Science.gov

Sample records for address difficult problems

  1. What Makes a Beam Shaping Problem Difficult?

    SciTech Connect

    ROMERO,LOUIS; DICKEY,FRED M.

    2000-07-19

    The authors have discussed the three factors that they believe are the most important in determining the difficulty of a beam shaping problem: scaling, smoothness, and coherence. The arguments have been almost completely based on considering how these factors influence beam shaping lenses that were designed using geometrical optics. However, they believe that these factors control the difficulty of beam shaping problems even if one does not base ones design strategy on geometrical optics. For example, they have shown that a lens designed using geometrical optics will not work well unless {beta} is large. However, they have also shown that if {beta} is small the uncertainty principle shows that it is impossible to do a good job of beam shaping no matter how one designs ones lens.

  2. Addressing problems in complete dentures.

    PubMed

    LaBarre, Eugene; Giusti, Lola; Pitigoi-Aron, Gabriela

    2007-10-01

    The authors have compiled a set of solutions to the most common issues influencing the success of complete denture cases. A brief review and discussion of occlusal vertical dimension is presented, followed by a troubleshooting guide to problems such as inadequate retention and stability, discomfort, and other problems affecting treatment outcome.

  3. Novel reinforcement learning approach for difficult control problems

    NASA Astrophysics Data System (ADS)

    Becus, Georges A.; Thompson, Edward A.

    1997-09-01

    We review work conducted over the past several years and aimed at developing reinforcement learning architectures for solving difficult control problems and based on and inspired by associative control process (ACP) networks. We briefly review ACP networks able to reproduce many classical instrumental conditioning test results observed in animal research and to engage in real-time, closed-loop, goal-seeking interactions with their environment. Chronologically, our contributions include the ideally interfaced ACP network which is endowed with hierarchical, attention, and failure recognition interface mechanisms which greatly enhanced the capabilities of the original ACP network. When solving the cart-pole problem, it achieves 100 percent reliability and a reduction in training time similar to that of Baird and Klopf's modified ACP network and additionally an order of magnitude reduction in number of failures experienced for successful training. Next we introduced the command and control center/internal drive (Cid) architecture for artificial neural learning systems. It consists of a hierarchy of command and control centers governing motor selection networks. Internal drives, similar hunger, thirst, or reproduction in biological systems, are formed within the controller to facilitate learning. Efficiency, reliability, and adjustability of this architecture were demonstrated on the benchmark cart-pole control problem. A comparison with other artificial learning systems indicates that it learns over 100 times faster than Barto, et al's adaptive search element/adaptive critic element, experiencing less failures by more than an order of magnitude while capable of being fine-tuned by the user, on- line, for improved performance without additional training. Finally we present work in progress on a 'peaks and valleys' scheme which moves away from the one-dimensional learning mechanism currently found in Cid and shows promises in solving even more difficult learning control

  4. Physicians' attitudes toward using deception to resolve difficult ethical problems.

    PubMed

    Novack, D H; Detering, B J; Arnold, R; Forrow, L; Ladinsky, M; Pezzullo, J C

    1989-05-26

    To assess physicians' attitudes toward the use of deception in medicine, we sent a questionnaire to 407 practicing physicians. The questionnaire asked for responses to difficult ethical problems potentially resolvable by deception and asked general questions about attitudes and practices. Two hundred eleven (52%) of the physicians responded. The majority indicated a willingness to misrepresent a screening test as a diagnostic test to secure an insurance payment and to allow the wife of a patient with gonorrhea to be misled about her husband's diagnosis if that were believed necessary to ensure her treatment and preserve a marriage. One third indicated they would offer incomplete or misleading information to a patient's family if a mistake led to a patient's death. Very few physicians would deceive a mother to avoid revealing an adolescent daughter's pregnancy. When forced to make difficult ethical choices, most physicians indicated some willingness to engage in forms of deception. They appear to justify their decisions in terms of the consequences and to place a higher value on their patients' welfare and keeping patients' confidences than truth telling for its own sake.

  5. Underbalanced drilling solves difficult drilling problems and enhances production

    SciTech Connect

    Cuthbertson, R.L.; Vozniak, J.

    1997-02-01

    An alternate approach to drilling, completing and working over new and existing wells has dramatically improved the efficiency of these operations. This method is called underbalanced drilling (UBD). Improvements in both the equipment and technique during the past 5 years have made this process economical and necessary to solve many difficult drilling problems. Additionally, by reducing drilling or workover damage, dramatic improvements in oil and gas production rates and ultimate reserves are realized, resulting in extra profits for today`s operators. This article will detail the advantages of UBD and give specific examples of its applications, A series of related articles will follow, including: new UBD equipment, land and off-shore case histories, coiled tubing drilling, underbalanced workovers, software technology and subsea applications to examine the reality and future of this technology.

  6. Problem Solvers: Solutions--The Inaugural Address

    ERIC Educational Resources Information Center

    Dause, Emily

    2014-01-01

    Fourth graders in Miss Dause's and Mrs. Hicks's mathematics classes at South Mountain Elementary School in Dillsburg, Pennsylvania, worked with the data from the Inauagural Address problem that was previously published published in the February 2013 issue of "Teaching Children Mathematics". This activity allowed students to showcase…

  7. Autocheck: Addressing the Problem of Rural Transportation.

    ERIC Educational Resources Information Center

    Payne, Guy A.

    This paper describes a project implemented by a social worker from the Glynn County School District in rural Georgia to address transportation problems experienced by students and their families. The project aims to assist families who are unable to keep appointments or attend other important events due to unreliable transportation. A county needs…

  8. The ‘Physics Cup’: interesting problems are difficult

    NASA Astrophysics Data System (ADS)

    Kalda, J.

    2013-07-01

    An overview of the online competition, Physics Cup—IPhO2012 is given. This preceded the 43rd International Physics Olympiad and included ten problems, published monthly. Three problems, the most popular among the contestants, are discussed in detail. These problems deal with laser speckle patterns, geometrical optics and LC circuits with four degrees of freedom. The results of the competition and of the poll carried out among the contestants are used to discuss the relationship between the properties of the problems: difficulty, closeness to reality and beauty (as perceived by the contestants).

  9. Why Is the Overheating Problem Difficult: the Role of Entropy

    NASA Technical Reports Server (NTRS)

    Liou, Meng-Sing

    2013-01-01

    The development of computational fluid dynamics over the last few decades has yielded enormous successes and capabilities being routinely employed today; however there remain some open problems to be properly resolved-some are fundamental in nature and some resolvable by operational changes. These two categories are distinguished and broadly explored previously. One, that belongs to the former, is the so-called overheating problem, especially in rarefying flow. This problem up to date still dogs every method known to the author; a solution to it remains elusive. The study in this paper concludes that: (1) the entropy increase is quantitatively linked to the increase in the temperature increase, (2) it is argued that the overheating is inevitable in the current shock capturing or traditional finite difference framework, and (3) a simple hybrid method is proposed that removes the overheating problem in the rarefying problems, but also retains the property of accurate shock capturing. This remedy (enhancement of current numerical methods) can be included easily in the present Eulerian codes.

  10. Methods for measuring denitrification: Diverse approaches to a difficult problem

    USGS Publications Warehouse

    Groffman, Peter M; Altabet, Mary A.; Böhlke, J.K.; Butterbach-Bahl, Klaus; David, Mary B.; Firestone, Mary K.; Giblin, Anne E.; Kana, Todd M.; Nielsen , Lars Peter; Voytek, Mary A.

    2006-01-01

    Denitrification, the reduction of the nitrogen (N) oxides, nitrate (NO3−) and nitrite (NO2−), to the gases nitric oxide (NO), nitrous oxide (N2O), and dinitrogen (N2), is important to primary production, water quality, and the chemistry and physics of the atmosphere at ecosystem, landscape, regional, and global scales. Unfortunately, this process is very difficult to measure, and existing methods are problematic for different reasons in different places at different times. In this paper, we review the major approaches that have been taken to measure denitrification in terrestrial and aquatic environments and discuss the strengths, weaknesses, and future prospects for the different methods. Methodological approaches covered include (1) acetylene-based methods, (2) 15N tracers, (3) direct N2 quantification, (4) N2:Ar ratio quantification, (5) mass balance approaches, (6) stoichiometric approaches, (7) methods based on stable isotopes, (8) in situ gradients with atmospheric environmental tracers, and (9) molecular approaches. Our review makes it clear that the prospects for improved quantification of denitrification vary greatly in different environments and at different scales. While current methodology allows for the production of accurate estimates of denitrification at scales relevant to water and air quality and ecosystem fertility questions in some systems (e.g., aquatic sediments, well-defined aquifers), methodology for other systems, especially upland terrestrial areas, still needs development. Comparison of mass balance and stoichiometric approaches that constrain estimates of denitrification at large scales with point measurements (made using multiple methods), in multiple systems, is likely to propel more improvement in denitrification methods over the next few years.

  11. Computational strategies to address chromatin structure problems

    NASA Astrophysics Data System (ADS)

    Perišić, Ognjen; Schlick, Tamar

    2016-06-01

    While the genetic information is contained in double helical DNA, gene expression is a complex multilevel process that involves various functional units, from nucleosomes to fully formed chromatin fibers accompanied by a host of various chromatin binding enzymes. The chromatin fiber is a polymer composed of histone protein complexes upon which DNA wraps, like yarn upon many spools. The nature of chromatin structure has been an open question since the beginning of modern molecular biology. Many experiments have shown that the chromatin fiber is a highly dynamic entity with pronounced structural diversity that includes properties of idealized zig-zag and solenoid models, as well as other motifs. This diversity can produce a high packing ratio and thus inhibit access to a majority of the wound DNA. Despite much research, chromatin’s dynamic structure has not yet been fully described. Long stretches of chromatin fibers exhibit puzzling dynamic behavior that requires interpretation in the light of gene expression patterns in various tissue and organisms. The properties of chromatin fiber can be investigated with experimental techniques, like in vitro biochemistry, in vivo imagining, and high-throughput chromosome capture technology. Those techniques provide useful insights into the fiber’s structure and dynamics, but they are limited in resolution and scope, especially regarding compact fibers and chromosomes in the cellular milieu. Complementary but specialized modeling techniques are needed to handle large floppy polymers such as the chromatin fiber. In this review, we discuss current approaches in the chromatin structure field with an emphasis on modeling, such as molecular dynamics and coarse-grained computational approaches. Combinations of these computational techniques complement experiments and address many relevant biological problems, as we will illustrate with special focus on epigenetic modulation of chromatin structure.

  12. History Museums and Social Cohesion: Building Identity, Bridging Communities, and Addressing Difficult Issues

    ERIC Educational Resources Information Center

    Rosenberg, Tracy Jean

    2011-01-01

    Museums have the capacity to enhance social cohesion, which is the product of a trusting, connected community. History museums and historic sites, in particular, can serve communities by stimulating dialogue on difficult issues, accurately representing all the people of a nation, and creating forums for discussion among groups with disparate…

  13. Poetry and Prose as Pedagogical Tools for Addressing Difficult Knowledges: Translocational Positionality and Issues of Collective Political Agency

    ERIC Educational Resources Information Center

    Keddie, Amanda

    2012-01-01

    In this paper the focus is on the possibilities that poetry and prose offer as pedagogical tools that can both accommodate and address difficult and painful knowledges. The paper presents and analyses poems and prose written by students at a non-traditional secondary school for disadvantaged girls (many of whom identify as Indigenous Australian).…

  14. Addressing the Curriculum Problem in Doctoral Education

    ERIC Educational Resources Information Center

    Green, Bill

    2012-01-01

    How best to understand the curriculum problem in doctoral research education: that is the question that this paper engages. It begins by noting that curriculum as such is little referenced and inadequately theorised in higher education and certainly in doctoral education, and indeed has been described as a "missing term". The paper then…

  15. Addressing the Travelling Salesman Problem through Evolutionary Adaptation

    DTIC Science & Technology

    1987-01-01

    M FILE Cun ARI Research Note 87-04 -- w CM o> < i Q < ADDRESSING THE TRAVELLING SALESMAN PROBLEM THROUGH EVOLUTIONARY ADAPTATION David B...TITLE raid SubMII«; ’ 1 Addressing the Travelling Salesman Problem 1 Through Evolutionary...1 Optimizing the " travelling salesman" problem continues to

  16. A Research Methodology for Studying What Makes Some Problems Difficult to Solve

    ERIC Educational Resources Information Center

    Gulacar, Ozcan; Fynewever, Herb

    2010-01-01

    We present a quantitative model for predicting the level of difficulty subjects will experience with specific problems. The model explicitly accounts for the number of subproblems a problem can be broken into and the difficultly of each subproblem. Although the model builds on previously published models, it is uniquely suited for blending with…

  17. The difficult temperament in adolescence: associations with substance use, family support, and problem behaviors.

    PubMed

    Windle, M

    1991-03-01

    This study investigated interrelations between the number of difficult temperament factors (e.g., arrhythmicity, inflexibility, high distractibility) and substance use, perceived family support, and problem behaviors for a sample of 297 adolescents (M age = 15.7 years). The number of adolescent difficult temperament factors was associated significantly with more childhood behavior problems (e.g., hyperactivity, conduct disordered symptoms), which suggests some continuity of disordered behavior from childhood to adolescence. Number of adolescent difficult temperament factors also was associated with a higher percentage of substance users (for cigarettes, alcohol, marijuana, hard drugs), lower perceived family support, higher levels of depressive symptoms, and more delinquent activity. Number of difficult temperament factors was not associated significantly with gender or age of respondents.

  18. Interactive film scenes for tutor training in problem-based learning (PBL): dealing with difficult situations

    PubMed Central

    2010-01-01

    Background In problem-based learning (PBL), tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials. Methods Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all). Results An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues. The tool was well accepted and considered worth the time spent on it (81.62 ± 16.91; 62.94 ± 16.76). Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 ± 19.46). The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with

  19. A case study in automated theorem proving: A difficult problem about commutators

    SciTech Connect

    McCune, W.

    1995-02-01

    This paper shows how the automated deduction system OTTER. was used to prove the group theory theorem {chi}{sup 3} = e {implies} [[[y, z], u], v] = e, where e is the identity, and [XI Y] is the commutator {chi}{prime}y{prime}{chi}y. This is a difficult problem for automated provers, and several lengthy searches were run before a proof was found. Problem formulation and search strategy played a key role in the success. I believe that ours is the first automated proof of the theorem.

  20. Interesting and Difficult Mathematical Problems: Changing Teachers' Views by Employing Multiple-Solution Tasks

    ERIC Educational Resources Information Center

    Guberman, Raisa; Leikin, Roza

    2013-01-01

    The study considers mathematical problem solving to be at the heart of mathematics teaching and learning, while mathematical challenge is a core element of any educational process. The study design addresses the complexity of teachers' knowledge. It is aimed at exploring the development of teachers' mathematical and pedagogical conceptions…

  1. A Cascade Optimization Strategy for Solution of Difficult Multidisciplinary Design Problems

    NASA Technical Reports Server (NTRS)

    Patnaik, Surya N.; Coroneos, Rula M.; Hopkins, Dale A.; Berke, Laszlo

    1996-01-01

    A research project to comparatively evaluate 10 nonlinear optimization algorithms was recently completed. A conclusion was that no single optimizer could successfully solve all 40 problems in the test bed, even though most optimizers successfully solved at least one-third of the problems. We realized that improved search directions and step lengths, available in the 10 optimizers compared, were not likely to alleviate the convergence difficulties. For the solution of those difficult problems we have devised an alternative approach called cascade optimization strategy. The cascade strategy uses several optimizers, one followed by another in a specified sequence, to solve a problem. A pseudorandom scheme perturbs design variables between the optimizers. The cascade strategy has been tested successfully in the design of supersonic and subsonic aircraft configurations and air-breathing engines for high-speed civil transport applications. These problems could not be successfully solved by an individual optimizer. The cascade optimization strategy, however, generated feasible optimum solutions for both aircraft and engine problems. This paper presents the cascade strategy and solutions to a number of these problems.

  2. Time Management: Addressing and Assessing Classroom Participation Problems

    DTIC Science & Technology

    2015-01-01

    Time Management Addressing and Assessing Classroom Participation Problems Cary A. Balser Abstract While research shows that technology in...the classroom has costs, in econometrics (as in other technical courses) computer use is very nearly a necessary condition. Therefore, I used a...undergraduate institution with a clear focus on STEM, technology in the classroom is very nearly necessitated by the content in many technical courses

  3. Can small institutes address some problems facing biomedical researchers?

    PubMed

    Sheetz, Michael P

    2014-11-01

    At a time of historically low National Institutes of Health funding rates and many problems with the conduct of research (unfunded mandates, disgruntled reviewers, and rampant paranoia), there is a concern that biomedical research as a profession is waning in the United States (see "Rescuing US biomedical research from its systemic flaws" by Alberts and colleagues in the Proceedings of the National Academy of Sciences). However, it is wonderful to discover something new and to tackle tough puzzles. If we could focus more of our effort on discussing scientific problems and doing research, then we could be more productive and perhaps happier. One potential solution is to focus efforts on small thematic institutes in the university structure that can provide a stimulating and supportive environment for innovation and exploration. With an open-lab concept, there are economies of scale that can diminish paperwork and costs, while providing greater access to state-of-the-art equipment. Merging multiple disciplines around a common theme can catalyze innovation, and this enables individuals to develop new concepts without giving up the credit they deserve, because it is usually clear who did the work. Small institutes do not solve larger systemic problems but rather enable collective efforts to address the noisome aspects of the system and foster an innovative community effort to address scientific problems.

  4. Still a difficult business? Negotiating alcohol-related problems in general practice consultations.

    PubMed

    Rapley, Tim; May, Carl; Frances Kaner, Eileen

    2006-11-01

    This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.

  5. Addressing the clinical needs of problem drug user patients

    PubMed Central

    Krupski, Antoinette; West, Imara I.; Graves, Meredith C.; Atkins, David C.; Maynard, Charles; Bumgardner, Kristin; Donovan, Dennis; Ries, Richard; Roy-Byrne, Peter

    2016-01-01

    Introduction Illicit drug use is a serious public health problem associated with significant co-occurring medical disorders, mental disorders, and social problems. Yet most individuals with drug use disorders have never been treated, though they often seek medical treatment in primary care. The purpose of the present study was to examine baseline characteristics of persons presenting in primary care across a range of problem drug use severity to identify their clinical needs. Methods We examined socio-demographic characteristics, medical and psychiatric comorbidities, drug use severity, social and legal problems, and service utilization for 868 patients with drug problems recruited from primary care clinics in a safety-net medical setting. Based on Drug Abuse Screening Test (DAST-10) results, individuals were categorized as having low, intermediate, or substantial/severe drug use severity. Results Patients with substantial/severe drug use severity had serious drug use (opiates, stimulants, sedatives, intravenous drug use), high levels of homelessness (50%), psychiatric comorbidity (69%), arrests for serious crimes (24%), and frequent use of expensive emergency department and inpatient hospitals. Patients with low drug use severity were primarily users of marijuana with little reported use of other drugs, less psychiatric co-morbidity, and more stable lifestyles. Patients with intermediate drug use severity fell in-between the substantial/severe and low drug use severity subgroups on most variables. Conclusions Patients with highest drug use severity are likely to require specialized psychiatric and substance abuse care in addition to ongoing medical care that is equipped to address the consequences of severe/substantial drug use including intravenous drug use. Because of their milder symptoms, patients with low drug use severity may benefit from a collaborative care model that integrates psychiatric and substance abuse care in the primary care setting. Patients

  6. SIMS: addressing the problem of heterogeneity in databases

    NASA Astrophysics Data System (ADS)

    Arens, Yigal

    1997-02-01

    The heterogeneity of remotely accessible databases -- with respect to contents, query language, semantics, organization, etc. -- presents serious obstacles to convenient querying. The SIMS (single interface to multiple sources) system addresses this global integration problem. It does so by defining a single language for describing the domain about which information is stored in the databases and using this language as the query language. Each database to which SIMS is to provide access is modeled using this language. The model describes a database's contents, organization, and other relevant features. SIMS uses these models, together with a planning system drawing on techniques from artificial intelligence, to decompose a given user's high-level query into a series of queries against the databases and other data manipulation steps. The retrieval plan is constructed so as to minimize data movement over the network and maximize parallelism to increase execution speed. SIMS can recover from network failures during plan execution by obtaining data from alternate sources, when possible. SIMS has been demonstrated in the domains of medical informatics and logistics, using real databases.

  7. Time to address the problems at the neural interface

    NASA Astrophysics Data System (ADS)

    Durand, Dominique M.; Ghovanloo, Maysam; Krames, Elliot

    2014-04-01

    interface with the CNS. In 2013, two symposia were held independently to discuss this problem: one was held at the International Neuromodulation Society's 11th World Congress in Berlin and supported by the International Neuromodulation Society1 and the other at the 6th International Neural Engineering conference in San Diego2 and was supported by the NSF. Clearly, the neuromodulation and the neural engineering communities are keen to solve this problem. Experts from the field were assembled to discuss the problems and potential solutions. Although many important points were raised, few emerged as key issues. (1) The ability to access remotely and reliably internal neural signals . Although some of the technological problems have already been solved, this ability to access neural signals is still a significant problem since reliable and robust transcutaneous telemetry systems with large numbers of signals, each with wide bandwidth, are not readily available to researchers. (2) A translation strategy taking basic research to the clinic . The lack of understanding of the biological response to implanted constructs and the inability to monitor the sites and match the mechanical properties of the probe to the neural tissue properties continue to be an unsolved problem. In addition, the low levels of collaboration among neuroscientists, clinicians, patients and other stakeholders throughout different phases of research and development were considered to be significant impediments to progress. (3) Fundamental tools development procedures for neural interfacing . There are many laboratories testing various devices with different sets of criteria, but there is no consensus on the failure modes. The reliability, robustness of metrics and testing standards for such devices have not been established, either in academia or in industry. To start addressing this problem, the FDA has established a laboratory to test the reliability of some neural devices. Although the discussion was mostly

  8. The Crisis Manual for Early Childhood Teachers: How To Handle the Really Difficult Problems.

    ERIC Educational Resources Information Center

    Miller, Karen

    More and more teachers report the increasing incidence of crises in children's lives, crises that interfere with the child's ability to learn. Noting that developmentally appropriate curricula must respond to the issues of immediate concern and interest to children, this source book assists teachers in facing difficult issues in the classroom and…

  9. Difficult problems and their solutions in patients with cancer pain of the head and neck areas.

    PubMed

    Sist, T; Wong, C

    2000-01-01

    Pain management can be especially difficult in patients with head and neck cancer due to the erosive nature of the neoplasms that invade the region, the rich innervation of the head and neck, and other factors. Consequently, diagnosis is a complex process that cannot be dealt with in a cursory fashion. Furthermore, tumor pain can mimic noncancer conditions, nonmalignant orofacial disorders can be suggestive of tumor growth, and antineoplastic treatment-related conditions can be difficult to distinguish from tumor recurrence. A series of case reports illustrates key elements of diagnosis and pain management in patients with head and neck cancer. These elements include 1) detailed assessment of pain intensity and characteristics; 2) appropriate use of analgesic adjuvant medications; 3) use of diagnostic and therapeutic nerve blocks and myofascial trigger point injections; and 4) a high index of suspicion regarding tumor recurrence pain.

  10. Evidence-Based Practices for Addressing Classroom Behavior Problems

    ERIC Educational Resources Information Center

    Park, Hye-Suk Lee; Lynch, Sharon A.

    2014-01-01

    Teachers of young children can plan proactively so that they avoid some of the serious problem behaviors in the classroom. The strategies presented in this article are part of a problem solving approach to challenging behavior based on the principles of positive behavioral support. Although these methods presented here have research-based…

  11. An Address on the Population Problem: Address to the Massachusetts Institute of Technology.

    ERIC Educational Resources Information Center

    McNamara, Robert S.

    In this speech, Robert McNamara examines the background of the world population problem, analyzes its current trends, evaluates the measures available to deal with it, and suggests actions governments and others can take to help solve it. It now appears that significant fertility decline may have begun in developing countries. Data seem to…

  12. Addressing Problems Encountered in Case-Based Teaching

    ERIC Educational Resources Information Center

    Turgeon, A. J.

    2007-01-01

    TURF 436 (Case Studies in Turfgrass Management) is the capstone course for turfgrass science majors at the Pennsylvania State University. Students are introduced to problems and complex problematic situations encountered in the management of golf and sports turf and in professional lawn-care operations. Following completion of the orientation case…

  13. Selective Prevention: Addressing Vulnerability to Problem Drug Use in Europe

    ERIC Educational Resources Information Center

    Burkhart, Gregor; Gyarmathy, V. Anna; Bo, Alessandra

    2011-01-01

    Following the 2003 publication of the European Union (EU) Council Recommendations and the 2005-2008 and 2009-2012 EU Drugs Action Plans, increasing attention has been given in EU member states' drug policies to populations that are vulnerable to problem drug use (PDU). Monitoring data reported to the EMCDDA by designated agencies from 30 countries…

  14. How Do Medical Teachers Address the Problem of Transfer?

    ERIC Educational Resources Information Center

    Laksov, Klara Bolander; Lonka, Kirsti; Josephson, Anna

    2008-01-01

    Clinical teachers often complain that medical students have forgotten or somehow "lost" knowledge that has been taught at pre-clinical levels at the time of entering the clinical part of education. The purpose of this qualitative study was to explore, whether transfer of knowledge was identified as a problem by the teaching staff of…

  15. "Growing" Education in Difficult Environments Promoting Problem Solving: A Case from Palestine

    ERIC Educational Resources Information Center

    Jabr, Dua

    2009-01-01

    This paper presents a collaborative educational experiment "The Death of the Dead Sea: A Problem Based Learning" that was applied in two governmental high schools in Ramallah, Palestine in the school year 2006-2007. The students' role was to raise awareness to the phenomenon of the saltiest lake that shrinks towards extinction. In spite…

  16. Predicting Growth Curves of Early Childhood Externalizing Problems: Differential Susceptibility of Children with Difficult Temperament

    ERIC Educational Resources Information Center

    Mesman, Judi; Stoel, Reinoud; Bakermans-Kranenburg, Marian J.; van IJzendoorn, Marinus H.; Juffer, Femmie; Koot, Hans M.; Alink, Lenneke R. A.

    2009-01-01

    Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2-3 years for having high levels of externalizing…

  17. Air toxics risk standards: are we addressing the real problems?

    SciTech Connect

    Laurie Miller; Richard Becker; Ted Cromwell

    2005-06-01

    Cost-effective risk reductions from major stationary emission sources have seen significant progress. EPA and state data demonstrate that their programs have dramatically reduced emissions and risk from these sources. Analyses indicate that the next generation of risk reductions for stationary sources will be provide little risk reduction, but will be much more costly and more challenging from a policy perspective. Facing these tough choices, EPA and state regulators should, with stakeholder input, be developing scientifically driven and cost-effective approaches to provide the public with honest answers and results. Air toxics risk policies and programs must prioritize and address significant remaining air toxics risks, educate and communicate to the public about the decision alternatives, build support for a holistic approach and openly communicate results. 6 refs.

  18. Automatic mesh adaptivity for hybrid Monte Carlo/deterministic neutronics modeling of difficult shielding problems

    DOE PAGES

    Ibrahim, Ahmad M.; Wilson, Paul P.H.; Sawan, Mohamed E.; ...

    2015-06-30

    The CADIS and FW-CADIS hybrid Monte Carlo/deterministic techniques dramatically increase the efficiency of neutronics modeling, but their use in the accurate design analysis of very large and geometrically complex nuclear systems has been limited by the large number of processors and memory requirements for their preliminary deterministic calculations and final Monte Carlo calculation. Three mesh adaptivity algorithms were developed to reduce the memory requirements of CADIS and FW-CADIS without sacrificing their efficiency improvement. First, a macromaterial approach enhances the fidelity of the deterministic models without changing the mesh. Second, a deterministic mesh refinement algorithm generates meshes that capture as muchmore » geometric detail as possible without exceeding a specified maximum number of mesh elements. Finally, a weight window coarsening algorithm decouples the weight window mesh and energy bins from the mesh and energy group structure of the deterministic calculations in order to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to enhance an FW-CADIS calculation of the prompt dose rate throughout the ITER experimental facility. Using these algorithms resulted in a 23.3% increase in the number of mesh tally elements in which the dose rates were calculated in a 10-day Monte Carlo calculation and, additionally, increased the efficiency of the Monte Carlo simulation by a factor of at least 3.4. The three algorithms enabled this difficult calculation to be accurately solved using an FW-CADIS simulation on a regular computer cluster, eliminating the need for a world-class super computer.« less

  19. Automatic mesh adaptivity for hybrid Monte Carlo/deterministic neutronics modeling of difficult shielding problems

    SciTech Connect

    Ibrahim, Ahmad M.; Wilson, Paul P.H.; Sawan, Mohamed E.; Mosher, Scott W.; Peplow, Douglas E.; Wagner, John C.; Evans, Thomas M.; Grove, Robert E.

    2015-06-30

    The CADIS and FW-CADIS hybrid Monte Carlo/deterministic techniques dramatically increase the efficiency of neutronics modeling, but their use in the accurate design analysis of very large and geometrically complex nuclear systems has been limited by the large number of processors and memory requirements for their preliminary deterministic calculations and final Monte Carlo calculation. Three mesh adaptivity algorithms were developed to reduce the memory requirements of CADIS and FW-CADIS without sacrificing their efficiency improvement. First, a macromaterial approach enhances the fidelity of the deterministic models without changing the mesh. Second, a deterministic mesh refinement algorithm generates meshes that capture as much geometric detail as possible without exceeding a specified maximum number of mesh elements. Finally, a weight window coarsening algorithm decouples the weight window mesh and energy bins from the mesh and energy group structure of the deterministic calculations in order to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to enhance an FW-CADIS calculation of the prompt dose rate throughout the ITER experimental facility. Using these algorithms resulted in a 23.3% increase in the number of mesh tally elements in which the dose rates were calculated in a 10-day Monte Carlo calculation and, additionally, increased the efficiency of the Monte Carlo simulation by a factor of at least 3.4. The three algorithms enabled this difficult calculation to be accurately solved using an FW-CADIS simulation on a regular computer cluster, eliminating the need for a world-class super computer.

  20. A preliminary evaluation of SOLVE: addressing psychosocial problems at work.

    PubMed

    Probst, Tahira M; Gold, David; Caborn, Joannah

    2008-01-01

    The International Labour Organization (ILO) has developed a workplace intervention known as SOLVE, aimed at reducing the incidence of psychosocial problems related to job stress, workplace violence, tobacco use, drug and alcohol abuse, and HIV/AIDS. Although this ILO intervention is widely implemented, this article reports the first attempt to empirically assess its effectiveness. Using pre- and posttests of knowledge related to the course content gathered from 268 individuals in 7 countries who attended 1 of 15 SOLVE courses, analyses show that participant learning significantly improved as a function of attending the training. Knowledge gains were consistent regardless of course attended, language used to deliver the training program, and country in which the training took place. Implications of the SOLVE program are discussed, and future steps for further intervention development and assessment are recommended.

  1. Addressing the Pilot security problem with gLExec

    SciTech Connect

    Sfiligoi, I.; Koeroo, O.; Venekamp, G.; Yocum, D.; Groep, D.; Petravick, D.; /Fermilab

    2007-09-01

    The Grid security mechanisms were designed under the assumption that users would submit their jobs directly to the Grid gatekeepers. Many groups are however starting to use pilot-based infrastructures, where users submit jobs to a centralized queue and are successively transferred to the Grid resources by the pilot infrastructure. While this approach greatly improves the user experience, it does introduce several security and policy issues, the more serious being the lack of system level protection between the users and the inability for Grid sites to apply fine grained authorization policies. One possible solution to the problem is provided by gLExec, a X.509 aware suexec derivative. By using gLExec, the pilot workflow becomes as secure as any traditional one.

  2. Addressing critical astrophysical problems with NASA's small explorer (SMEX) missions

    NASA Astrophysics Data System (ADS)

    Guinan, Edward F.; Ribas, Ignasi

    The Small Explorer (SMEX) program of NASA was initiated during the late 1980s to provide frequent, cost-effective opportunities to carry out sharply focused and relatively space science missions. The SMEX program together with the Mid-size Explorer (MIDEX) program were timely reactions to the increasingly long development times and cost over-runs for a number of large space missions during the previous decades. SMEX spacecrafts are typically 180 to 250 kg with orbit-averaged power consumptions of 50-200 watts. Frequently innovative or novel technologies and instrumentation are employed to achieve important results. The current cost cap (which includes cost of launch vehicle, development and operations) is 75M (Fiscal Year 2000 US). For comparison, the cost cap of the MIDEX mission is $135M. Both SMEX and MIDEX are solicited Principal Investigator (PI) missions that are peer-reviewed before selection. The SMEX program is supported by the NASA's Office of Space Research (OSS) and a wide spectrum of science is addressed. The themes include Origin and Evolution of Stars and Planets, the Structure and Evolution of the Universe, and the Sun-Earth Connection. Within these major themes, the missions may also focus on fundamental laws of physics as they relate to astrophysics and cosmology. So far, seven SMEX missions have been flown or are approved for flight within one or two years. In this paper, the past, current, and possible future SMEX missions are discussed and evaluated. Some highlights and important scientific returns from the current and approved missions are also included.

  3. Applied social and behavioral science to address complex health problems.

    PubMed

    Livingood, William C; Allegrante, John P; Airhihenbuwa, Collins O; Clark, Noreen M; Windsor, Richard C; Zimmerman, Marc A; Green, Lawrence W

    2011-11-01

    Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented "with fidelity" by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research-practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists.

  4. Cancer of the oesophagus and gastroesophageal junction – a difficult clinical problem

    PubMed Central

    Kot, Marta; Kotucha, Bartłomiej; Stępień, Renata; Kozieł, Dorota

    2014-01-01

    Introduction Cancer located in the oesophagus and gastroesophageal junction is a complex clinical problem and the results of its treatment still remain unsatisfactory. The objective of the study was the clinical analysis of a group of patients with cancer of the oesophagus or gastroesophageal junction, who received combined medical and surgical treatment. Material and methods The analysis was performed on a group of 128 patients with the diagnosis of oesophageal cancer or cancer of the gastroesophageal junction. Analysis of medical records and follow-up examinations were used in the research procedure. Results From among 128 patients with a diagnosis of oesophageal or gastroesophageal junction cancer, 50 (38.5%) received surgical resections. The surgery most frequently performed (n = 15) was sub-total oesophageal resection according to Akiyama procedure by right-sided thoracotomy (oesophageal anastomosis in the neck). The largest group were patients (n = 26) with stage T3N1M0 of advancement of the disease. In all cases of cancer located in the lower third of the oesophagus, an adenocarcinoma pattern was diagnosed in the histopathological examination, whereas in the case of cancers located in the middle third and upper third of the thoracic oesophagus a carcinoma planoepitheliale pattern was seen. Anastomotic leaks occurred in seven patients (14%). Six patients died during the post-operative period (12%). The mean survival time in the group of analysed patients was two years. Conclusions Cancer of the oesophagus or gastroesophageal junction is associated with low resectability, high risk of complications after surgery, and poor oncologic outcome. It is necessary to seek new methods of treatment. PMID:25477759

  5. Difficult thyroidectomies

    PubMed Central

    PELIZZO, M.R.

    2015-01-01

    The “difficult thyroidectomies” (DT) are motivated by several factors that, alone or in association with each other, make surgery more laborious and increase the related risks. Topographical, technical and anatomical criteria have been used by us to classify DT with a view to illustrating specific problems and suggesting appropriate strategies. According to topographical criteria we considered mediastinal goiter and resurgery; according to technical criteria we considered the presence of auto-immune thyroiditis and locally advanced malignancies; on the basis of anatomical criteria, we considered the presence of “non recurrent” laryngeal nerve and of a pre-operatory vocal cord palsy. PMID:26017102

  6. Difficult conversations in orthopaedics.

    PubMed

    Marks, Michael R; Phillips, Donna; Halsey, David A; Wong, Andrew

    2015-01-01

    There is an overall lack of training in the communication skills needed by physicians to effectively navigate challenging patient encounters. So-called difficult patients have specific obstructive behaviors that make it challenging to establish a successful doctor-patient partnership and can elicit strong negative emotions in the physician. Instead of labeling the patient as difficult, it is more useful to consider encounters as difficult events and rely on diagnostic and interventional techniques similar to those used in solving any other clinical problem. In difficult interactions, patients may have the perception that the physician is less technically skilled, they were allotted inadequate time, received poor explanations, and were overall dissatisfied with the visit. Physicians who experience difficult encounters may find it difficult to communicate with patients. The physician is often not attuned to the psychosocial aspects of patient care and is frustrated and uneasy with patients. To improve patient and physician satisfaction and healthcare outcomes, it is helpful to review the skills and strategies for delivering bad news, managing angry patients, addressing financial concerns, and dealing with drug-seeking patients.

  7. School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

    ERIC Educational Resources Information Center

    Stephan, Sharon H.; Connors, Elizabeth H.

    2013-01-01

    Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

  8. Beating the Odds: Preparing Graduates to Address Gambling-Related Problems

    ERIC Educational Resources Information Center

    Engel, Rafael J.; Bechtold, Jody; Kim, Yoonmi; Mulvaney, Elizabeth

    2012-01-01

    As gambling opportunities proliferate, social workers are likely to see clients with gambling-related problems, but they often lack the expertise to address these concerns. This descriptive study assessed the inclusion of content on gambling-related problems in graduate social work curricula. Responses to an online survey from 86 (43.7%) of the…

  9. Achieving Success with More Students: Addressing the Problem of Students At Risk, K-12.

    ERIC Educational Resources Information Center

    Pennsylvania State Dept. of Education, Harrisburg.

    This resource book was developed to provide information that state and local leaders can use to stimulate discussion of the problem of students at risk and support the planning of initiatives that address the problem. An overview defines students at risk, summarizes the content of the book, and lists recent reports and publications on the problem…

  10. An Approach for Addressing the Multiple Testing Problem in Social Policy Impact Evaluations

    ERIC Educational Resources Information Center

    Schochet, Peter Z.

    2009-01-01

    In social policy evaluations, the multiple testing problem occurs due to the many hypothesis tests that are typically conducted across multiple outcomes and subgroups, which can lead to spurious impact findings. This article discusses a framework for addressing this problem that balances Types I and II errors. The framework involves specifying…

  11. A Problem-Solving Approach to Addressing Current Global Challenges in Education

    ERIC Educational Resources Information Center

    Chapman, Judith D.; Aspin, David N.

    2013-01-01

    This paper begins with an analysis of global problems shaping education, particularly as they impact upon learning and life chances. In addressing these problems a range of philosophical positions and controversies are considered, including: traditional romantic and institutional views of schooling; and more recent maximalist, neo-liberal,…

  12. Conflict management: difficult conversations with difficult people.

    PubMed

    Overton, Amy R; Lowry, Ann C

    2013-12-01

    Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed.

  13. Conflict Management: Difficult Conversations with Difficult People

    PubMed Central

    Overton, Amy R.; Lowry, Ann C.

    2013-01-01

    Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed. PMID:24436688

  14. Does problem complexity matter for environmental policy delivery? How public authorities address problems of water governance.

    PubMed

    Kirschke, Sabrina; Newig, Jens; Völker, Jeanette; Borchardt, Dietrich

    2017-03-08

    Problem complexity is often assumed to hamper effective environmental policy delivery. However, this claim is hardly substantiated, given the dominance of qualitative small-n designs in environmental governance research. We studied 37 types of contemporary problems defined by German water governance to assess the impact of problem complexity on policy delivery through public authorities. The analysis is based on a unique data set related to these problems, encompassing both in-depth interview-based data on complexities and independent official data on policy delivery. Our findings show that complexity in fact tends to delay implementation at the stage of planning. However, different dimensions of complexity (goals, variables, dynamics, interconnections, and uncertainty) impact on the different stages of policy delivery (goal formulation, stages and degrees of implementation) in various ways.

  15. When Your Child Is Difficult: Solve Your Toughest Child-Raising Problems with a Four-Step Plan That Works.

    ERIC Educational Resources Information Center

    Silberman, Mel

    Written for parents, this book discusses four steps for dealing with children's difficult behavior. The book is divided into two parts. Part 1, "The Building Blocks," discusses baseline perspectives parents need to establish in order to effectively deal with difficult behavior. Topics covered include: (1) parents' dual roles as caregivers and…

  16. Measuring Sixth-Grade Students' Problem Solving: Validating an Instrument Addressing the Mathematics Common Core

    ERIC Educational Resources Information Center

    Bostic, Jonathan David; Sondergeld, Toni A.

    2015-01-01

    This article describes the development of a problem-solving instrument intended for classroom use that addresses the Common Core State Standards for Mathematics. In this study, 137 students completed the assessment, and their responses were analyzed. Evidence for validity was collected and examined using the current standards for educational and…

  17. Families and Positive Behavior Support: Addressing Problem Behavior in Family Contexts.

    ERIC Educational Resources Information Center

    Lucyshyn, Joseph M., Ed.; Dunlap, Glen, Ed.; Albin, Richard W., Ed.

    The 19 chapters of this volume address theory, research, and practice concerning positive behavior support with families of children and youth with developmental disabilities and problem behavior. The chapters are: (1) "Positive Behavior Support with Families" (Joseph Lucyshyn and others); (2) "Finding Positive Behavior Support One…

  18. Routing and Addressing Problems in Large Metropolitan-Scale Internetworks. ISI Research Report.

    ERIC Educational Resources Information Center

    Finn, Gregory G.

    This report discusses some of the problems and limitations in existing internetwork design for the connection of packet-switching networks of different technologies and presents an algorithm that has been shown to be suitable for internetworks of unbounded size. Using a new form of address and a flat routing mechanism called Cartesian routing,…

  19. How Are 2-Year US Colleges Addressing Student Alcohol Use and Related Problems?

    ERIC Educational Resources Information Center

    Lenk, Kathleen M.; Nelson, Toben F.; Erickson, Darin J.; Toomey, Traci L.

    2015-01-01

    A considerable amount of attention and research has been dedicated to addressing alcohol use and related problems among students at 4-year colleges; however, less attention has been given to alcohol-related issues among students at 2-year technical/community colleges. This article describes research that expands on a study by Chiauzzi and…

  20. Addressing Possible Problems of Validity and Reliability in Qualitative Educational Research.

    ERIC Educational Resources Information Center

    Van Rooy, Wilhelmina

    The ways in which potential problems in terms of validity were addressed by a beginning researcher conducting research into teacher attitudes are described. The researcher, a doctoral candidate, studied the beliefs, attitudes, and values of four experienced high school biology teachers. Principles and practices of research were set into place…

  1. On Using Meta-Modeling and Multi-Modeling to Address Complex Problems

    ERIC Educational Resources Information Center

    Abu Jbara, Ahmed

    2013-01-01

    Models, created using different modeling techniques, usually serve different purposes and provide unique insights. While each modeling technique might be capable of answering specific questions, complex problems require multiple models interoperating to complement/supplement each other; we call this Multi-Modeling. To address the syntactic and…

  2. Addressing the Missing Instructional Data Problem: Using a Teacher Log to Document Tier 1 Instruction

    ERIC Educational Resources Information Center

    Kurz, Alexander; Elliott, Stephen N.; Roach, Andrew T.

    2015-01-01

    Response-to-intervention (RTI) systems posit that Tier 1 consists of high-quality general classroom instruction using evidence-based methods to address the needs of most students. However, data on the extent to which general education teachers provide such instruction are rarely collected. This missing instructional data problem may result in RTI…

  3. Difficult Temperament Moderates Links between Maternal Responsiveness and Children's Compliance and Behavior Problems in Low-Income Families

    ERIC Educational Resources Information Center

    Kochanska, Grazyna; Kim, Sanghag

    2013-01-01

    Background: Research has shown that interactions between young children's temperament and the quality of care they receive predict the emergence of positive and negative socioemotional developmental outcomes. This multimethod study addresses such interactions, using observed and mother-rated measures of difficult temperament, children's…

  4. A Practical Management Model for Difficult Situations.

    ERIC Educational Resources Information Center

    Shepherd, Paul

    1991-01-01

    A discussion of the student activities administrator's role in solving substantial problems on the job looks at typical difficult situations and offers models for dealing with them. Each model consists of five practical steps for problem resolution. Situations addressed include emergencies, motivational crises, and externally imposed…

  5. "As a matter of fact, this is not difficult to understand!": the addresses to the reader in Greek and Latin pharmacological poetry.

