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Sample records for challenges facing pediatric

  1. High-risk medical devices, children and the FDA: regulatory challenges facing pediatric mechanical circulatory support devices.

    PubMed

    Almond, Christopher S D; Chen, Eric A; Berman, Michael R; Less, Joanne R; Baldwin, J Timothy; Linde-Feucht, Sarah R; Hoke, Tracey R; Pearson, Gail D; Jenkins, Kathy; Duncan, Brian W; Zuckerman, Bram D

    2007-01-01

    Pediatric mechanical circulatory support is a critical unmet need in the United States. Infant- and child-sized ventricular assist devices are currently being developed largely through federal contracts and grants through the National Heart, Lung, and Blood Institute (NHLBI). Human testing and marketing of high-risk devices for children raises epidemiologic and regulatory issues that will need to be addressed. Leaders from the US Food and Drug Administration (FDA), NHLBI, academic pediatric community, and industry convened in January 2006 for the first FDA Workshop on the Regulatory Process for Pediatric Mechanical Circulatory Support Devices. The purpose was to provide the pediatric community with an overview of the federal regulatory process for high-risk medical devices and to review the challenges specific to the development and regulation of pediatric mechanical circulatory support devices. Pediatric mechanical circulatory support present significant epidemiologic, logistic, and financial challenges to industry, federal regulators, and the pediatric community. Early interactions with the FDA, shared appreciation of challenges, and careful planning will be critical to avoid unnecessary delays in making potentially life-saving devices available for children. Collaborative efforts to address these challenges are warranted.

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

    PubMed

    Phillips, Charles D

    2015-01-01

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

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

    PubMed

    Phillips, Charles D; Hawes, Catherine

    2015-01-01

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

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

    PubMed Central

    Phillips, Charles D; Hawes, Catherine

    2015-01-01

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

  5. Pediatric Sedation: A Global Challenge

    PubMed Central

    Gozal, David; Mason, Keira P.

    2010-01-01

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

  6. Challenges Facing Special Education.

    ERIC Educational Resources Information Center

    Meyen, Edward L., Ed.; And Others

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

  7. Face transplantation: Anesthetic challenges

    PubMed Central

    Dalal, Aparna

    2016-01-01

    Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products. A silicon face mask created from the facial impression is used to reconstruct the face and preserve the donor’s dignity. The recipient airway management most commonly used is primary intubation of an existing tracheostoma with a flexometallic endotracheal tube. The recipient surgery usually averages to 19-20 h. Since the face is a very vascular organ, there is usually massive bleeding, both in the dissection phase as well as in the reperfusion phase. Prior to reperfusion, often, after one sided anastomosis of the graft, the contralateral side is allowed to bleed to get rid of the preservation solution and other additives. Intraoperative product replacement should be guided by laboratory values and point of care testing for coagulation and hemostasis. In face transplantation, bolus doses of pressors or pressor infusions have been used intraoperatively in several patients to manage hypotension. This article reviews the anesthetic considerations for management for face transplantation, and some of the perioperative challenges faced. PMID:28058213

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

    PubMed Central

    Phillips, Charles D.

    2015-01-01

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

  9. Challenges facing production grids

    SciTech Connect

    Pordes, Ruth; /Fermilab

    2007-06-01

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

  10. Persistent pharmacokinetic challenges to pediatric drug development

    PubMed Central

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

    2014-01-01

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

  11. Emerging Challenges Facing School Principals

    ERIC Educational Resources Information Center

    Wise, Donald

    2015-01-01

    This article provides insights into the challenges facing US public school principals. A survey was sent to a random sample of over 10,000 principals throughout the US. Written responses from a representative sample were analyzed for content and themes. Results indicate that principals are facing emerging challenges never before seen in education,…

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

    PubMed

    Feudtner, Chris; Nathanson, Pamela G

    2014-02-01

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

  13. The Challenges Facing American Education.

    ERIC Educational Resources Information Center

    Mondale, Walter F.

    1982-01-01

    Three challenges of adaptation face education: great demographic change, the technological revolution, and change in social and cultural attitudes. The first task is to improve elementary and secondary education, but then it is to renew support of higher and graduate education as an essential investment in people. (Author/MSE)

  14. Current challenges in pediatric nutrition.

    PubMed

    Krawinkel, Michael B

    2011-10-01

    In pediatric nutrition the most important overall theme is breastfeeding. While there is no alternative in most mammals--and offspring would die if the mother had no milk or could not feed the newborn--human mothers were offered alternative ways of infant feeding. Today restoring breastfeeding is a major goal for pediatricians, midwifes, and lactation advisers. Feeding the premature baby and adding long chain fatty acids and prebiotics to formula is an area of growing interest. Undernutrition is a special challenge for nutritional care because even in recent years severely undernourished children die of inadequate management with too much volume and too much protein in the initial phase. Much knowledge has been gained about parenteral nutrition for children with gut failure. Even children with very short bowel length at birth have a good prognosis and can often achieve enteral adaptation. New solutions for parenteral nutrition, new materials, and new care concepts have been identified. Problems considered inherent to parenteral nutrition are widely preventable.

  15. Pediatric papillary thyroid cancer: current management challenges

    PubMed Central

    Verburg, Frederik A; Van Santen, Hanneke M; Luster, Markus

    2017-01-01

    Although with a standardized incidence of 0.54 cases per 100,000 persons, differentiated thyroid cancer (DTC) is a rare disease in children and adolescents, it nonetheless concerns ~1.4% of all pediatric malignancies. Furthermore, its incidence is rising. Due to the rarity and long survival of pediatric DTC patients, in most areas of treatment little evidence exists. Treatment of pediatric DTC is therefore littered with controversies, many questions therefore remain open regarding the optimal management of pediatric papillary thyroid cancer (PTC), and many challenges remain unsolved. In the present review, we aim to provide an overview of these challenging areas of patient and disease management in pediatric PTC patients. Data on diagnosis, surgery, radionuclide, and endocrine therapy are discussed, and the controversies therein are highlighted. PMID:28096684

  16. Sponge systematics facing new challenges.

    PubMed

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

    2012-01-01

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

  17. Pediatric oncology in Morocco: achievements and challenges.

    PubMed

    Hessissen, Laila; Madani, Abdellah

    2012-03-01

    Cancer in children is quickly becoming one of the leading causes of non traumatic death among children. In pediatric oncology, palliative care is a primary component of the cancer control plan. In low income countries also known as emerging nations or developing countries access to adequate care remains a challenge for most pediatric oncology patients. In Morocco the situation has dramatically improved in the last few years as both the government and NGOs have become more aware of the importance and urgency of the issue. The incidence of cancer in patients under 15 years of age in Morocco is estimated to be 1000 new cases per year and the incidence of leukemia to be 100 new cases diagnosed per year. Pediatric cancer patients are mostly managed by public hospitals. Thus they are highly influenced by the Moroccan public health system, which is now considering cancer management a priority. Since health cover is very limited, most chemotherapy drugs were purchased by local parent associations. Recently, a new large Moroccan NGO (ALSC) provides anti-cancer drugs to all government-run oncology units. Despite all the progress, Morocco has witnessed in the pediatric oncology field, the palliative aspect of the care is not yet organized. Pediatric oncology is supported by the work of the National Society of Pediatric Oncolgy. The opioide therapy is available. However its use is strongly limited by the current restrictive and obsolete legislation which represents a major barrier to care. Despite the latest progress, pediatric oncology in Morocco still needs to improve in order to achieve performances comparable to those of the developed world. These improvements include better survival rates, less treatment abandonment, developing new techniques, improving quality of life and creating data collection teams. In order for this action to succeed all the stakeholders (government, NGOs, medical societies, oncology teams) must work together and coordinate their efforts.

  18. Challenges Facing Group Work Online

    ERIC Educational Resources Information Center

    Chang, Bo; Kang, Haijun

    2016-01-01

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

  19. Homeland Security. Management Challenges Facing Federal Leadership

    DTIC Science & Technology

    2002-12-01

    Security Management Challenges Facing Federal Leadership 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT... challenged in meeting dual or unrelated missions while maintaining and strengthening homeland security operations. Government organizational changes...including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi

  20. Facing Violence - A Global Challenge.

    PubMed

    Wenzel, Thomas; Kienzler, Hanna; Wollmann, Andreas

    2015-09-01

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

  1. Pediatric dental sedation: challenges and opportunities.

    PubMed

    Nelson, Travis M; Xu, Zheng

    2015-01-01

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

  2. Pediatric dental sedation: challenges and opportunities

    PubMed Central

    Nelson, Travis M; Xu, Zheng

    2015-01-01

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

  3. Exploring the challenges faced by polytechnic students

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

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

  4. Challenges in pediatric chronic inflammatory demyelinating polyneuropathy.

    PubMed

    Haliloğlu, Göknur; Yüksel, Deniz; Temoçin, Cağri Mesut; Topaloğlu, Haluk

    2016-12-01

    Chronic inflammatory demyelinating neuropathy, a treatable immune-mediated disease of the peripheral nervous system is less common in childhood compared to adults. Despite different sets of diagnostic criteria, lack of a reliable biologic marker leads to challenges in diagnosis, follow-up and treatment. Our first aim was to review clinical presentation, course, response to treatment, and prognosis in our childhood patients. We also aimed to document diagnostic and therapeutic pitfalls and challenges at the bedside. Our original cohort consisted of 23 pediatric patients who were referred to us with a clinical diagnosis of chronic inflammatory demyelinating neuropathy. Seven patients reaching to an alternative diagnosis were excluded. In the remaining patients, diagnostic, treatment and follow-up data were compared in typical patients who satisfied both clinical and electrodiagnostic criteria and atypical patients who failed to meet minimal research chronic inflammatory demyelinating neuropathy electrodiagnostic requirements. Eight of 16 patients (50%) met the minimal chronic inflammatory demyelinating neuropathy research diagnostic requirements. There was only a statistically significant difference (p = 0.010) in terms of European Neuromuscular Centre childhood chronic inflammatory diagnostic mandatory clinical criteria between the two groups. Misdiagnosis due to errors in electrophysiological interpretation (100%, n = 8), cerebrospinal fluid cytoalbuminologic dissociation (100%, n = 4 and/or subjective improvement on any immunotherapy modality (80 ± 19.27%)) was frequent. Pediatric CIDP is challenging in terms of diagnostic and therapeutic pitfalls at the bedside. Diagnostic errors due to electrophysiological interpretation, cerebrospinal fluid cytoalbuminologic dissociation, and/or subjective improvement on immunotherapy should be considered.

  5. Fiber quality challenges facing the cotton industry

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  6. Facing the Challenges of a Turbulent Economy

    ERIC Educational Resources Information Center

    Gann, Pamela B.

    2009-01-01

    As college presidents face the challenges of a turbulent and uncertain economy, they are working to assess the impacts on their strategic financial positions and to develop response plans that reflect their institutional missions and values. How can college presidents navigate during these difficult economic times as they seek to hold on to the…

  7. Challenges Beginning Teachers Face in Hong Kong

    ERIC Educational Resources Information Center

    Lam, Bick-Har

    2014-01-01

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

  8. Cultural Challenges Faced by Mexican Immigrant Students

    ERIC Educational Resources Information Center

    Zugel, Kevin

    2012-01-01

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

  9. Challenges Facing Early Childhood Programs Worldwide

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2008-01-01

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

  10. Transitioning Challenges Faced by Chinese Graduate Students

    ERIC Educational Resources Information Center

    Huang, Ying

    2012-01-01

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

  11. Anatomy Education Faces Challenges in Pakistan

    ERIC Educational Resources Information Center

    Memon, Ismail K.

    2009-01-01

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

  12. Adaptation challenges facing internationally educated nurses.

    PubMed

    Chege, Nancy; Garon, Maryanne

    2010-01-01

    This article describes the challenges facing internationally educated nurses working in the United States, combining an extensive literature review with the personal perspectives of a registered nurse from Kenya. An extensive literature search was conducted, and databases were collected and reviewed, while the nurse was participating in an internship at a hospital in a border city in California. Intertwining the personal experiences of the first author with an extensive literature review, the areas of communication, culture shock, nursing roles, and practice and orientation needs are covered. This article reinforces the difficulties faced by internationally educated nurses and makes suggestions for helping them make the adjustment to the US workforce.

  13. The pediatric heart network: meeting the challenges to multicenter studies in pediatric heart disease

    PubMed Central

    Burns, Kristin M.; Pemberton, Victoria L.; Pearson, Gail D.

    2017-01-01

    Purpose of review Because of the relatively small numbers of pediatric patients with congenital heart disease cared for in any individual center, there is a significant need for multicenter clinical studies to validate new medical or surgical therapies. The Pediatric Heart Network (PHN), with 15 years of experience in multicenter clinical research, has tackled numerous challenges when conducting multicenter studies. Recent findings This review describes the challenges encountered and the strategies employed to conduct high-quality, collaborative research in pediatric cardiovascular disease. Summary Sharing lessons learned from the PHN can provide guidance to investigators interested in conducting pediatric multicenter studies. PMID:26196261

  14. Challenges facing early career academic cardiologists.

    PubMed

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

    2014-06-03

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

  15. Academic pediatric radiology in 2010: challenges and opportunities.

    PubMed

    Taylor, George A

    2010-04-01

    Academic pediatric radiology is under considerable stress as the result of ongoing financial pressures and recent health-care legislation. This article reviews the current challenges, and suggests both departmental and individual strategies important in sustaining our academic mission.

  16. Pediatric cataract: challenges and future directions

    PubMed Central

    Medsinge, Anagha; Nischal, Ken K

    2015-01-01

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

  17. Technical challenges faced by the immigrant psychoanalyst.

    PubMed

    Akhtar, Salman

    2006-01-01

    This paper delineates the technical challenges faced by immigrant analysts. These include (i) maintaining cultural neutrality toward "native" patients, (ii) wondering about the patient's motivations for choosing an ethnoculturally different analyst, (iii) scanning the patient's associations for interethnic clues to deeper transferences, (iv) negotiating the dilemmas posed by conducting analysis in a language other than one's mother tongue, and (v) avoiding shared projections, acculturation gaps, and nostalgic collusion in working with homoethnic immigrant analysands. While by no means irrelevant to the clinical work of non-immigrant analysts, these tasks seem to have a greater importance for the immigrant analyst. Brief clinical vignettes are offered to illustrate these propositions and to highlight the tension between the universality of fundamental intrapsychic and relational configurations, on the one hand, and the nuances of cultural and linguistic context, on the other.

  18. The challenges facing wearable sensor systems.

    PubMed

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

    2012-01-01

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

  19. Four Challenges That Global Health Networks Face

    PubMed Central

    Shiffman, Jeremy

    2017-01-01

    Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD), maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is problem definition: generating consensus on what the problem is and how it should be addressed. The second is positioning: portraying the issue in ways that inspire external audiences to act. The third is coalition-building: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power.

  20. Clinical and economic challenges facing pharmacogenomics.

    PubMed

    Cohen, J; Wilson, A; Manzolillo, K

    2013-08-01

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

  1. Challenges in pediatric video-EEG monitoring.

    PubMed

    Sullivan, Joseph E; Corcoran-Donnelly, Maureen; Dlugos, Dennis J

    2007-06-01

    Video-EEG (VEEG) monitoring is now commonly used in children. When designing a pediatric video-EEG monitoring unit, there are many issues that need to be considered to take full advantage of this technology. Topics such as the physical layout of the VEEG unit, VEEG equipment, networking, staffing, and lines of communication regarding referrals and VEEG interpretation must be considered. Only after careful consideration of these issues, can video-EEG monitoring be successful and provide safe, state of the art clinical care in an efficient manner.

  2. Challenges Facing Design and Analysis Tools

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  3. Pediatric hepatocellular carcinoma: challenges and solutions

    PubMed Central

    Schmid, Irene; von Schweinitz, Dietrich

    2017-01-01

    Hepatocellular carcinoma (HCC) is a very rare entity in children, making it nearly impossible to orchestrate Phase II/III studies even as multinational cooperative trials. In contrast to adults, nearly 50% of the children have a response (α-fetoprotein decline and/or tumor shrinkage) to chemotherapeutic agents such as cisplatin and doxorubicin (PLADO), demonstrating that HCC in childhood can be chemotherapy sensitive. As a result, the main treatment options in pediatric HCC focus on systemic drug therapies and resection as the central therapy. In nonmetastatic patients with complete resection upfront, the 5-year event-free survival and overall survival has reached 80%–90%. In almost all reported studies, children received adjuvant chemotherapy (mostly PLADO), but it has never been proven that postoperative chemotherapy is superior to observation. No data are available for the effects of sorafenib. The 3-year survival is <20% in children with unresectable HCC independent of the chemotherapy given preoperatively. Currently, PLADO in combination with sorafenib is recommended with the goal of achieving operability status. Alternatively, data are promising for the combination of sorafenib with gemcitabine and oxaliplatin. For children with nonresectable and nonmetastastic liver tumors, it has been shown that the Milan criteria regarding liver transplantation are not applicable – individual decisions have to be made. Transarterial chemoembolization could be offered to patients with chemotherapy-resistant liver tumors for palliative care or potentially to achieve surgical resectability, and therefore cure. Information about the feasibility or effects of new agents or approaches as discussed in adult HCC patients is not available for childhood HCC. Research has to be done for characterizing the molecular and genomic mechanisms of pediatric HCC to support the development of novel therapeutic approaches and the implementation of personalized medicine. PMID:28144610

  4. Pediatric trauma care in Africa: the evolution and challenges.

    PubMed

    Abdur-Rahman, Lukman O; van As, A B Sebastian; Rode, Heinz

    2012-05-01

    Childhood trauma is one of the major health problems in the world. Although pediatric trauma is a global phenomenon in low- and middle-income countries, sub-Saharan countries are disproportionally affected. We reviewed the available literature relevant to pediatric trauma in Africa using the MEDLINE database, local libraries, and personal contacts. A critical review of all cited sources was performed with an emphasis on the progress made over the past decades as well as the ongoing challenges in the prevention and management of childhood trauma. After discussing the epidemiology and spectrum of pediatric trauma, we focus on the way forward to reduce the burden of childhood injuries and improve the management and outcome of injured children in Africa.

  5. An Exploration of Challenges Facing Division III Athletic Directors

    ERIC Educational Resources Information Center

    Engbers, Jeffrey L.

    2011-01-01

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

  6. Challenges Faced by Female-Students in Engineering-Education

    ERIC Educational Resources Information Center

    Madara, Diana Starovoytova; Cherotich, Sharon

    2016-01-01

    Gender-related challenges in learning technical courses are universal phenomenon. These challenges could restrain female students from achieving their fullest potential. The main focus of this study, therefore, is to examine self-recognized challenges faced by undergraduate female students in pursuing engineering at the School of Engineering…

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

    ERIC Educational Resources Information Center

    Olneck, Michael R.

    2011-01-01

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

  8. Challenges Facing Teachers New to Working in Schools Overseas

    ERIC Educational Resources Information Center

    Halicioglu, Margaret L.

    2015-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  10. CHALLENGES FACING HIGH POWER PROTON ACCELERATORS

    SciTech Connect

    Plum, Michael A

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Weaver, Debbi

    2006-01-01

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

  13. Working Face-to-Face for Pediatric CT Dose Reduction: A Community Toolkit

    PubMed Central

    Armao, Diane; Hartman, Terry; Shea, Christopher M.; Sams, Cassandra; Fordham, Lynn Ansley; Smith, J. Keith

    2016-01-01

    Although children are especially vulnerable to the health risks of ionizing radiation, approximately 8 million CTs are performed on children in the USA. Widespread dose variation is common, particularly in non-pediatric focused facilities. In this article we present our rationale and hands-on approach in developing and refining a toolkit aimed at helping a community hospital with pediatric CT dose reduction. PMID:27942250

  14. Challenges IT Instructors Face in the Self-Education Process

    ERIC Educational Resources Information Center

    Ruzic-Dimitrijevic, Ljiljana; Dimitrijevic, Maja

    2010-01-01

    Every few years, there is a breakthrough in information technology, introducing a new concept that becomes widely used. This paper deals with the challenges IT (information technology) instructors face due to these rapid developments in the IT industry. More specifically, we are interested in the challenges instructors of the introductory IT…

  15. Leading Schools Facing Challenging Circumstances: Some Insights from Western Australia

    ERIC Educational Resources Information Center

    Gillett, Jonathan; Clarke, Simon; O'Donoghue, Tom

    2016-01-01

    This paper examines leadership strategies that are most likely to engender success in schools that may be defined as facing challenging circumstances. First, it presents an overview of the relevant literature in order to illustrate distinctive challenges that tend to be encountered in these environments, as well as strategies that are adopted for…

  16. Challenges Faced by Project Competition Participants and Recommended Solutions

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Gmelch, Walter H., Ed.

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

  18. Challenges facing the development of cancer vaccines.

    PubMed

    Fishman, Mayer

    2014-01-01

    Just like any other effective immunization in medicine, cancer vaccines need to have antigens with particular specificity and immunostimulatory features, the immune responses to be elicited in the body, and therapeutic effect-regression or prevention of the cancer-must be meaningful and clinically observable. There are many choices for cancer antigens, such as tissue-specific proteins, cancer-specific proteins, class I- or class II-restricted peptides derived from those, or in situ and whole-cell-derived products are some examples. Another translational issue is that cancer patients are heterogeneous with respect to the extent to which the immune system is already activated with potential to impact the tumor growth or, conversely, the extent to which the immune system has been impaired through a prior and ongoing interaction with the tumor. Conventional or immunologic tests have potential to define a subset of patients with better chance or response, so that particular vaccines can be tested. Treatment of cancer patients is expensive, and trials are slow. To meet these challenges in practical terms will require not only careful scientific technical work for product development, coordination with clinicians to define patient subsets with diseases that can show responses, but also a comprehensive, practical implementation so that we can unlock the full potential of anticancer vaccines.

  19. 77 FR 2556 - Ethical and Regulatory Challenges in the Development of Pediatric Medical Countermeasures; Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... HUMAN SERVICES Food and Drug Administration Ethical and Regulatory Challenges in the Development of... announcing a public workshop entitled ``Ethical and Regulatory Challenges in the Development of Pediatric... ensure that these products are safe and effective in the pediatric population. The challenges...

  20. Pediatric Bipolar Disorder: Diagnostic Challenges in Identifying Symptoms and Course of Illness

    PubMed Central

    Singh, Tanvir

    2008-01-01

    Based on available literature, this article reviews the challenges associated with diagnosing pediatric bipolar disorder. The article also reviews and provides discussion on the assessment tools, complex mood cycling, and clinical symptoms of pediatric bipolar disorder. The challenge of differentiating common comorbid disorders like attention deficit hyperactivity disorder and conduct disorder from pediatric bipolar disorder is presented and discussed. A discussion of the validity of diagnosis in longitudinal studies is also provided. PMID:19727283

  1. Teaching the Mentally Handicapped Child: Challenges Teachers Are Facing

    ERIC Educational Resources Information Center

    Olivier, M. A. J.; Williams, E. E.

    2005-01-01

    This research study focused on the special nature (i.e. different from mainstream education) of special education and the experiences of teachers with regard to the challenges they face in teaching the mentally handicapped child. Special schoolteachers have the responsibility to offer not only good, but also highly individualized and goal-directed…

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

    ERIC Educational Resources Information Center

    Sincar, Mehmet

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Rehnke, Mary Ann

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

  4. The Challenges Facing Catholic Education in France Today

    ERIC Educational Resources Information Center

    Moog, François

    2016-01-01

    The effects of secularisation on society demand a rethinking of the identity and mission of Catholic schools in France. In 2013, the French bishops published a new directory which offers new approaches, described here, based on the three challenges facing Catholic education in France: linking social responsibility and evangelisation, setting up…

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

    ERIC Educational Resources Information Center

    Bayar, Adem

    2016-01-01

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

  6. Accommodating Extension Clients Who Face Language, Vision, or Hearing Challenges

    ERIC Educational Resources Information Center

    Angima, Sam; Etuk, Lena; Maddy, Deborah

    2016-01-01

    A survey-based study explored approaches used by one land-grant university to meet the needs of Extension clients who face language, vision, or hearing challenges. In attempts to serve such clients, the greatest gaps existed for clients whose main language was Spanish, followed by those who had vision impairments and then those who had hearing…

  7. MO-D-BRB-01: Pediatric Treatment Planning I: Overview of Planning Strategies and Challenges

    SciTech Connect

    Olch, A.

    2015-06-15

    Most Medical Physicists working in radiotherapy departments see few pediatric patients. This is because, fortunately, children get cancer at a rate nearly 100 times lower than adults. Children have not smoked, abused alcohol, or been exposed to environmental carcinogens for decades, and of course, have not fallen victim to the aging process. Children get very different cancers than adults. Breast or prostate cancers, typical in adults, are rarely seen in children but instead a variety of tumors occur in children that are rarely seen in adults; examples are germinomas, ependymomas and primitive neuroectodermal tumors, which require treatment of the child’s brain or neuroblastoma, requiring treatment in the abdomen. The treatment of children with cancer using radiation therapy is one of the most challenging planning and delivery problems facing the physicist. This is because bones, brain, breast tissue, and other organs are more sensitive to radiation in children than in adults. Because most therapy departments treat mostly adults, when the rare 8 year-old patient comes to the department for treatment, the physicist may not understand the clinical issues of his disease which drive the planning and delivery decisions. Additionally, children are more prone than adults to developing secondary cancers after radiation. For bilateral retinoblastoma for example, an irradiated child has a 40% chance of developing a second cancer by age 50. The dosimetric tradeoffs made during the planning process are complex and require careful consideration for children treated with radiotherapy. In the first presentation, an overview of childhood cancers and their corresponding treatment techniques will be given. These can be some of the most complex treatments that are delivered in the radiation therapy department. These cancers include leukemia treated with total body irradiation, medulloblastoma, treated with craniospinal irradiation plus a conformal boost to the posterior fossa

  8. Meanings of state hospital nursing. I: Facing challenges.

    PubMed

    Thomas, M D; Beaven, J; Blacksmith, J; Ekland, E; Hein, J; Osborne, O H; Reno, J

    1999-02-01

    The purpose of this study was to describe the meaning of work for nurses employed in two state psychiatric hospitals. Nurses at both hospitals participated in designing and carrying out the research. In Phase I, nurses described situations in which they had been observers or participant observers and the way that they understood what was occurring in the situations described. The data from these descriptions were analyzed in collaboration with small groups of nurse co-investigators at each hospital. In Phase II, patterns of meaning identified in Phase I were checked and further refined based on focus groups and interviews with nurses at both hospitals. The interrelated dilemmas faced by nurses are discussed as (1) challenges in clinical decision making, (2) challenges regarding personal control, and (3) challenges of maintaining professional standards. Ways of meeting these challenges, coping, and making meaning are discussed in a companion article, "Meanings of State Hospital Nursing II: Coping and Making Meaning".

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

    ERIC Educational Resources Information Center

    LeDrew, June; Cummings-Vickaryous, Bonnie

    2010-01-01

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

  10. MO-DE-207-04: Imaging educational program on solutions to common pediatric imaging challenges

    SciTech Connect

    Krishnamurthy, R.

    2015-06-15

    This imaging educational program will focus on solutions to common pediatric imaging challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. The educational program will begin with a detailed discussion of the optimal configuration of fluoroscopes for general pediatric procedures. Following this introduction will be a focused discussion on the utility of Dual Energy CT for imaging children. The third lecture will address the substantial challenge of obtaining consistent image post -processing in pediatric digital radiography. The fourth and final lecture will address best practices in pediatric MRI including a discussion of ancillary methods to reduce sedation and anesthesia rates. Learning Objectives: To learn techniques for optimizing radiation dose and image quality in pediatric fluoroscopy To become familiar with the unique challenges and applications of Dual Energy CT in pediatric imaging To learn solutions for consistent post-processing quality in pediatric digital radiography To understand the key components of an effective MRI safety and quality program for the pediatric practice.

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

    PubMed Central

    Carter, Pam; Martin, Graham

    2016-01-01

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

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

    PubMed

    Carter, Pam; Martin, Graham

    2016-01-21

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

  13. A Variety of Diversity: Facing Higher Education's Educational Challenges

    NASA Astrophysics Data System (ADS)

    Dey, Eric L.

    2008-10-01

    First among the many important challenges facing American higher education is the need to improve the effectiveness of our educational programs. Public concern has heightened the sense of urgency for colleges and universities to make progress on improving and measuring educational outcomes, which is made more challenging by the varieties of diversity facing us. Diversity is not just an issue related to student recruitment or experience, but rather it is one that also relates to institutions and their faculties. New educational methods must address such diversity to be effective, and one possible example can be found in ongoing research at the University of Michigan that explores the educational implications of implementing a web-based lecture capture system in large lecture courses. Student use of and reactions to such systems is important, as is the potential to influence course performance for students in general, but also for underrepresented and at-risk student subpopulations. In addition to helping bring our current landscape into focus, this paper will identify effective practices as well as continuing challenges to improving educational practice for undergraduate students.

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

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

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

  15. Pediatric cardiovascular safety: challenges in drug and device development and clinical application.

    PubMed

    Bates, Katherine E; Vetter, Victoria L; Li, Jennifer S; Cummins, Susan; Aguel, Fernando; Almond, Christopher; Dubin, Anne M; Elia, Josephine; Finkle, John; Hausner, Elizabeth A; Joseph, Francesca; Karkowsky, Abraham M; Killeen, Matthew; Lemacks, Jodi; Mathis, Lisa; McMahon, Ann W; Pinnow, Ellen; Rodriguez, Ignacio; Stockbridge, Norman L; Stockwell, Margaret; Tassinari, Melissa; Krucoff, Mitchell W

    2012-10-01

    Development of pediatric medications and devices is complicated by differences in pediatric physiology and pathophysiology (both compared with adults and within the pediatric age range), small patient populations, and practical and ethical challenges to designing clinical trials. This article summarizes the discussions that occurred at a Cardiac Safety Research Consortium-sponsored Think Tank convened on December 10, 2010, where members from academia, industry, and regulatory agencies discussed important issues regarding pediatric cardiovascular safety of medications and cardiovascular devices. Pediatric drug and device development may use adult data but often requires additional preclinical and clinical testing to characterize effects on cardiac function and development. Challenges in preclinical trials include identifying appropriate animal models, clinically relevant efficacy end points, and methods to monitor cardiovascular safety. Pediatric clinical trials have different ethical concerns from adult trials, including consideration of the subjects' families. Clinical trial design in pediatrics should assess risks and benefits as well as incorporate input from families. Postmarketing surveillance, mandated by federal law, plays an important role in both drug and device safety assessment and becomes crucial in the pediatric population because of the limitations of premarketing pediatric studies. Solutions for this wide array of issues will require collaboration between academia, industry, and government as well as creativity in pediatric study design. Formation of various epidemiologic tools including registries to describe outcomes of pediatric cardiac disease and its treatment as well as cardiac effects of noncardiovascular medications, should inform preclinical and clinical development and improve benefit-risk assessments for the patients. The discussions in this article summarize areas of emerging consensus and other areas in which consensus remains elusive

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

    NASA Astrophysics Data System (ADS)

    Alsharari, Salman

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

  17. Pediatric priority in kidney allocation: challenging its acceptability.

    PubMed

    Capitaine, Laura; Van Assche, Kristof; Pennings, Guido; Sterckx, Sigrid

    2014-06-01

    Any organ which is allocated to one individual represents a missed opportunity for someone else. Given the important repercussions which organ allocation policies inevitably have for certain people, any prioritization policy should rest on a solid argumentative basis. In this study, we analyze the widespread practice of prioritizing pediatric patients in the allocation of kidneys. While official policy documents offer no arguments in support of pediatric priority, such arguments can be found in the academic literature on pediatric renal transplantation. Our study is the first to bring together and critically analyze these. We identify five commonly cited arguments and show that none of these succeeds in justifying pediatric priority policies. We argue that the legitimacy of such policies may be further undermined by their potential adverse effects on both adults and children.

  18. Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions.

    PubMed

    Muir, Ryan T; Wang, Shelly; Warf, Benjamin C

    2016-11-01

    OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

  19. Challenges facing European agriculture and possible biotechnological solutions.

    PubMed

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

    2016-10-01

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

  20. Pediatric AIDS/HIV Infection: An Emerging Challenge to Pediatric Psychology.

    ERIC Educational Resources Information Center

    Olson, Roberta A.; And Others

    1989-01-01

    The increasing number of cases of pediatric Acquired Immonodeficiency Syndrome (AIDS) presents unique issues for psychologists in the areas of prevention, clinical treatment, public education, research, neuropsychological effects, psychoneuroimmunology, and ethical concerns. (Author/DB)

  1. Challenges Faced by Refugee New Parents from Africa in Canada.

    PubMed

    Stewart, M; Dennis, C L; Kariwo, M; Kushner, K E; Letourneau, N; Makumbe, K; Makwarimba, E; Shizha, E

    2015-08-01

    This study examines challenges faced by refugee new parents from Africa in Canada. Refugee new parents from Zimbabwe (n = 36) and Sudan (n = 36) were interviewed individually about challenges of coping concurrently with migration and new parenthood and completed loneliness and trauma/stress measures. Four group interviews with refugee new parents (n = 30) were subsequently conducted. Participants reported isolation, loneliness, and stress linked to migration and new parenthood. New gender roles evoked marital discord. Barriers to health-related services included language. Compounding challenges included discrimination, time restrictions for financial support, prolonged immigration and family reunification processes, uncoordinated government services, and culturally insensitive policies. The results reinforce the need for research on influences of refugees' stressful experiences on parenting and potential role of social support in mitigating effects of stress among refugee new parents. Language services should be integrated within health systems to facilitate provision of information, affirmation, and emotional support to refugee new parents. Our study reinforces the need for culturally appropriate services that mobilize and sustain support in health and health related (e.g., education, employment, immigration) policies.

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

    PubMed

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

    2016-10-01

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

  3. The challenges faced by living stock collections in the USA

    PubMed Central

    McCluskey, Kevin; Boundy-Mills, Kyria; Dye, Greg; Ehmke, Erin; Gunnell, Gregg F; Kiaris, Hippokratis; Polihronakis Richmond, Maxi; Yoder, Anne D; Zeigler, Daniel R; Zehr, Sarah; Grotewold, Erich

    2017-01-01

    Many discoveries in the life sciences have been made using material from living stock collections. These collections provide a uniform and stable supply of living organisms and related materials that enhance the reproducibility of research and minimize the need for repetitive calibration. While collections differ in many ways, they all require expertise in maintaining living organisms and good logistical systems for keeping track of stocks and fulfilling requests for specimens. Here, we review some of the contributions made by living stock collections to research across all branches of the tree of life, and outline the challenges they face. DOI: http://dx.doi.org/10.7554/eLife.24611.001 PMID:28266913

  4. Psychometric Properties of the FACES-IV in a Pediatric Oncology Population

    PubMed Central

    Marsac, Meghan L.

    2011-01-01

    Objective The purpose of this study was to examine the psychometric properties of the Family Adaptability and Cohesion Evaluation Scales, version IV (FACES-IV) in families of children with cancer. Methods As part of a larger program of research, 147 mothers and 40 fathers from 162 families of children with cancer completed the FACES-IV. Parents and one healthy child from each family (77 girls; age M = 12.8, SD = 2.8) completed additional measures of family functioning and parenting. Results Internal consistencies above .70 were found for all subscales except one (Enmeshed, α = .65). Intercorrelations of the subscales were similar to the validation sample but seemed inconsistent with the Circumplex Model on which the measure is based. Analyses raised questions regarding construct validity for the Enmeshed and Rigid subscales. Conclusions These preliminary findings suggest that more research is needed prior to widespread use of the FACES-IV in pediatric oncology populations. PMID:20147435

  5. Facing up to the Challenges of Advancing Craniofacial Research

    PubMed Central

    Trainor, Paul A.; Richtsmeier, Joan T.

