. PMID:16623129

  11. Organ shortage: the greatest challenge facing transplant medicine.

    PubMed

    Shafran, David; Kodish, Eric; Tzakis, Andreas

    2014-07-01

    The success of organ transplantation as a treatment for end-stage organ disease has yielded a series of ethical quandaries originating from the issue of organ shortage. Scarcity of organs for transplantation necessitates formulation of just and fair allocation policies as well as ethically viable solutions to bridging the vast gap between organ supply and demand. The concept of "triage" provides a useful paradigm in which to contextualize the organ shortage issue. This entails subjugating the welfare of the individual patient for the benefit of the wider community as an ethically justified response to the challenge of scarcity. PMID:24831673

  12. Issue and challenges facing rechargeable thin film lithium batteries

    SciTech Connect

    Patil, Arun; Patil, Vaishali; Shin, Dong Wook; Choi, Ji-Won; Paik, Dong-Soo; Yoon, Seok-Jin

    2008-08-04

    New materials hold the key to fundamental advances in energy conversion and storage, both of which are vital in order to meet the challenge of global warming and the finite nature of fossil fuels. Nanomaterials in particular offer unique properties or combinations of properties as electrodes and electrolytes in a range of energy devices. Technological improvements in rechargeable solid-state batteries are being driven by an ever-increasing demand for portable electronic devices. Lithium batteries are the systems of choice, offering high energy density, flexible, lightweight design and longer lifespan than comparable battery technologies. We present a brief historical review of the development of lithium-based thin film rechargeable batteries highlight ongoing research strategies and discuss the challenges that remain regarding the discovery of nanomaterials as electrolytes and electrodes for lithium batteries also this article describes the possible evolution of lithium technology and evaluates the expected improvements, arising from new materials to cell technology. New active materials under investigation and electrode process improvements may allow an ultimate final energy density of more than 500 Wh/L and 200 Wh/kg, in the next 5-6 years, while maintaining sufficient power densities. A new rechargeable battery technology cannot be foreseen today that surpasses this. This report will provide key performance results for thin film batteries and highlight recent advances in their development.

  13. Tumor Heterogeneity in Hepatocellular Carcinoma: Facing the Challenges.

    PubMed

    Lu, Li-Chun; Hsu, Chih-Hung; Hsu, Chiun; Cheng, Ann-Lii

    2016-04-01

    Tumor heterogeneity in hepatocellular carcinoma (HCC), such as that found in second primary tumors after curative treatment, synchronous multifocal tumors of different clonality, or intratumor heterogeneity, poses severe challenges for the development and administration of systemic molecular targeted therapies. Various methodologies, including historical DNA ploidy analysis, integrated hepatitis B virus DNA analysis, DNA fingerprinting, and next-generation sequencing technologies, are used to explore tumor heterogeneity in HCC. It is estimated that 30%-60% of recurrent or metastatic tumors harbor clones different from the primary tumor, 22%-79% of synchronous tumors vary clonally, and 12%-66% of single tumors contain intratumor heterogeneity. Substantial intertumor and intratumor heterogeneity renders biomarker identification, which is critical for the development and administration of molecular targeted therapy, challenging when applied to a single tumor biopsy specimen. The use of circulating tumor cells or circulating tumor DNA to evaluate overall tumor heterogeneity may help resolve this problem. This article reviews previous studies of tumor heterogeneity and discusses the implications and future opportunities regarding tumor heterogeneity in HCC. PMID:27386431

  14. Tumor Heterogeneity in Hepatocellular Carcinoma: Facing the Challenges

    PubMed Central

    Lu, Li-Chun; Hsu, Chih-Hung; Hsu, Chiun; Cheng, Ann-Lii

    2016-01-01

    Tumor heterogeneity in hepatocellular carcinoma (HCC), such as that found in second primary tumors after curative treatment, synchronous multifocal tumors of different clonality, or intratumor heterogeneity, poses severe challenges for the development and administration of systemic molecular targeted therapies. Various methodologies, including historical DNA ploidy analysis, integrated hepatitis B virus DNA analysis, DNA fingerprinting, and next-generation sequencing technologies, are used to explore tumor heterogeneity in HCC. It is estimated that 30%-60% of recurrent or metastatic tumors harbor clones different from the primary tumor, 22%-79% of synchronous tumors vary clonally, and 12%-66% of single tumors contain intratumor heterogeneity. Substantial intertumor and intratumor heterogeneity renders biomarker identification, which is critical for the development and administration of molecular targeted therapy, challenging when applied to a single tumor biopsy specimen. The use of circulating tumor cells or circulating tumor DNA to evaluate overall tumor heterogeneity may help resolve this problem. This article reviews previous studies of tumor heterogeneity and discusses the implications and future opportunities regarding tumor heterogeneity in HCC.

  15. Facing technological challenges of Solar Updraft Power Plants

    NASA Astrophysics Data System (ADS)

    Lupi, F.; Borri, C.; Harte, R.; Krätzig, W. B.; Niemann, H.-J.

    2015-01-01

    The Solar Updraft Power Plant technology addresses a very challenging idea of combining two kinds of renewable energy: wind and solar. The working principle is simple: a Solar Updraft Power Plant (SUPP) consists of a collector area to heat the air due to the wide-banded ultra-violet solar radiation, the high-rise solar tower to updraft the heated air to the atmosphere, and in between the power conversion unit, where a system of coupled turbines and generators transforms the stream of heated air into electric power. A good efficiency of the power plant can only be reached with extra-large dimensions of the tower and/or the collector area. The paper presents an up-to-date review of the SUPP technology, focusing on the multi-physics modeling of the power plant, on the structural behavior of the tower and, last but not least, on the modeling of the stochastic wind loading process.

  16. Post-approval studies in France, challenges facing medical devices.

    PubMed

    Levesque, Karine; Coqueblin, Claire; Guillot, Bernard; Aubourg, Lucie; Avouac, Bernard; Carbonneil, Cédric; Cucherat, Michel; Descamps-Mandine, Patricia; Hanoka, Serge; Goldberg, Marcel; Josseran, Anne; Parquin, François; Pitel, Séverine; Ratignier, Christelle; Sechoy, Odile; Szwarcenstein, Karine; Tanti, André; Teiger, Emmanuel; Thevenet, Nicolas

    2014-01-01

    Medical devices are characterized notably by a wide heterogeneity (from tongue depressors to hip prostheses, and from non-implantable to invasive devices), a short life cycle with recurrent incremental innovations (from 18 months to 5 years), and an operator-dependent nature. The objective of the current round table was to develop proposals and recommendations concerning the prerequisites needed in order to meet the French health authorities expectations concerning requests for post-approval studies for medical devices, required in cases where short and long-term consequences are unknown. These studies, which are the responsibility of the manufacturer or the distributor of the medical device, are designed to confirm the role of the medical device in the therapeutic management strategy in a real-life setting. There are currently approximately 150 post-approval studies underway, mainly concerning class III devices, and the majority face difficulties implementing the study or meeting the study objectives. In light of this, the round table endeavored to clearly identify the conditions for implementation of post-approval studies specific to the characteristics of medical devices. Various areas of progress have been envisaged to improve the performance of these studies, and by consequence, the efficiency of reimbursement of medical devices by the national health insurance. These include providing manufacturers with the opportunity to better anticipate post-approval requirements, defining a study-specific primary objective, integrating a phase allowing dialogue between the manufacturer, the health authorities and the scientific committee, and increasing awareness and training of health professionals on the impact of post-approval clinical studies in terms of the reimbursement of medical devices by the national insurance. PMID:25230354

  17. Challenges for Novice School Leaders: Facing Today's Issues in School Administration

    ERIC Educational Resources Information Center

    Beam, Andrea P.; Claxton, Russell L.; Smith, Samuel J.

    2016-01-01

    Challenges for novice school leaders evolve as information is managed differently and as societal and regulatory expectations change. This study addresses unique challenges faced by practicing school administrators (n = 159) during their first three years in a school leadership position. It focuses on their perceptions, how perceptions of present…

  18. The Challenges Faced by Chinese Higher Education as It Expands in Scale

    ERIC Educational Resources Information Center

    Xiaohao, Ding

    2004-01-01

    This article reports the challenges faced by Chinese higher education as it expands in scale. The scale of China's higher education has seen unprecedented expansion in recent years. This article explores the new opportunities and challenges that such expansion brings to China's higher education. The author states that, aside from the many…

  19. Challenges Facing Rural Community Colleges: Issues and Problems Today and over the Past 30 Years

    ERIC Educational Resources Information Center

    Pennington, Kevin; Williams, Mitchell R.; Karvonen, Meagan

    2006-01-01

    For over 30 years, researchers and practitioners have identified challenges unique to small, rural community colleges. The purpose of this study was to examine the distinctive problems facing rural community colleges today and the challenges those institutions must address to fulfill their mission in rural America. There are 5 current challenges…

  20. Endometriosis and ovarian cancer: links, risks, and challenges faced

    PubMed Central

    Pavone, Mary Ellen; Lyttle, Brianna M

    2015-01-01

    Endometriosis is a benign gynecological condition characterized by specific histological, molecular, and clinical findings. It affects 5%–10% of premenopausal women, is a cause of infertility, and has been implicated as a precursor for certain types of ovarian cancer. Advances in technology, primarily the ability for whole genome sequencing, have led to the discovery of new mutations and a better understanding of the function of previously identified genes and pathways associated with endometriosis associated ovarian cancers (EAOCs) that include PTEN, CTNNB1 (β-catenin), KRAS, microsatellite instability, ARID1A, and the unique role of inflammation in the development of EAOC. Clinically, EAOCs are associated with a younger age at diagnosis, lower stage and grade of tumor, and are more likely to occur in premenopausal women when compared with other ovarian cancers. A shift from screening strategies adopted to prevent EAOCs has resulted in new recommendations for clinical practice by national and international governing bodies. In this paper, we review the common histologic and molecular characteristics of endometriosis and ovarian cancer, risks associated with EAOCs, clinical challenges and give recommendations for providers. PMID:26170722

  1. Mars can wait: facing the challenges of our civilization.

    PubMed

    Goodman, Geoffrey; Gershwin, M Eric; Bercovich, Dani

    2014-12-01

    We are overwhelmed by warnings about inevitable geophysical and human problems. Earth is beset by escalating, manmade, environmental crises and our exploding population will eventually lack water, food and vital materials. This suggests, together with increasing poverty, deepening social unrest and advanced techniques for mass killing, that civilization will break down long before atmospheric CO2 or resistant microbes become catastrophic. Despite intensive searching, life has not been found in space, even though thousands of planets have been found and life there may be as problematic and unpredictable as on Earth. The human brain is already a 'universe', with 85 billion neurons and a hundred trillion synapses, more than the stars in our galaxy. Understanding consciousness, the brain, its aging and pathologies, and eliminating the propensity for human aggression are urgent challenges. During 1958-2012, NASA spent $800 billion. In contrast, the annual cost of brain disease in the U.S. is $600 billion, more than cardiovascular disease and cancer combined. We suggest that a massive switching of financial and human resources is required to explore the full potential of the human brain. Visiting Mars can wait. We further propose a novel Two-Brain Hypothesis: the animal 'brain' evolved as two fundamentally different though interdependent, complementary organs: one electroionic (tangible, known and accessible), and the other, electromagnetic (intangible and difficult to access)--a relatively independent, stable, structured and functional 3D compendium of variously induced interacting EM fields. PMID:25630201

  2. Facing regulatory challenges of on-line hemodiafiltration.

    PubMed

    Kümmerle, Wolfgang

    2011-01-01

    On-line hemodiafiltration (on-line HDF) is the result of a vision that triggered multifarious changes in very different areas. Driven by the idea to offer better medical treatment for renal patients, technological innovations were developed and established that also constituted new challenges in the field of regulatory affairs. The existing regulations predominantly addressed the quality and safety of those products needed to perform dialysis treatment which were supplied by industrial manufacturers. However, the complexity of treatment system required for the provision of on-line fluids demanded a holistic approach encompassing all components involved. Hence, focus was placed not only on single products, but much more on their interfacing, and the clinical infrastructure, in particular, had to undergo substantial changes. The overall understanding of the interaction between such factors, quite different in their nature, was crucial to overcome the arising regulatory obstacles. This essay describes the evolution of the on-line HDF procedure from the regulatory point of view. A simplified diagram demonstrates the path taken from the former regulatory understanding to the realization of necessary changes. That achievement was only possible through 'management of preview' and consequent promotion of technical and medical innovations as well as regulatory re-evaluations. PMID:22188690

  3. Pediatric facial transplantation: Ethical considerations

    PubMed Central

    Flynn, Jennifer; Shaul, Randi Zlotnik; Hanson, Mark D; Borschel, Gregory H; Zuker, Ronald

    2014-01-01

    Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement. PMID:25114614

  4. The changing face of critical care medicine: nurse practitioners in the pediatric intensive care unit.

    PubMed

    Molitor-Kirsch, Shirley; Thompson, Lisa; Milonovich, Lisa

    2005-01-01

    Over the last 50 years, healthcare has undergone countless changes. Some of the important changes in recent years have been budget cuts, decreased resident work hours, and increased patient acuity. The need for additional clinical expertise at the bedside has resulted in nurse practitioners becoming an integral part of the healthcare delivery team. To date, little has been published regarding the role of the nurse practitioners in intensive care units. This article outlines how one pediatric hospital has successfully utilized nurse practitioners in the intensive care unit. PMID:15876885

  5. The Enormous Challenge faced by China to Reduce Earthquake Losses

    NASA Astrophysics Data System (ADS)

    Wang, Y.; Mooney, W. D.; Wang, B.