    PubMed

    Hautala, Svetlana

    2014-01-01

    Once written down, every pharmacological text becomes open to all kinds of distortion of its content. It may have been inaccurately copied, for example, or its dosages may have been intentionally altered. The transcription in verse of pharmacological preparations was supposed to protect the text against any distortion, for metrical demands of verse do not easily allow for the substitution of the specified quantities of a remedy's ingredients. Furthermore, rhythmical poetry can facilitate memorization of the prescriptions. Beside its very practical functions, this production was not alien to inspiration from the Muses, and physicians shared with poets the right to invoke the gods' favour for their lines. The present paper focuses on the addresses to the readers in Greek and Latin pharmacological poetry; it shows how the practical function of preserving and transmitting information was interwoven with the author's own literary ambitions.

  6. Exploring the role of Natural Helpers in efforts to address disparities for children with conduct problems

    PubMed Central

    Acevedo-Polakovich, I. David; Niec, Larissa N.; Barnett, Miya L.; Bell, Katrina M.; Aguilar, Gerardo; Vilca, Jeanette; Abbenante-Honold, Emily S.; Christian, Allison S.; Peer, Samuel O.

    2014-01-01

    The incorporation of natural helpers into services has been suggested as an innovative strategy to address disparities for historically underserved children with conduct problems. In order to inform incorporation efforts, this study examined the perceptions of natural helpers serving one U.S. Latina/o community regarding need for services for children with conduct problems, their reactions to a specific parent training intervention, and the training and support needed to deliver this intervention successfully. Participants identified a need for culturally-responsive services for children with conduct problems, and felt that parent training would be appropriate for the families they serve. Participants further identified specific training and support that they would require in order to deliver parent training with fidelity and effectiveness. Findings support the suggestion that natural helpers have the potential to address service disparities among Latina/o children with conduct problems. Recommendations from natural helpers should guide the development of culturally-adapted preventive interventions that help address existing service disparities. PMID:24910488

  7. [Difficult asthma].

    PubMed

    Chanez, Pascal; Vachier, Isabelle; Bourdin, Arnaud; Halimi, Laurence; Godard, Philippe

    2006-10-01

    Difficult asthma is a major issue in pulmonary medicine today because of its cost for patients and society. Difficult asthma is asthma that remains uncontrolled despite optimal specialist management. The validity of the diagnosis must be reconsidered in these cases: associated or differential diagnoses may be involved in the lack of control, and it is always necessary to assess the patient's treatment adhesion. Sufficient time--at least a year--must be taken to get to know the patient and to meet the objectives set. The standard asthma therapies should be tested objectively. Severe asthma is the reality of difficult asthma that endures despite a reaffirmed diagnosis, optimal compliance and controlled comorbidities. Better knowledge is needed of the pathophysiology of these patients' asthma. Improved knowledge of these phenotypes will make it possible to develop innovative treatments. They will need to be validated in clinical research for subsequent use that is wider but more rational because targeted at phenotypes likely to benefit from them.

  8. Overcoming barriers to addressing education problems with research design: a panel discussion.

    PubMed

    Yarris, Lalena M; Gruppen, Larry D; Hamstra, Stanley J; Anders Ericsson, K; Cook, David A

    2012-12-01

    A plenary panel session at the 2012 Academic Emergency Medicine consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" discussed barriers educators face in imagining, designing, and implementing studies to address educational challenges. This proceedings article presents a general approach to getting started in education research. Four examples of studies from the medical education literature that illustrate a distinct way to approach specific research questions are discussed. The study designs used are applicable to a variety of education research problems in emergency medicine (EM). Potential applications of studies are discussed, as well as effects and lessons learned.

  9. What is occupational therapy’s role in addressing sleep problems among older adults?

    PubMed Central

    Leland, Natalie E.; Marcione, Nicole; Niemiec, Stacey L. Schepens; Don Fogelberg, Kaivalya Kelkar

    2014-01-01

    Sleep problems, prevalent among older adults, are associated with poor outcomes and high healthcare costs. In 2008, rest and sleep became its own area of occupation in the AOTA Occupational Therapy Practice Framework. This scoping review examined a broad context of sleep research in order to highlight efficacious interventions for older adults that fall within the occupational therapy scope of practice and present an agenda for research and practice. Four sleep intervention areas clearly aligned with the Practice Framework, including cognitive behavioral therapy for insomnia, physical activity, and multi-component interventions. Occupational therapy is primed to address sleep problems by targeting the context and environment, performance patterns, and limited engagement in evening activities that may contribute to poor sleep. Occupational therapy researchers and clinicians need to work collaboratively to establish the evidence-base for occupation-centered sleep interventions in order to improve the health and quality of life of the older adult. PMID:24844879

  10. Brown Superfund Basic research Program: a multistakeholder partnership addresses real-world problems in contaminated communities.

    PubMed

    Senier, Laura; Hudson, Benjamin; Fort, Sarah; Hoover, Elizabeth; Tillson, Rebecca; Brown, Phil

    2008-07-01

    The NIEHS funds several basic and applied research programs, many of which also require research translation or outreach. This paper reports on a project by the Brown University Superfund Basic Research Program (SBRP), in which outreach and research translation teams collaborated with state regulatory agency personnel and community activists on a legislative initiative to mitigate the financial impacts of living in a contaminated community. The Environmentally Compromised Home Ownership (ECHO) program makes home equity loans of up to $25,000 available to qualified applicants. This collaboration provides a case study in community engagement and demonstrates how research translation and outreach activities that are clearly differentiated yet well-integrated can improve a suite of basic and applied research. Although engaging diverse constituencies can be difficult community-engaged translation and outreach have the potential to make research findings more useful to communities, address some of the social impacts of contamination, and empower stakeholders to pursue their individual and collectively held goals for remediation. The NIEHS has recently renewed its commitment to community-engaged research and advocacy, making this an optimal time to reflect on how basic research programs that engage stakeholders through research translation and outreach can add value to the overall research enterprise.

  11. A pilot study of a primary prevention curriculum to address preschool behavior problems.

    PubMed

    Upshur, Carole; Wenz-Gross, Melodie; Reed, George

    2013-10-01

    Behavior problems among preschool children are common. They are important targets for intervention because early externalizing problems and self-regulation issues tend to persist without appropriate attention, and can affect later mental health and school achievement outcomes. However, few preschool curricula addressing social and emotional development exist, and evidence for effects are mixed. In this study, the Second Step Pre/Kindergarten Social and Emotional Learning curriculum was adapted and tested in a small cluster randomized pilot study of community preschool classrooms to determine if it could improve outcomes in: (1) individual children's teacher-rated behavior problems and prosocial skills; (2) classroom climate (classroom interactions and two measures of disruptive behavior); and (3) teacher interaction skills. Year 1 outcomes were modest and were accounted for by baseline differences. In Year 2, classroom climate, measured by independent observers, differed significantly in intervention classrooms, largely because of declines in control classrooms, and there was some evidence for better teacher interaction skills in intervention classrooms. The pattern of effects suggests important impacts on classroom quality worth investigating in a larger study. Both fidelity and implementation rates, as well as positive teacher responses to the curriculum, indicate potential for widespread adoption.

  12. Addressing the Intersecting Problems of Opioid Misuse and Chronic Pain Treatment

    PubMed Central

    Denisco, Richard A.; Chandler, Redonna K.; Compton, Wilson M.

    2012-01-01

    Misuse of prescription opioid medications has continued as a major public health problem in the United States. Review of major epidemiologic data bases shows that the prevalence of opioid misuse rose markedly through the 1990’s and the early part of the current decade. In this same period of time the number of prescriptions for chronic non-cancer pain increased markedly, and the intersection of these two public health problems remains a concern. Further, despite some leveling off of the overall rate of prescription opioid misuse in the past several years, surveillance data show high and increasing mortality associated with these drugs. Analysis of the 2006 National Survey of Drug Use and Health indicates the increasing prevalence of prescription opioid misuse is associated more with an increase in the general availability of these medications than misuse of the medications by those who were directly prescribed them. National Institute on Drug Abuse initiatives to address the prescription opioid problem include programs to stimulate research in the basic and clinical sciences, and education of physicians and other health personnel. PMID:18837638

  13. Addressing the access problem for patients with serious mental illness who require tertiary medical care.

    PubMed

    Hensel, Jennifer M; Flint, Alastair J

    2015-02-01

    There is evidence to suggest that people with serious mental illness (SMI) have lower access to tertiary care than patients without SMI, particularly when care is complex. Barriers are present at the level of the individual, providers, and the health care system. High levels of co-morbidity and the associated health care costs, along with a growing focus on facilitating equal access to quality care for all, urges health care systems to address existing gaps. Some interventions have been successful at improving access to primary care for patients with SMI, but relatively little research has focused on access to complex interventions. This paper summarizes the scope of the problem regarding access to complex tertiary medical care among people with SMI. Barriers are discussed and potential solutions are proposed. Policies and programs must be developed, implemented, and evaluated to determine cost-effectiveness and impact on outcomes.

  14. In Situ Airborne Instrumentation: Addressing and Solving Measurement Problems in Ice Clouds

    SciTech Connect

    Baumgardner, Darrel; Kok, Greg; Avallone, L.; Bansemer, A.; Borrmann, S.; Brown, P.; Bundke, U.; Chuang, P. Y.; Cziczo, D.; Field, P.; Gallagher, M.; Gayet, J. -F.; Korolev, A.; Kraemer, M.; McFarquhar, G.; Mertes, S.; Moehler, O.; Lance, S.; Lawson, P.; Petters, M. D.; Pratt, K.; Roberts, G.; Rogers, D.; Stetzer, O.; Stith, J.; Strapp, W.; Twohy, C.; Wendisch, M.

    2012-02-01

    A meeting of 31 international experts on in situ measurements from aircraft was held to identify unresolved questions concerning ice formation and evolution in ice clouds, assess the current state of instrumentation that can address these problems, introduce emerging technology that may overcome current measurement issues and recommend future courses of action that can improve our understanding of ice cloud microphysical processes and their impact on the environment. The meeting proceedings and outcome has been described in detail in a manuscript submitted to the Bulletin of the American Meteorological Society (BAMS) on March 24, 2011. This paper is currently under review. The remainder of this summary, in the following pages, is the text of the BAMS article. A technical note that will be published by the National Center for Atmospheric Research is currently underway and is expected to be published before the end of the year.

  15. In Situ Airborne Instrumentation: Addressing and Solving Measurement Problems in Ice Clouds

    DOE PAGES

    Baumgardner, Darrel; Kok, Greg; Avallone, L.; ...

    2012-02-01

    A meeting of 31 international experts on in situ measurements from aircraft was held to identify unresolved questions concerning ice formation and evolution in ice clouds, assess the current state of instrumentation that can address these problems, introduce emerging technology that may overcome current measurement issues and recommend future courses of action that can improve our understanding of ice cloud microphysical processes and their impact on the environment. The meeting proceedings and outcome has been described in detail in a manuscript submitted to the Bulletin of the American Meteorological Society (BAMS) on March 24, 2011. This paper is currently undermore » review. The remainder of this summary, in the following pages, is the text of the BAMS article. A technical note that will be published by the National Center for Atmospheric Research is currently underway and is expected to be published before the end of the year.« less

  16. Addressing the problem of interruptability in the construction of large space structures

    NASA Technical Reports Server (NTRS)

    Davidson, Roger A.; Morgenthaler, George W.

    1989-01-01

    Large scale space missions of the near future will depend upon successful multi-launch coordination and construction in the space environment. One of the main challenges is how to accomplish a valid global analysis of a construction project with the intent of improving safety, reducing overall mission cost, and total construction time. These three items are dependent on the interruptability of the project, which is the ability of the project to recover from unplanned interruptions; such as failure of the launch vehicle; sudden, on-orbit, crew illness; or damage from a space debris impact on the partially completed space structure. A new method for addressing and analyzing this type of problem is being developed. The method is called Program Interruptability and Risk Evaluation Technique, or PIRET. PIRET has been developed in order to model and analyze potential interruptability concerns of the construction of the U.S. Space Station Freedom (SSF), although PIRET is applicable to any complex, multi-launch structural assembly. This paper is a progress report on the continuing research of the NASA Center for Space Construction at the University of Colorado, Boulder into this area of space construction interruptability. The paper will define the problem of interruptability, will diagram the PIRET approach to space construction, will share results from a preliminary PIRET analysis of SSF, and will show that PIRET is a useful tool for modelling space construction interruptability.

  17. Potential effects of the introduction of the discrete address beacon system data link on air/ground information transfer problems

    NASA Technical Reports Server (NTRS)

    Grayson, R. L.

    1981-01-01

    This study of Aviation Safety Reporting System reports suggests that benefits should accure from implementation of discrete address beacon system data link. The phase enhanced terminal information system service is expected to provide better terminal information than present systems by improving currency and accuracy. In the exchange of air traffic control messages, discrete address insures that only the intended recipient receives and acts on a specific message. Visual displays and printer copy of messages should mitigate many of the reported problems associated with voice communications. The problems that remain unaffected include error in addressing the intended recipient and messages whose content is wrong but are otherwise correct as to format and reasonableness.

  18. Activity Theory as a Tool to Address the Problem of Chemistry's Lack of Relevance in Secondary School Chemical Education

    ERIC Educational Resources Information Center

    Van Aalsvoort, Joke

    2004-01-01

    In a previous article, the problem of chemistry's lack of relevance in secondary chemical education was analysed using logical positivism as a tool. This article starts with the hypothesis that the problem can be addressed by means of activity theory, one of the important theories within the sociocultural school. The reason for this expectation is…

  19. Multidimensional Family Therapy: Addressing Co-Occurring Substance Abuse and Other Problems among Adolescents with Comprehensive Family-Based Treatment

    PubMed Central

    Rowe, Cynthia L.

    2010-01-01

    Synopsis Adolescent substance abuse rarely occurs without other psychiatric and developmental problems, yet it is often treated and researched as if it can be isolated from comorbid conditions. Few comprehensive interventions are available that effectively address the range of co-occurring problems associated with adolescent substance abuse. This article reviews the clinical interventions and research evidence supporting the use of Multidimensional Family Therapy (MDFT) for adolescents with substance abuse and co-occurring problems. MDFT is uniquely suited to address adolescent substance abuse and related disorders given its comprehensive interventions that systematically target the multiple interacting risk factors underlying many developmental disruptions of adolescence. PMID:20682221

  20. Addressing the Spectrum of Adolescent Weight-Related Problems: Engaging Parents and Communities

    ERIC Educational Resources Information Center

    Neumark-Sztainer, Dianne

    2007-01-01

    Weight-related problems, including eating disorders, disordered eating, and obesity, are prevalent among adolescents. School and community-based educators and health care providers have an important role to play in the prevention of weight-related problems in youth. This article includes: 1) a brief overview of weight-related problems in…

  1. A Case Study of Team-Initiated Problem Solving Addressing Student Behavior in One Elementary School

    ERIC Educational Resources Information Center

    Todd, Anne W.; Horner, Robert H.; Berry, Dorothy; Sanders, Carol; Bugni, Michelle; Currier, Allison; Potts, Nicky; Newton, J. Stephen; Algozzine, Bob; Algozzine, Kate

    2012-01-01

    Team-Initiated Problem Solving (TIPS) is an approach for organizing school team meetings to improve identification of targeted problems, use of data in the development of solutions, and development of implemented action plans. TIPS has been demonstrated in single-case and randomized controlled trial studies to improve the effectiveness of teams to…

  2. Portrayal as a Way of Addressing Problems in Communicating Evaluation Findings.

    ERIC Educational Resources Information Center

    Hall, Melvin E.

    Program portrayal is one way of addressing the need for increased descriptive capability in evaluation research. Portrayal supplements traditional reporting by utilizing subjective, anecdotal, or impressionistic information, in an appropriately communicable form, to enrich the description of program transactions, settings, and outcomes. It is…

  3. Using State Merging and State Pruning to Address the Path Explosion Problem Faced by Symbolic Execution

    DTIC Science & Technology

    2014-06-19

    the number of possible paths within a program grows exponentially with respect to loops and conditionals. New techniques are needed to address the path...increasing the code coverage. Each algorithm is tested over 66 of the GNU COREUTILS utilities. State merging combined with state pruning outperforms...30 3.6.1 GNU COREUTILS . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.7 Performance Metrics

  4. Efforts to Empower Teachers in Ethiopia to Address Local Environmental Problems: Achievements and Limitations

    ERIC Educational Resources Information Center

    Dalelo, Aklilu

    2009-01-01

    It is believed that the possibilities of integrating environmental issues into the formal and nonformal education programs depend on the capacity of teachers who put such programs into effect. A pilot project, aimed at building the capacity of schools in Ethiopia to address key environmental issues, was initiated in 2004. Among the major…

  5. Addressing the Intercultural via Task-Based Language Teaching: Possibility or Problem?

    ERIC Educational Resources Information Center

    East, Martin

    2012-01-01

    A frequent weakness of communicative approaches to foreign language teaching is a neglect of the intercultural dimension. Cultural knowledge is often treated as an addendum which focuses on learning facts about the target country. This article explores whether task-based language teaching (TBLT) can successfully address the intercultural…

  6. Addressing racial disparities in social welfare programs: using social equity analysis to examine the problem.

    PubMed

    Gooden, Susan T

    2006-01-01

    The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) allows states considerable discretion in developing and implementing their Temporary Assistance for Needy Families (TANF) programs. Little research so far has compared the implementation of TANF programs across racial groups. Without such analysis, it is difficult to interpret program outcomes. Using client survey data from a large Manpower Demonstration Research Corporation (MDRC) study, the Project on Devolution and Urban Change, this article compares African-American, Hispanic and White Clients' experiences with diversion, case management, sanctioning, exiting welfare, and dispute resolution. Using residual differences analysis, this article identifies significant differences in treatment among racial and ethnic groups.

  7. Aviation Security: Slow Progress in Addressing Long-Standing Screener Performance Problems

    DTIC Science & Technology

    2007-11-02

    aviation security , in particular airport screeners. Securing an air transportation system the size of this nation’s-with hundreds of airports, thousands of aircraft, and tens of thousands of flights daily carrying millions of passengers and pieces of baggage-is a difficult task. Events over the past decade have shown that the threat of terrorism against the United States is an ever-present danger. Aviation is an attractive target for terrorists, and because the air transportation system is critical to the nation’s well-being, protecting it is an important

  8. A Concept Space Approach to Addressing the Vocabulary Problem in Scientific Information Retrieval: An Experiment on the Worm Community System.

    ERIC Educational Resources Information Center

    Chen, Hsinchun; Ng, Tobun D.; Martinez, Joanne; Schatz, Bruce R.

    1997-01-01

    Presents an algorithmic approach to addressing the vocabulary problem in scientific information retrieval and information sharing, using the molecular biology domain as an example. A cognitive study and a follow-up document retrieval study were conducted using first a conjoined fly-worm thesaurus and then an actual worm database and the conjoined…

  9. GPS: Actions Needed to Address Ground System Development Problems and User Equipment Production Readiness

    DTIC Science & Technology

    2015-09-01

    review the status of OCX development and DOD’s efforts to field M- code signal capability. This report addresses (1) the extent to which DOD is...meeting cost, schedule, and performance requirements for OCX; (2) the progress DOD is making in delivering M- code capable MGUE by the end of fiscal year...2017; and (3) the challenges DOD faces in synchronizing the development of GPS III, OCX, and MGUE to deploy M- code . To conduct this work, GAO

  10. Incorporating Natural Helpers to Address Service Disparities for Young Children with Conduct Problems

    PubMed Central

    Acevedo-Polakovich, I. David; Niec, Larissa N.; Barnet, Miya L.; Bell, Katrina M.

    2013-01-01

    In response to the high levels of unmet need among historically underserved young children with conduct problems, this paper outlines some of the key issues involved in incorporating natural helpers into the delivery of parenting interventions for the treatment of conduct problems among historically underserved children. Strategies for the selection and training of natural helpers are discussed along with challenges that might be encountered in these processes. Directions for future research are also highlighted. With appropriate selection and training procedures in place, natural helpers may increase the accessibility of services for children and families and foster the reduction of service disparities. PMID:24729649

  11. Analysis of Arguments Constructed by First-Year Engineering Students Addressing Electromagnetic Induction Problems

    ERIC Educational Resources Information Center

    Almudi, Jose Manuel; Ceberio, Mikel

    2015-01-01

    This study explored the quality of arguments used by first-year engineering university students enrolled in a traditional physics course dealing with electromagnetic induction and related problem solving where they had to assess whether the electromagnetic induction phenomenon would occur. Their conclusions were analyzed for the relevance of the…

  12. Addressing Students' Difficulties with Faraday's Law: A Guided Problem Solving Approach

    ERIC Educational Resources Information Center

    Zuza, Kristina; Almudí, José-Manuel; Leniz, Ane; Guisasola, Jenaro

    2014-01-01

    In traditional teaching, the fundamental concepts of electromagnetic induction are usually quickly analyzed, spending most of the time solving problems in a more or less rote manner. However, physics education research has shown that the fundamental concepts of the electromagnetic induction theory are barely understood by students. This article…

  13. Ecosystem services and cooperative fisheries research to address a complex fishery problem

    EPA Science Inventory

    The St. Louis River represents a complex fishery management problem. Current fishery management goals have to be developed taking into account bi-state commercial, subsistence and recreational fisheries which are valued for different characteristics by a wide range of anglers, as...

  14. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals

    ERIC Educational Resources Information Center

    Thompson, Tess; Kreuter, Matthew W.; Boyum, Sonia

    2016-01-01

    Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N = 1,090) with at least one behavioral…

  15. Addressing Cultural Diversity: Effects of a Problem-Based Intercultural Learning Unit

    ERIC Educational Resources Information Center

    Busse, Vera; Krause, Ulrike-Marie

    2015-01-01

    This article explores to what extent a problem-based learning unit in combination with cooperative learning and affectively oriented teaching methods facilitates intercultural learning. As part of the study, students reflected on critical incidents, which display misunderstandings or conflicts that arise as a result of cultural differences. In…

  16. Addressing the Wicked Problem of Quality in Higher Education: Theoretical Approaches and Implications

    ERIC Educational Resources Information Center

    Krause, Kerri-Lee

    2012-01-01

    This article explores the wicked problem of quality in higher education, arguing for a more robust theorising of the subject at national, institutional and local department level. The focus of the discussion rests on principles for theorising in more rigorous ways about the multidimensional issue of quality. Quality in higher education is proposed…

  17. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    NASA Astrophysics Data System (ADS)

    Wiek, Arnim; Foley, Rider W.; Guston, David H.

    2012-09-01

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology's contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  18. The Life You Save May Be Your Own: New Jersey Addresses Prevention of Adolescent Problems.

    ERIC Educational Resources Information Center

    Kean, Thomas H.

    1989-01-01

    New Jersey's governor describes his state's response to the problems and needs of adolescents by creating the School-Based Youth Services Program. The program involves schools and community agencies in the provision of comprehensive services to teenagers, including mental health and family counseling, health services, and other interventions. (AF)

  19. Addressing Bullying Problems in Irish Schools and in Cyberspace: A Challenge for School Management

    ERIC Educational Resources Information Center

    Corcoran, Lucie; Mc Guckin, Conor

    2014-01-01

    Background: School management, in Ireland and also internationally, are currently faced with the problem of peer aggression among students both in a traditional school context and in a cyber context. Although Irish school principals are obliged to implement policy and procedures to counter bullying among students, there is a need for guidance that…

  20. Education Technologies in Addressing the Problem of Forming the Socially Active Individual

    ERIC Educational Resources Information Center

    Popova, Irina N.

    2016-01-01

    The article is devoted to the analysis of technological support of the educational process in solving the problem of forming the socially active individual. The authors studied the value of the category "social activity" and analyzed educational technologies that have an impact on its formation. The obtained results gave the possibility…

  1. New technologies address the problem areas of coiled-tubing cementing

    SciTech Connect

    Carpenter, R.B. )

    1992-05-01

    Coiled-tubing cementing has been practiced successfully on the Alaskan North Slope for several years. This paper discusses the special problems faced when this technology was applied to offshore U.S. gulf coast operations. The innovative solutions and procedures developed to improve the economic and technical success of coiled-tubing cementing are also discussed. Comparative laboratory and computer studies, as well as field case histories, will be presented to show the economic merit of this technology.

  2. Scientific problems addressed by the Spektr-UV space project (world space Observatory—Ultraviolet)

    NASA Astrophysics Data System (ADS)

    Boyarchuk, A. A.; Shustov, B. M.; Savanov, I. S.; Sachkov, M. E.; Bisikalo, D. V.; Mashonkina, L. I.; Wiebe, D. Z.; Shematovich, V. I.; Shchekinov, Yu. A.; Ryabchikova, T. A.; Chugai, N. N.; Ivanov, P. B.; Voshchinnikov, N. V.; Gomez de Castro, A. I.; Lamzin, S. A.; Piskunov, N.; Ayres, T.; Strassmeier, K. G.; Jeffrey, S.; Zwintz, S. K.; Shulyak, D.; Gérard, J.-C.; Hubert, B.; Fossati, L.; Lammer, H.; Werner, K.; Zhilkin, A. G.; Kaigorodov, P. V.; Sichevskii, S. G.; Ustamuich, S.; Kanev, E. N.; Kil'pio, E. Yu.

    2016-01-01

    The article presents a review of scientific problems and methods of ultraviolet astronomy, focusing on perspective scientific problems (directions) whose solution requires UV space observatories. These include reionization and the history of star formation in the Universe, searches for dark baryonic matter, physical and chemical processes in the interstellar medium and protoplanetary disks, the physics of accretion and outflows in astrophysical objects, from Active Galactic Nuclei to close binary stars, stellar activity (for both low-mass and high-mass stars), and processes occurring in the atmospheres of both planets in the solar system and exoplanets. Technological progress in UV astronomy achieved in recent years is also considered. The well advanced, international, Russian-led Spektr-UV (World Space Observatory—Ultraviolet) project is described in more detail. This project is directed at creating a major space observatory operational in the ultraviolet (115-310 nm). This observatory will provide an effective, and possibly the only, powerful means of observing in this spectral range over the next ten years, and will be an powerful tool for resolving many topical scientific problems.

  3. Dual-Use Partnership Addresses Performance Problems with "Y" Pattern Control Valves

    NASA Technical Reports Server (NTRS)

    Bailey, John W.

    2004-01-01

    A Dual-Use Cooperative Agreement between the Propulsion Test Directorate (PTD) at Stennis Space Center (SSC) and Oceaneering Reflange, Inc. of Houston, TX has produced an improved 'Y' pattern split-body control valve for use in the propulsion test facilities at Stennis Space Center. The split-body, or clamped bonnet technology, provides for a 'cleaner' valve design featuring enhanced performance and increased flow capacity with extended life expectancy. Other points addressed by the partnership include size, weight and costs. Overall size and weight of each valve will be reduced by 50% compared to valves currently in use at SSC. An initial procurement of two 10 inch valves will result in an overall cost reduction of 15% or approximately $50,000 per valve.

  4. Identification of critical substorm-expansion-phase phenomena: Problems addressable with GEM observations

    SciTech Connect

    Lyons, L.R.

    1994-09-01

    Understanding the physics of the substorm process is currently a crucial topic in magnetospheric physics. Fundamental to this understanding is the determination of what phenomena occur in the magnetosphere during the expansion phase, where these phenomena occur, and how they propagate during the expansion phase. Satellite observations have given researchers important point measurements of what happens; however there is potential for enhancing the use of ground-based observations to study the substorm phenomena. Such enhanced use of ground-based measurements is already taking place as part of the GEM (Geospace Environment Modeling) boundary-layer campaign and is planned to continue throughout the tail/substorm campaign. This report identifies expansion-phase phenomena observed locally within the nightside magnetosphere and from the ground, believed to be of fundamental importance for understanding large-scale substorm processes. The phenomena observed in situ are related to the phenomena observed from the ground. The primary goal is to identify outstanding questions that could be addressed during the GEM tail/substorm campaign using ground-based data from GEM observing periods in coordination with available satellite observations.

  5. Can Go address the multicore issues of today and the manycore problems of tomorrow?

    NASA Astrophysics Data System (ADS)

    Binet, Sébastien

    2012-06-01

    Current High Energy and Nuclear Physics (HENP) libraries and frameworks were written before multicore systems became widely deployed and used. From this environment, a 'single-thread' processing model naturally emerged but the implicit assumptions it encouraged are greatly impairing our abilities to scale in a multicore/manycore world. While parallel programming - still in an intensive phase of R&D despite the 30+ years of literature on the subject - is an obvious topic to consider, other issues (build scalability, code clarity, code deployment and ease of coding) are worth investigating when preparing for the manycore era. Moreover, if one wants to use another language than C++, a language better prepared and tailored for expressing concurrency, one also needs to ensure a good and easy reuse of already field-proven libraries. We present the work resulting from such investigations applied to the Go programming language. We first introduce the concurrent programming facilities Go is providing and how its module system addresses the build scalability and dependency hell issues. We then describe the process of leveraging the many (wo)man-years put into scientific Fortran/C/C++ libraries and making them available to the Go ecosystem. The ROOT data analysis framework, the C-BLAS library and the Herwig-6 MonteCarlo generator will be taken as examples. Finally, performances of the tools involved in a small analysis written in Go and using ROOT I/O library will be presented.

  6. Addressing students' difficulties with Faraday's law: A guided problem solving approach

    NASA Astrophysics Data System (ADS)

    Zuza, Kristina; Almudí, José-Manuel; Leniz, Ane; Guisasola, Jenaro

    2014-06-01

    In traditional teaching, the fundamental concepts of electromagnetic induction are usually quickly analyzed, spending most of the time solving problems in a more or less rote manner. However, physics education research has shown that the fundamental concepts of the electromagnetic induction theory are barely understood by students. This article proposes an interactive teaching sequence introducing the topic of electromagnetic induction. The sequence has been designed based on contributions from physics education research. Particular attention is paid to the relationship between experimental findings (macroscopic level) and theoretical interpretation (microscopic level). An example of the activities that have been designed will also be presented, describing the implementation context and the corresponding findings. Since implementing the sequence, a considerable number of students have a more satisfactory grasp of the electromagnetic induction explicative model. However, difficulties are manifested in aspects that require a multilevel explanation, referring to deep structures where the system description is better defined.

  7. Addressing the problem of glass thickness variation in the indirect slumping technology

    NASA Astrophysics Data System (ADS)

    Proserpio, Laura; Wellnhofer, Christoph; Breunig, Elias; Friedrich, Peter; Winter, Anita

    2015-09-01

    The indirect hot slumping technology is being developed at Max-Planck-Institute for extraterrestrial Physics (MPE) for the manufacturing of lightweight astronomical X-ray telescopes. It consists of a thermal shaping process to replicate the figure of a suitable mould into segments of X-ray mirror shells made by glass. Several segments are aligned and mounted into elemental modules, a number of which is then assembled together to form the telescope. To obtain mirror segments of high optical quality, the realization of the slumping thermal cycle itself is of fundamental importance, but also the starting materials, primarily the mould and the glass foils, play a major role. This paper will review the MPE approach in the slumping technology development and will then concentrate on the glass, with particular regards to the problem of thickness variation.

  8. Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context.

    PubMed

    Christofides, Anna; Schauer, Claudia; Zlotkin, Stanley H

    2005-12-01

    Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada's remote north. The major risk factors for IDA include prolonged consumption of evaporated cow's milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalence of IDA in Canadian children is between 3.5% and 10.5% in the general population, in two Northern Ontario First Nations communities and one Inuit community, the anemia rate was 36%, with 56% having depleted iron stores. Traditional methods of preventing IDA, including targeted fortification, dietary diversification and supplementation, have not solved the problem. The authors' research group at The Hospital for Sick Children in Toronto, Ontario, conceived of the strategy of 'home fortification' with 'Sprinkles' - single-dose sachets containing micronutrients in a powder form, which are easily sprinkled onto any foods prepared in the household. In Sprinkles, the iron (ferrous fumarate) is encapsulated within a thin lipid layer to prevent the iron from interacting with food. Sprinkles have been shown to be efficacious in the treatment of anemia in many developing countries. Their use in Aboriginal communities to treat and prevent anemia is described in the present paper. The authors believe that children in Aboriginal communities across Canada would potentially benefit if Sprinkles were incorporated into Health Canada's current distribution system, in combination with a social marketing strategy to encourage their use.

  9. What kind of curriculum can better address community needs? Problems arisen by hypothetical-deductive reasoning.

    PubMed

    Haeri, A; Hemmati, P; Yaman, H

    2007-06-01

    The aim of this study was to identify problems arisen by conventional curricula, the guidelines for development of an appropriate educational model for 21st century, and the advantages and disadvantages of the last two curricular models. The medical education literature published from 1995 through 2002 of four reputable journals in medical education were searched (Academic Medicine, Teaching and Learning in Medicine, Medical Education, and Medical Teacher). First the possibly best articles were identified. During the second screening process 76 of 180 articles were found to be highly relevant to our questions. A review of the chosen articles revealed a concept map which starts from currently applied hypothetical-deductive reasoning (HDR)-based curricula in many medical schools all around the world. Results revelaed that continuing cyclical process might be time consuming, enhance burden of faculty and might be stressful for students involved. Current issues in health care system are possibly attributable to current HDR-based curricular models including PBL. Advantages of reiterative PBL theory can not be denied, but it appears that its limited application should be mainly seen in some academic classes to develop some generic transferable skills simultaneously with other teaching methods. Therefore vast application of HDR in clinical settings is not recommended according to our study. However the relationships demonstrated between factors and outcomes mentioned in the concept map can be used to run some new studies to test some hypotheses.

  10. Reducing underage and young adult drinking: how to address critical drinking problems during this developmental period.

    PubMed

    Windle, Michael; Zucker, Robert A

    2010-01-01

    Forty years ago, when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded, alcoholism was considered an adult disease driven principally by physiological determinants. As NIAAA expanded its research portfolio, new data and insights were obtained that led to an increased focus on underage and young adult drinking. Fostered by interdisciplinary research, etiologic models were developed that recognized the multiplicity of relevant genetic and environmental influences. This shift in conceptualizing alcohol use disorders also was based on findings from large-scale, national studies indicating that late adolescence and early young adulthood were peak periods for the development of alcohol dependence and that early initiation of alcohol use (i.e., before age 15) was associated with a fourfold increase in the probability of subsequently developing alcohol dependence. In recent years, developmental studies and models of the initiation, escalation, and adverse consequences of underage and early young adult drinking have helped us to understand how alcohol use may influence, and be influenced by, developmental transitions or turning points. Major risk and protective factors are being identified and integrated into screening, prevention, and treatment programs to optimize interventions designed to reduce drinking problems among adolescents and young adults. In addition, regulatory policies, such as the minimum drinking age and zero-tolerance laws, are being implemented and evaluated for their impact on public health.

  11. Activity theory as a tool to address the problem of chemistry's lack of relevance in secondary school chemical education

    NASA Astrophysics Data System (ADS)

    van Aalsvoort, Joke

    In a previous article, the problem of chemistry's lack of relevance in secondary chemical education was analysed using logical positivism as a tool. This article starts with the hypothesis that the problem can be addressed by means of activity theory, one of the important theories within the sociocultural school. The reason for this expectation is that, while logical positivism creates a divide between science and society, activity theory offers a model of society in which science and society are related. With the use of this model, a new course for grade nine has been constructed. This results in a confirmation of the hypothesis, at least at a theoretical level. A comparison with the Salters' approach is made in order to demonstrate the relative merits of a mediated way of dealing with the problem of the lack of relevance of chemistry in chemical education.

  12. A roadmap for climate change adaptation in Sweden's forests: addressing wicked problems using adaptive management

    NASA Astrophysics Data System (ADS)

    Rist, L.; Felton, A.; Samuelsson, L.; Marald, E.; Karlsson, B.; Johansson, U.; Rosvall, O.

    2013-12-01

    Climate change is expected to have significant direct and indirect effects on forest ecosystems. Forests will have to adapt not only to changes in mean climate variables but also to increased climatic variability and altered disturbance regimes. Rates of change will likely exceed many forests capabilities to naturally adapt and many of today's trees will be exposed to the climates of 2090. In Sweden the effects are already being seen and more severe impacts are expected in the future. Exacerbating the challenge posed by climate change, a large proportion of Sweden's forests are, as a consequence of dominant production goals, greatly simplified and thus potentially more vulnerable to the uncertainties and risks associated with climate change. This simplification also confers reduced adaptive capacity to respond to potential impacts. Furthermore, many adaptation measures themselves carry uncertainties and risks. Future changes and effects are thus uncertain, yet forest managers, policymakers, scientists and other stakeholders must act. Strategies that build social and ecological resilience in the face of multiple interacting unknowns and surprises are needed. Adaptive management aims to collect and integrate knowledge about how a managed system is likely to respond to alternative management schemes and changing environmental conditions within a continuous decision process. There have been suggestions that adaptive management is not well suited to the large complex uncertainties associated with climate change and associated adaptation measures. However, more recently it has been suggested that adaptive management can handle such wicked problems, given adequate resources and a suitable breakdown of the targeted uncertainties. Here we test this hypothesis by evaluating how an adaptive management process could be used to manage the uncertainties and risks associated with securing resilient, biodiverse and productive forests in Sweden in the face of climate change. We

  13. Lattice Boltzmann Methods to Address Fundamental Boiling and Two-Phase Problems

    SciTech Connect

    Uddin, Rizwan

    2012-01-01

    This report presents the progress made during the fourth (no cost extension) year of this three-year grant aimed at the development of a consistent Lattice Boltzmann formulation for boiling and two-phase flows. During the first year, a consistent LBM formulation for the simulation of a two-phase water-steam system was developed. Results of initial model validation in a range of thermo-dynamic conditions typical for Boiling Water Reactors (BWRs) were shown. Progress was made on several fronts during the second year. Most important of these included the simulation of the coalescence of two bubbles including the surface tension effects. Work during the third year focused on the development of a new lattice Boltzmann model, called the artificial interface lattice Boltzmann model (AILB model) for the 3 simulation of two-phase dynamics. The model is based on the principle of free energy minimization and invokes the Gibbs-Duhem equation in the formulation of non-ideal forcing function. This was reported in detail in the last progress report. Part of the efforts during the last (no-cost extension) year were focused on developing a parallel capability for the 2D as well as for the 3D codes developed in this project. This will be reported in the final report. Here we report the work carried out on testing the AILB model for conditions including the thermal effects. A simplified thermal LB model, based on the thermal energy distribution approach, was developed. The simplifications are made after neglecting the viscous heat dissipation and the work done by pressure in the original thermal energy distribution model. Details of the model are presented here, followed by a discussion of the boundary conditions, and then results for some two-phase thermal problems.

  14. Data Movement Dominates: Advanced Memory Technology to Address the Real Exascale Power Problem

    SciTech Connect

    Bergman, Keren

    2014-08-28

    Energy is the fundamental barrier to Exascale supercomputing and is dominated by the cost of moving data from one point to another, not computation. Similarly, performance is dominated by data movement, not computation. The solution to this problem requires three critical technologies: 3D integration, optical chip-to-chip communication, and a new communication model. The central goal of the Sandia led "Data Movement Dominates" project aimed to develop memory systems and new architectures based on these technologies that have the potential to lower the cost of local memory accesses by orders of magnitude and provide substantially more bandwidth. Only through these transformational advances can future systems reach the goals of Exascale computing with a manageable power budgets. The Sandia led team included co-PIs from Columbia University, Lawrence Berkeley Lab, and the University of Maryland. The Columbia effort of Data Movement Dominates focused on developing a physically accurate simulation environment and experimental verification for optically-connected memory (OCM) systems that can enable continued performance scaling through high-bandwidth capacity, energy-efficient bit-rate transparency, and time-of-flight latency. With OCM, memory device parallelism and total capacity can scale to match future high-performance computing requirements without sacrificing data-movement efficiency. When we consider systems with integrated photonics, links to memory can be seamlessly integrated with the interconnection network-in a sense, memory becomes a primary aspect of the interconnection network. At the core of the Columbia effort, toward expanding our understanding of OCM enabled computing we have created an integrated modeling and simulation environment that uniquely integrates the physical behavior of the optical layer. The PhoenxSim suite of design and software tools developed under this effort has enabled the co-design of and performance evaluation photonics-enabled OCM

  15. The Difficult Dialogues Initiative at Clark University: A Case Study

    ERIC Educational Resources Information Center

    Buie, Sarah; Wright, Walter

    2010-01-01

    For the last five years, the Higgins School of Humanities has worked to develop a culture of dialogue at Clark University through its Difficult Dialogues Initiative. People know that genuine communication, creative collaboration, and effective problem solving are necessary to address the challenges they face as a nation and world; a renewed…

  16. The Brown Superfund Basic Research Program: A Multistakeholder Partnership Addresses Real-World Problems in Contaminated Communities

    PubMed Central

    Senier, Laura; Hudson, Benjamin; Fort, Sarah; Hoover, Elizabeth; Tillson, Rebecca; Brown, Phil

    2008-01-01

    The NIEHS funds several basic and applied research programs, many of which also require research translation or outreach. This paper reports on a project by the Brown University Superfund Basic Research Program (SBRP), in which outreach and research translation teams collaborated with state regulatory agency personnel and community activists on a legislative initiative to mitigate the financial impacts of living in a contaminated community. The Environmentally Compromised Home Ownership (ECHO) program makes home equity loans of up to $25,000 available to qualified applicants. This collaboration provides a case study in community engagement and demonstrates how research translation and outreach activities that are clearly differentiated yet well integrated can improve a suite of basic and applied research. Although engaging diverse constituencies can be difficult, community-engaged translation and outreach have the potential to make research findings more useful to communities, address some of the social impacts of contamination, and empower stakeholders to pursue their individual and collectively-held goals for remediation. The NIEHS has recently renewed its commitment to community-engaged research and advocacy, making this an optimal time to reflect on how basic research programs that engage stakeholders through research translation and outreach can add value to the overall research enterprise. PMID:18677987

  17. SUPPORT Tools for evidence-informed health Policymaking (STP) 5: Using research evidence to frame options to address a problem.

    PubMed

    Lavis, John N; Wilson, Michael G; Oxman, Andrew D; Grimshaw, Jeremy; Lewin, Simon; Fretheim, Atle

    2009-12-16

    This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers and those supporting them may find themselves in one or more of the following three situations that will require them to characterise the costs and consequences of options to address a problem. These are: 1. A decision has already been taken and their role is to maximise the benefits of an option, minimise its harms, optimise the impacts achieved for the money spent, and (if there is substantial uncertainty about the likely costs and consequences of the option) to design a monitoring and evaluation plan, 2. A policymaking process is already underway and their role is to assess the options presented to them, or 3. A policymaking process has not yet begun and their role is therefore to identify options, characterise the costs and consequences of these options, and look for windows of opportunity in which to act. In situations like these, research evidence, particularly about benefits, harms, and costs, can help to inform whether an option can be considered viable. In this article, we suggest six questions that can be used to guide those involved in identifying policy and programme options to address a high-priority problem, and to characterise the costs and consequences of these options. These are: 1. Has an appropriate set of options been identified to address a problem? 2. What benefits are important to those who will be affected and which benefits are likely to be achieved with each option? 3. What harms are important to those who will be affected and which harms are likely to arise with each option? 4. What are the local costs of each option and is there local evidence about their cost-effectiveness? 5. What adaptations might be made to any given option and could they alter its benefits, harms and costs? 6. Which stakeholder views and experiences might influence an option

  18. Addressing the sexual problems of Iranian women in a primary health care setting: A quasi-experimental study

    PubMed Central

    Rostamkhani, Fatemeh; Jafari, Fatemeh; Ozgoli, Giti; Shakeri, Masomeh

    2015-01-01

    Background: The World Health Organization emphasizes on integration of sexual health into primary health care services, educating people and health care workers about sexuality, and promoting optimal sexual health. Despite the high prevalence of sexual problems, these problems are poorly managed in primary health care services. This study was conducted to evaluate the efficacy and feasibility of the first two steps of PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Treatment) model for handling of women sexual problems in a primary health care setting. Materials and Methods: This was a quasi-experimental study that was carried out in Zanjan, northwest of Iran. Eighty women who had got married in the past 5 years and had sexual problem were randomly assigned to control and intervention groups. The intervention group received consultation based on PLISSIT model by a trained midwife and the control group received routine services. Female Sexual Function Index (FSFI) questionnaire was used for assessing and tracking any changes in sexual function. Data were collected at three points: Before consultation and 2 and 4 weeks after consultation. Paired t-test and repeated measures analysis of variance (ANOVA) test were used for comparison of scores within groups. Results: Significant improvement was found in FSFI sub-domain scores, including sexual desire (P < 0.0001), arousal (P < 0.0001), lubrication (P < 0.0001), orgasm (P = 0.005), satisfaction (P = 0.005), pain (P < 0.0001), and FSFI total score (P < 0.0001) in the intervention group compared to the control group. Conclusions: This study showed that PLISSIT model can meet the sexual health needs of clients in a primary health care setting and it can be used easily by health workers in this setting for addressing sexual complaints and dysfunctions. PMID:25709703

  19. Using ecotechnology to address water quality and wetland habitat loss problems in the Mississippi basin: a hierarchical approach.