    2015-01-01

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

  6. The Foinaven field: Facing the new frontier drilling challenges

    SciTech Connect

    Jackson, G.; Jenkins, M.; Cameron, C.; Reed, H.

    1996-02-01

    The opening up of the West of Shetland province presents a new range of challenges and opportunities from those encountered in nearby North Sea oil fields. Drilling and operational problems have to be faced in an even harsher and more remote environment -- the nearest landfall is the Shetland Islands, 100 miles to the east, but seas are from the Atlantic with a significantly larger and longer swell. The results can be seen in the progress that has been made in the 21 months of well construction activities, from exploration drilling to the laying of subsea hardware production systems. Nineteen exploration wells have been drilled; three Foinaven development wells have been completed with Christmas trees on and tested; nine further conductors have been set on the Foinaven drill sites, with intermediate casings run and installed in three of those; and two appraisal wells have been successfully completed with extended well tests. But in this period of intense activity several lessons can be learned for the oil industry worldwide. This paper reviews the engineering problems and materials selection associated with this development. It includes information on bit selection, hole stability, drilling challenges, drilling fluids, tool reliability, coring equipment, horizontal methods, and well testing and completion.

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

    PubMed Central

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Ahumada, Luis; Galdames, Sergio; Clarke, Simon

    2016-01-01

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

  9. Defense Travel System. Overview of Prior Reported Challenges Faced by DOD in Implementation and Utilization

    DTIC Science & Technology

    2008-04-15

    Committee on Armed Services, House of Representatives DEFENSE TRAVEL SYSTEM Overview of Prior Reported Challenges Faced by DOD in Implementation and... Travel System. Overview of Prior Reported Challenges Faced by DOD in Implementation and Utilization 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...Did This Study Highlights Accountability Integrity Reliability April 15, 2008 DEFENSE TRAVEL SYSTEM Overview of Prior Reported Challenges Faced by

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

    PubMed

    Saadia, Marc; Valencia, Roberto

    2015-01-01

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

  11. A personal perspective on challenges that face women scientists

    NASA Astrophysics Data System (ADS)

    Cashman, Katharine

    2016-04-01

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

  12. Space Acquisitions: Challenges Facing DOD as it Changes Approaches to Space Acquisitions

    DTIC Science & Technology

    2016-03-09

    SPACE ACQUISITIONS Challenges Facing DOD as it Changes Approaches to Space Acquisitions Statement of Cristina T. Chaplain...2016 SPACE ACQUISITIONS Challenges Facing DOD as it Changes Approaches to Space Acquisitions Why GAO Did This Study DOD is shifting its traditional...approach to space acquisitions, bolstering its protection of space systems, and engaging with more commercial providers. Given the time and

  13. Challenges for the functional diffusion map in pediatric brain tumors

    PubMed Central

    Grech-Sollars, Matthew; Saunders, Dawn E.; Phipps, Kim P.; Kaur, Ramneek; Paine, Simon M.L.; Jacques, Thomas S.; Clayden, Jonathan D.; Clark, Chris A.

    2014-01-01

    Background The functional diffusion map (fDM) has been suggested as a tool for early detection of tumor treatment efficacy. We aim to study 3 factors that could act as potential confounders in the fDM: areas of necrosis, tumor grade, and change in tumor size. Methods Thirty-four pediatric patients with brain tumors were enrolled in a retrospective study, approved by the local ethics committee, to examine the fDM. Tumors were selected to encompass a range of types and grades. A qualitative analysis was carried out to compare how fDM findings may be affected by each of the 3 confounders by comparing fDM findings to clinical image reports. Results Results show that the fDM in areas of necrosis do not discriminate between treatment response and tumor progression. Furthermore, tumor grade alters the behavior of the fDM: a decrease in apparent diffusion coefficient (ADC) is a sign of tumor progression in high-grade tumors and treatment response in low-grade tumors. Our results also suggest using only tumor area overlap between the 2 time points analyzed for the fDM in tumors of varying size. Conclusions Interpretation of fDM results needs to take into account the underlying biology of both tumor and healthy tissue. Careful interpretation of the results is required with due consideration to areas of necrosis, tumor grade, and change in tumor size. PMID:24305721

  14. Pediatrics

    NASA Technical Reports Server (NTRS)

    Spackman, T. J.

    1978-01-01

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

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

    PubMed

    Sandford, Adam; Burton, A Mike

    2014-09-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Detomo, R.

    2005-05-01

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

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

    ERIC Educational Resources Information Center

    Patterson, Giovanna; Sprehe, J. Timothy

    2002-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  20. Challenges facing the development of the Arabic chatbot

    NASA Astrophysics Data System (ADS)

    AlHagbani, Eman Saad; Khan, Muhammad Badruddin

    2016-07-01

    The future information systems are expected to be more intelligent and will take human queries in natural language as input and answer them promptly. To develop a chatbot or a computer program that can chat with humans in realistic manner to extent that human get impressions that he/she is talking with other human is a challenging task. To make such chatbots, different technologies will work together ranging from artificial intelligence to development of semantic resources. Sophisticated chatbots are developed to perform conversation in number of languages. Arabic chatbots can be helpful in automating many operations and serve people who only know Arabic language. However, the technology for Arabic language is still in its infancy stage due to some challenges surrounding the Arabic language. This paper offers an overview of the chatbot application and the several obstacles and challenges that need to be resolved to develop an effective Arabic chatbot.

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

    PubMed

    Henrickson, Michael

    2011-08-16

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

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

    PubMed Central

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Lipka, Sara

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Lent, ReLeah Cossett

    2008-01-01

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

  5. Can-Do Spirit: Facing the Challenges of Budget Cuts

    ERIC Educational Resources Information Center

    Edwards, Buffy

    2012-01-01

    In this era of higher student enrollment coupled with budget cuts, some school library professionals are considering retirement, while others are standing up to defend the profession they know has a strong positive impact on student learning. Many school librarians who weather difficulties do so by choosing to find energy in the challenges of…

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

    ERIC Educational Resources Information Center

    Jung, Adrian; Nam, Sang; Han, Shini

    2015-01-01

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

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

    PubMed

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

    2016-09-01

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

  8. The Fourth Annual Meeting of the International Network for Pediatric Hemophilia: Current Challenges and Recommendations in the Clinical Care of Children with Hemophilia

    PubMed Central

    Ljung, Rolf; van den Berg, Marijke; Valentino, Leonard A.; Manco-Johnson, Michael

    2010-01-01

    Summary The International Network for Pediatric Hemophilia (INPH) comprises a group of physicians committed to the unique care of and challenges facing pediatric hemophilia patients. By collaborating on an international level, extensive experience can be shared on current practice, new trends can be discussed and scientifically valid studies can be developed and performed. The three overall objectives of the group (scientific progress, education and networking) are achieved at each annual meeting starting with a round table on the members’ current research and clinical activities, project reports of INPH study initiatives, followed by invited educational presentations and interactive discussions. The meetings close with proposals of new projects, future directions of the group and concluding remarks. The Fourth Annual INPH meeting, held in 2009 in Boston, MA, USA, focused on inhibitor development and hemophilic arthropathy in the clinical care of children with hemophilia. PMID:20823999

  9. Focusing a Transition: Challenges Facing the New Administration

    DTIC Science & Technology

    2016-09-01

    full- time attention of a Chief Management Officer. Our report describes those management challenges that require attention and the role that we...Department. The largest organization in the world requires the full- time attention of a Chief Management Officer. Our report describes the...Chief Financial Officer/Comptroller, and the Deputy Chief Management Officer. The Secretary should invest the time to set the criteria for these

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  11. Myth 15: High-Ability Students Don't Face Problems and Challenges

    ERIC Educational Resources Information Center

    Moon, Sidney M.

    2009-01-01

    One rationale for failure to address the needs of high-ability students in schools is that high-ability students do not need special services because they do not face any special problems or challenges. A more extreme corollary of this attitude is the notion that high ability is so protective that students with high ability do not face problems or…

  12. Pharmacotherapy challenges of Fontan-associated plastic bronchitis: a rare pediatric disease.

    PubMed

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

    2013-09-01

    Pediatric pharmacotherapy is often challenging due to the paucity of available clinical data on the safety and efficacy of drugs that are commonly used in children. This quandary is even more prevalent in children with rare diseases. Although extrapolations for dosing and administration are often made from available adult data with similar disease states, this translation becomes even more problematic in rare pediatric diseases. Understanding of rare disease pathophysiology is typically poor, and few, if any, effective therapies have been studied and identified. One condition that illustrates these issues is plastic bronchitis, a rare, most often pediatric disease that is characterized by the production of obstructive bronchial airway casts. This illness primarily occurs in children with congenital heart disease, often after palliative surgery. Plastic bronchitis is a highly clinically relevant and therapeutically challenging problem with a high mortality rate, and, a generally accepted effective pharmacotherapy regimen has yet to be identified. Furthermore, the disease is ill defined, which makes timely identification and treatment of children with plastic bronchitis difficult. The pharmacotherapies currently used to manage this disease are largely anecdotal and vary between the use of macrolide antibiotics, mucolytics, bronchodilators, and inhaled fibrinolytics in a myriad of combinations. The purpose of this review is 2-fold: first, to highlight the dilemma of treating plastic bronchitis, and second, to bring attention to the continuing need for studies of drug therapies used in children so safe and effective drug regimens can be established, particularly for rare diseases.

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

    PubMed

    Shafran, David; Kodish, Eric; Tzakis, Andreas

    2014-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. Facing technological challenges of Solar Updraft Power Plants

    NASA Astrophysics Data System (ADS)

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

    2015-01-01

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

  16. [China faces a challenge of breast cancer prevention and control].

    PubMed

    Zhang, B N; Chen, W Q; Zhang, X; Qiao, Y L

    2016-10-23

    The incidence and mortality of breast cancer is in an increasing trend. In contrast to the global breast cancer situation, the prevention and control is challenging in China. Some suggestions are presented to the project of breast cancer prevention and control in China. Combining the global screening experiences with the epidemiological features of Chinese female breast cancer, aims to improve the population screening and early detection rate. Standardizing clinical diagnosis and treatment practice, aims to increase the efficacy and decrease the mortality. Intervening lifestyle and dietary behaviors, and intends to reduce risk exposure and incidence. Building national breast cancer registry provides preventive strategies. Great efforts should be made to carry out large sample multicenter clinical trails and translational research on the prevention and cotrol of breast cancer coordiated by health care service and science and technology administrations. Breast cancer prevention and control has a long way to go in China.

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

    PubMed

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  19. Challenges Faced by a Faith-Based School in a Rural, Predominantly Secular Setting: Implications

    ERIC Educational Resources Information Center

    Evangelinou-Yiannakis, Angela

    2016-01-01

    A new, independent Catholic school in rural Australia has had to face significant challenges in relation to its distinct Catholic ethos and curriculum. The challenges have included resistance from parents of the School with regard to the weekly time allocation for Religious Education, the nature of the faith-based curriculum, and the way in which…

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

    ERIC Educational Resources Information Center

    Xiaohao, Ding

    2004-01-01

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

  1. Challenges Facing Hispanic-Serving Institutions in the First Decade of the 21st Century

    ERIC Educational Resources Information Center

    de los Santos, Alfredo G., Jr.; Cuamea, Karina Michelle

    2010-01-01

    In 2007, the presidents and chancellors of Hispanic-serving institutions identified 5 challenges that their institutions will face as the end of the first decade of the 21st century approaches. Almost 8 of 10 respondents listed lack of funding as the most important challenge. The 2nd most important issue was the poor academic preparedness of…

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Nguyen, Nguyenvu; Pezzella, A Thomas

    2015-04-01

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

  5. Defense Weather Satellites: DOD Faces Acquisition Challenges for Addressing Capability Needs

    DTIC Science & Technology

    2016-07-07

    as weather forecasting and climate research. As existing weather satellite systems age, DOD faces potential gaps in its space-based weather...planning, execution, and sustainment of U.S. military operations and for civilian uses, such as weather forecasting and climate research. As DOD’s...4GAO, Space Acquisitions: Challenges Facing DOD as it Changes Approaches to Space Acquisitions, GAO-16-471T (Washington, D.C.: Mar. 9, 2016); GAO

  6. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit.

    PubMed

    Ismail, Ahmad

    2016-12-01

    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  7. Outpatient penicillin use after negative skin testing and drug challenge in a pediatric population.

    PubMed

    Picard, Matthieu; Paradis, Louis; Nguyen, Mélanie; Bégin, Philippe; Paradis, Jean; Des Roches, Anne

    2012-01-01

    The practice of elective penicillin skin testing could be compromised by the fact that patients, their parents, or their physicians remain reluctant to reuse penicillin-class antibiotics (PCAs) despite a negative evaluation by an allergist. This study addresses reuse of PCAs in a pediatric population after negative penicillin skin testing and drug challenge and factors associated with its reluctance. All children evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between January 1998 and June 2000 with negative skin testing and drug challenge were included in the study. A telephone survey was conducted between May and October 2002 to assess the perception of the initial reaction by the parents, subsequent use of antibiotics, and antibiotic-related adverse reactions. Among the 200 children selected, parents of 170 (85%) children completed the survey. Since the allergist evaluation, 130 (76%) children had received antibiotics. PCA was used in 59 (45%) children. Parents of 24 (18%) children refused PCAs because they still feared an adverse reaction. They were more likely to have been very frightened by their child's allergic reaction than other parents whose children had used PCAs (p = 0.008). Although elective penicillin skin testing is useful and safe in the pediatric population, a significant proportion of parents still refuse PCAs even though they are needed. Identification of parents that were very frightened by their children's allergic reactions and additional reassurance could improve this situation.

  8. Children with developmental disabilities at a pediatric hospital: staff education to prevent and manage challenging behaviors.

    PubMed

    Johnson, Norah L; Lashley, Joel; Stonek, Alice V; Bonjour, Annette

    2012-12-01

    Children with developmental disabilities may get frustrated in unpredictable hospital environments. Frustration may escalate to challenging behaviors, which are a safety concern and may contribute to staff and patient injuries, use of restraints, and procedure delay or cancelations. The purpose of this article was to describe a pilot staff education program on preventing and managing challenging behaviors of children with developmental disabilities at a pediatric hospital. The 2-hour-long education (1 hour on-line and 1 hour instructor led) content focused on family-centered care and communication skills, including verbal judo™ modified for use in the health care setting. Participants in the instructor-led sessions reported improved knowledge and decreased fear about caring for children with developmental disabilities. Relationships of the education and fewer staff injuries, fewer canceled procedures, and decreased use of restraints merit further study.

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  10. Challenges faced by multidisplinary new investigators on addressing grand challenges in global health

    PubMed Central

    2014-01-01

    Background The grand challenges approach aims to spark innovative and transformative strategies to overcome barriers to significant global health issues. Grand Challenges Canada endorses an ‘Integrated Innovation™’ approach that focuses on the intersection of scientific/technological, social and business innovation. In this article we explore themes emerging from a dialogue between the authors, who are multidisciplinary recipients of the ‘Rising Stars in Global Health’ award from Grand Challenges Canada, regarding benefits of engaging in integrated innovation research, and recommendations for how this approach may develop in the future. Discussion Our dialogue followed a semi-structured interview format that addressed three topics: 1) reflections on applying an Integrated Innovation™ approach for global health; 2) thoughts on participation in the Grand Challenges 2012 meeting; and 3) authors’ visions of Grand Challenges Canada and the Grand Challenge movement towards 2020. The dialogue was transcribed verbatim and we used thematic analysis techniques to identify, analyze and report themes in the data. Benefits of working using the Grand Challenges approach centered on two themes: a) the potential for scientific breakthrough and b) building interdisciplinary collaborations and a community of scholars. Challenges and opportunities for Grand Challenges in moving forward included: a) capacity building, particularly regarding Integrated Innovation™ and scale-up planning; b) interdisciplinary and international mentorship for new investigators; and c) potential for future commercialization. Conclusions Our discussion highlighted that Integrated Innovation™ offers the opportunity to develop new theories, methods and approaches to global health while simultaneously fostering a collaborative spirit grounded in international, interdisciplinary collaborations. However, the arguable over-emphasis on corporatization poses a major challenge for new investigators

  11. Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology.

    PubMed

    Magalhães-Sant'Ana, M; More, S J; Morton, D B; Hanlon, A

    2016-10-29

    Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation.

  12. Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology

    PubMed Central

    Magalhães-Sant'Ana, M.; More, S. J.; Morton, D. B.; Hanlon, A.

    2016-01-01

    Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. PMID:27613779

  13. Pediatric facial transplantation: Ethical considerations

    PubMed Central

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

    2014-01-01

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

  14. Informational Cultures: Facing Challenges of Institutional Research within Cross-Continental Settings.

    ERIC Educational Resources Information Center

    Nedwek, Brian P.; Neal, John E.

    1994-01-01

    Challenges faced by institutions of higher education when performing institutional research on different continents are examined. The discussion is based on the experiences of two universities with undergraduate programs in foreign countries. Three levels of organizational activity (strategic, managerial, operational) and several information…

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

    ERIC Educational Resources Information Center

    Alias, Aliza

    2014-01-01

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

  16. Improving Teacher Quality, a Keyword for Improving Education Facing Global Challenges

    ERIC Educational Resources Information Center

    Jusuf, Husain

    2005-01-01

    Research shows that teachers are the single most important factor in student learning in schools. Students who have access to highly qualified teachers achieve at a higher rate, regardless of other factors. Teachers to be highly qualified must be well prepared, especially in improving the quality of education facing global challenges. For this…

  17. Challenges Facing the 2007-08 California State Budget. Commission Report 06-16

    ERIC Educational Resources Information Center

    California Postsecondary Education Commission, 2006

    2006-01-01

    This report discusses the State of California's fiscal condition and guides the reader through numerous factors that will influence State spending on higher education in the coming fiscal year. It also offers insight and observations on challenging policy decisions the Governor, the Legislature, and higher education leaders face in the coming…

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Eslami, Zohreh R.

    2005-01-01

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

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

    ERIC Educational Resources Information Center

    Spiro, Rivka; Hill, Robert

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Gudgel, Mark

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Mahfoodh, Omer Hassan Ali

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Rajasingham, Lalita

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Brown, Jason D.

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Reid, Ken

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Kuo, Ya-Hui

    2011-01-01

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

  7. "Accounting Education at a Crossroad in 2010" and "Challenges Facing Accounting Education in Australia"

    ERIC Educational Resources Information Center

    de Lange, Paul; Watty, Kim

    2011-01-01

    Of the various reports released in 2010, two purport to examine the state of accounting education in Australia. These are "Accounting Education at a Crossroad in 2010" and "Challenges Facing Accounting Education in Australia". Both were released as collaborations of the leading academic organisation, the Accounting and Finance…

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

    ERIC Educational Resources Information Center

    Garwe, Evelyn Chiyevo

    2014-01-01

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

  9. Challenges Facing Older Adults with Intellectual Disabilities. Research Digest No. 1

    ERIC Educational Resources Information Center

    Posey, Virginia; Myers; Diane

    2005-01-01

    The authors discuss special challenges faced by older adults with intellectual disabilities. The 2004 report from The President's Committee for People with Intellectual Disabilities (PCPID) stated that in 1970 only about eleven percent of people with intellectual disabilities in the United States were over 55. It is expected that by 2040 the…

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

    ERIC Educational Resources Information Center

    Coope, Caroline M.; Theobald, Sally

    2006-01-01

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

  11. Localized cold urticaria to the face in a pediatric patient: a case report and literature review.

    PubMed

    Sciallis, Gabriel F; Krych, Esther H

    2010-01-01

    We present a curious case of localized cold urticaria restricted to the face in a 10-year-old girl. Testing for the condition using an ice cube was positive only in the facial area. After 2 years, the patient continues to experience localized urticaria only on her face on cold exposure. A review of the available published medical literature on cold urticaria was performed using Ovid and PubMed databases. The literature search was not limited to the English language. Only three other cases of cold urticaria localized to the face were identified. Upon review of the published reports on cold urticaria and discussion of classification and diagnostic testing, we conclude that cold urticaria clearly is a rare and poorly understood entity.

  12. Return of Individual Research Results & Incidental Findings: Facing the Challenges of Translational Science

    PubMed Central

    Wolf, Susan M.

    2014-01-01

    The debate over return of individual research results and incidental findings to research participants is a key frontier in research ethics and practice. Fundamentally, this is a problem of translational science, a question of when information about an individual that is generated in research should be communicated for clinical attention, as the technology itself is moving into clinical care. There is growing consensus that investigators should offer participants at least those individual findings of high clinical importance and actionability. Increasing attention to what information biobanks and secondary researchers owe people who provide data and samples offers an opportunity to treat these source individuals as research partners. Cutting-edge issues include return of results in pediatric populations and return to kin and family, including after death of the proband. Progress will require facing the continuum linking research and clinical care and developing standards and models for return. PMID:23875796

  13. [Brazilian Army nurses and transportation of the wounded: a challenge faced during World War II].

    PubMed

    Bernardes, Margarida Maria Rocha; Lopes, Gertrudes Teixeira

    2007-01-01

    This historic-sociologic study aims to analyse the challenges faced by the Brazilian Expeditionary Force's Air Transportation Nurses of the Army with the Theatre of Operations on the course of World War II. The primary source was comprised of a photograph from this time period and oral testimonies of those who participated in the conflict. Ideas by sociologist Pierre Bourdieu support the discussion. Results suggest that Brazilian nurses were challenged to transport the wounded without medical advice. We conclude that the challenge to fulfill the task imposed, which led to independent decision-making, gave confidence and autonomy to the ones already responsible for the transportation of the wounded.

  14. From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics.

    PubMed

    Shonkoff, Jack P

    2003-02-01

    Rapidly advancing research in neurobiology and the behavioral and social sciences, coupled with dramatic changes in the social and economic circumstances under which families are raising young children, has created a highly dynamic context for early childhood policy, service delivery, and child rearing in the United States. A recent report from the National Research Council and the Institute of Medicine, presents a critical analysis of that complex knowledge base and a set of recommendations designed to close the gap between what we know and what we do to promote the healthy development of young children. This article examines the report through the lens of developmental and behavioral pediatrics and highlights both exciting opportunities and sobering challenges.

  15. But I Don't Understand You: One Faculty's Observations of the Challenges Facing International Healthcare Students

    ERIC Educational Resources Information Center

    DuBose, Cheryl O.

    2017-01-01

    International students face many challenges when pursuing a degree in higher education. Communication and cultural differences are typically cited as the most challenging aspects of any study abroad program. Students attempting to complete a healthcare program face sometimes insurmountable issues, as communication, cultural differences, and…

  16. International dermatology: the many faces and challenges of the specialty in the global village.

    PubMed

    Lotti, Torello; Handog, Evangeline B; Hercogová, Jana; Ramos-E-Silva, Marcia

    2008-04-01

    The technical advances of the last century changed the understanding of the science of cutaneous physiology and pathology and the role of the dermatologist. The major challenges the international dermatologic community faces today are the lack of a common, logical, and accepted language within the specialty; long-accepted but questionable policies to advance academic careers; and the marginalization of dermatology. Methods for communicating and circulating data and ideas also have changed radically. The distribution of knowledge and essential/practical tools in different regions of the world is inequitable, and developing countries must cope with the challenges of high-impact skin diseases.

  17. Expanding the Shield and Facing the Challenges: Integration of Women in Botswana Defence Force

    DTIC Science & Technology

    2003-03-01

    for, and to a large degree, accomplished a reevaluation of the traditional views of the role of women in society . Feminism has helped sensitize the...African women from economic empowerment .17 Women in many African societies are not only denied opportunities by laws and stereotypical...the Shield and Facing the Challenges: Integration of Women in Botswana Defence Force 6. AUTHOR( S ) Mpho C. Mophuting 5. FUNDING NUMBERS 7

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

    PubMed Central

    2013-01-01

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

  19. Challenges of Clinical Trial Design for Targeted Agents Against Pediatric Leukemias

    PubMed Central

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

    2015-01-01

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

  20. Choroid plexus papilloma-A case highlighting the challenges of extrapolating pediatric chemotherapy regimens to adult populations.

    PubMed

    Barman, Stephen L; Jean, Gary W; Dinsfriend, William M; Gerber, David E

    2016-02-01

    The treatment of adults who present with rare pediatric tumors is not characterized well in the literature. We report an instance of a 40-year-old African American woman with a diagnosis of choroid plexus carcinoma admitted to the intensive care unit for severe sepsis seven days after receiving chemotherapy consisting of carboplatin (350 mg/m(2) on Days 1 and 2 plus etoposide 100 mg/m(2) on Days 1-5). Her laboratory results were significant for an absolute neutrophil count of 0/µL and blood cultures positive for Capnocytophagia species. She was supported with broad spectrum antibiotics and myeloid growth factors. She eventually recovered and was discharged in stable condition. The management of adults with malignancies most commonly seen in pediatric populations presents substantial challenges. There are multiple age-specific differences in renal and hepatic function that explain the need for higher dosing in pediatric patients without increasing the risk of toxicity. Furthermore, differences in pharmacokinetic parameters such as absorption, distribution, and clearance are present but are less likely to affect patients. It is expected that the pediatric population will have more bone marrow reserve and, therefore, less susceptible to myelosuppression. The extrapolation of pediatric dosing to an adult presents a problematic situation in treating adults with malignancies that primarily effect pediatric patients. We recommend extrapolating from adult treatment regimens with similar agents rather than extrapolating from pediatric treatment regimens to reduce the risk of toxicity. We also recommend the consideration of adding myeloid growth factors. If the treatment is tolerated without significant toxicity, dose escalation can be considered.

  1. The major medical ethical challenges facing the public and healthcare providers in Saudi Arabia

    PubMed Central

    Alkabba, Abdulaziz F.; Hussein, Ghaiath M. A.; Albar, Adnan A.; Bahnassy, Ahmad A.; Qadi, Mahdi

    2012-01-01

    Background: Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. Materials and Methods: The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting. Results: The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics. Conclusion: Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges. PMID:22518351

  2. On preventing the extinction of the physician-scientist in pediatric pulmonology.

    PubMed

    Rubenstein, Ronald C; Kreindler, James L

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Hakami, Samah Mohammed

    2012-01-01

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

  8. Challenges and issues facing the future of nursing education: implications for ethnic minority faculty and students.

    PubMed

    Davis, Sheila P; Davis, Danyetta D

    2010-01-01

    Current trends in higher education in the United States demand that nursing take stock of how it is prepared or being prepared to face challenges and issues impacting on its future. The intense effort made to attract students to pursue advanced training in science and engineering in the United States pales in comparison to the numbers of science and engineering majors produced yearly in international schools. As a result, more and more jobs are being outsourced to international markets. Could international outsourcing become a method of nursing education? Authors submit that to remain competitive, the nursing profession must attract a younger cohort of technologically savvy students and faculty reflective of the growing diverse population in the United States. Additionally, nursing programs in research universities face even more daunting challenges as it relates to mandates for funded research programs of educational units. This article offers suggestions and recommendations for nursing programs in higher education institutions on ways to attract and retain ethnic minorities and of how to harness the power of research to address burgeoning societal health challenges.

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

    ScienceCinema

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

    2016-07-12

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

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

    SciTech Connect

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

    2010-08-05

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Kissoon, Niranjan

    2005-01-01

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

  14. Biomarkers in pediatrics: children as biomarker orphans.

    PubMed

    Savage, William J; Everett, Allen D

    2010-12-01

    Biomarkers have enormous potential to improve patient care by establishing tests of diagnosis, prognosis, and treatment effects. Successfully translating a biomarker from discovery to clinical application demands high-quality discovery research and high-quality clinical studies for biomarker validation; however, there are additional challenges that face biomarker research in pediatrics. There are also additional characteristics of pediatric medicine that make biomarker research especially needed. This review focuses on the fundamentals of biomarkers, the additional considerations needed for applying biomarker research to children, and recommendations for advancing pediatric biomarker research.

  15. Development of pediatric cardiology in latin america: accomplishments and remaining challenges.

    PubMed

    Capelli, Horacio; Kreutzer, Christian; Kreutzer, Guillermo

    2011-01-01

    Until the first quarter of the 20th century, most physicians were more than happy to differentiate congenital heart lesions from rheumatic heart disease, which then was rampant. As early as 1932, Dr Rodolfo Kreutzer, from Buenos Aires, Argentina, was already involved in the study of congenital heart defects. He started off assessing children with a stethoscope and with Einthoven electrocardiography equipment. The cardiac unit at the Buenos Aires Children's Hospital was created in 1936. It established the onset of pediatric cardiology in Argentina and fueled its development in South America. Nearly at the same time, Agustin Castellanos from Cuba also became a pioneer in the assessment of congenital heart disease. He described the clinical applications of intravenous angiocardiography in 1937. Meanwhile in Mexico, Dr Ignacio Chavez founded the National Institute of Cardiology in 1944 in Mexico City. It was the first center in the world to be exclusively devoted to cardiology. From this center, Victor Rubio and Hugo Limon performed the first therapeutic cardiac catheterization in 1953. Meanwhile, Professor Euriclydes Zerbini from Sao Paulo, Brazil, built the largest and most important school of cardiac surgeons in South America. In Santiago, Chile, the Calvo Makenna Hospital was the center where Helmut Jaegger operated on the first infant with extracorporeal circulation in Latin America in 1956. The patient was a 1-month-old baby, with complete transposition of the great arteries, who underwent an Albert procedure. Currently, there are many fully equipped centers all over the region, capable of dealing with most lesions and of providing excellent medical, interventional, and surgical treatment. Outcomes have improved substantially over the last 20 years. These achievements have gone beyond our pioneers' dreams. However, many neonates and young infants die prior to surgery because referral centers are overburdened and have long surgical waiting lists. Clearly, we still

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

    PubMed Central

    King, Rauni Prittinen

    2015-01-01

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

  17. The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units.

    PubMed

    Cobo, Nicole H; Sankar, Raman; Murata, Kristina K; Sewak, Sarika L; Kezele, Michele A; Matsumoto, Joyce H

    2015-02-01

    Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients.

  18. Pediatric cardiovascular care in Uganda: Current status, challenges, and opportunities for the future

    PubMed Central

    Aliku, Twalib Olega; Lubega, Sulaiman; Namuyonga, Judith; Mwambu, Tom; Oketcho, Michael; Omagino, John O; Sable, Craig; Lwabi, Peter

    2017-01-01

    In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs) and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI), having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans. PMID:28163428

  19. Why Learning Common Fractions Is Uncommonly Difficult: Unique Challenges Faced by Students With Mathematical Disabilities.

    PubMed

    Berch, Daniel B

    2016-07-18

    In this commentary, I examine some of the distinctive, foundational difficulties in learning fractions and other types of rational numbers encountered by students with a mathematical learning disability and how these differ from the struggles experienced by students classified as low achieving in math. I discuss evidence indicating that students with math disabilities exhibit a significant delay or deficit in the numerical transcoding of decimal fractions, and I further maintain that they may face unique challenges in developing the ability to effectively translate between different types of fractions and other rational number notational formats-what I call conceptual transcoding I also argue that characterizing this level of comprehensive understanding of rational numbers as rational number sense is irrational, as it misrepresents this flexible and adaptive collection of skills as a biologically based percept rather than a convergence of higher-order competencies that require intensive, formal instruction.

  20. Challenges in Facing the Lung Cancer Epidemic and Treating Advanced Disease in Latin America.

    PubMed

    Raez, Luis E; Santos, Edgardo S; Rolfo, Christian; Lopes, Gilberto; Barrios, Carlos; Cardona, Andres; Mas, Luis A; Arrieta, Oscar; Richardet, Eduardo; Vallejos S, Carlos; Wistuba, Ignacio; Gandara, David; Hirsch, Fred R

    2017-01-01

    Lung cancer, the deadliest cancer worldwide, is of particular concern in Latin America. The rising incidence poses a myriad of challenges for the region, which struggles with limited resources to meet the health care needs of its low- and middle-income populations. In this environment, we are concerned that governments are relatively unaware of the pressing need to implement effective strategies for screening, diagnosis, and treatment of lung cancer. The region has also been slow in adopting molecularly-based therapies in the treatment of advanced disease: testing for epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements are not routine, and access to targeted agents such as monoclonal antibodies and tyrosine kinase inhibitors is problematic. In this paper, we review the current situation in the management of lung cancer in Latin America, hoping that this initiative will help physicians, patient associations, industry, governments, and other stakeholders better face this epidemic in the near future.

  1. Challenges of microtome-based serial block-face scanning electron microscopy in neuroscience.

    PubMed

    Wanner, A A; Kirschmann, M A; Genoud, C

    2015-08-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  3. 77 FR 76053 - Proposed Collection; Comment Request; Pediatric Palliative Care Campaign Pilot Survey

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

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

  4. United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

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

    2013-01-01

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

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

    PubMed

    Halim, Abdel-Baset

    2015-06-01

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

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

    PubMed

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

    2015-10-01

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

  7. From economic development to public health improvement: China faces equity challenges.

    PubMed

    Liu, S; Griffiths, S M

    2011-10-01

    In the past three decades China has been going through a period of rapid economic growth, which has had profound repercussions for the nation's public health system. Prior to the current health reforms much of the population was left uninsured and facing high financial risk from inadequate healthcare, with especially deep divisions between the urban and rural populations, which continues to pose a huge challenge to health equity and social justice. This paper explores the relationship between economic development and public health and discusses a series of health disparity issues that are emerging in China. These include: (1) health risk and access to care issues among unregistered urban populations (i.e. migrants); (2) low recognition of mental health, and the stigma associated with people with mental illness or communicable disease; and (3) challenges to the traditional system of family care for the elderly, as younger generations migrate to the cities and the remaining rural population ages. Implications for government policy and action to address these issues and improve public health as well as equity are discussed.

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2010-12-01

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

  10. Making strides and meeting challenges in pediatric allogeneic hematopoietic cell transplantation clinical trials in the United States: Past, present and future.

    PubMed

    Satwani, Prakash; Kahn, Justine; Jin, Zhezhen

    2015-11-01

    Over the past 20years, the field of pediatric allogeneic hematopoietic cell transplantation has made ground-breaking strides in the successful treatment of patients with both malignant and non-malignant diseases. As the field advances, so does the need for high-quality studies including randomized controlled trials, aimed at answering clinically important questions about optimizing care and outcomes of children undergoing alloHCT. In an effort to actively address emerging clinical questions, three main cooperative groups in the U.S. have joined forces to develop and implement multiple clinical trials for pediatric alloHCT patients. These groups include the Blood and Marrow Transplant Clinical Trials Network, the Children's Oncology Group and the Pediatric Blood and Marrow Transplant Consortium. Though the field of stem cell transplantation continues to advance, conducting clinical trials in the pediatric population is a unique challenge and as a result, optimal outcomes have yet to be reached in this population. Because of the limited number of pediatric transplant patients at each institution in the U.S., trials aimed at answering important clinical questions still struggle to accrue acceptable numbers of patients in an appropriate amount of time and thus gathering statistically useful data has posed a challenge for the field. In an effort to mitigate some of the challenges associated with obtaining statistically and clinically meaningful information about pediatric alloHCT, the implementation of new cooperative group trials is active and ongoing.