    2014-12-01

    In past six years, several big earthquakes occurred in Chinese continent that have caused enormous economic loss and casualties. These earthquakes include the following: 2008 Mw=7.9 Wenchuan; 2010 Mw=6.9 Yushu; 2013 Mw=6.6 Lushan; and 2013 Mw=5.9 Minxian events. On August 4, 2014 the Mw=6.1 earthquake struck Ludian in Yunnan province. Althought it was a moderate size earthquake, the casualties have reached at least 589 people. In fact, more than 50% of Chinese cities and more than 70% of large to medium size cities are located in the areas where the seismic intensity may reach Ⅶ or higher. Collapsing buildings are the main cause of Chinese earthquake casualties; the secondary causes are induced geological disasters such as landslide and barrier lakes. Several enormous challenges must be overcome to reduce hazards from earthquakes and secondary disasters.(1)Much of the infrastructure in China cannot meet the engineering standard for adequate seismic protection. In particular, some buildings are not strong enough to survive the potential strong ground shaking, and some of them did do not keep away from the active fault with a safe distance. It will be very costly to reinforce or rebuild such buildings. (2) There is lack of the rigorous legislation on earthquake disaster protection. (3) It appears that both government and citizen rely too much on earthquake prediction to avoid earthquake casualties. (4) Geologic conditions is very complicate and in need of additional studies, especially in southwest of China. There still lack of detail survey on potential geologic disasters, such as landslides. Although we still cannot predict earthquakes, it is possible to greatly reduce earthquake hazards. For example, some Chinese scientists have begun studies with the aim of identifying active faults under large cities and to propose higher building standards. It will be a very difficult work to improve the quality and scope of earthquake disaster protection dramatically in

  6. The 1000 Canadian Faces of Lupus: Influence of Ethnicity on Disease in the Pediatric Cohort

    PubMed Central

    Levy, Deborah M.; Peschken, Christine A.; Tucker, Lori B.; Chédeville, Gaëlle; Huber, Adam M.; Pope, Janet E.; Silverman, Earl D.

    2012-01-01

    Purpose To determine the influence of ethnicity and sociodemographic factors on disease characteristics of the Canadian Pediatric Lupus population. Methods Childhood-onset SLE (cSLE) patients at four pediatric centers in Halifax, Montreal, Toronto and Vancouver were consecutively recruited. Sociodemographics and disease data were collected. Patients were categorized by their primary self-selected ethnicity, and exploratory cluster analyses were examined for disease expression by ethnicity. Results We enrolled 213 cSLE patients, and ethnicity data were available for 206 patients: White (31%), Asian (30%), South Asian (15%), Black (10%), Latino/Hispanic (4%), Aboriginal (4%) and Arab/Middle Eastern (3%). The frequency of clinical classification criteria (malar rash, arthritis, serositis and renal disease) and autoantibodies significantly differed among ethnicities. Medications were prescribed equally across ethnicities: 76% were taking prednisone, 86% anti-malarials, and 56% required additional immunosuppressants. Cluster analysis partitioned three main groups – mild (N = 50), moderate (N = 82) and severe (N = 68) disease clusters. Only 20% of White patients were in the severe cluster compared to 51% of Asian and 41% of Black patients (p=0.03). However, disease activity indices and damage scores were similar across ethnicities. Conclusion Canadian cSLE patients reflect our multi-ethnic population, with differences in disease manifestations, autoantibody profiles and severity of disease expression by ethnicity. PMID:22744999

  7. The many faces of Ewing sarcoma: difficult to diagnose pediatric cases.

    PubMed

    Fouda, Asharf; Mansour, Ahmed; Al-Tonbary, Youssef

    2009-01-01

    Ewing sarcoma (ES) is the second most frequent primary malignant bone cancer, following osteosarcoma. ES is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. We describe four children aged 3, 3.5, 9, and 9.5 years, who presented with two femur masses simultaneously (patient 1), a huge mediastinal mass (patient 2), an abdomino-mediastinal mass with dysphagia (patient 3), and a huge abdomino-pelvic mass (patient 4). Our patients were of younger age and had abnormal presentations that made initial diagnosis difficult, but also are representative of the different problems encountered in pediatric practice. Biopsy initially revealed round cell tumor and by immunohistochemistry, CD99 was positive, which confirmed the diagnosis of ES. Our patients were difficult to diagnosis.The patients were misdiagnosed initially, so there was a delay in diagnosis. Definitive diagnosis required use of various radiological imaging methods and immunohistochemistry. PMID:20139055

  8. Assessment of Institutional and Personnel-Related Challenges Facing Educational Programme for the Mentally Challenged Persons at Kaimosi Special School, Kenya

    ERIC Educational Resources Information Center

    Mmbwanga, Daniel M.; Matemba, Collins K.; Bota, Kennedy N.

    2015-01-01

    The mentally challenged child (MC) can achieve a lot if the right environment and curriculum are designed for him/her. However, the realization of the desirable outcomes faces many challenges. The objective of the study was to examine institutional and personnel-related challenges facing education programs for the MC persons at Kaimosi Special…

  9. A qualitative exploration of the major challenges facing pharmacovigilance in Saudi Arabia

    PubMed Central

    Aljadhey, Hisham; Mahmoud, Mansour A.; Alshammari, Thamir M.; Al-Dhaeefi, Mohammed; Louet, Hervé Le; Perez-Gutthann, Susana; Pitts, Peter J.

    2015-01-01

    Objectives: To explore the challenges facing pharmacovigilance in Saudi Arabia and formulate recommendations to improve it from the perspective of healthcare professionals in Saudi Arabia. Methods: This was a qualitative study of 4 focus group discussions with pharmacists, physicians, and academicians held under the auspices of the King Saud University School of Pharmacy and the Center for Medicine in the Public Interest, Riyadh, Saudi Arabia. A total of 29 eligible healthcare professionals were invited to participate in the discussion. The predefined themes of the study were the current practice and major challenges facing pharmacovigilance in regulatory bodies, hospitals, the community, and academia, as well as recommendations to improve pharmacovigilance practice. Result: Of the 29 participants invited, 27 attended the discussion. Challenges facing regulatory bodies included complicated adverse drug reactions (ADR) reporting forms, lack of feedback on ADRs submitted to the Saudi Food and Drug Authority, lack of decisions from the local authority to withdraw medications, and lack of data on pharmacovigilance. The challenges to pharmacovigilance in hospitals included the lack of knowledge of the significance of ADR reporting, workload, blaming culture, and lack of collaboration between regulatory bodies and hospitals. However, challenges facing pharmaceutical industries included the lack of drug manufacturers in Saudi Arabia and lack of interest in pharmacovigilance. Recommendations to improve pharmacovigilance included the need for communication, stronger regulatory requirements, the need for research, the need for unified ADRs reporting, and continuous education and training. Conclusion: The study has identified the challenges facing pharmacovigilance in Saudi Arabia and made certain recommendations to overcome them. These recommendations might be helpful for regulatory bodies to enhance spontaneous reporting and promote pharmacovigilance. PMID:26318468

  10. Challenges facing developers of CAD/CAM models that seek to predict human working postures

    NASA Astrophysics Data System (ADS)

    Wiker, Steven F.

    2005-11-01

    This paper outlines the need for development of human posture prediction models for Computer Aided Design (CAD) and Computer Aided Manufacturing (CAM) design applications in product, facility and work design. Challenges facing developers of posture prediction algorithms are presented and discussed.

  11. New Challenges Facing Universities in the Internet-Driven Global Environment

    ERIC Educational Resources Information Center

    Rajasingham, Lalita

    2011-01-01

    This paper explores some new challenges facing universities in a global multimediated Internet-based environment, as they seek alternative paradigms and options to remain true to their core business. At a time of rapid technological change, and contested, complex concepts associated with globalisation, knowledge is becoming a primary factor of…

  12. Challenges Faced by Preceptors Serving in Dual Roles as Health Care Providers and Clinical Educators

    ERIC Educational Resources Information Center

    Dodge, Thomas; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Preceptors play an integral role in training athletic training students (ATSs). Balancing roles as health care providers and educators can often be challenging. Role strain is a documented concern for the preceptor, yet limited information is available regarding other issues faced while supervising ATSs. Objective: To explore preceptor…

  13. Global Education: Instructional Strategies Used and Challenges Faced by In-Service Teachers

    ERIC Educational Resources Information Center

    Eslami, Zohreh R.

    2005-01-01

    This article examines the result of a study on teachers' reported use of instructional strategies in dealing with the U.S.-Iraq war, the resources that they use, the challenges that they face in implementing a globally oriented curriculum, and the sources of influence on their commitment to global education. A questionnaire was developed and used…

  14. Addressing the Challenges Special Needs Students Face when Transitioning from the Classroom to the Workplace

    ERIC Educational Resources Information Center

    Gagliardi, Frank

    2010-01-01

    One of the biggest fears and challenges a parent of a child with special needs faces is navigating the post-22 landscape. When a child hits the age of 22, the Department of Elementary and Secondary Education (DESE) is no longer required to provide daily services and support. Whatever the abilities, or disabilities, of a child, every parent has the…

  15. Challenges Facing Women Academic Leadership in Secondary Schools of Irbid Educational Area

    ERIC Educational Resources Information Center

    Al-Jaradat, Mahmoud Khaled Mohammad

    2014-01-01

    This study aimed at identifying the challenges facing women academic leadership in secondary schools of Irbid Educational Area. A random sample of 187 female leaders were chosen. They responded to a 49-item questionnaire prepared by the researcher. The items were distributed into four domains: organizational, personal, social and physical…

  16. Challenges Faced by Teachers Implementing Socio-Scientific Issues as Core Elements in Their Classroom Practices

    ERIC Educational Resources Information Center

    Bossér, Ulrika; Lundin, Mattias; Lindahl, Mats; Linder, Cedric

    2015-01-01

    Teachers may face considerable challenges when implementing socio-scientific issues (SSI) in their classroom practices, such as incorporating student-centred teaching practices and exploring knowledge and values in the context of socioscientific issues. This year-long study explores teachers' reflections on the process of developing their…

  17. Language Challenges Faced by International Graduate Students in the United States

    ERIC Educational Resources Information Center

    Kuo, Ya-Hui

    2011-01-01

    Universities and colleges in the United States require international graduate students to provide certain English proficiency documents along with their admission applications before they are admitted to their programs. This study explored the language challenges faced by international graduate students at a Southern university in the U.S. The…

  18. Changes to Educational Policy and Management in Wales: Facing the "Cuts" and New Strategic Challenges

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

    Like the rest of the United Kingdom, Wales is facing a new challenge from the implementation of the Coalition Government's cuts. The Welsh Assembly Government [WAG, renamed Welsh Government (WG), in May 2011] budget was reduced by 1.8 billion British Pounds over the next four years. WAG responded by introducing its own revised austerity budget…

  19. Challenges Faced by Institutions of Higher Education in Migrating to Distance Learning.

    ERIC Educational Resources Information Center

    Broskoske, Stephen L.; Harvey, Francis A.

    This paper presents the results of a research study conducted in fall 1999 to examine the challenges facing higher educational institutions in migrating to distance learning. The study consisted of five case studies conducted at higher educational institutions in Pennsylvania. At each institution the researchers interviewed the president and other…

  20. Oral Academic Discourse Socialisation: Challenges Faced by International Undergraduate Students in a Malaysian Public University

    ERIC Educational Resources Information Center

    Mahfoodh, Omer Hassan Ali

    2014-01-01

    This paper reports a qualitative study which examines the challenges faced by six international undergraduate students in their socialisation of oral academic discourse in a Malaysian public university. Data were collected employing interviews. Students' presentations were also collected. Semi-structured interviews were transcribed verbatim and…

  1. Community Colleges at the Crossroads: Challenges Facing the Western States. Background Papers for a Legislative Workshop.

    ERIC Educational Resources Information Center

    Lenth, Charles S.

    Background materials are presented on demographic trends, economic changes, financing patterns and governance decisions affecting community colleges in the western United States. Following an executive summary, chapter I provides an overview of the characteristics of public community colleges and the particular challenges they face. Chapter II…

  2. Transition Program: The Challenges Faced by Special Needs Students in Gaining Work Experience

    ERIC Educational Resources Information Center

    Alias, Aliza

    2014-01-01

    Transition program for special needs students is known to open opportunities for students with learning disabilities to gain work experience in actual work environment. The program provides training activities and also an opportunity to go for internship to gain work experience. Therefore, this study is to identify the challenges faced by special…

  3. Challenges Facing Canadian Federal Offenders Newly Released to the Community: A Concept Map

    ERIC Educational Resources Information Center

    Brown, Jason D.

    2004-01-01

    The purpose of the study was to describe the needs of newly released Canadian federal offenders as perceived by community parole supervisors. Seventy-four Canadian parole supervisors were asked to answer the following question: "What challenges do parolees face in the first 90 days after release?" The data were analyzed using multidimensional…

  4. Academic, Social, and Economic Challenges Faced by Latinos to Attain a College Degree

    ERIC Educational Resources Information Center

    Stevenson, Kenel

    2009-01-01

    This study examined the academic, social and economic challenges faced by Latino students to attain a college degree. In addition, of prime importance was the need for improvement and persistence, which led to retention in college enrollment rates for Latino students both at the secondary and postsecondary levels. Findings from this study…

  5. A Short Twenty Years: Meeting the Challenges Facing Teachers Who Bring Rwanda into the Classroom

    ERIC Educational Resources Information Center

    Gudgel, Mark

    2013-01-01

    As the twentieth anniversary of the 1994 genocide in Rwanda approaches, Mark Gudgel argues that we should face the challenges posed by teaching about Rwanda. Drawing on his experience as a history teacher in the US, his experience researching and supporting others' classrooms in the US and UK, his training in Holocaust education and his…

  6. Quality Assurance Challenges and Opportunities Faced by Private Universities in Zimbabwe

    ERIC Educational Resources Information Center

    Garwe, Evelyn Chiyevo

    2014-01-01

    The study sought to provide an understanding of the quality assurance challenges and opportunities faced by private universities in Zimbabwe. The study analyzed the factors determining provision of quality higher education in private universities and the resultant effects of failing to achieve the minimum acceptable standards. The author employed…

  7. Children at Risk of Neglect: Challenges Faced by Child Protection Practitioners in Guatemala City

    ERIC Educational Resources Information Center

    Coope, Caroline M.; Theobald, Sally

    2006-01-01

    Objectives: The objectives were to (1) delineate the definition, common forms, and perceived risk factors contributing to child neglect in Guatemala from the perspective of different stakeholders and (2) identify the challenges faced by child protection practitioners in identifying children at risk of neglect within the context of Guatemala.…

  8. Military Veterans Face Challenges in Accessing Educational Benefits at Florida Community Colleges

    ERIC Educational Resources Information Center

    Spiro, Rivka; Hill, Robert

    2010-01-01

    Florida's community colleges are seeing an influx of students who face unique challenges. They are the men and women who served in the military after the attacks of September 11, 2001, and who are now attending college on the new Post-9/11 GI Bill, with its greatly enhanced educational benefits, and on the expanded, old Montgomery GI Bill, which…

  9. Challenges Caring for Adults With Congenital Heart Disease in Pediatric Settings: How Nurses Can Aid in the Transition.