    PubMed

    Day, John W; Yañéz Arancibia, Alejandro; Mitsch, William J; Lara-Dominguez, Ana Laura; Day, Jason N; Ko, Jae-Young; Lane, Robert; Lindsey, Joel; Lomeli, David Zarate

    2003-12-01

    Human activities are affecting the environment at continental and global scales. An example of this is the Mississippi basin where there has been a large scale loss of wetlands and water quality deterioration over the past century. Wetland and riparian ecosystems have been isolated from rivers and streams. Wetland loss is due both to drainage and reclamation, mainly for agriculture, and to isolation from the river by levees, as in the Mississippi delta. There has been a decline in water quality due to increasing use of fertilizers, enhanced drainage and the loss of wetlands for cleaning water. Water quality has deteriorated throughout the basin and high nitrogen in the Mississippi river is causing a large area of hypoxia in the Gulf of Mexico adjacent to the Mississippi delta. Since the causes of these problems are distributed over the basin, the solution also needs to be distributed over the basin. Ecotechnology and ecological engineering offer the only ecologically sound and cost-effective method of solving these problems. Wetlands to promote nitrogen removal, mainly through denitrification but also through burial and plant uptake, offer a sound ecotechnological solution. At the level of the Mississippi basin, changes in farming practices and use of wetlands for nitrogen assimilation can reduce nitrogen levels in the River. There are additional benefits of restoration of wetland and riverine ecosystems, flood control, reduction in public health threats, and enhanced wildlife and fisheries. At the local drainage basin level, the use of river diversions in the Mississippi delta can address both problems of coastal land loss and water quality deterioration. Nitrate levels in diverted river water are rapidly reduced as water flows through coastal watersheds. At the local level, wetlands are being used to treat municipal wastewater. This is a cost-effective method, which results in improved water quality, enhanced wetland productivity and increased accretion. The

  20. Difficult colon polypectomy

    PubMed Central

    Vormbrock, Klaus; Mönkemüller, Klaus

    2012-01-01

    Colorectal cancer (CRC) is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a “difficult polyp” as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many “difficult polyps” will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful, advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endoscopist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps. PMID:22816006

  1. Addressing the Antibiotic Resistance Problem with Probiotics: Reducing the Risk of Its Double-Edged Sword Effect

    PubMed Central

    Imperial, Ivan C. V. J.; Ibana, Joyce A.

    2016-01-01

    Antibiotic resistance is a global public health problem that requires our attention. Indiscriminate antibiotic use is a major contributor in the introduction of selective pressures in our natural environments that have significantly contributed in the rapid emergence of antibiotic-resistant microbial strains. The use of probiotics in lieu of antibiotic therapy to address certain health conditions in both animals and humans may alleviate these antibiotic-mediated selective pressures. Probiotic use is defined as the actual application of live beneficial microbes to obtain a desired outcome by preventing diseased state or improving general health. Multiple studies have confirmed the beneficial effects of probiotic use in the health of both livestock and humans. As such, probiotics consumption is gaining popularity worldwide. However, concerns have been raised in the use of some probiotics strains that carry antibiotic resistance genes themselves, as they have the potential to pass the antibiotic resistance genes to pathogenic bacteria through horizontal gene transfer. Therefore, with the current public health concern on antibiotic resistance globally, in this review, we underscore the need to screen probiotic strains that are used in both livestock and human applications to assure their safety and mitigate their potential in significantly contributing to the spread of antibiotic resistance genes in our natural environments. PMID:28018315

  2. How Schools Address Students' Mental Health and Drug and Alcohol Concerns and Problems: Lessons from Student Assistance Programs

    ERIC Educational Resources Information Center

    Fertman, Carl I.; Tarasevich, Susan L.

    2004-01-01

    Conversations with school superintendents, board members, principals, teachers, counselors, and nurses about their students' social and emotional health show how actively they are working to help students confront difficult issues. Topping the list of issues are drug and alcohol use and abuse, depression, and violence among students. Equally…

  3. A Radio Model: A Community Strategy To Address the Problems and Needs of Mexican American Women Farmworkers.

    ERIC Educational Resources Information Center

    Lopez-Trevino, Maria Elena

    Interviews with 60 Mexican-American female farmworkers in the Coachella Valley (California) identified their major problems, needs, and suggestions of topics to be presented in a community-based educational radio program. Two major problems identified by these women were low wages and occupational exposure to pesticides. Contrary to cultural…

  4. Indoor Air Quality: Federal and State Actions To Address the Indoor Air Quality Problems of Selected Buildings.

    ERIC Educational Resources Information Center

    Guerrero, Peter F.

    U.S. House of Representative members requested that the General Accounting Office determine what federal and state actions have been taken in addressing indoor air quality (IAQ) concerns raised in certain school, state, and federal buildings within Vermont, Maryland, and the District of Columbia. This report responds to this request and describes…

  5. Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.

    PubMed

    Velligan, Dawn I; Weiden, Peter J; Sajatovic, Martha; Scott, Jan; Carpenter, Daniel; Ross, Ruth; Docherty, John P

    2010-09-01

    Poor adherence to medication can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey (39 questions, 521 options) on adherence problems in schizophrenia and bipolar disorder was completed by 41 experts in 2008. This article first reviews the literature on interventions aimed at improving adherence. It then presents the experts' recommendations for targeting factors that can contribute to nonadherence and relates them to the literature. The following psychosocial/programmatic and pharmacologic interventions were rated first line for specific problems that can lead to nonadherence: ongoing symptom/ side-effect monitoring for persistent symptoms or side effects; services targeting logistic problems; medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) for lack of routines or cognitive deficits; and adjusting the dose or switching to a different oral antipsychotic for persistent side effects (also high second-line for persistent symptoms). Among pharmacologic interventions, the experts gave high second-line ratings to switching to a long-acting antipsychotic when lack of insight, substance use, persistent symptoms, logistic problems, lack of routines, or lack of family/ social support interfere with adherence and to simplifying the treatment regimen when logistic problems, lack of routines, cognitive deficits, or lack of family/social support interfere with adherence. Psychosocial/programmatic interventions that received high second-line ratings in a number of situations included medication monitoring/environmental supports, patient psychoeducation, more frequent and/or longer visits if possible, cognitive behavioral therapy (CBT), family-focused therapy

  6. The virtual network supporting the front lines: addressing emerging behavioral health problems following the tsunami of 2004.

    PubMed

    Reissman, Dori B; Schreiber, Merritt; Klomp, Richard W; Hoover, Michele; Kowalski-Trakofler, Kathleen; Perez, Jon

    2006-10-01

    The devastation wreaked by the 2004 tsunami in the Indian Ocean required extensive multinational and nongovernmental relief efforts to address the massive loss of infrastructure, people, and society. This article addresses approaches to behavioral incident management from a process perspective, through the lens of one official stateside channel of emergency operations. The process highlights the formation and connectivity of multidisciplinary teams that virtually supported the efforts of a seven-person, on-scene, behavioral health team aboard the USNS Mercy as part of Operation Unified Assistance in the Indian Ocean. Frontline health diplomacy and behavioral health relief efforts were greatly augmented by the virtual network of support from leading experts around the globe. Future disaster response and recovery efforts ought to build on the success of such virtual support networks, by planning for appropriate technology, expertise, and mutual aid partnerships.

  7. Dealing with the difficult patient.

    PubMed Central

    Smith, S.

    1995-01-01

    Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients. PMID:7494768

  8. Difficult Decisions: AIDS.

    ERIC Educational Resources Information Center

    Slesnick, Irwin L.

    1988-01-01

    Focuses on public education about the acquired immune deficiency syndrome (AIDS) epidemic. Discusses the problems of a second epidemic of fear and anxiety. Presents several questions for classroom discussion and analysis of the public fear of AIDS. Gives some statistics highlighting misinformation about AIDS. (CW)

  9. A Demonstration of the Universal Problem-Solving Approach to Address Children's Inappropriate Behavior in Head Start Classrooms

    ERIC Educational Resources Information Center

    Snell, Martha E.; Voorhees, Mary D.; Walker, Virginia L.; Berlin, Rebecca A.; Jamison, Kristen Roorbach; Stanton-Chapman, Tina L.

    2014-01-01

    The purpose of this demonstration was to evaluate a universal intervention during teacher-identified routines that were characterized by significant classwide problem behavior. Six Head Start classrooms (seven groups of children, with one classroom divided into two groups) received two workshops and two coaching sessions on universal Positive…

  10. Megacities in the coastal zone: Using a driver-pressure-state-impact-response framework to address complex environmental problems

    NASA Astrophysics Data System (ADS)

    Sekovski, Ivan; Newton, Alice; Dennison, William C.

    2012-01-01

    The purpose of this study was to elaborate on the role of coastal megacities in environmental degradation and their contribution to global climate change. Although only less than 4 percent of the total world's population resides in coastal megacities, their impact on environment is significant due to their rapid development, high population densities and high consumption rate of their residents. This study was carried out by implementing a Drivers-Pressures-States-Impacts-Responses (DPSIR) framework. This analytical framework was chosen because of its potential to link the existing data, gathered from various previous studies, in causal relationship. In this text, coastal megacities have been defined as cities exceeding 10 million inhabitants, situated in "near-coastal zone". Their high rates of the consumption of food, water, space and energy were observed and linked to the high performance rates of related economic activities (industry, transportation, power generation, agriculture and water extraction). In many of the studied coastal megacities, deteriorated quality of air and water was perceived, which can, in combination with global warming, lead to health problems and economic and social disturbance among residents. The extent of problems varied between developing and developed countries, showing higher rates of population growth and certain harmful emissions in megacities of developing countries, as well as more problems regarding food and water shortages, sanitation, and health care support. Although certain projections predict slowdown of growth in most coastal megacities, their future impact on environment is still unclear due to the uncertainties regarding future climate change and trajectories of consumption patterns.

  11. Getting to the root of the problem: health promotion strategies to address the social determinants of health.

    PubMed

    Gore, Dana M; Kothari, Anita R

    2013-01-08

    Although extensive research shows that the social determinants of health influence the distribution and course of chronic diseases, there is little programming in public health that addresses the social determinants as a disease prevention strategy. This paper discusses different types of health promotion initiatives and differentiates them based on whether they attempt to impact intermediate (environmental) determinants of health or structural determinants of health. We argue for the importance of programming targeted at the structural determinants as opposed to programming targeted solely at the immediate environment. Specifically, the former has more potential to create significant improvements in health, contribute to long-term social change and increase health equity. We urge public health leaders to take this distinction into consideration during public health program planning, and to build capacity in the public health workforce to tackle structural mechanisms that lead to poor health and health inequities.

  12. MANAGEMENT OF DIFFICULT URTICARIA

    PubMed Central

    Yadav, Sudha; Bajaj, A K

    2009-01-01

    Chronic urticaria, a major health problem causing patient's distress, induces often physicians' dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatment of underlying disorders, and non-pharmacological approach along with pharmacotherapy. First line drug therapy comprises non-sedative and sedative antihistamines, second line doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, etc. and third line cyclosporine, dapsone, colchicin, etc. PMID:20161863

  13. Information and meaning revisiting Shannon's theory of communication and extending it to address todays technical problems.

    SciTech Connect

    Bauer, Travis LaDell

    2009-12-01

    This paper has three goals. The first is to review Shannon's theory of information and the subsequent advances leading to today's statistics-based text analysis algorithms, showing that the semantics of the text is neglected. The second goal is to propose an extension of Shannon's original model that can take into account semantics, where the 'semantics' of a message is understood in terms of the intended or actual changes on the recipient of a message. The third goal is to propose several lines of research that naturally fall out of the proposed model. Each computational approach to solving some problem rests on an underlying model or set of models that describe how key phenomena in the real world are represented and how they are manipulated. These models are both liberating and constraining. They are liberating in that they suggest a path of development for new tools and algorithms. They are constraining in that they intentionally ignore other potential paths of development. Modern statistical-based text analysis algorithms have a specific intellectual history and set of underlying models rooted in Shannon's theory of communication. For Shannon, language is treated as a stochastic generator of symbol sequences. Shannon himself, subsequently Weaver, and at least one of his predecessors are all explicit in their decision to exclude semantics from their models. This rejection of semantics as 'irrelevant to the engineering problem' is elegant and combined with developments particularly by Salton and subsequently by Latent Semantic Analysis, has led to a whole collection of powerful algorithms and an industry for data mining technologies. However, the kinds of problems currently facing us go beyond what can be accounted for by this stochastic model. Today's problems increasingly focus on the semantics of specific pieces of information. And although progress is being made with the old models, it seems natural to develop or extend information theory to account for

  14. Looking beyond first-world problems: an emerging global workplace is encouraging more biomedical engineers to address the health issues of the developing world.

    PubMed

    Tucker, Lindsay

    2014-01-01

    Each year, the developed world is flooded with complex new medical technologies, from robotic prosthetics to remote-controlled aspirin implants. Meanwhile, only about 10% of health research funds are spent addressing the pressing problems of developing nations, although these countries make up 93% of the worldwide burden of disease. In short, while a small fraction of the world pops brand-name pharmaceuticals, the majority suffers from poor sanitation, contaminated drinking water, preventable disease, and child mortality.

  15. Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia's Copperbelt

    PubMed Central

    2011-01-01

    Background Maternal mortality in developing countries is high and international targets for reduction are unlikely to be met. Zambia's maternal mortality ratio was 591 per 100,000 live births according to survey data (2007) while routinely collected data captured only about 10% of these deaths. In one district in Zambia medical staff reviewed deaths occurring in the labour ward but no related recommendations were documented nor was there evidence of actions taken to avert further deaths. The Investigate Maternal Deaths and Act (IMDA) approach was designed to address these deficiencies and is comprised of four components; identification of maternal deaths; investigation of factors contributing to the deaths; recommendations for action drawn up by multiple stakeholders and monitoring of progress through existing systems. Methods A pilot was conducted in one district of Zambia. Maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. The information was summarized and presented at eleven data sharing meetings to key decision makers, during which recommendations for action were drawn up. An output indicator to monitor progress was included in the routine performance assessment tool. High impact interventions were identified using frequency analysis. Results A total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Sixty three recommendations were drawn up by key decision-makers of which two thirds were implemented by the end of the pilot period. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood. Conclusion In resource constrained settings the IMDA

  16. Difficult Decisions Made Easier

    NASA Technical Reports Server (NTRS)

    2006-01-01

    NASA missions are extremely complex and prone to sudden, catastrophic failure if equipment falters or if an unforeseen event occurs. For these reasons, NASA trains to expect the unexpected. It tests its equipment and systems in extreme conditions, and it develops risk-analysis tests to foresee any possible problems. The Space Agency recently worked with an industry partner to develop reliability analysis software capable of modeling complex, highly dynamic systems, taking into account variations in input parameters and the evolution of the system over the course of a mission. The goal of this research was multifold. It included performance and risk analyses of complex, multiphase missions, like the insertion of the Mars Reconnaissance Orbiter; reliability analyses of systems with redundant and/or repairable components; optimization analyses of system configurations with respect to cost and reliability; and sensitivity analyses to identify optimal areas for uncertainty reduction or performance enhancement.

  17. Is epidemiology correcting its vision problem? A perspective on our perspective: 2012 presidential address for American College of Epidemiology.

    PubMed

    McKeown, Robert E

    2013-10-01

    Epidemiology, like all disciplines, exists within and is shaped by a culture that frames its ways of understanding. In the last 60 years epidemiology as a discipline and scientific approach has undergone major transition, but remains challenged by vestiges of the limiting frameworks of our origins which shape the way we approach questions, and even the questions we choose to investigate. A part of the current transformation is a reframing of our perspective and a broadening of our methods to encourage creativity and to encompass new types of evidence and new approaches to investigation and interpretation. Epidemiologists are developing innovative ways to approach increasingly complex problems and becoming more open to multi-disciplinary approaches to solving epidemiologic challenges.

  18. The Algorithm Selection Problem

    NASA Technical Reports Server (NTRS)

    Minton, Steve; Allen, John; Deiss, Ron (Technical Monitor)

    1994-01-01

    Work on NP-hard problems has shown that many instances of these theoretically computationally difficult problems are quite easy. The field has also shown that choosing the right algorithm for the problem can have a profound effect on the time needed to find a solution. However, to date there has been little work showing how to select the right algorithm for solving any particular problem. The paper refers to this as the algorithm selection problem. It describes some of the aspects that make this problem difficult, as well as proposes a technique for addressing it.

  19. Private property rights and selective private forest conservation: could a Nordic hybrid policy address a United States problem?

    PubMed

    Mortimer, Michael J

    2008-05-01

    Political and legal conflicts between the need for targeted private forest conservation and the continued assurance of private property rights in the U.S. presents a seemingly intractable resource management problem. Scandinavian use of habitat protection areas on private forests offers an additional tool that may be suitable for solving the historical and on-going tension found within U.S. efforts to reconcile desires to maintain lands in a forested condition while also respecting private property rights. This article presents a comparative cross-sectional policy analysis of Sweden, Finland, and the U.S., supported with a supplemental case example from the Commonwealth of Virginia. Similarities in all three countries among forest ownership patterns, use of public subsidies, and changing attitudes towards conservation are generally encouraging. Additionally, Virginia's current consideration and development of state-wide forest policies focused on forestland and open space conservation suggests both a need and an opportunity to systematically assess the applicability of the Nordic forest reserve approach to local private forest conservation. Future research at a high-resolution, and specifically at the state level, should focus on the social and political factors that would ultimately determine the viability of a forest reserve program.

  20. Developmental Biology and Regenerative Medicine: Addressing the Vexing Problem of Persistent Muscle Atrophy in the Chronically Torn Human Rotator Cuff

    PubMed Central

    Meyer, Gretchen A.

    2016-01-01

    Persistent muscle atrophy in the chronically torn rotator cuff is a significant obstacle for treatment and recovery. Large atrophic changes are predictive of poor surgical and nonsurgical outcomes and frequently fail to resolve even following functional restoration of loading and rehabilitation. New insights into the processes of muscle atrophy and recovery gained through studies in developmental biology combined with the novel tools and strategies emerging in regenerative medicine provide new avenues to combat the vexing problem of muscle atrophy in the rotator cuff. Moving these treatment strategies forward likely will involve the combination of surgery, biologic/cellular agents, and physical interventions, as increasing experimental evidence points to the beneficial interaction between biologic therapies and physiologic stresses. Thus, the physical therapy profession is poised to play a significant role in defining the success of these combinatorial therapies. This perspective article will provide an overview of the developmental biology and regenerative medicine strategies currently under investigation to combat muscle atrophy and how they may integrate into the current and future practice of physical therapy. PMID:26847008

  1. U.S. view of human problems to be addressed for long duration space flights. [physiological and psychological effects

    NASA Technical Reports Server (NTRS)

    Berry, C. A.

    1973-01-01

    The Russian and American space programs have consisted of several thousands of hours of exposure of man to the space environment. In spite of numerous biological phenomena of adaptation observed, the space travellers have displayed, after their return, no enduring pathological effect. Although the usable data remain too limited to reflect fully the effects of space flight, it is possible to sketch the biological responses in the absence of gravity and to define the work bases for the future. Beyond its basic physiological effects, weightlessness has operational consequences in the daily life of the astronauts. These consequences will be still more evident during missions of long duration. The conclusions drawn in flight as well as on the ground are reviewed, and future requirements concerning prolonged flights are outlined. The gaps in actual knowledge are discussed and solutions are suggested. The problems of habitability are considered, particularly those which remain at present without satisfactory solutions: psychological responses to a confined life, cleaning, hygiene, and used material.

  2. Engaging Men in Difficult Dialogues about Privilege

    ERIC Educational Resources Information Center

    Loschiavo, Chris; Miller, David S.; Davies, Jon

    2007-01-01

    Male privilege is one aspect of social inequality that underlies much of the oppression and violence that occurs on college campuses. Mad Skills, a program addressing power and privilege with college men, is described along with general recommendations about how to engage men in difficult dialogues. The PIE Model is used to describe defensive…

  3. The molecular matching problem

    NASA Technical Reports Server (NTRS)

    Kincaid, Rex K.

    1993-01-01

    Molecular chemistry contains many difficult optimization problems that have begun to attract the attention of optimizers in the Operations Research community. Problems including protein folding, molecular conformation, molecular similarity, and molecular matching have been addressed. Minimum energy conformations for simple molecular structures such as water clusters, Lennard-Jones microclusters, and short polypeptides have dominated the literature to date. However, a variety of interesting problems exist and we focus here on a molecular structure matching (MSM) problem.

  4. A knowledge-based agent prototype for Chinese address geocoding

    NASA Astrophysics Data System (ADS)

    Wei, Ran; Zhang, Xuehu; Ding, Linfang; Ma, Haoming; Li, Qi

    2009-10-01

    Chinese address geocoding is a difficult problem to deal with due to intrinsic complexities in Chinese address systems and a lack of standards in address assignments and usages. In order to improve existing address geocoding algorithm, a spatial knowledge-based agent prototype aimed at validating address geocoding results is built to determine the spatial accuracies as well as matching confidence. A portion of human's knowledge of judging the spatial closeness of two addresses is represented via first order logic and the corresponding algorithms are implemented with the Prolog language. Preliminary tests conducted using addresses matching result in Beijing area showed that the prototype can successfully assess the spatial closeness between the matching address and the query address with 97% accuracy.

  5. Presidential address.

    PubMed

    Vohra, U

    1993-07-01

    The Secretary of India's Ministry of Health and Family Welfare serves as Chair of the Executive Council of the International Institute for Population Sciences in Bombay. She addressed its 35th convocation in 1993. Global population stands at 5.43 billion and increases by about 90 million people each year. 84 million of these new people are born in developing countries. India contributes 17 million new people annually. The annual population growth rate in India is about 2%. Its population size will probably surpass 1 billion by the 2000. High population growth rates are a leading obstacle to socioeconomic development in developing countries. Governments of many developing countries recognize this problem and have expanded their family planning programs to stabilize population growth. Asian countries that have done so and have completed the fertility transition include China, Japan, Singapore, South Korea, and Thailand. Burma, Malaysia, North Korea, Sri Lanka, and Vietnam have not yet completed the transition. Afghanistan, Bangladesh, Iran, Nepal, and Pakistan are half-way through the transition. High population growth rates put pressure on land by fragmenting finite land resources, increasing the number of landless laborers and unemployment, and by causing considerable rural-urban migration. All these factors bring about social stress and burden civic services. India has reduced its total fertility rate from 5.2 to 3.9 between 1971 and 1991. Some Indian states have already achieved replacement fertility. Considerable disparity in socioeconomic development exists among states and districts. For example, the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh have female literacy rates lower than 27%, while that for Kerala is 87%. Overall, infant mortality has fallen from 110 to 80 between 1981 and 1990. In Uttar Pradesh, it has fallen from 150 to 98, while it is at 17 in Kerala. India needs innovative approaches to increase contraceptive prevalence rates

  6. A Bayesian Maximum Entropy approach to address the change of support problem in the spatial analysis of childhood asthma prevalence across North Carolina

    PubMed Central

    LEE, SEUNG-JAE; YEATTS, KARIN; SERRE, MARC L.

    2009-01-01

    The spatial analysis of data observed at different spatial observation scales leads to the change of support problem (COSP). A solution to the COSP widely used in linear spatial statistics consists in explicitly modeling the spatial autocorrelation of the variable observed at different spatial scales. We present a novel approach that takes advantage of the non-linear Bayesian Maximum Entropy (BME) extension of linear spatial statistics to address the COSP directly without relying on the classical linear approach. Our procedure consists in modeling data observed over large areas as soft data for the process at the local scale. We demonstrate the application of our approach to obtain spatially detailed maps of childhood asthma prevalence across North Carolina (NC). Because of the high prevalence of childhood asthma in NC, the small number problem is not an issue, so we can focus our attention solely to the COSP of integrating prevalence data observed at the county-level together with data observed at a targeted local scale equivalent to the scale of school-districts. Our spatially detailed maps can be used for different applications ranging from exploratory and hypothesis generating analyses to targeting intervention and exposure mitigation efforts. PMID:20300553

  7. Contextual analysis of machine-printed addresses

    NASA Astrophysics Data System (ADS)

    Cullen, Peter B.; Ho, Tin K.; Hull, Jonathan J.; Prussak, Michal; Srihari, Sargur N.

    1992-08-01

    The assignment of a nine digit ZIP Code (ZIP + 4 Code) to the digital image of a machine printed address block is a problem of central importance in automated mail sorting. This problem is especially difficult since most addresses do not contain ZIP + 4 Codes and often the information that must be read to match an address to one of the 28 million entries in the ZIP + 4 file is either erroneous, incomplete, or missing altogether. This paper discusses a system for interpreting a machine printed address and assigning a ZIP + 4 Code that uses a constraint satisfaction approach. Words in an address block are first segmented and parsed to assign probable semantic categories. Word images are then recognized by a combination of digit, character, and word recognition algorithms. The control structure uses a constraint satisfaction problem solving approach to match the recognition results to an entry in the ZIP + 4 file. It is shown how this technique can both determine correct responses as well as compensate for incomplete or erroneous information. Experimental results demonstrate the success of this system. In a recent test on over 1000 machine printed address blocks, the ZIP + 4 encode rate was over 73 percent. This compares to the success rate of current postal OCRs which is about 45 percent. Additionally, the word recognition algorithm recognizes over 92 percent of the input images (over 98 percent in the top 10 choices.

  8. Effective communication during difficult conversations.

    PubMed

    Polito, Jacquelyn M

    2013-06-01

    A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior

  9. 'SIMPLES': a structured primary care approach to adults with difficult asthma.

    PubMed

    Ryan, Dermot; Murphy, Anna; Ställberg, Björn; Baxter, Noel; Heaney, Liam G

    2013-09-01

    The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having 'difficult asthma'. Some will have difficult, 'therapy resistant' asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a 'difficult asthma' clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.

  10. The National Historic Preservation Act is Not Your Problem, But How You are Addressing it for Your CERCLA Project May Be - 12344

    SciTech Connect

    Cusick, Lesley T.

    2012-07-01

    The 1995 Environmental Protection Agency (EPA) and U.S. Department of Energy (DOE) joint 'Policy on Decommissioning of Department of Energy Facilities Under CERCLA was developed so that decommissioning could occur in a manner that ensures protection of worker and public health and the environment, that is consistent with Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), that provides for stakeholder involvement, and that achieves risk reduction without unnecessary delay'. The source of the 'unnecessary delays' the joint policy intended to avert could be attributed to numerous factors such as obtaining permits, conducting administrative activities, or implementing regulatory processes that could yield, among other things, differing preferred alternatives. Why, you might ask, more than fifteen years later, does DOE continue to struggle through CERCLA projects with unnecessary delays? From problem identification, to determination of nature and extent, to alternative analysis and ultimately remedy selection and implementation, reaching a compliant and effective clean-up end-point can be a process that seems to mimic geologic timescales. The source of these delays is often the failure to use all of the tools the CERCLA process offers. As one example, renewed commitment to follow the CERCLA process to address the regulatory reviews pursuant to the National Historic Preservation Act (NHPA) is called for. Project managers implementing CERCLA actions in any agency, not only DOE, do not need to be apprehensive about using the CERCLA process for NHPA review but should welcome it. It is critical that methods are used that address substantive NHPA requirements clearly and consistently, and that they are shared and communicated as frequently as needed to interested and questioning stakeholders. (author)

  11. Addressing healthcare.

    PubMed

    Daly, Rich

    2013-02-11

    Though President Barack Obama has rarely made healthcare references in his State of the Union addresses, health policy experts are hoping he changes that strategy this year. "The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with," says Dr. James Weinstein, left, of the Dartmouth-Hitchcock health system.

  12. Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings

    PubMed Central

    2011-01-01

    Background Most adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework. Method Analysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings. Results Data are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for personal, peer and family

  13. HRD in Difficult Times. Symposium.

    ERIC Educational Resources Information Center

    2002

    This document contains three papers on challenges facing human resource development today. "In Difficult Times: Influences of Attitudes and Expectations Towards Training and Redeployment Opportunities in a Hospital Retraction Programme" (Sandra Watson, Jeff Hyman) presents reasons behind the low uptake of training and redeployment…

  14. The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

    PubMed Central

    Unwin, Nigel; Samuels, T. Alafia; Hassell, Trevor; Brownson, Ross C.; Guell, Cornelia

    2017-01-01

    Background: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods: A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of

  15. Difficult Children and Difficult Parents: Constructions by Child Care Providers

    ERIC Educational Resources Information Center

    Owens, Erica; Ring, Gail

    2007-01-01

    As more mothers of young children work, concerns about child care have gained prominence. Analyses of this topic typically address availability, safety, and costs of care, or the impact of care on children's "outcomes." When providers' input is included, it is generally used as an assessment tool to reinforce the researcher's conceptual framework.…

  16. Non-adherence in difficult asthma and advances in detection.

    PubMed

    Lindsay, John T; Heaney, Liam G

    2013-12-01

    Non-adherence to anti-inflammatory therapies is common in patients referred for specialist assessment at difficult-to-treat asthma services. In the difficult asthma setting, non-adherence to treatment is associated with poor baseline asthma control, increased frequency of exacerbations and asthma-related hospitalizations, as well as increased risk of death. Here, we present a review of the current literature surrounding the prevalence and risks of non-adherence in difficult asthma and we report on current methods of measuring treatment adherence and advances in the detection of non-adherence. We will also explore methods by which non-adherence in difficult asthma can be addressed.

  17. Problems arising in the diagnosis of primary ovarian transitional cell carcinoma after the occurrence of a transitional cell carcinoma of the bladder: a report of a difficult case and a critical review of literature.

    PubMed

    Raspollini, Maria Rosaria; Paglierani, Milena; Taddei, Gian Luigi

    2009-03-01

    Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer that morphologically resembles a TCC of the bladder. The most frequent metastases to ovaries come from the gastrointestinal tract and from breast carcinoma, but metastatic TCCs from the urinary tract to the ovary have been reported. TCC of the bladder is the sixth most common cancer in European and North American countries and its incidence has been increasing. We recently observed a woman, who previously had undergone endoscopic resection of a TCC of the bladder. She was affected by an ovarian bilateral tumor with features of malignant transitional cell tumor, characterized by papillae with multilayered transitional epithelium infiltrating the ovarian stroma. In this study, we showed the utility of WT1 and a panel of immunohistochemical markers in the difficult differential diagnosis between bladder and ovarian TCC.

  18. Inaugural address

    NASA Astrophysics Data System (ADS)

    Joshi, P. S.

    2014-03-01

    From jets to cosmos to cosmic censorship P S Joshi Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400005, India E-mail: psj@tifr.res.in 1. Introduction At the outset, I should like to acknowledge that part of the title above, which tries to capture the main flavour of this meeting, and has been borrowed from one of the plenary talks at the conference. When we set out to make the programme for the conference, we thought of beginning with observations on the Universe, but then we certainly wanted to go further and address deeper questions, which were at the very foundations of our inquiry, and understanding on the nature and structure of the Universe. I believe, we succeeded to a good extent, and it is all here for you in the form of these Conference Proceedings, which have been aptly titled as 'Vishwa Mimansa', which could be possibly translated as 'Analysis of the Universe'! It is my great pleasure and privilege to welcome you all to the ICGC-2011 meeting at Goa. The International Conference on Gravitation and Cosmology (ICGC) series of meetings are being organized by the Indian Association for General Relativity and Gravitation (IAGRG), and the first such meeting was planned and conducted in Goa in 1987, with subsequent meetings taking place at a duration of about four years at various locations in India. So, it was thought appropriate to return to Goa to celebrate the 25 years of the ICGC meetings. The recollections from that first meeting have been recorded elsewhere here in these Proceedings. The research and teaching on gravitation and cosmology was initiated quite early in India, by V V Narlikar at the Banares Hindu University, and by N R Sen in Kolkata in the 1930s. In course of time, this activity grew and gained momentum, and in early 1969, at the felicitation held for the 60 years of V V Narlikar at a conference in Ahmedabad, P C Vaidya proposed the formation of the IAGRG society, with V V Narlikar being the first President. This

  19. Parental Knowledge of Behavioral Principles Following Training to Address Sleep Problems in Children with Autism Spectrum Disorders: A Follow-up Study

    ERIC Educational Resources Information Center

    Turner, Kylan

    2012-01-01

    Sleep problems are a common occurrence among children with autism spectrum disorders (ASD). In addition to the challenges that sleep problems present for children's neurodevelopment, learning, and daytime behaviors, sleep problems in children present significant challenges for the entire family. Research studies on behavioral interventions to…

  20. [Difficult to control severe asthma].

    PubMed

    Magnan, Antoine; Pipet, Anaïs

    2011-03-01

    Difficult to control severe asthma is characterized by the persistence of inacceptable symptoms of asthma despite a continuous treatment with at least high doses of inhaled steroids and long acting bronchodilators. The diagnosis is done after a period of observation and some investigations that will allow confirm the diagnosis of asthma, eliminate alternative diagnosis and etiological forms that would be difficult to treat intrinsically (allergic broncho-pulmonary aspergillosis, Churg and Strauss disease, chronic eosinophilic pneumonia, occupational asthma). At the end of this period devoted to diagnosis a systematic approach is set up to take care of these patients. Therapeutic education includes action plans and measures for triggering factors avoidance in order to prevent exacerbations. Comorbidities such as rhinitis, nasal polyposis, gastro-oesophageal reflux and obesity are taken into account. Lastly, the treatment must be adapted according to the patient's preferences and aims, and to the asthma severity. Ultimately in steroid-dependent asthma, the lowest efficient dose is tracked continuously. For these patients, new molecules are needed.

  1. Management of difficult infantile haemangiomas.

    PubMed

    Maguiness, Sheilagh M; Frieden, Ilona J

    2012-03-01

    Infantile haemangiomas are common vascular tumours of infancy. They typically present shortly after birth, undergo a period of rapid proliferation, and then slowly involute over many years. Although most patients require no intervention, appropriate investigation and treatment may be necessary in a minority of cases. Identifying which patients require further investigation or intervention can be difficult due to the heterogeneity of clinical presentation. This is compounded by a lack of rigorous randomised controlled trials on haemangioma management. Therefore, the rationale for treatment is not always straightforward. Haemangiomas occur anywhere on the body, have superficial, deep or mixed morphology, and depending on anatomic location, size and subtype, can be associated with underlying structural anomalies and many other potential complications. Generally, the management of difficult haemangiomas is best approached on a case-by-case basis. Over the last few years, there have been several advances in our understanding of haemangiomas, together with some exciting new therapeutic options. In the following review, the authors discuss the various possible complications of infantile haemangiomas, the rationale for treatment and appropriate possible interventions.

  2. Convocation address.

    PubMed

    Kakodkar, A

    1999-07-01

    This convocation addressed by Dr. Anil Kakodkar focuses on the challenges faced by graduating students. In his speech, he emphasized the high level of excellence achieved by the industrial sector; however, he noted that there has been a loss of initiative in maximizing value addition, which was worsened by an increasing population pressure. In facing a stiff competition in the external and domestic markets, it is imperative to maximize value addition within the country in a competitive manner and capture the highest possible market share. To achieve this, high-quality human resources are central. Likewise, family planning programs should become more effective and direct available resources toward national advantage. To boost the domestic market, he suggests the need to search for strengths to achieve leadership position in those areas. First, an insight into the relationship between the lifestyles and the needs of our people and the natural resource endowment must be gained. Second, remodeling of the education system must be undertaken to prepare the people for adding the necessary innovative content in our value addition activities. Lastly, Dr. Kakodkar emphasizes the significance of developing a strong bond between parents and children to provide a sound foundation and allow the education system to grow upon it.

  3. Opening Address

    NASA Astrophysics Data System (ADS)

    Yamada, T.

    2014-12-01

    Ladies and Gentlemen, it is my great honor and pleasure to present an opening address of the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3). On the behalf of the organizing committee, I certainly welcome all your visits to KGU Kannai Media Center belonging to Kanto Gakuin University, and stay in Yokohama. In particular, to whom come from abroad more than 17 countries, I would appreciate your participations after long long trips from your homeland to Yokohama. The first international workshop on "State of the Art in Nuclear Cluster Physics", called SOTANCP, was held in Strasbourg, France, in 2008, and the second one was held in Brussels, Belgium, in 2010. Then the third workshop is now held in Yokohama. In this period, we had the traditional 10th cluster conference in Debrecen, Hungary, in 2012. Thus we have the traditional cluster conference and SOTANCP, one after another, every two years. This obviously shows our field of nuclear cluster physics is very active and flourishing. It is for the first time in about 10 years to hold the international workshop on nuclear cluster physics in Japan, because the last cluster conference held in Japan was in Nara in 2003, about 10 years ago. The president in Nara conference was Prof. K. Ikeda, and the chairpersons were Prof. H. Horiuchi and Prof. I. Tanihata. I think, quite a lot of persons in this room had participated at the Nara conference. Since then, about ten years passed. So, this workshop has profound significance for our Japanese colleagues. The subjects of this workshop are to discuss "the state of the art in nuclear cluster physics" and also discuss the prospect of this field. In a couple of years, we saw significant progresses of this field both in theory and in experiment, which have brought better and new understandings on the clustering aspects in stable and unstable nuclei. I think, the concept of clustering has been more important than ever. This is true also in the

  4. Welcome Address

    NASA Astrophysics Data System (ADS)

    Kiku, H.

    2014-12-01

    Ladies and Gentlemen, It is an honor for me to present my welcome address in the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3), as the president of Kanto Gakuin University. Particularly to those from abroad more than 17 countries, I am very grateful for your participation after long long trips from your home to Yokohama. On the behalf of the Kanto Gakuin University, we certainly welcome your visit to our university and stay in Yokohama. First I would like to introduce Kanto Gakuin University briefly. Kanto Gakuin University, which is called KGU, traces its roots back to the Yokohama Baptist Seminary founded in 1884 in Yamate, Yokohama. The seminary's founder was Albert Arnold Bennett, alumnus of Brown University, who came to Japan from the United States to establish a theological seminary for cultivating and training Japanese missionaries. Now KGU is a major member of the Kanto Gakuin School Corporation, which is composed of two kindergartens, two primary schools, two junior high schools, two senior high schools as well as KGU. In this university, we have eight faculties with graduate school including Humanities, Economics, Law, Sciences and Engineering, Architecture and Environmental Design, Human and Environmental Studies, Nursing, and Law School. Over eleven thousands students are currently learning in our university. By the way, my major is the geotechnical engineering, and I belong to the faculty of Sciences and Engineering in my university. Prof. T. Yamada, here, is my colleague in the same faculty. I know that the nuclear physics is one of the most active academic fields in the world. In fact, about half of the participants, namely, more than 50 scientists, come from abroad in this conference. Moreover, I know that the nuclear physics is related to not only the other fundamental physics such as the elementary particle physics and astrophysics but also chemistry, medical sciences, medical cares, and radiation metrology

  5. Creative Strategies in Difficult Times

    ERIC Educational Resources Information Center

    Lucas, Susann

    2003-01-01

    It is a frequent, if not ongoing, problem: deep funding cuts despite increased enrollments, and accompanying need for more instructors and updated technology. According to Joe Barwick, Roy Flores, Bernadine Chuck Fong, Al Lorenzo, Judith Redwine, and Jerry Sue Thornton, community colleges should start at the top when they deal with institutional…

  6. Addressing Sexual Harassment

    ERIC Educational Resources Information Center

    Young, Ellie L.; Ashbaker, Betty Y.

    2008-01-01

    This article discusses ways on how to address the problem of sexual harassment in schools. Sexual harassment--simply defined as any unwanted and unwelcome sexual behavior--is a sensitive topic. Merely providing students, parents, and staff members with information about the school's sexual harassment policy is insufficient; schools must take…

  7. President's Address

    PubMed Central

    Craig, Maurice

    1928-01-01

    Conditions which experience has proved conducive to mental disturbance considered.—Suggestions as to their treatment.—A weakened inhibition, rather than any positive condition, is probably the most important factor in the production of the exhaustion psycho-neuroses or psychoses. This view is supported by the prophylactic value of giving for prolonged periods small doses of bromide to hypersensitive children or to highly-strung persons exposed to stress or tropical climate, etc.—Pavlov's work on the conditioned reflexes in dogs quoted in support of the author's clinical experience: Pavlov states that bromides should not be regarded as sedatives, diminishing the excitability of the central nervous system, but as simply regulating the nervous system by strengthening the intensity of internal inhibition. This agrees with the author's clinical experience, as small doses of bromide taken regularly over a period of many years do not diminish the mental powers but in fact increase them. Question of sleeplessness considered with regard to the way in which sedatives act. Most of these do not act as so-called “sleeping draughts”; research may ultimately show that their action is to strengthen a weakened inhibition and that sleep is only a secondary benefit.—Value of sedatives before and after surgical operation. Importance of toxæmia in the production of mental disorder; insomnia often precedes a toxic process and permits it to become active. The theory of weakened inhibition explains many problems; e.g., why certain brilliant children or adults break down and why at first there is no interference with their normal mental activity which only becomes involved as sleep and other bodily functions become affected; why a toxæmia may affect the nervous system of certain people; why a breakdown may follow over-stimulation or occur with advancing years; why some persons relapse when certain treatment is discontinued; why treatment should at times be continuous, and why

  8. School-Wide Positive Behavior Support: Can It Help Address the Problem of Disproportionate Minority Representation in the Emotional Disturbance Disability Category?

    ERIC Educational Resources Information Center

    Porter, Jodi Abraham

    2012-01-01

    This research project investigated the possibility of School-Wide Positive Behavior Support (SWPBS) as a way to address racial/ethnic disproportionality in the Emotional Disturbance (ED) category. The sample consisted of 114 elementary schools from a suburban school district in the Mid-Atlantic region. There were 57 SWPBS schools and 57 non-SWPBS…

  9. Physiology of difficult rock climbing.

    PubMed

    Watts, Phillip B

    2004-04-01

    The purpose of this review is to explore existing research on the physiological aspects of difficult rock climbing. Findings will be categorized into the areas of an athlete profile and an activity model. An objective here is to describe high-level climbing performance; thus the focus will primarily be on studies that involve performances at the 5.11/6c (YDS/French) level of difficulty or higher. Studies have found climbers to be small in stature with low body mass and low body fat. Although absolute strength values are not unusual, strength to body mass ratio is high in accomplished climbers. There is evidence that muscular endurance and high upper body power are important. Climbers do not typically possess extremely high aerobic power, typically averaging between 52-55 ml.kg(-1).min(-1) for maximum oxygen uptake. Performance time for a typical ascent ranges from 2 to 7 min and oxygen uptake (VO2) averages around 20-25 ml.kg(-1).min(-1) over this period. Peaks of over 30 ml.kg(-1).min(-1) for VO2 have been reported. VO2 tends to plateau during sustained climbing yet remains elevated into the post-climb recovery period. Blood lactate accumulates during ascent and remains elevated for over 20 min post-climbing. Handgrip endurance decreases to a greater degree than handgrip strength with severe climbing. On the basis of this review, it appears that a specific training program for high-level climbing would include components for developing high, though not elite-level, aerobic power; specific muscular strength and endurance; ATP-PC and anaerobic glycolysis system power and capacity; and some minimum range of motion for leg and arm movements.