  11. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation

    PubMed Central

    2011-01-01

    Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day). Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled. A global crisis of health care providers and human resources stems from insufficient workforce production, inability to retain workers in areas of greatest need, distribution disparity and poor management of both health care systems and health workforce. Internationally, the pediatric rheumatology workforce will also be in very short supply for the foreseeable future relative to projected demand. Physician extenders are an essential resource to meet this demand in underserved regions. They can be trained in common aspects of musculoskeletal medicine and rheumatic conditions. Innovative strategies have been introduced in the United Kingdom to address musculoskeletal medicine educational deficiencies. Telemedicine offers an important capacity to improve access to care despite distance

  12. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation.

    PubMed

    Henrickson, Michael

    2011-09-12

    Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day). Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled.A global crisis of health care providers and human resources stems from insufficient workforce production, inability to retain workers in areas of greatest need, distribution disparity and poor management of both health care systems and health workforce. Internationally, the pediatric rheumatology workforce will also be in very short supply for the foreseeable future relative to projected demand. Physician extenders are an essential resource to meet this demand in underserved regions. They can be trained in common aspects of musculoskeletal medicine and rheumatic conditions. Innovative strategies have been introduced in the United Kingdom to address musculoskeletal medicine educational deficiencies. Telemedicine offers an important capacity to improve access to care despite distance

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

    NASA Astrophysics Data System (ADS)

    El-Shazly, A. K.

    2003-12-01

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

  14. Pediatric Neuropathology in Africa: Local Experience in Nigeria and Challenges and Prospects for the Continent.

    PubMed

    Olasode, Babatunde J; Onyia, Chiazor U

    2016-09-15

    The present state of pediatric neuropathology practice is in rudimentary developmental stages in most parts of sub-Saharan Africa. We sought to determine the pattern of neurosurgical lesions in children diagnosed in southwestern Nigeria and briefly address issues surrounding the practice of this aspect of pathology in Africa. We performed a retrospective review of histopathologic results of biopsies obtained from pediatric patients with neurosurgical lesions at the Department of Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between January 2001 and December 2011. Demographic and clinical data were extracted from the Ife-Ijesha cancer registry and histopathological diagnoses were confirmed. A total of 111 biopsies were reviewed with a maximum of 17 in 2001 and minimum of 3 in 2005. Patient ages ranged between 1 day and 16 years with a male:female ratio of 1.02:1. There were 53 spinal lesions, 15 intracranial lesions, 36 scalp masses, 6 skull lesions and 1 muscle biopsy. Most of the specimens were from myelomeningoceles. This documentation of the major types of pediatric neurological conditions encountered in clinical practice in this relatively resource-limited setting indicate the need for collaboration with better developed centers to improve training in neurosurgery and neuropathology to enhance the quality of clinical care for young patients in Africa.

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

    PubMed Central

    Weintraub, Jane A.; Breland, Carol E.

    2016-01-01

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

  16. Reflecting on some of the challenges facing postgraduate nursing education in South Africa.

    PubMed

    Essa, Ilhaam

    2011-04-01

    Considering the dearth of professional nurses in South Africa today, and the fact that postgraduate nursing education can contribute towards enhancing the competences of those in the profession, I shall examine some of the challenges faced by a group of previously enrolled postgraduate nursing students which resulted in their non-completion of a formal qualification. The focus of this investigation was a 2008 cohort of students that did not complete their non-clinical postgraduate diplomas at the institution where I work. Of the 29 students who did not complete their studies, I have selected a group of 8 students through a purposive non-random sample with the objective to ascertain some of the reasons for them not completing their diploma. My aim was to examine some of the reasons as to why postgraduate nursing students do not complete their qualification and to suggest ways as to how the curriculum can be reconstructed as to counteract some of students' pitfalls. Based on my qualitative interpretive analysis, I shall argue that these students did not complete their diplomas on the grounds of, having experienced a lack of institutional and social support; their inability to cope with the demands of academic rigour; their experiences of isolation and exclusion; and, the inability to cope with unimagined realities. My contention is that if postgraduate nursing is not adequately attended to, the possibility that nursing education would not contribute to the transformation of the profession, is highly possible.

  17. ORNL Experience and Challenges Facing Dynamic Wireless Power Charging of EV's

    DOE PAGES

    Miller, John M.; Jones, Perry T.; Li, Jan-Mou; ...

    2015-05-21

    As visionary as dynamic, or in-motion, wireless charging of electric vehicles appears the concept is well over a century old as this paper will show. This is because the concept of magnetic induction dates back to the pioneering work of physicist Michael Faraday in the early 19th century. Today wireless power transfer (WPT) is being standardized for stationary and quasi-stationary charging of electric vehicles (EV). The Society of Automotive Engineers (SAE) has undertaken the standardization of stationary charging and will make this public during 2016. In addition to this the IEEE-SA (Standards Activities) initiated standards development for EV?s in theirmore » EVWPT working group in 2012. This study introduces the many challenges facing EVWPT in not only high power transfer to a moving vehicle and energy management at a utility scale, but communications in a vehicle to infrastructure (V2I) environment and management of high data rates, ultra-low latency, and dealing with communications loss in dense urban areas. Finally, future concepts such as guideway powering of EV?s are presented to illustrate one technical trajectory EVWPT may take.« less

  18. ORNL Experience and Challenges Facing Dynamic Wireless Power Charging of EV's

    SciTech Connect

    Miller, John M.; Jones, Perry T.; Li, Jan-Mou; Onar, Omer C.

    2015-05-21

    As visionary as dynamic, or in-motion, wireless charging of electric vehicles appears the concept is well over a century old as this paper will show. This is because the concept of magnetic induction dates back to the pioneering work of physicist Michael Faraday in the early 19th century. Today wireless power transfer (WPT) is being standardized for stationary and quasi-stationary charging of electric vehicles (EV). The Society of Automotive Engineers (SAE) has undertaken the standardization of stationary charging and will make this public during 2016. In addition to this the IEEE-SA (Standards Activities) initiated standards development for EV?s in their EVWPT working group in 2012. This study introduces the many challenges facing EVWPT in not only high power transfer to a moving vehicle and energy management at a utility scale, but communications in a vehicle to infrastructure (V2I) environment and management of high data rates, ultra-low latency, and dealing with communications loss in dense urban areas. Finally, future concepts such as guideway powering of EV?s are presented to illustrate one technical trajectory EVWPT may take.

  19. A Perspective on the Trends and Challenges Facing Porphyrin-Based Anti-Microbial Materials.

    PubMed

    Jiang, Lu; Gan, Ching Ruey Raymond; Gao, Jian; Loh, Xian Jun

    2016-07-01

    The emergence of multidrug resistant bacterium threatens to unravel global healthcare systems, built up over centuries of medical research and development. Current antibiotics have little resistance against this onslaught as bacterium strains can quickly evolve effective defense mechanisms. Fortunately, alternative therapies exist and, at the forefront of research lays the photodynamic inhibition approach mediated by porphyrin based photosensitizers. This review will focus on the development of various porphyrins compounds and their incorporation as small molecules, into polymers, fibers and thin films as practical therapeutic agents, utilizing photodynamic therapy to inhibit a wide spectrum of bacterium. The use of photodynamic therapy of these porphyrin molecules are discussed and evaluated according to their electronic and bulk material effect on different bacterium strains. This review also provides an insight into the general direction and challenges facing porphyrins and derivatives as full-fledged therapeutic agents and what needs to be further done in order to be bestowed their rightful and equal status in modern medicine, similar to the very first antibiotic; penicillin itself. It is hoped that, with this perspective, new paradigms and strategies in the application of porphyrins and derivatives will progressively flourish and lead to advances against disease.

  20. Critical Care for Pediatric Asthma: Wide Care Variability and Challenges for Study

    PubMed Central

    Bratton, Susan L; Newth, Christopher J. L.; Zuppa, Athena F.; Moler, Frank W.; Meert, Kathleen L.; Berg, Robert A.; Berger, John; Wessel, David; Pollack, Murray; Harrison, Rick; Carcillo, Joseph A.; Shanley, Thomas P.; Liu, Teresa; Holubkov, Richard; Dean, J. Michael; Nicholson, Carol E.

    2011-01-01

    Objective To describe pediatric severe asthma care, complications and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network (CPCCRN). Design Retrospective cohort study. Setting Pediatric intensive care units (PICU)s in the United States that submit administrative data to the Pediatric Health Information System (PHIS). Patients Children 1-18 years treated in a PHIS PICU for asthma during 2004 to 2008. Interventions None Measurement and Main Results 13,552 children were studied; 2,812 (21%) treated in a CPCCRN and 10,740 (79%) in a non-CPCCRN PICU. Medication use in individual CPCCRN centers differed widely: ipratropium bromide (41-84%) terbutaline (11-74%), magnesium sulfate (23-64%) and methylxanthines (0-46%). Complications including pneumothorax (0-0.6%), cardiac arrest (0.2-2%) and aspiration (0.2-2%) were rare. Overall use of medical therapies and complications at CPCCRN centers were representative of pediatric asthma care at non-CPCCRN PICUs. Median length of PICU stay at CPCCRN centers was 1 to 2 days and death was rare (0.1-3%). Ten percent of children treated at CPCCRN centers received invasive mechanical ventilation compared to12 percent at non-CPCCRN centers. Overall 44% of patients who received invasive mechanical ventilation were intubated in the PICU. Children intubated outside the PICU had significantly shorter median ventilation days (1 vs.3), PICU days (2 vs. 4) and hospital days (4 vs. 7) compared to those intubated in the PICU. Among children who received mechanical respiratory support significantly more (41 vs. 25%) were treated with non-invasive ventilation and significantly fewer (41 vs. 58%) were intubated prior to PICU care when treated in a PHIS hospital emergency department. Conclusions Marked variations in medication therapies and mechanical support exist. Death and other complications were rare. Over half of patients treated with mechanical ventilation were intubated prior to PICU

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

    NASA Astrophysics Data System (ADS)

    Maletzky, Monica; Mhopjeni, Kombada

    2014-05-01

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

  2. Re-envisioning pediatric nursing education.

    PubMed

    Carlson, Karen L

    2012-01-01

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

  3. Professional Development for Teachers of Students Who Are Deaf or Hard of Hearing: Facing the Assessment Challenge

    ERIC Educational Resources Information Center

    Cawthon, Stephanie

    2009-01-01

    Teachers of students with "low-incidence" disabilities, such as students who are deaf or hard of hearing, face unique challenges in putting education policy into practice. The present article presents professional development findings from the Third Annual National Survey of Accommodations and Assessment for Students Who Are Deaf or Hard…

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  6. Knowledge Production and Transmission in a Changing Society: Challenges Facing Law Lecturers in a Distance Education Environment in South Africa

    ERIC Educational Resources Information Center

    Scott, Susan

    2006-01-01

    In this article I highlight the challenges facing a law lecturer in a multicultural society in transformation where the student is being prepared to serve society in different occupational fields as a professional person. I indicate that the law itself cannot effect change. For this we need properly trained lawyers. For an effective transformation…

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

    ERIC Educational Resources Information Center

    Walmsley, Ben

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Xu, Lichan

    2015-01-01

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

  9. Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

    ERIC Educational Resources Information Center

    Greene, Carolyn A.; Ford, Julian D.; Ward-Zimmerman, Barbara; Honigfeld, Lisa; Pidano, Anne E.

    2016-01-01

    Background: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It…

  10. Pediatric Sarcoma in Central America: Outcomes, Challenges and Plans for Improvement

    PubMed Central

    Friedrich, Paola; Ortiz, Roberta; Strait, Kelly; Fuentes, Soad; Gamboa, Yéssica; Arambú, Ingrid; Ah-Chu-Sanchez, María; London, Wendy; Rodríguez-Galindo, Carlos; Antillón-Klussmann, Federico; Báez, Fulgencio

    2012-01-01

    Background Children with cancer in middle-income countries have inferior outcomes to those in high-income countries. The magnitude and drivers for this survival gap are not well understood. We sought to describe patterns of clinical presentation, magnitude of treatment abandonment, and survival in children with sarcoma in Central America. Methods Retrospective review of hospital-based registries from national pediatric oncology referral centers. Patients with newly diagnosed osteosarcoma, Ewing sarcoma (Ewing), rhabdomyosarcoma (RMS), and soft tissue sarcomas (STS) between 1/1/00-12/31/09 were included. Survival analysis was performed using standard definitions of overall and event-free survival (OS and EFS) and with abandonment included as an event (AOS and AEFS). Results A total of 785 new cases of pediatric sarcoma were reported (264 osteosarcoma, 175 Ewing, 240 RMS, and 106 STS). Metastatic disease at presentation was high (osteosarcoma 38%, Ewing 39%, RMS 29% and STS 21%). Treatment abandonment rate was high, particularly among patients with extremity bone sarcomas (osteosarcoma 30%, Ewing 15%, RMS 25% and STS 15%). Of 559 patients experiencing a first event, 59% had either relapse or progressive disease. The 4-year OS was 40% (SE±3%) and EFS was 30% (SE±2%), but further decreased to 31% (SE±2%) and 24% (SE±2%), when abandonment was taken into account. Conclusion High rate of metastases and treatment abandonment, and difficulty with upfront treatment effectiveness are important contributors to poor survival of children with pediatric sarcomas in Central America. Initiatives for early diagnosis, psychosocial support, quality improvement, and multidisciplinary care are warranted to improve outcomes. PMID:22972687

  11. Challenges identifying genetic determinants of pediatric cancers--the childhood leukemia experience.

    PubMed

    Sinnett, Daniel; Labuda, Damian; Krajinovic, Maja

    2006-01-01

    Pediatric cancers affect approximately 1 in every 500 children before the age of 15. Little is known about the etiology of this heterogeneous group of diseases despite the fact they constitute the major cause of death by disease among this population. Because of its relatively high prevalence, most of the work done in pediatric oncogenetics has been focused on leukemias, particularly acute lymphoblastic leukemia (ALL). Although it is now well accepted that genetic variation plays a significant role in determining individual's cancer susceptibility, few studies have explored genetic susceptibility to childhood leukemia with respect to common polymorphisms. The biochemical and genetic mechanisms contributing to cancer susceptibility are numerous and can be grouped into broad categories: (1) cellular growth and differentiation, (2) DNA replication and repair, (3) metabolism of carcinogens (4) apoptosis, (5) oxidative stress response and (6) cell cycle. To evaluate whether candidate genes in these pathways are involved in childhood leukemogenesis, we conducted case-control studies. We showed that leukemogenesis in children may be associated with DNA variants in some of these genes and that the combination of genotypes seems to be more predictive of risk than either of them independently. We also observed that, at least at some loci, the parental genetics might be important in predicting the risk of cancer in this pediatric model of a complex disease. Taken together, these results indicate that the investigation of a single enzyme and/or a single genotype might not be sufficient to explain the etiology of childhood leukemia because of the complexity of the environment and that of the inter-individual variability in cancer susceptibility.

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

    PubMed Central

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

    2016-01-01

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

  13. Guillain-Barré in a 10-month-old: diagnostic challenges in a pediatric emergency.

    PubMed

    Orlik, Kseniya; Griffin, Gregory D

    2014-01-01

    A 10-month-old male infant presented to the emergency department (ED) with a chief complaint of weakness, decreased mobility, and regression of motor milestones over a period of 6 days. Significant medical history included a Roseola infection 5 weeks before ED presentation. The patient's pediatrician and chiropractor had both previously diagnosed the patient with strains and sprains. After progression of symptoms, the patient presented to the ED and was discharged home to follow up as an outpatient. The patient subsequently returned to the ED and was admitted to neurology with concern for Guillain-Barré syndrome, which was later confirmed after inpatient workup. The patient was successfully treated and released. Guillain-Barré represents a spectrum of acute immune mediated polyneuropathies. There are several variant forms provoked by infection that precedes the onset of symptoms. Diagnosis and management of Guillain-Barré in the ED will be reviewed, along with the importance of early pediatric intensive care involvement for children presenting with signs of flaccid quadriparesis; rapidly progressive weakness; impending respiratory failure; bulbar palsy; and, most importantly, autonomic cardiovascular instability. Guillain-Barré is rare in children younger than 2 years; however, it must be considered in the differential diagnosis of any patient who presents with progressive weakness and history of a recent infection. It is important to recognize the variety and severity of neurologic symptoms associated with Guillain-Barré across a spectrum, especially with the diagnostic difficulties associated with the pediatric population.

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

    PubMed

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

    2012-08-15

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

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

    ERIC Educational Resources Information Center

    Temtime, Zelealem T.; Mmereki, Rebana N.

    2011-01-01

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

  16. Training and practice of pediatric surgery in Africa: past, present, and future.

    PubMed

    Elhalaby, Essam A; Uba, Francis A; Borgstein, Eric S; Rode, Heinz; Millar, Alastair J W

    2012-05-01

    The evolution and recognition of pediatric surgery as a specialty in Africa can be divided into 4 distinct phases, starting from early 1920s till the present. The pace of development has been quite variable in different parts of Africa. Despite all recent developments, the practice of pediatric surgery in Africa continues to face multiple challenges, including limited facilities, manpower shortages, the large number of sick children, disease patterns specific to the region, late presentation and advanced pathology, lack of pediatric surgeons outside the tertiary hospitals, and inadequate governmental support. Standardization of pediatric surgery training across the continent is advocated. Collaboration with well-established pediatric surgical training centers in Africa and other developed countries is necessary. The problems of delivery of pediatric surgical services need to be addressed urgently, if the African child is to have access to essential pediatric surgical services like his or her counterpart in the high-income parts of the world.

  17. Challenges

    ERIC Educational Resources Information Center

    Moore, Thomas R.

    1975-01-01

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

  18. Treatment of pediatric chronic inflammatory demyelinating polyneuropathy: Challenges, controversies and questions.

    PubMed

    Desai, Jay; Ramos-Platt, Leigh; Mitchell, Wendy G

    2015-01-01

    Pediatric chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon acquired disorder of unknown cause, presumed to have an immunological basis. We report 20 patients seen at Children's Hospital Los Angeles over a period of 10 years. The outcome of our patients was favorable in a vast majority with good response to various treatments instituted. However, residual neurologic deficit was common. The choice of treatment modality was empirical and selected by the treating neurologist. Intravenous immunoglobulin (IVIG) and corticosteroids were most commonly utilized for treatment. Plasmapheresis, mycophenolate mofetil, rituximab, cyclophosphamide, azathioprine, and abatacept were added if the patients were refractory to IVIG or became corticosteroid dependent. The spectrum of disease severity ranged from a single monophasic episode, to multiphasic with infrequent relapses with good response to IVIG, to progressive disease refractory to multiple therapies.

  19. Challenges faced by the HIV health services planning council in Oakland, California, 1991-1994.

    PubMed

    Kieler, B W; Rundall, T G; Saporta, I; Sussman, P C; Keilch, R; Warren, N; Black, S; Brinkley, B; Barney, L

    1996-01-01

    This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible metropolitan area (the Oakland EMA) under Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathered primary data through observation of planning council meetings, examination of documentary evidence, and in-depth interviews with key participants. An important finding of this study was the inconsistency observed between the rational, linear planning model embedded in the CARE Act legislation and the politicized, emergent, and, at times, chaotic planning process actually observed in the Oakland EMA. The primary reasons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on administrative support at the local level; reluctance of program administrators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns about the representativeness of the council's membership; competition among providers of services for funding; conflicting demands for services by persons affected by HIV disease; disagreements between the council and providers of services over policies and procedures for administering the services contracts; and concerns about the council's involvement in the selection of specific agencies for funding, its lapses in compliance with rules of order, and its failure to accurately record minutes of all of its meetings. Despite the challenges faced by the Oakland planning council, it was able to meet its Title I obligations, which resulted in significant increases in the availability of medical and social services for persons affected by HIV disease. However, dealing with the confusion and conflicts

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  1. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care.

    PubMed

    Vaughn, Lisa M; DeJonckheere, Melissa; Pratap, Jayant Nick

    2016-06-09

    Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.

  2. Total soft-tissue reconstruction of the middle and lower face with multiple simultaneous free flaps in a pediatric patient.

    PubMed

    Burt, J D; Burns, A J; Muzaffar, A R; Byrd, H S; Hobar, P C; Beran, S J; Adams, W P; Kenkel, J M

    2000-06-01

    A 2-year-old boy sustained a massive facial soft-tissue wound secondary to a dog attack. Essentially all the soft tissues of the face were absent, including innervation and intraoral lining. We describe the reconstruction of this defect with five simultaneous free tissue transfers. To our knowledge, this is the first report of five simultaneous free flaps in any patient.

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

    NASA Astrophysics Data System (ADS)

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

    2004-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

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

    PubMed

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

    2016-04-01

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

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

    ERIC Educational Resources Information Center

    Hsieh, Hui-hua

    2012-01-01

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

  7. Lift Every Voice and Sing: Faculty of Color Face the Challenges of the Tenure Track

    ERIC Educational Resources Information Center

    Garrison-Wade, Dorothy F.; Diggs, Gregory A.; Estrada, Diane; Galindo, Rene

    2012-01-01

    This article highlights some of the obstacles facing tenure-track faculty of color in academia. Through the perspective of Critical Race Theory (CRT) and by using a counterstories method, four faculty of color share their experiences as they explore diversity issues through engaging in a 1-year self-study. Findings of this qualitative study…

  8. Strategies for Accommodating Extension Clients Who Face Language, Vision, or Hearing Challenges

    ERIC Educational Resources Information Center

    Angima, Sam; Etuk, Lena; Maddy, Deborah

    2016-01-01

    Extension services nationwide seek to equalize access to university resources for all learners. In this article, we focus on accommodation as a tool of our trade. We discuss findings and implications from a study that documented approaches used by one state's Extension professionals to accommodate clients who face language, vision, or hearing…

  9. Challenges Face Arab Students in Writing Well-Developed Paragraphs in English

    ERIC Educational Resources Information Center

    Rass, Ruwaida Abu

    2015-01-01

    This study aimed to investigate problems facing Palestinian Arab students from Israel who are majoring in teaching English as a Foreign Language (EFL) in developing well-written paragraphs in English. They usually transfer the stylistic features of their first language, Arabic to the target language, English. For example, they tend to write long…

  10. Medical Readiness: DoD Faces Challenges in Implementing Its Anthrax Vaccine Immunization Program

    DTIC Science & Technology

    1999-10-01

    VeernsAfa.s U.Seatde ,i anin S *ie A "Jha Vacin Immuniation Proara DISTRI13UTION STATEMENT AApproved for Public Release Distribution Unlimited...the grave and urgent danger facing Service Members from the lethal threat of anthrax, but did not mention the excellent long-term safety record of the

  11. Language and Cultural Challenges Facing Business Faculty in the Ever-Expanding Global Classroom

    ERIC Educational Resources Information Center

    Vogel, Glen M.

    2013-01-01

    More than 690,000 foreign students studied in the United States during the 2009-10 academic year. As non-native English-speaking students continue to pour into American educational institutions, one question many educators have is: are these international students adequately prepared for the language and cultural demands they will face when they…

  12. Coping with Quality Assurance Challenges Faced by Secondary Schools' Headteachers in Gucha District, Kenya

    ERIC Educational Resources Information Center

    Mobegi, Florence Osiri; Ondigi, Benjamin A.

    2011-01-01

    Since independence, the Kenyan government has demonstrated its commitment to the provision of quality secondary school education through allocation of financial resources, provision of trained teachers and establishment of quality assurance department. However, despite the substantial allocation of resources, secondary schools still face major…

  13. An Exploratory Study of Distinguishing Challenges Faced by Mid-Life Teacher Candidates

    ERIC Educational Resources Information Center

    Tanksley, James F.

    2012-01-01

    The United States public education system is facing a possible shortage of several hundred thousand teachers over the next decade. To overcome the projected shortfall in teacher supply, schools of education of state university and college systems may need to look to the fastest growing segment of the college student population, the non-traditional…

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

    PubMed Central

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

    2016-01-01

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

  15. Tuberculosis 1: exploring the challenges facing its control and how to reduce its spread.

    PubMed

    Jarvis, Miles

    The first in this two part unit on tuberculosis discusses global and UK rates, and explains strategies to control it in the UK. Certain challenges are discussed, such as HIV co-infection and drug resistance.

  16. Antituberculosis Drug-Induced Liver Injury with Autoimmune Features: Facing Diagnostic and Treatment Challenges

    PubMed Central

    Pinto Pais, Isabel; Duarte, Raquel; Carvalho, Isabel

    2017-01-01

    The authors present a case report of antituberculosis drug-induced liver injury that offered diagnostic challenges (namely, the possibility of drug-induced autoimmune hepatitis) and treatment difficulties. PMID:28116201

  17. An overview of the challenges facing care homes in the UK.

    PubMed

    Cousins, Carol; Burrows, Ruth; Cousins, Gary; Dunlop, Eileen; Mitchell, Gary

    2016-10-28

    Care homes are an increasingly important part of the UK's healthcare system. Despite their importance, particularly in providing care for older people with complex needs, the sector is often disadvantaged and overlooked by commissioners, policymakers and researchers. The authors provide an overview of some important challenges for the sector. These challenges relate to funding, education and research, overseas staff, career pathways and staff recruitment and retention. They conclude that recruitment and retention of registered nurses is arguably the greatest challenge, as high staff turnover is the catalyst for other challenges identified. The care home sector should be considered as equal to hospitals, community settings and hospices. Care homes offer registered nurses many opportunities for development of clinical and organisational skills.

  18. Fear of Vomiting and Low Body Weight in Two Pediatric Patients: Diagnostic Challenges

    PubMed Central

    Maertens, Charlotte; Couturier, Jennifer; Grant, Christina; Johnson, Natasha

    2017-01-01

    Fear of vomiting can be a symptom associated with several disorders, including Eating Disorders (ED), Specific Phobia (Emetophobia), Avoidant Restrictive Food Intake Disorder (ARFID) and Obsessive Compulsive Disorder (OCD), making proper diagnosis challenging. At this time the literature exploring this symptom is limited, and to our knowledge very few cases have been described in the child and adolescent population. We report here the cases of one child and one adolescent presenting with significant weight loss, food restriction and fear of vomiting. The child’s fear of vomiting masked a concurrent desire to achieve fitness and weight loss, which was uncovered following weight restoration. The adolescent patient, although significantly underweight and food avoidant, also expressed no concerns with body image, until weight restored. The history, course in hospital and management of these patients is discussed, along with several challenges that complicated the diagnosis. PMID:28331505

  19. Fear of Vomiting and Low Body Weight in Two Pediatric Patients: Diagnostic Challenges.

    PubMed

    Maertens, Charlotte; Couturier, Jennifer; Grant, Christina; Johnson, Natasha

    2017-01-01

    Fear of vomiting can be a symptom associated with several disorders, including Eating Disorders (ED), Specific Phobia (Emetophobia), Avoidant Restrictive Food Intake Disorder (ARFID) and Obsessive Compulsive Disorder (OCD), making proper diagnosis challenging. At this time the literature exploring this symptom is limited, and to our knowledge very few cases have been described in the child and adolescent population. We report here the cases of one child and one adolescent presenting with significant weight loss, food restriction and fear of vomiting. The child's fear of vomiting masked a concurrent desire to achieve fitness and weight loss, which was uncovered following weight restoration. The adolescent patient, although significantly underweight and food avoidant, also expressed no concerns with body image, until weight restored. The history, course in hospital and management of these patients is discussed, along with several challenges that complicated the diagnosis.

  20. Charter Schools: New Charter Schools across the Country and in the District of Columbia Face Similar Start-Up Challenges. Report to Congressional Requesters.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    This study analyzed federal and state charter school laws, addressing challenges faced by charter school startups nationwide, state resources available to address these challenges, and how the District of Columbia compares in terms of charter school challenges and resources. Data came from interviews with Department of Education officials, charter…

  1. Challenges faced by professional nurses when implementing the Expanded Programme on Immunisation at rural clinics in Capricorn District, Limpopo

    PubMed Central

    Tladi, Flora M.

    2016-01-01

    Background Immunisation is the cornerstone of primary healthcare. Apart from the provision of safe water, immunisation remains the most cost-effective public health intervention currently available. Immunisation prevents infectious conditions that are debilitating, fatal and have the potential to cause huge public health burdens, both financially and socially, in South Africa. Aim To determine the challenges faced by professional nurses when implementing the Expanded Programme on Immunisation (EPI) at rural clinics in Capricorn District, Limpopo Province, South Africa. Setting The study was conducted in selected primary healthcare clinics of Capricorn District, Limpopo Province. Methods A qualitative explorative descriptive contextual research design was used to gather data related to the challenges faced by professional nurses when implementing EPI at rural clinics in Capricorn District. Results The findings revealed that professional nurses had knowledge of the programme, but that they experienced several challenges during implementation of EPI that included staff shortages and problems related to maintenance of the vaccines’ potency. Conclusions The Department of Health as well as the nursing administration should monitor policies and guidelines, and especially maintenance of a cold chain for vaccines, to ensure that they are practised throughout Limpopo Province. The problem of staff shortages also needs to be addressed so that the EPI can achieve its targeted objectives. PMID:27380844

  2. The challenges and outcomes of living donor kidney transplantation in pediatric and adolescent age group in a developing country: A critical analysis from a single center of north India

    PubMed Central

    Srivastava, Aneesh; Prabhakaran, Sandeep; Sureka, Sanjoy Kumar; Kapoor, Rakesh; Kumar, Anant; Sharma, R. K.; Prasad, Narayan; Ansari, M. S.

    2015-01-01

    Introduction: Renal transplantation is the treatment of choice for children with end-stage renal disease (ESRD). We evaluated the outcome of renal transplantation in the pediatric and adolescent age groups in the perspective of a developing country as compared with developed nations while highlighting the challenges we have faced in a pediatric transplant programme. Materials and Methods: Seventy live related pediatric and adolescent renal transplantations were reviewed retrospectively. Variables analyzed were etiology of ESRD, pre-transplant renal replacement modality, donor relationship, surgical complications, rejection episodes, immuno-suppression regimens, compliance to immunosuppression, graft survival and overall survival. Results: The cohort consisted of 13 (18%) female and 57 male (82%) recipients. The mean age was 14 ± 1.4 years. The etiology of ESRD was chronic glomerulonephritis (n = 43), chronic interstitial nephritis (n = 26) and Alport's syndrome (n = 1). Fifty-six (80%) children were on hemo-dialysis and 10 (14%) on peritoneal dialysis prior to transplantation. 80.5% and 61% patients were strictly compliant to immunosuppresant medications at 1 and 5 years. The 1, 3 and 5 year graft survival rates were 94.3%, 89.2% and 66.8%, respectively. The overall survival rates were 95.7%, 96.4% and 94.1% for 1, 3 and 5 years, respectively. Conclusions: The spectrum of etiology of ESRD differs in our patients from the west, with chronic glomerulonephritis being the most common etiology. Early graft survival is comparable, but the 5-year graft survival is clearly inferior as compared with developed countries. PMID:25624573

  3. [Political challenges facing the consolidation of the Sistema Único de Saúde: a historical approach].

    PubMed

    Rodrigues, Paulo Henrique de Almeida

    2014-01-01

    This article investigates the circumstances in which Brazil’s sanitation reform was conceived and the Sistema Único de Saúde (SUS) was constructed. A brief analysis is conducted of Brazil’s political transition to democracy, focusing on three political challenges facing the consolidation of SUS: its weak support base amongst workers, competition with the private sector, and the fragmentation of its administration caused by its municipalization. Finally, the changes in the scenario caused by the weakening of neoliberalism since the 2008 crisis, the reemergence of a multipolar political scenario internationally, and the financing conditions of the Brazilian State are described.

  4. Game Face

    ERIC Educational Resources Information Center

    Weiner, Jill

    2005-01-01

    In this article, the author discusses "Game Face: Life Lessons Across the Curriculum", a teaching kit that challenges assumptions and builds confidence. Game Face, which is derived from a book and art exhibition, "Game Face: What Does a Female Athlete Look Like?", uses layered and powerful images of women and girls participating in sports to teach…

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... basis of the CO's written determination that the challenged offeror's representation is valid. (1) This determination is final for IA unless it is appealed to the PAM, and the CO is notified of the appeal before award. (2) If an award was made before the time the CO received notice of appeal, the contract must...

  6. 48 CFR 1480.903 - Award in the face of challenge.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... basis of the CO's written determination that the challenged offeror's representation is valid. (1) This determination is final for IA unless it is appealed to the PAM, and the CO is notified of the appeal before award. (2) If an award was made before the time the CO received notice of appeal, the contract must...

  7. 17 Challenges Faced by Cantonese Speakers in a UK University Mandarin Course

    ERIC Educational Resources Information Center

    Lo, Lan

    2016-01-01

    After Hong Kong returned to China in 1997, those in the Chinese migrant community in the UK who anticipated returning to China saw the significant benefits of learning Mandarin. The challenges are not only related to the social and cultural differences between the Cantonese and Mandarin migrant groups, but also the intrinsic linguistic differences…

  8. American Higher Education: A Special Tradition Faces a Special Challenge. Occasional Paper Number 16.

    ERIC Educational Resources Information Center

    Shapiro, Harold T.

    Traditions that have affected the evolution of U.S. higher education, along with a challenge for the future, are considered by the president of the University of Michigan. Attention is directed to ideas that over time have produced the original colonial colleges, followed by the land-grant universities, the great polytechnic schools, the…

  9. Concern, Compassion, & Community: Facing the Daunting Worldwide Challenges of HIV/AIDS.

    ERIC Educational Resources Information Center

    Grossman, Arnold H.

    1997-01-01

    Examines barriers to and challenges of professional involvement in enhancing leisure lifestyles and quality of life for people with AIDS, discussing the therapeutic recreation specialist's role and examining service delivery within a framework of the social context of AIDS. Issues related to HIV/AIDS prevention and strategies for implementation…

  10. Facing the Challenge of Teaching and Learning EFL Reading: Beyond the Language of Critique.

    ERIC Educational Resources Information Center

    Sehlaoui, Abdelilah Salim

    2001-01-01

    Summarizes challenges in teaching English-as-a-Foreign-Language (EFL) reading in Morocco. Argues that teachers are needed who can change and reconstruct their own identities through sound pedagogical practice and effective leadership. Provides an example of such leadership by describing how and why classroom libraries were created and a regional…

  11. Are Schools Getting Tongue-Tied? ESL Programs Face New Challenges

    ERIC Educational Resources Information Center

    Schachter, Ron

    2013-01-01

    Spanish-speaking students, but the ESL map is undergoing a dramatic transformation that is challenging K12 schools to cope with a burgeoning number of different native languages--more than 100 in some locations--as new immigrants arrive in districts across the country. The number…

  12. How Zoos Are Meeting the Challenges Facing Biodiversity: Bristol Zoo Gardens as a Case Study

    ERIC Educational Resources Information Center

    Garrett, Simon

    2010-01-01

    As ideas about effective conservation of biodiversity develop, zoos are adapting their roles to meet the new challenges. This article considers these changes, using the work of Bristol and other UK zoos as a case study. The significance of zoos in both global and local conservation of biodiversity, their role in promoting public engagement and…

  13. What Challenges Does the Salesian Mission in Education Face in Italy?

    ERIC Educational Resources Information Center

    Malizia, Guglielmo

    2016-01-01

    Two centuries have passed since the birth of Don Bosco and this occasion can be a significant opportunity for the re-launching of the Congregation in Italy. From this point of view, it is certainly important to try to identify the more relevant challenges. This article divides them into external and internal. The first come from the problems…

  14. Toward a More Equitable Future: The Trends and Challenges Facing America's Latino Children

    ERIC Educational Resources Information Center

    Foxen, Patricia; Mather, Mark

    2016-01-01

    Rapid demographic change is transforming the landscape of America in exciting and challenging ways. This report, an update of the 2010 publication "America's Future: Latino Child Well-Being in Numbers and Trends," provides a comprehensive overview of national and state-level trends in the characteristics and well-being of Hispanic…

  15. Challenges Faced by Military Families: Perceptions of United States Marine Corps School Liaisons

    ERIC Educational Resources Information Center

    Aronson, Keith R.; Perkins, Daniel F.