    PubMed

    Anton, Kristin

    2016-08-01

    As surgery for complex congenital heart disease is becoming more advanced, an increasing number of patients are surviving into adulthood, yet many of these adult patients remain in the pediatric hospital system. Caring for adult patients is often a challenge for pediatric nurses, because the nurses have less experience and comfort with adult care, medications, comorbid conditions, and rehabilitation techniques. As these patients age, the increased risk of complications and comorbid conditions from their heart disease may complicate their care further. Although these patients are admitted on a pediatric unit, nurses can aid in promoting their independence and help prepare them to transition into the adult medical system. Nurses, the comprehensive medical teams, and patients' families can all effectively influence the process of preparing these patients for transition to adult care. PMID:27481810

  10. Challenges of clinical trial design for targeted agents against pediatric leukemias.

    PubMed

    Mussai, Francis Jay; Yap, Christina; Mitchell, Christopher; Kearns, Pamela

    2014-01-01

    The past 40 years have seen significant improvements in both event-free and overall survival for children with acute lymphoblastic and acute myeloid leukemia (ALL and AML, respectively). Serial national and international clinical trials have optimized the use of conventional chemotherapeutic drugs and, along with improvements in supportive care that have enabled the delivery of more intensive regimens, have been responsible for the major improvements in patient outcome seen over the past few decades. However, the benefits of dose intensification have likely now been maximized, and over the same period, the identification of new cytotoxic drugs has been limited. Therefore, challenges remain if survival is to be improved further. In pediatric ALL, 5-year-survival rates of over 85% have been achieved with risk-stratified therapy, but a notable minority of patients will still not be cured. In pediatric AML, different challenges remain. A slower improvement in overall survival has taken place in this patient population. Despite the obvious morphological heterogeneity of AML blasts, biological stratification is comparatively limited, and translation into risk-stratified therapeutic approaches has only best characterized by the use of retinoic acid for t(15;17)-positive AML. Even where prognostic markers have been identified, limited therapeutic options or multi-drug resistance of AML blasts has limited the impact on patient benefit. For both, the acute morbidities of current treatment remain significant and may be life-threatening alone. In addition, the Childhood Cancer Survivor Study (CCSS) highlighted many leukemia survivors develop one or more chronic medical conditions attributable to treatment (1, 2). As the biology of leukemogenesis has become better understood, key molecules and intracellular pathways have been identified that offer the possibility of targeting directly the leukemia cells while sparing normal cells. Consequently, there is now a drive to develop

  11. Why Face a Challenge? The Reason behind Intrinsically Motivated Students' Spontaneous Choice of Challenging Tasks

    ERIC Educational Resources Information Center

    Inoue, Noriyuki

    2007-01-01

    In a task choice situation, why do some students spontaneously choose challenging tasks while others do not? In the study, 114 undergraduate students were first asked of their perceived competence and interest in solving number puzzles at both individual and situational levels, and then asked to choose one puzzle from four difficulty levels. They…

  12. Addressing mental health challenges facing the "Next America": A call for culture change.

    PubMed

    McLeigh, Jill D; Melton, Gary B

    2015-09-01

    Provides an editorial addressing future mental health challenges. The articles in this issue highlight the need to create environments conducive to promoting the well-being of future generations. The articles build on symposia held by the American Orthopsychiatric Association in 2015, which focused on the effects on well-being of changing sociodemographics and labor market trends. Included in these pages are articles that lay out some of the challenges young people today face and strategies for helping them transition to adulthood successfully. PMID:26460709

  13. Evaluation of the Progress and Challenges facing the Ponseti Method Program in Vietnam

    PubMed Central

    Wu, Vincent; Nguyen, Michelle; Nhi, Huynh Manh; Thanh, Do Van; Oprescu, Florin; Cook, Thomas; Morcuende, Jose A.

    2012-01-01

    Introduction In 2003, an ICRC-SFD Ponseti program was introduced in southern Vietnam. Additional programs were introduced by the Prosthetics Outreach Foundation and independently by physicians trained at our center. The purpose of this study was to evaluate the impact, progress and challenges facing Ponseti practitioners and patients' family members in Vietnam. In addition, web-conferencing (Ponseti Virtual Forum) for continued medical education in the method was also assessed. Methods Multiple questionnaires were developed to conduct face-to-face practitioner interviews, focus group interviews, and parental interviews. Observation was done at multiple site clinics to determine or confirm additional challenges faced by practitioners. Web conferencing was introduced to sites in Ho Chi Minh City and Da Nang City. Results The number of clubfoot patients treated with the Ponseti method has increased over time with approximately 1,252 infants treated between 2003 and 2010. Specific challenges were identified relating to communication, networking, distance and transportation, and finances for both practitioners and parents. The PVF was not only found to facilitate rapid, relevant dissemination of medical knowledge – thus increasing physician and patient satisfaction – but it may also be found to act as an interface in which medical culture, insight, and compassion are shared benefiting all virtual forum participants. Conclusion The identified progress and challenges mirrored that of similar studies done in other countries with several factors affecting progress. Focusing on improving communication channels and networking while working with the ministry of health may improve the facilitation of the Ponseti method in Vietnam. Further implementation and evaluation of the PVF may act as a guide for current and future programs in Vietnam or other countries. PMID:23576933

  14. Challenges facing translational research organizations in China: a qualitative multiple case study

    PubMed Central

    2013-01-01

    Background Translational medicine is attracting much attention worldwide and many translational research organizations (TROs) have been established. In China, translational medicine has developed rapidly, but faces many challenges. This study was aimed at exploring these challenges faced by emerging TROs in China. Method A qualitative, multiple case study approach was used to assess the challenges faced by TROs in China. Data were collected between May and August 2012. Results Eight cases were identified. Overall, four themes that characterized TROs in China emerged from analyses: 1. objectives, organizer, and funding resources, 2. participating partners and research teams, 3. management, and 4. achievements. All TROs had objectives related to translating basic discovery to clinic treatment and cultivating translational researchers. In terms of organizer and funding resources, 7 out of 8 TROs were launched only by universities and/or hospitals, and funded mostly through research grants. As for participating partners and multidisciplinary research teams, all but one of the TROs only involved biomedical research institutions who were interested in translational research, and characterized as clinical research centers; 7 out of 8 TROs involved only researchers from biomedicine and clinical disciplines and none involved disciplines related to education, ethnicity, and sociology, or engaged the community. Current management of the TROs were generally nested within the traditional research management paradigms, and failed to adapt to the tenets of translational research. Half of the TROs were at developmental stages defined as infrastructure construction and recruitment of translational researchers. Conclusions TROs in China face the challenge of attracting sustainable funding sources, widening multidisciplinary cooperation, cultivating multi-disciplinary translational researchers and adapting current research management to translational research. Greater emphasis should

  15. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

    PubMed Central

    Muhly, Wallis T; Gurnaney, Harshad G; Ganesh, Arjunan

    2015-01-01

    The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs) for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation. PMID:26609245

  16. Thiamine Deficiency in Tropical Pediatrics: New Insights into a Neglected but Vital Metabolic Challenge

    PubMed Central

    Hiffler, Laurent; Rakotoambinina, Benjamin; Lafferty, Nadia; Martinez Garcia, Daniel

    2016-01-01

    In humans, thiamine is a micronutrient prone to depletion that may result in severe clinical abnormalities. This narrative review summarizes current knowledge on thiamine deficiency (TD) and bridges the gap between pathophysiology and clinical presentation by integrating thiamine metabolism at subcellular level with its function to vital organs. The broad clinical spectrum of TD is outlined, with emphasis on conditions encountered in tropical pediatric practice. In particular, TD is associated with type B lactic acidosis and classic forms of beriberi in children, but it is often unrecognized. Other severe acute conditions are associated with hypermetabolism, inducing a functional TD. The crucial role of thiamine in infant cognitive development is also highlighted in this review, along with analysis of the potential impact of TD in refeeding syndrome during severe acute malnutrition (SAM). This review aims to increase clinical awareness of TD in tropical settings where access to diagnostic tests is poor, and advocates for an early therapeutic thiamine challenge in resource-limited settings. Moreover, it provides evidence for thiamine as treatment in critical conditions requiring metabolic resuscitation, and gives rationale to the consideration of increased thiamine supplementation in therapeutic foods for malnourished children. PMID:27379239

  17. Thiamine Deficiency in Tropical Pediatrics: New Insights into a Neglected but Vital Metabolic Challenge.

    PubMed

    Hiffler, Laurent; Rakotoambinina, Benjamin; Lafferty, Nadia; Martinez Garcia, Daniel

    2016-01-01

    In humans, thiamine is a micronutrient prone to depletion that may result in severe clinical abnormalities. This narrative review summarizes current knowledge on thiamine deficiency (TD) and bridges the gap between pathophysiology and clinical presentation by integrating thiamine metabolism at subcellular level with its function to vital organs. The broad clinical spectrum of TD is outlined, with emphasis on conditions encountered in tropical pediatric practice. In particular, TD is associated with type B lactic acidosis and classic forms of beriberi in children, but it is often unrecognized. Other severe acute conditions are associated with hypermetabolism, inducing a functional TD. The crucial role of thiamine in infant cognitive development is also highlighted in this review, along with analysis of the potential impact of TD in refeeding syndrome during severe acute malnutrition (SAM). This review aims to increase clinical awareness of TD in tropical settings where access to diagnostic tests is poor, and advocates for an early therapeutic thiamine challenge in resource-limited settings. Moreover, it provides evidence for thiamine as treatment in critical conditions requiring metabolic resuscitation, and gives rationale to the consideration of increased thiamine supplementation in therapeutic foods for malnourished children. PMID:27379239

  18. Challenges Facing Families at the End of Life in Three Settings

    PubMed Central

    Kehl, Karen A.; Kirchhoff, Karin T.; Kramer, Betty J.; Hovland-Scafe, Cyndi

    2010-01-01

    This study examined the challenges faced by family members at the end of life in different care settings and how those challenges compare across settings. A total of 30 participants, who had a family member die in inpatient hospice, a skilled nursing facility or a community support program were interviewed. Semi-structured interviews were recorded and transcribed. Text was coded using qualitative thematic analysis. Themes were determined by consensus. Twelve challenges were identified across care sites. Two themes emerged in all three settings: bearing witness and the experience of loss. The study findings contribute to our knowledge of family perceptions of care in different settings and raises awareness of the need for further research describing the experiences at the end of life in different settings and the importance of creating and testing interventions for both setting specific needs and universal issues. PMID:20563315

  19. One in Four Questioned Children Faces Problems Regarding Reintegration Into Physical Education at School After Treatment for Pediatric Cancer.

    PubMed

    Kesting, Sabine V; Götte, Miriam; Seidel, Corinna C; Rosenbaum, Dieter; Boos, Joachim

    2016-04-01

    Resumption of physical activity and reintegration into social surroundings after treatment for pediatric cancer is of high importance to recover from the burden of disease and treatment and to positively influence long-term health outcomes. Eighty-three children who had completed intensive treatment for pediatric cancer were surveyed regarding their participation in physical education at school (PES). The results show a concerning low rate of participation, particularly in children treated for pediatric bone tumors, and associated barriers. Reported reasons for quitting PES seem to be conquerable by individual and entity-related support to enable participation according to the children's desire. PMID:26681662

  20. The Hurricane Problem - The Three Faces of the Big Data Challenges

    NASA Astrophysics Data System (ADS)

    Hristova-Veleva, S. M.; Boothe, M.; Gopalakrishnan, S.; Haddad, Z. S.; Knosp, B.; Lambrigtsen, B.; Li, P.; Montgomery, M. T.; Niamsuwan, N.; Shen, T. P. J.; Tallapragada, V.; Tanelli, S.; Trahan, S.; Turk, F. J.; Vu, Q. A.

    2015-12-01

    Despite recent progress in hurricane track forecasts, we still lack understanding of the multi-scale interactions that sometimes lead to cylogenesis or rapid intesification and other times do not. To improve hurricane forecasts we need to understand the physical processes that control hurricane evolution and to evaluate whether the models represent them properly. This is where we face Big Data challenges in three different ways: dealing with a multitude of observations; extracting relevant information from voluminous model forecast; and performing carefully designed diagnostics to evaluate the models. Satellite observations provide invaluable information. However, needed are long-term observations of multiple parameters, from a multitude of instruments. These data come from disparate sources, in different formats, with varying latency. Bringing all these observations to bear on addressing the hurricane problem presents the observational side of the Big Data challenges. Hurricane evolution is sensitive to the storm internal dynamics as well as environmental characteristics. This is why accurate forecasting requires the use of regional models, with higher resolution and better parameterizations, as well as the use of global models that better depict the large-scale environment, necessary for properly capturing the important scale interactions. Extracting relevant information from the extremely voluminous model forecasts, we face the model-related side of the Big Data challenges. To properly evaluate the models we need to go beyond the comparison of the geophysical fields and use instrument simulators to compute synthetic observations from the model fields for a more direct comparison. Producing realistic synthetic data requires the use of complex, computationally intensive, instrument simulators. This demand, in addition to developing on-line analytics to support model evaluation, is where we face the analytics side of the Big Data challenges. We are now developing a

  1. Applying the Rasch Model to Measure Acculturation Challenges Faced by Saudi Female Students in the United States

    ERIC Educational Resources Information Center

    Hakami, Samah Mohammed

    2012-01-01

    The purpose of this study was to explore the major acculturation challenges faced by Saudi female students who study in the U.S. and to develop a scale to measure potential acculturation challenges. The construction of the scale was based on a table of specification that included nine domains of possible acculturation challenges: (a)…

  2. Facing Our Energy Challenges in a New Era of Science (2011 EFRC Forum)

    SciTech Connect

    Dehmer, Patricia M.