  10. Listen-Identify-Brainstorm-Reality-Test-Encourage (LIBRE) Problem-Solving Model: Addressing Special Education Teacher Attrition through a Cognitive-Behavioral Approach to Teacher Induction

    ERIC Educational Resources Information Center

    Guerra, Norma S.; Hernandez, Art; Hector, Alison M.; Crosby, Shane

    2015-01-01

    Special education teacher attrition rates continue to challenge the profession. A cognitive-behavioral problem-solving approach was used to examine three alternative certification program special education teachers' professional development through a series of 41 interviews conducted over a 2-year period. Beginning when they were novice special…

  11. The Role of an Educational Learning Theory: Explaining Difficult Learning.

    ERIC Educational Resources Information Center

    Bereiter, Carl

    The possibility of developing a learning theory that is designed to insure its relevance to educational problems is discussed. It is suggested that the constitutive problem for an educational psychology of learning is how one learns things that are difficult to learn. Behaviorist learning theories fail almost entirely to explain why anything is…

  12. Validated Questionnaires heighten detection of Difficult Asthma Comorbidities.

    PubMed

    Radhakrishna, Naghmeh; Tay, Tunn Ren; Hore-Lacy, Fiona; Stirling, Robert; Hoy, R; Dabscheck, Eli; Hew, Mark

    2016-10-07

    Objective Multiple extra-pulmonary comorbidities contribute to difficult asthma, but their diagnosis can be challenging and time consuming. Previous data on comorbidity detection have focused on clinical assessment, which may miss certain conditions. We aimed to locate relevant validated screening questionnaires to identify extra-pulmonary comorbidities that contribute to difficult asthma, and evaluate their performance during a difficult asthma evaluation. Methods MEDLINE was searched to identify key extra-pulmonary comorbidities that contribute to difficult asthma. Screening questionnaires were chosen based on ease of use, presence of a cut off score, and adequate validation to help systematically identify comorbidities. In a consecutive series of 86 patients referred for systematic evaluation of difficult asthma, questionnaires were administered prior to clinical consultation. Results Six difficult asthma comorbidities and corresponding screening questionnaires were found: sinonasal disease (allergic rhinitis and chronic rhinosinusitis), vocal cord dysfunction, dysfunctional breathing, obstructive sleep apnea, anxiety and depression, and gastro-oesophageal reflux disease. When the questionnaires were added to the referring clinician's impression, the detection of all six comorbidities was significantly enhanced. The average time for questionnaire administration was approximately 40 minutes. Conclusions The use of validated screening questionnaires heightens detection of comorbidities in difficult asthma. The availability of data from a battery of questionnaires prior to consultation can save time and allow clinicians to systematically assess difficult asthma patients and to focus on areas of particular concern. Such an approach would ensure that all contributing comorbidities have been addressed before significant treatment escalation is considered.

  13. Clostridium difficile phages: still difficult?

    PubMed Central

    Hargreaves, Katherine R.; Clokie, Martha R. J.

    2014-01-01

    Phages that infect Clostridium difficile were first isolated for typing purposes in the 1980s, but their use was short lived. However, the rise of C. difficile epidemics over the last decade has triggered a resurgence of interest in using phages to combat this pathogen. Phage therapy is an attractive treatment option for C. difficile infection, however, developing suitable phages is challenging. In this review we summarize the difficulties faced by researchers in this field, and we discuss the solutions and strategies used for the development of C. difficile phages for use as novel therapeutics. Epidemiological data has highlighted the diversity and distribution of C. difficile, and shown that novel strains continue to emerge in clinical settings. In parallel with epidemiological studies, advances in molecular biology have bolstered our understanding of C. difficile biology, and our knowledge of phage–host interactions in other bacterial species. These three fields of biology have therefore paved the way for future work on C. difficile phages to progress and develop. Benefits of using C. difficile phages as therapeutic agents include the fact that they have highly specific interactions with their bacterial hosts. Studies also show that they can reduce bacterial numbers in both in vitro and in vivo systems. Genetic analysis has revealed the genomic diversity among these phages and provided an insight into their taxonomy and evolution. No strictly virulent C. difficile phages have been reported and this contributes to the difficulties with their therapeutic exploitation. Although treatment approaches using the phage-encoded endolysin protein have been explored, the benefits of using “whole-phages” are such that they remain a major research focus. Whilst we don’t envisage working with C. difficile phages will be problem-free, sufficient study should inform future strategies to facilitate their development to combat this problematic pathogen. PMID:24808893

  14. Dynamic Problem Solving: A New Assessment Perspective

    ERIC Educational Resources Information Center

    Greiff, Samuel; Wustenberg, Sascha; Funke, Joachim

    2012-01-01

    This article addresses two unsolved measurement issues in dynamic problem solving (DPS) research: (a) unsystematic construction of DPS tests making a comparison of results obtained in different studies difficult and (b) use of time-intensive single tasks leading to severe reliability problems. To solve these issues, the MicroDYN approach is…

  15. [Therapeutic abortion: a difficult choice].

    PubMed

    Gratton-Jacob, F

    1981-01-01

    showed that nurses were among the last people they would consider consulting about personal difficulties. Although fewer than 10% of women have serious psychiatric problems following an abortion, it is a stressful event for all who undergo it, and nurses can offer several types of assistance, including offering support and helping the patient to explore her feelings and reactions and to make firm decisions. Nurses should provide patients with all needed information on the procedure and subsequent contraception, and they should make themselves available after the procedure.

  16. Fusion proteins as alternate crystallization paths to difficult structure problems

    NASA Technical Reports Server (NTRS)

    Carter, Daniel C.; Rueker, Florian; Ho, Joseph X.; Lim, Kap; Keeling, Kim; Gilliland, Gary; Ji, Xinhua

    1994-01-01

    The three-dimensional structure of a peptide fusion product with glutathione transferase from Schistosoma japonicum (SjGST) has been solved by crystallographic methods to 2.5 A resolution. Peptides or proteins can be fused to SjGST and expressed in a plasmid for rapid synthesis in Escherichia coli. Fusion proteins created by this commercial method can be purified rapidly by chromatography on immobilized glutathione. The potential utility of using SjGST fusion proteins as alternate paths to the crystallization and structure determination of proteins is demonstrated.

  17. Addressing the identification problem in age-period-cohort analysis: a tutorial on the use of partial least squares and principal components analysis.

    PubMed

    Tu, Yu-Kang; Krämer, Nicole; Lee, Wen-Chung

    2012-07-01

    In the analysis of trends in health outcomes, an ongoing issue is how to separate and estimate the effects of age, period, and cohort. As these 3 variables are perfectly collinear by definition, regression coefficients in a general linear model are not unique. In this tutorial, we review why identification is a problem, and how this problem may be tackled using partial least squares and principal components regression analyses. Both methods produce regression coefficients that fulfill the same collinearity constraint as the variables age, period, and cohort. We show that, because the constraint imposed by partial least squares and principal components regression is inherent in the mathematical relation among the 3 variables, this leads to more interpretable results. We use one dataset from a Taiwanese health-screening program to illustrate how to use partial least squares regression to analyze the trends in body heights with 3 continuous variables for age, period, and cohort. We then use another dataset of hepatocellular carcinoma mortality rates for Taiwanese men to illustrate how to use partial least squares regression to analyze tables with aggregated data. We use the second dataset to show the relation between the intrinsic estimator, a recently proposed method for the age-period-cohort analysis, and partial least squares regression. We also show that the inclusion of all indicator variables provides a more consistent approach. R code for our analyses is provided in the eAppendix.

  18. Development and initial evaluation of a telephone-delivered, behavioral activation, and problem-solving treatment program to address functional goals of breast cancer survivors.

    PubMed

    Lyons, Kathleen D; Hull, Jay G; Kaufman, Peter A; Li, Zhongze; Seville, Janette L; Ahles, Tim A; Kornblith, Alice B; Hegel, Mark T

    2015-01-01

    The purpose of this research was to develop and pilot test an intervention to optimize functional recovery for breast cancer survivors. Over two studies, 31 women enrolled in a goal-setting program via telephone. All eligible women enrolled (37% of those screened) and 66% completed all study activities. Completers were highly satisfied with the intervention, using it to address, on average, four different challenging activities. The longitudinal analysis showed a main effect of time for overall quality of life (F(5, 43.1) = 5.1, p = 0.001) and improvements in active coping (F (3, 31.7) = 4.9, p = 0.007), planning (F (3, 36.0) = 4.1, p = 0.01), reframing (F (3, 29.3) = 8.5, p < 0.001), and decreases in self-blame (F (3,31.6) = 4.3, p = 0.01). The intervention is feasible and warrants further study to determine its efficacy in fostering recovery and maximizing activity engagement after cancer treatment.

  19. Development and Initial Evaluation of a Telephone-Delivered, Behavioral Activation and Problem-solving Treatment Program to Address Functional Goals of Breast Cancer Survivors

    PubMed Central

    Lyons, Kathleen D.; Hull, Jay G.; Kaufman, Peter A.; Li, Zhongze; Seville, Janette L.; Ahles, Tim A.; Kornblith, Alice B.; Hegel, Mark T.

    2015-01-01

    The purpose of this research was to develop and pilot test an intervention to optimize functional recovery for breast cancer survivors. Over two studies, 31 women enrolled in a goal-setting program via telephone. All eligible women enrolled (37% of those screened) and 66% completed all study activities. Completers were highly satisfied with the intervention, using it to address, on average, four different challenging activities. The longitudinal analysis showed a main effect of time for overall quality of life (F(5, 43.1) = 5.1, p = 0.001) and improvements in active coping (F (3, 31.7) = 4.9, p = 0.007), planning (F (3, 36.0) = 4.1, p = 0.01), reframing (F (3, 29.3) = 8.5, p < 0.001), and decreases in self-blame (F (3,31.6) = 4.3, p = 0.01). The intervention is feasible and warrants further study to determine its efficacy in fostering recovery and maximizing activity engagement after cancer treatment. PMID:25668509

  20. Difficult-to-treat asthma in childhood.

    PubMed

    Adams, Alexandra; Saglani, Sejal

    2013-06-01

    Asthma continues to be one of the greatest burdens to healthcare resources throughout the developed world. In most cases, good symptom control can be achieved with low-dose inhaled corticosteroids, and can be cared for in the primary and secondary healthcare systems. However, there is a group in whom control is not achieved despite high-dose inhaled corticosteroids and maximal add-on therapies; these are children with problematic severe asthma that should be referred to a specialist team for further investigation and management. In this review we aimed to provide an evidence-based guide for pediatricians providing care for children with asthma in secondary healthcare settings. The review focuses on a proposed investigation and management strategy for children aged between 6 and 16 years with problematic severe asthma, and is supported as far as possible by evidence from the literature. We first address recent advances in nomenclature and then discuss our proposed course of investigation and management of these children. Distinction of children with true, severe, therapy-resistant asthma from those with asthma that is difficult to treat because of unaddressed underlying modifiable factors is critical and is discussed in detail.

  1. Content addressable memory project

    NASA Technical Reports Server (NTRS)

    Hall, J. Storrs; Levy, Saul; Smith, Donald E.; Miyake, Keith M.

    1992-01-01

    A parameterized version of the tree processor was designed and tested (by simulation). The leaf processor design is 90 percent complete. We expect to complete and test a combination of tree and leaf cell designs in the next period. Work is proceeding on algorithms for the computer aided manufacturing (CAM), and once the design is complete we will begin simulating algorithms for large problems. The following topics are covered: (1) the practical implementation of content addressable memory; (2) design of a LEAF cell for the Rutgers CAM architecture; (3) a circuit design tool user's manual; and (4) design and analysis of efficient hierarchical interconnection networks.

  2. Managing difficult polyps: techniques and pitfalls

    PubMed Central

    Tholoor, Shareef; Tsagkournis, Orestis; Basford, Peter; Bhandari, Pradeep

    2013-01-01

    There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that ‘difficult polyp’ is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach. PMID:24714799

  3. Professional Support for Families in Difficult Life Situations

    ERIC Educational Resources Information Center

    Zakirova, Venera G.; Gaysina, Guzel I.; Raykova, Elena

    2016-01-01

    Relevance of the problem stated in the article is determined by the presence of a significant number of families in difficult life situations who need in professional support and socio-psychological assistance. The article aims to substantiate the effectiveness of the structural-functional model of professional supporting for families in difficult…

  4. Brief Therapy with Difficult Clients. Hatherleigh Professional Education.

    ERIC Educational Resources Information Center

    Loar, Lynn

    1995-01-01

    Brief therapy is an effective, time-limited approach that invokes clients values, appreciates their strengths, and is based on mutual respect. Counseling nonvoluntary clients can be extremely difficult because of the intense degree of denial, minimization, or rationalization of problems such clients typically bring to therapy. Therapists must…

  5. Difficult Knowledge and Social Studies (Teacher) Education

    ERIC Educational Resources Information Center

    Garrett, H. James

    2010-01-01

    Social studies education is a field in which those involved--teachers and students--encounter what can be called "difficult knowledge". Difficult knowledge is a theoretical construct suggesting that when an individual encounters representations of social and historical trauma in a learning situation there exists a host of emotional and pedagogical…

  6. Addressing the Problems of Homeless Adolescents

    ERIC Educational Resources Information Center

    Murphy, Joseph F.; Tobin, Kerri

    2012-01-01

    Homeless adolescents, known as "unaccompanied youth," constitute a small but important portion of the overall homeless population, one that needs particular attention at school. In this article, we review existing literature to provide a background for educational leaders, researchers, and policymakers hoping to understand the phenomenon of…

  7. The Difficult Hair Loss Patient: A Particular Challenge

    PubMed Central

    Trüeb, Ralph M

    2013-01-01

    Few dermatologic complaints carry as much emotional overtones as hair loss. Adding to the patient's worry may be prior frustrating experiences with physicians, who trivialize hair loss. A detailed patient history, physical examination and few pertinent screening blood tests usually establish a specific diagnosis. Once the diagnosis is certain, treatment appropriate for that diagnosis is likely to control the problem. Treatment options are available, though limited, in terms of indications and efficacy. Success depends both on comprehensions of the underlying pathology and on unpatronizing sympathy from the part of the physician. Ultimately, patients need to be educated about the basics of the hair cycle and why considerable patience is required for effective cosmetic recovery. Communication is an important component of patient care. For a successful encounter at an office visit, one needs to be sure that the patient's key concerns have been addressed. Physicians should recognize that alopecia goes well beyond the simple physical aspects of hair loss. Patients’ psychological reactions to hair loss are less related to physicians’ ratings than to patients’ own perceptions. Some of the patients have difficulties adjusting to hair loss. The best way to alleviate the emotional distress is to eliminate the hair disease that is causing it. Treatment success relies on patient compliance. Rather than being the patient's failure, patient non-compliance results from failure of the physician to ensure confidence and motivation. Finally, patients with hypochondriacal, body dysmorphic, somatoform, or personality disorders remain difficult to manage. The physician should be careful not to be judgmental or scolding because this may rapidly close down communication. The influence of the prescribing physician should be kept in mind, since inspiring confidence versus scepticism and fear clearly impacts the outcome of treatment. Sometimes the patient gains therapeutic benefit

  8. Difficult asthma: assessment and management, Part 1.

    PubMed

    Long, Aidan A; Fanta, Christopher H

    2012-01-01

    A minority of asthma patients have disease that proves difficult to control with usual medications and experience ongoing symptoms, poor quality of life, and limitations in activity and/or frequent asthma exacerbations. This group of patients accounts for much of the expense associated with asthma care and is the focus of national and international collaborative study groups. Distinguishing between "difficult-to-manage asthma" and truly "therapy-resistant asthma" is helpful and promotes a systematic consideration of contributory factors. Critical evaluation of factors contributing to difficult-to-manage asthma including adverse environment, comorbidities, nonadherence, and incorrect diagnosis is recommended in a systematic fashion in Part 1 of this contribution.

  9. CHALLENGES OF OBSTETRIC ANESTHESIA: DIFFICULT LARYNGEAL VISUALIZATION.

    PubMed

    Alanoğlu, Zekeriyya; Erkoç, Süheyla Karadağ; Güçlü, Çiğdem Yildirim; Meço, Başak Ceyda Orbey; Baytaş, Volkan; Can, Özlem Selvi; Alkiş, Neslihan

    2016-03-01

    Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.

  10. Address tracing for parallel machines

    NASA Technical Reports Server (NTRS)

    Stunkel, Craig B.; Janssens, Bob; Fuchs, W. Kent

    1991-01-01

    Recently implemented parallel system address-tracing methods based on several metrics are surveyed. The issues specific to collection of traces for both shared and distributed memory parallel computers are highlighted. Five general categories of address-trace collection methods are examined: hardware-captured, interrupt-based, simulation-based, altered microcode-based, and instrumented program-based traces. The problems unique to shared memory and distributed memory multiprocessors are examined separately.

  11. Possibly Impossible Patients: Management of Difficult Behavior in Oncology Outpatients

    PubMed Central

    Peteet, John R.; Meyer, Fremonta L.; Miovic, Michael K.

    2011-01-01

    Angry, threatening, or otherwise disruptive behavior by patients can interfere with necessary oncologic treatment, sometimes to the point of rendering continued care impossible. We offer oncology clinicians guidance in dealing with difficult outpatients by discussing the differential diagnosis and multidisciplinary management of treatment-disrupting behavior in the ambulatory oncology setting. We review the existing literature on dealing with difficult patients and present clinical experience at a comprehensive cancer center where a formalized, institutional process for responding to disruptive outpatients has been developed. A structured, multidisciplinary approach to deal with difficult behavior in oncology outpatients can improve care and staff morale. Staff using this approach can identify causes of treatment-disrupting behavior, develop and implement appropriate behavior plans, facilitate communication, address mental health issues, and ensure that decisions to terminate a relationship with a patient are ethical, clinically justified, and supported by due process. In the future, clinical recommendations and institutional guidelines for dealing with difficult patients should be evaluated with more structured, quantitative research. PMID:22043189

  12. Difficult childhood asthma: management and future.

    PubMed

    Tillie-Leblond, Isabelle; Deschildre, Antoine; Gosset, Philippe; de Blic, Jacques

    2012-09-01

    Diagnosis and management of severe asthma implies the definition of different entities, that is, difficult asthma and refractory severe asthma, but also the different phenotypes included in the term refractory severe asthma. A complete evaluation by a physician expert in asthma is necessary, adapted for each child. Identification of mechanisms involved in different phenotypes in refractory severe asthma may improve the therapeutic approach. The quality of care and monitoring of children with severe asthma is as important as the prescription drug, and is also crucial for differentiating between severe asthma and difficult asthma, whereby expertise is required.

  13. Two heads are better than one: Australian tobacco control experts' and mental health change champions' consensus on addressing the problem of high smoking rates among people with mental illness.

    PubMed

    Rowley, Della; Lawn, Sharon; Coveney, John

    2016-04-01

    Objective The aims of the present study were to explore the beliefs of Australian experts in tobacco control and change champions working in mental health and tobacco cessation, and to identify measures for addressing the problem of high smoking rates for people with mental illness. Methods Qualitative interviews were undertaken to explore participants' views, and the Delphi technique was used to achieve consensus on ways in which the problem would be best addressed. Results This consensus centred on the need for leadership within the mental health system. The problem was reconceptualised from being solely the responsibility of the mental health sector into an issue that requires the combined resources of a partnership and shared leadership between government and non-government services, public health leaders, policy makers and people with mental illness and their families. Conclusions Collaboration would raise the priority of the issue, reduce the debilitating effect of stigma and discrimination within the mental health sector and would place smoking reduction firmly on the political and public agenda. A recovery-orientated focus would increase the skill base and be inclusive of workers, families and carers of people with mental illness who face smoking issues on a daily basis. Reconceptualising this as an issue that would benefit from cooperation and partnerships would disrupt the notion that the problem is solely the responsibility of the mental health sector. What is known about the topic? Rates of smoking have remained high for people with mental illness despite population-wide public health strategies successfully reducing smoking rates in the general population. For people with mental illness, the benefits of quitting smoking for both their mental and physical health are overshadowed by concerns about the complexity of their needs. There is a lack of knowledge about how smoking cessation support can be improved to increase success rates in smokers with

  14. Uhl's anomaly: a difficult prenatal diagnosis.

    PubMed

    Vaujois, Laurence; van Doesburg, Nicolaas; Raboisson, Marie-Josée

    2015-03-01

    Uhl's anomaly is an evolutive disease leading to terminal right ventricular failure. The most difficult differential diagnosis at presentation is the Ebstein disease. We describe the evolution of a foetus with Uhl's anomaly from 21 to 30 weeks of gestation, with progressive reduction in the right ventricular anterior myocardium suggestive of apoptosis, leading to foetal demise.

  15. Questions That Science Teachers Find Difficult (II).

    ERIC Educational Resources Information Center

    Goodwin, Alan

    2003-01-01

    Presents some questions that science teachers find difficult. Focuses on three further questions relating to "simple" everyday situations that are normally explained in terms of the kinetic theory of matter. Identifies looking at the difference between chemical and physical changes as the most problematic question. (Author/YDS)

  16. What's Difficult about Chemistry? An Irish Perspective

    ERIC Educational Resources Information Center

    Childs, Peter E.; Sheehan, Maria

    2009-01-01

    This semi-longitudinal investigation identified the chemistry topics that the majority of Irish chemistry pupils/students find difficult, from Junior Certificate level (age 15/16 years) right the way through to University level (age 18+). Pupils/students completed a five point, Likert-type questionnaire listing the topics covered in the different…

  17. Teaching Difficult Topics with Primary Sources

    ERIC Educational Resources Information Center

    Potter, Lee Ann

    2011-01-01

    "Difficult" or "challenging" topics to teach include racism, violence, genocide, bullying, gangs, abuse (physical, emotional, and substance), slavery, suffering, hatred, terrorism, war, disease, loss, addiction, and more. But by confronting them with students, in the safety of a classroom through thoughtfully constructed lessons (ones that take…

  18. Approaches for Resolving Dynamic IP Addressing.

    ERIC Educational Resources Information Center

    Foo, Schubert; Hui, Siu Cheung; Yip, See Wai; He, Yulan

    1997-01-01

    A problem with dynamic Internet protocol (IP) addressing arises when the Internet connection is through an Internet provider since the IP address is allocated only at connection time. This article examines a number of online and offline methods for resolving the problem. Suggests dynamic domain name system (DNS) and directory service look-up are…

  19. Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation.

    PubMed

    Marshall, S D; Pandit, J J

    2016-02-01

    There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very 'radical evolution'.Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises.All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption.

  20. Managing Difficult Patients: Roles of Psychologists in the Age of Interdisciplinary Care.

    PubMed

    Robiner, William N; Petrik, Megan L

    2017-03-10

    Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system. The definition, scope, and impact of difficult patients in healthcare settings are reviewed, including an examination of patient, clinician, and systems factors that contribute to the etiology of difficult clinical encounters. Strategies are discussed that may prevent or limit the adverse impact of difficult patients in healthcare, with special emphasis on the roles of psychologists in interprofessional healthcare teams.

  1. Honey bees selectively avoid difficult choices.

    PubMed

    Perry, Clint J; Barron, Andrew B

    2013-11-19

    Human decision-making strategies are strongly influenced by an awareness of certainty or uncertainty (a form of metacognition) to increase the chances of making a right choice. Humans seek more information and defer choosing when they realize they have insufficient information to make an accurate decision, but whether animals are aware of uncertainty is currently highly contentious. To explore this issue, we examined how honey bees (Apis mellifera) responded to a visual discrimination task that varied in difficulty between trials. Free-flying bees were rewarded for a correct choice, punished for an incorrect choice, or could avoid choosing by exiting the trial (opting out). Bees opted out more often on difficult trials, and opting out improved their proportion of successful trials. Bees could also transfer the concept of opting out to a novel task. Our data show that bees selectively avoid difficult tasks they lack the information to solve. This finding has been considered as evidence that nonhuman animals can assess the certainty of a predicted outcome, and bees' performance was comparable to that of primates in a similar paradigm. We discuss whether these behavioral results prove bees react to uncertainty or whether associative mechanisms can explain such findings. To better frame metacognition as an issue for neurobiological investigation, we propose a neurobiological hypothesis of uncertainty monitoring based on the known circuitry of the honey bee brain.

  2. Pituitary Carcinoma: Difficult Diagnosis and Treatment

    PubMed Central

    2011-01-01

    Context: Although pituitary tumors are common, pituitary carcinoma is very rare and is only diagnosed when pituitary tumor noncontiguous with the sellar region is demonstrated. Diagnosis is difficult, resulting in delays that may adversely effect outcome that is traditionally poor. Barriers to earlier diagnosis and management strategies for pituitary carcinoma are discussed. Evidence Acquisition: PubMed was employed to identify relevant studies, a review of the literature was conducted, and data were summarized and integrated from the author's perspective. Evidence Synthesis: The available data highlight the difficulties in diagnosis and management and practical challenges in conducting clinical trials in this rare condition. They suggest that earlier diagnosis with aggressive multimodal therapy may be advantageous in some cases. Conclusions: Although pituitary carcinoma remains difficult to diagnose and treat, recent developments have led to improved outcomes in selected cases. With broader use of molecular markers, efforts to modify current histopathological criteria for pituitary carcinoma diagnosis may now be possible. This would assist earlier diagnosis and, in combination with targeted therapies, potentially improve long-term survival. PMID:21956419

  3. Biomarkers in the Management of Difficult Asthma

    PubMed Central

    Schleich, Florence; Sophie, Demarche; Renaud, Louis

    2016-01-01

    Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is time-consuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma. PMID:26467509

  4. Biomarkers in the Management of Difficult Asthma.

    PubMed

    Schleich, Florence; Demarche, Sophie; Louis, Renaud

    2016-01-01

    Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is timeconsuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma.

  5. Children with difficult asthma: a practical approach.

    PubMed

    Payne, D N; Balfour-Lynn, I M

    2001-05-01

    Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.

  6. Effective Climate Communication with Difficult Audiences

    NASA Astrophysics Data System (ADS)

    Denning, S.

    2015-12-01

    Climate communication is often fraught with ideological baggage ("noise") that makes it very difficult to connect to audiences. In these cases, it is helpful to use "best practices" known from other fields of communication. Engaging audiences with authenticity, using plain language, respecting cultural and political differences, and a sprinkling of humor can go a long way toward establishing a connection. It's important to avoid common but polarizing tropes from popular media, and often quite helpful to frame climate issues in novel or unexpected ways that cut across entrenched political discourse. Emerging social science research Beyond ideology, climate change is Simple, Serious, and Solvable. Effective communication of these three key ideas can succeed when the science argument is carefully framed to avoid attack of the audience's ethical identity. Simple arguments from common sense and everyday experience are more successful than data. Serious consequences to values that resonate with the audience can be avoided by solutions that don't threaten those values.

  7. Hybrid ceramic bearings for difficult applications

    SciTech Connect

    Dezzani, M.M.; Pearson, P.K.

    1996-04-01

    The Torrington Company, under contract from the Advanced Research Projects Agency (ARPA), has developed a hybrid bearing with improved properties for difficult applications. M50 and M50 NiL steel rings were nitrided to produce rolling contact raceway surfaces with hardnesses near Rockwell C 70. Rings were assembled with NBD-200 silicon nitride balls. Full-scale bearing tests were run under conditions that included 150 C temperature, surface flaws created by hard particle contamination, partial EHD lubrication, and the sliding action of balls running under thrust loading. The hybrid bearings had longer life than all steel bearings and demonstrated resistance to the surface peeling mode of failure initiation. Higher strength of the rolling contact surfaces, high residual compressive stresses in the nitrided layers, and a more favorable action in ceramic to steel rolling contact are discussed as the reasons for improved performance of the hybrid over all-steel bearings.

  8. Dealing with Institutional Racism on Campus: Initiating Difficult Dialogues and Social Justice Advocacy Interventions

    ERIC Educational Resources Information Center

    D'Andrea, Michael; Daniels, Judy

    2007-01-01

    The authors describe social justice advocacy interventions to initiate difficult discussions at the university where they are employed. They emphasize the need to foster difficult dialogues about the problem of institutional racism among students, faculty members, and administrators where they work. The Privileged Identity Exploration (PIE) model…

  9. Changing Jobs in Difficult Financial Times

    ERIC Educational Resources Information Center

    Brown, Wayne

    2009-01-01

    Starting a new CIO job is always a challenge. There is a new department and institution to learn about, people to meet, and problems to solve. There is always plenty to learn and projects to realize. Throwing in economic challenges to the new-job transition can feel like one is attempting to climb a mountain without any gear. Fortunately, there…

  10. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

    PubMed Central

    Zarogoulidis, Paul; Kontakiotis, Theodoros; Tsakiridis, Kosmas; Karanikas, Michael; Simoglou, Christos; Porpodis, Konstantinos; Mitrakas, Alexandros; Esebidis, Agisilaos; Konoglou, Maria; Katsikogiannis, Nikolaos; Zervas, Vasilis; Aggelopoulou, Christina; Mikroulis, Dimitrios; Zarogoulidis, Konstantinos

    2012-01-01

    Management of a “difficult airway” remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a “difficult airway” and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality. PMID:22802693

  11. Addressing Ozone Layer Depletion

    EPA Pesticide Factsheets

    Access information on EPA's efforts to address ozone layer depletion through regulations, collaborations with stakeholders, international treaties, partnerships with the private sector, and enforcement actions under Title VI of the Clean Air Act.

  12. Definitions of Complexity are Notoriously Difficult

    NASA Astrophysics Data System (ADS)

    Schuster, Peter

    Definitions of complexity are notoriously difficult if not impossible at all. A good working hypothesis might be: Everything is complex that is not simple. This is precisely the way in which we define nonlinear behavior. Things appear complex for different reasons: i) Complexity may result from lack of insight, ii) complexity may result from lack of methods, and (iii) complexity may be inherent to the system. The best known example for i) is celestial mechanics: The highly complex Pythagorean epicycles become obsolete by the introduction of Newton's law of universal gravitation. To give an example for ii), pattern formation and deterministic chaos became not really understandable before extensive computer simulations became possible. Cellular metabolism may serve as an example for iii) and is caused by the enormous complexity of biochemical reaction networks with up to one hundred individual reaction fluxes. Nevertheless, only few fluxes are dominant in the sense that using Pareto optimal values for them provides near optimal values for all the others...

  13. Navigating language barriers under difficult circumstances.

    PubMed

    Schenker, Yael; Lo, Bernard; Ettinger, Katharine M; Fernandez, Alicia

    2008-08-19

    The proportion of the U.S. population with limited English proficiency is growing. Physicians often find themselves caring for patients with limited English proficiency in settings with limited language services. There has been little exploration of the decisions physicians face when providing care across language barriers. The authors offer a conceptual framework to aid physicians in thinking through difficult choices about language services and provide responses to common questions encountered in the care of patients with limited English proficiency. Specifically, they describe 4 factors that should inform the decision to call an interpreter (the clinical situation, degree of language gap, available resources, and patient preference), discuss who may be an appropriate interpreter, and offer strategies for when a professional interpreter is not available. The authors use a hypothetical case to illustrate how decisions about language services may evolve over the course of an interaction. This conceptual and practical approach can help clinicians to improve the quality of care provided to patients with limited English proficiency.

  14. Why behavior change is difficult to sustain.

    PubMed

    Bouton, Mark E

    2014-11-01

    Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs.

  15. Student Homicidal Violence in Schools: An International Problem

    ERIC Educational Resources Information Center

    Bondu, Rebecca; Cornell, Dewey G.; Scheithauer, Herbert

    2011-01-01

    School homicides have become a worldwide phenomenon. In the decade following the Columbine shooting there have been at least forty similar events in other countries. This article addresses the international scope of this problem and some of the complex conceptual issues that make student homicidal violence difficult to define and study. Meaningful…

  16. Health care reform: informing difficult choices.

    PubMed

    Maynard, A; Bloor, K

    1995-01-01

    During the last decade, policy makers in a large number of countries have attempted various reforms of their health care systems. Health care reform has been described as a 'global epidemic' (Klein, 1993). All health care reforms consist of very complex policy choices, some of which are examined in this article. After an introductory exploration of ideological issues, the objectives of health care reformers are considered. Three major policy objectives of health care reform are examined: cost containment; efficiency; and, equity. Three types of reform which have been advocated are also considered: public planning; market regulation; and provider-advocated reforms such as a 'basic package' with copayments and alternative means of finance. Finally, appropriate features of efficient health care reform are suggested, addressing explicit policy goals.

  17. Developing and Validating a Conceptual Model of Recurring Problems in Teaching Clinic

    ERIC Educational Resources Information Center

    Smith, C. Scott; Morris, Magdalena; Hill, William; Francovich, Chris; Christiano, Jennifer

    2006-01-01

    Recurrent problems in medical teaching clinic are common and difficult to address because of complex interpersonal dynamics. To minimize this difficulty, we developed a conceptual model that simplifies problems and identifies the root cause of tension between groups in clinic. We used recursive analysis and modeling of the data from a larger…

  18. All India Difficult Airway Association 2016 guidelines for the management of anticipated difficult extubation

    PubMed Central

    Kundra, Pankaj; Garg, Rakesh; Patwa, Apeksh; Ahmed, Syed Moied; Ramkumar, Venkateswaran; Shah, Amit; Divatia, Jigeeshu Vasishtha; Shetty, Sumalatha Radhakrishna; Raveendra, Ubaradka S; Doctor, Jeson R; Pawar, Dilip K; Singaravelu, Ramesh; Das, Sabyasachi; Myatra, Sheila Nainan

    2016-01-01

    Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should

  19. The Difficult-to-Control Asthmatic: A Systematic Approach

    PubMed Central

    2006-01-01

    With the judicious use of inhaled corticosteroids, β2 agonists, and leukotriene modifiers, most patients with asthma are easily controlled and managed. However, approximately 5% of asthmatics do not respond to standard therapy and are classified as "difficult to control." [1] Typically, these are patients who complain of symptoms interfering with daily living despite long-term treatment with inhaled corticosteroids in doses up to 2,000 μg daily. Many factors can contribute to poor response to conventional therapy, and especially for these patients, a systematic approach is needed to identify the underlying causes. First, the diagnosis of asthma and adherence to the medication regimen should be confirmed. Next, potential persisting exacerbating triggers need to be identified and addressed. Concomitant disorders should be discovered and treated. Lastly, the impact and implications of socioeconomic and psychological factors on disease control can be significant and should be acknowledged and discussed with the individual patient. Less conventional and novel strategies for treating corticosteroid-resistant asthma do exist. However, their use is based on small studies that do not meet evidence-based criteria; therefore, it is essential to sort through and address the above issues before reverting to other therapy. PMID:20525155

  20. Intentional Communication: Computationally Easy or Difficult?

    PubMed Central

    van Rooij, Iris; Kwisthout, Johan; Blokpoel, Mark; Szymanik, Jakub; Wareham, Todd; Toni, Ivan

    2011-01-01

    Human intentional communication is marked by its flexibility and context sensitivity. Hypothesized brain mechanisms can provide convincing and complete explanations of the human capacity for intentional communication only insofar as they can match the computational power required for displaying that capacity. It is thus of importance for cognitive neuroscience to know how computationally complex intentional communication actually is. Though the subject of considerable debate, the computational complexity of communication remains so far unknown. In this paper we defend the position that the computational complexity of communication is not a constant, as some views of communication seem to hold, but rather a function of situational factors. We present a methodology for studying and characterizing the computational complexity of communication under different situational constraints. We illustrate our methodology for a model of the problems solved by receivers and senders during a communicative exchange. This approach opens the way to a principled identification of putative model parameters that control cognitive processes supporting intentional communication. PMID:21747765

  1. Addressing Social Issues.

    ERIC Educational Resources Information Center

    Schoebel, Susan

    1991-01-01

    Maintains that advertising can help people become more aware of social responsibilities. Describes a successful nationwide newspaper advertising competition for college students in which ads address social issues such as literacy, drugs, teen suicide, and teen pregnancy. Notes how the ads have helped grassroots programs throughout the United…

  2. Invitational Addresses, 1965.

    ERIC Educational Resources Information Center

    Gates, Arthur I.; And Others

    The full texts of invitational addresses given at the 1965 International Reading Association (IRA) Convention in Detroit, Michigan, by six recipients of IRA citation awards are presented. Gates suggests steps IRA should take to revive and redirect reading research. McCallister discusses the implications of the changing and expanding vocabulary of…

  3. States Address Achievement Gaps.

    ERIC Educational Resources Information Center

    Christie, Kathy

    2002-01-01

    Summarizes 2 state initiatives to address the achievement gap: North Carolina's report by the Advisory Commission on Raising Achievement and Closing Gaps, containing an 11-point strategy, and Kentucky's legislation putting in place 10 specific processes. The North Carolina report is available at www.dpi.state.nc.us.closingthegap; Kentucky's…

  4. Sexual Problems

    MedlinePlus

    ... for a healthy life Mental health for men Sexual health for men Male infertility Prostate health Sexual problems ... updates. Enter email address Submit Home > Men's Health > Sexual health for men Men's Health This information in Spanish ( ...

  5. Addressing Issues Related to Technology and Engineering

    ERIC Educational Resources Information Center

    Technology Teacher, 2008

    2008-01-01

    This article presents an interview with Michael Hacker and David Burghardt, codirectors of Hoftra University's Center for Technological Literacy. Hacker and Burghardt address issues related to technology and engineering. They argue that teachers need to be aware of the problems kids are facing, and how to present these problems in an engaging…

  6. Addressing contrasting cognitive models in scientific collaboration

    NASA Astrophysics Data System (ADS)

    Diviacco, P.

    2012-04-01

    If the social aspects of scientific communities and their internal dynamics is starting to be recognized and acknowledged in the everyday lives of scientists, it is rather difficult for them to find tools that could support their activities consistently with this perspective. Issues span from gathering researchers to mutual awareness, from information sharing to building meaning, with the last one being particularly critical in research fields as the geo-sciences, that deal with the reconstruction of unique, often non-reproducible, and contingent processes. Reasoning here is, in fact, mainly abductive, allowing multiple and concurrent explanations for the same phenomenon to coexist. Scientists bias one hypothesis over another not only on strictly logical but also on sociological motivations. Following a vision, scientists tend to evolve and isolate themselves from other scientists creating communities characterized by different cognitive models, so that after some time these become incompatible and scientists stop understanding each other. We address these problems as a communication issue so that the classic distinction into three levels (syntactic, semantic and pragmatic) can be used. At the syntactic level, we highlight non-technical obstacles that condition interoperability and data availability and transparency. At the semantic level, possible incompatibilities of cognitive models are particularly evident, so that using ontologies, cross-domain reconciliation should be applied. This is a very difficult task to perform since the projection of knowledge by scientists, in the designated community, is political and thus can create a lot of tension. The strategy we propose to overcome these issues pertains to pragmatics, in the sense that it is intended to acknowledge the cultural and personal factors each partner brings into the collaboration and is based on the idea that meaning should remain a flexible and contingent representation of possibly divergent views

  7. Reaction Workup Planning: A Structured Flowchart Approach, Exemplified in Difficult Aqueous Workup of Hydrophilic Products

    ERIC Educational Resources Information Center

    Hill, George B.; Sweeney, Joseph B.

    2015-01-01

    Reaction workup can be a complex problem for those facing novel synthesis of difficult compounds for the first time. Workup problem solving by systematic thinking should be inculcated as mid-graduate-level is reached. A structured approach is proposed, building decision tree flowcharts to analyze challenges, and an exemplar flowchart is presented…

  8. Address on the Occasion of the Meeting of the Second Committee of Governmental Experts on Problems in the Field of Copyright and of the Protection of Performers, Producers of Phonograms and Broadcasting Organizations Raised by Transmission via Space Satellites.

    ERIC Educational Resources Information Center

    Maheu, Rene

    These opening remarks by the Director General of Unesco briefly discuss that organization's activities in the area of copyright within the field of satellite communication. They were addressed to members of a committee whose purpose is to determine whether the protection of signals transmitted by communications satellites does or does not require…

  9. Problems of Assessing the New Curricula Being Introduced in African Countries. Keynote address for the Annual Meeting of the International Association for Educational Assessment (9th, Malawi, Blantyre, June 13-17, 1983).

    ERIC Educational Resources Information Center

    Boma, A. N.

    The state of the art of assessment is viewed in light of practical and realistic options. The classical terminologies of achievement, validity, reliability, internal and external assessment, prediction, and formative and summative evaluation, are often referred to in the address, with the realization that those presenting later papers would not be…

  10. Content Addressable Memory Project

    DTIC Science & Technology

    1990-11-01

    The Content Addressable M1-emory Project consists of the development of several experimental software systems on an AMT Distributed Array Processor...searching (database) compiler algorithms memory management other systems software) Linear C is an unlovely hybrid language which imports the CAM...memory from AMT’s operating system for the DAP; how- ever, other than this limitation, the memory management routines work exactly as their C counterparts

  11. Effects of Multi-Tier Academic and Behavior Instruction on Difficult-to-Teach Students

    ERIC Educational Resources Information Center

    Algozzine, Bob; Wang, Chuang; White, Richard; Cooke, Nancy; Marr, Mary Beth; Algozzine, Kate; Helf, Shawnna S.; Duran, Grace Zamora

    2012-01-01

    This article addresses the effects of 3-tiered comprehensive reading and behavior interventions on K-3 student outcomes in 7 urban elementary schools with a high prevalence of students considered difficult to teach. Specific features of each level of the implementation are described including screening and tier placement procedures, scheduling and…

  12. Bioreactors Addressing Diabetes Mellitus

    PubMed Central

    Minteer, Danielle M.; Gerlach, Jorg C.

    2014-01-01

    The concept of bioreactors in biochemical engineering is a well-established process; however, the idea of applying bioreactor technology to biomedical and tissue engineering issues is relatively novel and has been rapidly accepted as a culture model. Tissue engineers have developed and adapted various types of bioreactors in which to culture many different cell types and therapies addressing several diseases, including diabetes mellitus types 1 and 2. With a rising world of bioreactor development and an ever increasing diagnosis rate of diabetes, this review aims to highlight bioreactor history and emerging bioreactor technologies used for diabetes-related cell culture and therapies. PMID:25160666

  13. Bioreactors addressing diabetes mellitus.

    PubMed

    Minteer, Danielle M; Gerlach, Jorg C; Marra, Kacey G

    2014-11-01

    The concept of bioreactors in biochemical engineering is a well-established process; however, the idea of applying bioreactor technology to biomedical and tissue engineering issues is relatively novel and has been rapidly accepted as a culture model. Tissue engineers have developed and adapted various types of bioreactors in which to culture many different cell types and therapies addressing several diseases, including diabetes mellitus types 1 and 2. With a rising world of bioreactor development and an ever increasing diagnosis rate of diabetes, this review aims to highlight bioreactor history and emerging bioreactor technologies used for diabetes-related cell culture and therapies.

  14. Addressing ketamine bladder syndrome.

    PubMed

    Logan, Karen

    The rise in ketamine misuse means more health professionals will need to diagnose, refer and treat ketamine bladder syndrome. Prevention and raising awareness of the problem among multidisciplinary teams will help limit damage to the bladder as well as making treatment and management more effective.

  15. Addressing Environmental Health Inequalities

    PubMed Central

    Gouveia, Nelson

    2016-01-01

    Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), “Addressing Environmental Health Inequalities—Proceedings from the ISEE Conference 2015”, we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics. PMID:27618906

  16. The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.

    PubMed

    Onishi, So L; Hebert, Randy S

    2016-02-01

    Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior. A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural). Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters.

  17. Addressing the insider threat

    SciTech Connect

    Hochberg, J.G.; Jackson, K.A.; McClary, J.F.; Simmonds, D.D.

    1993-05-01

    Computers have come to play a major role in the processing of information vital to our national security. As we grow more dependent on computers, we also become more vulnerable to their misuse. Misuse may be accidental, or may occur deliberately for purposes of personal gain, espionage, terrorism, or revenge. While it is difficult to obtain exact statistics on computer misuse, clearly it is growing. It is also clear that insiders -- authorized system users -- are responsible for most of this increase. Unfortunately, their insider status gives them a greater potential for harm This paper takes an asset-based approach to the insider threat. We begin by characterizing the insider and the threat posed by variously motivated insiders. Next, we characterize the asset of concern: computerized information of strategic or economic value. We discuss four general ways in which computerized information is vulnerable to adversary action by the insider: disclosure, violation of integrity, denial of service, and unauthorized use of resources. We then look at three general remedies for these vulnerabilities. The first is formality of operations, such as training, personnel screening, and configuration management. The second is the institution of automated safeguards, such as single-use passwords, encryption, and biometric devices. The third is the development of automated systems that collect and analyze system and user data to look for signs of misuse.

  18. Addressing the insider threat

    SciTech Connect

    Hochberg, J.G.; Jackson, K.A.; McClary, J.F.; Simmonds, D.D.