    2013-01-01

    The global war on terror has placed a number of stressful demands on service members and their families. Although the military offers a wide range of services and supports to military families, not all families are willing or able to use them. For example, geographically dispersed families can find it challenging to connect with military support…

  16. Students' Reasons for Studying Special Needs Education: Challenges Facing Inclusive Education

    ERIC Educational Resources Information Center

    Hausstatter, Rune Sarromaa

    2007-01-01

    This article attempts to clarify some of the problems and challenges currently met by the teaching profession in special education, in particular those relating to why students choose to study special needs education and what they expect to learn. There are two major reasons why students choose to become a "special needs" teacher: to…

  17. Jobs, Jobs, Jobs: Challenges Community Colleges Face to Reach the Unemployed

    ERIC Educational Resources Information Center

    Katsinas, Stephen G.; D'Amico, Mark M.; Friedel, Janice N.

    2011-01-01

    Unemployment rates continued to fall slowly as the economy gains strength following the longest recession in over half a century. This report addressed the challenges of the community colleges attempting to reach the unemployed and underemployed. Responses from a survey conducted by the Education Policy Center at the University of Alabama, were…

  18. Design and Development of Virtual Reality: Analysis of Challenges Faced by Educators

    ERIC Educational Resources Information Center

    Hanson, Kami; Shelton, Brett E.

    2008-01-01

    There exists an increasingly attractive lure of using virtual reality applications for teaching in all areas of education, but perhaps the largest detriment to its use is the intimidating nature of VR technology for non-technical instructors. What are the challenges to using VR technology for the design and development of VR-based instructional…

  19. Retiring Right: Survey Says Presidents Face Challenges in the Next Phase of Life

    ERIC Educational Resources Information Center

    Moriarty, Daniel

    2010-01-01

    Retirement today is a complex and challenging process. People live longer after they retire and must adapt continuously to meet financial and personal needs. Retirees need a plan in preparation for retirement and in retirement so they can feel fulfilled, active, and productive, not to mention financially independent. This is particularly true of…

  20. Vic: The Challenges Facing Schools in a Small, Newly Diverse, Catalan City

    ERIC Educational Resources Information Center

    Simo, Nuria; Telford, Jon

    2012-01-01

    The arrival over the last 15 years of a substantial number of pupils of immigrant origin has presented Catalan schools with significant challenges. The schools in Vic (70 km north of Barcelona) have been at the forefront of attempts to adjust to this new multicultural reality. This article describes the results of three studies carried out by the…

  1. Survivorship in Non-Small Cell Lung Cancer: Challenges Faced and Steps Forward.

    PubMed

    Vijayvergia, Namrata; Shah, Prashant C; Denlinger, Crystal S

    2015-09-01

    Improvements in curative therapies and the advent of screening have led to increased numbers of non-small cell lung cancer (NSCLC) survivors. Most survivors have undergone invasive treatment (surgery, radiation therapy, and/or chemotherapy) and carry a higher comorbidity burden than survivors of other cancers. Overall quality of life (QOL) and health-related quality of life (HRQOL) suffer during the treatment phase, with the potential for long-term decline, and both clinical characteristics and treatment impact these measures. Physical and mental components of HRQOL seem to be most at risk for decline. The issues faced by survivors include physical symptoms such as respiratory issues, fatigue, hearing loss, neuropathy, and postsurgical pain; psychological distress leading to depression, financial issues, and poor compliance with recommended guidelines; and fear or risk of recurrence and secondary malignancies. This article summarizes the major issues faced by NSCLC survivors and suggests appropriate management. Future collaborative efforts are needed to further elucidate the complex issues that affect overall QOL and HRQOL in NSCLC survivors and to develop appropriate interventions in this large and diverse survivor population.

  2. Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1.

    PubMed

    Lee, Robert; Schwartz, Robert A

    2010-11-01

    Molluscum contagiosum (MC) is a common dermatologic infection that usually affects school-aged children, sexually active young adults, and immunocompromised individuals. It is a benign and self-limiting disease, with most cases undergoing spontaneous resolution within 6 to 9 months. However, a more severe and prolonged course is associated with immunosuppression or atopic dermatitis (AD). Management can be challenging; it needs to be decided whether to treat MC or let it run its natural course. It may be managed with reassurance and benign neglect; however, therapeutic intervention may be indicated to prevent autoinoculation and transmission, especially in patients at risk for severe disease. Guardians concerned about cosmesis should understand that therapy may leave pigmentary alterations and sometimes scars. The 3 major therapeutic modalities employed are physical destruction, immunomodulation, and antiviral agents. Combinations of these therapies may be employed. Therapeutic modalities will be discussed in part 2.

  3. 21st century challenges faced by nursing faculty in educating for compassionate practice: embodied interpretation of phenomenological data.

    PubMed

    Curtis, Katherine

    2013-07-01

    Nursing faculty are facing challenges in facilitating student learning of complex concepts such as compassionate practice. Compassion is a stated expectation of Registered Nurse (RN) and student nurse practice, and yet how it is enabled and learned within the challenging environments of university and health service provider organisations are not yet understood. There is currently an international concern that student nurses are not being adequately prepared for compassion to flourish and for compassionate practice to be sustained upon professional qualification. In order to investigate the experiences of nursing faculty in their preparation of student nurses for compassionate practice, an exploratory aesthetic phenomenological research study was undertaken using in depth interviews with five nurse teachers in the North of England. Findings from this study were analysed and presented using embodied interpretation, and indicate that nurse teachers recognise the importance of the professional ideal of compassionate practice alongside specific challenges this expectation presents. They have concerns about how the economically constrained and target driven practice reality faced by RNs promotes compassionate practice, and that students are left feeling vulnerable to dissonance between learned professional ideals and the RNs' practice reality they witness. Nurse teachers also experience dissonance within the university setting, between the pressures of managing large student groups and the time and opportunity required for small group discussion with students that enables compassion to develop in a meaningful and emotionally sustainable way. Teachers also express discomfort due to a perceived promotion of an 'unachievable utopia' within practice, identifying how the constraints within practice could be better managed to support professional ideals. The nurse teachers within this exploratory study identify the need for strong nurse leadership in practice to challenge

  4. Gender and Sexuality in Pediatrics.

    PubMed

    Merens, Teri A

    2016-05-01

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

  5. Overview of the critical disaster management challenges faced during Van 2011 earthquakes.

    PubMed

    Tolon, Mert; Yazgan, Ufuk; Ural, Derin N; Goss, Kay C

    2014-01-01

    On October 23, 2011, a M7.2 earthquake caused damage in a widespread area in the Van province located in eastern Turkey. This strong earthquake was followed by a M5.7 earthquake on November 9, 2011. This sequence of damaging earthquakes led to 644 fatalities. The management during and after these earthquake disaster imposed many critical challenges. In this article, an overview of these challenges is presented based on the observations by the authors in the aftermath of this disaster. This article presents the characteristics of 2011 Van earthquakes. Afterward, the key information related to the four main phases (ie, preparedness, mitigation, response, and recovery) of the disaster in Van is presented. The potential strategies that can be taken to improve the disaster management practice are identified, and a set of recommendations are proposed to improve the existing situation.

  6. The changing face of nanomaterials: Risk assessment challenges along the value chain.

    PubMed

    Mattsson, Mats-Olof; Simkó, Myrtill

    2017-03-01

    Risk assessment (RA) of manufactured nanomaterials (MNM) is essential for regulatory purposes and risk management activities. Similar to RA of "classical" chemicals, MNM RA requires knowledge about exposure as well as of hazard potential and dose response relationships. What makes MNM RA especially challenging is the multitude of materials (which is expected to increase substantially in the future), the complexity of MNM value chains and life cycles, the accompanying possible changes in material properties over time and in contact with various environmental and organismal milieus, and the difficulties to obtain proper exposure data and to consider the proper dose metric. This article discusses these challenges and also critically overviews the current state of the art regarding MNM RA approaches.

  7. Asian Security Challenges-Planning the Face of Strategic Uncertainties. Volume 1. Main Report

    DTIC Science & Technology

    1994-10-01

    body of cold-war analytic and planning techniques to be unseated; methodologically, the region is tabula rasa . We found that net assessments have their...countries. The result was substantially enhanced comprehension of the roles played by the U.S. and Soviet research, deVelopment, and acquisition processes...address these challenges. Technology will no doubt have an important role in the military power of many Asian nations, although not necessarily in

  8. The Challenge Facing Efforts to Encourage Military Use of Biodiesel as a Drop-In Fuel

    DTIC Science & Technology

    2012-05-01

    150 years after the first drilling derricks were erected in Titusville, Pennsylvania; Man has a renewed need to satisfy that addiction . Human’s... addiction to oil has intensified the research and development into new forms of alternative fuels. The challenges today are numerous and multi-layered...oil prices increase the demand for corn-based biofuel production, and higher sugar prices have increased the demand for com-based sweeteners. There is

  9. Ice in the Hot Box—What Adaptation Challenges Might We Face? (Invited)

    NASA Astrophysics Data System (ADS)

    Alley, R. B.

    2010-12-01

    Warming is projected to reduce ice, despite the tendency for increased precipitation. The many projected impacts include amplification of warming, sea-ice shrinkage opening seaways, and loss of water storage in snowpacks. However, sea-level rise may combine the largest effects with the greatest uncertainties. Rapid progress in understanding ice sheets has not yet produced projections with appropriately narrow uncertainties and high confidence to allow detailed planning. The range of recently published scaling arguments and back-of-the-envelope calculations is wide but often includes 1 m of rise this century. Steve Schneider’s many contributions on dangerous anthropogenic influence and on decision-making in the face of uncertainty help provide context for interpreting these preliminary and rapidly evolving results.

  10. Pediatric Heart Failure in the Developing World.

    PubMed

    Ramakrishnan, Sivasubramanian

    2014-01-01

    The exact prevalence of heart failure among children of developing countries is not known, as the data is limited. The relative frequency of different causes of pediatric heart failure varies widely across different countries and even among different parts of large countries like India. Children of developing countries face a double burden of etiologies. Conditions such us congenital heart disease, myocarditis and cardiomyopathies are common causes of pediatric of heart failure. In addition, diseases like rheumatic heart disease, nutritional deficiencies, and other tropical diseases also result in heart failure among children of the developing countries. However, most of the developing countries have low resources and hence management of pediatric heart failure becomes challenging. Advanced therapies for heart failure are rarely used in children of developing countries and cardiac transplant remains a distant dream.

  11. One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio

    PubMed Central

    Yang, Xi Jessie; Park, Taezoon; Siah, Tien Ho Kewin; Ang, Bee Leng Sophia; Donchin, Yoel

    2015-01-01

    INTRODUCTION The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio. METHODS We adopted a multifaceted approach, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders’ and recipients’ verbal communication, and recipients’ handwritten notes) and handover environmental factors were analysed. The relationship between ‘to-do’ tasks and information transfer, handover quality and handover duration was examined using analysis of variance. RESULTS Verbal handovers for 152 patients were observed. Handwritten notes on 102 (67.1%) patients and handover quality ratings for 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of non-modifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication) allowed for interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location. CONCLUSION Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised. PMID:25532519

  12. Challenges and Opportunities for International Cooperative Studies in Pediatric Hematopoeitic Cell Transplantation: Priorities of the Westhafen Intercontinental Group

    PubMed Central

    Schultz, Rudolph Kirk R.; Baker, Kevin Scott; Boelens, Jaap J.; Bollard, Catherine M.; Egeler, R. Maarten; Cowan, Mort; Ladenstein, Ruth; Lankester, Arjan; Locatelli, Franco; Lawitschka, Anita; Levine, John E.; Loh, Mignon; Nemecek, Eneida; Niemeyer, Charlotte; Prasad, Vinod K.; Rocha, Vanderson; Shenoy, Shalini; Strahm, Brigitte; Veys, Paul; Wall, Donna; Bader, Peter; Grupp, Stephan A.; Pulsipher, Michael A.; Peters, Christina

    2014-01-01

    More than 20% of allogeneic hematopoietic cell transplantations (HCTs) are performed in children and adolescents at a large number of relatively small centers. Unlike adults, at least one-third of HCTs in children are performed for rare, nonmalignant indications. Clinical trials to improve HCT outcomes in children have been limited by small numbers and these pediatric-specific features. The need for a larger number of pediatric HCT centers to participate in trials has led to the involvement of international collaborative groups. Representatives of the Pediatric Blood and Marrow Transplant Consortium, European Group for Blood and Marrow Transplantation’s Pediatric Working Group, International Berlin-Frankfurt-Munster (iBFm) Stem Cell Transplantation Committee, and Children’s Oncology Group’s Hematopoietic Stem Cell Transplantation Discipline Committee met on October 3, 2012, in Frankfurt, Germany to develop a consensus on the highest priorities in pediatric HCT. In addition, it explored the creation of an international consortium to develop studies focused on HCT in children and adolescents. This meeting led to the creation of an international HCT network, dubbed the Westhafen Intercontinental Group, to develop worldwide priorities and strategies to address pediatric HCT issues. This review outlines the priorities of need as identified by this consensus group. PMID:23883618

  13. China: facing a long-term care challenge on an unprecedented scale.

    PubMed

    Glass, Anne P; Gao, Yuan; Luo, Jing

    2013-07-01

    Population ageing is occurring in China at a breathtaking pace and rapidly becoming a major public health issue. Due to the one-child policy, rural/urban migration and other societal changes, the family-dependent long-term care (LTC) of the past will no longer suffice. Barely existent now, both institutional and community-based services will need to expand to meet the growing need. China is still at an earlier stage in economic development and will be challenged to build these services and train staff. Furthermore, many elders are not yet covered by financial and insurance support. This massive demographic transition requires political efforts to develop integrated and sustainable national LTC systems.

  14. India's Largest Hospital Insurance Program Faces Challenges In Using Claims Data To Measure Quality.

    PubMed

    Morton, Matthew; Nagpal, Somil; Sadanandan, Rajeev; Bauhoff, Sebastian

    2016-10-01

    The routine data generated by India's universal coverage programs offer an important opportunity to evaluate and track the quality of health care systematically and on a large scale. We examined the potential and challenges of measuring the quality of hospital care through claims data from India's hospital insurance program for the poor, Rashtriya Swasthya Bima Yojana (RSBY). Using data from one district in India, we illustrate how these data already provide useful insights and show that simple efforts to enhance data quality and an effort to expand the data captured could facilitate RSBY's ability to track quality of care. The data collected by RSBY has significant potential to characterize and uncover the provision of low-quality care and help inform much-needed efforts to raise the quality of hospital care.

  15. Cyber crime: can a standard risk analysis help in the challenges facing business continuity managers?

    PubMed

    Vande Putte, Danny; Verhelst, Marc

    Risk management has never been easy. Finding efficient mitigating measures is not always straightforward. Finding measures for cyber crime, however, is a really huge challenge because cyber threats are changing all the time. As the sophistication of these threats is growing, their impact increases. Moreover, society and its economy have become increasingly dependent on information and communication technologies. Standard risk analysis methodologies will help to score the cyber risk and to place it in the risk tolerance matrix. This will allow business continuity managers to figure out if there is still a gap with the maximum tolerable outage for time-critical business processes and if extra business continuity measures are necessary to fill the gap.

  16. Challenges, uncertainties and issues facing gas production from gas hydrate deposits

    SciTech Connect

    Moridis, G.J.; Collett, T.S.; Pooladi-Darvish, M.; Hancock, S.; Santamarina, C.; Boswell, R.; Kneafsey, T.; Rutqvist, J.; Kowalsky, M.; Reagan, M.T.; Sloan, E.D.; Sum, A.K.; Koh, C.

    2010-11-01

    The current paper complements the Moridis et al. (2009) review of the status of the effort toward commercial gas production from hydrates. We aim to describe the concept of the gas hydrate petroleum system, to discuss advances, requirement and suggested practices in gas hydrate (GH) prospecting and GH deposit characterization, and to review the associated technical, economic and environmental challenges and uncertainties, including: the accurate assessment of producible fractions of the GH resource, the development of methodologies for identifying suitable production targets, the sampling of hydrate-bearing sediments and sample analysis, the analysis and interpretation of geophysical surveys of GH reservoirs, well testing methods and interpretation of the results, geomechanical and reservoir/well stability concerns, well design, operation and installation, field operations and extending production beyond sand-dominated GH reservoirs, monitoring production and geomechanical stability, laboratory investigations, fundamental knowledge of hydrate behavior, the economics of commercial gas production from hydrates, and the associated environmental concerns.

  17. The Office of Site Closure: Progress in the Face of Challenges

    SciTech Connect

    Fiore, J. J.; Murphie, W. E.; Meador, S. W.

    2002-02-26

    The Office of Site Closure (OSC) was formed in November 1999 when the Department of Energy's (DOE's) Office of Environmental Management (EM) reorganized to focus specifically on site cleanup and closure. OSC's objective is to achieve safe and cost-effective cleanups and closures that are protective of our workers, the public, and the environment, now and in the future. Since its inception, OSC has focused on implementing a culture of safe closure, with emphasis in three primary areas: complete our responsibility for the Closure Sites Rocky Flats, Mound, Fernald, Ashtabula, and Weldon Spring; complete our responsibility for cleanup at sites where the DOE mission has been completed (examples include Battelle King Avenue and Battelle West Jefferson in Columbus, and General Atomics) or where other Departmental organizations have an ongoing mission (examples include the Brookhaven, Livermore, or Los Alamos National Laboratories, and the Nevada Test Site); and create a framework a nd develop specific business closure tools that will help sites close, such as guidance for and decisions on post-contract benefit liabilities, records retention, and Federal employee incentives for site closure. This paper discusses OSC's 2001 progress in achieving site cleanups, moving towards site closure, and developing specific business closure tools to support site closure. It describes the tools used to achieve progress towards cleanup and closure, such as the application of new technologies, changes in contracting approaches, and the development of agreements between sites and with host states. The paper also identifies upcoming challenges and explores options for how Headquarters and the sites can work together to address these challenges. Finally, it articulates OSC's new focus on oversight of Field Offices to ensure they have the systems in place to oversee contractor activities resulting in site cleanups and closures.

  18. Challenge theme 2: assuring water availability and quality in the 21st century: Chapter 4 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Callegary, James; Langeman, Jeff; Leenhouts, Jim; Martin, Peter

    2013-01-01

    Along the United States–Mexican border, the health of communities, economies, and ecosystems is inextricably intertwined with the availability and quality of water, but effective water management in the Borderlands is complicated. Water users compete for resources, and their needs are increasing. Managers are faced with issues such as finding a balance between agriculture and rapidly growing cities or maintaining public supplies while ensuring sufficient resources for aquatic ecosystems. In addition to human factors, the dry climate of the Borderlands, as compared to more temperate regions, also increases the challenge of balancing water supplies between humans and ecosystems. Warmer, drier, and more variable conditions across the southwestern United States—the projected results of climate change (Seager and others, 2007)—would further stress water supplies.

  19. Challenges facing the farm animal veterinary profession in England: A qualitative study of veterinarians' perceptions and responses.

    PubMed

    Ruston, Annmarie; Shortall, Orla; Green, Martin; Brennan, Marnie; Wapenaar, Wendela; Kaler, Jasmeet

    2016-05-01

    The farm animal veterinary profession in the UK has faced a number of challenges in recent decades related to the withdrawal of government funding and a contraction of the agricultural sector. They have come under pressure to respond by developing skills and focusing on disease prevention advisory services. However, this puts veterinarians in competition with other providers of these services, and moves in this direction have only been partial. Failure to respond to these challenges puts the veterinary profession at risk of de-professionalisation-a loss of their monopoly over knowledge, an erosion of client beliefs in their service ethos and a loss of work autonomy. This paper explores how farm animal veterinarians in England perceive these challenges and are responding to them. Semi-structured qualitative interviews were carried out with 28 veterinarians from Royal College of Veterinary Surgeon farm accredited practices. Veterinarians were chosen from high, medium and low density cattle farming regions. Interviews were recorded, transcribed and themes identified through the constant comparison method. The majority of respondents recognised the challenges facing the veterinary profession. Most believed their role had changed, moving towards that of a disease prevention adviser who was part of the farm management team. In terms of maintaining and redefining their professional status, farm animal veterinarians do have a defined body of knowledge and the ability to develop trusting relationships with clients, which enhances their competitiveness. However, while they recognise the changes and challenges, moves towards a disease prevention advisory model have only been partial. There seem to be little effort towards using Farm accreditation status or other strategies to promote their services. They do not appear to be finding effective strategies for putting their knowledge on disease prevention into practice. Disease prevention appears to be delivered on farm on an ad

  20. Laser gingivectomy for pediatrics.

    PubMed

    Kelman, Michelle M; Poiman, David J; Jacobson, Barry L

    2010-01-01

    Traditional gingivectomy procedures have been a challenge for pediatric dentists who confront issues of patient cooperation and discomfort. Treatment of pediatric patients must involve minimal operative and postoperative discomfort. Laser soft-tissue surgery has been shown to be well accepted by children. For the pediatric patient, the greatest advantage of the laser is the lack of local anesthesia injection and the associated pre- and postoperative discomfort. The following case report describes a gingivectomy procedure performed on a 14-year-old female.

  1. Facing up to programmatic challenges created by the HIV/AIDS epidemic in sub-Saharan Africa.

    PubMed

    Heidari, Shirin; Harries, Anthony D; Zachariah, Rony

    2011-07-06

    Three decades after the emergence of HIV, we have made great strides in our response to the epidemic, from prevention of transmission to testing and treatment. However, it is still common in high-prevalence settings for people to not know their HIV status, and estimates are that globally, a mere 36% of those eligible for treatment are receiving it. On top of this, for every person with HIV entering treatment, two more are infected. The operational obstacles to overcoming the challenges and fully implementing proven strategies are numerous. The operational research and implementation sciences aim to provide a sound basis for how to maximize the use of limited resources by investigating the best models to deliver services and implement programmes in various settings and contexts. In this special issue, the Journal of the International AIDS Society intends to highlight some of the operational and programmatic challenges that are faced in sub-Saharan Africa, home to the largest population living with HIV. Our hope is that readers gain insight into some of the challenges associated with the HIV/AIDS epidemic and a changing environment in the region, and become familiar with some applications of operational research and implementation science in HIV healthcare settings.

  2. Challenges faced by elderly guardians in sustaining the adherence to antiretroviral therapy in HIV-infected children in Zimbabwe.

    PubMed

    Skovdal, M; Campbell, C; Madanhire, C; Nyamukapa, C; Gregson, S

    2011-08-01

    Grandparents throughout sub-Saharan Africa have shown immense courage and fortitude in providing care and support for AIDS-affected children. However, growing old comes with a number of challenges which can compromise the quality of care and support they are able to provide, particularly for children infected by HIV and enrolled on antiretroviral therapy (ART) programmes. For ART to be effective, and for infected children not to develop drug-resistance, a complex treatment regimen must be followed. Drawing on the perspectives of 25 nurses and eight grandparents of HIV-infected children in Manicaland, eastern Zimbabwe, we explore some of the challenges faced by grandparents in sustaining children's adherence to ART. These challenges, serving as barriers to paediatric ART, are poverty, immobility, deteriorating memory and poor comprehension of complex treatments. Although older HIV-infected children were found to play an active role in sustaining the adherence to their programme of treatment by contributing to income and food generating activities and reminding their guardians about check-ups and drug administration, such contribution was not available from younger children. There is therefore an urgent need to develop ART services that both take into consideration the needs of elderly guardians and acknowledge and enhance the agency of older children as active and responsible contributors to ART adherence.

  3. An opportunity and an imperative: Chapter 11 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Updike, Randall G.; Page, William R.

    2013-01-01

    Along the nearly 3,200 kilometers (almost 2,000 miles) of the United States–Mexican border, we are witnessing the expression of the challenges of the 21st century. The Borderlands have become a microcosm for the entire United States and Mexico; the issues faced in that region are felt throughout both nations—water availability and quality, ecosystem health, natural resource needs, safety from natural hazards, and human socioeconomic well-being. If these issues were not challenging enough, we now recognize that the difficulties of addressing them are exacerbated by the onset of climate change, and as we come to better understand the complexities of the components of these challenge themes, we discover that each part is inextricably intertwined with other overarching issues. Further, because we are a creative and progressive society, we all seek to understand and appreciate the natural environments associated with the Borderlands while at the same time benefitting from the region’s many social and economic values. It is little wonder that we as a society find it increasingly difficult to ask the right questions, much less find suitable answers to the questions we do ask. For the many scientists who have worked in the Borderlands and contributed to the preceding chapters, this circular is a way to describe to the two nations of the region the capabilities the U.S. Geological Survey can provide to assist in that quest for knowledge and understanding in preparation for the future.

  4. Northern Eurasia Future Initiative: Facing the Challenges of Global Change in the 21st century

    NASA Astrophysics Data System (ADS)

    Groisman, Pavel; Gutman, Garik; Gulev, Sergey; Maksyutov, Shamil; Qi, Jiaguo

    2016-04-01

    foci emerged in discussions within the NEESPI community during the past 20 months. Presentation will provide justification of these foci and approach examples addressing them. The societal challenges, particularly the socio-economic challenges are the top priority in most of them. Throughout the NEESP Initiative duration, support for it studies has been provided by different national and international Agencies of the United States (in particular, the NASA Land Cover and Land Use Change Program), the Russian Federation (in particular, the Ministry of Education and Science, e.g., mega-grant 14.B25.31.0026), European Union, Japan, and China. After the NEFI White Paper release, we anticipate a similar kind of support for this new Initiative.

  5. Northern Eurasia Future Initiative: Facing the Challenges of Global Change in the 21st century

    NASA Astrophysics Data System (ADS)

    Groisman, P. Y.; Gulev, S.; Maksyutov, S. S.; Qi, J.

    2015-12-01

    foci emerged in discussions within the NEESPI community during the past 12 months. Presentation will provide justification of these foci and approach examples addressing them. The societal challenges, particularly the socio-economic challenges are the top priority in most of them. .

  6. The challenges of purpose in the face of chaos: commentary paper by Professor Beverley Raphael.

    PubMed

    Raphael, Beverley

    2008-12-01

    This paper addresses the issues and purposes of psychiatric research into disaster. Purposes include those that are focused on basic scientific questions, such as the role of disaster stressors in contributing to the development of psychiatric morbidity, and research attempting to identify the level of mental health need. There is also intervention research but this is limited in the acute emergency and longer term. These questions and the methodologies to address them, overlap significantly. Many studies use different measures of exposure, disorder and other disaster variables. There is also a wide range of population groups studied, making comparison of findings difficult. Thus, for these large scale events affecting populations, studies may not readily meet either the purposes of affected populations or government funders. Nor are interventions systematically operationalized to promoted replication. Challenges lie in the diversity of researchers, the pluralistic nature of Western society and the rapid development of the field. It is suggested that a set of disaster mental health research standards, based on core principles and data, would facilitate national and international collaboration and the interests of individual researcher. This could lead to comparable studies that could progress the field, while at the same time fostering innovations which could link to these research programmes. Strategic partnerships with government and other funders, as well as affected communities, could strengthen advocacy and commitment for disaster mental health research.

  7. Transcultural nursing: facing the challenges of advocacy and diversity/universality.

    PubMed

    Kavanagh, K H

    1993-01-01

    This paper is in response to an invitation to address the topic of advocacy and diversity from the perspective of past and present transcultural nursing. With origins in nursing, with its philosophy of active intervention, and in anthropology, where relativism proposes merit in diverse (including non-interventive) approaches to health and illness, transcultural nursing grapples with potential epistemological conflict as it helps shape health care in highly industrialized, multicultural societies and even more varied global contexts. As a developing subdiscipline, transcultural nursing continuously reexamines dialectical relationships between change and preservation and between health care needs and the risk of imposition. Whereas advocacy is viewed as a moral imperative in nursing, diversity (which can be used to argue against acknowledgement of differences and to promote the pretense that everything is the same for everyone) remains better developed conceptually than operationally, while universality too often falls prey to misuse as an argument against acknowledgement of diversity. Within a framework constructed from the juxtaposition of advocacy with diversity/universality (Leininger, 1988c, 1991), this article appraises the accomplishments and challenges of transcultural nursing as it moves into its second quarter century. It is proposed that the future of transcultural nursing should emphasize development of realistic nursing roles that include a confluence of advocacy and diversity/universality and negotiation of responsible social conceptualizations of cultural issues such as "race" and diversity.

  8. Facing the challenges of multiscale modelling of bacterial and fungal pathogen-host interactions.

    PubMed

    Schleicher, Jana; Conrad, Theresia; Gustafsson, Mika; Cedersund, Gunnar; Guthke, Reinhard; Linde, Jörg

    2016-02-08

    Recent and rapidly evolving progress on high-throughput measurement techniques and computational performance has led to the emergence of new disciplines, such as systems medicine and translational systems biology. At the core of these disciplines lies the desire to produce multiscale models: mathematical models that integrate multiple scales of biological organization, ranging from molecular, cellular and tissue models to organ, whole-organism and population scale models. Using such models, hypotheses can systematically be tested. In this review, we present state-of-the-art multiscale modelling of bacterial and fungal infections, considering both the pathogen and host as well as their interaction. Multiscale modelling of the interactions of bacteria, especially Mycobacterium tuberculosis, with the human host is quite advanced. In contrast, models for fungal infections are still in their infancy, in particular regarding infections with the most important human pathogenic fungi, Candida albicans and Aspergillus fumigatus. We reflect on the current availability of computational approaches for multiscale modelling of host-pathogen interactions and point out current challenges. Finally, we provide an outlook for future requirements of multiscale modelling.

  9. Challenges faced by China compared with the US in developing wind power

    NASA Astrophysics Data System (ADS)

    Lu, Xi; McElroy, Michael B.; Peng, Wei; Liu, Shiyang; Nielsen, Chris P.; Wang, Haikun

    2016-06-01

    In the 21st Conference of the Parties held in Paris in December 2015, China pledged to peak its carbon emissions and increase non-fossil energy to 20% by 2030 or earlier. Expanding renewable capacity, especially wind power, is a central strategy to achieve these climate goals. Despite greater capacity for wind installation in China compared to the US (145.1 versus 75.0 GW), less wind electricity is generated in China (186.3 versus 190.9 TWh). Here, we quantify the relative importance of the key factors accounting for the unsatisfactory performance of Chinese wind farms. Different from the results in earlier qualitative studies, we find that the difference in wind resources explains only a small fraction of the present China-US difference in wind power output (-17.9% in 2012); the curtailment of wind power, differences in turbine quality, and delayed connection to the grid are identified as the three primary factors (respectively -49.3%, -50.2%, and -50.3% in 2012). Improvements in both technology choices and the policy environment are critical in addressing these challenges.

  10. Challenges, uncertainties, and issues facing gas production from gas-hydrate deposits

    USGS Publications Warehouse

    Moridis, G.J.; Collett, T.S.; Pooladi-Darvish, M.; Hancock, S.; Santamarina, C.; Boswel, R.; Kneafsey, T.; Rutqvist, J.; Kowalsky, M.B.; Reagan, M.T.; Sloan, E.D.; Sum, A.K.; Koh, C.A.

    2011-01-01

    The current paper complements the Moridis et al. (2009) review of the status of the effort toward commercial gas production from hydrates. We aim to describe the concept of the gas-hydrate (GH) petroleum system; to discuss advances, requirements, and suggested practices in GH prospecting and GH deposit characterization; and to review the associated technical, economic, and environmental challenges and uncertainties, which include the following: accurate assessment of producible fractions of the GH resource; development of methods for identifying suitable production targets; sampling of hydrate-bearing sediments (HBS) and sample analysis; analysis and interpretation of geophysical surveys of GH reservoirs; well-testing methods; interpretation of well-testing results; geomechanical and reservoir/well stability concerns; well design, operation, and installation; field operations and extending production beyond sand-dominated GH reservoirs; monitoring production and geomechanical stability; laboratory investigations; fundamental knowledge of hydrate behavior; the economics of commercial gas production from hydrates; and associated environmental concerns. ?? 2011 Society of Petroleum Engineers.

  11. Facing the challenge of mammalian neural microcircuits: taking a few breaths may help

    PubMed Central

    Feldman, Jack L; Kam, Kaiwen

    2015-01-01

    Breathing in mammals is a seemingly straightforward behaviour controlled by the brain. A brainstem nucleus called the preBötzinger Complex sits at the core of the neural circuit generating respiratory rhythm. Despite the discovery of this microcircuit almost 25 years ago, the mechanisms controlling breathing remain elusive. Given the apparent simplicity and well-defined nature of regulatory breathing behaviour, the identification of much of the circuitry, and the ability to study breathing in vitro as well as in vivo, many neuroscientists and physiologists are surprised that respiratory rhythm generation is still not well understood. Our view is that conventional rhythmogenic mechanisms involving pacemakers, inhibition or bursting are problematic and that simplifying assumptions commonly made for many vertebrate neural circuits ignore consequential detail. We propose that novel emergent mechanisms govern the generation of respiratory rhythm. That a mammalian function as basic as rhythm generation arises from complex and dynamic molecular, synaptic and neuronal interactions within a diverse neural microcircuit highlights the challenges in understanding neural control of mammalian behaviours, many (considerably) more elaborate than breathing. We suggest that the neural circuit controlling breathing is inimitably tractable and may inspire general strategies for elucidating other neural microcircuits. PMID:25556783

  12. Potential challenges facing distributed leadership in health care: evidence from the UK National Health Service.

    PubMed

    Martin, Graeme; Beech, Nic; MacIntosh, Robert; Bushfield, Stacey

    2015-01-01

    The discourse of leaderism in health care has been a subject of much academic and practical debate. Recently, distributed leadership (DL) has been adopted as a key strand of policy in the UK National Health Service (NHS). However, there is some confusion over the meaning of DL and uncertainty over its application to clinical and non-clinical staff. This article examines the potential for DL in the NHS by drawing on qualitative data from three co-located health-care organisations that embraced DL as part of their organisational strategy. Recent theorising positions DL as a hybrid model combining focused and dispersed leadership; however, our data raise important challenges for policymakers and senior managers who are implementing such a leadership policy. We show that there are three distinct forms of disconnect and that these pose a significant problem for DL. However, we argue that instead of these disconnects posing a significant problem for the discourse of leaderism, they enable a fantasy of leadership that draws on and supports the discourse.

  13. Firefighter Training in Sweden: From Face-to-Face Learning in Training Grounds to Distance Learning--A Challenge for Exercise Instructors?

    ERIC Educational Resources Information Center

    Holmgren, Robert

    2016-01-01

    When distance learning supported by digital technologies was introduced in firefighter training in Sweden some years ago, training exercise instructors accustomed to face-to-face teaching in the field had to adapt their professional roles to an electronic landscape with a number of new opportunities and constraints. Based on activity theory and…

  14. Pesticide Health and Safety Challenges Facing Informal Sector Workers: A Case of Small-scale Agricultural Workers in Tanzania.

    PubMed

    Ngowi, Aiwerasia; Mrema, Ezra; Kishinhi, Stephen

    2016-08-01

    The Tanzania informal sector is growing fast, with precarious working conditions and particular hazards for women and children in agriculture. Hazardous agricultural chemicals including pesticides are mostly imported and have been used for many years. Despite the role played by pesticides in food security and vector control, these chemicals are responsible for acute and chronic illnesses among communities. The availability of obsolete persistent organic pesticides on the open market indicates existence of an inadequate regulatory system. People who get injured or ill in the agriculture sector in Tanzania receive health services in primary health care facilities where professionals have little or no knowledge of pesticides. We are presenting the pesticide health and safety challenges faced by small-scale farmers who fall in the informal sector. Achievements that have been made by the government and other players to reduce and prevent pesticide exposures and poisoning are also outlined.