    2011-05-26

    Patricia Dehmer, Deputy Director for Science Programs at DOE, opened the May 26, 2011 EFRC Forum session, 'Global Perspectives on Frontiers in Energy Research,' with the talk, 'Facing Our Energy Challenges in a New Era of Science.' In her presentation, Dr. Dehmer gave a tutorial on the energy challenges facing our Nation and showed how the DOE research portfolio addresses those issues. The 2011 EFRC Summit and Forum brought together the EFRC community and science and policy leaders from universities, national laboratories, industry and government to discuss 'Science for our Nation's Energy Future.' In August 2009, the Office of Science established 46 Energy Frontier Research Centers. The EFRCs are collaborative research efforts intended to accelerate high-risk, high-reward fundamental research, the scientific basis for transformative energy technologies of the future. These Centers involve universities, national laboratories, nonprofit organizations, and for-profit firms, singly or in partnerships, selected by scientific peer review. They are funded at $2 to $5 million per year for a total planned DOE commitment of $777 million over the initial five-year award period, pending Congressional appropriations. These integrated, multi-investigator Centers are conducting fundamental research focusing on one or more of several 'grand challenges' and use-inspired 'basic research needs' recently identified in major strategic planning efforts by the scientific community. The purpose of the EFRCs is to integrate the talents and expertise of leading scientists in a setting designed to accelerate research that transforms the future of energy and the environment.

  3. Facing Our Energy Challenges in a New Era of Science (2011 EFRC Forum)

    ScienceCinema

    Dehmer, Patricia M. (Deputy Director for Science Programs at DOE)

    2012-03-20

    Patricia Dehmer, Deputy Director for Science Programs at DOE, opened the May 26, 2011 EFRC Forum session, 'Global Perspectives on Frontiers in Energy Research,' with the talk, 'Facing Our Energy Challenges in a New Era of Science.' In her presentation, Dr. Dehmer gave a tutorial on the energy challenges facing our Nation and showed how the DOE research portfolio addresses those issues. The 2011 EFRC Summit and Forum brought together the EFRC community and science and policy leaders from universities, national laboratories, industry and government to discuss 'Science for our Nation's Energy Future.' In August 2009, the Office of Science established 46 Energy Frontier Research Centers. The EFRCs are collaborative research efforts intended to accelerate high-risk, high-reward fundamental research, the scientific basis for transformative energy technologies of the future. These Centers involve universities, national laboratories, nonprofit organizations, and for-profit firms, singly or in partnerships, selected by scientific peer review. They are funded at $2 to $5 million per year for a total planned DOE commitment of $777 million over the initial five-year award period, pending Congressional appropriations. These integrated, multi-investigator Centers are conducting fundamental research focusing on one or more of several 'grand challenges' and use-inspired 'basic research needs' recently identified in major strategic planning efforts by the scientific community. The purpose of the EFRCs is to integrate the talents and expertise of leading scientists in a setting designed to accelerate research that transforms the future of energy and the environment.

  4. Bench-to-bedside review: Humanism in pediatric critical care medicine – a leadership challenge

    PubMed Central

    Kissoon, Niranjan

    2005-01-01

    A humanistic approach to leadership is especially important in the case of children in the technology-rich intensive care unit (ICU) environment. Leaders should create a humanistic milieu in which the needs of critically ill children, their families and staff are never overlooked. Humanistic leaders are tactful, accessible, approachable and versatile, and have a sense of humour. Humanness in the ICU environment has many faces and poses a challenge to many in leadership positions. Humanistic leaders treat others as they hope they will become. They are constantly questioning themselves, seeking awareness of themselves and others, but most importantly they are constantly learning and evolving. Ultimately, humanistic leadership creates an ICU culture that supports all, is conducive to enriching lives, and is sensitive to the needs of patients and their families. PMID:16137386

  5. Pediatric pain management: the multidisciplinary approach

    PubMed Central

    Odell, Shannon; Logan, Deirdre E

    2013-01-01

    Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain rehabilitation centers. This review offers a summary of the challenges faced by these programs and areas for future study. PMID:24250232

  6. 77 FR 76053 - Proposed Collection; Comment Request; Pediatric Palliative Care Campaign Pilot Survey

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... Care Campaign Pilot Survey Summary: In compliance with the requirement of Section 3506(c)(2)(A) of the.... Proposed Collection: Pediatric Palliative Care Campaign Pilot Survey-0925-New-National Institute of Nursing... developed a Pediatric Palliative Care Campaign to address the communications challenges faced by health...

  7. Nanomaterials for Polymer Electrolyte Membrane Fuel Cells; Materials Challenges Facing Electrical Energy Storate

    SciTech Connect

    Gopal Rao, MRS Web-Editor; Yury Gogotsi, Drexel University; Karen Swider-Lyons, Naval Research Laboratory

    2010-08-05

    Symposium T: Nanomaterials for Polymer Electrolyte Membrane Fuel Cells Polymer electrolyte membrane (PEM) fuel cells are under intense investigation worldwide for applications ranging from transportation to portable power. The purpose of this seminar is to focus on the nanomaterials and nanostructures inherent to polymer fuel cells. Symposium topics will range from high-activity cathode and anode catalysts, to theory and new analytical methods. Symposium U: Materials Challenges Facing Electrical Energy Storage Electricity, which can be generated in a variety of ways, offers a great potential for meeting future energy demands as a clean and efficient energy source. However, the use of electricity generated from renewable sources, such as wind or sunlight, requires efficient electrical energy storage. This symposium will cover the latest material developments for batteries, advanced capacitors, and related technologies, with a focus on new or emerging materials science challenges.

  8. Challenges facing internationalisation of nursing practice, nurse education and nursing workforce in Australia.

    PubMed

    Parker, Vicki; McMillan, Margaret

    2007-04-01

    This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context. PMID:17563321

  9. Quality of life of family caregivers and challenges faced in caring for patients with lung cancer.

    PubMed

    Fujinami, Rebecca; Otis-Green, Shirley; Klein, Linda; Sidhu, Rupinder; Ferrell, Betty

    2012-12-01

    Family caregivers (FCGs) of patients with lung cancer face multiple challenges that affect their quality of life and well-being. Whether challenged physically, emotionally, socially, or spiritually, distress in one area may compound challenges in other areas. To maintain function and health of FCGs as they provide valuable care for the health and well-being of the patient, attention must be given to the needs of FCGs for support and education. The purpose of this article is to describe the multifaceted challenges that FCGs of patients with lung cancer experience using case studies selected from a National Cancer Institute-funded program project. The cases are discussed in terms of how the FCG's quality of life is impacted by the caregiver role, as well as how stressors in one or more domains of quality of life compound difficulties in coping with the demands of the role. The importance of the oncology nurse's assessment of FCGs' needs for support, education, and self-care through the lung cancer illness trajectory is discussed while presenting accessible community resources to meet those needs. PMID:23178364

  10. Facing the challenges and building solutions in clinical psychiatric nursing in Iran: a qualitative study.

    PubMed

    Zarea, Kourosh; Nikbakht-Nasrabadi, Alireza; Abbaszadeh, Abbas; Mohammadpour, Ali

    2012-10-01

    Psychiatric nurses play an important role in the process of caring for mentally ill patients and are continually faced with the numerous challenges and complex issues related to this field. This study aimed to understand the perspectives of psychiatric nurses regarding the issues they face while providing care and examine the possible solutions for improvement of inpatient care in clinical settings. The study adopted a qualitative approach that utilized a content analysis of audio taped, semi-structured interviews that had been conducted with 24 nurses. Two main themes emerged from the data. The first, Challenges in Providing Care within Psychiatric Wards, had the following subthemes: Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, and Sociocultural Issues. The second theme, Solutions for Improving Psychiatric Care, had the subthemes of Empowerment across four domains: Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context. The results indicated that if nurses are expected to provide optimal nursing care within a psychiatric ward, then there is a need for a stable and responsible organizational structure, skilled psychiatric nurses, and community-based care along with an anti-stigma program. PMID:23017047

  11. When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

    PubMed Central

    Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

    2013-01-01

    Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an

  12. Pediatric tuberculosis drug market: an insider perspective on challenges and solutions.

    PubMed

    Usherenko, I; Basu Roy, U; Mazlish, S; Liu, S; Benkoski, L; Benkoscki, L; Coutts, D; Epstein, S; Qian, M; Rafiq, S; Scott, C

    2015-12-01

    Representative stakeholders were consulted on how they felt access to pediatric tuberculosis (TB) drugs could be improved. A key recommendation is the development of new child-friendly, adequately dosed formulations with a good shelf life in all climate zones. There is also an urgent need to improve the diagnosis and reporting of children with TB. Manufacturers of pediatric TB medications are to be incentivized through improved coordination among all stakeholders, with streamlined regulatory approvals and increased consumer education on drug and regimen guidelines. Finally, pooled procurement is advised to ensure sustained market supply against affordable prices. PMID:26564537

  13. Fetal Alcohol Spectrum Disorders and Challenges Faced by Caregivers: Clinicians' Perspectives.

    PubMed

    Baskin, Jonathan; Delja, Jolie R; Mogil, Catherine; Gorospe, Clarissa M; Paley, Blair

    2016-01-01

    BackgroundThere is a notable absence of evidence based early interventions for young children with FASD.  ObjectiveThis study examines clinicians' perspectives regarding the needs of caregivers of children with FASD and how such perspectives informed the development of a family-centered early intervention for young children with prenatal alcohol exposure.  Method19 professionals who work with children with prenatal alcohol exposure and / or in out-of-home care were recruited to participate in focus groups. The facilitator used a semi-structured topic guide to elicit feedback from participants. These data were transcribed, coded, and categorized to reflect themes in a manner informed by a grounded theory approach. A second investigator repeated the process. Codes were chosen and assigned to data by consensus.   ResultsThe coded data yielded five distinct perceived challenges faced by caregivers: (1) seeking and possibly receiving a diagnosis; (2) processing emotions and coming to terms with the child's difficulties; (3) seeking support and belonging within a knowledgeable community; (4) developing a new understanding of the child's behavior; and (5) becoming an educator, advocate, and expert on the child and FASD.   ConclusionProfessionals believe specific capacities are essential insofar as the human service systems that caregivers engage are perceived to be under-equipped to respond to the distinct set of challenges faced by children with FASD and their families. Findings are discussed in terms of how the proposed intervention was designed to address such challenges and to cultivate those key capacities in order for families to meet their children's needs. PMID:27462878

  14. Challenges and Opportunities Faced by Biofield Practitioners in Global Health and Medicine: A White Paper.

    PubMed

    Guarneri, Erminia; King, Rauni Prittinen

    2015-11-01

    Biofield therapies (BTs) are increasingly employed in contemporary healthcare. In this white paper, we review specific challenges faced by biofield practitioners resulting from a lack of (1) a common scientific definition of BT; (2) common educational standards for BT training (including core competencies for clinical care); (3) collaborative team care education in complementary and alternative medicine (CAM) and in integrative health and medicine (IHM); (4) a focused agenda in BT research; and (5) standardized devices and scientifically validated mechanisms in biofield research. We present a description of BT and discuss its current status and challenges as an integrative healthcare discipline. To address the challenges cited and to enhance collaboration across disciplines, we propose (1) standardized biofield education that leads to professional licensure and (2) interprofessional education (IPE) competencies in BT training required for licensed healthcare practitioners and encouraged for other practitioners using these therapies. Lastly, we discuss opportunities for growth and a potential strategic agenda to achieve these goals. The Academy of Integrative Health and Medicine (AIHM) provides a unique forum to facilitate development of this emerging discipline, to facilitate IPE, and to further increase the availability of BT to patients. PMID:26665047

  15. Challenges and Opportunities Faced by Biofield Practitioners in Global Health and Medicine: A White Paper

    PubMed Central

    King, Rauni Prittinen

    2015-01-01

    Biofield therapies (BTs) are increasingly employed in contemporary healthcare. In this white paper, we review specific challenges faced by biofield practitioners resulting from a lack of (1) a common scientific definition of BT; (2) common educational standards for BT training (including core competencies for clinical care); (3) collaborative team care education in complementary and alternative medicine (CAM) and in integrative health and medicine (IHM); (4) a focused agenda in BT research; and (5) standardized devices and scientifically validated mechanisms in biofield research. We present a description of BT and discuss its current status and challenges as an integrative healthcare discipline. To address the challenges cited and to enhance collaboration across disciplines, we propose (1) standardized biofield education that leads to professional licensure and (2) interprofessional education (IPE) competencies in BT training required for licensed healthcare practitioners and encouraged for other practitioners using these therapies. Lastly, we discuss opportunities for growth and a potential strategic agenda to achieve these goals. The Academy of Integrative Health and Medicine (AIHM) provides a unique forum to facilitate development of this emerging discipline, to facilitate IPE, and to further increase the availability of BT to patients. PMID:26665047

  16. Accountable Care Organizations and Clinical Commissioning Groups Face an Uncertain Challenge for Improving Public Health

    PubMed Central

    Noble, Douglas J.

    2012-01-01

    Accountable Care Organizations (ACOs) in the United States of America (USA) and Clinical Commissioning Groups (CCGs) in the United Kingdom (UK) are newly proposed cross-organisational structures in health services both tasked with a role which includes improving public health. Although there are very significant differences between the UK and USA health systems, there appears to be some similar confusion as to how ACOs and CCGs will regard and address public or population health. This short perspective article gives an overview of ACOs in the USA and CCGs in the UK, with the underlying context of possible public health functions. It concludes by considering the challenges facing both countries and highlighting the opportunity for shared learning. Acknowledgments this article was based on a research proposal prepared for the Commonwealth Fund’s Harkness Fellowship in Health Care Policy and Practice 2012/2013. PMID:25170452

  17. Cultural Challenges Faced by American Mission Control Personnel Working with International Partners

    NASA Technical Reports Server (NTRS)

    Clement, J. L.; Ritsher, J. B.