    1993-01-01

    Computers have come to play a major role in the processing of information vital to our national security. As we grow more dependent on computers, we also become more vulnerable to their misuse. Misuse may be accidental, or may occur deliberately for purposes of personal gain, espionage, terrorism, or revenge. While it is difficult to obtain exact statistics on computer misuse, clearly it is growing. It is also clear that insiders -- authorized system users -- are responsible for most of this increase. Unfortunately, their insider status gives them a greater potential for harm This paper takes an asset-based approach to the insider threat. We begin by characterizing the insider and the threat posed by variously motivated insiders. Next, we characterize the asset of concern: computerized information of strategic or economic value. We discuss four general ways in which computerized information is vulnerable to adversary action by the insider: disclosure, violation of integrity, denial of service, and unauthorized use of resources. We then look at three general remedies for these vulnerabilities. The first is formality of operations, such as training, personnel screening, and configuration management. The second is the institution of automated safeguards, such as single-use passwords, encryption, and biometric devices. The third is the development of automated systems that collect and analyze system and user data to look for signs of misuse.

  19. Content addressable memory project

    NASA Technical Reports Server (NTRS)

    Hall, Josh; Levy, Saul; Smith, D.; Wei, S.; Miyake, K.; Murdocca, M.

    1991-01-01

    The progress on the Rutgers CAM (Content Addressable Memory) Project is described. The overall design of the system is completed at the architectural level and described. The machine is composed of two kinds of cells: (1) the CAM cells which include both memory and processor, and support local processing within each cell; and (2) the tree cells, which have smaller instruction set, and provide global processing over the CAM cells. A parameterized design of the basic CAM cell is completed. Progress was made on the final specification of the CPS. The machine architecture was driven by the design of algorithms whose requirements are reflected in the resulted instruction set(s). A few of these algorithms are described.

  20. Difficult Behaviors in the Emergency Department: A Cohort Study of Housed, Homeless and Alcohol Dependent Individuals

    PubMed Central

    Svoboda, Tomislav

    2015-01-01

    Background This study contrasted annual rates of difficult behaviours in emergency departments among cohorts of individuals who were homeless and low-income housed and examined predictors of these events. Methods Interviews in 1999 with men who were chronically homeless with drinking problems (CHDP) (n = 50), men from the general homeless population (GH) (n = 61), and men residing in low-income housing (LIH) (n = 58) were linked to catchment area emergency department records (n = 2817) from 1994 to 1999. Interview and hospital data were linked to measures of difficult behaviours. Results Among the CHDP group, annual rates of visits with difficult behaviours were 5.46; this was 13.4 (95% CI 10.3–16.5) and 14.3 (95% CI 11.2–17.3) times higher than the GH and LIH groups. Difficult behaviour incidents included physical violence, verbal abuse, uncooperativeness, drug seeking, difficult histories and security involvement. Difficult behaviours made up 57.54% (95% CI 55.43–59.65%), 24% (95% CI 19–29%), and 20% (95% CI 16–24%) of CHDP, GH and LIH visits. Among GH and LIH groups, 87% to 95% were never involved in verbal abuse or violence. Intoxication increased all difficult behaviours while decreasing drug seeking and leaving without being seen. Verbal abuse and violence were less likely among those housed, with odds ratios of 0.24 (0.08, 0.72) and 0.32 (0.15, 0.69), respectively. Conclusions Violence and difficult behaviours are much higher among chronically homeless men with drinking problems than general homeless and low-income housed populations. They are concentrated among subgroups of individuals. Intoxication is the strongest predictor of difficult behaviour incidents. PMID:25919015

  1. [Keynote address: Climate change

    SciTech Connect

    Forrister, D.

    1994-12-31

    Broadly speaking, the climate issue is moving from talk to action both in the United States and internationally. While few nations have adopted strict controls or stiff new taxes, a number of them are developing action plans that are making clear their intention to ramp up activity between now and the year 2000... and beyond. There are sensible, economically efficient strategies to be undertaken in the near term that offer the possibility, in many countries, to avoid more draconian measures. These strategies are by-and-large the same measures that the National Academy of Sciences recommended in a 1991 report called, Policy Implications of Greenhouse Warming. The author thinks the Academy`s most important policy contribution was how it recommended the nations act in the face of uncertain science and high risks--that cost effective measures are adopted as cheap insurance... just as nations insure against other high risk, low certainty possibilities, like catastrophic health insurance, auto insurance, and fire insurance. This insurance theme is still right. First, the author addresses how the international climate change negotiations are beginning to produce insurance measures. Next, the author will discuss some of the key issues to watch in those negotiations that relate to longer-term insurance. And finally, the author will report on progress in the United States on the climate insurance plan--The President`s Climate Action Plan.

  2. Identifying problem and compulsive gamblers.

    PubMed Central

    van Es, R.

    2000-01-01

    OBJECTIVE: To present a meta-analysis of current research on the prevalence, identification, and treatment of problem and compulsive gamblers. QUALITY OF EVIDENCE: Problem and compulsive gambling was not a socio-scientific concern until the last two decades. Hence research on this topic is limited. The summary and analysis for this paper relied on computer searches of journal and news abstracts in addition to direct contact with organizations addressing the identification and treatment of compulsive gamblers. MAIN MESSAGE: An estimated 5% of those who gamble run into problems. About 1% of those who gamble are predicted to experience serious problems. Successful treatment of problem and compulsive gambling continues to be a challenge. Although cognitive therapy has been the favoured approach, a combination of several therapeutic approaches is advocated. CONCLUSIONS: Problem and compulsive gambling can present a real health threat. As with other addictions, treatment strategies continue to be a baffling social problem. Aware and informed physicians can have a pivotal role in the difficult process of identifying, acknowledging, and remediating problem and compulsive gambling. PMID:10907572

  3. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    PubMed

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

  4. Move difficult solids-bearing fluids with submersible pumps

    SciTech Connect

    Pastore, P.R.

    1993-09-01

    This article describes how, alone or combined with versatile horizontal mixers, the submersible pump has significant advantages when the worst powerplant slurries have to be moved. The ever-growing need to deal with slurries and other solids-bearing liquids has directed attention to the pumping systems necessary to deal with the high diversity and large volumes of what are often wastes. Many powerplant services and locations, including coalpiles, sumps, and ash handling, call for pumping of solids-bearing liquids. In nearly every case, the wastes are not directly connected with the plant's economic function of power generation but nevertheless consume power and call for heavy capital and maintenance sums. For this reason, powerplants benefit from improved handling of these materials. There are basic differences between pumping of the two-phase slurries and wastes, especially when open reservoirs are part of the flowpaths, and pumping of the traditional, comparatively clean, single-phase liquids of the powerplant. Supply of liquid to the pump is one significant differences. Placement of conventional pumps for slurry service is another problem. Pumping from a closed system, such as a tank, can call for extra space, with a dry pit to hold a lineshaft pump. A conventional pump motor at a low level in a pit is in danger of flooding. An alternative solution to the problem of pump and drive type for the powerplant's difficult solids-bearing liquids is the submersible pump. This type has an entirely sealed motor and can be easily moved and reset advantageously for pumping at any time. Designed to operate with pump and motor fully submerged for long periods, the submersible pump can nevertheless also be mounted in a dry well next to a tank. The pump's ability to run submerged protects the system if the dry well should become flooded.

  5. Application of Kinesio Taping method for newborn swallowing difficultly

    PubMed Central

    Lin, Chien-Lin; Wu, Wei-Ting; Chang, Ke-Vin; Lin, Hong-Yi; Chou, Li-Wei

    2016-01-01

    Abstract Background: Preterm infants are at an increased risk of sucking problems, swallowing difficulty, and poor nourishment. During the neonatal period, the neurobehavioral organization of a preterm baby is poor compared with that of appropriate gestational age infants. Kinesio Taping has been widely used for edema control, joint protection, and proprioception training. With the help of augmentation of the sensory input for muscle facilitation and inhibition through tapping, the coordination of the target muscle groups can be improved. Until now, no research is available on the use of Kinesio Taping for the swallowing difficulty of infant. Methods: We reported a preterm infant suffering from brain edema at birth and swallowing difficultly until 40 weeks. The swallowing reflex was delayed. Moreover, lip closure and rooting reflex combined with the dysfunction grade of jaw movement were poor. We performed KT methods on the baby under the theory of the direction of the tape for facilitate or inhibit the muscle. Result: After the Kinesio Taping treatment, the sucking function was improved with good lip closure.One week later, the baby was discharged without the use of an oral gastric tube. Conclusion: Kinesio Taping contributed significantly to the improvement of impaired sucking and swallowing and could be implemented as a regular rehabilitative approach for infants suffering from these difficulties. PMID:27495080

  6. Protection of mineral deposits - a way towards difficult compromises

    NASA Astrophysics Data System (ADS)

    Radwanek-Bąk, Barbara; Nieć, Marek

    2014-05-01

    Mineral deposits are non-renewable natural resources. Their protection and reasonable exploitation are crucial requests resulting from sustainable development principles. Those are also fundamental issues in frame of the intergeneration justice and fairness concept. Protection of mineral resources should be based on interrelated activities: maintaining the possibility of economic use of the identified mineral resources, reduced consumption of mineral resources and ensuring satisfactory results of new prospecting and development of innovative technologies for the mineral resources base. The main problem with guarantee to the use of mineral resources is the accessibility to sites with documented deposits and prospective areas of their occurrence. Often, this contradicts with the interests of residents, planners and needs of the biotic environment protection, thus is often a source of conflicts. Legislative regulations are necessary to mitigate such arguable matters. SWOT analysis carried out with respect to introducing such legal regulations serves to identify the sources of conflicts and difficulties associated with their solution. Consensus reaching is a difficult task, so all decision makers are required to show their mutual understanding and willingness to achieve the goals taking into consideration all benefits for the population (including future generations). Foundations for finding the middle ground are: making the communities aware of their demands on minerals and of indispensable conditions for satisfying these demands; providing complete and accessible information; factual, non-emotional negotiations between decision makers and the public.

  7. The difficult chore of measuring coordination by EXAFS.

    SciTech Connect

    Ravel, B.; Kelly, S. D.; Biosciences Division

    2007-01-01

    Neither the theory nor the interpretation of Extended X-Ray-Absorption Fine-Structure (EXAFS) spectroscopy requires assumptions of crystalline symmetry or periodicity. As a result, EXAFS is a tool applied to a wide range of scientific disciplines and to a wide variety of experimental systems. A simple enumeration of the atoms in the coordination environment of the absorber is often the primary goal of an EXAFS experiment. There are, however, a number of pitfalls in the way of an accurate determination of coordination number (CN). These include statistical limitations of the EXAFS fitting problem, empirical effects due to sample preparation, and the assumptions made about the physical structure surrounding the absorber in the course of data analysis. In this paper we examine several of these pitfalls and their effects upon the determination of CN. Where possible, we offer suggestions for avoiding or mitigating the pitfalls. We hope this paper will help guide the general EXAFS practitioner through the difficult chore of accurately determining CN.

  8. The Difficult Chore of Measuring Coordination by EXAFS

    SciTech Connect

    Ravel, B.; Kelly, S. D.

    2007-02-02

    Neither the theory nor the interpretation of Extended X-Ray-Absorption Fine-Structure (EXAFS) spectroscopy requires assumptions of crystalline symmetry or periodicity. As a result, EXAFS is a tool applied to a wide range of scientific disciplines and to a wide variety of experimental systems. A simple enumeration of the atoms in the coordination environment of the absorber is often the primary goal of an EXAFS experiment. There are, however, a number of pitfalls in the way of an accurate determination of coordination number (CN). These include statistical limitations of the EXAFS fitting problem, empirical effects due to sample preparation, and the assumptions made about the physical structure surrounding the absorber in the course of data analysis. In this paper we examine several of these pitfalls and their effects upon the determination of CN. Where possible, we offer suggestions for avoiding or mitigating the pitfalls. We hope this paper will help guide the general EXAFS practitioner through the difficult chore of accurately determining CN.

  9. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    PubMed Central

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  10. The difficult airway: mechanisms for effective dissemination of critical information.

    PubMed

    Mark, L J; Beattie, C; Ferrell, C L; Trempy, G; Dorman, T; Schauble, J F

    1992-01-01

    The perioperative management and dissemination of critical information regarding a patient with an unexpected difficult intubation, including successful application of a difficult airway algorithm (Figure 1), are described. Documentation and dissemination of critical information include entry of patient data into an in-hospital computerized Difficult Airway/Intubation Registry, simultaneous application of a highly visible Difficult Airway/Intubation Patient Wrist Band (coded for access to computer registry), summary reports distributed to health care providers, and enrollment of the patient in the Medic Alert Foundation International's newly established category difficult airway/intubation for 24-hour access. We postulate that the widespread use of the procedures described in this report may reduce the contribution of unexpected difficult airway/intubation to anesthetic morbidity and mortality.

  11. Addressing the underperformance of faculty and staff.

    PubMed

    Kenner, Carole; Pressler, Jana L

    2006-01-01

    Many new nursing leaders assuming work as deans, assistant deans, or interim deans have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, both deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

  12. "Making a Lion into a Pussycat": Working with Difficult Group Members

    ERIC Educational Resources Information Center

    Eckstein, Nancy J.

    2005-01-01

    Groups are defined as a small, interdependent group of individuals who share a common identity and interact with one another, usually face to face over time. While groups can be an effective way to explore issues and provide creative solutions to problems, rarely do members in groups get through the process without encountering a difficult group…

  13. Positive Behavioral Support: Including People with Difficult Behavior in the Community.

    ERIC Educational Resources Information Center

    Koegel, Lynn Kern, Ed.; And Others

    Twenty papers on positive behavioral support for people with difficult behavior are grouped into four sections: (1) family issues and family support; (2) education issues; (3) social inclusion; and (4) community inclusion. Papers include: "Parent Education for Prevention and Reduction of Severe Problem Behaviors" (Lynn Kern Koegel et…

  14. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in Paediatrics

    PubMed Central

    Pawar, Dilip K; Doctor, Jeson Rajan; Raveendra, Ubaradka S; Ramesh, Singaravelu; Shetty, Sumalatha Radhakrishna; Divatia, Jigeeshu Vasishtha; Myatra, Sheila Nainan; Shah, Amit; Garg, Rakesh; Kundra, Pankaj; Patwa, Apeksh; Ahmed, Syed Moied; Das, Sabyasachi; Ramkumar, Venkateswaran

    2016-01-01

    The All India Difficult Airway Association guidelines for the management of the unanticipated difficult tracheal intubation in paediatrics are developed to provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in children between 1 and 12 years of age. The incidence of unanticipated difficult airway in normal children is relatively rare. The recommendations for the management of difficult airway in children are mostly derived from extrapolation of adult data because of non-availability of proven evidence on the management of difficult airway in children. Children have a narrow margin of safety and mismanagement of the difficult airway can lead to disastrous consequences. In our country, a systematic approach to airway management in children is lacking, thus having a guideline would be beneficial. This is a sincere effort to protocolise airway management in children, using the best available evidence and consensus opinion put together to make airway management for children as safe as possible in our country. PMID:28003692

  15. Addressing Medical Errors in Hand Surgery

    PubMed Central

    Johnson, Shepard P.; Adkinson, Joshua M.; Chung, Kevin C.

    2014-01-01

    Influential think-tank such as the Institute of Medicine has raised awareness about the implications of medical errors. In response, organizations, medical societies, and institutions have initiated programs to decrease the incidence and effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is considerable effort to implement system-wide changes, there is little guidance for hand surgeons on how to address medical errors. Admitting an error is difficult, but a transparent environment where patients are notified of errors and offered consolation and compensation is essential to maintain trust. Further, equipping hand surgeons with a guide for addressing medical errors will promote compassionate patient interaction, help identify system failures, provide learning points for safety improvement, and demonstrate a commitment to ethically responsible medical care. PMID:25154576

  16. Navigation in Difficult Environments: Multi-Sensor Fusion Techniques

    DTIC Science & Technology

    2010-03-01

    data are applied to improve the robustness of secondary sensors’ signal processing. Applications of the multi-sensor fusion approach are illustrated...algorithms. 1.0 MOTIVATION Many existing and perspective applications of navigation systems would benefit notably from the ability to navigate...accurately and reliably in difficult environments. Examples of difficult navigation scenarios include urban canyons, indoor applications , radio

  17. The Bullard laryngoscope. Reports of two cases of difficult intubation.

    PubMed

    Midttun, M; Laerkholm Hansen, C; Jensen, K; Pedersen, T

    1994-04-01

    The Bullard laryngoscope is a new combination of a fibreoptic light source and an anatomically shaped rigid blade, to aid visualization of the larynx. We present two patients with expected severe difficult endotracheal intubation and describe their anaesthetic management. Our experience confirms previous observations which showed that the Bullard laryngoscope provides an excellent view of the vocal cords in patients with severe difficult airways.

  18. End-of-life issues: difficult decisions and dealing with grief.

    PubMed

    Loomis, Beth

    2009-06-01

    People face many challenging psychosocial and spiritual issues as they approach the end of their lives, and caregivers need advice on how to help them. Choosing among treatment options, handling grief, addressing unfinished business, and coping with loss of self-sufficiency are difficult for the dying person, and caregivers must deal with surrogate decision making, raw emotions in the patient and in family members, and the caregivers' own grief. Listening and coping skills are discussed.

  19. Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence.

    PubMed

    Sadler, Michelle; Santos, Mário Jds; Ruiz-Berdún, Dolores; Rojas, Gonzalo Leiva; Skoko, Elena; Gillen, Patricia; Clausen, Jette A

    2016-05-01

    During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices.

  20. The Reach Address Database (RAD)

    EPA Pesticide Factsheets

    The Reach Address Database (RAD) stores reach address information for each Water Program feature that has been linked to the underlying surface water features (streams, lakes, etc) in the National Hydrology Database (NHD) Plus dataset.

  1. Productive friction: how difficult business partnerships can accelerate innovation.

    PubMed

    Hagel, John; Brown, John Seely

    2005-02-01

    Companies are becoming more dependent on business partners, but coordinating with outsiders takes its toll. Negotiating terms, monitoring performance, and, if needs are not being met, switching from one partner to another require time and money. Such transaction costs, Ronald Coase explained in his 1937 essay "The Nature of the Firm," drove many organizations to bring their activities in-house. But what if Coase placed too much emphasis on these costs? What if friction between companies can be productive? Indeed, as John Hagel and John Seely Brown point out, interactions between organizations can yield benefits beyond the goods or services contracted for. Companies get better at what they do--and improve faster than their competitors--by working with outsiders whose specialized capabilities complement their own. Different enterprises bring different perspectives and competencies. When these enterprises tackle a problem together, they dramatically increase the chances for innovative solutions. Of course, misunderstandings often arise when people with different backgrounds and skill sets try to collaborate. Opposing sides may focus on the distance that separates them rather than the common challenges they face. How can companies harness friction so that it builds capabilities? Start by articulating performance goals that everyone buys into. Then make sure people are using tangible prototypes to wrangle over. Finally, assemble teams with committed people who bring different perspectives to the table. As individual problems are being addressed, take care that the underpinnings of shared meaning and trust are also being woven between the companies. Neither can be dictated--but they can be cultivated. Without them, the performance fabric quickly unravels, and business partnerships disintegrate into rivalrous competition.

  2. [Difficult patient in dentistry. Construction of a model of personal attributes for identification].

    PubMed

    Peñaranda Hernández, P M

    1989-01-01

    The communication between the dentist and the patient, or what we have called dentist-patient relationship constitute itself a clue to solve primary problems derived of the professional practice. In this relationship with patients, the dentist may face what we have called difficult patient. This difficult patient have several behavioral characteristics which can alter the dentist emotional equilibrium, the capacity of making proper diagnosis and finally a successful treatment may not be obtain as an end result. The difficult patient behavior may be explained by a variety of factors such as: the type of pathology, the office environment, the community and/or institution to which the patient belongs, the dentist emotional circumstance and at last the patient life style. In this research work, we interview 50 professionals from the metropolitan area with an average of 18 years in practiCe, each dentist explained situations in which the patient behavior could be typified as difficult. A number of 202 difficult patient cases were obtained and they were classified into 14 categories. 5 categories presented a higher frequency: a) Schedule and/or appointment timing. b) Patients not following instructions and/or altering treatment. c) Anxious patients. d) Patients unhappy with their treatment. e) Authoritarian patients or patients without good manners. This 5 categories were present in the 60% of the situations and can be taken as a model with specific behavioral characteristics as to identify the difficult patient. This is valuable in order to manage this type of patients and be successful.

  3. Problems and Approaches for Blood Transfusion in the Developing Countries.

    PubMed

    Roberts, David J; Field, Stephen; Delaney, Meghan; Bates, Imelda

    2016-04-01

    A safe supply of blood and the knowledge, skill, and resources for the appropriate use of blood are essential for medical services. Many problems are faced in the development of transfusion services in low- or medium-income countries (LMICs). Unfortunately, in many countries, providing safe blood is made more difficult by a lack of blood donors and the high frequency of transfusion-transmissible infections. The problems are compounded by the frequent need for urgent life-saving transfusions. This article examines the problems in supply, safety, and use of blood and how they are being addressed in LMICs, predominantly focusing on sub-Saharan Africa.

  4. Distraction during learning with hypermedia: difficult tasks help to keep task goals on track.

    PubMed

    Scheiter, Katharina; Gerjets, Peter; Heise, Elke

    2014-01-01

    In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when working on easy, but not on difficult tasks. In Experiment 1, 66 students learned about probability theory using worked examples and solved corresponding test problems, whose task difficulty was manipulated. As a second factor, the presence of interesting information unrelated to the primary task was varied. Results showed that students solved more easy than difficult probability problems correctly. However, the presence of interesting, but task-irrelevant information did not interfere with performance. In Experiment 2, 68 students again engaged in example-based learning and problem solving in the presence of task-irrelevant information. Problem-solving difficulty was varied as a first factor. Additionally, the presence of a pending goal related to the task-irrelevant information was manipulated. As expected, problem-solving performance declined when a pending goal was present during working on easy problems, whereas no interference was observed for difficult problems. Moreover, the presence of a pending goal reduced the time on task-relevant information and increased the time on task-irrelevant information while working on easy tasks. However, as revealed by mediation analyses these changes in overt information processing behavior did not explain the decline in problem-solving performance. As an alternative explanation it is suggested that goal conflicts resulting from pending goals claim cognitive resources, which are then no longer available for learning and problem solving.

  5. Emergency Difficult Airway Management in a Patient with Severe Epidermolysis Bullosa

    PubMed Central

    Özkan, Ahmet Selim; Kayhan, Gülay Erdoğan; Akbaş, Sedat; Kaçmaz, Osman; Durmuş, Mahmut

    2016-01-01

    Epidermolysis bullosa (EB) is a rare disease characterised by vesiculobullous lesions with minimal trauma to the skin and mucous membranes. Bleeding, scar tissue, contractures, oedema and lesions that can spread throughout the body can cause a difficult airway and vascular access in patients with EB. Therefore, anaesthetic management in patients with EB is a major problem even for experienced anaesthesiologists. Herein, we report a case of difficult airway management in a patient diagnosed with severe EB who presented for emergency tracheostomy because of respiratory failure under general anaesthesia. PMID:27909609

  6. Strategies and algorithms for management of the difficult airway.

    PubMed

    Heidegger, Thomas; Gerig, Hans J; Henderson, John J

    2005-12-01

    Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.

  7. Student homicidal violence in schools: an international problem.

    PubMed

    Bondü, Rebecca; Cornell, Dewey G; Scheithauer, Herbert

    2011-01-01

    School homicides have been become a worldwide phenomenon. In the decade following the Columbine shooting there have been at least forty similar events in other countries. This article addresses the international scope of this problem and some of the complex conceptual issues that make student homicidal violence difficult to define and study. Meaningful research on risk and protective factors that can inform evidence-based preventive models is summarized.

  8. Inflammatory bowel disease in adolescents: What problems does it pose?

    PubMed Central

    Lu, Ying; Markowitz, James

    2011-01-01

    Adolescents with inflammatory bowel disease face daily and long-term challenges that may be difficult for teenagers to manage. The developmental and psychosocial changes unique to this age group include becoming more autonomous and being more vulnerable to peer influence. These changes may lead to problems in medical management such as poor medication adherence and risky behavior. Being aware of these issues will help the medical team provide anticipatory guidance to address these concerns. PMID:21734775

  9. Analysis of Network Address Shuffling as a Moving Target Defense

    SciTech Connect

    Carroll, Thomas E.; Crouse, Michael B.; Fulp, Errin W.; Berenhaut, Kenneth S.

    2014-06-10

    Address shuffling is a type of moving target defense that prevents an attacker from reliably contacting a system by periodically remapping network addresses. Although limited testing has demonstrated it to be effective, little research has been conducted to examine the theoretical limits of address shuffling. As a result, it is difficult to understand how effective shuffling is and under what circumstances it is a viable moving target defense. This paper introduces probabilistic models that can provide insight into the performance of address shuffling. These models quantify the probability of attacker success in terms of network size, quantity of addresses scanned, quantity of vulnerable systems, and the frequency of shuffling. Theoretical analysis will show that shuffling is an acceptable defense if there is a small population of vulnerable systems within a large network address space, however shuffling has a cost for legitimate users. These results will also be shown empirically using simulation and actual traffic traces.

  10. CONTENT-ADDRESSABLE MEMORY SYSTEMS,

    DTIC Science & Technology

    The utility of content -addressable memories (CAM’s) within a general purpose computing system is investigated. Word cells within CAM may be...addressed by the character of all or a part of cell contents . Multimembered sets of word cells may be addressed simultaneously. The distributed logical...package is developed which allows simulation of CAM commands within job programs run on the IBM 7090 and derives tallies of execution times corresponding to a particular realization of a CAM system . (Author)

  11. Addressing the United States Debt and Deficit

    DTIC Science & Technology

    2010-03-01

    effectively with the American debt and deficit, by first describing the background of our current government approach to the economy , then examining the...to address the problem of deficit financing and the associated debt in a positive manner and thereby strengthen the economy of the United States...current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining what

  12. A Need to Address Illiteracy Problems in the Military Services.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    To determine the effects of deficient reading skills in the military service, researchers met with military and civilian officials from four recruit training centers, major research activities personnel, and the commands accountable for education and training. Next, questionnaires were sent to fifteen recruit training centers to obtain data on the…

  13. A Decision Aid for Addressing Supervisor Span of Control Problems

    DTIC Science & Technology

    1984-01-01

    34 SNALRT 2880 2880 2880 9 20 30 <- SAMMO 2880 1440 720 3 21 6 SMAINT 1440 1440 1440 5 22 40 "" SMED 1440 1440 1440 5 23 20 , TASK LIBRARY FOR THREE...5 22 60 SMED 1440 1440 1440 5 23 20 TASK LIBRARY FOR FOUR LAUNCHER PLATOON MOVE 1440 480 240 7 1 8 2 1 3 50 4 3 -------------_ 5 57 m 6 1 •7 1 8 50 9...2880 2880 9 20 30 SAMMO 2880 720 360 3 21 6 SMAINT 1440 1440 1440 5 22 80 SMED 1440 1440 1440 5 23 20 TASK LIBRARY FOR FIVE LAUNCHER PLATOON MOVE 1440

  14. Teachers' Engagement with Published Research: Addressing the Knowledge Problem

    ERIC Educational Resources Information Center

    Cain, Tim

    2015-01-01

    Despite the increased interest in research impact, there is very little empirical evidence that educational research can inform practice directly, and furthermore, a body of literature which suggests that this is, in principle, impossible. This paper reports on a study in which secondary school teachers were given research findings about teaching…

  15. New ways to develop biosensors towards addressing practical problems

    NASA Astrophysics Data System (ADS)

    Starodub, N. F.

    2013-11-01

    The main modern approaches which were realized at the development of new generation of biosensors intended for application in field of diagnostics, food quality control and environmental monitoring are presented. The main attention was paid to creation of the multi-parametrical and multi-functional enzymatic and immune biosensors which were realized for the complex diagnostics of diabetes, autoimmune state and for the control of process of sugar production. The label-free bioaffine devices based on the nano-porouse silicon (NPS) with the registration of specific formed signal by chemiluminescence (ChL) and photoresistivity and intended for the determination mycotoxins and diagnostics of retroviral bovine leukemia (RBL) are analyzed too. Improving of ion sensitive field effect transistors (ISFETs) through changing silicon nitride on the cerium oxide is discussed as perspective approach in case of micotoxins and Salmonella control. In the conclusion the possibility to replace biological sensitive elements by artificial ones is considered.

  16. Addressing the Problem of Service Teaching Introductory Economics Subjects

    ERIC Educational Resources Information Center

    Barrett, Steven

    2005-01-01

    Enrolments in undergraduate economics programs have been falling constantly since the early 1990s. This trend coincides with the increasing popularity of business and management degrees. Consequently, the major activity of many, if not most economics departments and schools in Australia is service teaching of introductory economics to first year…

  17. Addressing Problems with Scene-Based Wave Front Sensing

    SciTech Connect

    Chan, C

    2003-08-05

    Scene-Based Wave Front Sensing uses the correlation between successive subimages to determine phase aberrations which blur digital images. Adaptive Optics technology uses deformable mirrors to correct for these phase aberrations and make the images clearer. The correlation between temporal subimages gives tip-tilt information. If these images do not have identical image content, tip-tilt estimations may be incorrect. Motion detection is necessary to help avoid errors initiated by dynamic subimage content. In this document, I will discuss why edge detection fails as a motion detection method on low resolution images and how thresholding the normalized variance of individual pixels is successful for motion detection.

  18. phenix.mr_rosetta: a new tool for difficult molecular replacement problems

    SciTech Connect

    Terwilliger, Thomas C; Read, Randy; De Maio, Frank; Baker, David

    2011-01-12

    The PHENIX development team is working with the Baker laboratory at the University of Washington to combine the power of Rosetta structure modeling with PHENIX automated molecular replacement (MR), model-building, density modification, and refinement. The basic idea is to find MR solutions with phenix. automr, rebuild them with Rosetta, including electron density map information, then rebuild those models with phenix. autobuild. The combination of Rosetta rebuilding and phenix rebuilding is the key part of this method. MR solutions are found with phenix. automr (Phaser), scored with LLG (optionally following Rosetta relaxation), the best solutions are picked and rebuilt with Rosetta including map information, the resulting models are scored with Rosetta, and then rescored with LLG, and the top models are rebuilt with phenix. autobuild. It can be very useful for cases where the search model used in molecular replacement is slightly too distant to rebuild successfully with phenix. autobuild. It can also be useful in cases where the model is too distant to even find a molecular replacement solution, and prerefinement with Rosetta can yield an improved search model.

  19. The FDA and genetic testing: improper tools for a difficult problem

    PubMed Central

    Willmarth, Kirk

    2015-01-01

    The US Food and Drug Administration (FDA) has recently issued draft guidance on how it intends to regulate laboratory-developed tests, including genetic tests. This article argues that genetic tests differ from traditional targets of FDA regulation in both product as well as industry landscape, and that the FDA's traditional tools are ill-suited for regulating this space. While existing regulatory gaps do create risks in genetic testing, the regulatory burden of the FDA's proposal introduces new risks for both test providers and patients that may offset the benefits. Incremental expansion of current oversight outside of the FDA can mitigate many of the risks necessitating increased oversight while avoiding the creation of new ones that could undermine this industry. PMID:27774193

  20. The Syllis gracilis species complex: A molecular approach to a difficult taxonomic problem (Annelida, Syllidae).

    PubMed

    Álvarez-Campos, Patricia; Giribet, Gonzalo; Riesgo, Ana

    2017-04-01

    Syllis gracilis is an emblematic member of the subfamily Syllinae (Syllidae, Annelida), which inhabits shallow, temperate coastal waters and can be found on algae, coral rubble, and sponges. Their distinctive ypsiloid chaetae, usually found in specimens from populations all around the world, led to the consideration of the species as cosmopolitan, even though four other species have similar chaetae: Syllis magellanica, S. picta, S. mayeri and S. ypsiloides. The discovery of deeply divergent lineages in the Mediterranean Sea, that were morphologically similar, questioned the cosmopolitanism of S. gracilis and suggested the possibility of it being a species complex. In order to assess the speciation patterns within the putative S. gracilis complex, we undertook species delimitation and phylogenetic analyses on 61 specimens morphologically ascribed to Syllis gracilis and closely related species using a multilocus molecular dataset (two mitochondrial and two nuclear markers). Our results suggest high levels of genetic differentiation between the S. gracilis populations analyzed, some of which have morphologically distinctive features. Five to eight distinct lineages (depending on the analysis) were identified, all with geographically restricted distributions. Although the presence of ypsiloid chaetae has been traditionally considered the main character to identify S. gracilis, we conclude that this feature is homoplastic. Instead, we propose that characters such as the degree of fusion of blades and shafts in chaetae, the morphology of the posterior chaetae or the animal color pattern should be considered to differentiate lineages within the S. gracilis species complex. Our study does not support the cosmopolitanism of S. gracilis, and instead provides morphological and molecular evidence of the existence of a complex of pseudo-cryptic species.

  1. Solving difficult problems creatively: a role for energy optimised deterministic/stochastic hybrid computing

    PubMed Central

    Palmer, Tim N.; O’Shea, Michael

    2015-01-01

    How is the brain configured for creativity? What is the computational substrate for ‘eureka’ moments of insight? Here we argue that creative thinking arises ultimately from a synergy between low-energy stochastic and energy-intensive deterministic processing, and is a by-product of a nervous system whose signal-processing capability per unit of available energy has become highly energy optimised. We suggest that the stochastic component has its origin in thermal (ultimately quantum decoherent) noise affecting the activity of neurons. Without this component, deterministic computational models of the brain are incomplete. PMID:26528173

  2. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem.

    PubMed

    Berger, Zoltán; De La Fuente, Hernán; Meneses, Manuel; Matamala, Fernanda; Sepúlveda, Makarena; Rojas, Claudia

    2017-01-01

    We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  3. The FDA and genetic testing: improper tools for a difficult problem.

    PubMed

    Willmarth, Kirk

    2015-02-01

    The US Food and Drug Administration (FDA) has recently issued draft guidance on how it intends to regulate laboratory-developed tests, including genetic tests. This article argues that genetic tests differ from traditional targets of FDA regulation in both product as well as industry landscape, and that the FDA's traditional tools are ill-suited for regulating this space. While existing regulatory gaps do create risks in genetic testing, the regulatory burden of the FDA's proposal introduces new risks for both test providers and patients that may offset the benefits. Incremental expansion of current oversight outside of the FDA can mitigate many of the risks necessitating increased oversight while avoiding the creation of new ones that could undermine this industry.

  4. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem

    PubMed Central

    De La Fuente, Hernán; Meneses, Manuel; Matamala, Fernanda; Sepúlveda, Makarena; Rojas, Claudia

    2017-01-01

    We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis. PMID:28321347

  5. Addressing structural and observational uncertainty in resource management.

    PubMed

    Fackler, Paul; Pacifici, Krishna

    2014-01-15

    Most natural resource management and conservation problems are plagued with high levels of uncertainties, which make good decision making difficult. Although some kinds of uncertainties are easily incorporated into decision making, two types of uncertainty present more formidable difficulties. The first, structural uncertainty, represents our imperfect knowledge about how a managed system behaves. The second, observational uncertainty, arises because the state of the system must be inferred from imperfect monitoring systems. The former type of uncertainty has been addressed in ecology using Adaptive Management (AM) and the latter using the Partially Observable Markov Decision Processes (POMDP) framework. Here we present a unifying framework that extends standard POMDPs and encompasses both standard POMDPs and AM. The approach allows any system variable to be observed or not observed and uses any relevant observed variable to update beliefs about unknown variables and parameters. This extends standard AM, which only uses realizations of the state variable to update beliefs and extends standard POMDP by allowing more general stochastic dependence among the observable variables and the state variables. This framework enables both structural and observational uncertainty to be simultaneously modeled. We illustrate the features of the extended POMDP framework with an example.

  6. Regional anesthesia in difficult airway: The quest for a solution continues

    PubMed Central

    Khetarpal, Ranjana; Chatrath, Veena; Dhawan, Akshay; Attri, Joginder Pal

    2016-01-01

    Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words “regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks.” More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation. PMID:27212743

  7. Regional anesthesia in difficult airway: The quest for a solution continues.

    PubMed

    Khetarpal, Ranjana; Chatrath, Veena; Dhawan, Akshay; Attri, Joginder Pal

    2016-01-01

    Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks." More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation.

  8. Difficult airway equipment: a survey of standards across metropolitan Perth.

    PubMed

    Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S

    2014-09-01

    The importance of appropriate equipment to manage the difficult airway has been highlighted by the publication of the Australian and New Zealand College of Anaesthetists (ANZCA) guidelines in 2012. We set out to audit compliance with these guidelines in all public and private sites providing general anaesthesia in metropolitan Perth. Public and private health care websites identified 39 sites of which 37 were studied. Institutional and ethics approval was obtained. A tick-box design audit tool, based on the ANZCA guidelines, was used to collect information regarding the dedicated difficult airway container (DDAC) at each site. As recommended in the guidelines, only equipment within the DDAC was considered. Further data about each site, including the number of theatre suites, satellite anaesthetic areas, use of capnography and categories of patients treated (adult, obstetric and paediatric) were collected. An adult DDAC was found at 92% of all sites, but none of the sites had all the essential equipment listed in the ANZCA guidelines. There was limited provision of adult difficult airway equipment within private sites compared to public, and less provision of paediatric difficult airway equipment across all sites treating paediatric patients in metropolitan Perth. Capnography was available in 76% of post anaesthesia care units and used regularly in 27%. Adherence to the ANZCA guidelines regarding the DDAC could be improved. Standardised equipment across a metropolitan region would be of value in the management of the difficult airway.

  9. Preauricular skin tags and difficult tracheal intubation: a case report.

    PubMed

    Moschini, V; Collini, R

    2009-10-01

    Despite the large variety of equipment available for pediatric intubations, difficult tracheal intubation is still a main factor in deaths associated with anesthesia, especially in children with congenital anomalies of the airways or with rare diseases and syndromes. The aim of this study was to focus attention on the possibility of difficult intubation in children with preauricular tags. This condition is reported as both isolated and associated with more complex syndromes, including nephrourological anomalies and multiple craniofacial dysmorphysms. We retrospectively analyzed the anesthesia procedures for seven children (aged between 3 and 18 months) who underwent surgical ablation of preauricular tags between October 2006 and April 2008 at the Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena of Milan. Two of these children, both native residents of Sri Lanka, presented with a problematic airway and difficult tracheal intubation, which was suspected in one case but totally unexpected in the other. Considering the International Guidelines for difficult intubation in pediatrics and the data of other authors, our conclusions for how to approach a child with preauricular tags are: 1) to verify whether the defect is isolated or associated with other malformations; 2) to analyze the medical history and to perform an accurate physical examination to identify a possibly difficult airway; and 3) to not exceed three attempts to intubate and, if possible, to choose an alternative strategy.

  10. The difficult primary total knee arthroplasty: a review.

    PubMed

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

  11. Difficult asthma in adults: recognition and approaches to management.

    PubMed

    Harrison, B D W

    2005-09-01

    Difficult asthma must be distinguished from severe asthma. It is then important in patients with suspected difficult asthma to ensure that the diagnosis is correct, and that if the patient has asthma that the attributed symptoms are indeed all genuinely due to the asthma and not to coexisting physical or psychogenic respiratory conditions. It is also important to be alert when there is discordance between symptoms and objective lung function in order to recognize both poor perceivers and over-reactors. Difficult asthma can occur in patients with objectively mild, moderate or severe disease, but the consequences are most dramatic in patients with severe asthma. Asthma may be difficult for the patient, for the clinician or both because of disease factors, doctor or nurse therapist factors, and/or patient factors. Investigation requires access to the full range of respiratory, imaging and allergy tests. It also requires a multidisciplinary approach involving ear, nose and throat specialists and speech therapists, and access to psychiatric and psychological assessment and therapies. Poor compliance is associated with significantly poorer asthma and asthma-related health outcomes. Poor compliance can be recognized in two-thirds of such patients by their not attending scheduled appointments. Poor compliance is significantly associated with anxiety, social deprivation and adverse family circumstances, and these characteristics and adversities probably contribute to the poorly compliant behaviour. In difficult asthma it is important to identify and manage the condition causing the symptoms rather than prescribing more and more asthma therapy. Recognizing psychosocial adversity is essential. A structured approach is essential. There remains a small number of patients with genuine steroid-resistant asthma, some with predominately neutrophilic rather than eosinophilic airway inflammation, and others for whom the secondary gain of continuing symptoms is overwhelming. There is

  12. Non-attendance at a difficult-asthma clinic.

    PubMed

    McDonough, Beverley; Mault, Susan

    Increasing demand for our weekly difficult-asthma clinic means routine appointments are at a premium. This led us to explore the reasons why patients failed to attend for appointments and whether contacting them by telephone within a week of their missed scheduled appointment increased attendance. Memory lapses were the most common reason for non-attendance. Telephoning non-attenders led to a two-fold increase in attendance at subsequent clinics. Non-attendance may be a reflection of poor concordance, which, in itself, may contribute to a patient's difficult asthma.

  13. Treatment resistant depression in primary care: co-constructing difficult encounters.

    PubMed

    McPherson, Susan; Byng, Richard; Oxley, Donna

    2014-05-01

    Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients' atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings.

  14. Nonadherence in difficult asthma - facts, myths, and a time to act.

    PubMed

    Lindsay, John T; Heaney, Liam G

    2013-01-01

    Nonadherence to prescribed treatment is an important cause of difficult asthma. Rates of nonadherence amongst asthmatic patients have been shown to range between 30% and 70%. This is associated with poor health care outcomes and increased health care costs. There is no such thing as a "typical" nonadherent patient. The reasons driving nonadherence are multifactorial. Furthermore, adherence is a variable behavior and not a trait characteristic. Adherence rates can vary between the same individual across treatments for different conditions. There is no consistent link between socioeconomic status and nonadherence, and although some studies have shown that nonadherence is more common amongst females, this is not a universal finding. The commonly held perception that better adherence is driven by greater disease severity has been demonstrated to not be the case, in both pediatric and adult patients. Identification of nonadherence is the first step. If adherence is not checked, it is likely that poor adherence will be labeled as refractory disease. Failure to identify poor adherence may lead to inappropriate escalation of therapy, including the potential introduction of complex biological therapies. Surrogate measures, such as prescription counting, are not infallible. Nonadherence can be difficult to identify in clinical practice, and a systematic approach using a variety of tools is required. Nonadherence can be successfully addressed. Therefore, assessment of adherence is of paramount importance in difficult asthma management, in order to reduce exacerbations and steroid-related side effects as well as hospital and intensive care admissions, health care cost, and inappropriate treatment escalation. In this paper, we present an overview of the literature surrounding nonadherence in difficult asthma. We explore the facts and myths surrounding the factors driving nonadherence as well as how it can be identified and addressed.

  15. Creating a Caring Classroom in which to Teach Difficult Histories

    ERIC Educational Resources Information Center

    Sheppard, Maia G.

    2010-01-01

    This paper reports findings from a study that explored the classroom culture that developed in a university history classroom when the professor's pedagogical decisions encouraged students to make personal connections with difficult issues, events, and ideas in history and their own lives. The author describes how this experienced teacher…

  16. Complement Constructions in English: Fairly Difficult for EFL Language Learners

    ERIC Educational Resources Information Center

    Fazeli, Fatemeh; Shokrpour, Nasrin

    2012-01-01

    Complement constructions vary significantly in English and Persian. There are more complementation structures in English than in Persian and a complement structure in Persian might have more than one equivalent in English. Producing complement structures (CSs) in English is very difficult for native speakers of Persian, especially in an EFL…

  17. Optimising the management of patients with difficult asthma.

    PubMed

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction.

  18. Wagging the Dog: Managing Museum Priorities in a Difficult Economy

    ERIC Educational Resources Information Center

    Bradburne, James M.

    2010-01-01

    In these difficult financial times, it is more important than ever to manage money carefully. Educators who don't do so are vulnerable, for despite a thirty-year history of increasing authority and status within and without the museum, education departments are still more expendable than curatorial or collections departments in some museums. This…

  19. Disaffection and Inclusion: Merton's Mainstream Approach to Difficult Behaviour.

    ERIC Educational Resources Information Center

    Barrow, Giles

    This booklet describes an inclusive approach to disaffection in Merton Education Authority, a school district southwest of London (England). Instead of concentrating on providing for students with emotional and behavior difficulties in an off-site behavior support center, Merton switched its main efforts to preventing difficult behavior through…

  20. Confronting "Difficult Knowledge": Critical Aesthetics and War in the Classroom

    ERIC Educational Resources Information Center

    Heybach Vivirito, Jessica A.