  15. Eculizumab for atypical hemolytic-uremic syndrome in India: First report from India and the challenges faced

    PubMed Central

    Sethi, S. K.; Rohatgi, S.; Dragon-Durey, M. A.; Raghunathan, V.; Dhaliwal, M.; Rawat, A.; Jha, P.; Bansal, S. B.; Raina, R.; Kher, V.

    2017-01-01

    Much progress has been made in understanding the pathophysiology and treatment of atypical hemolytic uremic syndrome (aHUS). Plasma therapy is the mainstay of treatment for aHUS. The availability of the first effective anti-complement therapeutic agent, eculizumab, has dramatically changed the outlook of this disease. However, its use in clinical practice raises important questions, such as who should receive the drug, when to start such therapy, and is it safe to stop treatment once the disease is controlled. We describe here for the 1st time in India, use of eculizumab in a 12-year-old boy with aHUS. We also describe in this report challenges faced in procuring the drug, and an ideal, evidence-based method of treating aHUS in children. PMID:28182046

  16. Facing policy challenges with inter- and transdisciplinary soil research focused on the UN Sustainable Development Goals

    NASA Astrophysics Data System (ADS)

    Bouma, Johan; Montanarella, Luca

    2016-04-01

    Our current information society, populated by increasingly well-informed and critical stakeholders, presents a challenge to both the policy and science arenas. The introduction of the UN Sustainable Development Goals (SDGs) offers a unique and welcome opportunity to direct joint activities towards these goals. Soil science, even though it is not mentioned as such, plays an important role in realizing a number of SDGs focusing on food, water, climate, health, biodiversity, and sustainable land use. A plea is made for a systems approach to land use studies, to be initiated by soil scientists, in which these land-related SDGs are considered in an integrated manner. To connect with policy makers and stakeholders, two approaches are functional. The first of these is the policy cycle when planning and executing research, which includes signaling, design, decision making, implementation, and evaluation. Many current research projects spend little time on signaling, which may lead to disengagement of stakeholders. Also, implementation is often seen as the responsibility of others, while it is crucial to demonstrate - if successful - the relevance of soil science. The second approach is the DPSIR approach when following the policy cycle in land-related research, distinguishing external drivers, pressures, impact, and responses to land use change that affect the state of the land in the past, present, and future. Soil science cannot by itself realize SDGs, and interdisciplinary studies on ecosystem services (ESs) provide an appropriate channel to define contributions of soil science in terms of the seven soil functions. ESs, in turn, can contribute to addressing the six SDGs (2, 3, 6, 12, 13, and 15) with an environmental, land-related character. SDGs have a societal focus and future soil science research can only be successful if stakeholders are part of the research effort in transdisciplinary projects, based on the principle of time-consuming "joint learning". The

  17. Immunological Challenges Facing Translation of Alginate Encapsulated Porcine Islet Xenotransplantation to Human Clinical Trials.

    PubMed

    Krishnan, Rahul; Ko, David; Foster, Clarence E; Liu, Wendy; Smink, A M; de Haan, Bart; De Vos, Paul; Lakey, Jonathan R T

    2017-01-01

    Transplantation of alginate-encapsulated islets has the potential to treat patients suffering from type I diabetes, a condition characterized by an autoimmune attack against insulin-secreting beta cells. However, there are multiple immunological challenges associated with this procedure, all of which must be adequately addressed prior to translation from trials in small animal and nonhuman primate models to human clinical trials. Principal threats to graft viability include immune-mediated destruction triggered by immunogenic alginate impurities, unfavorable polymer composition and surface characteristics, and release of membrane-permeable antigens, as well as damage associated molecular patterns (DAMPs) by the encapsulated islets themselves. The lack of standardization of significant parameters of bioencapsulation device design and manufacture (i.e., purification protocols, surface-modification grafting techniques, alginate composition modifications) between labs is yet another obstacle that must be overcome before a clinically effective and applicable protocol for encapsulating islets can be implemented. Nonetheless, substantial progress is being made, as is evident from prolonged graft survival times and improved protection from immune-mediated graft destruction reported by various research groups, but also with regard to discoveries of specific pathways involved in explaining observed outcomes. Progress in the latter is essential for a comprehensive understanding of the mechanisms responsible for the varying levels of immunogenicity of certain alginate devices. Successful translation of encapsulated islet transplantation from in vitro and animal model testing to human clinical trials hinges on application of this knowledge of the pathways and interactions which comprise immune-mediated rejection. Thus, this review not only focuses on the different factors contributing to provocation of the immune reaction by encapsulated islets, but also on the defining

  18. A New Ethical Challenge for Institutional Review Boards (IRBs)/Ethics Committees (ECs) in the Assessment of Pediatric Clinical Trials.

    PubMed

    Rose, Klaus; Kummer, Hans

    2015-05-28

    Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA)'s Pediatric Committee (PDCO) may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs)/ethics committees (ECs) and that clinical trials resulting from negotiations with EMA's PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients.

  19. A New Ethical Challenge for Institutional Review Boards (IRBs)/Ethics Committees (ECs) in the Assessment of Pediatric Clinical Trials

    PubMed Central

    Rose, Klaus; Kummer, Hans

    2015-01-01

    Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA)’s Pediatric Committee (PDCO) may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs)/ethics committees (ECs) and that clinical trials resulting from negotiations with EMA’s PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients. PMID:27417359

  20. Challenges for Ecosystem Services Provided by Coral Reefs In the Face of Climate Change

    NASA Astrophysics Data System (ADS)

    Kikuchi, R. K.; Elliff, C. I.

    2014-12-01

    to increase resilience and guarantee the adaptation of this ecosystem to climate change. Thus, considering that the majority of the marine ecosystem services we benefit from are provided from coastal habitats, of which coral reefs play an important role, the challenge at hand is in fact the interaction between local factors and climate change

  1. Pediatric urticaria.

    PubMed

    Tsakok, Teresa; Du Toit, George; Flohr, Carsten

    2014-02-01

    Although urticaria is not a life-threatening disease, its impact on quality of life in children should not be overlooked. A systematic search of online databases, including Medline, was performed to inform a review aiming to equip clinicians with an evidence-based approach to all aspects of pediatric urticaria. This review hinges on an illustrative case and includes a summary table of studies pertaining to disease management in children. The multiple issues faced by patients, their families, and treating clinicians are highlighted, and the current literature on the presentation, natural history, investigation, and management of this poorly understood condition is assessed.

  2. From medical invention to clinical practice: the reimbursement challenge facing new device procedures and technology--part 3: payment.

    PubMed

    Raab, G Gregory; Parr, David H

    2006-11-01

    This paper, the last of 3 that discuss the reimbursement challenges facing new medical device technology in various issues of this journal, addresses the structural diversity of Medicare's various payment systems. These systems vary widely in how they establish prices, how they incorporate new technologies and procedures, and the means by which they are updated and maintained. Their importance extends beyond Medicare because other payers use these payment rates as a basis for setting rates of their own. Device manufacturers and medical practitioners must often navigate several of these payment systems concurrently to ensure that technologies and procedures (that are already coded properly and covered) receive a fair payment rate. It is important to recognize that coverage can be undermined without adequate payment and that this situation will dampen further product innovation. The 3 papers, taken together, document the challenges posed by insurer reimbursement policies and show that a close working relationship between the manufacturers that develop new medical technologies and physician practitioners is needed if reimbursement hurdles are to be managed and medical innovation is to continue.

  3. The Childhood Adenotonsillectomy Trial (CHAT): Rationale, Design, and Challenges of a Randomized Controlled Trial Evaluating a Standard Surgical Procedure in a Pediatric Population

    PubMed Central

    Redline, Susan; Amin, Raouf; Beebe, Dean; Chervin, Ronald D.; Garetz, Susan L.; Giordani, Bruno; Marcus, Carole L.; Moore, Renee H.; Rosen, Carol L.; Arens, Raanan; Gozal, David; Katz, Eliot S.; Mitchell, Ronald B.; Muzumdar, Hiren; Taylor, H.G.; Thomas, Nina; Ellenberg, Susan

    2011-01-01

    Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used “standard practice” surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions. Citation: Redline S; Amin R; Beebe D; Chervin RD; Garetz SL; Giordani B; Marcus CL; Moore RH; Rosen CL; Arens R; Gozal D; Katz ES; Mitchell RB; Muzumdar H; Taylor HG; Thomas N; Ellenberg S. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. SLEEP 2011;34(11):1509-1517. PMID:22043122

  4. Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

    PubMed Central

    Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

    2016-01-01

    Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and

  5. Institutional design and organizational practice for universal coverage in lesser-developed countries: challenges facing the Lao PDR.

    PubMed

    Ahmed, Shakil; Annear, Peter Leslie; Phonvisay, Bouaphat; Phommavong, Chansaly; Cruz, Valeria de Oliveira; Hammerich, Asmus; Jacobs, Bart

    2013-11-01

    There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage.

  6. Adding innovative practices and technology to central line bundle reduces bloodstream infection rate in challenging pediatric population.

    PubMed

    Pavia, Marianne; Mazza, Marianne

    2016-01-01

    A specialized pediatric hospital serves many patients with short bowel syndrome. The patients' fecal residue plus frequent access of intravenous lines increases bloodstream infection (BSI) risk. To reduce BSIs, the hospital first implemented an alcohol-dispensing disinfection cap and then added 3 more interventions, with both the cap-only phase and the multipronged phase successfully lowering the hospital's BSI rate.

  7. Challenges Facing Guitar Education

    ERIC Educational Resources Information Center

    Harrison, Eli

    2010-01-01

    The guitar is an extremely versatile instrument. It can produce complex chords and arpeggiated textures as readily as single-note melodies. In the twentieth century alone, it has appeared in a wide range of genres; classical, jazz, blues, rock, and bossa nova compose a partial list. The guitar is also a difficult instrument. Inconsistencies across…

  8. Charter Authorizers Face Challenges

    ERIC Educational Resources Information Center

    Gustafson, Joey

    2013-01-01

    Since the first charter school opened 20 years ago in Minnesota, charters have been a focus of school reform advocates and the subject of substantial research. Yet the regulators of the charter industry (called "authorizers" or "sponsors") remain a mystery to many. In fact, many authorizers work in isolation, developing their…

  9. Current Challenges Facing the Translation of Brain Computer Interfaces from Preclinical Trials to Use in Human Patients

    PubMed Central

    Murphy, Maxwell D.; Guggenmos, David J.; Bundy, David T.; Nudo, Randolph J.

    2016-01-01

    Current research in brain computer interface (BCI) technology is advancing beyond preclinical studies, with trials beginning in human patients. To date, these trials have been carried out with several different types of recording interfaces. The success of these devices has varied widely, but different factors such as the level of invasiveness, timescale of recorded information, and ability to maintain stable functionality of the device over a long period of time all must be considered in addition to accuracy in decoding intent when assessing the most practical type of device moving forward. Here, we discuss various approaches to BCIs, distinguishing between devices focusing on control of operations extrinsic to the subject (e.g., prosthetic limbs, computer cursors) and those focusing on control of operations intrinsic to the brain (e.g., using stimulation or external feedback), including closed-loop or adaptive devices. In this discussion, we consider the current challenges facing the translation of various types of BCI technology to eventual human application. PMID:26778962

  10. Current Challenges Facing the Translation of Brain Computer Interfaces from Preclinical Trials to Use in Human Patients.

    PubMed

    Murphy, Maxwell D; Guggenmos, David J; Bundy, David T; Nudo, Randolph J

    2015-01-01

    Current research in brain computer interface (BCI) technology is advancing beyond preclinical studies, with trials beginning in human patients. To date, these trials have been carried out with several different types of recording interfaces. The success of these devices has varied widely, but different factors such as the level of invasiveness, timescale of recorded information, and ability to maintain stable functionality of the device over a long period of time all must be considered in addition to accuracy in decoding intent when assessing the most practical type of device moving forward. Here, we discuss various approaches to BCIs, distinguishing between devices focusing on control of operations extrinsic to the subject (e.g., prosthetic limbs, computer cursors) and those focusing on control of operations intrinsic to the brain (e.g., using stimulation or external feedback), including closed-loop or adaptive devices. In this discussion, we consider the current challenges facing the translation of various types of BCI technology to eventual human application.

  11. District of Columbia: D.C. Public Schools' Modernization Program Faces Major Challenges. Testimony before the Subcommittee on the District of Columbia, Committee on Appropriations, House of Representatives.

    ERIC Educational Resources Information Center

    Cooper, David E.

    This Congressional testimony focuses on the challenges faced by the District of Columbia in modernizing its public schools. Specifically, it addresses: (1) increases in the cost of modernizing the schools; (2) delays in completing the schools; (3) quality inspection problems; and (4) concerns about managing asbestos hazards. The testimony…

  12. An Investigation into Challenges Faced by Secondary School Teachers and Pupils in Algebraic Linear Equations: A Case of Mufulira District, Zambia

    ERIC Educational Resources Information Center

    Samuel, Koji; Mulenga, H. M.; Angel, Mukuka

    2016-01-01

    This paper investigates the challenges faced by secondary school teachers and pupils in the teaching and learning of algebraic linear equations. The study involved 80 grade 11 pupils and 15 teachers of mathematics, drawn from 4 selected secondary schools in Mufulira district, Zambia in Central Africa. A descriptive survey method was employed to…

  13. Facing Human Capital Challenges of the 21st Century: Education and Labor Market Initiatives in Lebanon, Oman, Qatar, and the United Arab Emirates

    ERIC Educational Resources Information Center

    Gonzalez, Gabriella; Karoly, Lynn A.; Constant, Louay; Salem, Hanine; Goldman, Charles A.

    2008-01-01

    Countries in the Arab region are faced with the challenge of developing their populations' skills and technical knowledge, or human capital, in order to compete in the 21st century global economy. The authors describe the education and labor market initiatives implemented or under way in four countries in the Arab region -- Lebanon, Oman, Qatar,…

  14. Science Education and the Challenges Facing Its Integration into the 21st Century School System in a Globalized World: A Case of Igbo Nation

    ERIC Educational Resources Information Center

    Ezeudu, F. O.; Nkokelonye, C. U.; Ezeudu, S. A.

    2013-01-01

    This paper is a study of historical foundations of science education in Igboland, its nature and scope as well as the challenges facing its integration into the 21st century school system in a globalized world. The authors found that there were many scientific activities in Igbo culture, but many problems hinder their integration into the basic…

  15. "It's Intense, to an Extent": A Qualitative Study of the Emotional Challenges Faced by Staff Working on a Treatment Programme for Intellectually Disabled Sex Offenders

    ERIC Educational Resources Information Center

    Sandhu, Daljit K.; Rose, John; Rostill-Brookes, Helen J.; Thrift, Su

    2012-01-01

    Background: This study explores the emotional challenges faced by staff working on a sex offender treatment programme for people with an intellectual disability. Methods: Semi-structured interviews were carried out with eight participants working on a treatment programme for sex offenders with an intellectual disability. Interviews were analysed…

  16. When Worlds Collide--Examining the Challenges Faced by Teacher Education Programmes Combining Professional Vocational Competence with Academic Study, Lessons from Further Education to Higher Education

    ERIC Educational Resources Information Center

    Shaw, Angela

    2016-01-01

    This paper examines the challenges faced by higher education institutions in designing, teaching and quality assuring programmes of study which, of necessity, must combine the gaining of professional vocational competence with academic study. The paper gives recognition to the policy framework in which these programmes fit--with particular…

  17. Pediatric vasculitis.

    PubMed

    Weiss, Pamela F

    2012-04-01

    Childhood vasculitis is a challenging and complex group of conditions that are multisystem in nature and often require integrated care from multiple subspecialties, including rheumatology, dermatology, cardiology, nephrology, neurology, and gastroenterology. Vasculitis is defined as the presence of inflammation in the blood vessel wall. The site of vessel involvement, size of the affected vessels, extent of vascular injury, and underlying pathology determine the disease phenotype and severity. This article explores the classification and general features of pediatric vasculitis, as well as the clinical presentation, diagnostic evaluation, and therapeutic options for the most common vasculitides.

  18. The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery.

    PubMed

    Tchervenkov, Christo I; Jacobs, Jeffrey Phillip; Bernier, Pierre-Luc; Stellin, Giovanni; Kurosawa, Hiromi; Mavroudis, Constantine; Jonas, Richard A; Cicek, Sertac M; Al-Halees, Zohair; Elliott, Martin J; Jatene, Marcelo B; Kinsley, Robin H; Kreutzer, Christian; Leon-Wyss, Juan; Liu, Jinfen; Maruszewski, Bohdan; Nunn, Graham R; Ramirez-Marroquin, Samuel; Sandoval, Nestor; Sano, Shunji; Sarris, George E; Sharma, Rajesh; Shoeb, Ayman; Spray, Thomas L; Ungerleider, Ross M; Yangni-Angate, Hervé; Ziemer, Gerhard

    2008-12-01

    The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].

  19. Professional boundary issues in pediatric palliative care.

    PubMed

    Jankowski, Jane B

    2014-03-01

    This article explores the hypothesis that when a child has a life-limiting illness, the interpersonal boundaries between the patient, the patient's parents, and the health care team members differ from traditional provider, patient, and parent boundaries because of the unique dynamics of palliative care in pediatrics. Providers from the Journey's Palliative Care Team at Albany Medical Center completed a brief survey about working in pediatric palliative care and what ethical challenges they have faced in trying to maintain professional boundaries as new palliative care providers. A retrospective review of survey responses and a review of relevant literature offer insight into the various concerns reported by the Journey's team. Conclusions about delivering comprehensive ethically sound palliative care services may serve as a pathway for future studies.

  20. NCI, NHLBI/PBMTC First International Consensus Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: The Need for Pediatric Specific Long Term Follow-up Guidelines

    PubMed Central

    Pulsipher, Michael A.; Skinner, Roderick; McDonald, George B.; Hingorani, Sangeeta; Armenian, Saro H.; Cooke, Kenneth R.; Gracia, Clarisa; Petryk, Anna; Bhatia, Smita; Bunin, Nancy; Nieder, Michael L.; Dvorak, Christopher C.; Sung, Lillian; Sanders, Jean E.; Kurtzberg, Joanne; Baker, K. Scott

    2012-01-01

    Existing standards for screening and management of late effects occurring in children who have undergone hematopoietic cell transplantation (HCT) include recommendations from pediatric cancer networks and consensus guidelines from adult-oriented transplantation societies applicable to all recipients of HCT. While these approaches have significant merit, they are not pediatric-HCT focused and they do not address post-HCT challenges faced by children with complex non-malignant disorders. In this article we discuss the strengths and weaknesses of current published recommendations and conclude that pediatric-specific guidelines for post-HCT screening and management would be beneficial to the long-term health of these patients and would promote late-effects research in this field. Our panel of late effects experts also provides recommendations for follow up and therapy of selected post-HCT organ and endocrine complications in pediatric patients. PMID:22248713

  1. Pediatric inflammatory bowel disease

    PubMed Central

    Diefenbach, Karen A; Breuer, Christopher K

    2006-01-01

    Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents. The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies, and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn’s disease and ulcerative colitis. Once diagnosed, the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population. Surgical management is usually indicated for failure of medical management, complication, or malignancy. Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented. The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease. PMID:16718840

  2. Pediatric Palliative Care

    PubMed Central

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palliative care, but continued research into this important area of pediatrics will lead to improvements in the care of children with life-threatening illnesses. PMID:23118638

  3. Cytogenetic studies of Brazilian pediatric myelodysplastic syndrome cases: challenges and difficulties in a large and emerging country

    PubMed Central

    Velloso, E.D.R.P.; Chauffaille, M.L.; Peliçario, L.M.; Tanizawa, R.S.S.; Toledo, S.R.C.; Gaiolla, R.D.; Lopes, L.F.

    2013-01-01

    Myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukemia (JMML) are rare hematopoietic stem cell diseases affecting children. Cytogenetics plays an important role in the diagnosis of these diseases. We report here the experience of the Cytogenetic Subcommittee of the Brazilian Cooperative Group on Pediatric Myelodysplastic Syndromes (BCG-MDS-PED). We analyzed 168 cytogenetic studies performed in 23 different cytogenetic centers; 84 of these studies were performed in patients with confirmed MDS (primary MDS, secondary MDS, JMML, and acute myeloid leukemia/MDS+Down syndrome). Clonal abnormalities were found in 36.9% of the MDS cases and cytogenetic studies were important for the detection of constitutional diseases and for differential diagnosis with other myeloid neoplasms. These data show the importance of the Cooperative Group for continuing education in order to avoid a late or wrong diagnosis. PMID:23314345

  4. Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia

    PubMed Central

    Slone, Jeremy S.; Chunda-Liyoka, Catherine; Perez, Marta; Mutalima, Nora; Newton, Robert; Chintu, Chifumbe; Kankasa, Chipepo; Chipeta, James; Heimburger, Douglas C.; Vermund, Sten H.; Friedman, Debra L.

    2014-01-01

    Background There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia. Methods Using an established database, a retrospective cohort study was conducted of children aged 0–15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records. Results Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23–0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05–2.58). Conclusions Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection

  5. A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents.

    PubMed

    St George, Sara M; Pulgarón, Elizabeth R; Ferranti, Dina; Agosto, Yaray; Toro, Maria I; Ramseur, Kevin C; Delamater, Alan M

    2017-04-01

    Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.

  6. Pediatric functional gastrointestinal disorders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irrita...

  7. Consumers or Citizens? Whose Voice Will Healthwatch Represent and Will It Matter? Comment on "Challenges Facing Healthwatch, a New Consumer Champion in England".

    PubMed

    Wright, Brad

    2016-06-22

    Efforts to achieve effective and meaningful patient and public involvement (PPI) in healthcare have existed for nearly a century, albeit with limited success. This brief commentary discusses a recent paper by Carter and Martin exploring the "Challenges Facing Healthwatch, a New Consumer Champion in England," and places these challenges in the context of the broader struggle to give a voice to healthcare consumers and citizens. With an overview of what can go right and-perhaps more importantly-what can go wrong, the question remains: will Healthwatch-and other PPI efforts in healthcare-represent the voice of consumers or citizens and will it matter?

  8. Intimate partner violence and challenges facing women living with HIV/AIDS in accessing antiretroviral treatment at Singida Regional Hospital, central Tanzania

    PubMed Central

    Kosia, Agnes; Kakoko, Deodatus; Semakafu, Ave Maria Emilius; Nyamhanga, Tumaini; Frumence, Gasto

    2016-01-01

    Background Human immunodeficiency virus (HIV) remains a global public health problem. Sub-Saharan Africa is the region most affected by HIV/AIDS in the world. Globally, and in Tanzania in particular, women are more affected by HIV/AIDS than men. Tanzania has been reported to be among the countries with the highest burden of intimate partner violence (IPV). This study explored the challenges facing women living with HIV/AIDS (LWHA) attending the care and treatment clinic (CTC) in Singida Regional Hospital in Tanzania. Design A qualitative study was performed in which data were collected through in-depth interviews with 35 women LWHA who also experienced IPV. Content analysis was used to analyse the data. Results The study findings showed that women LWHA experienced challenges from their male partners in the form of lack of fare to attend CTC, delayed attendance to CTC, verbal threats and intimidation, mistrust partner resulting in changed antiretroviral (ARV) dosing time. Also, systemic challenges such as malfunction of CD4 count testing apparatus contributed to mistrust from their male partners which led to IPV. Conclusion In this study, women LWHA experienced IPV challenges that resulted in poor adherence to ARV medication and CTC attendance, as well as insufficient time to collect ARV medication. It is recommended that the government address systemic challenges faced by women LWHA, introduce multiple approaches to address the needs of women LWHA experiencing IPV, and develop strong policies to prevent IPV against women in Tanzania, regardless of their HIV status. PMID:27987296

  9. Pediatric sedation.

    PubMed

    Daud, Yasmeen N; Carlson, Douglas W

    2014-08-01

    Pediatric sedation is an evolving field performed by an extensive list of specialties. Well-defined sedation systems within pediatric facilities are paramount to providing consistent, safe sedation. Pediatric sedation providers should be trained in the principles and practice of sedation, which include patient selection, pre-sedation assessment to determine risks during sedation, selection of optimal sedation medication, monitoring requirements, and post-sedation care. Training, credentialing, and continuing sedation education must be incorporated into sedation systems to verify and monitor the practice of safe sedation. Pediatric hospitalists represent a group of providers with extensive pediatric knowledge and skills who can safely provide pediatric sedation.

  10. Pediatric Rhinosinusitis.

    PubMed

    Badr, Dana T; Gaffin, Jonathan M; Phipatanakul, Wanda

    2016-09-01

    Rhinosinusitis, is defined as an inflammation of the paranasal and nasal sinus mucosae. Chronic rhinosinusitis (CRS)is a common problem in the pediatric age group and the diagnosis and treatment are challenging due to the chronicity and similarity of symptoms with allergic rhinitis and adenoid hypertrophy. Although it is less common than acute rhinosinusitis, CRS is becoming more frequent and significantly affects the quality of life in children and can substantially impair daily function. CRS is characterized by sinus symptoms lasting more than 3 months despite medical therapy. Many factors are involved in the pathogenesis of this disease and include a primary insult with a virus followed bybacterial infection and mucosal inflammation, along with predisposition to allergies. The standard treatment of pediatricacute bacterial rhinosinusitis (ABRS) is nasal irrigation and antibiotic use. Medical treatment of pediatric CRS includes avoidance of allergens in allergic patients (environmental or food) and therapy with nasal irrigation, nasal corticosteroids sprays, nasal decongestants, and antibiotics directed at the most common sinonasalorganisms (Haemophilusinfluenzae, Streptococcus pneumoniae, and Moraxella catarrhalis). Surgical therapy is rarely needed after appropriate medical therapy. Referral to an otolaryngologist and allergy specialist is recommended in case of failure of medical treatment.

  11. The Challenges Faced by Eastern European Students within a 16-19 Education Setting in the United Kingdom

    ERIC Educational Resources Information Center

    Babalola, Shade

    2015-01-01

    To examine the challenges encountered by Eastern European students within a sixth form college in the United Kingdom. This paper aims to consider the difficulties encountered by this particular ethnic group examining the impact the challenges may have on their performance, success and achievement. This paper will also highlight equality and…

  12. Challenges Students' Face in Their Transition from Primary to Secondary School and the Interventions Schools Take to Ease the Transition

    ERIC Educational Resources Information Center

    Tarekegne, Wudu Melese

    2015-01-01

    This study explores the major challenges that affect students' enrollment and participation and the key measures schools take to mitigate the challenge and help students continue their education. The data were collected from 23 secondary school grade nine students in Amahara Regional State in Ethiopia using the structured questionnaires from…

  13. Emergent Teacher-Researchers: A Reflection on the Challenges Faced when Conducting Research in the English Classroom

    ERIC Educational Resources Information Center

    Blakemore, Helen

    2012-01-01

    The following narrative reflects on the dilemmas and problems faced by inexperienced researchers working within the field of education. Focusing on a research project completed in fulfilment of an MA in Teaching and Learning, the article recounts the decisions made by one emergent researcher and evaluates how far the chosen methods may have helped…

  14. Pediatric MS

    MedlinePlus

    ... with Others on MSconnection.org Join a Local Support Group Ask an MS Navigator Edward M. Dowd Personal ... navigate the school system through the Pediatric MS Support Group . Treating pediatric MS Studies have shown that the ...

  15. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge.

    PubMed

    Rodriguez-Galindo, Carlos; Friedrich, Paola; Alcasabas, Patricia; Antillon, Federico; Banavali, Shripad; Castillo, Luis; Israels, Trijn; Jeha, Sima; Harif, Mhammed; Sullivan, Michael J; Quah, Thuan Chong; Patte, Catherine; Pui, Ching-Hon; Barr, Ronald; Gross, Thomas

    2015-09-20

    Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported.

  16. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge

    PubMed Central

    Rodriguez-Galindo, Carlos; Friedrich, Paola; Alcasabas, Patricia; Antillon, Federico; Banavali, Shripad; Castillo, Luis; Israels, Trijn; Jeha, Sima; Harif, Mhammed; Sullivan, Michael J.; Quah, Thuan Chong; Patte, Catherine; Pui, Ching-Hon; Barr, Ronald; Gross, Thomas

    2015-01-01

    Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported. PMID:26304881

  17. Comprehensive training for the future pediatric cardiologist

    PubMed Central

    Subramanyan, Raghavan

    2016-01-01

    India faces a huge burden of pediatric and adult congenital heart diseases (CHDs). Many acquired valvar, myocardial, and vascular diseases also need treatment in childhood and adolescence. The emergence of pediatric cardiology as an independent specialty has been a relatively recent development. A few centers of excellence in pediatric cardiology have developed. However, the requirement of pediatric cardiac care and pediatric cardiologists is far in excess of what is available. There are no guidelines at present in India for uniform training in pediatric cardiology. Many training programs are nonstructured and do not focus on the regional needs. Both core training and advanced training programs are essential to provide adequate numbers of community-level pediatric cardiologists and academic leaders respectively. This article proposes a detailed plan and curriculum for comprehensive training of future pediatric cardiologists in India. PMID:27011684

  18. Pediatric ventricular assist devices

    PubMed Central

    Burki, Sarah; Zafar, Farhan; Morales, David Luis Simon

    2015-01-01

    The domain of pediatric ventricular assist device (VAD) has recently gained considerable attention. Despite the fact that, historically, the practice of pediatric mechanical circulatory support (MCS) has lagged behind that of adult patients, this gap between the two groups is narrowing. Currently, the Berlin EXCOR VAD is the only pediatric-specific durable VAD approved by the U.S Food and Drug Administration (FDA). The prospective Berlin Heart trial demonstrated a successful outcome, either bridge to transplantation (BTT), or in rare instances, bridge to recovery, in approximately 90% of children. Also noted during the trial was, however, a high incidence of adverse events such as embolic stroke, bleeding and infection. This has incentivized some pediatric centers to utilize adult implantable continuous-flow devices, for instance the HeartMate II and HeartWare HVAD, in children. As a result of this paradigm shift, the outlook of pediatric VAD support has dramatically changed: Treatment options previously unavailable to children, including outpatient management and even destination therapy, have now been becoming a reality. The sustained demand for continued device miniaturization and technological refinements is anticipated to extend the range of options available to children—HeartMate 3 and HeartWare MVAD are two examples of next generation VADs with potential pediatric application, both of which are presently undergoing clinical trials. A pediatric-specific continuous-flow device is also on the horizon: the redesigned Infant Jarvik VAD (Jarvik 2015) is undergoing pre-clinical testing, with a randomized clinical trial anticipated to follow thereafter. The era of pediatric VADs has begun. In this article, we discuss several important aspects of contemporary VAD therapy, with a particular focus on challenges unique to the pediatric population. PMID:26793341

  19. Pediatric Injury

    MedlinePlus

    ... Control and Prevention’s Safe Child website . What is pediatric critical care? Children who have severe or life-threatening injuries ... are staffed by physicians with specialized training in pediatric critical care medicine ("pediatric intensivists"). Because children can experience a ...

  20. Pediatric Mortality in a Rural Tertiary Care Center in Liberia

    PubMed Central

    Tsai, Carmelle; Walters, Camila B.; Sampson, John; Kateh, Francis; Chang, Mary P.

    2017-01-01

    Liberia is a low-income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post-war and pre-Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post-war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0%) of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post-war, and lower than that reported immediately post-war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes. PMID:28146099

  1. Acquisition Workforce Strategy: The Challenge Department of Defense (DoD) Faces to Improve its Acquisition Workforce

    DTIC Science & Technology

    2011-12-01

    Rebalance the department’s programs and enhance capabilities to fight the wars we are in today and the scenarios we are most likely to face in the... Layton , 2007). While DoD is years beyond the $400.00 11 hammer issue, performance-based services contracts have become the latest topic of...current acquisition problems are not new. Evelyn Layton noted in The Defense Acquisition University: Training Professionals for the Acquisition

  2. Moral Dilemmas in Pediatric Orthopedics.

    PubMed

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result.

  3. Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research.

    PubMed

    Tuthill, Emily L; Chan, Jessica; Butler, Lisa M

    2015-01-01

    Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.

  4. Proceedings of a USGS Workshop on Facing Tomorrow's Challenges Along the U.S.-Mexico Border - Monitoring, Modeling, and Forecasting Change Within the Arizona-Sonora Transboundary Watersheds

    USGS Publications Warehouse

    Norman, Laura M.; Hirsch, Derrick D.; Ward, A. Wesley

    2008-01-01

    INTRODUCTION TO THE WORKSHOP PROCEEDINGS Competition for water resources, habitats, and urban areas in the Borderlands has become an international concern. In the United States, Department of Interior Bureaus, Native American Tribes, and other State and Federal partners rely on the U.S. Geological Survey (USGS) to provide unbiased science and leadership in the Borderlands region. Consequently, the USGS hosted a workshop, ?Facing Tomorrow?s Challenges along the U.S.-Mexico Border,? on March 20?22, 2007, in Tucson, Ariz., focused specifically on monitoring, modeling, and forecasting change within the Arizona-Sonora Transboundary Watersheds

  5. Coast Guard: Observations on Progress Made and Challenges Faced in Developing and Implementing a Common Operational Picture

    DTIC Science & Technology

    2013-07-31

    Geographic Information System (EGIS), a tool for viewing COP information that did not meet user needs. The challenges Coast Guard...oriented Geographic Information System (GIS) displays that are linked to information sources.2 COP-related systems include systems that can be used...Coast Guard geographic information system used to view and manage information about geographic places, analyze spatial relationships, and

  6. Facing the Challenge--Developing an Instructional Plan for Portuguese as Foreign Language in Brazil Based on Multiliteracy

    ERIC Educational Resources Information Center

    Schlindwein, Ana Flora

    2013-01-01

    Adopting the multiliteracy concept and embracing the challenge of developing meaningful and captivating classes for Portuguese as Foreign Language in Brazil, this paper proposes an approach which includes the use of different technologies to learn and teach Portuguese, the reading of graphic novel adaptations of Brazilian literature classics and…

  7. Challenges Pre-School Teachers Face in the Implementation of the Early Childhood Curriculum in the Cape Coast Metropolis

    ERIC Educational Resources Information Center

    Ntumi, Simon

    2016-01-01

    The study examined the challenges that pre-school teachers encounter in the implementation of the early childhood curriculum; exploring teaching methods employed by pre-schools teachers in the Cape Coast Metropolis. The study employed descriptive survey as the research design. A convenient sample of 62 pre-school teachers were selected from a…

  8. Learning to Teach English Language in the Practicum: What Challenges do Non-Native ESL Student Teachers Face?

    ERIC Educational Resources Information Center

    Gan, Zhengdong

    2013-01-01

    This study investigates the challenges sixteen non-native preservice ESL teachers in a Bachelor of Education (English Language) (BEdEL) programme from Hong Kong experienced in an eight-week teaching practicum. Qualitative data from semi-structured interviews and reflective journals were collected from all 16 participants to obtain a detailed…

  9. STEM Is Elementary: Challenges Faced by Elementary Teachers in the Era of the Next Generation Science Standards

    ERIC Educational Resources Information Center

    Isabelle, Aaron D.