    2006-01-01

    Operating the International Space Station (ISS) involves an indefinite, continuous series of long-duration international missions, and this requires an unprecedented degree of cooperation across multiple sites, organizations, and nations. Both junior and senior mission control personnel have had to find ways to address the cultural challenges inherent in such work, but neither have had systematic training in how to do so. The goals of this study were to identify and evaluate the major cultural challenges faced by ISS mission control personnel and to highlight the approaches that they have found most effective to surmount these challenges. We pay particular attention to the approaches successfully employed by the senior personnel and the training needs identified by the junior personnel. We also evaluate the extent to which the identified approaches and needs are consistent across the two samples. METHODS: Participants included a sample of 14 senior ISS flight controllers and a contrasting sample of 12 more junior controllers. All participants were mission operations specialists chosen on the basis of having worked extensively with international partners. Data were collected using a semi-structured qualitative interview and content analyzed using an iterative process with multiple coders and consensus meetings to resolve discrepancies. RESULTS: The senior respondents had substantial consensus on several cultural challenges and on key strategies for dealing with them, and they offered a wide range of specific tactics for implementing these strategies. Data from the junior respondents will be presented for the first time at the meeting. DISCUSSION: Although specific to American ISS personnel, our results are consistent with recent management, cultural, and aerospace research on other populations. We aim to use our results to improve training for current and future mission control personnel working in international or multicultural mission operations teams.

  18. Challenges of microtome‐based serial block‐face scanning electron microscopy in neuroscience

    PubMed Central

    WANNER, A. A.; KIRSCHMANN, M. A.

    2015-01-01

    Summary Serial block‐face scanning electron microscopy (SBEM) is becoming increasingly popular for a wide range of applications in many disciplines from biology to material sciences. This review focuses on applications for circuit reconstruction in neuroscience, which is one of the major driving forces advancing SBEM. Neuronal circuit reconstruction poses exceptional challenges to volume EM in terms of resolution, field of view, acquisition time and sample preparation. Mapping the connections between neurons in the brain is crucial for understanding information flow and information processing in the brain. However, information on the connectivity between hundreds or even thousands of neurons densely packed in neuronal microcircuits is still largely missing. Volume EM techniques such as serial section TEM, automated tape‐collecting ultramicrotome, focused ion‐beam scanning electron microscopy and SBEM (microtome serial block‐face scanning electron microscopy) are the techniques that provide sufficient resolution to resolve ultrastructural details such as synapses and provides sufficient field of view for dense reconstruction of neuronal circuits. While volume EM techniques are advancing, they are generating large data sets on the terabyte scale that require new image processing workflows and analysis tools. In this review, we present the recent advances in SBEM for circuit reconstruction in neuroscience and an overview of existing image processing and analysis pipelines. PMID:25907464

  19. Re-envisioning pediatric nursing education.

    PubMed

    Carlson, Karen L

    2012-01-01

    A majority of children are healthy and never hospitalized in acute care settings. With the challenges faced in the delivery of pediatric nursing education, is it reasonable to continue to insist that all nursing students have an acute care pediatric nursing experience? This article presents arguments for the need to re-envision pediatric nursing education to use limited pediatric nursing faculty and pediatric clinical sites in innovative ways to maintain high-quality outcomes for undergraduate nursing students. The article outlines issues, provides ideas, and advocates for increased use of available innovations. Virtual learning communities and a wealth of other new technologies provide new and inventive ways to deliver essential content. Pediatric nursing leaders need to demonstrate new pedagogies and discourage teaching specialty content in the same manner it has been taught for more than 40 years. The challenges are important to practicing nurses as well as academic faculty because of the implications for the future nursing workforce in pediatric settings and healthcare of children. PMID:23073251

  20. United States-Mexican Borderlands: facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Updike, Randall G.; Ellis, Eugene G.; Page, William R.; Parker, Melanie J.; Hestbeck, Jay B.; Horak, William F.

    2013-01-01

    Along the nearly 3,200 kilometers (almost 2,000 miles) of the United States–Mexican border, in an area known as the Borderlands, we are witnessing the expression of the challenges of the 21st century. This circular identifies several challenge themes and issues associated with life and the environment in the Borderlands, listed below. The challenges are not one-sided; they do not originate in one country only to become problems for the other. The issues and concerns of each challenge theme flow in both directions across the border, and both nations feel their effects throughout the Borderlands and beyond. The clear message is that our two nations, the United States and Mexico, face the issues in these challenge themes together, and the U.S. Geological Survey (USGS) understands it must work with its counterparts, partners, and customers in both countries. Though the mission of the USGS is not to serve as land manager, law enforcer, or code regulator, its innovation and creativity and the scientific and technical depth of its capabilities can be directly applied to monitoring the conditions of the landscape. The ability of USGS scientists to critically analyze the monitored data in search of signals and trends, whether they lead to negative or positive results, allows us to reach significant conclusions—from providing factual conclusions to decisionmakers, to estimating how much of a natural resource exists in a particular locale, to predicting how a natural hazard phenomenon will unfold, to forecasting on a scale from hours to millennia how ecosystems will behave. None of these challenge themes can be addressed strictly by one or two science disciplines; all require well-integrated, cross-discipline thinking, data collection, and analyses. The multidisciplinary science themes that have become the focus of the USGS mission parallel the major challenges in the border region between Mexico and the United States. Because of this multidisciplinary approach, the USGS

  1. Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome.

    PubMed

    Vickery, Alistair; Thompson, Peter L

    2014-11-17

    The general practitioner is essential in the management of the patient who has recently been discharged from hospital following an acute coronary syndrome (ACS), particularly as duration of hospital stay is shorter than in previous decades. GPs caring for patients after an ACS face numerous challenges. Often, the first of these is insufficient or delayed documentation from the discharging hospital, although electronic discharge summaries are alleviating this problem. Post-ACS patients often have comorbidities, and GPs play a key role in managing these. Patients taking dual antiplatelet therapy who need surgery, and post-ACS patients with atrial fibrillation, require particular care from GPs. Patients will often approach their GP for advice on the safety of other drugs, such as smoking cessation medication, and phosphodiesterase type 5 inhibitors for erectile dysfunction. For patients complaining of persistent lethargy after an ACS, GPs must consider several differential diagnoses, including depression, hypotension, hypovolaemia, and side effects of β-blockers. GPs play an important ongoing role in ensuring that target cholesterol levels are reached with statin therapy; this includes ensuring long-term adherence. They may also need to advise patients who want to stop statin therapy, usually due to perceived side effects. Many of these challenges can be met with improved and respectful communication between the hospital, the treating cardiologist and the GP. The patient needs to be closely involved in the decision-making process, particularly when balancing the risks of bleeding versus thrombosis. PMID:25390497

  2. The Informatics Challenges Facing Biobanks: A Perspective from a United Kingdom Biobanking Network

    PubMed Central

    Groves, Martin; Jordan, Lee B.; Stobart, Hilary; Purdie, Colin A.; Thompson, Alastair M

    2015-01-01

    The challenges facing biobanks are changing from simple collections of materials to quality-assured fit-for-purpose clinically annotated samples. As a result, informatics awareness and capabilities of a biobank are now intrinsically related to quality. A biobank may be considered a data repository, in the form of raw data (the unprocessed samples), data surrounding the samples (processing and storage conditions), supplementary data (such as clinical annotations), and an increasing ethical requirement for biobanks to have a mechanism for researchers to return their data. The informatics capabilities of a biobank are no longer simply knowing sample locations; instead the capabilities will become a distinguishing factor in the ability of a biobank to provide appropriate samples. There is an increasing requirement for biobanking systems (whether in-house or commercially sourced) to ensure the informatics systems stay apace with the changes being experienced by the biobanking community. In turn, there is a requirement for the biobanks to have a clear informatics policy and directive that is embedded into the wider decision making process. As an example, the Breast Cancer Campaign Tissue Bank in the UK was a collaboration between four individual and diverse biobanks in the UK, and an informatics platform has been developed to address the challenges of running a distributed network. From developing such a system there are key observations about what can or cannot be achieved by informatics in isolation. This article will highlight some of the lessons learned during this development process. PMID:26418270

  3. Some imminent but overlooked preanalytical and analytical challenges currently facing biomarkers and companion diagnostics.

    PubMed

    Halim, Abdel-Baset

    2015-06-01

    An incredibly high failure rate in the pharmaceutical industry has positioned personalized medicine with its prerequisite drug-diagnostic codevelopment, commonly known as companion diagnostics (CDx), in the frontline as an potential rescuer. This hopefulness is potentiated by the recent major advances and competitiveness in molecular diagnostics, making laboratory tests widely accessible at affordable prices. If executed correctly, biomarkers and CDx can potentially help the drug industry by enhancing the probability of success and possibly accelerating time to market; help the diagnostics industry develop tests utilizing precious, clinically annotated human samples; and, more importantly, benefit patients by supporting accurate diagnosis and selection of the most efficacious and least toxic therapies. However, this spectacular road is not yet paved, and it faces an enormous number of challenges. This paper will list these challenges and highlight some critical problems with representative examples of imminent but still overlooked preanalytical and analytical variables that can defeat the whole purpose of biomarkers and CDx and mislead drug developers and clinicians. The paper will provide some suggestions for mitigation. PMID:25758153

  4. The Informatics Challenges Facing Biobanks: A Perspective from a United Kingdom Biobanking Network.

    PubMed

    Quinlan, Philip R; Groves, Martin; Jordan, Lee B; Stobart, Hilary; Purdie, Colin A; Thompson, Alastair M

    2015-10-01

    The challenges facing biobanks are changing from simple collections of materials to quality-assured fit-for-purpose clinically annotated samples. As a result, informatics awareness and capabilities of a biobank are now intrinsically related to quality. A biobank may be considered a data repository, in the form of raw data (the unprocessed samples), data surrounding the samples (processing and storage conditions), supplementary data (such as clinical annotations), and an increasing ethical requirement for biobanks to have a mechanism for researchers to return their data. The informatics capabilities of a biobank are no longer simply knowing sample locations; instead the capabilities will become a distinguishing factor in the ability of a biobank to provide appropriate samples. There is an increasing requirement for biobanking systems (whether in-house or commercially sourced) to ensure the informatics systems stay apace with the changes being experienced by the biobanking community. In turn, there is a requirement for the biobanks to have a clear informatics policy and directive that is embedded into the wider decision making process. As an example, the Breast Cancer Campaign Tissue Bank in the UK was a collaboration between four individual and diverse biobanks in the UK, and an informatics platform has been developed to address the challenges of running a distributed network. From developing such a system there are key observations about what can or cannot be achieved by informatics in isolation. This article will highlight some of the lessons learned during this development process. PMID:26418270

  5. Challenges, benefits and factors to enhance recruitment and inclusion of children in pediatric dental research

    PubMed Central

    Weintraub, Jane A.; Breland, Carol E.

    2016-01-01

    Summary Background Historically, children have been excluded from clinical research. Many drugs and procedures have not been tested on children. The International Conference on Harmonization and the Food and Drug Administration guidance now stress that children should be included in research unless there is a reason for exclusion. Compared to adults, recruitment of children at different life stages requires different considerations. Objective To review published studies and gray literature to identify pediatric recruitment strategies and develop recommendations. Results There is limited clinical research literature available to recommend recruitment strategies and methods for pediatric trials. Formal guidelines for reporting recruitment activities in publications are scant. Recommendations are made based on current practices regarding protocol design, obtaining consent and engaging child, parent and caregiver in research. Conclusions A scientific approach is needed to determine the best design for recruitment of pediatric clinical studies. Investigators should report and publish recruitment and retention strategies that facilitate this important aspect of the research process to increase transparency, efficiency and identification of the most effective methods for dental researchers. PMID:26148273

  6. STaRRS in Yellowstone: Addressing Challenges Facing Student-Teacher-Scientist Partnerships

    NASA Astrophysics Data System (ADS)

    Houseal, A.; Gallagher, R.; Fuhrmann, B.; Sanford, R.

    2010-12-01

    The literature outlines many challenges faced by Student-Teacher-Scientist Partnerships (STSPs) including cultural differences between the scientific research and education communities. For example, shared vocabulary terms with dissimilar definitions can create communication problems. Other issues include accuracy in data collection, meeting the needs of a very diverse group of partners, connecting students with research science in a meaningful way, and maintaining the infrastructure necessary to develop and maintain these partnerships. Additionally, evidence, other than anecdotal, of the success of these partnerships is limited, especially as school year and research cycles are often on different schedules or have very different goals. Students, Teachers, and Rangers & Research Scientists: Investigating Systems at Mammoth Hot Springs in Yellowstone National Park (STaRRS) was an STSP developed to address some of these challenges, model some solutions within an STSP, and identify some possible outcomes for participating teachers and their students. Three strategies used to address some of these challenges that will be discussed briefly in this presentation include: (a) embedding the STSP in an already existing National Park Service environmental education program; (b) development of three types of research activities connecting teachers, students, and scientists to the research, and (c) a professional development (PD) model that included all partners in an on-going year-long process. Results from an accompanying research study will also be presented. Using a pretest-intervention-posttest design, this study revealed significant changes in attitude regarding science and scientists of participating STaRRS teachers. Student data gathered using a quasi-experimental pretest-intervention-posttest treatment and comparison group design also demonstrated significant changes in their attitudes and gains in earth science content knowledge.