    2012-01-01

    This qualitative multi-site case study explores critical aesthetic experiences in teacher education classrooms, and advocates for the inclusion of theoretical and practical knowledge of "difficult knowledge," visual culture, and critical aesthetics in the classroom. Social reality consists of a perpetual stream of tragic and horrific…

  1. Developing Difficult Dialogues: An Evaluation of Classroom Implementation

    ERIC Educational Resources Information Center

    Placier, Peggy; Kroner, Crystal; Burgoyne, Suzanne; Worthington, Roger

    2012-01-01

    The University of Missouri (MU) participated in the Ford Foundation's Difficult Dialogues Initiative (DDI) supporting faculty development projects at over 40 institutions of higher education from 2006-2010. This paper reports findings from an evaluation conducted with instructors who not only engaged in faculty development workshops but also…

  2. Attentional Capacity Allocation while Reading Easy and Difficult Text.

    ERIC Educational Resources Information Center

    Fleming, Kevin K.; Inhoff, Albrecht W.

    To examine the difference in attention capacity when reading difficult or easy text, a study presented text that varied in difficulty to 22 subjects via a computer monitor. The text was presented in a self-paced manner, one word at a time. Reading times for each word were obtained by computing latencies between key presses. Whenever a flashing…

  3. Nursing Home Consultation: Difficult Residents and Frustrated Staff.

    ERIC Educational Resources Information Center

    Block, Christopher; And Others

    1987-01-01

    Night shift nursing home aides who received in-service training in behavior therapy designed and implemented intervention programs for two of their most difficult residents. Describes programs and their outcomes. Discusses use of staff members as agents of behavior change. (Author/NB)

  4. Myth 5: Creativity Is Too Difficult to Measure

    ERIC Educational Resources Information Center

    Treffinger, Donald J.

    2009-01-01

    In his 1982 response to the myth that "creativity is too difficult to measure," Dr. Joe Khatena (a long-time contributor to the literature on creativity), characterized creativity as the "most exciting dimension of mental functioning." Building on a three-dimensional view of creativity (emphasizing the "individual," the "environment," and the…

  5. Privileged Identity Exploration: Examining Counselor Trainees' Reactions to Difficult Dialogues

    ERIC Educational Resources Information Center

    Watt, Sherry K.; Curtis, Gregg C.; Drummond, Jerri; Kellogg, Angela H.; Lozano, Adele; Nicoli, Gina Tagliapietra; Rosas, Marisela

    2009-01-01

    In this qualitative study, the authors examined master's-level counselor trainees' reactions to difficult dialogues in the classroom regarding racism, heterosexism/homophobia, and ableism over a 3-year period. Using the Consensual Qualitative Research method as introduced by C. E. Hill, B. J. Thompson, and E. N. Williams (1997), the data analysis…

  6. Why Reference to the Past Is Difficult for Agrammatic Speakers

    ERIC Educational Resources Information Center

    Bastiaanse, Roelien

    2013-01-01

    Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to the past is selectively impaired in agrammatic…

  7. Refugees and Migrants: Problems and Program Responses. A Look at the Causes and Consequences of Today's Major International Population Flows, and at the Ford Foundation's New Programs to Address the Problems of Refugees and Migrants in the United States and Elsewhere in the World. A Working Paper.

    ERIC Educational Resources Information Center

    Ford Foundation, New York, NY.

    The paper reflects the Ford Foundation's emphasis since 1980 on long-term problems of refugees and migrants across national borders, and the desire of the Foundation staff to strengthen the long-term capacity of key institutions and communities to cope with population flows. Focus is first on the consequences of migrant flows for sending and…

  8. Mind wandering while reading easy and difficult texts.

    PubMed

    Feng, Shi; D'Mello, Sidney; Graesser, Arthur C

    2013-06-01

    Mind wandering is a phenomenon in which attention drifts away from the primary task to task-unrelated thoughts. Previous studies have used self-report methods to measure the frequency of mind wandering and its effects on task performance. Many of these studies have investigated mind wandering in simple perceptual and memory tasks, such as recognition memory, sustained attention, and choice reaction time tasks. Manipulations of task difficulty have revealed that mind wandering occurs more frequently in easy than in difficult conditions, but that it has a greater negative impact on performance in the difficult conditions. The goal of this study was to examine the relation between mind wandering and task difficulty in a high-level cognitive task, namely reading comprehension of standardized texts. We hypothesized that reading comprehension may yield a different relation between mind wandering and task difficulty than has been observed previously. Participants read easy or difficult versions of eight passages and then answered comprehension questions after reading each of the passages. Mind wandering was reported using the probe-caught method from several previous studies. In contrast to the previous results, but consistent with our hypothesis, mind wandering occurred more frequently when participants read difficult rather than easy texts. However, mind wandering had a more negative influence on comprehension for the difficult texts, which is consistent with the previous data. The results are interpreted from the perspectives of the executive-resources and control-failure theories of mind wandering, as well as with regard to situation models of text comprehension.

  9. Difficult decisions in the surgical care of military casualties with major torso trauma.

    PubMed

    Bowley, D M; Jansen, J O; Nott, D; Sapsford, W; Streets, C G; Tai, N R M

    2011-09-01

    Testing and difficult decision-making is a sine qua non of surgical practice on military operations. Better pre-hospital care protocols, reduced evacuation timelines and increased scrutiny of outcome have rightfully emphasised the requirement of surgeons to "get it right, first time and every time" when treating patients. This article addresses five contentious areas concerning severe torso trauma, with relevant literature summarised by a subject matter expert, in order to produce practical guidance that will assist the newly deployed surgeon in delivering optimal clinical outcomes.

  10. Why is it so difficult to integrate ethics in Health Technology Assessment (HTA)? The epistemological viewpoint.

    PubMed

    Refolo, P; Sacchini, D; Brereton, L; Gerhardus, A; Hofmann, B; Lysdahl, K B; Mozygemba, K; Oortwijn, W; Tummers, M; van der Wilt, G J; Wahlster, P; Spagnolo, A G

    2016-10-01

    Ethics has been identified as a key element in Health Technology Assessment (HTA) since its conception. However, ethical issues are still not frequently addressed explicitly in HTA. Several valuable reasons have been identified. The basis of the article is the claim that ethics is often not part of HTA for "epistemological reasons". Hence, the main aim of the contribution is to explore in more details and emphasize them by using the fact/value dichotomy. Our conclusion is that current HTA configuration is predominantly based on the comparison among objective and empirically testable "facts", whilst ethics is not empirically testable. In this sense, there is a sort of "epistemological gap", which can explain why it is so difficult to integrate ethics in HTA. We suggest that the epistemological differences among the various domains of HTA are addressed more explicitly.

  11. Multi-Conformer Ensemble Docking to Difficult Protein Targets

    SciTech Connect

    Ellingson, Sally R.; Miao, Yinglong; Baudry, Jerome; Smith, Jeremy C.

    2014-09-08

    We investigate large-scale ensemble docking using five proteins from the Directory of Useful Decoys (DUD, dud.docking.org) for which docking to crystal structures has proven difficult. Molecular dynamics trajectories are produced for each protein and an ensemble of representative conformational structures extracted from the trajectories. Docking calculations are performed on these selected simulation structures and ensemble-based enrichment factors compared with those obtained using docking in crystal structures of the same protein targets or random selection of compounds. We also found simulation-derived snapshots with improved enrichment factors that increased the chemical diversity of docking hits for four of the five selected proteins. A combination of all the docking results obtained from molecular dynamics simulation followed by selection of top-ranking compounds appears to be an effective strategy for increasing the number and diversity of hits when using docking to screen large libraries of chemicals against difficult protein targets.

  12. The unrecognised difficult extubation: a call for vigilance.

    PubMed

    Antoine, J; Hussain, Z; El-Sayed, I; Apfel, C C

    2010-09-01

    Tracheal extubation remains a critical and often overlooked period of difficult airway management. A 66-year-old man, scheduled for C5-C7 anterior fusion, with an easy view of the vocal cords, presented with a sublaryngeal obstruction that required a reduced tracheal tube size. Despite correct tube placement, intra-operative ventilation remained difficult. At the end of surgery a pulsatile tracheal compression was fibreopticially observed above the carina. After discussion with the attending otolaryngologist, neuromuscular blockade was antagonised and the patient was able to maintain normal minute volumes while spontaneously ventilating. With the otolaryngologist present, and with the patient conscious, the trachea was successfully extubated over an airway exchange catheter. A subsequent CT scan revealed an impingement of the trachea by the innominate artery and a mildly ectatic ascending and descending aorta that, in conjunction with tracheomalacia and neuromuscular blockade, could explain the observed signs and symptoms.

  13. Endoscopic management of difficult common bile duct stones

    PubMed Central

    Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

    2013-01-01

    Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

  14. Long-duration animal tracking in difficult lighting conditions.

    PubMed

    Stern, Ulrich; Zhu, Edward Y; He, Ruo; Yang, Chung-Hui

    2015-07-01

    High-throughput analysis of animal behavior requires software to analyze videos. Such software typically depends on the experiments' being performed in good lighting conditions, but this ideal is difficult or impossible to achieve for certain classes of experiments. Here, we describe techniques that allow long-duration positional tracking in difficult lighting conditions with strong shadows or recurring "on"/"off" changes in lighting. The latter condition will likely become increasingly common, e.g., for Drosophila due to the advent of red-shifted channel rhodopsins. The techniques enabled tracking with good accuracy in three types of experiments with difficult lighting conditions in our lab. Our technique handling shadows relies on single-animal tracking and on shadows' and flies' being accurately distinguishable by distance to the center of the arena (or a similar geometric rule); the other techniques should be broadly applicable. We implemented the techniques as extensions of the widely-used tracking software Ctrax; however, they are relatively simple, not specific to Drosophila, and could be added to other trackers as well.

  15. Long-duration animal tracking in difficult lighting conditions

    NASA Astrophysics Data System (ADS)

    Stern, Ulrich; Zhu, Edward Y.; He, Ruo; Yang, Chung-Hui

    2015-07-01

    High-throughput analysis of animal behavior requires software to analyze videos. Such software typically depends on the experiments’ being performed in good lighting conditions, but this ideal is difficult or impossible to achieve for certain classes of experiments. Here, we describe techniques that allow long-duration positional tracking in difficult lighting conditions with strong shadows or recurring “on”/“off” changes in lighting. The latter condition will likely become increasingly common, e.g., for Drosophila due to the advent of red-shifted channelrhodopsins. The techniques enabled tracking with good accuracy in three types of experiments with difficult lighting conditions in our lab. Our technique handling shadows relies on single-animal tracking and on shadows’ and flies’ being accurately distinguishable by distance to the center of the arena (or a similar geometric rule); the other techniques should be broadly applicable. We implemented the techniques as extensions of the widely-used tracking software Ctrax; however, they are relatively simple, not specific to Drosophila, and could be added to other trackers as well.

  16. Long-duration animal tracking in difficult lighting conditions

    PubMed Central

    Stern, Ulrich; Zhu, Edward Y.; He, Ruo; Yang, Chung-Hui

    2015-01-01

    High-throughput analysis of animal behavior requires software to analyze videos. Such software typically depends on the experiments’ being performed in good lighting conditions, but this ideal is difficult or impossible to achieve for certain classes of experiments. Here, we describe techniques that allow long-duration positional tracking in difficult lighting conditions with strong shadows or recurring “on”/“off” changes in lighting. The latter condition will likely become increasingly common, e.g., for Drosophila due to the advent of red-shifted channelrhodopsins. The techniques enabled tracking with good accuracy in three types of experiments with difficult lighting conditions in our lab. Our technique handling shadows relies on single-animal tracking and on shadows’ and flies’ being accurately distinguishable by distance to the center of the arena (or a similar geometric rule); the other techniques should be broadly applicable. We implemented the techniques as extensions of the widely-used tracking software Ctrax; however, they are relatively simple, not specific to Drosophila, and could be added to other trackers as well. PMID:26130571

  17. Revisiting Tension Band Fixation for Difficult Patellar Fractures.

    PubMed

    Hambright, Dustin S; Walley, Kempland C; Hall, Amber; Appleton, Paul T; Rodriguez, Edward K

    2017-02-01

    Patella fractures with comminution, osteoporotic bone, and/or previously failed fixation are exceedingly difficult to reduce and fix. Moreover, the risk of symptomatic constructs and patients who are poorly compliant with postoperative activity restrictions can make these complex fracture patterns an even more challenging scenario. Although there is an array of techniques described for comminuted patella fractures, there lacks an accepted surgical technique for these difficult cases. In this clinical series, we describe an enhancement to the traditional tension band construct that uses additional wires and multiple tension bands to gather and fix comminuted fracture patterns in nontransverse planes, bolster osteoporotic bone, and secure fractures in patients undergoing a revision and/or have potential to be poorly compliant with postoperative activity restrictions. The clinical outcomes of 27 patients demonstrate high rates of bony union, functional range of motion, and low rates of both infection and failure. In conclusion, using the basic principles of tension band wiring remains highly versatile, useful, and economical in approaching difficult patella fractures.

  18. Current Trends in the Management of Difficult Urinary Catheterizations

    PubMed Central

    Willette, Paul A.; Coffield, Scott

    2012-01-01

    Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients. PMID:23359117

  19. A Task Force to Address Bullying.

    PubMed

    Keller, Ronald; Budin, Wendy C; Allie, Tammy

    2016-02-01

    Bullying in the workplace can create a dysfunctional environment that is associated with serious physical and psychological harm to the person being bullied. Nurses' experience with bullying has gained considerable attention in recent years, and warrants further discussion. Nurse leaders need to develop and implement effective bullying prevention initiatives that will foster the functioning of a professional and productive staff in a healthy work environment. The aim of this article is to review workplace bullying as experienced by nurses, and describe how nurses at a Magnet-designated academic medical center developed and implemented a bullying task force to address the problem.

  20. Every Other Day. Keynote Address.

    ERIC Educational Resources Information Center

    Tiller, Tom

    Schools need to be reoriented and restructured so that what is taught and learned, and the way in which it is taught and learned, are better integrated with young people's real-world experiences. Many indicators suggest that the meaningful aspects of school have been lost in the encounter with modern times. The title of this address--"Every…

  1. Agenda to address climate change

    SciTech Connect

    1998-10-01

    This document looks at addressing climate change in the 21st century. Topics covered are: Responding to climate change; exploring new avenues in energy efficiency; energy efficiency and alternative energy; residential sector; commercial sector; industrial sector; transportation sector; communities; renewable energy; understanding forests to mitigate and adapt to climate change; the Forest Carbon budget; mitigation and adaptation.

  2. Addressing Phonological Questions with Ultrasound

    ERIC Educational Resources Information Center

    Davidson, Lisa

    2005-01-01

    Ultrasound can be used to address unresolved questions in phonological theory. To date, some studies have shown that results from ultrasound imaging can shed light on how differences in phonological elements are implemented. Phenomena that have been investigated include transitional schwa, vowel coalescence, and transparent vowels. A study of…

  3. Keynote Address: Rev. Mark Massa

    ERIC Educational Resources Information Center

    Massa, Mark S.

    2011-01-01

    Rev. Mark S. Massa, S.J., is the dean and professor of Church history at the School of Theology and Ministry at Boston College. He was invited to give a keynote to begin the third Catholic Higher Education Collaborative Conference (CHEC), cosponsored by Boston College and Fordham University. Fr. Massa's address posed critical questions about…

  4. State of the Lab Address

    ScienceCinema

    King, Alex

    2016-07-12

    In his third-annual State of the Lab address, Ames Laboratory Director Alex King called the past year one of "quiet but strong progress" and called for Ames Laboratory to continue to build on its strengths while responding to changing expectations for energy research.

  5. Research strategies for addressing uncertainties

    USGS Publications Warehouse

    Busch, David E.; Brekke, Levi D.; Averyt, Kristen; Jardine, Angela; Welling, Leigh; Garfin, Gregg; Jardine, Angela; Merideth, Robert; Black, Mary; LeRoy, Sarah

    2013-01-01

    Research Strategies for Addressing Uncertainties builds on descriptions of research needs presented elsewhere in the book; describes current research efforts and the challenges and opportunities to reduce the uncertainties of climate change; explores ways to improve the understanding of changes in climate and hydrology; and emphasizes the use of research to inform decision making.

  6. The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments

    PubMed Central

    Shatté, Andrew; Perlman, Adam; Smith, Brad; Lynch, Wendy D.

    2017-01-01

    Objective: To examine whether resilience has a protective effect in difficult work environments. Methods: A survey of 2063 individuals measured individual resilience, stress, burnout, sleep problems, likelihood of depression, job satisfaction, intent to quit, absences, and productivity. It also measured work characteristics: job demands, job influence, and social support. Multivariate and logistic regression models examined the main effects and interactions of resilience and job characteristics. Results: High strain work environments (high demand, low influence, and low support) have an unfavorable effect on all outcomes. Resilience has a protective effect on all outcomes. For stress, burnout, and sleep, higher resilience has a more protective effect under low-strain conditions. For depression, absence and productivity, resilience has a more protective effect when job strain is high. Conclusions: Workers with high resilience have better outcomes in difficult work environments. PMID:28002352

  7. How to motivate your problem people.

    PubMed

    Nicholson, Nigel

    2003-01-01

    Managers who motivate with incentives and the power of their vision and passion succeed only in energizing employees who want to be motivated. So how do you motivate intractable employees--the ones who never do what you want and also take up all your time? According to Nigel Nicholson, you can't: Individuals must motivated themselves. Nicholson advocates a method that turns conventional approaches to motivation upside down. Instead of pushing solutions on problem employees, the manager should pull solutions out of them by creating circumstances in which the employees can channel their motivation toward achievable goals. That means addressing any obstacles-possibly even the manager's own demotivating style--that might be hindering the employees. The author's method demands that a manager take charge of a difficult situation and resolve it. An investment of time is required, but it will bring the manager to a resolution sooner than other means would. Using detailed examples, Nicholson walks the reader through his method, pointing out potential pitfalls along the way. First, the manager creates a rich picture of the problem person. Second, the manager exercises flexibility and reframes goals so that the employee can meet them. Third, in a carefully staged, face-to-face conversation, the manager meets with the problem employee on neutral ground. Whether a problem is solved or simply resolved, the payoffs from using this method extend beyond the specific employees who have been difficult to motivate. Besides increasing a manager's chances of motivation problem people, the method can inspire an entire team by signaling that the organization deals with difficult people rather than discarding them.

  8. Advancing efforts to address youth violence involvement.

    PubMed

    Weist, M D; Cooley-Quille, M

    2001-06-01

    Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

  9. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

    PubMed Central

    Myatra, Sheila Nainan; Shah, Amit; Kundra, Pankaj; Patwa, Apeksh; Ramkumar, Venkateswaran; Divatia, Jigeeshu Vasishtha; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Ahmed, Syed Moied; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Garg, Rakesh

    2016-01-01

    The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart. PMID:28003690

  10. Non-adherence in difficult asthma: time to take it seriously.

    PubMed

    Heaney, Liam G; Horne, Rob

    2012-03-01

    Recent studies have demonstrated a high prevalence of non-adherence with anti-inflammatory medication in patients referred for specialist assessment with difficult-to-control asthma. As well as poor asthma outcome and increased healthcare cost, failure to detect non-adherence makes identification of true treatment-resistant/refractory asthma challenging. This is because guideline definitions of refractory asthma are all predicated on failure to respond to high-dose anti-inflammatory therapy but do not state how adherence with this therapy should be assessed. With the advent of novel expensive biological therapies, the systematic identification of non-adherence becomes more essential to avoid targeting therapies at an inappropriate patient group. Novel biomarkers of steroid exposure, in combination with more traditional surrogate measures such as prescription filling assessment, may allow more objective assessments of non-adherence to be developed in the future. When identified, non-adherence can potentially be targeted and improved, but the key challenge is to empower patients to make informed choices about medicines rather than decisions influenced by misplaced beliefs about benefit and harm. There is an urgent need for the systematic development of individualised interventions which allow non-adherence to be effectively managed. Thus, non-adherence must become a priority in the clinical assessment of difficult-to-control asthma because addressing non-adherence is likely to deliver greater benefits in this group than any novel treatment. It is essential that future research examines strategies and interventions to address non-adherence in subjects with difficult-to-control asthma.

  11. Promoting Interdisciplinary Collaboration: Trainees Addressing Siloed Medical Education

    ERIC Educational Resources Information Center

    Kitts, Robert Li; Christodoulou, Joanna; Goldman, Stuart

    2011-01-01

    Objective: Professional siloing within medical institutions has been identified as a problem in medical education, including resident training. The authors discuss how trainees from different disciplines can collaborate to address this problem. Method: A group of trainees from psychiatry, developmental medicine, neurology, and education came…

  12. Encountering the Foreign: Teaching and Learning with Difficult Artworks

    ERIC Educational Resources Information Center

    Hanson, Kristan M.

    2014-01-01

    In this article the author addresses one of the essential questions that face teachers today: How can we welcome the foreign into our lessons in an authentic way that makes education relevant to the ongoing social, cultural, and political dialogues through which diverse learners understand themselves and their worlds? In response to this question,…

  13. Cystic hygroma: A difficult airway and its anaesthetic implications

    PubMed Central

    Gurulingappa; Awati, M N; Aleem, Md Asif

    2011-01-01

    A 2-month-old child presented with gross and huge swelling on the left side of the neck with difficulty in feeding. It was diagnosed to be cystic hygroma and a decision was made to excise the swelling to enable the child thrive better. Difficult intubation was anticipated and the child was intubated with inhalation induction. The intra-operative period was smooth and the tumour was excised completely. Post-operatively, it was decided to ventilate the child because of airway difficulties. PMID:22223912

  14. Contentious Conversations: Using Mediation Techniques in Difficult Clinical Ethics Consultations.

    PubMed

    Fiester, Autumn

    2015-01-01

    Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)-and surely the least discussed-are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with "difficult" patients, families, or patient-careprovider interactions.

  15. Occupational medicine and the construction of "difficult reputations".

    PubMed

    Guidotti, Tee L

    2008-01-01

    The creation of "difficult reputations" is a collective act of disparagement often undertaken to diminish the influence of the target individual or group for political reasons. This process can be observed in efforts to discredit the field of occupational medicine and the American College of Occupational and Environmental Medicine (ACOEM) by revising its history. Examples are given from Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' and LaDou, in which new sources of historical information do not support the allegations or impressions conveyed. This tendency is inimical to progress in occupational health in general and may be highly destructive to the field if not recognized and discouraged.

  16. Addressing language barriers to healthcare in India.

    PubMed

    Narayan, Lalit

    2013-01-01

    In spite of a growing recognition of the importance of doctor-patient communication, the issue of language barriers to healthcare has received very little attention in India. The Indian population speaks over 22 major languages with English used as the lingua franca for biomedicine. Large-scale internal migration has meant that health workers are encountering increasing instances of language discordance within clinical settings. Research done predominantly in the West has shown language discordance to significantly affect access to care, cause problems of comprehension and adherence, and decrease the satisfaction and quality of care. Addressing language barriers to healthcare in India requires a stronger political commitment to providing non-discriminatory health services, especially to vulnerable groups such as illiterate migrant workers. Research will have to address three broad areas: the ways in which language barriers affect health and healthcare, the efficacy of interventions to overcome language barriers, and the costs of language barriers and efforts to overcome them. There is a need to address such barriers in health worker education and clinical practice. Proven strategies such as hiring multilingual healthcare workers, providing language training to health providers, employing in situ translators or using telephone interpretation services will have to be evaluated for their appropriateness to the Indian context. Internet-based initiatives, the proliferation of mobile phones and recent advances in machine translation promise to contribute to the solution.

  17. The anterior open bite problem (infraclusion).

    PubMed

    Champagne, M

    1995-06-01

    Anterior open bite is a major orthodontic problem that is very difficult to treat (Fig. 1). It may not be the most frequent problem but it is a major functional problem. Quite often it is very difficult to correct an anterior open bite problem and even more difficult to treat in an adult after growth. Most of the time anterior open bite is a myofunctional problem related to a bad habit like thumb or finger sucking and/or is related to a breathing and swallowing problem. How can we understand the functional open bite problem? What are the available treatment options? This article will try to answer some of these questions.

  18. Atomic clusters with addressable complexity

    NASA Astrophysics Data System (ADS)

    Wales, David J.

    2017-02-01

    A general formulation for constructing addressable atomic clusters is introduced, based on one or more reference structures. By modifying the well depths in a given interatomic potential in favour of nearest-neighbour interactions that are defined in the reference(s), the potential energy landscape can be biased to make a particular permutational isomer the global minimum. The magnitude of the bias changes the resulting potential energy landscape systematically, providing a framework to produce clusters that should self-organise efficiently into the target structure. These features are illustrated for small systems, where all the relevant local minima and transition states can be identified, and for the low-energy regions of the landscape for larger clusters. For a 55-particle cluster, it is possible to design a target structure from a transition state of the original potential and to retain this structure in a doubly addressable landscape. Disconnectivity graphs based on local minima that have no direct connections to a lower minimum provide a helpful way to visualise the larger databases. These minima correspond to the termini of monotonic sequences, which always proceed downhill in terms of potential energy, and we identify them as a class of biminimum. Multiple copies of the target cluster are treated by adding a repulsive term between particles with the same address to maintain distinguishable targets upon aggregation. By tuning the magnitude of this term, it is possible to create assemblies of the target cluster corresponding to a variety of structures, including rings and chains.

  19. Multi-Conformer Ensemble Docking to Difficult Protein Targets

    DOE PAGES

    Ellingson, Sally R.; Miao, Yinglong; Baudry, Jerome; ...

    2014-09-08

    We investigate large-scale ensemble docking using five proteins from the Directory of Useful Decoys (DUD, dud.docking.org) for which docking to crystal structures has proven difficult. Molecular dynamics trajectories are produced for each protein and an ensemble of representative conformational structures extracted from the trajectories. Docking calculations are performed on these selected simulation structures and ensemble-based enrichment factors compared with those obtained using docking in crystal structures of the same protein targets or random selection of compounds. We also found simulation-derived snapshots with improved enrichment factors that increased the chemical diversity of docking hits for four of the five selected proteins.more » A combination of all the docking results obtained from molecular dynamics simulation followed by selection of top-ranking compounds appears to be an effective strategy for increasing the number and diversity of hits when using docking to screen large libraries of chemicals against difficult protein targets.« less

  20. Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

    PubMed Central

    Shin, Minho; Choi, Namkyu; Yoo, Youngsun; Kim, Yooseok; Kim, Sungsoo

    2016-01-01

    Purpose Laparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA). Methods We retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA. Results A total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients. Conclusion LSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC. PMID:27847794

  1. Receiving difficult news. Views of patients in an inpatient setting.

    PubMed

    Cleary, Michelle; Hunt, Glenn E; Escott, Phil; Walter, Garry

    2010-06-01

    For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than be ing told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients' questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.

  2. High Metal Removal Rate Process for Machining Difficult Materials

    SciTech Connect

    Bates, Robert; McConnell, Elizabeth

    2016-06-29

    Machining methods across many industries generally require multiple operations to machine and process advanced materials, features with micron precision, and complex shapes. The resulting multiple machining platforms can significantly affect manufacturing cycle time and the precision of the final parts, with a resultant increase in cost and energy consumption. Ultrafast lasers represent a transformative and disruptive technology that removes material with micron precision and in a single step manufacturing process. Such precision results from athermal ablation without modification or damage to the remaining material which is the key differentiator between ultrafast laser technologies and traditional laser technologies or mechanical processes. Athermal ablation without modification or damage to the material eliminates post-processing or multiple manufacturing steps. Combined with the appropriate technology to control the motion of the work piece, ultrafast lasers are excellent candidates to provide breakthrough machining capability for difficult-to-machine materials. At the project onset in early 2012, the project team recognized that substantial effort was necessary to improve the application of ultrafast laser and precise motion control technologies (for micromachining difficult-to-machine materials) to further the aggregate throughput and yield improvements over conventional machining methods. The project described in this report advanced these leading-edge technologies thru the development and verification of two platforms: a hybrid enhanced laser chassis and a multi-application testbed.

  3. Books to Help Kids Deal with Difficult Times, I.

    ERIC Educational Resources Information Center

    Klein, Norma

    1987-01-01

    An author of books for young adults discusses the need for realism in adolescent literature as a means of helping teenagers to cope with real problems and describes her most recent book, which deals with euthanasia. (CLB)

  4. Rethinking of photodynamic therapy on cerebral glioma: the difficult of necrotic tissue exclusion and its sequence

    NASA Astrophysics Data System (ADS)

    Qiu, Yongming; Lu, Zhaofeng; Liu, Zhe; Luo, Qi-Zhong

    2005-07-01

    The photodynamic therapy of cerebral gliomas is one kind of adjunctive therapy after operative tumor removal. But it is not widely accepted until now. We report two cases of failure treatment in our totally consecutive ten patients treated with this method and analyse the cause of the poor outcome. Unlike the uninary system and digest system, the difficult of necrotic tumor or brain tissue exclusion in the brain is marked and resulted in poor result. Our view is that the problem of massive necrotic tumor tissue exclusion which is the wish of therapist and the key of achieving good result might limit the further application of photodynamic therapy on cerebral gliomas.

  5. Orthopedic problems in geriatric dogs and cats.

    PubMed

    Beale, Brian S

    2005-05-01

    Senior dogs and cats with orthopedic injuries and diseases often require a treatment plan that differs from that of younger patients. Injured bone and soft tissues tend to heal more slowly in the geriatric patient. The older animal is likely to have a less competent immune system and may have compromised metabolic and endocrine function. Pre-existing musculoskeletal problems may make ambulation difficult for an animal convalescing from a new orthopedic problem. Special attention is often needed when treating these patients for fractures, joint instability, infection, and neoplasia. In general, issues that should be addressed in the geriatric patient include reducing intraoperative and anesthesia time, enhancing bone and soft tissue healing, return to early function, control of postoperative pain, physical therapy, and proper nutrition.

  6. Image Coding Based on Address Vector Quantization.

    NASA Astrophysics Data System (ADS)

    Feng, Yushu

    Image coding is finding increased application in teleconferencing, archiving, and remote sensing. This thesis investigates the potential of Vector Quantization (VQ), a relatively new source coding technique, for compression of monochromatic and color images. Extensions of the Vector Quantization technique to the Address Vector Quantization method have been investigated. In Vector Quantization, the image data to be encoded are first processed to yield a set of vectors. A codeword from the codebook which best matches the input image vector is then selected. Compression is achieved by replacing the image vector with the index of the code-word which produced the best match, the index is sent to the channel. Reconstruction of the image is done by using a table lookup technique, where the label is simply used as an address for a table containing the representative vectors. A code-book of representative vectors (codewords) is generated using an iterative clustering algorithm such as K-means, or the generalized Lloyd algorithm. A review of different Vector Quantization techniques are given in chapter 1. Chapter 2 gives an overview of codebook design methods including the Kohonen neural network to design codebook. During the encoding process, the correlation of the address is considered and Address Vector Quantization is developed for color image and monochrome image coding. Address VQ which includes static and dynamic processes is introduced in chapter 3. In order to overcome the problems in Hierarchical VQ, Multi-layer Address Vector Quantization is proposed in chapter 4. This approach gives the same performance as that of the normal VQ scheme but the bit rate is about 1/2 to 1/3 as that of the normal VQ method. In chapter 5, a Dynamic Finite State VQ based on a probability transition matrix to select the best subcodebook to encode the image is developed. In chapter 6, a new adaptive vector quantization scheme, suitable for color video coding, called "A Self -Organizing

  7. Toward Solving the Problem of Problem Solving: An Analysis Framework

    ERIC Educational Resources Information Center

    Roesler, Rebecca A.

    2016-01-01

    Teaching is replete with problem solving. Problem solving as a skill, however, is seldom addressed directly within music teacher education curricula, and research in music education has not examined problem solving systematically. A framework detailing problem-solving component skills would provide a needed foundation. I observed problem solving…

  8. Predictors of Difficult Intubation Among Malay Patients in Indonesia

    PubMed Central

    Tantri, Aida Rosita; Firdaus, Riyadh; Salomo, Sahat Tumpal

    2016-01-01

    Background Failure to maintain an adequate airway can lead to brain damage and death. To reduce the risk of difficulty in maintaining an airway during general anesthesia, there are several known predictors of difficult intubation. People with a Malay background have different craniofacial structures in comparison with other individuals. Therefore, different predictors should be used for patients of Malay race. Objectives The aim of this study was to determine the ability to predict difficult visualization of the larynx (DVL) in Malay patients based on several predictors, such as the modified Mallampati test (MMT), thyromental distance (TMD), and hyomental distance ratio (HMDR). Patients and Methods This cross-sectional study included 277 consecutive patients requiring general anesthesia. All subjects were evaluated using the MMT, TMD, and HMDR, and the cut-off points for the airway predictors were Mallampati III and IV, < 6.5 cm, and < 1.2, respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack-Lehane (CL) classification. CL grades III and IV were considered difficult visualization. The area under the curve (AUC), sensitivity, and specificity for each predictor were calculated both as sole and combined predictors. Logistic regression analysis was used to determine independent predictors of DVL. Results Difficulty in visualizing the larynx was found in 28 (10.1%) patients. The AUC, sensitivity, and specificity for the three airway predictors were as follows: MMT: 0.614, 10.7%, and 99.2%; HMDR: 0.743, 64.2%, and 74%; and TMD: 0.827, 82.1%, and 64.7%. The combination providing the best prediction in our study involved the MMT, HMDR, and TMD with an AUC, sensitivity, and specificity of 0.835, 60.7%, and 88.8%, respectively. Logistic regression analysis showed that the MMT, HMDR, and TMD were independent predictors of DVL. Conclusions The TMD, with a cut-off point of 65 mm, had superior diagnostic value compared with the HMDR and

  9. The bogeyman cometh: a strategic approach for difficult adolescents.

    PubMed

    O'Connor, J J; Hoorwitz, A N

    1984-06-01

    Unpredictable and threatening events can sometimes alter one's view of reality. The altered perception may in turn result in altered forms of behavior and interaction with others. Deliberate efforts to facilitate this altered perception is sometimes attempted by invoking mythical forces such as the Bogeyman, Death, Satan, a shaman, or a sorcerer. Anthropological observations of shamanic magic suggest a number of components that appear to be responsible for these reality-altering experiences. These can be employed to create such experiences in the treatment of difficult adolescents for whom usual solutions have been ineffective. The experience results in systemic changes that render the adolescent accessible to more usual forms of treatment and more functional interactions with adults. The crafting of this kind of experience is illustrated in a case example. Parallels with other clinical practices as well as ethical considerations are discussed.

  10. Implications of the KONVERGENCE Model for Difficult Cleanup Decisions

    SciTech Connect

    Piet, Steven James; Dakins, Maxine Ellen; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon

    2002-08-04

    Abstract—Some cleanup decisions, such as cleanup of intractable contaminated sites or disposal of spent nuclear fuel, have proven difficult to make. Such decisions face high resistance to agreement from stakeholders possibly because they do not trust the decision makers, view the consequences of being wrong as too high, etc. Our project’s goal is to improve sciencebased cleanup decision-making. This includes diagnosing intractable situations, as a step to identifying a path toward sustainable solutions. Companion papers describe the underlying philosophy of the KONVERGENCE Model for Sustainable Decisions,1 and the overall framework and process steps.2 Where knowledge, values, and resources converge (the K, V, and R in KONVERGENCE), you will find a sustainable decision – a decision that works over time. For intractable cases, serious consideration of the adaptable class of alternatives is warranted – if properly implemented and packaged.

  11. Paradoxical pop-ups: Why are they difficult to catch?

    NASA Astrophysics Data System (ADS)

    McBeath, Michael K.; Nathan, Alan M.; Bahill, A. Terry; Baldwin, David G.

    2008-08-01

    Professional baseball players occasionally find it difficult to gracefully approach seemingly routine pop-ups. We describe a set of towering pop-ups with trajectories that exhibit cusps and loops near the apex. For a normal fly ball the horizontal velocity continuously decreases due to drag caused by air resistance. For pop-ups the Magnus force is larger than the drag force. In these cases the horizontal velocity initially decreases like a normal fly ball, but after the apex, the Magnus force accelerates the horizontal motion. We refer to this class of pop-ups as paradoxical because they appear to misinform the typically robust optical control strategies used by fielders and lead to systematic vacillation in running paths, especially when a trajectory terminates near the fielder. Former major league infielders confirm that our model agrees with their experiences.

  12. Sampling in difficult to access refugee and immigrant communities.

    PubMed

    Spring, Marline; Westermeyer, Joseph; Halcon, Linda; Savik, Kay; Robertson, Cheryl; Johnson, David R; Butcher, James N; Jaranson, James

    2003-12-01

    We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999-2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.

  13. Various applications of endoscopic scissors in difficult endoscopic interventions.

    PubMed

    Kee, Won-Ju; Park, Chang-Hwan; Chung, Kyoung-Myeun; Park, Seon-Young; Jun, Chung-Hwan; Ki, Ho-seok; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2014-05-01

    Endoscopic scissors offer a benefit over other devices by avoiding potential complications related to thermal and mechanical injury of surrounding structures. We describe our experience with endoscopic scissors in three difficult endoscopic interventions. A fishbone embedded in the esophageal wall penetrated very close to the pulsating aorta and the bronchus. The fishbone was cut in half by endoscopic scissors and removed without injury to adjacent organs. A gastric submucosal tumor with an insulated core that could not be resected by electrosurgical devices was cut using endoscopic scissors following endoloop placement. Extravascular coil migration after transcatheter arterial embolization resulted in a duodenal ulcer. The metallic coil on the duodenal ulcer was cut by endoscopic scissors without mechanical or thermal injury.

  14. Identifying and Addressing Vaccine Hesitancy

    PubMed Central

    Kestenbaum, Lori A.; Feemster, Kristen A.

    2015-01-01

    In the 20th century, the introduction of multiple vaccines significantly reduced childhood morbidity, mortality, and disease outbreaks. Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as vaccine hesitant. This phenomenon has developed due to the confluence of multiple social, cultural, political and personal factors. As immunization programs continue to expand, understanding and addressing vaccine hesitancy will be crucial to their successful implementation. This review explores the history of vaccine hesitancy, its causes, and suggested approaches for reducing hesitancy and strengthening vaccine acceptance. PMID:25875982

  15. Identifying and addressing vaccine hesitancy.

    PubMed

    Kestenbaum, Lori A; Feemster, Kristen A

    2015-04-01

    In the 20th century, the introduction of multiple vaccines significantly reduced childhood morbidity, mortality, and disease outbreaks. Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as "vaccine hesitant." This phenomenon has developed due to the confluence of multiple social, cultural, political, and personal factors. As immunization programs continue to expand, understanding and addressing vaccine hesitancy will be crucial to their successful implementation. This review explores the history of vaccine hesitancy, its causes, and suggested approaches for reducing hesitancy and strengthening vaccine acceptance.

  16. Nanoscale content-addressable memory

    NASA Technical Reports Server (NTRS)

    Davis, Bryan (Inventor); Principe, Jose C. (Inventor); Fortes, Jose (Inventor)

    2009-01-01

    A combined content addressable memory device and memory interface is provided. The combined device and interface includes one or more one molecular wire crossbar memories having spaced-apart key nanowires, spaced-apart value nanowires adjacent to the key nanowires, and configurable switches between the key nanowires and the value nanowires. The combination further includes a key microwire-nanowire grid (key MNG) electrically connected to the spaced-apart key nanowires, and a value microwire-nanowire grid (value MNG) electrically connected to the spaced-apart value nanowires. A key or value MNGs selects multiple nanowires for a given key or value.

  17. Addressing inequities in healthy eating.

    PubMed

    Friel, Sharon; Hattersley, Libby; Ford, Laura; O'Rourke, Kerryn

    2015-09-01

    What, when, where and how much people eat is influenced by a complex mix of factors at societal, community and individual levels. These influences operate both directly through the food system and indirectly through political, economic, social and cultural pathways that cause social stratification and influence the quality of conditions in which people live their lives. These factors are the social determinants of inequities in healthy eating. This paper provides an overview of the current evidence base for addressing these determinants and for the promotion of equity in healthy eating.

  18. Addressing the workforce pipeline challenge

    SciTech Connect

    Leonard Bond; Kevin Kostelnik; Richard Holman

    2006-11-01

    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  19. Performance specifications: the nearly impossible versus the merely difficult

    NASA Astrophysics Data System (ADS)

    Hopper, Darrel G.

    2000-08-01

    Affordability is the objective of acquisition reform. The institution of 'performance' specifications in lieu of 'design' specifications is a key strategy. Design of a cockpit display, for example, is left to the prime contractor based on a performance requirement stated by the government. The prime delegates to the integrator. The integrator develops the display and bill of materials provided by vendors. There is no feedback loop from the vendors to the ultimate customer, the government. As a result of this situation a communication gap exists: the government, primes, and integrators have concluded that they should pay commodity prices for custom displays. One step in the closing of this gap is the establishment of cross- cutting common reference performance specifications for aerospace and defense displays. The performance specification for cockpit displays is nearly impossible to achieve -- the last ounce of technology and more is required. Commodity markets, such as consumer notebook computers, are based on but a fraction of currently available technology -- companies 'bank' technology and roll it out across several 18-month product generations. Ruggedized consumer displays can be used in aerospace and defense applications other than the cockpit, such as mission crew stations. The performance specification for non-cockpit aerospace and defense applications is merely difficult. Acquisition reform has been defined by the Secretary of Defense to mean DoD should leverage the commercial market to the maximal extent possible. For the achievement of this end, an entirely different approach is wanted for cockpit displays versus large platform mission displays. That is, the nearly impossible requires a different design and business approach from the merely difficult.

  20. Rural Health Issues. Keynote Address.

    ERIC Educational Resources Information Center

    Hart, Gary

    Medical students that come from rural areas are more likely to return to rural areas to practice, but rural students apply for medical school at half the rate of urban students. Factors that contribute to this problem are the lack of rural representation on medical school selection committees; centralization of medical education facilities in…

  1. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects.

    PubMed

    Mahajan, Khushbu; Relhan, Vineet; Relhan, Aditi Kochhar; Garg, Vijay Kumar

    2016-01-01

    Pityriasis rosea (PR) is a benign papulosquamous disorder seen commonly in clinical practice. Despite its prevalence and benign nature, there are still times when this common disorder presents in an uncommon way or course posing diagnostic or management problems for the treating physician. The etiopathogenesis of PR has always been a dilemma, and extensive research is going on to elicit the exact cause. This review focuses mainly on the difficult aspects of this benign common disorder such as etiopathogenesis, atypical manifestations, recurrent cases, differential diagnosis, therapy and pregnancy considerations. Although we could not find a black and white solution to all these problems, we have tried to compile the related literature to draw out some conclusions.

  2. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects

    PubMed Central

    Mahajan, Khushbu; Relhan, Vineet; Relhan, Aditi Kochhar; Garg, Vijay Kumar

    2016-01-01

    Pityriasis rosea (PR) is a benign papulosquamous disorder seen commonly in clinical practice. Despite its prevalence and benign nature, there are still times when this common disorder presents in an uncommon way or course posing diagnostic or management problems for the treating physician. The etiopathogenesis of PR has always been a dilemma, and extensive research is going on to elicit the exact cause. This review focuses mainly on the difficult aspects of this benign common disorder such as etiopathogenesis, atypical manifestations, recurrent cases, differential diagnosis, therapy and pregnancy considerations. Although we could not find a black and white solution to all these problems, we have tried to compile the related literature to draw out some conclusions. PMID:27512182

  3. Books to Help Kids Deal with Difficult Times, II.

    ERIC Educational Resources Information Center

    Oneal, Zibby

    1987-01-01

    This talk delivered at the "Focus '86...The Curriculum and You" Conference by an author of books for young adults, focuses on the problem of teenage suicide. The characters and situations of three books are described with emphasis on the need for human values within the community. (CLB)

  4. Interdisciplinarity in Swiss Schools: A Difficult Step into the Future

    ERIC Educational Resources Information Center

    Ghisla, Gianni; Bausch, Luca; Bonoli, Lorenzo

    2016-01-01

    Multi- and interdisciplinary education is a major postulate in the Swiss school system and has considerable weight in educational programs and learning objectives, both in compulsory school and at the upper secondary school level. However, materializing this postulate still poses problems at the political and institutional level, where the…

  5. Often Difficult--But Worth It. Collaboration among Professionals.

    ERIC Educational Resources Information Center

    Walker, Joyce A.