    2017-01-01

    For students to achieve the goals of the Next Generation Science Standards (NGSS) by Grade 12, thinking and acting like scientists and engineers must begin in the elementary grades. However, elementary teachers may find this challenging -because language arts and mathematics still dominate many classrooms--often at the expense of science. This…

  10. Only Two Hours? A Qualitative Study of the Challenges Parents Perceive in Restricting Child Television Time

    ERIC Educational Resources Information Center

    Evans, Cortney A.; Jordan, Amy B.; Horner, Jennifer

    2011-01-01

    This study examines parents' and children's reaction to the American Academy of Pediatrics recommendation to limit children's television (TV) viewing to 2 hours a day or less. To better understand the challenges faced by parents who would seek to adhere to the guidelines, we conducted qualitative small group interviews with 60 parent/child dyads…

  11. Reduction of head and face pain by challenging lateralization and basic emotions: a proposal for future assessment and rehabilitation strategies

    PubMed Central

    von Piekartz, Harry; Mohr, Gesche

    2014-01-01

    Chronic facial pain has many of the clinical characteristics found in other persistent musculoskeletal conditions, such as low back and cervical pain syndromes. Unique to this condition, however, is that painful facial movements may result in rigidity or altered ability to demonstrate mimicry, defined as the natural tendency to adopt the behavioral expressions of other persons involved in the interaction. Loss of ability to communicate through emotional expression can lead to impaired processing of emotions and ultimately social isolation. Diminished quality and quantity of facial expression is associated with chronic face pain, tempromandibular dysfunction, facial asymmetries, and neurological disorders. This report provides a framework for assessment of impaired emotional processing and associated somatosensory alterations. Principles for management for chronic facial pain should include graded motor imagery, in addition to standard treatments of manual therapy, exercise, and patient education. A case study is provided which illustrates these principles. PMID:24976745

  12. A prisoner's dilemma with asymmetrical payoffs: revealing the challenges faced by performing arts health and wellness practitioners.

    PubMed

    Shan, Gongbing; Visentin, Peter

    2010-03-01

    In a prisoner's dilemma, constructed narratives are used to demonstrate problems within individual rationality and decision-making. Performing artists can be seen as facing a type of prisoner's dilemma in their careers: they must practice repeated movements for long periods in order to improve, yet despite the short-term perception of gained artistic benefit, the long-term consequences may be playing-related musculoskeletal disorders and injury. To help avoid such an outcome, educators and health and wellness practitioners must function as negotiators, engaging in discussions of artistry as part of establishing credibility and encouraging behaviors that keep artists in efficient, healthy behaviors. By setting practice time limits that are considerate of the intensity of each specific task, performers can improve their performance on a daily basis and become more skilled at planning their future training.

  13. A web-based survey of the motivations and challenges faced by emerging researchers in the chiropractic profession

    PubMed Central

    de Luca, Katie; Tuchin, Peter; Bonello, Rod

    2015-01-01

    Objective To investigate the motivations, challenges and perceptions of the educational environment of emerging researchers in chiropractic. Methods A descriptive web-based survey of higher-degree chiropractic research students was performed between October and November 2013. The survey consisted of open and closed questions and the Dundee Ready Education Environment Measure. Results Twenty-two students currently enrolled in a higher-degree research program participated. Students were most commonly enrolled in a doctor of philosophy program at a part-time rate. Motivations of research were desire to improve the clinical care aspects of chiropractic for the public and belief that chiropractic research is lacking. The greatest challenges were the negative attitudes towards chiropractic, finding enough time to do everything required, and feelings of isolation. The higher-degree research educational environment was perceived to be more positive than negative, with the stimulating nature of research a positive feature. A negative feature of the educational environment was poor undergraduate preparation for higher-degree research. Conclusion This study is the first study to describe higher-degree chiropractic research students. Primary motivations included building research, while challenges included not only negative attitudes toward the chiropractic profession but also negative attitudes toward researchers from within the profession. The higher-degree research educational environment was perceived to be positive. By acknowledging the issues that surround emerging researchers in chiropractic, the profession is better placed to foster academics and build research capacity. PMID:26090697

  14. Phenotypic plasticity in the common garden snail: big guts and heavier mucus glands compete in snails faced with the dual challenge of poor diet and coarse substrate.

    PubMed

    Munn, Adam J; Treloar, Marguerite

    2016-12-26

    Phenotypic plasticity allows animals to manage environmental challenges. Studies aimed at quantifying plasticity often focus on one challenge, such as diet, and one organ system, such the gastrointestinal tract, but this approach may not adequately reflect how plasticity could buffer multiple challenges. Thus, we investigated the outcomes of a dual challenge experiment that fed land snails either a high-fibre (low quality) or a low-fibre (high quality) diet, and simultaneously exercised them daily over 1.2 m on either a smooth surface of polyvinyl chloride (PVC) or a rough sandpaper. By the end of 20 days, snails fed the poor quality diet had a longer crop and oesophagus and a heavier intestine and rectum than those offered a low-fibre diet. Additionally, high-fibre fed snails had a smaller spermoviduct and oviduct. When also exercised on sandpaper, high-fibre fed snails had a smaller digestive gland, a main energy store, than those exercised on PVC. All snails exercised on sandpaper had a heavier pedal mucus gland, used a loping gait and used less mucus than those on PVC plastic, but there was no difference in the average speed of snails on either surface, supporting the conclusion that loping is a mucus conserving gait. Notably, snails faced with both a diet and substrate challenge had a smaller kidney, which could directly effect fecundity. This demonstrates that our dual challenge approach has potential for evaluating the costs and limits of the plasticity necessary to fully appreciate the evolutionary significance of plasticity in snails and other species.

  15. Challenge theme 6: Natural hazard risks in the Borderlands: Chapter 8 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Page, William R.; Parcher, Jean W.; Stefanov, Jim

    2013-01-01

    Natural hazards such as earthquakes, landslides and debris flows, wildfires, hurricanes, and intense storm-induced flash floods threaten communities to varying degrees all along the United States–Mexican border. The U.S. Geological Survey (USGS) collaborates with Federal, State, and local agencies to minimize the effects of natural hazards by providing timely, unbiased science information to emergency response officials, resource managers, and the public to help reduce property damage, injury, and loss of life. The USGS often mobilizes response efforts during and after a natural hazard event to provide technical and scientific counsel on recovery and response, and it has a long history of deploying emergency response teams to major disasters in both domestic and international locations. This chapter describes the challenges of natural hazards in the United States–Mexican border region and the capabilities of the USGS in the fields of hazard research, monitoring, and assessment, as well as preventative mitigation and post-disaster response.

  16. Pediatric Sepsis.

    PubMed

    Prusakowski, Melanie K; Chen, Audrey P

    2017-02-01

    Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management. Recognition of pediatric sepsis is complicated by the various pediatric-specific comorbidities that contribute to its mortality and the age- and development-specific vital sign and clinical parameters that obscure its recognition. This article outlines the clinical presentation and management of sepsis in neonates, infants, and children, and highlights some key populations who require specialized care.

  17. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany.

    PubMed

    Ständer, Sonja; Pogatzki-Zahn, Esther; Stumpf, Astrid; Fritz, Fleur; Pfleiderer, Bettina; Ritzkat, Anika; Bruland, Philipp; Lotts, Tobias; Müller-Tidow, Carsten; Heuft, Gereon; Pavenstädt, Hermann-Joseph; Schneider, Gudrun; Van Aken, Hugo; Heindel, Walter; Wiendl, Heinz; Dugas, Martin; Luger, Thomas A

    2015-03-01

    The complex nature and difficult-to-establish aetiology of chronic pruritus (CP) makes it challenging to provide medical care for patients with CP. This challenge can only be met with a multidisciplinary approach. The first multidisciplinary Itch Centre in Germany was established at the University of Münster in 2002 to meet the needs of this patient population. More than 2,500 outpatients and 400 inpatients are diagnosed and receive treatment each year. To ensure evidence-based medical care, an electronic system for medical documentation and patient-reported outcomes was established. Automated data transfer to a research database enables comprehensive data analysis. Our translational research has characterized peripheral and central itch mechanisms, provided novel clustering of CP patients, and identified novel target-specific therapies (e.g. neurokinin 1 receptor-antagonist). The multidisciplinary approach, combined with basic, clinical and translational research, enables comprehensive medical care of patients as well as implementation of high-quality experimental and clinical studies.

  18. The Borderlands and climate change: Chapter 10 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Fitzpatrick, Joan; Gray, Floyd; Dubiel, Russell; Langman, Jeff; Moring, J. Bruce; Norman, Laura M.; Page, William R.; Parcher, Jean W.

    2013-01-01

    The prediction of global climate change in response to both natural forces and human activity is one of the defining issues of our times. The unprecedented observational capacity of modern earth-orbiting satellites coupled with the development of robust computational representations (models) of the Earth’s weather and climate systems afford us the opportunity to observe and investigate how these systems work now, how they have worked in the past, and how they will work in the future when forced in specific ways. In the most recent report on global climate change by the Intergovernmental Panel on Climate Change (IPCC; Solomon and others, 2007), analyses using multiple climate models support recent observations that the Earth’s climate is changing in response to a combination of natural and human-induced causes. These changes will be significant in the United States–Mexican border region, where the process of climate change affects all of the Borderlands challenge themes discussed in the preceding chapters. The dual possibilities of both significantly-changed climate and increasing variability in climate make it challenging to take full measure of the potential effects because the Borderlands already experience a high degree of interannual variability and climatological extremes.

  19. Challenge theme 7: Information support for management of border security and environmental protection: Chapter 9 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

    USGS Publications Warehouse

    Parcher, Jean W.; Page, William R.

    2013-01-01

    Historically, international borders were located far from the major political and economic capitals of their countries and rarely received adequate planning or infrastructure development. Today, as a result of global economics and increased movement of goods between nations, border regions play a much greater role in commerce, tourism, and transportation. For example, Mexico is the second largest destination for United States exports (Woodrow Wilson Center Mexico Institute, 2009). The rapid population and economic growth along the United States–Mexican border, undocumented human border crossings, and the unique natural diversity of resources in the Borderlands present challenges for border security and environmental protection. Assessing risks and implementing sustainable growth policies to protect the environment and quality of life greatly increase in complexity when the issues cross an international border, where social services, environmental regulations, lifestyles, and cultural beliefs are unique for each country. Shared airsheds, water and biological resources, national security issues, and disaster management needs require an integrated binational approach to assess risks and develop binational management strategies.

  20. Development of a pediatric palliative care team.

    PubMed

    Ward-Smith, Peggy; Linn, Jill Burris; Korphage, Rebecca M; Christenson, Kathy; Hutto, C J; Hubble, Christopher L

    2007-01-01

    The American Academy of Pediatrics has provided clinical recommendations for palliative care needs of children. This article outlines the steps involved in implementing a pediatric palliative care program in a Midwest pediatric magnet health care facility. The development of a Pediatric Advanced Comfort Care Team was supported by hospital administration and funded through grants. Challenges included the development of collaborative relationships with health care professionals from specialty areas. Pediatric Advanced Comfort Care Team services, available from the time of diagnosis, are provided by a multidisciplinary team of health care professionals and individualized on the basis of needs expressed by each child and his or her family.

  1. Challenger

    ERIC Educational Resources Information Center

    Allday, Jonathan

    2002-01-01

    The events that led to the spectacular destruction of the Space Shuttle "Challenger" in 1986 are detailed here. They show how NASA should have heeded engineers' worries over materials problems resulting from a launch in cold weather. Suggestions are made of how pupils could also learn from this tragedy. (Contains 4 figures and 2 footnotes.)

  2. Past, Present, and Future of Informed Consent in Pain and Genomics Research: Challenges Facing Global Medical Community.

    PubMed

    Compagnone, Christian; Schatman, Michael E; Rauck, Richard L; Van Zundert, Jan; Kraus, Monika; Primorac, Dragan; Williams, Frances; Allegri, Massimo; Saccani Jordi, Gloria; Fanelli, Guido

    2017-01-01

    In recent decades, there has been a revision of the role of institutional review boards with the intention of protecting human subjects from harm and exploitation in research. Informed consent aims to protect the subject by explaining all of the benefits and risks associated with a specific research project. To date, there has not been a review published analyzing issues of informed consent in research in the field of genetic/Omics in subjects with chronic pain, and the current review aims to fill that gap in the ethical aspects of such investigation. Despite the extensive discussion on ethical challenges unique to the field of genetic/Omics, this is the first attempt at addressing ethical challenges regarding Informed Consent Forms for pain research as the primary focus. We see this contribution as an important one, for while ethical issues are too often ignored in pain research in general, the numerous arising ethical issues that are unique to pain genetic/Omics suggest that researchers in the field need to pay even greater attention to the rights of subjects/patients. This article presents the work of the Ethic Committee of the Pain-Omics Group (www.painomics.eu), a consortium of 11 centers that is running the Pain-Omics project funded by the European Community in the 7th Framework Program theme (HEALTH.2013.2.2.1-5-Understanding and controlling pain). The Ethic Committee is composed of 1 member of each group of the consortium as well as key opinion leaders in the field of ethics and pain more generally.

  3. Beyond mean-field dynamics of ultra-cold bosonic atoms in higher dimensions: facing the challenges with a multi-configurational approach

    NASA Astrophysics Data System (ADS)

    Bolsinger, V. J.; Krönke, S.; Schmelcher, P.

    2017-02-01

    Exploring the impact of dimensionality on the quantum dynamics of interacting bosons in traps including particle correlations is an interesting but challenging task. Due to the different participating length scales, the modelling of the short-range interactions in three dimensions plays a special role. We review different approaches for the latter and elaborate that for multi-configurational computational strategies, finite-range potentials are adequate resulting in the need for large grids to resolve the relevant length scales. This results in computational challenges, which include the exponential scaling of complexity with the number of atoms. We show that the recently developed ab initio multi-layer multi-configurational time-dependent Hartee method for bosons (ML-MCTDHB) (2013 J. Chem. Phys. 139 134103) can face both numerical challenges and present an efficient numerical implementation of ML-MCTDHB in three spatial dimensions, particularly suited to describe the quantum dynamics for elongated traps. The beneficial scaling of our approach is demonstrated by studying the tunnelling dynamics of bosonic ensembles in a double well. Comparing three-dimensional with quasi-one dimensional simulations, we find dimensionality-induced effects in the density. Furthermore, we study the crossover from weak transversal confinement, where a mean-field description of the system is sufficient, towards tight transversal confinement, where particle correlations and beyond mean-field effects are pronounced.

  4. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  5. Pediatric considerations in homecare.

    PubMed

    Petit de Mange, E A

    1998-09-01

    "If I had known beforehand how difficult, demanding, time consuming, and exhausting it would be--having my child home on a ventilator--I would never have agreed to bring her home" (personal communication with a parent, 1994). This mother's statement strikes at the heart of pediatric high-tech homecare. Parents assume caregiver roles that professional health providers have taken years to develop. Nurses, as strangers, intrude into intimate family relationships that have cultivated over years. Pioneering agencies attempt to fill a gap in pediatric care using guidelines that have been entrenched in the medical and economic models for years. The multiple dimensions of high-tech pediatric homecare require more than provision of technical nursing services. In homecare, nurses are challenged by cultural differences, language barriers, loss of control, family dynamics, practicing in unfamiliar environments, and new technology. To ensure quality nursing care, all professional dimensions need to be considered to be of equal importance.

  6. van der Waals density functionals built upon the electron-gas tradition: Facing the challenge of competing interactions

    SciTech Connect

    Berland, Kristian; Arter, Calvin A.; Thonhauser, T.; Cooper, Valentino R.; Lee, Kyuho; Lundqvist, Bengt I.; Schröder, Elsebeth; Hyldgaard, Per

    2014-05-14

    The theoretical description of sparse matter attracts much interest, in particular for those ground-state properties that can be described by density functional theory. One proposed approach, the van der Waals density functional (vdW-DF) method, rests on strong physical foundations and offers simple yet accurate and robust functionals. A very recent functional within this method called vdW-DF-cx [K. Berland and P. Hyldgaard, Phys. Rev. B 89, 035412 (2014)] stands out in its attempt to use an exchange energy derived from the same plasmon-based theory from which the nonlocal correlation energy was derived. Encouraged by its good performance for solids, layered materials, and aromatic molecules, we apply it to several systems that are characterized by competing interactions. These include the ferroelectric response in PbTiO{sub 3}, the adsorption of small molecules within metal-organic frameworks, the graphite/diamond phase transition, and the adsorption of an aromatic-molecule on the Ag(111) surface. Our results indicate that vdW-DF-cx is overall well suited to tackle these challenging systems. In addition to being a competitive density functional for sparse matter, the vdW-DF-cx construction presents a more robust general-purpose functional that could be applied to a range of materials problems with a variety of competing interactions.

  7. van der Waals density functionals built upon the electron-gas tradition: Facing the challenge of competing interactions

    SciTech Connect

    Berland, Kristian; Arter, Calvin A; Cooper, Valentino R; Lee, Dr. Kyuho; Lundqvist, Prof. Bengt I.; Schroder, Prof. Elsebeth; Thonhauser, Prof. Timo; Hyldgaard, Per

    2014-01-01

    The theoretical description of sparse matter attracts much interest, in particular for those groundstate properties that can be described by density functional theory (DFT). One proposed approach, the van der Waals density functional (vdW-DF) method, rests on strong physical foundations and offers simple yet accurate and robust functionals. A very recent functional within this method called vdW-DF-cx [K. Berland and P. Hyldgaard, Phys. Rev. B, in print] stands out in its attempt to use an exchange energy derived from the same plasmon-based theory from which the nonlocal correlation energy was derived. Encouraged by its good performance for solids, layered materials, and aromatic molecules, we apply it to several systems that are characterized by competing interactions. These include the ferroelectric response in PbTiO3, the adsorption of small molecules within metal-organic frameworks (MOFs), the graphite/diamond phase transition, and the adsorption of an aromaticmolecule on the Ag(111) surface. Our results indicate that vdW-DF-cx is overall well suited to tackle these challenging systems. In addition to being a competitive density functional for sparse matter, the vdW-DF-cx construction presents a more robust general purpose functional that could be applied to a range of materials problems with a variety of competing interactions.

  8. [Team work and interdiciplinarity: challenges facing the implementation of comprehensive outpatient care for people with HIV/Aids in Pernambuco].

    PubMed

    Borges, Maria Jucineide Lopes; Sampaio, Aletheia Soares; Gurgel, Idê Gomes Dantas

    2012-01-01

    The complexity of providing healthcare to people with HIV/Aids requires investment in comprehensive action and care, constituting a challenge for the multidisciplinary work teams to build an interdisciplinary practice. This study sought to analyze comprehensive healthcare in the Specialized Assistance Services for HIV/Aids (SAE-HIV/Aids) in Recife, in the State of Pernambuco, starting with the process and organization of team work. This is a case study developed in three SAE-HIV/Aids units, based on a qualitative approach using different research techniques. The results show that SAE-HIV/Aids have complied with most of the Brazilian Health Ministry recommendations in terms of basic infrastructure, though none of them had a team of appropriate size. These services have shown signs of fragmentation and difficulty in establishing a systematic intersectorial and interdisciplinary practice, with failings in ensuring the reference and counter-reference flow. It was seen that there was little appreciation of the role of the manager as team leader. The need to perceive the user as a whole was identified, as well as for the team to work in a coordinated manner in order to ensure communicative and relational activities.

  9. [Social participation as a central strategy of community nutrition to face the challenges associated with the nutritional transition].

    PubMed

    Suárez-Herrera, José Carlos; O'Shanahan, José Joaquín Juan; Serra-Majem, Lluis

    2009-01-01

    In last decades modern societies are undergoing a rapid nutrition transition process that reinforces, at international level, the emergence of nutritional problems of contradictory nature, such as malnutrition and obesity. This represents a considerable challenge for contemporary Public Health leaders, who have been gradually developing a set of strategies which overwhelmingly adopt a population perspective. Nevertheless, the collective nature of these strategies could neglect the particular individual and family needs. We consider social participation as an approach to simultaneously reinforce both individual and population perspectives during the divers phases of development of Community Nutrition programs which tackle the paradoxical nature of this problematic. However in relation to some contextual factors, we find a growing trend to develop a more technocratic dimension of participatory practices, which distorts the emancipator and transformative potential of social participation. In order to avoid this tendency, we propose the use of the five intervention axes of the Ottawa Chart for Health Promotion as a guide for a systemic integration of social participation in planning, implementation and evaluation processes of Community Nutrition programs. We therefore take into account the integration of social participation in the efforts made in developing individual capacity-building, reinforcing collective action, creating enabling environments, health care reorganization, and finally, implementing nutritional and public health policies.

  10. Standards for Radiation Effects Testing: Ensuring Scientific Rigor in the Face of Budget Realities and Modern Device Challenges

    NASA Technical Reports Server (NTRS)

    Lauenstein, J M.

    2015-01-01

    An overview is presented of the space radiation environment and its effects on electrical, electronic, and electromechanical parts. Relevant test standards and guidelines are listed. Test standards and guidelines are necessary to ensure best practices, minimize and bound systematic and random errors, and to ensure comparable results from different testers and vendors. Test standards are by their nature static but exist in a dynamic environment of advancing technology and radiation effects research. New technologies, failure mechanisms, and advancement in our understanding of known failure mechanisms drive the revision or development of test standards. Changes to standards must be weighed against their impact on cost and existing part qualifications. There must be consensus on new best practices. The complexity of some new technologies exceeds the scope of existing test standards and may require development of a guideline specific to the technology. Examples are given to illuminate the value and limitations of key radiation test standards as well as the challenges in keeping these standards up to date.

  11. Pediatric ambulatory blood pressure monitoring: indications and interpretations.

    PubMed

    Flynn, Joseph T; Urbina, Elaine M

    2012-06-01

    The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

  12. Virtual Pediatric Hospital

    MedlinePlus

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  13. Challenges Facing Early Phase Trials Sponsored by the National Cancer Institute: An Analysis of Corrective Action Plans to Improve Accrual.

    PubMed

    Massett, Holly A; Mishkin, Grace; Rubinstein, Larry; Ivy, S Percy; Denicoff, Andrea; Godwin, Elizabeth; DiPiazza, Kate; Bolognese, Jennifer; Zwiebel, James A; Abrams, Jeffrey S

    2016-11-15

    Accruing patients in a timely manner represents a significant challenge to early phase cancer clinical trials. The NCI Cancer Therapy Evaluation Program analyzed 19 months of corrective action plans (CAP) received for slow-accruing phase I and II trials to identify slow accrual reasons, evaluate whether proposed corrective actions matched these reasons, and assess the CAP impact on trial accrual, duration, and likelihood of meeting primary scientific objectives. Of the 135 CAPs analyzed, 69 were for phase I trials and 66 for phase II trials. Primary reasons cited for slow accrual were safety/toxicity (phase I: 48%), design/protocol concerns (phase I: 42%, phase II: 33%), and eligibility criteria (phase I: 41%, phase II: 35%). The most commonly proposed corrective actions were adding institutions (phase I: 43%, phase II: 85%) and amending the trial to change eligibility or design (phase I: 55%, phase II: 44%). Only 40% of CAPs provided proposed corrective actions that matched the reasons given for slow accrual. Seventy percent of trials were closed to accrual at time of analysis (phase I = 48; phase II = 46). Of these, 67% of phase I and 70% of phase II trials met their primary objectives, but they were active three times longer than projected. Among closed trials, 24% had an accrual rate increase associated with a greater likelihood of meeting their primary scientific objectives. Ultimately, trials receiving CAPs saw improved accrual rates. Future trials may benefit from implementing CAPs early in trial life cycles, but it may be more beneficial to invest in earlier accrual planning. Clin Cancer Res; 22(22); 5408-16. ©2016 AACRSee related commentary by Mileham and Kim, p. 5397.

  14. Evaluation of the pain resource nurse role: a resource for improving pediatric pain management.

    PubMed

    McCleary, Lynn; Ellis, Jacqueline A; Rowley, Betty

    2004-03-01

    Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.

  15. Adalimumab in pediatric Crohn's disease.

    PubMed

    Patel, Ashish S; Suarez, Lisbet D; Rosh, Joel R

    2016-02-01

    Adalimumab, a human monoclonal antibody to tumor necrosis factor alpha (TNF-α), was initially approved for the treatment of moderate to severe rheumatoid arthritis in 2002. In the subsequent years, its anti-inflammatory properties were applied to the treatment of psoriatic arthritis, ankylosing spondylitis, adult Crohn's disease (CD), plaque psoriasis, polyarticular juvenile idiopathic arthritis, adult ulcerative colitis and most recently in 2014, pediatric CD. The biologic era in pediatric CD has changed and redefined the therapeutic approach to this challenging lifelong disease. This article summarizes the clinical legacy of adalimumab with a focus on its most recent expanded indication, pediatric CD.

  16. Pediatric critical care--a new frontier.

    PubMed

    Lin, Chu-Chuan; Hsieh, Kai-Sheng

    2009-10-01

    Pediatric intensive care is now a subspecialty of pediatric medicine. Different pathologic and physiologic processes occur in pediatric patients who require intensive care. Thus, the faculty and staffing requirement differ in many aspects from those of adult intensive care units (ICUs). In Taiwan, pediatric intensive care is relatively less developed than adult care. However, thanks to the implementation of national health insurance and increasing emphasis of children's health, the scope and quality of pediatric intensive care has widened and rapidly improved. Research has shown that full time in-ICU staffing and patient care will result in improved outcomes for critically ill pediatric patients. In this article, we review the literature and recent advances in pediatric intensive care; we also outline the challenges arising. Special emphasis was made to the clinical context of Taiwan.

  17. Pediatric imaging for the technologist

    SciTech Connect

    Sharko, G.; Wilmont, D.

    1987-01-01

    This book discusses the diagnostic techniques of radiology in pediatric patients. The topics discussed are: Computed tomography; radiography of skull, face, abdomen, skeleton; nuclear medicine; quality control of image processing and radiation doses of patients and standards of radiation protection of patients.

  18. Long-term immunogenicity of two pediatric doses of combined hepatitis A and B or monovalent hepatitis B vaccine in 8 to 10-year-old children and the effect of a challenge dose given seven years later.

    PubMed

    Gilca, Vladimir; Dionne, Marc; Boulianne, Nicole; Murphy, Donald; De Serres, Gaston

    2009-10-01

    A total of 465 children aged 8 to 10 years were vaccinated with 2 doses of Recombivax-HB 2.5 microg (RB) or Twinrix-Junior 10 microg/360 EL.U (TX), according to a 0 and 6 months schedule. Seven years postsecond dose, a challenge dose of vaccine was given. All vaccinees in the TX and 98% in the RB group showed an anamnestic response. Vaccination at the age of 8 to 10 years with two-pediatric doses of TX or RB given with a 6 months interval induces a long-lasting immunity in most vaccinees.

  19. Laser gingivectomy for pediatrics. A case report.

    PubMed

    Kelman, Michelle M; Poiman, David J; Jacobson, Barry L

    2009-01-01

    Traditional gingivectomy procedures have been a challenge for pediatric dentists who confront issues of patient cooperation and discomfort. Treatment of pediatric patients must involve minimal operative and postoperative discomfort. Laser soft-tissue surgery has been shown to be well accepted by children. For the pediatric patient, the greatest advantage of the laser is the lack of local anesthesia injection and the associated pre- and postoperative discomfort. The following case report describes a gingivectomy procedure performed on a 14-year-old female.

  20. Antibody-mediated rejection in pediatric kidney transplantation: pathophysiology, diagnosis, and management.

    PubMed

    Ng, Yolanda W; Singh, Manpreet; Sarwal, Minnie M

    2015-04-01

    Kidney transplant is the preferred treatment of pediatric end-stage renal disease. One of the most challenging aspects of pediatric kidney transplant is the prevention and treatment of antibody-mediated rejection (ABMR), which is one of the main causes of graft dysfunction and early graft loss. Most challenges are similar to those faced in adult kidney transplants; however, factors unique to the pediatric realm include naivety of the immune system and the small number of studies and randomized controlled trials available when considering pharmacological treatment options. Here, we present a case of ABMR in a pediatric patient and a review of the pathophysiology, diagnosis, and management of ABMR. ABMR in pediatric kidney transplant continues to be a frustrating condition to treat because (1) there still remain many unidentified potential antigens leading to ABMR, (2) children and adults are at different stages of their immune system development, and, thus, (3) the full pathophysiology of alloimmunity is still not completely understood, and (4) the efficacy and safety of treatment in adults may not be directly translated to children. As we continue to gain a better understanding towards the precise alloimmune mechanism that drives a particular ABMR, we can also improve pharmacotherapeutic choices. With continued research, they will become more precise in treating a particular mechanism versus using a broad scope of immunosuppression such as steroids. However, there is much more to be uncovered, such as identifying more non-human leukocyte antigens and their role in alloimmunity, determining the exact mechanism of adults achieving complete operational tolerance, and understanding the difference between pediatric and adult transplant recipients. Making strides towards a better understanding of these mechanisms will lead to continued efficacy and safety in treatment of pediatric ABMR.

  1. Pediatric Terminology

    Cancer.gov

    The National Institute of Child Health and Human Development (NICHD) is working with NCI Enterprise Vocabulary Services (EVS) to provide standardized terminology for coding pediatric clinical trials and other resea

  2. Pediatric Specialists

    MedlinePlus

    ... Family Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  3. Pediatric Anthropometry

    NASA Astrophysics Data System (ADS)

    Klinich, Kathleen D.; Reed, Matthew P.

    Anthropometry is the measurement of human size, shape, and physical capabilities. Most pediatric anthropometry data are gathered to describe child growth patterns, but data on body size, mass distribution, range of motion, and posture are used to develop crash test dummies and computational models of child occupants. Pediatric anthropometry data are also used to determine child restraint dimensions, so they will accommodate the applicable population of child occupants.

  4. Challenges in pediatric transplantation: the impact of chronic kidney disease and cardiovascular risk factors on long-term outcomes and recommended management strategies.

    PubMed

    Filler, Guido

    2011-02-01

    Barriers to successful outcomes following pediatric transplantation have shifted from ischemic reperfusion injury and rejection to more long-term complications. Of particular concern is the high prevalence of CKD owing to preexisting damage and nephrotoxicity, as well as other CV complications such as hypertension and cardiomyopathy. All of these contribute to graft loss and shortened life expectancy, thereby limiting the success story of solid-organ transplantation. Managing CKD and related CV morbidity should be integral to the care of pediatric transplant patients, and timely detection of any irregularities would increase the chances of restoring lost kidney function. GFR is still the widely accepted indicator of renal function, and nuclear medicine techniques are the gold standard measurement methods. These methods are limited by costs, radiation exposure and substrate injection, and current practice still uses the Schwartz estimate, despite its well-documented limitations. Newer endogenous markers of GFR, such as cystatin C clearance, give a more accurate measure of true GFR but have not been embraced in the management of pediatric transplant recipients. Furthermore, indirect markers (e.g., microalbuminuria and hypertension) could also aid early detection of renal damage. The effects of mainstay immunosuppressants on kidney and heart function are varied, with available data indicating favorable outcomes with tacrolimus compared with ciclosporin. There is a need for appropriately designed and powered randomized controlled trials to validate innovative concepts for tailored immunosuppression in the pediatric population. To date, very few studies have generated long-term data in pediatric renal transplant patients - results of 1-4-yr study favored tacrolimus over ciclosporin, but other immunosuppressive agents also need to be evaluated.

  5. RRR for NNN-a rapid research response for the Neglected Tropical Disease NGDO Network: a novel framework to challenges faced by the global programs targeting neglected tropical diseases.

    PubMed

    Toledo, Chelsea E; Jacobson, Julie; Wainwright, Emily C; Ottesen, Eric A; Lammie, Patrick J

    2016-03-01

    While global programs targeting the control or elimination of five of the neglected tropical diseases (NTDs)-lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis and trachoma-are well underway, they still face many operational challenges. Because of the urgency of 2020 program targets, the Bill & Melinda Gates Foundation and the U.S. Agency for International Development devised a novel rapid research response (RRR) framework to engage national programs, researchers, implementers and WHO in a Coalition for Operational Research on NTDs. After 2 years, this effort has succeeded as an important basis for the research response to programmatic challenges facing NTD programs.

  6. RRR for NNN—a rapid research response for the Neglected Tropical Disease NGDO Network: a novel framework to challenges faced by the global programs targeting neglected tropical diseases

    PubMed Central

    Toledo, Chelsea E.; Jacobson, Julie; Wainwright, Emily C.; Ottesen, Eric A.; Lammie, Patrick J.

    2016-01-01

    While global programs targeting the control or elimination of five of the neglected tropical diseases (NTDs)—lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis and trachoma—are well underway, they still face many operational challenges. Because of the urgency of 2020 program targets, the Bill & Melinda Gates Foundation and the U.S. Agency for International Development devised a novel rapid research response (RRR) framework to engage national programs, researchers, implementers and WHO in a Coalition for Operational Research on NTDs. After 2 years, this effort has succeeded as an important basis for the research response to programmatic challenges facing NTD programs. PMID:26940303

  7. Pediatric Mental Health Emergencies and Special Health Care Needs

    PubMed Central

    Chun, Thomas H.; Katz, Emily R.; Duffy, Susan J.

    2013-01-01

    SYNOPSIS Children with mental health problems are increasingly being evaluated and treated by both pediatric primary care and pediatric emergency physicians. This article focuses on the epidemiology, evaluation, and management of the two most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities. PMID:24093903

  8. Pediatric Glaucoma: Pharmacotherapeutic Options.

    PubMed

    Samant, Monica; Medsinge, Anagha; Nischal, Ken K

    2016-06-01

    Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

  9. Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

    PubMed Central

    Jason, Leonard A.; Barker, Kristen; Brown, Abigail

    2013-01-01

    Research on pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is reviewed in this article. Many recent articles in this area highlight the existence of key differences between the adult and pediatric forms of the illness. This review article provides an overview of pediatric ME/CFS, including epidemiology, diagnostic criteria, treatment, and prognosis. Challenges to the field are identified with the hope that in the future pediatric cases of ME/CFS can be more accurately diagnosed and successfully managed. PMID:24340168

  10. Educating residents in behavioral health care and collaboration: integrated clinical training of pediatric residents and psychology fellows.

    PubMed

    Pisani, Anthony R; leRoux, Pieter; Siegel, David M

    2011-02-01

    Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.

  11. Advances in pediatrics in 2014: current practices and challenges in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Cesari, Silvia; Sciorio, Elisa; Povesi-Dascola, Carlotta; Bernasconi, Sergio

    2015-10-31

    Major advances in the conduct of pediatric practice have been reported in the Italian Journal of Pediatrics in 2014. This review highlights developments in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses. Investigations endorse a need to better educate guardians and improve nutritional management in food allergy. Management of hyperbilirubinemia in neonates and of bronchiolitis have been improved by position statements of scientific societies. Novel treatments for infant colic and inflammatory bowel diseases have emerged. Studies suggest the diagnostic utility of ultrasonography in diagnosing community-acquired pneumonia. Progress in infectious diseases should include the universal varicella vaccination of children. Recommendations on asphyxia and respiratory distress syndrome have been highlighted in neonatology. Studies have evidenced that malnutrition remains a common underestimated problem in developing countries, while exposure to cancer risk factors in children is not negligible in Western countries. Advances in our understanding of less common diseases such as cystic fibrosis, plastic bronchitis, idiopathic pulmonary hemosiderosis facilitate diagnosis and management. Researches have led to new therapeutic approaches in patent ductus arteriosus and pediatric malignancies.

  12. MO-D-BRB-02: Pediatric Treatment Planning II: Applications of Proton Beams for Pediatric Treatment

    SciTech Connect

    Hua, C.