  7. Development and Preliminary Face and Content Validation of the “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatric Rheumatology

    PubMed Central

    Toupin April, Karine; Stinson, Jennifer; Boon, Heather; Duffy, Ciarán M.; Huber, Adam M.; Gibbon, Michele; Descarreaux, Martin; Spiegel, Lynn; Vohra, Sunita; Tugwell, Peter

    2016-01-01

    Objective Complementary and alternative medicine (CAM) is commonly used by children with juvenile idiopathic arthritis (JIA), yet no validated questionnaires assess that use. The objective of this study was to develop child self- and parent proxy-report questionnaires assessing CAM use and to determine the face and content validity of the “Which Health Approaches and Treatments are you using?” (WHAT) questionnaires in pediatric rheumatology. Methods A sequential phased mixed methods approach was used to develop the questionnaires. A Delphi Survey of 126 experts followed by an interdisciplinary consensus conference of 14 stakeholders in CAM, general pediatrics and pediatric rheumatology was held to develop consensus on the content of the questionnaires using a nominal group technique. To determine face and content validity of the questionnaires, two groups, including (a) a purposive sample of 22 children with JIA 8 to 18 years and their parents from the Children’s Hospital of Eastern Ontario and the Hospital for Sick Children, and (b) 21 Canadian pediatric rheumatology experts, participated in interviews. Participants were independently asked about the goal, understandability and comprehensiveness of the WHAT questionnaires, as well as the relevance of items. Results Consensus was reached on 17 items of the WHAT questionnaires. The domains found to be relevant were child’s CAM use, factors associated with CAM use, perceived impact of CAM use, and communication about CAM. A total of 15 items in the parent proxy-report questionnaire and 13 items in the child report questionnaire showed adequate content validity. Conclusions Consensus was reached by experts on the content of a pediatric CAM questionnaire. Face and content validity testing and modifications made to the WHAT questionnaires have helped ensure adequate preliminary validity for use in pediatric rheumatology. This constitutes the basis for further testing of these questionnaires in pediatric

  8. New Challenges Facing Small Undergraduate Departments And The Role Of Faculty And Administrators.

    NASA Astrophysics Data System (ADS)

    El-Shazly, A. K.

    2003-12-01

    Small geoscience departments with 5 faculty members or less in undergraduate institutions are facing serious challenges that will have a profound impact on their future, as well as the future of geoscience education. In addition to past and future budget cuts that affect all departments, small departments are more vulnerable to such problems as (i) decreased enrollments in introductory level classes, (ii) small number of geology majors, (iii) small number of graduates per year (iv) lack or paucity of equipment necessary for faculty and student research, (v) limited opportunities for external funding, (vi) need to offer upper division classes on an alternate year basis, (vii) difficulty in recruiting and retaining students, (viii) high teaching loads for faculty, and (ix) designing rigorous curricula based on 120 credit hours with a significant component of liberal art classes. These problems pose new challenges for faculty, department chairs and administrators. Faculty need to design curricula tailored to the need of the job market, without compromising rigor or the quality of the program. New classes/ concentrations in environmental science, hydrogeology and geographical information systems should be offered, and traditional classes in petrology, geophysics and tectonics should be maintained. Classes in Physics, Chemistry and Math should be core requirements. Student involvement in research should be encouraged at an early stage (sophomore/ junior levels). Department chairs need to assign duties in their department carefully to capitalize on the strengths of their faculty: faculty with strong research backgrounds should be helped in their efforts to pursue external funding opportunities, whereas those with strong teaching abilities should be evaluated primarily on their performance in the classroom. Student credit hour production should not be used as a criterion for evaluating faculty. Administrators should evaluate programs and departments based on the success

  9. The global pediatric antiretroviral market: analyses of product availability and utilization reveal challenges for development of pediatric formulations and HIV/AIDS treatment in children

    PubMed Central

    2010-01-01

    Background Important advances in the development and production of quality-certified pediatric antiretroviral (ARV) formulations have recently been made despite significant market disincentives for manufacturers. This progress resulted from lobbying and innovative interventions from HIV/AIDS activists, civil society organizations, and international organizations. Research on uptake and dispersion of these improved products across countries and international organizations has not been conducted but is needed to inform next steps towards improving child health. Methods We used information from the World Health Organization Prequalification Programme and the United States Food and Drug Administration to describe trends in quality-certification of pediatric formulations and used 7,989 donor-funded, pediatric ARV purchase transactions from 2002-2009 to measure uptake and dispersion of new pediatric ARV formulations across countries and programs. Prices for new pediatric ARV formulations were compared to alternative dosage forms. Results Fewer ARV options exist for HIV/AIDS treatment in children than adults. Before 2005, most pediatric ARVs were produced by innovator companies in single-component solid and liquid forms. Five 2-in1 and four 3-in-1 generic pediatric fixed-dose combinations (FDCs) in solid and dispersible forms have been quality-certified since 2005. Most (67%) of these were produced by one quality-certified manufacturer. Uptake of new pediatric FDCs outside of UNITAID is low. UNITAID accounted for 97-100% of 2008-2009 market volume. In total, 33 and 34 countries reported solid or dispersible FDC purchases in 2008 and 2009, respectively, but most purchases were made through UNITAID. Only three Global Fund country recipients reported purchase of these FDCs in 2008. Prices for pediatric FDCs were considerably lower than liquids but typically higher than half of an adult FDC. Conclusion Pediatric ARV markets are more fragile than adult markets. Ensuring a long

  10. PEPFAR scale-up of pediatric HIV services: innovations, achievements, and challenges.

    PubMed

    Abrams, Elaine J; Simonds, R J; Modi, Surbhi; Rivadeneira, Emilia; Vaz, Paula; Kankasa, Chipepo; Tindyebwa, Denis; Phelps, B Ryan; Bowsky, Sara; Teasdale, Chloe A; Koumans, Emilia; Ruff, Andrea J

    2012-08-15

    HIV/AIDS has had a profound impact on children around the world since the start of the epidemic. There are currently 3.4 million children under the age of 15 years living with HIV globally, and more than 450,000 children currently receiving lifesaving antiretroviral treatment. This article describes efforts supported by the President's Emergency Plan for AIDS Relief (PEPFAR) to expand access to treatment for children living with HIV in high-burden countries. The article also highlights a series of case studies that illustrate the impact that the PEPFAR initiative has had on the pediatric HIV epidemic. Through its support of host governments and partner organizations, the PEPFAR initiative has expanded HIV testing and treatment for pregnant women to reduce vertical transmission of HIV, increased access to early infant diagnosis for HIV-exposed infants, improved training and resources for clinicians who provide pediatric care and antiretroviral treatment, and, through public-private partnerships with pharmaceutical manufacturers, helped increase the number of medications available for the treatment of HIV-infected children in resource-limited settings. PMID:22797731

  11. PEPFAR Scale-up of Pediatric HIV Services: Innovations, Achievements, and Challenges

    PubMed Central

    Abrams, Elaine J.; Simonds, R. J.; Modi, Surbhi; Rivadeneira, Emilia; Vaz, Paula; Kankasa, Chipepo; Tindyebwa, Denis; Phelps, B. Ryan; Bowsky, Sara; Teasdale, Chloe A.; Koumans, Emilia; Ruff, Andrea J.

    2016-01-01

    HIV/AIDS has had a profound impact on children around the world since the start of the epidemic. There are currently 3.4 million children under the age of 15 years living with HIV globally, and more than 450,000 children currently receiving lifesaving antiretroviral treatment. This article describes efforts supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) to expand access to treatment for children living with HIV in high-burden countries. The article also highlights a series of case studies that illustrate the impact that the PEPFAR initiative has had on the pediatric HIV epidemic. Through its support of host governments and partner organizations, the PEPFAR initiative has expanded HIV testing and treatment for pregnant women to reduce vertical transmission of HIV, increased access to early infant diagnosis for HIV-exposed infants, improved training and resources for clinicians who provide pediatric care and antiretroviral treatment, and, through public–private partnerships with pharmaceutical manufacturers, helped increase the number of medications available for the treatment of HIV-infected children in resource-limited settings. PMID:22797731

  12. Testing for her2 in breast cancer: current pathology challenges faced in Canada.

    PubMed

    Hanna, W; Barnes, P; Berendt, R; Chang, M; Magliocco, A; Mulligan, A M; Rees, H; Miller, N; Elavathil, L; Gilks, B; Pettigrew, N; Pilavdzic, D; Sengupta, S

    2012-12-01

    This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (her2)-positive breast cancer currently faced by pathologists in Canada: Pre-analysis issues affecting the accuracy of her2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastasesher2 testing of core-needle biopsies compared with surgical specimensCriteria for retesting her2 status upon disease recurrenceLiterature searches for each topic were carried out using the medline, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005-2011) and the San Antonio Breast Cancer Symposium (2007-2011) were searched for relevant abstracts.All authors are expert breast pathologists with extensive experience of her2 testing, and several participated in the development of Canadian her2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of her2 testing practice. PMID:23300357

  13. [The challenges faced in the field of trauma care in China].

    PubMed

    Jiang, Baoguo

    2015-06-01

    With the continuous development of China's urbanization and socio-economic, death and disability caused by trauma has increased prominently, and trauma has become the first cause of death in the people younger than 45 years old. Compared with the treatment of other diseases, China are facing many problems and challenges in terms of trauma treatment, specifically focused in three areas: First, the medical profession and society had not attach enough attention to trauma; Second, trauma centers in our country is insufficient; The level of trauma care vary greatly between different regions, the doctors and nurses commitment to trauma care lack of standardized training; Third, scientific treatment process and treatment system that compliance with international standards and meet the geographical features of China is insufficient. In view of the above situation and existing problems, learn from the successful experience of foreign countries, we think we should proceed from the following three aspects to change the status of China's treatment of trauma gradually: First of all, we should establish Traumatology that deals with the treatment of serious wounds and injuries. Secondly we should establish the right trauma care system that suitable for China's conditions; The third point is the establishment of trauma specialist training system composed by "basic training" and "targeted training"; Final we should establish severe trauma multidisciplinary treatment team model in the process of trauma care. Thereby improving our overall level of trauma treatment through above means, reduce the disability and mortality caused by trauma, thus promoting the development of trauma forward. PMID:26359050

  14. Anti-racist pedagogy: challenges faced by faculty of color in predominantly white schools of nursing.

    PubMed

    Hassouneh, Dena

    2006-07-01

    Despite the significant effects of systems of oppression on health, nursing education tends not to include anti-racist pedagogy in its curricula, preferring instead to focus more narrowly on culture. This narrow focus allows nurses to depoliticize discussions of race and other social differences, largely ignoring the influence that systems of oppression, imperialism, and historical trauma have had on health in marginalized populations. In contrast, anti-racist pedagogy educates students in ways that make racialized power relations explicit, deconstruct the social construction of race, and analyze interlocking systems of oppression that serve to marginalize and exclude some groups while privileging others. This article describes anti-racist pedagogy from the perspective of a faculty member of color, drawing on personal experience and a review of the anti-racist pedagogical literature. Specifically, this article highlights some of the personal and professional challenges faced by faculty of color when engaged in anti-racist pedagogy in predominantly white schools of nursing. PMID:16863105

  15. Sexual assault nurse examiners' perceptions of funding challenges faced by SANE programs: "it stinks".

    PubMed

    Maier, Shana L

    2012-06-01

    Even though Sexual Assault Nurse Examiner (SANE) programs began over 30 years ago, and there is currently greater awareness of sexual violence, the question regarding the financial security of SANE prgrams remains a contemporary concern. Data from interviews with 40 SANEs', many of whom were also directors, from programs located in four states indicated that lack of funding continues to present challenges. Most (72%) directors revealed that there are problems with funding. Directors voiced concerns about program sustainability, as well as the ability to provide education in the community and training and continuing education opportunities for SANEs. Even though funding of programs is not the responsibility of SANEs not serving as directors, approximately one-third of regular SANEs were aware of budget cuts or financial struggles faced by their program. These SANEs also expressed concern about the sustainability of programs, the ability to train additional nurses, purchasing their equipment of choice, and lack of compensation. All suggestions for program improvements, directly or indirectly, required more funding. PMID:22621666

  16. The challenges facing mental health programs for post-conflict and refugee communities.

    PubMed

    Silove, Derrick

    2004-01-01

    The majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs. PMID:15453165

  17. Challenges faced in e-infrastructure at the Ministry of Mines and Energy, Namibia

    NASA Astrophysics Data System (ADS)

    Maletzky, Monica; Mhopjeni, Kombada

    2014-05-01

    The e-infrastructure at the Ministry of Mines is undergoing considerable restructuring with most of it in the planning phase. One of the main challenges faced is the Local Area Network that is outdated and not capable to handling the volume of data that is transferred in the network. Most of the Network Interface Cards (NIC) on the servers and all related LAN equipment have a capability of 10/100Mb/s and cannot support the volume of data transported over the network. This is not adequate for the need of high end users such as geoscientists who work with large geological, remote sensing and geophysical datasets. Taking the above into consideration the Ministry has embarked on implementing changes to the network. The initiative involves the acquisition of Cisco Layer3 switches that have the capability of transferring large volumes of data, up to 10Gb/s. Subsequent upgrades of the NICs and small form-factor pluggable (SFP) are planned in the near future. Apart from the internal network, the Ministry's present internet connection is insufficient as the Ministry shares the outbound link with all other Ministries in the Namibian government. The internet provided by the Office of the Prime Minister (OPM), which serves as the government's internet service provider (ISP), to our institution is currently 2Mb/s. OPM has embarked on the upgrade of the network infrastructure. The first phase of the involved the upgrade of the national point of presence (POP) to operate at a capacity of 300Mb/s. This would be followed by the expansion of a fibre network to all the government institutions. Upon completion, the internet performance will be improved as it is envisaged that the Ministry of Mines and Energy's bandwidth will be upgraded to 10Mb/s and hopefully alleviate the current strain on the system. This project is expected to be completed by June 2014. However, due to the challenges that our office is faced with, we have acquired a 4Mb/s internet link for the interim period

  18. A Reflective Perspective on the Challenges Facing Research-Led Teaching in the Performing and Creative Arts

    ERIC Educational Resources Information Center

    Walmsley, Ben

    2013-01-01

    This article provides a reflective perspective on the role that research-led teaching plays in the development of future arts workers in higher education. It explores the challenges faced by lecturers developing curricula in the performing and creative arts and argues that the increasing focus on employability can conflict with universities'…

  19. Some Challenges Facing Queer Youth Programs in Urban High Schools: Racial Segregation and De-Normalizing Whiteness

    ERIC Educational Resources Information Center

    McCready, Lance Trevor

    2004-01-01

    Relatively little is known about the unique challenges facing queer youth programs such as Project 10 and Gay-Straight Alliances, housed in urban high schools where the majority of students are poor, non-White, and/or non-native English speakers. This article begins a conversation about two important issues that the author believes have an impact…

  20. Transitional Challenges Faced by Post-Secondary International Students and Approaches for Their Successful Inclusion in Classrooms

    ERIC Educational Resources Information Center

    Xu, Lichan

    2015-01-01

    As the number of international students in post-secondary education institutions in Canada and the United States continues to increase substantially, much scholarly attention is being paid to the wide variety of transitional challenges that international students face. At the same time frequent controversial conversations are occurring about…

  1. Challenges Facing Higher Education at the Millennium. American Council on Education/Oryx Press Series on Higher Education.