    1988-01-01

    A joint effort between the Minnesota Extension Service and University of Minnesota School of Medicine produced a community-based research and educational program on stress, depression, and suicide prevention. The Teens in Distress program represents a successful collaborative effort and illustrates the potential problems when Extension…

  6. Secure Accommodation for Very Difficult Adolescents: Some Recent Research Findings.

    ERIC Educational Resources Information Center

    Bullock, Roger; And Others

    1990-01-01

    Reviews research which has clarified the needs and problems of adolescents in secure units and has highlighted the relationship between provision offered in child care, penal, and health services. Discusses new research findings, particularly those arising out of studies of young people (n=104) in two youth treatment centers. (Author/ABL)

  7. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

    PubMed Central

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-01-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how

  8. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

    PubMed Central

    Ramkumar, Venkateswaran; Dinesh, Ekambaram; Shetty, Sumalatha Radhakrishna; Shah, Amit; Kundra, Pankaj; Das, Sabyasachi; Myatra, Sheila Nainan; Ahmed, Syed Moied; Divatia, Jigeeshu Vasishtha; Patwa, Apeksh; Garg, Rakesh; Raveendra, Ubaradka S; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu

    2016-01-01

    The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs. PMID:28003691

  9. Predictions of space physics are difficult, especially when they are about the future

    NASA Astrophysics Data System (ADS)

    Cassak, P.

    2015-12-01

    This talk is about the future of space physics, the broad field of study addressing how the sun works, its interaction with Earth and other planets via the solar wind and solar eruptions, and the region of interplanetary space out to the edge of the solar system. It is the chief field feeding into the development of tools for space weather prediction. Space physics is at an exciting - yet critical - time in its evolution. Scientifically, the capabilities afforded by new ground- and space-based observations and the rapidly increasing speed of supercomputing resources are leading to unprecedented progress in the field. Recently launched missions such as the Van Allen Probes and the Magnetospheric MultiScale (MMS) mission, and upcoming missions such as Solar Probe Plus and Solar Orbiter, will open doors to science not previously accessible through observations. Predicting the future of space physics is difficult; this talk will offer thoughts on the road forward.

  10. Content-addressable holographic databases

    NASA Astrophysics Data System (ADS)

    Grawert, Felix; Kobras, Sebastian; Burr, Geoffrey W.; Coufal, Hans J.; Hanssen, Holger; Riedel, Marc; Jefferson, C. Michael; Jurich, Mark C.

    2000-11-01

    Holographic data storage allows the simultaneous search of an entire database by performing multiple optical correlations between stored data pages and a search argument. We have recently developed fuzzy encoding techniques for this fast parallel search and demonstrated a holographic data storage system that searches digital data records with high fidelity. This content-addressable retrieval is based on the ability to take the two-dimensional inner product between the search page and each stored data page. We show that this ability is lost when the correlator is defocussed to avoid material oversaturation, but can be regained by the combination of a random phase mask and beam confinement through total internal reflection. Finally, we propose an architecture in which spatially multiplexed holograms are distributed along the path of the search beam, allowing parallel search of large databases.

  11. Addressing viral resistance through vaccines

    PubMed Central

    Laughlin, Catherine; Schleif, Amanda; Heilman, Carole A

    2015-01-01

    Antimicrobial resistance is a serious healthcare concern affecting millions of people around the world. Antiviral resistance has been viewed as a lesser threat than antibiotic resistance, but it is important to consider approaches to address this growing issue. While vaccination is a logical strategy, and has been shown to be successful many times over, next generation viral vaccines with a specific goal of curbing antiviral resistance will need to clear several hurdles including vaccine design, evaluation and implementation. This article suggests that a new model of vaccination may need to be considered: rather than focusing on public health, this model would primarily target sectors of the population who are at high risk for complications from certain infections. PMID:26604979

  12. Addressing Failures in Exascale Computing

    SciTech Connect

    Snir, Marc; Wisniewski, Robert; Abraham, Jacob; Adve, Sarita; Bagchi, Saurabh; Balaji, Pavan; Belak, J.; Bose, Pradip; Cappello, Franck; Carlson, Bill; Chien, Andrew; Coteus, Paul; DeBardeleben, Nathan; Diniz, Pedro; Engelmann, Christian; Erez, Mattan; Fazzari, Saverio; Geist, Al; Gupta, Rinku; Johnson, Fred; Krishnamoorthy, Sriram; Leyffer, Sven; Liberty, Dean; Mitra, Subhasish; Munson, Todd; Schreiber, Rob; Stearley, Jon; Van Hensbergen, Eric

    2014-01-01

    We present here a report produced by a workshop on Addressing failures in exascale computing' held in Park City, Utah, 4-11 August 2012. The charter of this workshop was to establish a common taxonomy about resilience across all the levels in a computing system, discuss existing knowledge on resilience across the various hardware and software layers of an exascale system, and build on those results, examining potential solutions from both a hardware and software perspective and focusing on a combined approach. The workshop brought together participants with expertise in applications, system software, and hardware; they came from industry, government, and academia, and their interests ranged from theory to implementation. The combination allowed broad and comprehensive discussions and led to this document, which summarizes and builds on those discussions.

  13. Addressing failures in exascale computing

    SciTech Connect

    Snir, Marc; Wisniewski, Robert W.; Abraham, Jacob A.; Adve, Sarita; Bagchi, Saurabh; Balaji, Pavan; Belak, Jim; Bose, Pradip; Cappello, Franck; Carlson, William; Chien, Andrew A.; Coteus, Paul; Debardeleben, Nathan A.; Diniz, Pedro; Engelmann, Christian; Erez, Mattan; Saverio, Fazzari; Geist, Al; Gupta, Rinku; Johnson, Fred; Krishnamoorthy, Sriram; Leyffer, Sven; Liberty, Dean; Mitra, Subhasish; Munson, Todd; Schreiber, Robert; Stearly, Jon; Van Hensbergen, Eric

    2014-05-01

    We present here a report produced by a workshop on “Addressing Failures in Exascale Computing” held in Park City, Utah, August 4–11, 2012. The charter of this workshop was to establish a common taxonomy about resilience across all the levels in a computing system; discuss existing knowledge on resilience across the various hardware and software layers of an exascale system; and build on those results, examining potential solutions from both a hardware and software perspective and focusing on a combined approach. The workshop brought together participants with expertise in applications, system software, and hardware; they came from industry, government, and academia; and their interests ranged from theory to implementation. The combination allowed broad and comprehensive discussions and led to this document, which summarizes and builds on those discussions.

  14. Light addressable photoelectrochemical cyanide sensor

    SciTech Connect

    Licht, S.; Myung, N.; Sun, Y.

    1996-03-15

    A sensor is demonstrated that is capable of spatial discrimination of cyanide with use of only a single stationary sensing element. Different spatial regions of the sensing element are light activated to reveal the solution cyanide concentration only at the point of illumination. In this light addressable photoelectrochemical (LAP) sensor the sensing element consists of an n-CdSe electrode immersed in solution, with the open-circuit potential determined under illumination. In alkaline ferro-ferri-cyanide solution, the open-circuit photopotential is highly responsive to cyanide, with a linear response of (120 mV) log [KCN]. LAP detection with a spatial resolution of {+-}1 mm for cyanide detection is demonstrated. The response is almost linear for 0.001-0.100 m cyanide with a resolution of 5 mV. 38 refs., 7 figs., 1 tab.

  15. How is environmental conflict addressed by SIA?

    SciTech Connect

    Barrow, C.J.

    2010-09-15

    The fields of Environmental Conflict Management (ECM), Environmental Conflict Resolution (ECR), and Peace and Conflict Impact Assessment (PCIA) have become well established; however, as yet there has not been much use of Social Impact Assessment (SIA) to manage environmental conflicts. ECM, ECR and PCIA are mainly undertaken when problems are advanced or, more likely, have run their course (post-conflict). This paper examines how conflict is addressed by SIA and whether there is potential to develop it for more proactive assessment of conflicts (pre-conflict or while things develop). SIA has the potential to identify and clarify the cause(s) of environmental and natural resources conflicts, and could possibly enable some avoidance or early mitigation. A promising approach may be for 'conflict-aware' SIA to watch for critical conflict stages or thresholds and to monitor stakeholders. Effective conflict-aware SIA might also significantly contribute to efforts to achieve sustainable development.

  16. Improving oncology nurses' communication skills for difficult conversations.

    PubMed

    Baer, Linda; Weinstein, Elizabeth

    2013-06-01

    When oncology nurses have strong communication skills, they play a pivotal role in influencing patient satisfaction, adherence to plans of care, and overall clinical outcomes. However, research studies indicate that nurses tend to keep communication with patients and families at a superficial, nontherapeutic level. Processes for teaching goals-of-care communication skills and for implementing skills into clinical practice are not clearly defined. Nurses at a large comprehensive cancer center recognized the need for help with this skill set and sought out communication experts to assist in providing the needed education. An educational project was developed to improve therapeutic communication skills in oncology nurses during goals-of-care discussions and giving bad news. The program was tailored to nurses and social workers providing care to patients in a busy, urban, academic, outpatient oncology setting. Program topics included exploring the patient's world, eliciting hopes and concerns, and dealing with conflict about goals. Sharing and discussing specific difficult questions and scenarios were encouraged throughout the program. The program was well attended and well received by oncology nurses and social workers. Participants expressed interest in the continuation of communication programs to further enhance skills.

  17. [Difficult respiratory management in a patient with bilateral giant bullae].

    PubMed

    Fujita, Ayaka; Hashiba, Eiji; Takahira, Yoko; Kitayama, Masatou; Tubo, Toshihito; Hirota, Kazuyoshi

    2009-10-01

    We report a case of bilateral giant bullae in a patient with multiple traumas. He had his arm amputated at the shoulder because of a machine accident and admitted to our hospital. Chest X-ray showed right-sided pneumothorax with bilateral giant bullae. Trimming of the stump was performed immediately after the placement of a right chest tube. He gradually developed hypoxia and hypercapnia with acidemia during the operation because of atelectasis due to sputum. Postoperatively, enlargement of right giant bulla led to frequent respiratory failure and he received a bilateral bullectomy through a median sternotomy 3 weeks after the accident. It was difficult to ventilate him due to air leak from the bilateral bulla and SpO2 dropped to below 70% with 100% oxygen. We continued the operation with standby extracorporeal membrane oxygenator (ECMO). Although the operation was finished without ECMO finally, ECMO had better been kept ready during anethesia with giant bullae when life threatening complication may occur at any point.

  18. Pet dander and difficult-to-control asthma: Therapeutic options.

    PubMed

    Ling, Morris; Long, Aidan A

    2010-01-01

    The prevalence of sensitization to cat and dog allergens is high in the general population and poses a challenge to the physician managing allergic asthma. Adequate allergen avoidance is difficult to achieve because of the physical characteristics of airborne animal allergens and patient noncompliance. Allergen-specific high-dose subcutaneous immunotherapy has shown benefit in cat-allergic patients with asthma and rhinoconjunctivitis, whereas the data for dog-allergic patients are not as convincing. Alternative immunotherapy approaches including the sublingual route or allergen-derived peptide-based immunotherapy remain experimental. Pharmacotherapy of pet-allergic asthmatic patients requires a stepwise approach following established asthma management guidelines. In addition to short-acting beta-agonists and inhaled corticosteroids, prophylactic antihistamines before anticipated pet exposure, the use of intranasal steroids, and the use of leukotriene antagonists may also be considered as adjunctive therapy in pet-allergic patients with asthma and/or allergic rhinitis. Omalizumab appears to have particular efficacy in pet allergen-induced asthma. Novel therapies such as Fcgamma-Fel d 1 chimeric proteins still have to be evaluated in the human setting.

  19. Bronchogenic cyst in a patient with difficult asthma.

    PubMed

    Ben Razavi, Soheil; Bemanian, Mohammad Hassan; Taghipoor, Shokooh; Moghadam, Reza Nafisi; Behnamfar, Zahra

    2010-03-01

    Difficult to treat asthma is an asthma syndrome that brings in our mind other differentials. Mediastinal masses are not common findings, but are important variables. Bronchogenic cyst is a congenital anomaly of the foregut that is typically found in the mediastinum and diagnosed accidentally. We present a 4-year-old girl with allergic asthma that began at 8-months of age and finally a bronchogenic cyst was detected in this patient. The patient had history of asthma since she was eight months old. She had a history of several asthma attacks which had partly responded to asthma management. During the last episodes of asthma attacks, she was hospitalized in Pediatric Intensive Care Unit. Imaging studies showed a 4x3 cm mass in the posterior part of the thoracic cavity that had led to tracheal narrowing was found for which the patient underwent thoracotomy and in surgical exploration a cyst that had compressed the thoracic trachea. Pathological examination of the cyst revealed a bronchogenic cyst. Bronchogenic cyst is an uncommon developmental abnormality but in a patient with obstructive pattern of airways it should be considered in differential diagnosis of asthma, especially if the asthma management is not successful.

  20. Why is changing health-related behaviour so difficult?

    PubMed Central

    Kelly, M.P.; Barker, M.

    2016-01-01

    Objective to demonstrate that six common errors made in attempts to change behaviour have prevented the implementation of the scientific evidence base derived from psychology and sociology; to suggest a new approach which incorporates recent developments in the behavioural sciences. Study design the role of health behaviours in the origin of the current epidemic of non-communicable disease is observed to have driven attempts to change behaviour. It is noted that most efforts to change health behaviours have had limited success. This paper suggests that in medicine and policy making, discussions about behaviour change are subject to six common errors and that these errors have made the business of health-related behaviour change much more difficult than it needs to be. Methods overview of policy and practice attempts to change health related behaviour. Results the reasons why knowledge and learning about behaviour have made so little progress in non-communicable disease prevention are considered, and an alternative way of thinking about the behaviours involved is suggested. This model harnesses recent developments in the behavioural sciences. Conclusion it is important to understand the conditions preceding behaviour psychologically and sociologically and to combine psychological ideas about the automatic and reflective systems with sociological ideas about social practice. PMID:27184821

  1. ADEM-DIOS: an SCF convergence algorothm for difficult cases

    NASA Astrophysics Data System (ADS)

    Sellers, Harrell

    1991-05-01

    We present an SCF convergence algorithm which we call ADEM-DIOS for accelerated direct energy minimization-direct inversion in the optimized subspace. This method employs the direct energy minimization (steepest descent) procedure outlined by Seeger and Pople to generate a set of "optimized" approximate solutions that form a basis for a least squares interpolation based on the DIIS method of Pulay. In all of our test cases, which we chose because damped Roothaan—Hall iterations, ordinary DIIS, level shifting, and variable metric second-order optimization failed to bring about convergence, the ADEM-DIOS method achieved convergence in a fraction of the number of steps required when direct energy minimization was used alone. This method can be thought of as being essentially the DIIS convergence acceleration technique applied to an "iterative subspace" generated by the direct energy minimization procedure. While we do not expect ADEM-DIOS to be significantly faster per cycle than second-order optimization algorithms based on Bacskay's method, the convergence ability of ADEM-DIOS is insensitive to the initial parameter set and should be more applicable in difficult cases. We consider th usefulness of this new algorithm to be in those cases in which other algorithms have difficulty in achieving convergence.

  2. 77 FR 59629 - Statutorily Mandated Designation of Difficult Development Areas for 2013

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... URBAN DEVELOPMENT Statutorily Mandated Designation of Difficult Development Areas for 2013 AGENCY... notice designates ``Difficult Development Areas'' (DDAs) for purposes of the Low-Income Housing Tax... ``Statutorily Mandated Designation of Difficult Development Areas and Qualified Census Tracts for...

  3. Addressing Science Use Cases with HELIO

    NASA Astrophysics Data System (ADS)

    Bentley, R. D.; Aboudarham, J.; Csillaghy, A.; Jacquey, C.; Hapgood, M. A.; Messerotti, M.; Gallagher, P.; Bocchialini, K.; Hurlburt, N. E.; Roberts, D.; Sanchez Duarte, L.

    2009-12-01

    The Heliophysics Integrated Observatory (HELIO) is a new VO project funded under the EC's Seventh Framework Programme (FP7). It includes thirteen partners scattered over six countries and is led by University College London. HELIO is designed to support the heliophysics community and is based on a Service Oriented Architecture. The services developed by and integrated into HELIO can be used to address a wide range of science problems; they can be used individually or as part of a work-flow driven search engine that can use a propagation (or other) model to help locate obervations that describe interesting phenomena. We will describe and discuss how the components of HELIO could be used to address science use cases, particularly how a user can adapt the work flow to their own science interests. Networking is one of the three Activities of the HELIO Integrated Infrastructure Initiatives (I3) project. Within this activity we plan to involve the community in all aspects of the design and testing of the HELIO system, including determining which data and metadata should be included, how the quality and content of metadata can be included, etc. We are investigating ways of making HELIO "domain-aware" so that researchers who are specialists in one of the communities that constitute heliophysics can easily identify, access and use data they need from the other communities. We will discuss how the community can help us develop this capability.

  4. AZT trials pose difficult breast-feeding dilemma.

    PubMed

    1998-02-01

    International AIDS experts and HIV infected women in Africa may soon face an impossible dilemma if short-term AZT treatment prevents perinatal transmission. HIV-infected mothers may not be able to afford infant formula or may not have access to safe water to mix with the formula, and may expose the child to HIV again through breast feeding. Few studies have addressed the breast feeding issue, although a controversial placebo-controlled study is underway in Nairobi. Pediatricians have promoted breast feeding as the preferred means to feed infants, and in many cases, mothers do not have other viable choices. Women who cannot afford formula may be forced to expose their children to HIV.

  5. Addressing concerns and achieving expectations

    SciTech Connect

    Miller, C.L.

    1995-12-01

    Approximately 2-1/2 years ago many of us were gathered here in Prague at a similar conference with a similar name, {open_quotes}Energy and Environment: Transitions in Eastern Europe.{close_quotes} Over 300 professionals from 26 nations attended. The objective of the conference was to: Facilitate the Solution of Long and Short Term Energy and Environmental Problems in Eastern Europe by Bringing Together People, ideas and technologies which could be applied to specific problems in a logical step-by-step manner. It was conceded at the time that the long term solution would consist of thoughtfully integrated steps and that the conference was the first step. We are here in the Czech Republic again this week to continue what was started. As before, this conference continues to: (1) Provide a forum to identify and discuss cost-effective environmentally acceptable energy and environmental technology options and their associated socioeconomic issues. (2) Stimulate the Formation of business partnerships (3) Identify key barrier issues hindering technology applications and identify implementation pathways that eliminate or avoid obstacles to progress.

  6. Access inequalities addressed by audit.

    PubMed

    Singh, Rajiv; Pentland, Brian

    2005-08-01

    The Disability Discrimination Act (1995) protects disabled people from discrimination in access to services, facilities and goods as well as in education and employment. All hospitals have an inherent duty to enable access to services but this will now be enshrined in law. As the health sector has most contact with disability, it may be expected that most hospitals would already be in a good position to comply with the Act, especially one treating many patients with disability. However we identified many problems in a rehabilitation hospital setting by means of a simple access audit in March 2004. Recommendations were set out and by March 2005 considerable improvements had been made costing Pound 100,000. Although many necessary changes will be expensive, not all problems identified require costly correction. Many simply involve a change in staff attitudes and practices. We recommend that all hospitals start to identify the changes needed under the Act by means of a simple access audit that can be carried out by hospital staff with no specialist equipment.

  7. Species Delimitation in Taxonomically Difficult Fungi: The Case of Hymenogaster

    PubMed Central

    Stielow, Benjamin; Bratek, Zoltan; Orczán, Akos Kund I.; Rudnoy, Szabolcs; Hensel, Gunnar; Hoffmann, Peter; Klenk, Hans-Peter; Göker, Markus

    2011-01-01

    Background False truffles are ecologically important as mycorrhizal partners of trees and evolutionarily highly interesting as the result of a shift from epigeous mushroom-like to underground fruiting bodies. Since its first description by Vittadini in 1831, inappropriate species concepts in the highly diverse false truffle genus Hymenogaster has led to continued confusion, caused by a large variety of prevailing taxonomical opinions. Methodology In this study, we reconsidered the species delimitations in Hymenogaster based on a comprehensive collection of Central European taxa comprising more than 140 fruiting bodies from 20 years of field work. The ITS rDNA sequence dataset was subjected to phylogenetic analysis as well as clustering optimization using OPTSIL software. Conclusions Among distinct species concepts from the literature used to create reference partitions for clustering optimization, the broadest concept resulted in the highest agreement with the ITS data. Our results indicate a highly variable morphology of H. citrinus and H. griseus, most likely linked to environmental influences on the phenology (maturity, habitat, soil type and growing season). In particular, taxa described in the 19th century frequently appear as conspecific. Conversely, H. niveus appears as species complex comprising seven cryptic species with almost identical macro- and micromorphology. H. intermedius and H. huthii are described as novel species, each of which with a distinct morphology intermediate between two species complexes. A revised taxonomy for one of the most taxonomically difficult genera of Basidiomycetes is proposed, including an updated identification key. The (semi-)automated selection among species concepts used here is of importance for the revision of taxonomically problematic organism groups in general. PMID:21311589

  8. Tools to cope with difficult-to-express proteins.

    PubMed

    Saccardo, Paolo; Corchero, José Luís; Ferrer-Miralles, Neus

    2016-05-01

    The identification of DNA coding sequences contained in the genome of many organisms coupled to the use of high throughput approaches has fueled the field of recombinant protein production. Apart from basic research interests, the growing relevance of this field is highlighted by the global sales of the top ten biopharmaceuticals on the market, which exceeds the trillion USD in a steady increasing tendency. Therefore, the demand of biological compounds seems to have a long run on the market. One of the most popular expression systems is based on Escherichia coli cells which apart from being cost-effective counts with a large selection of resources. However, a significant percentage of the genes of interest are not efficiently expressed in this system, or the expressed proteins are accumulated within aggregates, degraded or lacking the desired biological activity, being finally discarded. In some instances, expressing the gene in a homologous expression system might alleviate those drawbacks but then the process usually increases in complexity and is not as cost-effective as the prokaryotic systems. An increasing toolbox is available to approach the production and purification of those difficult-to-express proteins, including different expression systems, promoters with different strengths, cultivation media and conditions, solubilization tags and chaperone coexpression, among others. However, in most cases, the process follows a non-integrative trial and error strategy with discrete success. This review is focused on the design of the whole process by using an integrative approach, taken into account the accumulated knowledge of the pivotal factors that affect any of the key processes, in an attempt to rationalize the efforts made in this appealing field.

  9. Why is it so difficult to measure big G?

    NASA Astrophysics Data System (ADS)

    Faller, James

    2015-04-01

    The determination of the Newtonian constant of gravitation, big G, continues to be one of Nature's greatest challenges to the skills and cunning of experimental physicists. The reasons: Big G is small, scientists are human, and error budgets are flawed. In spite of the fact that on the scale of the Universe, big G's effects are so big as to single handedly hold everything together, on the scale of a single research laboratory, big G's effects are so small that they go unnoticed. And, it is this ``smallness'' that makes the determination of this (seemingly unrelated to the rest of physics) fundamental constant so difficult. Furthermore, because they are human, scientists want to get the ``right'' (read previously obtained) answer; and this goal can affect their otherwise good judgment. Finally, error budgets are fundamentally flawed because they cannot make allowances for error sources that have not been thought of. During its nearly 300 year measurement history, the accuracy with which G is known has barely increased by three orders of magnitude; during the past 30 years the progress, measured by agreement rather than claimed accuracy of individual measurements, has been essentially zero. Nevertheless, this Mount Everest of precision measurement continues to provide an experimental challenge upon which metrologists can hone their laboratory skills for generations to come. Finally, this presentation will be understandable and interesting for ``students of all ages.'' In this year of GR100, Einstein will be mentioned more than once, and my hope is that some of you who would not normally ``risk'' attending a talk outside of your own specialty or discipline will consider coming to this one.

  10. A region addresses patient safety.

    PubMed

    Feinstein, Karen Wolk; Grunden, Naida; Harrison, Edward I

    2002-06-01

    The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points. In each of these areas of work, PRHI partners have assembled multifacility/multidisciplinary groups charged with defining perfection, establishing region-wide reporting systems, and devising and implementing recommended improvement strategies and interventions. Many design and conceptual elements of the PRHI strategy are adapted from the Toyota Production System and its Pittsburgh derivative, the Alcoa Business System. PRHI is in the proof-of-concept phase of development.

  11. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis.

    PubMed

    Miranda, L; Settembre, A; Capasso, P; Piccolboni, D; De Rosa, N; Corcione, F

    2001-03-01

    Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irreducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile woman with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.

  12. Difficult to treat recurrent stenosis of the aorta.

    PubMed

    Pawelec-Wojtalik, Małgorzata; Qureshi, Shakeel Ahmed; Weil, Jochen; Mrówczyński, Wojciech; Wojtalik, Michał; Siwińska, Aldona; Surmacz, Rafał; Smoczyk, Wiesław; Kukawczyńska, Elzbieta; Raś, Małgorzata

    2007-01-01

    The risk associated with repeated treatment of aortic stenosis is as high as 5% and increases to as much as 25% in complex heart diseases. Among the methods that are commonly accepted and used in the treatment of recurrent aortic stenosis are balloon dilatation and stent implantation. In this study we describe five patients with recurrent stenosis of the aorta treated with stent implantation. The short-term results of such treatment are promising. However, in some cases it is only palliative in character and does not completely resolve the problems arising from congenital heart disease. (Cardiol J 2007; 14: 186-192).

  13. Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.

    PubMed

    Whiteneck, Gale; Dijkers, Marcel P

    2009-11-01

    For rehabilitation and disability research, participation and environment are 2 crucial constructs that have been placed center stage by the International Classification of Functioning, Disability and Health (ICF). However, neither construct is adequately conceptualized by the ICF, and both are difficult to measure. This article addresses conceptual and methodologic issues related to these ICF constructs, and recommends an improved distinction between activities and participation, as well as elaboration of environment. A division of the combined ICF categories for activity and participation into 2 separate taxonomies is proposed to guide future research. The issue of measuring participation from objective and subjective perspectives is examined, and maintaining these distinct conceptual domains in the measurement of participation is recommended. The methodological issues contributing to the difficulty of measuring participation are discussed, including potential dimensionality, alternative metrics, and the appropriateness of various measurement models. For environment, the need for theory to focus research on those aspects of the environment that interact with individuals' impairments and functional limitations in affecting activities and participation is discussed, along with potential measurement models for those aspects. The limitations resulting from reliance on research participants as reporters on their own environment are set forth. Addressing these conceptual and methodological issues is required before the measurement of participation and environmental factors can advance and these important constructs can be used more effectively in rehabilitation and disability observational research and trials.

  14. Communicating genetic information: a difficult challenge for future pediatricians

    PubMed Central

    2007-01-01

    Background The role of the pediatrician as genetic counselor is ideal because pediatricians have medical knowledge and experience with genetic disorders (e.g. Down syndrome). Moreover, pediatricians can provide comprehensive care in a medical home to patients with genetic disorders. However, changes in the curriculum of the pediatric resident are necessary to address the future challenges of effectively communicating genetic information to patients. The objective of this study was to explore these challenges and make recommendations for training to adequately prepare pediatricians for their future role as genetic counselors. Methods Three reviewers independently searched PubMed, OVID, and Medline databases to identify articles describing the challenges of communicating genetic information to patients, published from 1960 to December 2005. After the publications were identified and reviewed, four major areas of interest were identified in order to categorize the findings. Results Twenty-five publications were identified during the literature search. From the review, the following categories were selected to organize the findings: (1) Inherent difficulties of communicating and comprehending genetic information; (2) Comprehension of genetic information by pediatricians; (3) Genetics training in residency programs; and (4) The effect of genetic information on the future role of pediatricians and potential legal implications. Conclusion Pediatricians and residents lack essential knowledge of genetics and communication skills for effective counseling of patients. The review indicated that successful communication of genetic information involves a number of important skills and considerations. It is likely that these skills and considerations are universally required for the communication of most complex specialized medical information. In the past, communication skills have not been considered a priority. Today, these skills have become a demanding professional and even

  15. Difficult reputations and the social reality of occupational medicine.

    PubMed

    Draper, Elaine

    2008-01-01

    This response to Tee Guidotti's (2008) critique of Elaine Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' (2003) argues that a forthright examination of the conflicts of those working in the field of occupational medicine is essential to maintaining the health of the profession and to promoting constructive policies. Research for 'The Company Doctor' reveals how doctors walk a tightrope of professional demands on them. The author describes how corporate employment affects medicine and science and how professionals working in corporations are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Analyzing company doctors' role in confronting toxics and responding to liability fears in corporations, the author argues that problems of lost credibility, stigmatization, and tarnished reputation that company doctors describe largely stem from the organizational constraints, economic interests, and other aspects of the social context of their work. These social forces exert powerful pressure on the ethical framework and daily work lives of these professionals as well as on the reputation of their field. The author discusses ways in which the conflicting demands from being both a corporate employee and a physician are a social and structural problem beyond individual ethics.

  16. Problems in baryon spectroscopy

    SciTech Connect

    Capstick, S.

    1994-04-01

    Current issues and problems in the physics of ground- and excited-state baryons are considered, and are classified into those which should be resolved by CEBAF in its present form, and those which may require CEBAF to undergo an energy upgrade to 8 GeV or more. Recent theoretical developments designed to address these problems are outlined.

  17. The Problems of Dissection.

    ERIC Educational Resources Information Center

    Davis, Pat

    1997-01-01

    Describes some problems of classroom dissection including the cruelty that animals destined for the laboratory suffer. Discusses the multilevel approach that the National Anti-Vivisection Society (NAVS) has developed to address the problems of animal dissection such as offering a dissection hotline, exhibiting at science teacher conferences, and…

  18. Problems Facing Rural Schools.

    ERIC Educational Resources Information Center

    Stewart, C. E.; And Others

    Problems facing rural Scottish schools range from short term consideration of daily operation to long term consideration of organizational alternatives. Addressed specifically, such problems include consideration of: (1) liaison between a secondary school and its feeder primary schools; (2) preservice teacher training for work in small, isolated…

  19. USGS Science: Addressing Our Nation's Challenges

    USGS Publications Warehouse

    Larson, Tania M.

    2009-01-01

    With 6.6 billion people already living on Earth, and that number increasing every day, human influence on our planet is ever more apparent. Changes to the natural world combined with increasing human demands threaten our health and safety, our national security, our economy, and our quality of life. As a planet and a Nation, we face unprecedented challenges: loss of critical and unique ecosystems, the effects of climate change, increasing demand for limited energy and mineral resources, increasing vulnerability to natural hazards, the effects of emerging diseases on wildlife and human health, and growing needs for clean water. The time to respond to these challenges is now, but policymakers and decisionmakers face difficult choices. With competing priorities to balance, and potentially serious - perhaps irreversible - consequences at stake, our leaders need reliable scientific information to guide their decisions. As the Nation's earth and natural science agency, the USGS monitors and conducts scientific research on natural hazards and resources and how these elements and human activities influence our environment. Because the challenges we face are complex, the science needed to better understand and deal with these challenges must reflect the complex interplay among natural and human systems. With world-class expertise in biology, geology, geography, hydrology, geospatial information, and remote sensing, the USGS is uniquely capable of conducting the comprehensive scientific research needed to better understand the interdependent interactions of Earth's systems. Every day, the USGS helps decisionmakers to minimize loss of life and property, manage our natural resources, and protect and enhance our quality of life. This brochure provides examples of the challenges we face and how USGS science helps decisionmakers to address these challenges.

  20. Vortex generator design for aircraft inlet distortion as a numerical optimization problem

    NASA Technical Reports Server (NTRS)

    Anderson, Bernhard H.; Levy, Ralph

    1991-01-01

    Aerodynamic compatibility of aircraft/inlet/engine systems is a difficult design problem for aircraft that must operate in many different flight regimes. Takeoff, subsonic cruise, supersonic cruise, transonic maneuvering, and high altitude loiter each place different constraints on inlet design. Vortex generators, small wing like sections mounted on the inside surfaces of the inlet duct, are used to control flow separation and engine face distortion. The design of vortex generator installations in an inlet is defined as a problem addressable by numerical optimization techniques. A performance parameter is suggested to account for both inlet distortion and total pressure loss at a series of design flight conditions. The resulting optimization problem is difficult since some of the design parameters take on integer values. If numerical procedures could be used to reduce multimillion dollar development test programs to a small set of verification tests, numerical optimization could have a significant impact on both cost and elapsed time to design new aircraft.

  1. Reservoir technology research at LBL addressing geysers issues

    SciTech Connect

    Lippmann, M.J.; Bodvarsson, G.S.

    1990-04-01

    The Geothermal Technology Division of the Department of Energy is redirecting a significant part of its Reservoir Technology funding to study problems now being experienced at The Geysers. These include excessive pressure drawdown and associated decline in well flow rates, corrosion due to high chloride concentration in the produced steam and high concentration of noncondensible gases in some parts of the field. Lawrence Berkeley Laboratory (LBL) is addressing some of these problems through field, laboratory and theoretical studies. 11 refs., 6 figs.

  2. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge.

    PubMed

    Khan, Maria S; McCubbin, Mark; Nand, Sucha

    2014-01-01

    anemic. About 20% have hepatic and renal dysfunction. The treatment consists of systemic chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone plus rituximab (CHOP-R) and central nervous system prophylaxis. Retrospective data suggests that, with treatment, 51% to 82% of the patients achieve a complete remission and 27% to 56% are alive at 2-year follow-up. Conclusion. IVLBCL is a difficult diagnosis to make as the disease remains confined to the vascular lumen. It may be associated with certain viral illnesses, and this association needs to be explored further. It is important to consider this diagnosis in the appropriate settings because patients may achieve durable remissions with therapy.

  3. An address geocoding solution for Chinese cities

    NASA Astrophysics Data System (ADS)

    Zhang, Xuehu; Ma, Haoming; Li, Qi

    2006-10-01

    We introduce the challenges of address geocoding for Chinese cities and present a potential solution along with a prototype system that deal with these challenges by combining and extending current geocoding solutions developed for United States and Japan. The proposed solution starts by separating city addresses into "standard" addresses which meet a predefined address model and non-standard ones. The standard addresses are stored in a structured relational database in their normalized forms, while a selected portion of the non-standard addresses are stored as aliases to the standard addresses. An in-memory address index is then constructed from the address database and serves as the basis for real-time address matching. Test results were obtained from two trials conducted in the city Beijing. On average 80% matching rate were achieved. Possible improvements to the current design are also discussed.

  4. Making endotracheal intubation easy and successful, particularly in unexpected difficult airway

    PubMed Central

    Abdulla, Susanne; Abdulla, Sina; Schwemm, Karl-Peter; Eckhardt, Regina; Abdulla, Walied

    2014-01-01

    Background: Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians. Purpose: We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study. Settings and Design: Operating room, emergency department, intensive care unit (ICU), retrospective observational study. Materials and Methods: A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise. Statistical Analysis: Descriptive. Results: Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists. Conclusions: The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed. PMID:24741494

  5. Modified Ilizarov in difficult Fracture of the Patella. A case report

    PubMed Central

    Baruah, Ranjit Kr.

    2016-01-01

    Introduction: Ilizarov technique yields satisfactory results in difficult situations. Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation. We are reporting one such case in a 27 years old male treated by modified Ilizarov technique. Case report: A 27-years old male with transverse fracture of the patella was fixed with tension band wiring. He indulged in heavy manual work including bicycling after 15 days of operation contrary to advice that led to loosening of implants and failure of reduction. He reported after 2 months of failure. A modified Ilizarov technique was contemplated. Implants were removed. After cleaning the margins, opposite olive wires (2 in each fragment) mounted in traction units were attached to two full rings, each fixed to distal femur and tibia. Sub-acute docking was done on the table followed by gradual docking till the fragments came in contact to each other. Compression was applied across the fracture site after confirmation of docking by X-ray at the rate of 0.25 mm every 3rd day till 1.0 mm of compression was achieved. Full weight bearing was possible immediately after surgery. Regular follow up was carried out to look for any pin site problems and loss of compression. Assembly was removed after X-ray confirmed sound healing after 2 months. Initially there was restriction of movements at the knee joint which improved gradually with physiotherapy. At one year follow-up, the patientcould squat completely. Conclusion: Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation Modified Ilizarov technique is beneficial for treating such a situation in terms of function and restoration of anatomy as it avoids soft tissue scarring which may follow in an attempt to do an open reduction. Gradual stretching of the soft tissue and subsequent controlled compression at the fracture site is the advantage of this technique. PMID:27299120

  6. OPENING ADDRESS: Heterostructures in Semiconductors

    NASA Astrophysics Data System (ADS)

    Grimmeiss, Hermann G.

    1996-01-01

    perspectives for future applications. We are most grateful that you agreed with the special format of the symposium which clearly does not follow conven- tional conferences. Allow me to call your special attention once again to two main differences: The presentations are not review papers praising already achieved break-throughs but introductions to a list of open questions and issues for which our understanding is still unsatisfactory. To give such presentations requires courage and scientific integrity. I would like to thank all speakers now already for their willingness to cope with such a difficult task. We have allocated at least 50 minutes for discussion after each presentation not only for discussing the paper as such but, if possible, to find answers to the open questions. If one or several participants in the audience during the discussion think they can contribute to improving our understanding of heterostructures, they are invited to write their ideas up and, if the referees agree, we are more than happy to publish these ideas in the proceedings. We admit that the program is rather demanding. For that reason, we plan to have a break on Thursday afternoon by first going to Denmark and touring the Hamlet castle of Kronborg. We then sail back to Sweden and will be hosted by the Krapperup castle where we will have a candle-light dinner and thereafter a baroque music concert featuring the Concerto Copenhagen. All participants, observers, and accompanying spouses are invited and we hope you will all enjoy the excur- sion. The local organising committee acknowledges with pleasure the financial and all other support received from the Nobel Foundation and the Nobel Institute of Physics as well as the initial initiative taken by the chairman of the Nobel Com- mittee for Physics, Prof. Nordling, who was the first to suggest this Nobel Symposium on "Heterostructures in Semicon- ductors". Special thanks also to the members of the program committee who have been of inestimable

  7. Addressing Cultural and Native Language Interference in Second Language Acquisition

    ERIC Educational Resources Information Center

    Allard, Daniele; Bourdeau, Jacqueline; Mizoguchi, Riichiro

    2011-01-01

    This paper addresses the problem of cultural and native language interference in second/foreign language acquisition. More specifically, it examines issues of interference that can be traced to a student's native language and that also have a cultural component. To this effect, an understanding of what actually comprises both interference and…

  8. Can Innovation Save Gifted Education? 2010 NAGC Presidential Address

    ERIC Educational Resources Information Center

    Robinson, Ann

    2012-01-01

    Connecting innovation with gifted education is a necessity not only in the current political climate but also because it is a field with deeply held beliefs about the importance of problem solving, creativity, imagination, and invention--all critical components of innovation. In this address, the author focuses on three key ideas. First, she…

  9. Are Teacher and Principal Candidates Prepared to Address Student Cyberbullying?

    ERIC Educational Resources Information Center

    Styron, Ronald A., Jr.; Bonner, Jessica L.; Styron, Jennifer L.; Bridgeforth, James; Martin, Cecelia

    2016-01-01

    The purpose of this study was to examine the preparation of teacher and principal candidates to address problems created in K-12 settings as a result of cyberbullying. Participants included teacher and principal preparation students. Findings indicated that respondents were familiar with the most common forms of cyberbullying and its impact on…

  10. Addressing Barriers to Learning. Volume 13, Number 2. Spring 2008

    ERIC Educational Resources Information Center

    Center for Mental Health in Schools at UCLA, 2008

    2008-01-01

    Concern about responding to behavior problems and promoting social and emotional learning are related and are embedded into the arenas we frame to encompass the content of student/learning supports. How these concerns are addressed is critical to the type of school and classroom climate that emerges and to student engagement and re-engagement in…

  11. Challenges in an Aging Society: Presidential Address to APPAM

    ERIC Educational Resources Information Center

    Swartz, Katherine

    2010-01-01

    The United States is at a critical crossroads in its history right now. The public policy problems that the people are facing are complex and interrelated, and the demographic changes that are about to significantly change their country are not well understood by large numbers of people. In this presidential address to the Association for Public…

  12. Addressing Barriers to Learning. Volume 12, Number 3. Summer 2007

    ERIC Educational Resources Information Center

    Center for Mental Health in Schools at UCLA, 2007

    2007-01-01

    Effective practices typically evolve over a long period in high-functioning, fully engaged systems. Historically, schools have been confronted with project after project, program after program, initiative after initiative. Many of these aim at addressing learning, behavior, and emotional problems and making schools safe and drug free. This issue…

  13. Biogenic hardparts: Difficult archives of the geological past (Invited)

    NASA Astrophysics Data System (ADS)

    Immenhauser, A.; Schone, B. R.; Hoffmann, R.; Niedermayr, A.

    2013-12-01

    endocytosis and vesicle transport, precursor mineralogies etc.) is surprisingly incomplete and in many cases based on descriptive rather than mechanistic approaches; (2) in analogy to all metazoans, biomineralization processes of mollusks and brachiopods are complex and involve different mechanisms for different elements. The combined uptake of specific elements both from inorganic and metabolic sources represents a major problem. Despite all of these problems, field experiments document that these biominerals respond to the aquatic geochemistry and the physical properties (temperature, salinity, pH etc.) of their environment, albeit in a more complex manner than conventionally assumed. Significant advances in multi-proxy research, however, require a more holistic view of the physico-chemical and biological processes involved. The present contribution represents a first tentative step towards this goal.

  14. Why Is It Difficult to Predict Language Impairment and Outcome in Patients with Aphasia after Stroke?

    PubMed Central

    Kasselimis, Dimitrios; Varkanitsa, Maria; Selai, Caroline; Potagas, Constantin; Evdokimidis, Ioannis

    2014-01-01

    One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. Despite intense research in the field of aphasiology, the type of language impairment has not yet been localized and correlated with brain damage, making it difficult to predict the language outcome for stroke patients with aphasia. Our primary objective is to present the available evidence that highlights the difficulties of predicting language impairment after stroke. The different levels of complexity involved in predicting the lesion site from language impairment and ultimately predicting the long-term outcome in stroke patients with aphasia were explored. Future directions and potential implications for research and clinical practice are highlighted. PMID:24829592

  15. Meniere's disease: Still a mystery disease with difficult differential diagnosis.

    PubMed

    Vassiliou, A; Vlastarakos, P V; Maragoudakis, P; Candiloros, D; Nikolopoulos, T P

    2011-01-01

    One hundred and forty-six years after its first description, the differential diagnosis of Meniere's disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere's disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus) is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere's disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere's disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.

  16. Analyzing a 35-Year Hourly Data Record: Why So Difficult?

    NASA Astrophysics Data System (ADS)

    Lynnes, C.

    2014-12-01

    At the Goddard Distributed Active Archive Center, we have recently added a 35-Year record of output data from the North American Land Assimilation System (NLDAS) to the Giovanni web-based analysis and visualization tool. Giovanni (Geospatial Interactive Online Visualization ANd aNalysis Infrastructure) offers a variety of data summarization and visualization to users that operate at the data center, obviating the need for users to download and read the data themselves for exploratory data analysis. However, the NLDAS data has proven surprisingly resistant to application of the summarization algorithms. Algorithms that were perfectly happy analyzing 15 years of daily satellite data encountered limitations both at the algorithm and system level for 35 years of hourly data. Failures arose, sometimes unexpectedly, from command line overflows, memory overflows, internal buffer overflows, and time-outs, among others. These serve as an early warning sign for the problems likely to be encountered by the general user community as they try to scale up to "Big Data" analytics. Indeed, it is likely that more users will seek to perform remote web-based analysis precisely to avoid the issues, or the need to reprogram around them. We will discuss approaches to mitigating the limitations and the implications for data systems serving the user communities that try to scale up their current techniques to analyze Big Data.