    2015-06-15

    Most Medical Physicists working in radiotherapy departments see few pediatric patients. This is because, fortunately, children get cancer at a rate nearly 100 times lower than adults. Children have not smoked, abused alcohol, or been exposed to environmental carcinogens for decades, and of course, have not fallen victim to the aging process. Children get very different cancers than adults. Breast or prostate cancers, typical in adults, are rarely seen in children but instead a variety of tumors occur in children that are rarely seen in adults; examples are germinomas, ependymomas and primitive neuroectodermal tumors, which require treatment of the child’s brain or neuroblastoma, requiring treatment in the abdomen. The treatment of children with cancer using radiation therapy is one of the most challenging planning and delivery problems facing the physicist. This is because bones, brain, breast tissue, and other organs are more sensitive to radiation in children than in adults. Because most therapy departments treat mostly adults, when the rare 8 year-old patient comes to the department for treatment, the physicist may not understand the clinical issues of his disease which drive the planning and delivery decisions. Additionally, children are more prone than adults to developing secondary cancers after radiation. For bilateral retinoblastoma for example, an irradiated child has a 40% chance of developing a second cancer by age 50. The dosimetric tradeoffs made during the planning process are complex and require careful consideration for children treated with radiotherapy. In the first presentation, an overview of childhood cancers and their corresponding treatment techniques will be given. These can be some of the most complex treatments that are delivered in the radiation therapy department. These cancers include leukemia treated with total body irradiation, medulloblastoma, treated with craniospinal irradiation plus a conformal boost to the posterior fossa

  13. Challenges Facing Amateur Athletics. Hearing before the Subcommittee on Commerce, Trade, and Consumer Protection of the Committee on Energy and Commerce. House of Representatives, One Hundred Seventh Congress, Second Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Committee on Energy and Commerce.

    This hearing examined challenges facing amateur athletics, focusing on several topics identified as relevant to the issue. Witnesses addressed the commercialization of collegiate sports and its impact. They also discussed how gambling affects amateur sports and looked at overall student athlete welfare. Testimony was presented by Michael Aguirre,…

  14. Developing Academic Literacy and Voice: Challenges Faced by a Mature ESL Student and Her Instructors (Desarrollo del discurso académico y la voz: retos de una estudiante de inglés como segunda lengua y sus profesores)

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

    Drawing on critical, socio-cultural and sociolinguistic theories of writing, text and voice, this ethnographic study examines the challenges that a mature ESL student and her instructors in a university course on Spanish Language Media face as they co-construct a common understanding of academic literacy and voice in an undergraduate General…

  15. To Grow or Not to Grow? A Post-Great Recession Synopsis of the Political, Financial, and Social Contract Challenges Facing the University of California. Research & Occasional Paper Series: CSHE.15.13

    ERIC Educational Resources Information Center

    Douglass, John Aubrey

    2013-01-01

    After more than two decades of state disinvestment, the University of California faces significant challenges and misunderstandings regarding its operating costs, its wide array of activities, and its mission. Reduced funding from the state for public higher education, including UC, has essentially severed the historic link between state…

  16. Testimony of Dr. Willard Sakiestewa Gilbert, President National Indian Education Association before the Education and Labor Subcommittee on Early Childhood, Elementary and Secondary Education on Challenges Facing Bureau of Indian Education Schools in Improving Student Achievement

    ERIC Educational Resources Information Center

    Gilbert, Willard Sakiestewa

    2008-01-01

    In this testimony, Dr. Willard Sakiestewa Gilbert talks on behalf of the National Indian Education Association with regard to the Bureau of Indian Education (BIE) and challenges facing BIE schools in improving student achievement. Founded in 1969, the National Indian Education Association (NIEA) is the largest organization in the nation dedicated…

  17. Pediatric Sarcomas.

    PubMed

    Williams, Regan F; Fernandez-Pineda, Israel; Gosain, Ankush

    2016-10-01

    Pediatric sarcomas are a heterogeneous group of tumors accounting for approximately 10% of childhood solid tumors. Treatment is focused on multimodality therapy, which has improved the prognosis over the past two decades. Current regimens focus on decreasing treatment for low-risk patients to decrease the long-term side effects while maximizing therapy for patients with metastatic disease to improve survival. Pediatric sarcomas can be divided into soft tissue sarcomas and osseous tumors. Soft tissue sarcomas are further delineated into rhabdomyosarcomas, which affect young children and nonrhabdomyosarcomas, which are most common in adolescents. The most common bone sarcomas are osteosarcomas and Ewing's sarcoma.

  18. Transitioning from pediatric care to adult care for adolescents with special health care needs: dentist perspectives (part 2)

    PubMed Central

    Bayarsaikhan, Zoljargal; Cruz, Stephanie; Neff, John; Chi, Donald L.

    2015-01-01

    Purpose To understand dental care transitions for adolescents with special health care needs (ASHCN) from the dentist perspective. Methods We conducted semi-structured interviews with 13 dentists (seven pediatric dentists and six general dentists) to learn about the dental transition process for ASHCN. Results Most dentists believed transitions from child-centered to adult-centered dental care were important for ASHCN. Dentists reported two main barriers to transitions: low dental reimbursements by Medicaid and a shortage of general dentists qualified or willing to treat ASHCN. Pediatric and general dentists reported playing complimentary roles in facilitating transitions for ASHCN and their families. Conclusions Dentists acknowledged the challenges that ASHCN and their families face in transitioning to adult-centered care and believed in the importance of ASHCN maintaining a dental home. Pediatric dentists and general dentists play a key role in working together to implement dental transition plans for the ASHCN and to ensure successful dental transitions. PMID:26531088

  19. Tropical pediatrics: 2002 to 2015.

    PubMed

    Santos Ocampo, Perla D; Santos Ocampo-Padilla, Cynthia

    2003-01-01

    It also presents the challenges that confront children in the tropics and their effects on the health of these children. These challenges include the technology divide, economic disparity, ecological changes, urbanization and industrialization, globalization, political instability, population explosion, and gender inequality. The paper paints a scenario of tropical pediatrics into the year 2015. Problems brought about by both underdevelopment and modernization, with urbanization and industrialization, will persist. Infectious diseases will continue to be the leading causes of deaths. The paper presents some significant achievements in the fight against tropical diseases and tries to predict what future progress will contribute to the alleviation of such diseases. The paper also outlines the commitment of the International Society of Tropical Pediatrics (ISTP) to improve the state of tropical pediatrics in the next 15 years.

  20. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy.

    PubMed

    Meschi, Tiziana; Ticinesi, Andrea; Prati, Beatrice; Montali, Arianna; Ventura, Antonio; Nouvenne, Antonio; Borghi, Loris

    2016-08-01

    Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continuity, effectiveness, safety and appropriateness of care are guaranteed by an innovative figure called "flow manager," with skilled clinical experience and managerial attitude, and by elaboration of an early personalized discharge plan anticipating every patient's needs according to lean methodology principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.

  1. Clinicians’ concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision‐making

    PubMed Central

    Caldon, Lisa J.M.; Collins, Karen A.; Reed, Malcolm W.; Sivell, Stephanie; Austoker, Joan; Clements, Alison M.; Patnick, Julietta; Elwyn, Glyn

    2011-01-01

    Abstract Background  There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. Objective  To examine specialist breast clinicians’ opinions about the provision of decision support interventions (DesIs) for patients. Methods  As part of the development of a web‐based DesI (BresDex), semi‐structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. Results  A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients’ needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. Conclusions  The concept of providing interventions to support patients in decision‐making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. PMID:21029281

  2. Humanitarian nursing challenges: a grounded theory study.

    PubMed

    Almonte, Angelica L C

    2009-05-01

    In response to the 2004 tsunami disaster in the Indian Ocean, the U.S. Navy deployed teams aboard the USNS Mercy to provide aid during Operation Unified Assistance (OUA). To date, few research studies have examined how Navy nurses prepared for and clinically performed during this relief operation. The current article describes the challenges faced by Navy nurses throughout OUA. A purposive convenience sample was recruited; 11 participated. Data were collected from interviews, observations, field notes, memos, and a demographic tool. Information was categorized, coded, compared to incoming data, then analyzed using Strauss and Corbin's open coding, axial coding, and selective coding methods. A theoretical model was developed to illustrate how participants experienced the mission. Key lessons learned were that most were unprepared for providing pediatric care, and saying "No" in delivering care. Recommendations include: deployment of advanced-practice nurses (specialists in pediatrics and well-mental health) and predeployment training on moral distress.

  3. Myocarditis - pediatric

    MedlinePlus

    ... enable JavaScript. Pediatric myocarditis is inflammation of the heart muscle in an infant or young child. Causes Myocarditis is rare in ... the infection. This can lead to symptoms of heart failure. ... to detect. However, in newborns and infants, symptoms may sometimes appear suddenly. Symptoms may include: ...

  4. Pediatric ultrasonography

    SciTech Connect

    Hayden, C.K. Jr.; Swischuk, L.E.

    1987-01-01

    Two leading experts explore the benefits and limitations of pediatric ultrasonography, explaining the latest techniques for optimal imaging of specific body regions: the head, chest, abdomen, pelvis, extremities, and soft tissues. Numerous illustrations emphasize significant points and combine with the text to show specifically what to look for when imaging children.

  5. Pediatric Dermatology

    PubMed Central

    McMahon, Patrick

    2017-01-01

    Skin changes are common in children. Common concerns are birthmarks (e.g., hemangiomas and port wine stains), atopic and contact dermatitis, acne, and alopecia areata. The authors review advances in common and not so common skin changes in pediatric patients. PMID:28360970

  6. Pediatric Sinusitis

    MedlinePlus

    ... Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to ...

  7. Scientific, economic, regulatory, and ethical challenges of bringing science-based pediatric nutrition products to the U.S. market and ensuring their availability for patients.

    PubMed

    Merritt, Russell J; Goldsmith, Arthur H

    2014-11-01

    Many nutrition products and related drugs are unavailable or not consistently available to clinicians despite a body of clinical data and experience supporting their use. Many of these can be related to drug shortages that have increased since 2009. In addition, there are potentially useful products that are not approved for a specific use or are no longer being manufactured. This review broadly examines the product availability gap from the perspectives of a clinician/former nutrition industry medical director and an economist. The process of pediatric nutrition product and related drug innovation, as well as its drivers and the steps involved in bringing a product to market, is first described. This is followed by an assessment of factors influencing product availability beyond the innovation process, including regulatory issues, manufacturing compliance, purchasing practices, and other factors related to drug and nutrition product pricing and reimbursement. Three pediatric case examples are reviewed and placed in the context of the prior review. Last, recent and future possible steps toward closing the product availability gap are discussed.

  8. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  9. Children's (Pediatric) Nuclear Medicine

    MedlinePlus Videos and Cool Tools

    ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  10. Facing the Challenges of Accessing, Managing, and Integrating Large Observational Datasets in Ecology: Enabling and Enriching the Use of NEON's Observational Data

    NASA Astrophysics Data System (ADS)

    Thibault, K. M.

    2013-12-01

    of tasks that previously required hours to days of each data user's time, with decreased error rates and increased useability of the data. The Ecological Data wiki (ecologicaldata.org) provides a forum for users of ecological datasets to share relevant metadata and tips and tricks for using the data, in order to flatten learning curves, as well as minimize redundancy of efforts among users of the same datasets. Finally, Software Carpentry (software-carpentry.org) has developed curricula for scientific computing and provides both online training and low cost, short courses that can be tailored to the specific needs of the students. Demand for these courses has been increasing exponentially in recent years, and represent a significant educational resource for biologists. I will conclude by linking these initiatives to the challenges facing ecologists related to the effective and efficient exploitation of NEON's diverse data streams.

  11. Pediatric tracheostomy.

    PubMed

    Campisi, Paolo; Forte, Vito

    2016-06-01

    Tracheotomy refers to a surgical incision made into a trachea. Tracheostomy, on the other hand, refers to a surgical procedure whereby the tracheal lumen is positioned in close proximity to the skin surface. Tracheostomy is an uncommon procedure in the pediatric population. When required tracheostomy is typically performed as an open surgical procedure under general anesthesia with the patient intubated. However, it may need to be performed under local anesthesia or over a rigid bronchoscope in the patient with a precarious airway. Over the past half century, the primary indication for pediatric tracheostomy has shifted from acute infectious airway compromise to the need for prolonged ventilatory support in neurologically compromised children. The surgical technique, choice of tracheostomy tube, and post-operative care requires a nuanced approach in infants and young children. This article will review these topics in a comprehensive fashion.

  12. Pediatric parasomnias.

    PubMed

    Mason, Thornton B A; Pack, Allan I

    2007-02-01

    Parasomnias in childhood are common, and often more frequent than in adults. The large number of parasomnias underscore that sleep is not simply a quiescent state, but can involve complex episodes of movement, ranging from subtle to dramatic and complex. Clinicians should be aware that many pediatric parasomnias are benign, self-limited, and may not persist into late childhood or adolescence. Importantly, parasomnias in childhood often differ in type from adults. Nevertheless, parasomnias across ages can be classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM sleep; and 3) other parasomnias. We detail here issues in the clinical diagosis, evaluation, and management of multiple pediatric parasomnias. The further study of parasomnias in children may help elucidate the multi-factorial etiologies of these fascinating conditions, shedding light on the potential genetic bases as well as environmental contributions.

  13. Procedural pediatric dermatology.

    PubMed

    Metz, Brandie J

    2013-04-01

    Due to many factors, including parental anxiety, a child's inability to understand the necessity of a procedure and a child's unwillingness to cooperate, it can be much more challenging to perform dermatologic procedures in children. This article reviews pre-procedural preparation of patients and parents, techniques for minimizing injection-related pain and optimal timing of surgical intervention. The risks and benefits of general anesthesia in the setting of pediatric dermatologic procedures are discussed. Additionally, the surgical approach to a few specific types of birthmarks is addressed.

  14. Pediatric stridor.

    PubMed

    Ida, Jonathan B; Thompson, Dana Mara

    2014-10-01

    Pediatric stridor is an important symptom of upper airway obstruction, and must be recognized early by evaluating physicians. Proper evaluation and management, both acutely and chronically, can provide improved outcomes and better quality of life for patients. This article discusses the physiology of stridor and its intimate relation to airway anatomy, the work-up of the stridorous child, and recent advances in treatment, and provides illustrative examples of common lesions.

  15. Pediatric nutrition.

    PubMed

    Greco, Deborah S

    2014-03-01

    This article discusses pediatric nutrition in puppies and kittens. Supplementation of basic nutrients such as fat, protein, minerals, vitamins, and essential fatty acids of the bitch is essential for the proper growth and development of puppies during the lactation period. Milk replacers are compared for use in puppies and kittens. Supplements such as colostrum and probiotics for promotion of a healthy immune system and prevention or treatment of stress-induced and weaning diarrhea are also discussed.

  16. Pediatric Virology

    PubMed Central

    Portnoy, Bernard

    1965-01-01

    Pediatric virology is not an isolàted discipline. Rather, the syndromes associated with viral infection are modified by the unique characteristics of infancy and childhood. Fortunately for the pediatrician, and certainly for children, viral infections in childhood are rarely fatal, and are almost never serious. Future efforts of the pediatrician and virologist should be directed toward increased fetal salvage as with rubella and the prevention of severe, viral lower respiratory tract disease. PMID:14298871

  17. Pediatric sialendoscopy.

    PubMed

    Bruch, Jean M; Setlur, Jennifer

    2012-01-01

    Sialendoscopy was introduced in the early 1990s as a minimally invasive alternative to standard methods for diagnosis and treatment of inflammatory and obstructive salivary gland disease. The technique was pioneered in adults; however, advances in instrumentation have allowed this to be adapted to the smaller salivary ductal anatomy found in the pediatric population. In this chapter, the technique of sialendoscopy for parotid and submandibular glands is described.

  18. Pediatric Interventional Radiology: Vascular Interventions.

    PubMed

    Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

    2016-07-01

    Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.

  19. Transition from Hospital to Home Following Pediatric Solid Organ Transplant: Qualitative Findings of Parent Experience

    PubMed Central

    Lerret, Stacee M.; Weiss, Marianne E; Stendahl, Gail; Chapman, Shelley; Neighbors, Katie; Amsden, Katie; Lokar, Joan; Voit, Ashley; Menendez, Jerome; Alonso, Estella M

    2014-01-01

    Transplant providers are challenged to determine appropriate interventions for patients and families due to limited published research regarding the context of the post-discharge experience from the perspective of parents of transplanted children. The purpose of this study is to describe the parent perspective of the transition from hospital to home following their child’s solid organ transplant. Within a mixed-methods design, 37 parents of pediatric heart, kidney and liver transplant recipients from three pediatric hospitals responded to qualitative interview questions on the day of hospital discharge and three weeks following hospital discharge. Insight to the discharge preparation process revealed necessary education components. Post-discharge themes were identified for coping, knowledge and adherence. The parents’ responses provide awareness as to specific stressors and concerns parents are faced with when their child is discharged from the hospital after solid organ transplant and opportunities for ways the transplant team can provide support. PMID:24814154

  20. Partnering health disparities research with quality improvement science in pediatrics.

    PubMed

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction.

  1. Partnering Health Disparities Research With Quality Improvement Science in Pediatrics

    PubMed Central

    Lion, K. Casey

    2015-01-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. PMID:25560436

  2. Pediatric vitiligo.

    PubMed

    Silverberg, Nanette B

    2014-04-01

    Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.

  3. Pediatric Appendicitis.

    PubMed

    Rentea, Rebecca M; St Peter, Shawn D

    2017-02-01

    Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis.

  4. Introduction to Pediatric Sepsis.

    PubMed

    Wheeler, Derek S

    2011-10-07

    Sepsis is a significant health problem in both critically ill children and adults. While the mortality rate from sepsis is much lower in children, sepsis is directly responsible for over 4,000 childhood deaths per year in the United States alone. At face value, this number suggests that more children die per year in the United States from sepsis as the primary cause than from cancer. Unfortunately, there are few studies on the epidemiology, pathophysiology, and management of sepsis in children. Moreover, extrapolation of adult data to critically ill children is probably not appropriate due to several key developmental differences in the host response to infection and response to therapy. Therefore, additional studies targeting sepsis in the pediatric population are urgently required.

  5. How Do I Teach English Learners? The Challenges Content Teachers Face--and What School Leaders Can Do to Support Them

    ERIC Educational Resources Information Center

    Russell, Felice Atesoglu

    2016-01-01

    Content teachers responsible for the instruction of English learner students will perceive myriad challenges when it comes to English learner students in the mainstream. School leaders can play a pivotal role in supporting and mitigating some of these challenges by recognizing what some of the pitfalls and issues might be for content teachers…

  6. Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers. Report to the Chairman, Committee on Finance, U.S. Senate.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

    This study examined the extent and characteristics of parental substance abuse among foster care cases, the difficulties agencies face in making timely permanency decisions for foster children with substance abusing parents, and initiatives that address reunifying families or achieving other permanency outcomes in a timely manner for foster…

  7. Docs are buying in. Faltering hospitals are finding new life with physician-owners, but they may face challenges getting their facilities up to speed.

    PubMed

    Romano, Michael

    2005-01-10

    More physicians are stepping forward to buy their own hospitals, often aging or faltering facilities that need some special attention. Kamlesh Gosai, left, led a group that helped keep open Brownsville (Pa.) General Hospital, saving 250 jobs. Often such doc investors are confident they'll suceed in managing their fellow physicians. But others warn they'll face some tough decisions.

  8. The challenge of changing the inactivated poliomyelitis vaccine in Latin America: declaration of the Latin American Society of Pediatric Infectious Diseases (SLIPE).

    PubMed

    Falleiros-Arlant, Luiza Helena; Avila-Agüero, María Luisa; Brea del Castillo, José; Mariño, Cristina

    2014-10-01

    Even though we have already covered 99% of the path to eradicate poliomyelitis from the world, this disease is still causing paralysis in children. Its eradication means not only the end of wild poliovirus circulation, but vaccine-derived poliovirus circulation as well. Taking into account different factors such as: current epidemiological data, adverse events of the attenuated oral poliomyelitis vaccine (OPV), the availability of an injectable inactivated vaccine (IPV) without the potential of causing the severe adverse events of the oral vaccine (OPV), the efficacy and effectiveness of the IPV in several countries of the world where it has been used for several years, the rationale of changing the vaccination schedule in different Latin American countries; the Latin American Society of Pediatric Infectious Diseases (SLIPE) announces its recommendation of switching to IPV in Latin America, by this Declaration, with an Action Plan for 2014-2015 period as regards vaccination against polio policies in Latin America. 1. The optimal proposed schedule consists of four IPV doses (three doses in the primary schedule plus a booster dose), whether IPV is combined or not with other indicated vaccines in the immunization program of the country. During the OPV to IPV transition phase, an alternative schedule is acceptable; 2. Countries should set optimal strategies in order to maintain and improve vaccination coverage, and implement a nominal immunization registry; 3. Improving the Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and setting up an environmental surveillance program; 4. Setting up strategies for introducing IPV in National Immunization Programs, such as communicating properly with the population, among others; 5. Bringing scientific societies closer to decision makers; 6. Ensuring optimal supply and prices for IPV introduction; 7. Training vaccination teams; 8. Enhancing the distribution and storing logistics of vaccines. In addition to the

  9. Face Painting.

    ERIC Educational Resources Information Center

    Brooks, Diana

    1995-01-01

    Discusses the use of face painting as a technique for making the endangered species issue tangible for children while addressing the complexity of the issue. Children are "given" an animal of their own and are educated about the animal while having their faces painted to resemble the animal. (LZ)

  10. Pediatric tracheomalacia.

    PubMed

    Fraga, Jose Carlos; Jennings, Russell W; Kim, Peter C W

    2016-06-01

    Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.

  11. Pediatric End-of-Life Issues and Palliative Care

    PubMed Central

    Michelson, Kelly Nicole; Steinhorn, David M.

    2007-01-01

    Optimizing the quality of medical care at the end of life has achieved national status as an important health care goal. Palliative care, a comprehensive approach to treating the physical, psychosocial and spiritual needs of patients and their families facing life-limiting illnesses, requires the coordinated efforts of a multidisciplinary group of caregivers. Understanding the basic principles of palliative care can aid emergency department staff in identifying patients who could benefit from palliative care services and in managing the challenging situations that arise when such patients present to the hospital for care. In this article we present the overall philosophy of pediatric palliative care, describe key elements of quality palliative care, and identify additional referral sources readers can access for more information. PMID:18438449

  12. Haiti earthquake 2010: a field hospital pediatric perspective.

    PubMed

    Farfel, Alon; Assa, Amit; Amir, Itzhac; Bader, Tarif; Bartal, Carmi; Kreiss, Yitshak; Sagi, Ram

    2011-04-01

    On January 12 2010, a 7.0-magnitude earthquake struck Haiti. The region had suffered an estimated 316,000 fatalities with approximately 300,000 injured and more than 1 million people who lost their houses. Following the quake, the Israeli Defense Force Medical Corps dispatched a field hospital unit to the capital city, Port au Prince. The hospital had a pediatric division which included pediatric emergency department, pediatric ward and neonatal unit. We elaborate on the various aspects of pediatric treatment that was provided by our hospital. A total of 363 pediatric patients (younger than 18 years) were admitted to our facility during its 10 days of operation. Out of this total, 272 pediatric patients were treated by the pediatric division, 79 (29%) were hospitalized and 57 (21%) required surgery. The pediatric team included seven pediatricians, one pediatric surgeon and six registered nurses. An electronic record and a hard copy file were created for each patient. Fifty-seven percent of the children presented with direct earthquake related injuries. Twelve patients required resuscitation and stabilization and three patients had died. The majority of injuries were orthopedic while infectious diseases accounted for most of the general pediatric diagnoses. In conclusion, operating a field hospital for a population affected by natural disaster is a complex mission. However, pediatric care has its own unique, challenging characteristics.

  13. Pediatric Hand Fractures

    PubMed Central

    Nellans, Kate W.; Chung, Kevin C.

    2014-01-01

    Summary Pediatric hand fractures are common childhood injuries. Identification of the fractures in the emergency room setting can be challenging owing to the physes and incomplete ossification of the carpus that are not revealed in the xrays. Most simple fractures can be treated with appropriate immobilization through buddy taping, finger splints, or casting. If correctly diagnosed, reduced and immobilized, these fractures usually result in excellent clinical outcomes. However, fractures may require operative stabilization if they have substantial angulation or rotation, extend into the joint, or cannot be held in a reduced position with splinting alone. Most fractures can be treated operatively with closed reduction and percutaneous pinning if addressed within the first week following the injury. In children, the thick, vascular-rich periosteum and bony remodeling potential make anatomic reductions and internal fixation rarely necessary. Most fractures complete bony healing in 3-4 weeks, with the scaphoid being a notable exception. Following immobilization, children rarely develop hand stiffness and formal occupational therapy is usually not necessary. Despite the high potential for excellent outcomes in pediatric hand fractures, some fractures remain difficult to diagnose and treat. PMID:24209954

  14. [New horizons in pediatrics].

    PubMed

    Grossman, Zachi

    2012-06-01

    The profession of pediatrics is constantLy changing. New morbidities are replacing old ones, as a reflection of the changes in society. Even today, old and rare morbidities, like scurvy or acute urinary retention, can be encountered in special settings and populations such as handicapped and developmentally delayed children. The availability of ever newer genetic tests highlights the duty of pediatricians to constantly update families for carrier detection, but also raises questions on the cLinical significance of asymptomatic mutations. Vaccination is one of the most effective pubLic health measures, but failure of medical staff to follow self vaccination recommendations might jeopardize protecting the children. Anti vaccination movement is rapidly growing due to the Internet. However, we must acknowledge the benefits inherent in Internet forums, for example, adolescents consulting anonymously regarding pubertal issues. A new and most needed aspect of care is treatment of pain in children. Increased staff awareness concerning anaLgesia is needed as well as promoting the use of medical clowns for anxiety and pain provoking procedures. Delivering appropriate healthcare to different societal demographic sectors is a challenge for pediatricians. The approach to fever phobia among ultra orthodox parents and advocacy for safety recommendations in the Arab population are two such exampLes. Finally, we shouLd always strive for innovative approaches in pediatric diseases affecting quality of life, and celiac disease is certainly promising in this direction.

  15. Pediatric allergy and immunology in Israel.

    PubMed

    Geller-Bernstein, Carmi; Etzioni, Amos

    2013-03-01

    After the geographic and sociodemographic settings as well as the health care in Israel are briefly described, the scope of pediatric allergy and immunology in Israel is presented. This includes specific disorders commonly encountered, the environment that induces symptoms, the specialists who treat them, and the common challenges of patients, parents, doctors, and allied health personnel who collaborate to manage the maladies and patient care. Allergies usually affect some overall 15-20% of the pediatric population. The main allergens are inhaled, ingested, or injected (insects stings). Generally, the incidence of the various allergens affecting children in Israel, is similar to other parts of the Western world. Owing to the high consanguinity rate in the Israeli population, the prevalence of the various immunodeficiency conditions (in the adaptive as well as the innate system) is higher than that reported worldwide. Pediatric allergists/immunologists also treat autoimmune disorders affecting the pediatric group. Pediatric allergy and clinical immunology are not separate specialties. The 25 specialists who treat children with allergic/immunologic diseases have undergone a basic training in Pediatrics. They also received an additional 2-yr training in allergy and clinical immunology and then have to pass the board examinations. They work mainly in pediatric allergy units, in several hospitals that are affiliated to the five medical schools in the country. Aside from clinical work, most of the centers are also heavily involved in clinical and basic research in allergy and immunology.

  16. When a Practitioner Becomes a University Faculty Member: A Review of Literature on the Challenges Faced by Novice Ex-Practitioner Teacher Educators

    ERIC Educational Resources Information Center

    Saito, Eisuke

    2013-01-01

    It is challenging for ex-practitioners beginning to teach in higher education settings due to their long experience in other fields. In this paper, as an example of a nexus of practitioners and academics, the focus is the issues of novice teacher educators at the beginning of their careers and support programmes for them. Three factors were…

  17. An Analysis of Challenges Faced by Students Learning in Virtual and Open Distance Learning System: A Case of Bindura University of Science Education (BUSE)

    ERIC Educational Resources Information Center

    Dodo, Obediah; Makwerere, David; Parwada, Matavire; Parwada, Cosmas

    2013-01-01

    After realizing that the traditional modes of tuition in Zimbabwe's andragogy had either gone obsolete or over-crowded, BUSE ventured into a "virtualised" model of open and distance learning as a way of out-doing other competing universities. However, as the programme was rolled out, there came a myriad of challenges affecting the…

  18. 77 FR 43846 - Food and Drug Administration Pediatric Medical Devices Workshop; Notice of Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-26

    ... HUMAN SERVICES Food and Drug Administration Food and Drug Administration Pediatric Medical Devices... Administration's (FDA) Office of Orphan Products Development is announcing the following workshop: FDA Pediatric Medical Devices Workshop. This meeting is intended to focus on challenges in pediatric device...

  19. Pediatric Suprasellar Tumors.

    PubMed

    McCrea, Heather J; George, Emilie; Settler, Allison; Schwartz, Theodore H; Greenfield, Jeffrey P

    2016-10-01

    The various childhood suprasellar tumors, while pathologically distinct, present similar clinical and surgical challenges as a result of their common anatomic location. These lesions are in close proximity to or may invade the optic nerve and chiasm, pituitary gland and infundibulum, hypothalamus, and third ventricle, leading to presenting features including visual field loss, impairment in visual acuity, endocrine dysfunction, and hydrocephalus. Though many suprasellar lesions are relatively benign in pathology, treatment may be complicated by high surgical morbidity resulting from damage to the hypothalamic-pituitary axis. Here we review the most frequent pediatric lesions occurring in the suprasellar region: craniopharyngioma, chiasmatic glioma, germ cell tumor, Rathke cleft and arachnoid cysts, pituitary adenoma, and histiocytosis. This review outlines both common presenting features and differentiating aspects of these lesions. It also includes classic radiographic presentations and treatment considerations for each lesion.

  20. Pediatric Brain Tumor Foundation

    MedlinePlus

    ... you insights into your child's treatment. LEARN MORE Brain tumors and their treatment can be deadly so ... Pediatric Brain Tumor Foundation Board Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  1. Pediatric Celiac Disease

    MedlinePlus

    ... of Pediatric Gastroenterology and Nutrition Nurses Print Share Celiac Disease Many kids have sensitivities to certain foods, ... protein found in wheat, rye, and barley. Pediatric Celiac Disease If your child has celiac disease, consuming ...

  2. Find a Pediatric Dentist

    MedlinePlus

    ... Litch's Law Log HIPAA Forms Practice Management and Marketing Newsletter Webinar Materials Member Resources 2017 General Assembly ... Archives Access Pediatric Dentistry Today Practice Management and Marketing Newsletter Pediatric Dentistry Journal Open Access Articles Policies & ...

  3. Pediatric Thyroid Cancer

    MedlinePlus

    ... Marketplace Find an ENT Doctor Near You Pediatric Thyroid Cancer Pediatric Thyroid Cancer Patient Health Information News media ... and neck issues, should be consulted. Types of thyroid cancer in children: Papillary : This form of thyroid cancer ...

  4. Pediatric diagnostic imaging

    SciTech Connect

    Gyll, C.; Blake, N.S.

    1986-01-01

    This book treats the practical problems of pediatric radiography and radiological procedures. Written jointly by a radiographer and a radiologist, it covers pediatric positioning and procedures. An extended chapter covers neonatal radiography and radiology.

  5. Nuances in pediatric trauma.

    PubMed

    Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

    2013-08-01

    Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury.

  6. Educational Challenges for Children with Cochlear Implants.

    ERIC Educational Resources Information Center

    Chute, Patricia M.; Nevins, Mary Ellen

    2003-01-01

    This article addresses educational challenges for children with severe to profound hearing loss who receive cochlear implants. Despite the implants, these children face acoustic challenges, academic challenges, attention challenges, associative challenges, and adjustment challenges. (Contains references.) (Author/DB)

  7. Nuclear imaging in pediatrics

    SciTech Connect

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed.

  8. Pediatric electrocardiographic imaging applications.

    PubMed

    Silva, Jennifer N A

    2015-03-01

    Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: (1) ECGI in patients with congenital heart disease and Wolff–Parkinson–White syndrome, (2) ECGI in patients with hypertrophic cardiomyopathy and preexcitation, (3) ECGI in pediatric patients with Wolff–Parkinson–White syndrome, and (4) ECGI for pediatric cardiac resynchronization therapy.

  9. Ethical Issues in Neonatal and Pediatric Clinical Trials

    PubMed Central

    Tarini, Beth; Lantos, John

    2012-01-01

    Synopsis Children have been identified as uniquely vulnerable clinical research subjects since the early 1970s. In this paper we review the historical underpinnings of this designation, the current regulatory framework for pediatric and neonatal research, and common problems in pediatric research oversight. We also present three areas of pediatric and neonatal research (genomic screening, healthy children donating stem cells, and therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy) that highlight contemporary challenges in pediatric research ethics, including balancing risk and benefit, informed consent and assent, and clinical equipoise. PMID:23036252

  10. Robotic Surgery may Not “Make the Cut” in Pediatrics

    PubMed Central

    Bruns, Nicholas E.; Soldes, Oliver S.; Ponsky, Todd A.

    2015-01-01

    Since the introduction of robotic surgery in children in 2001, it has been employed by select pediatric laparoscopic surgeons, but not to the degree of adult surgical specialists. It has been suggested that the technical capabilities of the robot may be ideal for complex pediatric surgical cases that require intricate dissection. However, due to the size constraints of the robot for small pediatric patients, the tight financial margins that pediatric hospitals face, and the lack of high level data displaying patient benefit when compared to conventional laparoscopic surgery, it may be some time before the robotic surgical platform is widely embraced in pediatric surgical practice. PMID:25729745

  11. Reflection on the Pharmaceutical Formulation Challenges Associated with a Paediatric Investigation Plan for an Off-Patent Drug.

    PubMed

    Walsh, Jennifer

    2017-02-01

    In Europe, the development of pediatric medicines for new patent protected products is mandatory and applicants are required to submit a Paediatric Investigation Plan (PIP) to the regulatory authorities. The process is voluntary for off-patent medicines and despite the availability of incentives, there is still a huge unmet need for the development of off-patent pediatric medicines. The aim of the EU grant funded "Labeling of Enalapril from Neonates to Adolescents" (LENA) project is to develop a new pediatric dosage form of the off-patent drug enalapril, for the treatment of heart failure in patients aged from birth to 18 years. This article provides an overview of some of the key formulation challenges that were faced during the product development programme and PIP process, including selection of dosage form and excipients, methodology for administration of the product and evaluation of patient acceptability.

  12. The application of social and adult learning theory to training in community pediatrics, social justice, and child advocacy.

    PubMed

    DeWitt, Thomas G

    2003-09-01

    Perhaps the greatest challenge we face today in medical education is how to establish a conceptual framework for conveying the context of community pediatrics and issues related to child health equity and social justice to practicing pediatricians and pediatricians in training. This will require a new infrastructure and approach to training to allow pediatricians to think and practice differently. The application of social and adult learning theory to the development and implementation of community pediatrics curricula will be necessary to succeed in these endeavors. In particular, we also will need to understand the educational processes required to motivate adult learners to acquire knowledge, attitudes, and skills outside the context and framework of their previous experiences and perceived professional needs.

  13. The APA and the rise of pediatric generalist network research.

    PubMed

    Wasserman, Richard; Serwint, Janet R; Kuppermann, Nathan; Srivastava, Rajendu; Dreyer, Benard

    2011-01-01

    The Academic Pediatric Association (APA, formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over 30 years ago. Individual APA members subsequently went on to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, 4 generalist networks--Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Research Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS)--have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges, and opportunities inherent in pediatric generalist network research.