    ERIC Educational Resources Information Center

    Hirsch, Werner Z., Ed.; Weber, Luc E., Ed.

    This collection of 17 essays focuses on the major changes that higher education needs to make so that it can effectively pursue teaching and research and significantly contribute public service in a rapidly changing world. The essays include: (1) "Survey of the Main Challenges Facing Higher Education at the Millennium" (Luc E. Weber); (2) "Meeting…

  2. College Students with Children Are Common and Face Many Challenges in Completing Higher Education. Briefing Paper #C404

    ERIC Educational Resources Information Center

    Nelson, Bethany; Froehner, Megan; Gault, Barbara

    2013-01-01

    This paper discusses the challenges college students with children face, as well as the steps colleges, universities, and the surrounding communities must take to help students succeed in their work as both students and parents. The role of parenthood in postsecondary settings needs greater focus from the higher education reform community. Unless…

  3. Challenges Facing Managers in Managing Conflict in Schools in the South and South Central Regions of Botswana

    ERIC Educational Resources Information Center

    Morake, Nnior Machomi; Monobe, Ratau John; Dingwe, Stephonia

    2011-01-01

    The purpose of this study was to examine the challenges facing managers in managing conflict in schools of South and South Central Regions of Botswana. In this study, the schedule of interview was used to collect empirical data. A random sample of 50 school managers and deputy school managers was selected for interviews. Major findings of the…

  4. Technical and Pedagogical Challenges Faced by Faculty and Students in Computer-Based Distance Education in Higher Education in Indiana.

    ERIC Educational Resources Information Center

    McElhinney, James H.; Nasseh, Bizhan

    1999-01-01

    This study reports faculty members' and students' responses to the technological and pedagogical challenges they faced in completing computer-based distance education. Topics include the need for adequate faculty training, the need for adequate student training, and the need for technical support available 24 hours a day. (Author/LRW)

  5. Designing pediatric vaccine formularies and pricing pediatric combination vaccines using operations research models and algorithms.

    PubMed

    Jacobson, Sheldon H; Sewell, Edward C; Allwine, Daniel A; Medina, Enrique A; Weniger, Bruce G

    2003-02-01

    The National Immunization Program, housed within the Centers for Disease Control and Prevention in the USA, has identified several challenges that must be faced in childhood immunization programs to deliver and procure vaccines that immunize children from the plethora of childhood diseases. The biomedical issues cited include how drug manufacturers can combine and formulate vaccines, how such vaccines are scheduled and administered and how economically sound vaccine procurement can be achieved. This review discusses how operations research models can be used to address the economics of pediatric vaccine formulary design and pricing, as well as how such models can be used to address a new set of pediatric formulary problems that will surface with the introduction of pediatric combination vaccines into the US pediatric immunization market. PMID:12901593

  6. Challenges Faced by Graduate Business Education in Southern Africa: Perceptions of MBA Participants

    ERIC Educational Resources Information Center

    Temtime, Zelealem T.; Mmereki, Rebana N.

    2011-01-01

    Purpose: The purpose of this paper is to examine the degree of satisfaction and perceived relevance of the Graduate Business Education (GBE) programme at the University of Botswana. Design/methodology/approach: A self-administered questionnaire and face to face interviews were used to collect data from Master of Business Administration (MBA)…

  7. The Changing Landscape of Pediatric Low-Grade Gliomas: Clinical Challenges and Emerging Therapies.

    PubMed

    Guerreiro Stucklin, Ana S; Tabori, Uri; Grotzer, Michael A

    2016-04-01

    Pediatric low-grade gliomas (PLGGs) are the most common brain tumors in children. Though histologically benign and associated with excellent outcome, patients with unresectable lesions-mostly young children with midline tumors-experience multiple progressions and are at increased risk for long-term neurological sequelae. PLGGs in children with underlying genetic predisposition syndromes-especially neurofibromatosis type 1 and tuberous sclerosis-have a distinct natural history and biology with important treatment implications. Given the complexity of medical issues, optimal management requires a large network of health care providers; treatment decisions must address both tumor control and potential side effects of the therapy. Current treatment strategies often fail to induce sustained tumor regression and many children require several lines of therapy, highlighting the need for novel therapies. Here, we review the current management of PLGG and discuss how new molecular targets-in particular alterations of the Ras/MAPK pathway-are rapidly changing our approach to PLGG. PMID:26764564

  8. Agency and communication challenges in discussions of informed consent in pediatric cancer research.

    PubMed

    Young, Amanda J; Kim, Loel; Shu Li; Baker, Justin N; Schmidt, Michael; Camp, Jonathan W; Barfield, Raymond C

    2010-05-01

    In this article we examine the discourse of four focus groups we conducted at a pediatric research hospital in which we queried teenage patients, parents, nurses, and physicians about their perceptions of the informed consent process in research. Autonomy, as the goal of informed consent, is a murky concept, with some ethicists questioning the possibility that it can ever be attained. We argue that it might be more productive to consider agency, which we define as language and action that are constructed, negotiated, and maintained through effective communication. Our goal was to understand how individuals rhetorically constructed agency in discussions of informed consent experiences. After transcribing and coding the focus group interviews, we identified six aspects of agency in participants' discourse: (a) defining roles, (b) seeking information, (c) providing information, (d) supporting others, (e) making decisions, and (f) claiming agency for self. Examining these aspects of agency indicated that efforts to improve the informed consent process must address: (a) status differentials, (b) role definitions, (c) information flow, and (d) relationships. PMID:20154295

  9. Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges.

    PubMed

    Otte, Jean-Bernard

    2016-09-01

    This review presents the author's personal perspective and contributions to the first steps, the development, the current status, and the remaining issues of pediatric liver transplantation (LT). Innumerable children around the world who have undergone LT have reached adulthood. The techniques have reached maturity. As shown by my own group's experience, grafts donated by living donors might provide the best short-term and longterm results. Debate persists about the optimal immunosuppression (IS), although the place of tacrolimus remains unchallenged. Tolerance induction protocols aiming to induce microchimerism have been tried in clinical transplantation without convincing results. Withdrawal of maintenance IS is possible in some children who underwent liver transplantation who have excellent clinical status and normal liver function tests but is not without risk of rejection and subsequent worsening of histology. The current trend favored by the Brussels' group is to minimize IS as soon after transplant as possible, aiming to obtain a state of "prope" or "almost" tolerance. Liver grafts are threatened in the long term by increasing hepatitis-related fibrosis, resulting most likely from immunological assault. Nowadays, the focus is on the longterm survival, quality of life (growth, academic performance, employment, self-fulfillment, fertility, raising a family, etc.), induction of tolerance, prevention of risks bound to decades of IS (nephrotoxicity and neurotoxicity, cardiovascular risk, de novo malignancies, etc.), and prevention of graft fibrosis. All these issues are fertile fields for younger scientists. Liver Transplantation 22 1284-1294 2016 AASLD. PMID:27096329

  10. On Preventing the Extinction of the Physician-Scientist in Pediatric Pulmonology

    PubMed Central

    Rubenstein, Ronald C.; Kreindler, James L.

    2013-01-01

    While the founders of Pediatric Pulmonology recognized the necessity of research as a vital part of the developing sub specialty, the field has struggled to develop and maintain physician-scientists and investigators. The clinical growth in Pediatric Pulmonology has resulted in significant challenges in career development faced by physician-scientists who aim to establish or maintain independent investigative programs. Such challenges may only be overcome with changes in how both trainees and established physician-scientists in Pediatric Pulmonology are supported. PMID:24479109

  11. Challenges

    ERIC Educational Resources Information Center

    Moore, Thomas R.

    1975-01-01

    Domestic and international challenges facing the National Society for the Prevention of Blindness are discussed; and U.S. and Russian programs in testing and correcting children's vision, developing eye safety programs in agriculture and industry, and disseminating information concerning the detection and treatment of cataracts are compared. (SB)

  12. Challenges faced when using radiocarbon measurements to estimate fossil fuel emissions in the UK.

    NASA Astrophysics Data System (ADS)

    Wenger, A.; O'Doherty, S.; Rigby, M. L.; Ganesan, A.; Manning, A.; Allen, G.

    2015-12-01

    Estimating the anthropogenic component of carbon dioxide emissions from direct atmospheric measurements is difficult, due to the large natural carbon dioxide fluxes. One way of determining the fossil fuel component of atmospheric carbon dioxide is the use of radiocarbon measurements. Whilst carbon reservoirs with a reasonably fast carbon exchange rate all have a similar radiocarbon content, fossil fuels are completely devoid of radiocarbon due to their age. Previous studies have 14CO2 (UK) this approach is compromised by the high density of 14CO2 emitting nuclear power plants. Of the 16 nuclear reactors in the UK, 14 are advanced gas cooled reactors, which have one of the highest 14CO2 emission rates of all reactor types. These radiocarbon emissions not only lead to a serious underestimation of the recently added fossil fuel CO2, by masking the depletion of 14C in CO2, but can in fact overshadow the depletion by a factor of 2 or more. While a correction for this enhancement can be applied, the emissions from the nuclear power plants are highly variable, and an accurate correction is therefore not straightforward. We present the first attempt to quantify UK fossil fuel CO2 emissions through the use of 14CO2. We employ a sampling strategy that makes use of a Lagrangian particle dispersion model, in combination with nuclear industry emission estimates, to forecast "good" sampling times, in an attempt to minimize the correction due to emissions from the nuclear industry. As part of the Greenhouse gAs Uk and Global Emissions (GAUGE) project, 14CO2measurements are performed at two measurement sites in the UK and Ireland, as well as during science flights around the UK. The measurement locations have been chosen with a focus on high emitting regions such as London and the Midlands. We discuss the unique challenges that face the determination of fossil fuel emissions through radiocarbon measurements in the UK and our sampling strategy to deal with them. In addition we

  13. Challenges faced by ice sheet projections: lessons from the SeaRISE effort

    NASA Astrophysics Data System (ADS)

    Nowicki, S.

    2013-12-01

    Projecting the future evolution of the Greenland and Antarctic ice sheets is a problem of enormous societal importance, as ice sheet influence our future sea levels. This crucial issue is however a non trivial task, as demonstrated by the Sea level Response to Ice Sheet Evolution (SeaRISE) effort: prescribing simple external forcings to a group of ice sheet models results in a spread in responses. Understanding the source of the diversity in the model results is therefore crucial in order to reduce the uncertainty in the projection. Just as in any future climate simulation, the analysis presented here demonstrates that the model spread in the SeaRISE effort is due to a number of factors. First is the problem of obtaining an initial configuration for the projection. The two commonly used methods, interglacial spin-up or data assimilation, have both advantages and drawbacks, and will affect the determination of fields that cannot be measured (such as basal slipperiness). Second is the uncertainty in actual observations, which includes but is not limited to surface mass balance, basal topography, ice thickness, and surface velocities. An additional issue with these observations is that they can be transient quantities which are not measured at the same time, but ice sheet models require them to be simultaneous. Third is the uncertainty in the models' physics and discretization, which is limited by our understanding (or lack of understanding) of crucial processes that often occur at subgrid scale relative to the resolution used by continental ice sheet models, and thus require parameterization. Grounding line migration and sliding laws are such an example. Fourth is the determination of the future forcing scenarios and their implementation as the external forcing. Unfortunately, as demonstrated in this analysis, all ice sheet models face these limitations to some degree, so that it is extremely difficult to identify a set of models and projections that should be

  14. HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania

    PubMed Central

    Leshabari, Sebalda C; Blystad, Astrid; de Paoli, Marina; Moland, Karen M

    2007-01-01

    Background Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. Methods A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.' Results The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession. Conclusion The findings illuminate the immense burden placed on nurses in their role as

  15. Pediatric Cataract Surgery in National Eye Centre Kaduna, Nigeria: Outcome and Challenges

    PubMed Central

    Umar, Murtala M.; Abubakar, Ahmed; Achi, Ibrahim; Alhassan, Mahmoud B.; Hassan, Amina

    2015-01-01

    Purpose: To assess the outcomes of congenital/developmental cataract from a tertiary eye care hospital in Northwest Nigeria. Materials and Methods: A retrospective chart review was performed of all patients diagnosed with congenital or developmental cataract who underwent surgery from January 2008 to December 2009. Data were collected on patient demographics, preoperative characteristics, intraoperative complications, and postoperative outcomes as well as complications. Results: A total of 181 eyes of 102 patients underwent surgery. There were 95 (52.5%) right eyes. There were 64 (62.7%) males. The mean age of the patients was 6.88 ± 7.97 years. Fifty-four (51.3%) patients were below 3 years old. Most (62%) patients had congenital cataract with a history of onset within the first year of life [39 (62.9%) patients]. Amblyopia, nystagmus, and strabismus were the most frequent ocular comorbidities accounting for 50.3%, 36.5%, and 35.4% of eyes respectively. The majority (84.3%) of the patients had surgery within 6 months of presentation. All patients underwent manual small incision cataract surgery (MSICS). Seventy-nine (77.5%) patients underwent simultaneous bilateral surgery. Intraocular lens implantation was performed in 83.4% eyes. The most common early and late postoperative complication was, posterior capsular opacity which occurred in 65 eyes of 43 children. In these cases, moderate visual acuity was predominant visual outcome. Conclusion: Treatment of pediatric cataract in our setting is complicated by demographic factors which results in late presentation and consequently, late treatment of children. Short-term visual outcome is fair. Data on long term postoperative outcomes could not be acquired due to poor follow-up. PMID:25624681