  17. Analyzing a 35-Year Hourly Data Record: Why So Difficult?

    NASA Technical Reports Server (NTRS)

    Lynnes, Chris

    2014-01-01

    At the Goddard Distributed Active Archive Center, we have recently added a 35-Year record of output data from the North American Land Assimilation System (NLDAS) to the Giovanni web-based analysis and visualization tool. Giovanni (Geospatial Interactive Online Visualization ANd aNalysis Infrastructure) offers a variety of data summarization and visualization to users that operate at the data center, obviating the need for users to download and read the data themselves for exploratory data analysis. However, the NLDAS data has proven surprisingly resistant to application of the summarization algorithms. Algorithms that were perfectly happy analyzing 15 years of daily satellite data encountered limitations both at the algorithm and system level for 35 years of hourly data. Failures arose, sometimes unexpectedly, from command line overflows, memory overflows, internal buffer overflows, and time-outs, among others. These serve as an early warning sign for the problems likely to be encountered by the general user community as they try to scale up to Big Data analytics. Indeed, it is likely that more users will seek to perform remote web-based analysis precisely to avoid the issues, or the need to reprogram around them. We will discuss approaches to mitigating the limitations and the implications for data systems serving the user communities that try to scale up their current techniques to analyze Big Data.

  18. Problem Solving

    ERIC Educational Resources Information Center

    Kinsella, John J.

    1970-01-01

    Discussed are the nature of a mathematical problem, problem solving in the traditional and modern mathematics programs, problem solving and psychology, research related to problem solving, and teaching problem solving in algebra and geometry. (CT)

  19. Bioethicists Can and Should Contribute to Addressing Racism.

    PubMed

    Danis, Marion; Wilson, Yolonda; White, Amina

    2016-01-01

    The problems of racism and racially motivated violence in predominantly African American communities in the United States are complex, multifactorial, and historically rooted. While these problems are also deeply morally troubling, bioethicists have not contributed substantially to addressing them. Concern for justice has been one of the core commitments of bioethics. For this and other reasons, bioethicists should contribute to addressing these problems. We consider how bioethicists can offer meaningful contributions to the public discourse, research, teaching, training, policy development, and academic scholarship in response to the alarming and persistent patterns of racism and implicit biases associated with it. To make any useful contribution, bioethicists will require preparation and should expect to play a significant role through collaborative action with others.

  20. Address burnout with a caring, nurturing environment.

    PubMed

    2014-06-01

    With their hectic schedules and demanding work responsibilities, emergency physicians are particularly vulnerable to symptoms of burnout. One study showed that more than half of emergency providers reported at least one symptom of burnout when they were asked to fill out a survey tool used to measure burnout--more than any other type of provider. It's a concern because physicians experiencing burnout may be less attentive to their patients, and some ultimately choose to leave medicine because they are no longer satisfied with their work. However, there are steps health systems and administrators can take to help physicians who are struggling, and prevent isolated problems from escalating into larger issues. When a national sample of more than 7,200 physicians agreed to take the Maslach Burnout Inventory, a survey tool used to measure burnout, nearly half (45.8%) reported at least one symptom of burnout, and 65% of the emergency providers reported symptoms of burnout. Burnout is not just fatigue. It involves disappointment in a relationship or relationships, and lack of satisfaction or fulfillment with work, according to experts. Symptoms may include moodiness, irritability, sarcasm, and may result in performance issues as well. Further, there may be physical changes such as weight loss or changes in appetite. To prevent or address burnout, experts advise health systems to nurture a caring, collaborative environment, and to make sure that providers have mentors or resources to reach out to if they are experiencing any work-related problems. They also advise administrators to make sure that burnout is a safe topic of conversation.

  1. The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors.

    PubMed

    Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B

    2011-10-01

    Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women's HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms-psychological distress and difficult sexual situations-that link social discrimination to women's sexual risk for HIV.

  2. Texts, Structure, and Collaboration: Reflections of a Professional Development Addressing Homophobia in Secondary Schools

    ERIC Educational Resources Information Center

    Jones, Joseph R.

    2015-01-01

    Homophobia is an incredible problem within educational settings. Therefore, we must begin examining how we can address the challenge in an effective manner. Researchers postulate professional development (PD) discussing homophobia is an appropriate method to address the problem. To date, there is little published literature that discusses how a PD…

  3. 16 CFR 0.2 - Official address.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Official address. The principal office of the Commission is at Washington, DC. All communications to the Commission should be addressed to the Federal Trade Commission, 600 Pennsylvania Avenue, NW, Washington,...

  4. 16 CFR 0.2 - Official address.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Official address. The principal office of the Commission is at Washington, DC. All communications to the Commission should be addressed to the Federal Trade Commission, 600 Pennsylvania Avenue, NW, Washington,...

  5. 16 CFR 0.2 - Official address.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Official address. The principal office of the Commission is at Washington, DC. All communications to the Commission should be addressed to the Federal Trade Commission, 600 Pennsylvania Avenue, NW, Washington,...

  6. 47 CFR 97.23 - Mailing address.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Mailing address. 97.23 Section 97.23 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO... name and mailing address. The mailing address must be in an area where the amateur service is...

  7. 47 CFR 97.23 - Mailing address.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Mailing address. 97.23 Section 97.23 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO... name and mailing address. The mailing address must be in an area where the amateur service is...

  8. 47 CFR 97.23 - Mailing address.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Mailing address. 97.23 Section 97.23 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO... name and mailing address. The mailing address must be in an area where the amateur service is...

  9. 47 CFR 97.23 - Mailing address.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Mailing address. 97.23 Section 97.23 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO... name and mailing address. The mailing address must be in an area where the amateur service is...

  10. 47 CFR 97.23 - Mailing address.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Mailing address. 97.23 Section 97.23 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AMATEUR RADIO... name and mailing address. The mailing address must be in an area where the amateur service is...

  11. 37 CFR 41.10 - Correspondence addresses.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Correspondence addresses. 41... Correspondence addresses. Except as the Board may otherwise direct, (a) Appeals. Correspondence in an application... correspondence in an application or a patent involved in an appeal to the Board for which an address is...

  12. 37 CFR 41.10 - Correspondence addresses.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Correspondence addresses. 41... Correspondence addresses. Except as the Board may otherwise direct, (a) Appeals. Correspondence in an application... correspondence in an application or a patent involved in an appeal to the Board for which an address is...

  13. 47 CFR 13.10 - Licensee address.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Licensee address. 13.10 Section 13.10 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS General § 13.10 Licensee address. In accordance with § 1.923 of this chapter all applications must specify an address where...

  14. 32 CFR 516.7 - Mailing addresses.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Mailing addresses. 516.7 Section 516.7 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION General § 516.7 Mailing addresses. Mailing addresses for organizations referenced...

  15. Multi Sensor Approach to Address Sustainable Development

    NASA Technical Reports Server (NTRS)

    Habib, Shahid

    2007-01-01

    The main objectives of Earth Science research are many folds: to understand how does this planet operates, can we model her operation and eventually develop the capability to predict such changes. However, the underlying goals of this work are to eventually serve the humanity in providing societal benefits. This requires continuous, and detailed observations from many sources in situ, airborne and space. By and large, the space observations are the way to comprehend the global phenomena across continental boundaries and provide credible boundary conditions for the mesoscale studies. This requires a multiple sensors, look angles and measurements over the same spot in accurately solving many problems that may be related to air quality, multi hazard disasters, public health, hydrology and more. Therefore, there are many ways to address these issues and develop joint implementation, data sharing and operating strategies for the benefit of the world community. This is because for large geographical areas or regions and a diverse population, some sound observations, scientific facts and analytical models must support the decision making. This is crucial for the sustainability of vital resources of the world and at the same time to protect the inhabitants, endangered species and the ecology. Needless to say, there is no single sensor, which can answer all such questions effectively. Due to multi sensor approach, it puts a tremendous burden on any single implementing entity in terms of information, knowledge, budget, technology readiness and computational power. And, more importantly, the health of planet Earth and its ability to sustain life is not governed by a single country, but in reality, is everyone's business on this planet. Therefore, with this notion, it is becoming an impractical problem by any single organization/country to bear this colossal responsibility. So far, each developed country within their means has proceeded along satisfactorily in implementing

  16. Problem Solvers: Problem--How Long Can You Stand?

    ERIC Educational Resources Information Center

    Teaching Children Mathematics, 2010

    2010-01-01

    Healthy lifestyles are increasingly emphasized these days. This month the authors begin a series of mathematical problems that also address physical activity. They hope that these problems offer opportunities to investigate mathematics and also reinforce the desire to lead a healthy life. In their first problem of the academic year, students…

  17. Balance Problems

    MedlinePlus

    ... often, it could be a sign of a balance problem. Balance problems can make you feel unsteady or as ... fall-related injuries, such as hip fracture. Some balance problems are due to problems in the inner ...

  18. Disarming Contankerous People: Coping with Difficult Personalities in ECE Work Settings

    ERIC Educational Resources Information Center

    Hernandez, Luis; Smith, Connie Jo

    2009-01-01

    Difficult personalities come in a variety of roles in just about every setting. While types have been identified in the typical corporate and business culture, difficult work personalities also inhabit the world of early childhood education (ECE) workplaces. Because difficult people have an impact on workplace morale and productivity, the topic…

  19. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

    PubMed Central

    Krebs, Erin E; Garrett, Joanne M; Konrad, Thomas R

    2006-01-01

    Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration. Results In unadjusted analyses, physicians who reported high frustration with patients were younger (p < 0.001); worked more hours per week (p = 0.041); and had more symptoms of depression, stress, and anxiety (p < 0.004 for all). In the final model, factors independently associated with high frustration included age < 40 years, work hours > 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse. Conclusion Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships. PMID:17026762

  20. Conformational origin of a difficult coupling in a human growth hormone releasing factor analog.

    PubMed

    Deber, C M; Lutek, M K; Heimer, E P; Felix, A M

    1989-01-01

    During the solid-phase synthesis of the human growth hormone releasing factor (GRF) analog [Ala15, Leu27, Asn28] -GRF(1-32)-OH, incorporation of Boc-Gln16 was determined to be incomplete. While aggregation of growing resin-bound peptide chains with concomitant beta-sheet formation and "precipitation" has been proposed to account in general for such "difficult coupling," no feature of sequence in the Gln16 region of this GRF analog provided an immediate rationale for this result. We now report 500 MHz 1H NMR spectra of a series of resin-bound GRF segments surrounding the Gln16 position (19-32 through 14-32), swelled in dimethylsulfoxide-d6 solutions [GRF(14-32) = Leu14-Ala-Gln-Leu-Ser(Bzl)-Ala-Arg(Tos)-Lys(CIZ)-Leu- Leu-Gln-Asp(OcHex)-Ile-Leu-Asn-Arg(Tos)-Gln-Gln-Gly32-PAM resin]. While relatively sharp spectra are observed for GRF(19-32), components with resonances broadened by an order-of-magnitude appear in spectra of the 18-32 and 17-32 peptide-resin, and the entire spectrum of 16-32 is ill-resolved and highly broadened. Subsequent spectra sharpen again (15-32, 14-32). These combined synthesis/spectroscopic experimental results, in conjunction with predictive analyses using standard Chou-Fasman 2 degrees structure parameters, suggest that the completeness of the Gln16 coupling is hindered by formation of a specific, folded beta-sheet/beta-turn structure in GRF(16-32) (with the turn located at 18-21, "upstream" of the difficult coupling site), and accompanying aggregation of peptide chains. This analysis suggests that awareness of such potential beta-sheet/beta-turn sequences can guide analog choices, and/or facilitate pre-programming of synthesis steps in anticipation of problem couplings.

  1. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  2. Final Report on Internet Addressable Lightswitch

    SciTech Connect

    Rubinstein, Francis; Pettler, Peter

    2001-08-27

    This report describes the work performed to develop and test a new switching system and communications network that is useful for economically switching lighting circuits in existing commercial buildings. The first section of the report provides the general background of the IBECS (Integrated Building Environmental Communications System) research and development work as well as the context for the development of the new switching system. The research and development effort that went into producing the first proof-of-concept (the IBECS Addressable Power Switch or APS) and the physical prototype of that concept is detailed in the second section. In the third section of the report, we detail the refined Powerline Carrier Based IBECS Title 24 Wall Switch system that evolved from the APS prototype. The refined system provided a path for installing IBECS switching technology in existing buildings that may not be already wired for light level switching control. The final section of the report describes the performance of the IBECS Title 24 Switch system as applied to a small demonstration in two offices at LBNL's Building 90. We learned that the new Powerline Carrier control systems (A-10 technology) that have evolved from the early X-10 systems have solved most of the noise problems that dogged the successful application of X-10 technologies in commercial buildings. We found that the new A-10 powerline carrier control technology can be reliable and effective for switching lighting circuits even in electrically noisy office environments like LBNL. Thus we successfully completed the task objectives by designing, building and demonstrating a new switching system that can provide multiple levels of light which can be triggered either from specially designed wall switches or from a digital communications network. By applying commercially available powerline carrier based technologies that communicate over the in-place lighting wiring system, this type of control can be

  3. Novel Duplicate Address Detection with Hash Function

    PubMed Central

    Song, GuangJia; Ji, ZhenZhou

    2016-01-01

    Duplicate address detection (DAD) is an important component of the address resolution protocol (ARP) and the neighbor discovery protocol (NDP). DAD determines whether an IP address is in conflict with other nodes. In traditional DAD, the target address to be detected is broadcast through the network, which provides convenience for malicious nodes to attack. A malicious node can send a spoofing reply to prevent the address configuration of a normal node, and thus, a denial-of-service attack is launched. This study proposes a hash method to hide the target address in DAD, which prevents an attack node from launching destination attacks. If the address of a normal node is identical to the detection address, then its hash value should be the same as the “Hash_64” field in the neighboring solicitation message. Consequently, DAD can be successfully completed. This process is called DAD-h. Simulation results indicate that address configuration using DAD-h has a considerably higher success rate when under attack compared with traditional DAD. Comparative analysis shows that DAD-h does not require third-party devices and considerable computing resources; it also provides a lightweight security resolution. PMID:26991901

  4. Content-addressable read/write memories for image analysis

    NASA Technical Reports Server (NTRS)

    Snyder, W. E.; Savage, C. D.

    1982-01-01

    The commonly encountered image analysis problems of region labeling and clustering are found to be cases of search-and-rename problem which can be solved in parallel by a system architecture that is inherently suitable for VLSI implementation. This architecture is a novel form of content-addressable memory (CAM) which provides parallel search and update functions, allowing speed reductions down to constant time per operation. It has been proposed in related investigations by Hall (1981) that, with VLSI, CAM-based structures with enhanced instruction sets for general purpose processing will be feasible.

  5. Little Known, Much Needed: Addressing the Cocurricular Needs of LGBTQ Students

    ERIC Educational Resources Information Center

    Ivory, Brian T.

    2012-01-01

    Due to the invisible nature of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) undergraduate population, it is difficult for student affairs professionals at community colleges to identify and address the needs of sexual minority students on campus. Given the lack of literature regarding LGBTQ students at community colleges, student…

  6. Sexual violence in India: addressing gaps between policy and implementation.

    PubMed

    Sharma, Prachi; Unnikrishnan, M K; Sharma, Abhishek

    2015-06-01

    The savage Delhi rape of 16 December 2012 was instrumental in generating the Verma Report that framed policies for amending the Criminal Laws related to sexual violence, professionalizing forensic/medical examination of victims, and sensitizing the police, electorate and the educational sectors. Unfortunately, even after a year, the Indian Home Ministry has abysmally failed to implement most recommendations, even underutilizing budgetary allocations. This article addresses gaps in governance systems and offers solutions to the problem of sexual violence in India.

  7. Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions.

    PubMed

    Knecht, Carlos; de Alvaro, Raquel; Martinez-Raga, Jose; Balanza-Martinez, Vicent

    2015-05-01

    The association between attention-deficit hyperactivity disorder (ADHD) and criminality has been increasingly recognized as an important societal concern. Studies conducted in different settings have revealed high rates of ADHD among adolescent offenders. The risk for criminal behavior among individuals with ADHD is increased when there is psychiatric comorbidity, particularly conduct disorder and substance use disorder. In the present report, it is aimed to systematically review the literature on the epidemiological, neurobiological, and other risk factors contributing to this association, as well as the key aspects of the assessment, diagnosis, and treatment of ADHD among offenders. A systematic literature search of electronic databases (PubMed, EMBASE, and PsycINFO) was conducted to identify potentially relevant studies published in English, in peer-reviewed journals. Studies conducted in various settings within the judicial system and in many different countries suggest that the rate of adolescent and adult inmates with ADHD far exceeds that reported in the general population; however, underdiagnosis is common. Similarly, follow-up studies of children with ADHD have revealed high rates of criminal behaviors, arrests, convictions, and imprisonment in adolescence and adulthood. Assessment of ADHD and comorbid condition requires an ongoing and careful process. When treating offenders or inmates with ADHD, who commonly present other comorbid psychiatric disorder complex, comprehensive and tailored interventions, combining pharmacological and psychosocial strategies are likely to be needed.

  8. Reenactment of televised content by 2-year olds: toddlers use language learned from television to solve a difficult imitation problem.

    PubMed

    Barr, Rachel; Wyss, Nancy

    2008-12-01

    Parents commonly label objects on television and for some programs, verbal labels are also provided directly via voice-over. The present study investigated whether toddlers' imitation performance from television would be facilitated if verbal labels were presented on television via voice-over or if they were presented by parents who were co-viewing with their toddlers. Sixty-one 2-year olds were randomly assigned to one of four experimental groups (voice-over video, parent video, parent video no label, parent live) or to a baseline control condition. Toddlers were tested with novel objects after a 24h delay. Although, all experimental groups imitated significantly more target actions than the baseline control group, imitation was facilitated by novel labels regardless of whether those labels were provided by parents or by voice-over on television. These findings have important implications for toddler learning from television.

  9. To Get Rid of a Difficult Employee, a College May Hush Up Problems in a Professor's Past.

    ERIC Educational Resources Information Center

    Leatherman, Courtney

    1996-01-01

    The common practice of keeping negative information about a faculty member quiet if he agrees to resign quietly is criticized by some who find it unethical or illegal. They feel employers should disclose full employment records. Others warn that colleges may invade the privacy of a professor or defame him by passing on unsubstantiated charges to a…

  10. Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem.

    PubMed

    Gaia, Diego Felipe; Breda, João Roberto; Fischer, Claudio Henrique; Palma, José Honório

    2013-12-01

    A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. The apex was punctured with a 7 French introducer sheath, and a hydrophilic guidewire was advanced with the aid of a right Judkins catheter and positioned across the defect in the left atrium. Fluoroscopic and tridimensional transoesophageal echocardiography was used to guide the manoeuvre. Next, a long introducer sheath was advanced through the guidewire and positioned inside the left atrium. Two Amplatzer Vascular Plug II (St Jude Medical) were deployed, resulting in a significant reduction in the perivalvular leak. The procedure was considered to be successful. The patient regained consciousness, and the orotracheal tube was removed in the operating theatre. No neurological deficits were detected, and the patient was transferred to the intensive care unit. The patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.

  11. Message Passing vs. Shared Address Space on a Cluster of SMPs

    NASA Technical Reports Server (NTRS)

    Shan, Hongzhang; Singh, Jaswinder Pal; Oliker, Leonid; Biswas, Rupak

    2000-01-01

    The convergence of scalable computer architectures using clusters of PCs (or PC-SMPs) with commodity networking has become an attractive platform for high end scientific computing. Currently, message-passing and shared address space (SAS) are the two leading programming paradigms for these systems. Message-passing has been standardized with MPI, and is the most common and mature programming approach. However message-passing code development can be extremely difficult, especially for irregular structured computations. SAS offers substantial ease of programming, but may suffer from performance limitations due to poor spatial locality, and high protocol overhead. In this paper, we compare the performance of and programming effort, required for six applications under both programming models on a 32 CPU PC-SMP cluster. Our application suite consists of codes that typically do not exhibit high efficiency under shared memory programming. due to their high communication to computation ratios and complex communication patterns. Results indicate that SAS can achieve about half the parallel efficiency of MPI for most of our applications: however, on certain classes of problems SAS performance is competitive with MPI. We also present new algorithms for improving the PC cluster performance of MPI collective operations.

  12. Universal Design Problem Solving

    ERIC Educational Resources Information Center

    Sterling, Mary C.

    2004-01-01

    Universal design is made up of four elements: accessibility, adaptability, aesthetics, and affordability. This article addresses the concept of universal design problem solving through experiential learning for an interior design studio course in postsecondary education. Students' experiences with clients over age 55 promoted an understanding of…

  13. 49 CFR 1102.1 - How addressed.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false How addressed. 1102.1 Section 1102.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE COMMUNICATIONS § 1102.1 How addressed. All communications...

  14. 49 CFR 1102.1 - How addressed.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false How addressed. 1102.1 Section 1102.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE COMMUNICATIONS § 1102.1 How addressed. All communications...

  15. 49 CFR 1102.1 - How addressed.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 8 2014-10-01 2014-10-01 false How addressed. 1102.1 Section 1102.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE COMMUNICATIONS § 1102.1 How addressed. All communications...

  16. 49 CFR 1102.1 - How addressed.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false How addressed. 1102.1 Section 1102.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE COMMUNICATIONS § 1102.1 How addressed. All communications...

  17. 49 CFR 1102.1 - How addressed.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 8 2011-10-01 2011-10-01 false How addressed. 1102.1 Section 1102.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE COMMUNICATIONS § 1102.1 How addressed. All communications...

  18. Public Address Systems. Specifications - Installation - Operation.

    ERIC Educational Resources Information Center

    Palmer, Fred M.

    Provisions for public address in new construction of campus buildings (specifications, installations, and operation of public address systems), are discussed in non-technical terms. Consideration is given to microphones, amplifiers, loudspeakers and the placement and operation of various different combinations. (FS)

  19. 49 CFR 369.6 - Address.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS REPORTS OF MOTOR CARRIERS § 369.6 Address. The following address must be used by motor carriers when submitting a report, requesting an exemption from filing...

  20. 16 CFR 0.2 - Official address.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Official address. 0.2 Section 0.2 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.2... 20580, unless otherwise specifically directed. The Commission's Web site address is www.ftc.gov....

  1. 37 CFR 41.10 - Correspondence addresses.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Correspondence addresses. 41....10 Correspondence addresses. Except as the Board may otherwise direct, (a) Appeals. Correspondence in... all other correspondence in an application or a patent involved in an appeal to the Board for which...

  2. 37 CFR 41.10 - Correspondence addresses.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Correspondence addresses. 41....10 Correspondence addresses. Except as the Board may otherwise direct, (a) Appeals. Correspondence in... all other correspondence in an application or a patent involved in an appeal to the Board for which...

  3. 37 CFR 41.10 - Correspondence addresses.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Correspondence addresses. 41....10 Correspondence addresses. Except as the Board may otherwise direct, (a) Appeals. Correspondence in... all other correspondence in an application or a patent involved in an appeal to the Board for which...

  4. History Forum Addresses Creation/Evolution Controversy.

    ERIC Educational Resources Information Center

    Schweinsberg, John

    1997-01-01

    A series of programs entitled Creationism and Evolution: The History of a Controversy was presented at the University of Alabama in Huntsville. The controversy was addressed from an historical and sociological, rather than a scientific perspective. Speakers addressed the evolution of scientific creationism, ancient texts versus sedimentary rocks…

  5. 34 CFR 674.44 - Address searches.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Address searches. 674.44 Section 674.44 Education..., DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Due Diligence § 674.44 Address searches. (a) If mail... litigation; (2) The account is assigned to the United States; or (3) The account is written off under §...

  6. 34 CFR 674.44 - Address searches.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 3 2011-07-01 2011-07-01 false Address searches. 674.44 Section 674.44 Education..., DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Due Diligence § 674.44 Address searches. (a) If mail... litigation; (2) The account is assigned to the United States; or (3) The account is written off under §...

  7. Forms of Address in Chilean Spanish

    ERIC Educational Resources Information Center

    Bishop, Kelley; Michnowicz, Jim

    2010-01-01

    The present investigation examines possible social and linguistic factors that influence forms of address used in Chilean Spanish with various interlocutors. A characteristic of the Spanish of Chile is the use of a variety of forms of address for the second person singular, "tu", "vos", and "usted", with corresponding…

  8. Image compression using address-vector quantization

    NASA Astrophysics Data System (ADS)

    Nasrabadi, Nasser M.; Feng, Yushu

    1990-12-01

    A novel vector quantization scheme, the address-vector quantizer (A-VQ), is proposed which exploits the interblock correlation by encoding a group of blocks together using an address-codebook (AC). The AC is a set of address-codevectors (ACVs), each representing a combination of addresses or indices. Each element of the ACV is an address of an entry in the LBG-codebook, representing a vector-quantized block. The AC consists of an active (addressable) region and an inactive (nonaddressable) region. During encoding the ACVs in the AC are reordered adaptively to bring the most probable ACVs into the active region. When encoding an ACV, the active region is checked, and if such an address combination exists, its index is transmitted to the receiver. Otherwise, the address of each block is transmitted individually. The SNR of the images encoded by the A-VQ method is the same as that of a memoryless vector quantizer, but the bit rate is by a factor of approximately two.

  9. New generation of content addressable memories for associative processing

    NASA Astrophysics Data System (ADS)

    Lewis, H. G., Jr.; Giambalov, Paul

    2000-05-01

    Content addressable memories (CAMS) store both key and association data. A key is presented to the CAN when it is searched and all of the addresses are scanned in parallel to find the address referenced by the key. When a match occurs, the corresponding association is returned. With the explosion of telecommunications packet switching protocols, large data base servers, routers and search engines a new generation of dense sub-micron high throughput CAMS has been developed. The introduction of this paper presents a brief history and tutorial on CAMS, their many uses and advantages, and describes the architecture and functionality of several of MUSIC Semiconductors CAM devices. In subsequent sections of the paper we address using Associative Processing to accommodate the continued increase in sensor resolution, number of spectral bands, required coverage, the desire to implement real-time target cueing, and the data flow and image processing required for optimum performance of reconnaissance and surveillance Unmanned Aerial Vehicles (UAVs). To be competitive the system designer must provide the most computational power, per watt, per dollar, per cubic inch, within the boundaries of cost effective UAV environmental control systems. To address these problems we demonstrate leveraging DARPA and DoD funded Commercial Off-the-Shelf technology to integrate CAM based Associative Processing into a real-time heterogenous multiprocessing system for UAVs and other platforms with limited weight, volume and power budgets.

  10. Balance Problems

    MedlinePlus

    ... version of this page please turn Javascript on. Balance Problems About Balance Problems Have you ever felt dizzy, lightheaded, or ... dizziness problem during the past year. Why Good Balance is Important Having good balance means being able ...

  11. Automated measurement of printer effective addressability

    NASA Astrophysics Data System (ADS)

    Cooper, Brian E.; Eid, Ahmed H.; Rippetoe, Edward E.

    2014-01-01

    When evaluating printer resolution, addressability is a key consideration. Addressability defines the maximum number of spots or samples within a given distance, independent of the size of the spots when printed. Effective addressability is the addressability demonstrated by the final, printed output. It is the minimum displacement possible between the centers of printed objects. In this paper, we present a measurement procedure for effective addressability that offers an automated way to experimentally determine the addressability of the printed output. It requires printing, scanning, and measuring a test target. The effective addressability test target contains two types of elements, repeated to fill the page: fiducial lines and line segments. The fiducial lines serve as a relative reference for the incremental displacements of the individual line segments, providing a way to tolerate larger-scale physical distortions in the printer. An ordinary reflection scanner captures the printed test target. By rotating the page on the scanner, it is possible to measure effective addressability well beyond the scanner's sampling resolution. The measurement algorithm computes the distribution of incremental displacements, forming either a unimodal or bimodal histogram. In the latter case, the mean of the second (non-zero) peak indicates the effective addressability. In the former case, the printer successfully rendered the target's resolution, requiring another iteration of the procedure after increasing the resolution of the test target. The algorithm automatically estimates whether the histogram is unimodal or bimodal and computes parameters describing the quality of the measured histogram. Several experiments have refined the test target and measurement procedure, including two round-robin evaluations by the ISO WG4 committee. Results include an analysis of approximately 150 printed samples. The effective addressability attribute and measurement procedure are included in

  12. Dealing with difficult deformations: construction of a knowledge-based deformation atlas

    NASA Astrophysics Data System (ADS)

    Thorup, S. S.; Darvann, T. A.; Hermann, N. V.; Larsen, P.; Ólafsdóttir, H.; Paulsen, R. R.; Kane, A. A.; Govier, D.; Lo, L.-J.; Kreiborg, S.; Larsen, R.

    2010-03-01

    Twenty-three Taiwanese infants with unilateral cleft lip and palate (UCLP) were CT-scanned before lip repair at the age of 3 months, and again after lip repair at the age of 12 months. In order to evaluate the surgical result, detailed point correspondence between pre- and post-surgical images was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation from before to after lip closure in infants with UCLP. The purpose of the present work was to show that use of prior information about typical deformations due to lip closure, through the construction of a knowledge-based atlas of deformations, could overcome the problem. Initially, mean volumes (atlases) for the pre- and post-surgical populations, respectively, were automatically constructed by non-rigid registration. An expert placed corresponding landmarks in the cleft area in the two atlases; this provided prior information used to build a knowledge-based deformation atlas. We model the change from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery.

  13. Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting

    PubMed Central

    Carpenter, Stephanie M.; Yates, J. Frank; Preston, Stephanie D.; Chen, Lydia

    2016-01-01

    Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional “coherence shifting,” the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed. PMID:26986752

  14. Electrowetting assisted air detrapping in transfer micromolding for difficult-to-mold microstructures.

    PubMed

    Li, Xiangming; Tian, Hongmiao; Wang, Chunhui; Li, Xin; Shao, Jinyou; Ding, Yucheng; Wang, Li

    2014-08-13

    As a widely applicable process for fabricating micro- or nanostructures, micromolding in atmosphere would require the removal or minimization of air-trapping in mold cavities so as to fill the liquid prepolymer fully into the mold for generating an exact polymer duplicate. This has been difficult, if not impossible, especially for a mold with high aspect ratio, varying size/shape, or isolated cavities because the air can be trapped inside such mold cavities in most variants of the molding process. This paper presents an electrowetting assisted transfer micromolding process to solve this problem. A feeding blade continuously supplies a UV-curable prepolymer over a dielectric-coated conductive mold placed on a progressively advancing stage. A voltage applied to the electrode pair composed of the feeding blade and mold generates an electrowetting of the prepolymer to the mold. The electrowetting allows for the three-phase contact line to pass progressively along the sidewalls and bottoms of the cavities, completely pushing out the air initially occupying the cavities, or generates an electrocapillary force large enough to pull the prepolymer deeply into the mold by compressing the air already trapped inside the cavities to a minimized volume. An experiment has been performed for micromolding with deep cavities of various shapes and sizes, demonstrating an essential improvement in the structural integrity of the polymer duplicates.

  15. Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting.

    PubMed

    Carpenter, Stephanie M; Yates, J Frank; Preston, Stephanie D; Chen, Lydia

    2016-01-01

    Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed.

  16. The role of academic research and teaching in addressing health in situations of conflict and instability.

    PubMed

    Collinson, Lucie

    2014-01-01

    The key roles of academic research and teaching in addressing health in situations of conflict and instability are to better inform and better equip actors with the knowledge and skills to address health problems. The four key contributions of research are: quantifying the health problem, examining the contextual circumstances, investigating the epidemiology of health problems and evaluation of health care and humanitarian interventions. The role of teaching can complement research by distributing its' findings in addition to teaching skill sets to apply this knowledge and conduct further research. Academic research and teaching both play imperative roles in enabling more successful approaches in addressing health in situations of conflict and instability.

  17. Special Medical Problems of Athletes.

    ERIC Educational Resources Information Center

    Couch, Joan M.

    1987-01-01

    This article addresses the situations in which athletes with special needs and considerations participate in sports. The health problems discussed are diabetes mellitus, exercise-induced asthma, exercise-induced anaphylaxis, and epilepsy. (MT)

  18. Singular perturbation analysis of AOTV-related trajectory optimization problems

    NASA Technical Reports Server (NTRS)

    Calise, Anthony J.; Bae, Gyoung H.

    1990-01-01

    The problem of real time guidance and optimal control of Aeroassisted Orbit Transfer Vehicles (AOTV's) was addressed using singular perturbation theory as an underlying method of analysis. Trajectories were optimized with the objective of minimum energy expenditure in the atmospheric phase of the maneuver. Two major problem areas were addressed: optimal reentry, and synergetic plane change with aeroglide. For the reentry problem, several reduced order models were analyzed with the objective of optimal changes in heading with minimum energy loss. It was demonstrated that a further model order reduction to a single state model is possible through the application of singular perturbation theory. The optimal solution for the reduced problem defines an optimal altitude profile dependent on the current energy level of the vehicle. A separate boundary layer analysis is used to account for altitude and flight path angle dynamics, and to obtain lift and bank angle control solutions. By considering alternative approximations to solve the boundary layer problem, three guidance laws were derived, each having an analytic feedback form. The guidance laws were evaluated using a Maneuvering Reentry Research Vehicle model and all three laws were found to be near optimal. For the problem of synergetic plane change with aeroglide, a difficult terminal boundary layer control problem arises which to date is found to be analytically intractable. Thus a predictive/corrective solution was developed to satisfy the terminal constraints on altitude and flight path angle. A composite guidance solution was obtained by combining the optimal reentry solution with the predictive/corrective guidance method. Numerical comparisons with the corresponding optimal trajectory solutions show that the resulting performance is very close to optimal. An attempt was made to obtain numerically optimized trajectories for the case where heating rate is constrained. A first order state variable inequality

  19. Genetics at School Level: Addressing the Difficulties

    ERIC Educational Resources Information Center

    Chu, Yu-Chien; Reid, Norman

    2012-01-01

    Background: A wide range of studies has offered suggestions why genetics is difficult and some of their key findings are summarised. Underpinning all of this is the way the brain works when handling information. The limitations of working memory capacity offer an interpretation of these difficulties. Purpose: The aim is to confirm that working…

  20. Financial abuse of older people by a family member: a difficult terrain for service providers in Australia.

    PubMed

    Adams, Valerie Margaret; Bagshaw, Dale; Wendt, Sarah; Zannettino, Lana

    2014-01-01

    Financial abuse by a family member is the most common form of abuse experienced by older Australians, and early intervention is required. National online surveys of 228 chief executive officers and 214 aged care service providers found that, while they were well placed to recognize financial abuse, it was often difficult to intervene successfully. Problems providers encountered included difficulties in detecting abuse, the need for consent before they could take action, the risk that the abusive family member would withdraw the client from the service, and a lack of resources to deal with the complexities inherent in situations of financial abuse.

  1. Addressing Conceptual Model Uncertainty in the Evaluation of Model Prediction Errors

    NASA Astrophysics Data System (ADS)

    Carrera, J.; Pool, M.

    2014-12-01

    Model predictions are uncertain because of errors in model parameters, future forcing terms, and model concepts. The latter remain the largest and most difficult to assess source of uncertainty in long term model predictions. We first review existing methods to evaluate conceptual model uncertainty. We argue that they are highly sensitive to the ingenuity of the modeler, in the sense that they rely on the modeler's ability to propose alternative model concepts. Worse, we find that the standard practice of stochastic methods leads to poor, potentially biased and often too optimistic, estimation of actual model errors. This is bad news because stochastic methods are purported to properly represent uncertainty. We contend that the problem does not lie on the stochastic approach itself, but on the way it is applied. Specifically, stochastic inversion methodologies, which demand quantitative information, tend to ignore geological understanding, which is conceptually rich. We illustrate some of these problems with the application to Mar del Plata aquifer, where extensive data are available for nearly a century. Geologically based models, where spatial variability is handled through zonation, yield calibration fits similar to geostatiscally based models, but much better predictions. In fact, the appearance of the stochastic T fields is similar to the geologically based models only in areas with high density of data. We take this finding to illustrate the ability of stochastic models to accommodate many data, but also, ironically, their inability to address conceptual model uncertainty. In fact, stochastic model realizations tend to be too close to the "most likely" one (i.e., they do not really realize the full conceptualuncertainty). The second part of the presentation is devoted to argue that acknowledging model uncertainty may lead to qualitatively different decisions than just working with "most likely" model predictions. Therefore, efforts should concentrate on

  2. Environmental problem solving

    SciTech Connect

    Miller, A.

    1999-06-01

    Human influences create both environmental problems and barriers to effective policy aimed at addressing those problems. In effect, environmental managers manage people as much as they manage the environment. Therefore, they must gain an understanding of the psychological and sociopolitical dimensions of environmental problems that they are attempting to resolve. The author reappraises conventional analyses of environmental problems using lessons from the psychosocial disciplines. The author combines the disciplines of ecology, political sociology and psychology to produce a more adaptive approach to problem-solving that is specifically geared toward the environmental field. Numerous case studies demonstrate the practical application of theory in a way that is useful to technical and scientific professionals as well as to policymakers and planners.

  3. Addressing Your Child's Weight at the Doctor

    MedlinePlus

    ... a Healthy Heart Healthy Kids Our Kids Programs Childhood Obesity What is childhood obesity? Overweight in Children BMI in Children Is Childhood Obesity an Issue in Your Home? Addressing your Child's ...

  4. 7 CFR 504.5 - Address.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... USER FEES § 504.5 Address. Deposits of and requests for microbial patent cultures should be directed to the Curator, ARS Patent Culture Collection, Northern Regional Research Center, USDA-ARS, 1815...

  5. 7 CFR 504.5 - Address.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... USER FEES § 504.5 Address. Deposits of and requests for microbial patent cultures should be directed to the Curator, ARS Patent Culture Collection, Northern Regional Research Center, USDA-ARS, 1815...

  6. 7 CFR 504.5 - Address.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... USER FEES § 504.5 Address. Deposits of and requests for microbial patent cultures should be directed to the Curator, ARS Patent Culture Collection, Northern Regional Research Center, USDA-ARS, 1815...

  7. 7 CFR 504.5 - Address.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... USER FEES § 504.5 Address. Deposits of and requests for microbial patent cultures should be directed to the Curator, ARS Patent Culture Collection, Northern Regional Research Center, USDA-ARS, 1815...

  8. 7 CFR 504.5 - Address.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... USER FEES § 504.5 Address. Deposits of and requests for microbial patent cultures should be directed to the Curator, ARS Patent Culture Collection, Northern Regional Research Center, USDA-ARS, 1815...

  9. 76 FR 27020 - Representative and Address Provisions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE United States Patent and Trademark Office Representative and Address Provisions ACTION: Proposed collection; comment request. SUMMARY: The United States Patent and Trademark Office (USPTO), as part of...

  10. Optical Addressing And Clocking Of RAM's

    NASA Technical Reports Server (NTRS)

    Johnston, Alan R.; Nixon, Robert H.; Bergman, Larry A.; Esener, Sadik

    1989-01-01

    Proposed random-access-memory (RAM) addressing system, in which memory linked optically to read/write logic circuits, greatly increases computer operating speed. System - comprises addressing circuits including numerous lasers as signal sources, numerous optical gates including optical detectors associated with memory cells, and holographic element to direct light signals to desired memory-cell locations - applied to high-capacity digital systems, supercomputers, and complex microcircuits.

  11. Faculty Teaching Diversity through Difficult Dialogues: Stories of Challenges and Success

    ERIC Educational Resources Information Center

    Gayles, Joy Gaston; Kelly, Bridget Turner; Grays, Shaefny; Zhang, Jing Jing; Porter, Kamaria P.

    2015-01-01

    Teaching diversity courses in graduate preparation programs is likely to trigger difficult dialogues that evoke a range of emotional responses. Difficult dialogues on diversity topics must be managed effectively in order to enhance multicultural competence. This interpretive study examined the experiences of faculty who teach diversity courses in…

  12. Identifying and Investigating Difficult Concepts in Engineering Mechanics and Electric Circuits. Research Brief

    ERIC Educational Resources Information Center

    Streveler, Ruth; Geist, Monica; Ammerman, Ravel; Sulzbach, Candace; Miller, Ronald; Olds, Barbara; Nelson, Mary

    2007-01-01

    This study extends ongoing work to identify difficult concepts in thermal and transport science and measure students' understanding of those concepts via a concept inventory. Two research questions provided the focal point: "What important concepts in electric circuits and engineering mechanics do students find difficult to learn?" and…

  13. Funds of (Difficult) Knowledge and the Affordances of Multimodality: The Case of Victor

    ERIC Educational Resources Information Center

    Becker, Ava

    2014-01-01

    Drawing on semi-structured interview data, this paper examines one man's multimodal engagement with the emotionally difficult aspects of his Chilean heritage. It builds on recent work (e.g., Marshall & Toohey, 2010) that has begun to unearth the intersection between funds of knowledge (González, Moll, & Amanti, 2005), difficult knowledge…

  14. Two cases of tracheal disease misdiagnosed as difficult-to-treat asthma.

    PubMed

    Alici, Ibrahim Onur; Kar Kurt, Ozlem; Dursun, Adile Berna; Yilmaz, Aydin; Erkekol, Ferda Oner

    2013-11-01

    Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.

  15. Deciphering the Distance between Distance Education and Working Professionals in Difficult Geographies

    ERIC Educational Resources Information Center

    Pandey, Jatin; Singh, Manjari

    2015-01-01

    This study investigates the factors that draw working professionals towards distance education programs, and the factors that sustain their distance education experience. The study is conducted in difficult terrains of Uttarakhand, a hilly state in India which helps us investigate the phenomenon in difficult geographies. Through interviews of ten…

  16. Difficult Knowledge and the English Classroom: A Catholic Framework Using Cormac McCarthy's "The Road"

    ERIC Educational Resources Information Center

    Jarvie, Scott; Burke, Kevin

    2015-01-01

    In this article, the authors explore the generative possibilities of risk-taking in the Catholic school English classroom. They associate pedagogical risk with what Deborah Britzman (1998) has called "difficult knowledge"--content that causes students to consider social trauma. Incorporating difficult knowledge meaningfully requires…

  17. Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption

    PubMed Central

    2012-01-01

    Background Numerous policies have been proposed to address the public health problem of obesity, resulting in a policy cacophony. The noise of so many policy options renders it difficult for policymakers to determine which policies warrant implementation. This has resulted in calls for more and better evidence to support obesity policy. However, it is not clear that evidence is the solution. This paper argues that to address the policy cacophony it is necessary to rethink the problem of obesity, and more specifically, how the problem of obesity is framed. This paper argues that the frame “obesity” be replaced by the frame “caloric overconsumption”, concluding that the frame caloric overconsumption can overcome the obesity policy cacophony. Discussion Frames are important because they influence public policy. Understood as packages that define issues, frames influence how best to approach a problem. Consequently, debates over public policy are considered battles over framing, with small shifts in how an issue is framed resulting in significant changes to the policy environment. This paper presents a rationale for reframing the problem of obesity as caloric overconsumption. The frame “obesity” contributes to the policy cacophony by including policies aimed at both energy output and energy input. However, research increasingly demonstrates that energy input is the primary cause of obesity, and that increases in energy input are largely attributable to the food environment. By focusing on policies that aim to prevent increases in energy input, the frame caloric overconsumption will reduce the noise of the obesity policy cacophony. While the proposed frame will face some challenges, particularly industry opposition, policies aimed at preventing caloric overconsumption have a clearer focus, and can be more politically palatable if caloric overconsumption is seen as an involuntary risk resulting from the food environment. Summary The paper concludes that

  18. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    PubMed Central

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05). Conclusion So the FLMA may be a better technique for management of patients with difficult airways. PMID:28274023

  19. Addressing the Academic and Social Needs of Young Male Students through School-Based Mentoring

    ERIC Educational Resources Information Center

    Alston, Curtis E.

    2013-01-01

    This study addressed the problem within the U.S. public school system to sustainably meet the academic and social needs of its African American male students. The administrative team of the elementary school in this study desired an evaluation of a school-based male mentoring program that was designed to address these needs. The program, Gentlemen…

  20. First on the List: Effectiveness at Self-Regulation and Prioritizing Difficult Exercise Goal Pursuit

    PubMed Central

    Delose, Julie E.; vanDellen, Michelle R.; Hoyle, Rick H.

    2015-01-01

    Identifying and understanding the goal pursuit strategies that distinguish effective self-regulators from less effective self-regulators is important for elucidating how individuals achieve their goals. We suggest that the timing of plans for difficult goal pursuits is one differentiation. A pilot study shows that effective self-regulators tend to believe they are best suited to pursue difficult goals earlier in the day, and two studies provide evidence that effective and less effective self-regulators differ in the timing of their plans for difficult goal pursuits. Results indicate that when exercising is perceived as difficult goal pursuit, effective self-regulators prioritize that difficult goal pursuit by planning to exercise earlier in the day whereas less effective self-regulators plan exercise for later in the day. PMID:26957951