  14. The APA and the Rise of Pediatric Generalist Network Research

    PubMed Central

    Wasserman, Richard; Serwint, Janet R.; Kuppermann, Nathan; Srivastava, Rajendu; Dreyer, Benard

    2010-01-01

    The Academic Pediatric Association (APA – formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over thirty years ago. Individual APA members went on subsequently to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, four generalist networks – Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS) – have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges and opportunities inherent in pediatric generalist network research. PMID:21282083

  15. NCI, NHLBI first international consensus conference on late effects after pediatric hematopoietic cell transplantation: etiology and pathogenesis of late effects after HCT performed in childhood--methodologic challenges.

    PubMed

    Bhatia, Smita; Davies, Stella M; Scott Baker, K; Pulsipher, Michael A; Hansen, John A

    2011-10-01

    Hematopoietic cell transplantation (HCT) is now a curative option for certain categories of patients with hematologic malignancies and other life-threatening illnesses. Technical and supportive care has resulted in survival rates that exceed 70% for those who survive the first 2 years after HCT. However, long-term survivors carry a high burden of morbidity, including endocrinopathies, musculoskeletal disorders, cardiopulmonary compromise, and subsequent malignancies. Understanding the etiologic pathways that lead to specific post-HCT morbidities is critical to developing targeted prevention and intervention strategies. Understanding the molecular underpinnings associated with graft-versus-host disease (GVHD), organ toxicity, relapse, opportunistic infection, and other long-term complications now recognized as health care concerns will have significant impact on translational research aimed at developing novel targeted therapies for controlling chronic GVHD, facilitating tolerance and immune reconstitution, reducing risk of relapse and secondary malignancies, minimizing chronic metabolic disorders, and improving quality of life. However, several methodological challenges exist in achieving these goals; these issues are discussed in detail in this paper.

  16. Facing the challenge of teaching emotions to individuals with low- and high-functioning autism using a new Serious game: a pilot study

    PubMed Central

    2014-01-01

    Background It is widely accepted that emotion processing difficulties are involved in Autism Spectrum Conditions (ASC). An increasing number of studies have focused on the development of training programs and have shown promising results. However, most of these programs are appropriate for individuals with high-functioning ASC (HFA) but exclude individuals with low-functioning ASC (LFA). We have developed a computer-based game called JeStiMulE based on logical skills to teach emotions to individuals with ASC, independently of their age, intellectual, verbal and academic level. The aim of the present study was to verify the usability of JeStiMulE (which is its adaptability, effectiveness and efficiency) on a heterogeneous ASC group. We hypothesized that after JeStiMulE training, a performance improvement would be found in emotion recognition tasks. Methods A heterogeneous group of thirty-three children and adolescents with ASC received two one-hour JeStiMulE sessions per week over four weeks. In order to verify the usability of JeStiMulE, game data were collected for each participant. Furthermore, all participants were presented before and after training with five emotion recognition tasks, two including pictures of game avatars (faces and gestures) and three including pictures of real-life characters (faces, gestures and social scenes). Results Descriptive data showed suitable adaptability, effectiveness and efficiency of JeStiMulE. Results revealed a significant main effect of Session on avatars (ANOVA: F (1,32) = 98.48, P < .001) and on pictures of real-life characters (ANOVA: F (1,32) = 49.09, P < .001). A significant Session × Task × Emotion interaction was also found for avatars (ANOVA: F (6,192) = 2.84, P = .01). This triple interaction was close to significance for pictures of real-life characters (ANOVA: F (12,384) = 1.73, P = .057). Post-hoc analyses revealed that 30 out of 35 conditions found a significant increase after

  17. Face Search at Scale.

    PubMed

    Wang, Dayong; Otto, Charles; Jain, Anil K

    2016-06-20

    rsons of interest among the billions of shared photos on these websites. Despite significant progress in face recognition, searching a large collection of unconstrained face images remains a difficult problem. To address this challenge, we propose a face search system which combines a fast search procedure, coupled with a state-of-the-art commercial off the shelf (COTS) matcher, in a cascaded framework. Given a probe face, we first filter the large gallery of photos to find the top-k most similar faces using features learned by a convolutional neural network. The k retrieved candidates are re-ranked by combining similarities based on deep features and those output by the COTS matcher. We evaluate the proposed face search system on a gallery containing 80 million web-downloaded face images. Experimental results demonstrate that while the deep features perform worse than the COTS matcher on a mugshot dataset (93.7% vs. 98.6% TAR@FAR of 0.01%), fusing the deep features with the COTS matcher improves the overall performance (99.5% TAR@FAR of 0.01%). This shows that the learned deep features provide complementary information over representations used in state-of-the-art face matchers. On the unconstrained face image benchmarks, the performance of the learned deep features is competitive with reported accuracies. LFW database: 98.20% accuracy under the standard protocol and 88.03% TAR@FAR of 0.1% under the BLUFR protocol; IJB-A benchmark: 51.0% TAR@FAR of 0.1% (verification), rank 1 retrieval of 82.2% (closed-set search), 61.5% FNIR@FAR of 1% (open-set search). The proposed face search system offers an excellent trade-off between accuracy and scalability on galleries with millions of images. Additionally, in a face search experiment involving photos of the Tsarnaev brothers, convicted of the Boston Marathon bombing, the proposed cascade face search system could find the younger brother's (Dzhokhar Tsarnaev) photo at rank 1 in 1 second on a 5M gallery and at rank 8 in 7

  18. Giant pediatric intraventricular meningioma: Case report and review of literature

    PubMed Central

    Munjal, Satyashiva; Vats, Atul; Kumar, Jitendra; Srivastava, Amit; Mehta, Veer Singh

    2016-01-01

    Intraventricular meningiomas are rare in the pediatric population. These tumors are often large in size and aggressive in behavior when they occur in children. The management of these tumors is a surgical challenge. PMID:27857790

  19. Funny Faces.

    ERIC Educational Resources Information Center

    Greene, Yvonne

    2000-01-01

    Presents a torn-paper and gadget-print activity for younger students, specifically pre-kindergarten to first grade, that can be done any time over the school year or at Halloween. Discusses how the students create their funny faces and lists the materials needed. (CMK)

  20. Face Prints.

    ERIC Educational Resources Information Center

    Hadash, Dre Ann

    1984-01-01

    Eighth graders made prints of their own faces, using photographic papers and chemicals. Describes the supplies needed and the printing process involved. Because junior high school students are so concerned with self, this was a very meaningful activity for them. (CS)

  1. Innovative clinical trial design for pediatric therapeutics

    PubMed Central

    Laughon, Matthew M; Benjamin, Daniel K; Capparelli, Edmund V; Kearns, Gregory L; Berezny, Katherine; Paul, Ian M; Wade, Kelly; Barrett, Jeff; Smith, Phillip Brian; Cohen-Wolkowiez, Michael

    2011-01-01

    Until approximately 15 years ago, sponsors rarely included children in the development of therapeutics. US and European legislation has resulted in an increase in the number of pediatric trials and specific label changes and dosing recommendations, although infants remain an understudied group. The lack of clinical trials in children is partly due to specific challenges in conducting trials in this patient population. Therapeutics in special populations, including premature infants, obese children and children receiving extracorporeal life support, are even less studied. National research networks in Europe and the USA are beginning to address some of the gaps in pediatric therapeutics using novel clinical trial designs. Recent innovations in pediatric clinical trial design, including sparse and scavenged sampling, population pharmacokinetic analyses and ‘opportunistic’ studies, have addressed some of the historical challenges associated with clinical trials in children. PMID:21980319

  2. The challenges of success: adolescents with perinatal HIV infection.

    PubMed

    Mofenson, Lynne M; Cotton, Mark F

    2013-06-18

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.

  3. The challenges of success: adolescents with perinatal HIV infection

    PubMed Central

    Mofenson, Lynne M; Cotton, Mark F

    2013-01-01

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults. PMID:23782484

  4. An equine pain face

    PubMed Central

    Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

    2015-01-01

    Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

  5. Patient-focused measures of functional health status and health-related quality of life in pediatric orthopedics: A case study in measurement selection

    PubMed Central

    Furlong, William; Barr, Ronald D; Feeny, David; Yandow, Suzanne

    2005-01-01

    The objectives of this report are to review the assessment of patient-focused outcomes in pediatric orthopedic surgery, to describe a framework for identifying appropriate sets of measures, and to illustrate an application of the framework to a challenging orthopedic problem. A detailed framework of study design and measurement factors is described. The factors are important for selecting appropriate instruments to measure health status and health-related quality of life (HRQL) in a particular context. A study to evaluate treatment alternatives for patients with neurofibromatosis type 1 and congenital tibial dysplasia (NF1-CTD) provides a rich illustration of the application of the framework. The application involves great variability in the instrument selection factors. Furthermore, these patients and their supportive caregivers face numerous complex health challenges with long-term implications for HRQL. Detailed summaries of important generic preference-based multi-attribute measurement systems, pediatric health profile instruments, and pediatric orthopedic-specific instruments are presented. Age-appropriate generic and specific measures are identified for study of NF1-CTD patients. Selected measures include the Activities Scale for Children, Gillette Functional Assessment Questionnaire Walking Scale, Health Utilities Index, and Pediatric Inventory of Quality of Life. Reliable and valid measures for application to pediatric orthopedics are available. There are important differences among measures. The selected measures complement each other. The framework in this report provides a guide for selecting appropriate measures. Application of appropriate sets of measures will enhance the ability to describe the morbidity of pediatric orthopedic patients and to assess the effectiveness of alternative clinical interventions. The framework for measurement of health status and HRQL from a patient perspective has relevance to many other areas of orthopedic practice. PMID

  6. The art of pediatric oncology nursing practice.

    PubMed

    Cantrell, Mary Ann

    2007-01-01

    Pediatric oncology nursing practice must incorporate both the science and the art of the discipline to foster positive physical and psychosocial treatment outcomes for pediatric oncology patients, especially those outcomes related to their health-related quality of life. In this article, the art of nursing care is described within the context of scientifically based care, and the art of nursing practice is evident in the implementation of the scientific principles and standards for pediatric oncology nursing practice. The author proposes that the art of pediatric oncology nursing practice ought to be evident in care activities that the nurse provides within a therapeutic relationship that is steeped in nursing presence. Although the art of nursing care and the nature of an effective therapeutic relationship is tacit, valued knowledge among pediatric oncology nurses, as well as children and adolescents with cancer and their families, it is difficult to describe and challenging to quantify its effect on patient care outcomes. This article discusses the art of pediatric oncology nursing practice and its influence on treatment outcomes.

  7. Examining the Roles of the Facilitator in Online and Face-to-Face PD Contexts

    ERIC Educational Resources Information Center

    Park, Gina; Johnson, Heather; Vath, Richard; Kubitskey, Beth; Fishman, Barry

    2013-01-01

    Online teacher professional development has become an alternative to face-to-face professional development. Such a shift from face-to-face to online professional development, however, brings new challenges for professional development facilitators, whose roles are crucial in orchestrating teacher learning. This paper is motivated by the need to…

  8. Juvenile Toxicology: Relevance and Challenges for Toxicologists and Pathologists

    PubMed Central

    Remick, Amera K.; Catlin, Natasha R.; Quist, Erin M.; Steinbach, Thomas J.; Dixon, Darlene

    2015-01-01

    The Society of Toxicologic Pathology (STP) Education Committee and the STP Reproductive Special Interest Group held a North Carolina regional meeting entitled, “Juvenile Toxicology: Relevance and Challenges for Toxicologists and Pathologists” on March 13, 2015, at the National Institute of Environmental Health Sciences/National Toxicology Program in Research Triangle Park, North Carolina. The purpose of this regional meeting was to familiarize attendees with the topic of juvenile toxicity testing and discuss its relevance to clinical pediatric medicine, regulatory perspectives, challenges of appropriate study design confronted by toxicologists, and challenges of histopathologic examination and interpretation of juvenile tissues faced by pathologists. The 1-day meeting was a success with over 60 attendees representing industry, government, research organizations, and academia. PMID:26220944

  9. Genetics of pediatric obesity.

    PubMed

    Manco, Melania; Dallapiccola, Bruno

    2012-07-01

    Onset of obesity has been anticipated at earlier ages, and prevalence has dramatically increased worldwide over the past decades. Epidemic obesity is mainly attributable to modern lifestyle, but family studies prove the significant role of genes in the individual's predisposition to obesity. Advances in genotyping technologies have raised great hope and expectations that genetic testing will pave the way to personalized medicine and that complex traits such as obesity will be prevented even before birth. In the presence of the pressing offer of direct-to-consumer genetic testing services from private companies to estimate the individual's risk for complex phenotypes including obesity, the present review offers pediatricians an update of the state of the art on genomics obesity in childhood. Discrepancies with respect to genomics of adult obesity are discussed. After an appraisal of findings from genome-wide association studies in pediatric populations, the rare variant-common disease hypothesis, the theoretical soil for next-generation sequencing techniques, is discussed as opposite to the common disease-common variant hypothesis. Next-generation sequencing techniques are expected to fill the gap of "missing heritability" of obesity, identifying rare variants associated with the trait and clarifying the role of epigenetics in its heritability. Pediatric obesity emerges as a complex phenotype, modulated by unique gene-environment interactions that occur in periods of life and are "permissive" for the programming of adult obesity. With the advent of next-generation sequencing techniques and advances in the field of exposomics, sensitive and specific tools to predict the obesity risk as early as possible are the challenge for the next decade.

  10. Using risk management files to identify and address causative factors associated with adverse events in pediatrics

    PubMed Central

    Hain, Paul D; Pichert, James W; Hickson, Gerald B; Bledsoe, Sandra H; Hamming, David; Hathaway, Jacob; Nguyen, Carolyn

    2007-01-01

    We report a retrospective analysis of 84 consecutive pediatrics-related internal review files opened by a medical center’s risk managers between 1996 and 2001. The aims were to identify common causative factors associated with adverse events/adverse outcomes (AEs) in a Pediatrics Department, then suggest ways to improve care. The main outcome was identification of any patterns of factors that contributed to AEs so that interventions could be designed to address them. Cases were noted to have at least one apparent contributing problem; the most common were with communication (44% of cases), diagnosis and treatment (37%), medication errors (20%), and IV/Central line issues (17%). 45% of files involved a child with an underlying diagnosis putting her/him at high risk for an adverse outcome. All Pediatrics Departments face multiple challenges in assuring consistent quality care. The extent to which the data generalize to other institutions is unknown. However, the data suggest that systematic analysis of aggregated claims files may help identify and drive opportunities for improvement in care. PMID:18472985

  11. New challenges facing interinstitutional social science and educational program evaluation research at academic health centers: a case study from the ELAM program.

    PubMed

    Morahan, Page S; Yamagata, Hisashi; McDade, Sharon A; Richman, Rosalyn; Francis, Ray; Odhner, Victoria C

    2006-06-01

    Since the mid-1990s, the protection of human subjects through institutional review boards (IRBs) has progressively broadened in scope. In this case study, the authors describe their challenges in effectively handling IRB processes to conduct educational and social sciences research within academic health centers, particularly (1) complications in conducting longitudinal interinstitutional research that involves multiple IRBs, each with different procedures that changed over ten years; and (2) factors affecting consent form and survey response rates when applying the biomedical IRB process to obtain the consent of human subjects for participation in social and educational research. The authors had a unique opportunity to follow the effect of changes in consent forms (from no form to a one-page form to a three-page form requiring signature of a witness), ways of administration (in person or by mail), and time of administration (at the time of the program or years later) on consent form and survey response rates among medical and dental school faculty members. The authors explore the extended timelines required for data collection and increased costs in dealing with these issues, as well as the effects on response rates of consent form language and administration procedures. The authors recommend strategies to lessen adverse effects of dealing with multiple IRBs at different institutions for social science and educational research, and discuss policy implications for funders, institutions and investigators.

  12. Pediatric HIV Infection and Developmental Disabilities.

    ERIC Educational Resources Information Center

    Seidel, John F.

    This paper presents an overview of the developmental disabilities associated with pediatric Human Immunodeficiency Virus (HIV) infection, and examines efficacious practices for assessment and intervention programming. The focus population is early childhood into school age. The paper describes the complex array of challenges presented by these…

  13. Pediatric Feeding: A Transdisciplinary Team's Perspective.

    ERIC Educational Resources Information Center

    Wooster, Donna M.; Brady, Nancy R.; Mitchell, Amy; Grizzle, Mary H.; Barnes, Margaret

    1998-01-01

    Applies principles of the transdisciplinary team approach to the needs of children with feeding disorders and describes a pediatric feeding team at the University of South Alabama Children's and Women's Hospital. Case studies illustrate the principles. Advantages and challenges in the transdisciplinary approach to feeding disorders are discussed.…

  14. Uncertain translation, uncertain benefit and uncertain risk: ethical challenges facing first-in-human trials of induced pluripotent stem (ips) cells.

    PubMed

    Fung, Ronald K F; Kerridge, Ian H

    2013-02-01

    The discovery of induced pluripotent stem (iPS) cells in 2006 was heralded as a major breakthrough in stem cell research. Since then, progress in iPS cell technology has paved the way towards clinical application, particularly cell replacement therapy, which has refueled debate on the ethics of stem cell research. However, much of the discourse has focused on questions of moral status and potentiality, overlooking the ethical issues which are introduced by the clinical testing of iPS cell replacement therapy. First-in-human trials, in particular, raise a number of ethical concerns including informed consent, subject recruitment and harm minimisation as well as the inherent uncertainty and risks which are involved in testing medical procedures on humans for the first time. These issues, while a feature of any human research, become more complex in the case of iPS cell therapy, given the seriousness of the potential risks, the unreliability of available animal models, the vulnerability of the target patient group, and the high stakes of such an intensely public area of science. Our paper will present a detailed case study of iPS cell replacement therapy for Parkinson's disease to highlight these broader ethical and epistemological concerns. If we accept that iPS cell technology is fraught with challenges which go far beyond merely refuting the potentiality of the stem cell line, we conclude that iPS cell research should not replace, but proceed alongside embryonic and adult somatic stem cell research to promote cross-fertilisation of knowledge and better clinical outcomes.

  15. Pediatric neurology of the dog and cat.

    PubMed

    Lavely, James A

    2006-05-01

    The neurologic examination in the puppy or kitten can be a challenging experience. Understanding the development of behavior reflexes and movement in puppies and kittens enables us to overcome some of these challenges and to recognize the neurologically abnormal patient. Subsequently,we can identify the neuroanatomic localization and generate a differential diagnosis list. This article first reviews the pediatric neurologic examination and then discusses diseases unique to these individuals.

  16. Fecal microbial transplant for the treatment of pediatric inflammatory bowel disease

    PubMed Central

    Wang, Alice Yuxin; Popov, Jelena; Pai, Nikhil

    2016-01-01

    The role of fecal microbial transplant (FMT) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. The success of FMT for the treatment of recurrent Clostridium difficile infection (RCDI) has bolstered interest in its potential application to other disease states, such as inflammatory bowel disease (IBD). FMT has particular interest in pediatrics, given the concerns of patients and parents about rates of adverse events with existing therapeutic options, and the greater cumulative medication burden associated with childhood-onset disease. Published literature on the use of FMT in pediatrics is sparse. Only 45 pediatric patients treated for RCDI have been reported, and only 27 pediatric patients with pediatric IBD. The pediatric microbiome may uniquely respond to microbial-based therapies. This review will provide a comprehensive overview of fecal microbial transplant and its potential role in the treatment of pediatric inflammatory bowel disease. We will discuss the microbiome in pediatric inflammatory bowel disease, existing adult and pediatric literature on the use of FMT in IBD treatment, and pediatric FMT trials that are currently recruiting patients. This review will also discuss features of the microbiome that may be associated with host response in fecal transplant, and potential challenges and opportunities for the future of FMT in pediatric IBD treatment. PMID:28058011

  17. Sedation for Pediatric Endoscopy

    PubMed Central

    2014-01-01

    It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy. PMID:24749082

  18. Food insecure families: description of access and barriers to food from one pediatric primary care center.

    PubMed

    DeMartini, Tori L; Beck, Andrew F; Kahn, Robert S; Klein, Melissa D

    2013-12-01

    Despite evidence that food insecurity negatively impacts child health, health care providers play little role in addressing the issue. To inform potential primary care interventions, we sought to assess a range of challenges faced by food insecure (FI) families coming to an urban, pediatric primary care setting. A cross-sectional study was performed at a hospital-based, urban, academic pediatric primary care clinic that serves as a medical home for approximately 15,000 patients with 35,000 annual visits. Subjects included a convenience sample of caregivers of children presenting for either well child or ill care over a 4 months period in 2012. A self-administered survey assessed household food security status, shopping habits, transportation access, budgeting priorities, and perceptions about nutrition access in one's community. Bivariate analyses between food security status and these characteristics were performed using Chi square statistics or Fisher's exact test. The survey was completed by 199 caregivers. Approximately 33% of families were FI; 93% received food-related governmental assistance. FI families were more likely to obtain food from a corner/convenience store, utilize food banks, require transportation other than a household car, and prioritize paying bills before purchasing food. FI families perceived less access to healthy, affordable foods within their community. Thus, FI families may face unique barriers to accessing food. Knowledge of these barriers could allow clinicians to tailor in-clinic screening and create family-centered interventions.

  19. About-face on face recognition ability and holistic processing

    PubMed Central

    Richler, Jennifer J.; Floyd, R. Jackie; Gauthier, Isabel

    2015-01-01

    Previous work found a small but significant relationship between holistic processing measured with the composite task and face recognition ability measured by the Cambridge Face Memory Test (CFMT; Duchaine & Nakayama, 2006). Surprisingly, recent work using a different measure of holistic processing (Vanderbilt Holistic Face Processing Test [VHPT-F]; Richler, Floyd, & Gauthier, 2014) and a larger sample found no evidence for such a relationship. In Experiment 1 we replicate this unexpected result, finding no relationship between holistic processing (VHPT-F) and face recognition ability (CFMT). A key difference between the VHPT-F and other holistic processing measures is that unique face parts are used on each trial in the VHPT-F, unlike in other tasks where a small set of face parts repeat across the experiment. In Experiment 2, we test the hypothesis that correlations between the CFMT and holistic processing tasks are driven by stimulus repetition that allows for learning during the composite task. Consistent with our predictions, CFMT performance was correlated with holistic processing in the composite task when a small set of face parts repeated over trials, but not when face parts did not repeat. A meta-analysis confirms that relationships between the CFMT and holistic processing depend on stimulus repetition. These results raise important questions about what is being measured by the CFMT, and challenge current assumptions about why faces are processed holistically. PMID:26223027

  20. Aortic Involvement in Pediatric Marfan syndrome: A Review.

    PubMed

    Ekhomu, Omonigho; Naheed, Zahra J

    2015-06-01

    Outlining specific protocols for the management of pediatric patients with Marfan syndrome has been challenging. This is mostly due to a dearth of clinical studies performed in pediatric patients. In Marfan syndrome, the major sources of morbidity and mortality relate to the cardiovascular system. In this review, we focus on aortic involvement seen in pediatric patients with Marfan syndrome, ranging from aortic dilatation to aortic rupture and heart failure. We discuss the histological, morphological, and pathogenetic basis of the cardiac manifestations seen in pediatric Marfan syndrome and use a specific case to depict our experienced range of cardiovascular manifestations. The survival for patients with Marfan syndrome may approach the expected survival for non-affected patients, with optimal management. With this potentiality in mind, we explore possible and actual management considerations for pediatric Marfan syndrome, examining both medical and surgical therapy modalities that can make the possibility of improved survival a reality.

  1. Biomarkers for CNS involvement in pediatric lupus

    PubMed Central

    Rubinstein, Tamar B; Putterman, Chaim; Goilav, Beatrice

    2015-01-01

    CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population. PMID:26079959

  2. Laser applications in pediatric airway surgery

    NASA Astrophysics Data System (ADS)

    Karamzadeh, Amir M.; Ahuja, Gurpreet S.; Nguyen, John D.; Crumley, Roger

    2003-06-01

    The smaller anatomy and limited access to instrumentation pose a challenge to the pediatric airway surgeon. The enhanced precision and ability to photocoagulate tissue while operating with the laser enhances the surgeon"s ability to successfully treat unique pediatric conditions such subglottic hemangiomas, congenital cysts, respiratory papillomatosis, and laryngeal or tracheal stenosis. Due to its shallow tissue penetration and thermal effect, the carbon dioxide (CO2) laser is generally considered the laser of choice for pediatric airway applications. The potential for increased scarring and damage to underlying tissue caused by the greater penetration depth and thermal effect of the Nd:YAG and KTP lasers preclude their use in this population. In this review, we will describe the specific advantages of using lasers in airway surgery, the current technology and where the current technology is deficient.

  3. Pediatric cardiopulmonary resuscitation.

    PubMed

    Orlowski, J P

    1983-04-01

    Pediatric cardiopulmonary resuscitation refers to those measures used to restore ventilation and circulation in children. This article defines how cardiopulmonary resuscitation in infants, children, and adolescents differs from cardiopulmonary resuscitation in adults and delineates the drugs and dosages to be used in the resuscitation of pediatric patients.

  4. Pediatric heart surgery - discharge

    MedlinePlus

    ... get enough calories to heal and grow. After heart surgery, most babies and infants (younger than 12 to 15 months) can take ... valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... open heart surgery References Bernstein D. General principles ...

  5. [Research in pediatrics].

    PubMed

    Herrera-Márquez, Julia Rocío; González-Cabello, Héctor Jaime

    2015-01-01

    In the interest of encouraging the promotion of research done by physicians of the Instituto Mexicano del Seguro Social, in this supplement we publish articles written by residents of different specialties related to critical themes on pediatrics. These residents are guided by affiliated physicians from the Hospital de Pediatría del Centro Médico Nacional Siglo XXI.

  6. Pediatric intensive care.

    PubMed

    Macintire, D K

    1999-07-01

    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  7. Teaching Prevention in Pediatrics.

    ERIC Educational Resources Information Center

    Cheng, Tina L.; Greenberg, Larrie; Loeser, Helen; Keller, David

    2000-01-01

    Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures.…

  8. Pediatric Care Online: A Pediatric Point-of-Care Tool.

    PubMed

    Vardell, Emily

    2016-01-01

    Pediatric Care Online is the American Academy of Pediatrics' point-of-care tool designed for health care providers. Pediatric Care Online builds on content from Red Book Online and Pediatric Patient Education and features Quick Reference topic pages for more than 250 pediatric health care topics. The multitude of resources available within Pediatric Care Online will be reviewed in this column, and a sample search will be used to illustrate the type of information available within this point-of-care pediatric resource.

  9. Outpatient Management of Pediatric Type 1 Diabetes

    PubMed Central

    Cogen, Fran R.

    2015-01-01

    The incidence of both type 1 and type 2 diabetes (T1DM and T2DM) continues to rise within the pediatric population. However, T1DM remains the most prevalent form diagnosed in children. It is critical that health-care professionals understand the types of diabetes diagnosed in pediatrics, especially the distinguishing features between T1DM and T2DM, to ensure proper treatment. Similar to all individuals with T1DM, lifelong administration of exogenous insulin is necessary for survival. However, children have very distinct needs and challenges compared to those in the adult diabetes population. Accordingly, treatment, goals, and age-appropriate requirements must be individually addressed. The main objectives for the treatment of pediatric T1DM include maintaining glucose levels as close to normal as possible, avoiding acute complications, and preventing long-term complications. In addition, unique to pediatrics, facilitating normal growth and development is important to comprehensive care. To achieve these goals, a careful balance of insulin therapy, medical nutrition therapy, and exercise or activity is necessary. Pharmacological treatment options consist of various insulin products aimed at mimicking prior endogenous insulin secretion while minimizing adverse effects. This review focuses on the management of pediatric T1DM in the outpatient environment, highlighting pharmacotherapy management strategies. PMID:26472948

  10. Outpatient Management of Pediatric Type 1 Diabetes.

    PubMed

    Beck, Joni K; Cogen, Fran R

    2015-01-01

    The incidence of both type 1 and type 2 diabetes (T1DM and T2DM) continues to rise within the pediatric population. However, T1DM remains the most prevalent form diagnosed in children. It is critical that health-care professionals understand the types of diabetes diagnosed in pediatrics, especially the distinguishing features between T1DM and T2DM, to ensure proper treatment. Similar to all individuals with T1DM, lifelong administration of exogenous insulin is necessary for survival. However, children have very distinct needs and challenges compared to those in the adult diabetes population. Accordingly, treatment, goals, and age-appropriate requirements must be individually addressed. The main objectives for the treatment of pediatric T1DM include maintaining glucose levels as close to normal as possible, avoiding acute complications, and preventing long-term complications. In addition, unique to pediatrics, facilitating normal growth and development is important to comprehensive care. To achieve these goals, a careful balance of insulin therapy, medical nutrition therapy, and exercise or activity is necessary. Pharmacological treatment options consist of various insulin products aimed at mimicking prior endogenous insulin secretion while minimizing adverse effects. This review focuses on the management of pediatric T1DM in the outpatient environment, highlighting pharmacotherapy management strategies.

  11. Outcomes in pediatric solid-organ transplantation.

    PubMed

    LaRosa, Christopher; Baluarte, H Jorge; Meyers, Kevin E C

    2011-03-01

    LaR Pediatric solid-organ transplantation is an increasingly successful treatment for organ failure. Five- and 10-yr patient survival rates have dramatically improved over the last couple of decades, and currently, over 80% of pediatric patients survive into adolescence and young adulthood. Waiting list mortality has been a concern for liver, heart, and intestinal transplantation, illustrating the importance of transplant as a life-saving therapy. Unfortunately, the success of pediatric transplantation comes at the cost of long-term or late complications that arise as a result of allograft rejection or injury, immunosuppression-related morbidity, or both. As transplant recipients enter adolescence treatment, non-adherence becomes a significant issue, and the medical and psychosocial impacts transition to adulthood not only with regard to healthcare but also in terms of functional outcomes, economic potential, and overall QoL. This review addresses the clinical and psychosocial challenges encountered by pediatric transplant recipients in the current era. A better understanding of pediatric transplant outcomes and adult morbidity and mortality requires further ongoing assessment.

  12. Famous face recognition, face matching, and extraversion.

    PubMed

    Lander, Karen; Poyarekar, Siddhi

    2015-01-01

    It has been previously established that extraverts who are skilled at interpersonal interaction perform significantly better than introverts on a face-specific recognition memory task. In our experiment we further investigate the relationship between extraversion and face recognition, focusing on famous face recognition and face matching. Results indicate that more extraverted individuals perform significantly better on an upright famous face recognition task and show significantly larger face inversion effects. However, our results did not find an effect of extraversion on face matching or inverted famous face recognition.

  13. Global Population Trends: Challenges Facing World Leaders.

    ERIC Educational Resources Information Center

    Scommegna, Paola, Ed.

    This pamphlet explores the dynamics of world population, highlighting steps world leaders can take to address population problems and improve the lives of people worldwide. With jet-age transportation and electronic communication, economic and social interdependence of nations is greater than ever before and is likely to increase in the future.…

  14. Female and Facing HIV: The Challenges

    MedlinePlus

    ... Video Games Video Sharing Sites Webcasts/ Webinars Widgets Wikis Follow Us on New Media Virtual Office Hours ... health, taking HIV medicine, and staying in regular medical care, you can keep the virus under control ...

  15. Facing the Challenge: Technology Training in Libraries.

    ERIC Educational Resources Information Center

    Marmion, Dan

    1998-01-01

    Discusses the need for more technology training for library employees. Highlights include computer literacy skills; productivity; knowledge of operating systems; troubleshooting with hardware; ongoing training in information technology; and placing more importance on the computer skills of prospective employees. (LRW)

  16. Facing CLIL Challenges at University Level

    ERIC Educational Resources Information Center

    Granados Beltrán, Carlo

    2011-01-01

    Experiments in Content Language Integrated Learning have been carried out most of the time at primary and secondary education. However, not much is known about what higher education institutions are doing in this respect. This article aims to present an experience that occurred in the Languages Department at Universidad Central (Bogotá, Colombia)…

  17. Overcoming regulatory and economic challenges facing pharmacogenomics.

    PubMed

    Cohen, Joshua P

    2012-09-15

    The number of personalized medicines and companion diagnostics in use in the United States has gradually increased over the past decade, from a handful of medicines and tests in 2001 to several dozen in 2011. However, the numbers have not reached the potential hoped for when the human genome project was completed in 2001. Significant clinical, regulatory, and economic barriers exist and persist. From a regulatory perspective, therapeutics and companion diagnostics are ideally developed simultaneously, with the clinical significance of the diagnostic established using data from the clinical development program of the corresponding therapeutic. Nevertheless, this is not (yet) happening. Most personalized medicines are personalized post hoc, that is, a companion diagnostic is developed separately and approved after the therapeutic. This is due in part to a separate and more complex regulatory process for diagnostics coupled with a lack of clear regulatory guidance. More importantly, payers have placed restrictions on reimbursement of personalized medicines and their companion diagnostics, given the lack of evidence on the clinical utility of many tests. To achieve increased clinical adoption of diagnostics and targeted therapies through more favorable reimbursement and incorporation in clinical practice guidelines, regulators will need to provide unambiguous guidance and manufacturers will need to bring more and better clinical evidence to the market place.

  18. Facing the Challenges of the Future.

    ERIC Educational Resources Information Center

    Mondale, Walter F.

    1984-01-01

    The United States has been warned frequently in recent years about the dangers of technological illiteracy. However, it is the danger of moral illiteracy that worries the author as he looks ahead to the 21st century. Domestic issues, the international arena, and the nuclear threat are discussed. (RM)

  19. Gender-Specific Health Challenges Facing Women

    MedlinePlus

    ... D. James C. Hill, Ph.D. History Dr. Joseph J. Kinyoun: Father of the NIH Kinyoun: NIH ... 2012 Overview The Indispensable Forgotten Man: Video Dr. Joseph Kinyoun The Indispensable Forgotten Man Authors Forward Background ...

  20. Holistic face training enhances face processing in developmental prosopagnosia

    PubMed Central

    Cohan, Sarah; Nakayama, Ken

    2014-01-01

    Prosopagnosia has largely been regarded as an untreatable disorder. However, recent case studies using cognitive training have shown that it is possible to enhance face recognition abilities in individuals with developmental prosopagnosia. Our goal was to determine if this approach could be effective in a larger population of developmental prosopagnosics. We trained 24 developmental prosopagnosics using a 3-week online face-training program targeting holistic face processing. Twelve subjects with developmental prosopagnosia were assessed before and after training, and the other 12 were assessed before and after a waiting period, they then performed the training, and were then assessed again. The assessments included measures of front-view face discrimination, face discrimination with view-point changes, measures of holistic face processing, and a 5-day diary to quantify potential real-world improvements. Compared with the waiting period, developmental prosopagnosics showed moderate but significant overall training-related improvements on measures of front-view face discrimination. Those who reached the more difficult levels of training (‘better’ trainees) showed the strongest improvements in front-view face discrimination and showed significantly increased holistic face processing to the point of being similar to that of unimpaired control subjects. Despite challenges in characterizing developmental prosopagnosics’ everyday face recognition and potential biases in self-report, results also showed modest but consistent self-reported diary improvements. In summary, we demonstrate that by using cognitive training that targets holistic processing, it is possible to enhance face perception across a group of developmental prosopagnosics and further suggest that those who improved the most on the training task received the greatest benefits. PMID:24691394