  16. Spatial and temporal overview of research in pediatric and congenital cardiology: trends and global challenges.

    PubMed

    Bräutigam, Martina; Kempny, Aleksander; Radke, Robert; Baumgartner, Helmut; Diller, Gerhard-Paul

    2014-08-01

    Available information on the global distribution of research output in pediatric cardiology (PC) is sparse. This study took a bibliometric approach to characterize research output, assess the level of competition, describe the geographic distribution of the leading research centers in the field, and investigate determinants of research output. In addition, the study characterized the journals publishing PC research and identified temporal trends in research interest over time. Publications presenting original research in PC between 1995 and 2011 were identified. A total of 9,410 relevant articles were identified based on a PubMed search followed by subsequent electronic filtering and manual review. A dramatic increase in PC publications was seen during the study period (from 309 in 1995 to 1,075 in 2011). This was accompanied by an increase in impact factors and an overproportional rise in PC contributions relative to the general PubMed trend. Research in PC was shown to be highly competitive and becoming increasingly so (Herfindahl-Hirschman index of 1.64%). Research output correlated with gross domestic product, national levels of corruption, education, urbanization, geography, and presence of national centers of excellence. The data presented in this report allow benchmarking of different cities and countries and provide insights into the potential determinants of high-quality publications and the spectrum of publishing journals. The report also highlights the central role of subspecialty journals and shows that PC research output is related to national wealth, surrogates of appropriate use of resources, an adequate workforce, and education. Additionally, it emphasizes the potential beneficial effects of establishing centers of excellence in the field. PMID:24584212

  17. Interprofessional team management in pediatric critical care: some challenges and possible solutions

    PubMed Central

    Stocker, Martin; Pilgrim, Sina B; Burmester, Margarita; Allen, Meredith L; Gijselaers, Wim H

    2016-01-01

    Background Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous. Methods We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts. Findings The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted. Conclusion Bottom–up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of

  18. Psychiatric issues in pediatric organ transplantation.

    PubMed

    Stuber, Margaret L

    2011-08-01

    Solid organ transplantation has become the first line of treatment for a growing number of life-threatening pediatric illnesses. With improved survival, research into the long-term outcome of transplant recipients has become important to clinicians. Adherence to medical instructions remains a challenge, particularly in the adolescent population. New immunosuppressant approaches promise to expand organ transplantation in additional directions. Extension of transplantation into replacement of organs such as faces and hands raises complex ethical issues. PMID:21855712

  19. Psychiatric issues in pediatric organ transplantation.

    PubMed

    Stuber, Margaret L

    2010-04-01

    Solid organ transplantation has become the first line of treatment for a growing number of life-threatening pediatric illnesses. With improved survival, research into the long-term outcome of transplant recipients has become important to clinicians. Adherence to medical instructions remains a challenge, particularly in the adolescent population. New immunosuppressant approaches promise to expand organ transplantation in additional directions. Extension of transplantation into replacement of organs such as faces and hands raises complex ethical issues. PMID:20478500

  20. Psychiatric Issues in Pediatric Organ Transplantation

    PubMed Central

    Stuber, Margaret L.

    2010-01-01

    Synopsis Solid organ transplantation has become the first line of treatment for a growing number of life-threatening pediatric illnesses. With improved survival, research into the long-term outcome of transplant recipients has become important to clinicians. Adherence to medical instructions remains a challenge, particularly in the adolescent population. New immunosuppressant approaches promise to expand organ transplantation in additional directions. Extension of transplantation into replacement of organs such as faces and hands raises complex ethical issues. PMID:20478500

  1. Pediatric facial burns.

    PubMed

    Kung, Theodore A; Gosain, Arun K

    2008-07-01

    Despite major advances in the area of burn management, burn injury continues to be a leading cause of pediatric mortality and morbidity. Facial burns in particular are devastating to the affected child and result in numerous physical and psychosocial sequelae. Although many of the principles of adult burn management can be applied to a pediatric patient with facial burns, the surgeon must be cognizant of several important differences. Facial burns and subsequent scar formation can drastically affect the growth potential of a child's face. Structures such as the nose and teeth may become deformed due to abnormal external forces caused by contractures. Serious complications such as occlusion amblyopia and microstomia must be anticipated and urgently addressed to avert permanent consequences, whereas other reconstructive procedures can be delayed until scar maturation occurs. Furthermore, because young children are actively developing the concept of self, severe facial burns can alter a child's sense of identity and place the child at high risk for future emotional and psychologic disturbances. Surgical reconstruction of burn wounds should proceed only after thorough planning and may involve a variety of skin graft, flap, and tissue expansion techniques. The most favorable outcome is achieved when facial resurfacing is performed with respect to the aesthetic units of the face. Children with facial burns remain a considerable challenge to their caregivers, and these patients require long-term care by a multidisciplinary team of physicians and therapists to optimize functional, cosmetic, and psychosocial outcomes. PMID:18650717

  2. THE MANY FACES OF CARING IN NURSING.

    PubMed

    Farrow, Jennifer

    2016-02-01

    Nonverbal communication is essential with children. Nurses are challenged when answers to assessment questions include shoulder shrugs and descriptions of 'ouchies' and pain all over that feels 'bad.' Pediatric nursing requires creativity and eliciting expression of emotions nonverbally. One way our patients express themselves is through art therapy. The art therapist on our unit uses masks with children who choose not to express themselves with words. I chose to create a mask as sculpture to nonverbally share my values, feelings, and compassion, just like my pediatric patients. As I worked with the mask, many faces of nursing emerged. PMID:27062865

  3. Improving ACT and SAT Scores: Making Progress, Facing Challenges. A Focus Report in the "Challenge to Lead" Series

    ERIC Educational Resources Information Center

    Jackson, Jenny; Lord, Joan

    2007-01-01

    The Southern Regional Education Board's (SREB) "Challenge to Lead" Goals for Education call for more students to take college admission tests, to score higher on those tests and for SREB states to reduce gaps in test scores among all groups of students. For states, achieving higher statewide scores is one sign that more students can go on to…

  4. Gender and Sexuality in Pediatrics.

    PubMed

    Merens, Teri A

    2016-05-01

    The terms gender and sexuality, once rarely discussed in a public forum, are now dominant topics of conversation on social media, in all forms of entertainment, politics, law, and medicine. The pediatric primary care physician, like all people and institutions involved in the delivery of health care, must be diligent about providing compassionate and competent care to patients and families contending with gender issues. The complex variety of obstacles these patients may face require a well-informed, sensitive clinician who can offer sound medical advice and appropriate referral. This article guides pediatricians through some of the challenges related to gender identity so they can assist their patients in navigating through any difficulties. [Pediatr Ann. 2016;45(5):e158-e161.]. PMID:27171801

  5. Challenges facing effective implementation of co-trimoxazole prophylaxis in children born to HIV-infected mothers in the public health facilities

    PubMed Central

    Kamuhabwa, Appolinary AR; Manyanga, Vicky

    2015-01-01

    Background If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented. Aim In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania. Methodology Four hundred and ninety-eight infants’ PMTCT (Prevention of Mother-to-Child Transmission of HIV) register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities. Results Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4%) children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8%) of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8%) received 240 mg per day. Only a small proportion (n=1, 0.2%) of children received 480 mg/day. Dose determination was based on the child’s age rather than body weight. Parents and guardians reported that 42 (13.1%) children had missed one or more doses of co-trimoxazole during the course of prophylaxis. The majority of health care workers (89.7%) reported that co-trimoxazole is very effective for the prevention of opportunistic infections among children, but frequent shortage of co

  6. Challenges and recognizable patterns in the en-face OCT of the retina

    NASA Astrophysics Data System (ADS)

    Rosen, Richard B.; Podoleanu, Adrian G.; Rogers, John A.; Garcia, Patricia; Lydon, Chris; Dunne, Shane; Dobre, George M.; Cucu, Radu G.; Jackson, David A.; Gentile, Ronald C.; Rosenthal, Jeanne L.; Muldoon, Thomas; Walsh, Joseph B.; Orlock, Dennis A.; Fisher, Yale; Yannuzzi, Lawrence A.

    2004-07-01

    Using an advanced prototype of en-face OCT/cSLO instrument, an extensive array of clinic pathologies were studied including macular degeneration, central serous retinopathy (CSR), macular hole, macular pucker, cystoid macular edema (CME), diabetic maculopathy, and macular trauma. We report observation of reoccurring patterns in the en-face OCT images which could be identified with different diseases. Uniquely specific and reoccurring patterns could be characterized for macular hole ("Chrysanthemum flower"), CME ("Swiss cheese wheel"), Macular Pucker ("Star"), CSR ("Target") and RPE Detachment ("Ring of Light"). Other entities such as polypoidal choroidopathy and diabetic edema residues had easily recognizable features but were variable enough to defy specific descriptive comparison. To facilitate the interpretation of the en-face OCT images, a three dimensional interactive simulation was designed which allows the demonstration of characteristic features and artifacts encountered in the acquisition of transverse images.

  7. Convergence in France facing Big Data era and Exascale challenges for Climate Sciences

    NASA Astrophysics Data System (ADS)

    Denvil, Sébastien; Dufresne, Jean-Louis; Salas, David; Meurdesoif, Yann; Valcke, Sophie; Caubel, Arnaud; Foujols, Marie-Alice; Servonnat, Jérôme; Sénési, Stéphane; Derouillat, Julien; Voury, Pascal

    2014-05-01

    The presentation will introduce a french national project : CONVERGENCE that has been funded for four years. This project will tackle big data and computational challenges faced by climate modeling community in HPC context. Model simulations are central to the study of complex mechanisms and feedbacks in the climate system and to provide estimates of future and past climate changes. Recent trends in climate modelling are to add more physical components in the modelled system, increasing the resolution of each individual component and the more systematic use of large suites of simulations to address many scientific questions. Climate simulations may therefore differ in their initial state, parameter values, representation of physical processes, spatial resolution, model complexity, and degree of realism or degree of idealisation. In addition, there is a strong need for evaluating, improving and monitoring the performance of climate models using a large ensemble of diagnostics and better integration of model outputs and observational data. High performance computing is currently reaching the exascale and has the potential to produce this exponential increase of size and numbers of simulations. However, post-processing, analysis, and exploration of the generated data have stalled and there is a strong need for new tools to cope with the growing size and complexity of the underlying simulations and datasets. Exascale simulations require new scalable software tools to generate, manage and mine those simulations ,and data to extract the relevant information and to take the correct decision. The primary purpose of this project is to develop a platform capable of running large ensembles of simulations with a suite of models, to handle the complex and voluminous datasets generated, to facilitate the evaluation and validation of the models and the use of higher resolution models. We propose to gather interdisciplinary skills to design, using a component-based approach, a

  8. Convergence in France facing Big Data era and Exascale challenges for Climate Sciences

    NASA Astrophysics Data System (ADS)

    Denvil, Sébastien; Dufresne, Jean-Louis; Salas, David; Meurdesoif, Yann; Valcke, Sophie; Caubel, Arnaud; Foujols, Marie-Alice; Servonnat, Jérôme; Sénési, Stéphane; Derouillat, Julien; Voury, Pascal

    2014-05-01

    The presentation will introduce a french national project : CONVERGENCE that has been funded for four years. This project will tackle big data and computational challenges faced by climate modeling community in HPC context. Model simulations are central to the study of complex mechanisms and feedbacks in the climate system and to provide estimates of future and past climate changes. Recent trends in climate modelling are to add more physical components in the modelled system, increasing the resolution of each individual component and the more systematic use of large suites of simulations to address many scientific questions. Climate simulations may therefore differ in their initial state, parameter values, representation of physical processes, spatial resolution, model complexity, and degree of realism or degree of idealisation. In addition, there is a strong need for evaluating, improving and monitoring the performance of climate models using a large ensemble of diagnostics and better integration of model outputs and observational data. High performance computing is currently reaching the exascale and has the potential to produce this exponential increase of size and numbers of simulations. However, post-processing, analysis, and exploration of the generated data have stalled and there is a strong need for new tools to cope with the growing size and complexity of the underlying simulations and datasets. Exascale simulations require new scalable software tools to generate, manage and mine those simulations ,and data to extract the relevant information and to take the correct decision. The primary purpose of this project is to develop a platform capable of running large ensembles of simulations with a suite of models, to handle the complex and voluminous datasets generated, to facilitate the evaluation and validation of the models and the use of higher resolution models. We propose to gather interdisciplinary skills to design, using a component-based approach, a

  9. Talking about epilepsy: Challenges parents face when communicating with their child about epilepsy and epilepsy-related issues.

    PubMed

    O'Toole, Stephanie; Lambert, Veronica; Gallagher, Pamela; Shahwan, Amre; Austin, Joan K

    2016-04-01

    The aim of this qualitative study was to explore the challenges that parents of children with epilepsy experienced when engaging in dialog with their child about epilepsy and epilepsy-related issues. Using a qualitative exploratory approach, interviews were conducted with 34 parents of children with epilepsy (aged 6-16years), consisting of 27 mothers and 7 fathers. Data were transcribed verbatim and thematically analyzed. Findings revealed five main themes: normalizing epilepsy, the invisibility of epilepsy, information concealment, fear of misinforming the child, and difficulty in discussing particular epilepsy-related issues. Many of the communicative challenges experienced by parents impacted on their ability to engage openly in parent-child dialog about epilepsy in the home. Parents face specific challenges when choosing to communicate with their child about epilepsy, relating to creating a sense of normality, reducing fear of causing their child worry, and having a lack of epilepsy-related knowledge. Healthcare professionals who work closely with families living with epilepsy should remain mindful of the importance of discussing family communication surrounding epilepsy and the challenges parents of children with epilepsy face when talking about epilepsy within the home. PMID:26900774

  10. Challenges Facing Chinese Academic Staff in a UK University in Terms of Language, Relationships and Culture

    ERIC Educational Resources Information Center

    Hsieh, Hui-hua

    2012-01-01

    The recruitment of international academic staff is viewed as one of the strategies to internationalise the universities. International academic staff, however, usually encounter many challenges when in a foreign context. This study aims to investigate the challenges of Chinese academic staff teaching in the UK in terms of language, relationships…