Science.gov

Sample records for challenges facing pediatric

  1. The Challenges Facing Training in Pediatric Surgery Worldwide

    PubMed Central

    Beasley, Spencer W.

    2013-01-01

    Like most specialties, pediatric surgery is becoming more complex, and changes to health systems have not always been in the best interests of trainees or their surgical teachers. This paper outlines four of the current challenges faced by training boards in pediatric surgery worldwide, and documents their implications for the future training of pediatric surgeons. PMID:24400270

  2. Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

    PubMed

    Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

    2017-07-01

    To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

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

    PubMed

    Grünberg, Jose

    2010-03-01

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

  4. Challenges faced by pediatric oncology fellows when patients die during their training.

    PubMed

    Granek, Leeat; Bartels, Ute; Barrera, Maru; Scheinemann, Katrin

    2015-03-01

    Given the paucity of research on the experience of pediatric oncology fellows regarding patient death, the purpose of this study was to explore the specific challenges that pediatric oncology fellows face when patients die during their training. Six pediatric oncology fellows at two academic cancer centers in Ontario, Canada, were interviewed about their experiences with patient death during their fellowship training. The grounded theory method of data collection and data analysis was used. Line-by-line coding was used to establish themes, and constant comparison was used to establish relationships among emerging codes and themes. Fellows reported structural challenges that included ward duty and lack of follow-up opportunities with bereaved families. Personal challenges included feelings of vulnerability as a result of being a trainee, inexperience with patient death, and feeling alone with one's reactions to patient death. Relational challenges included duration of relationships with families and with supervising staff and perceived lack of modeling on how to cope with patient deaths. Structural changes to the fellowship model can be made in order to enhance support with patient death, including informing fellows of all patient deaths and incorporating fellows into follow-up practices with bereaved families. Moreover, integrating fellows' debriefing (facilitated by grief counselors) after a patient death into fellow training, as well as greater involvement with palliative care physicians, can lessen feelings of isolation and help fellows learn effective strategies for dealing with patient deaths from experienced palliative care physicians. Copyright © 2015 by American Society of Clinical Oncology.

  5. 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.

  6. Ethical issues in pediatric face transplantation.

    PubMed

    Benghiac, Ana-Gabriela; Garrett, Jeremy R; Carter, Brian S

    2017-08-28

    Facial transplantation has become a reality in adult medicine. Children are subject to congenital craniofacial differences, disease-related, traumatic, or thermochemical craniofacial changes and might be suitable for face transplantation. This manuscript addresses unique ethical issues in considering potential pediatric face transplant. These challenges are operant at the individual, technologic, and psychosocial level for clinicians, investigators, and society. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. 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…

  8. 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…

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. Common challenge topics in pediatric transplantation

    PubMed Central

    Azeka, Estela; Jatene, Marcelo Biscegli; Miura, Nana; Fine, Richard

    2014-01-01

    This special issue is dedicated to the common challenge topics in pediatric transplantation. It contains 11 chapters, ranging from clinical research in pediatric transplantation to translational research (from bench to bedside). It includes comprehensive reviews from renowned scientists, clinicians and surgeons from five countries from the International Pediatric Transplantation Association (IPTA), Harvard University, the University of Miami and the University of São Paulo Medical School. The clinical management of specific issues, such as sensitized patients and ABO blood type-incompatible transplantation, is addressed. In addition, the challenges facing this patient population and the future perspectives for clinical research are discussed. PMID:24860851

  15. 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

  16. [Ambulatory pediatrics: a challenge].

    PubMed

    Ransy, V; Gevers, B; Landsberg, M

    2006-01-01

    Ambulatory paediatrics in University hospitals has remarkably evolved during the past decade, along with technological progress and the current need for undelayed information and attention; demand for hospital medical advice increases consequently, either directly in outpatients wards or indirectly by phone or e-mails. Specific medico-social aspects linked essentially to populations' migration, poverty, chronic stress and family splitting are regularly encountered. Hospital architecture and adequacy of medical and nursing staff must both be adjusted to these changing medical demands including medical teaching. We now face the ever-growing challenge of providing an adequate management of actual medico-psycho-social aspects and integrating up-to-date paediatrics in our daily practices.

  17. 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,…

  18. 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,…

  19. Persistent pharmacokinetic challenges to pediatric drug development.

    PubMed

    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.

  20. 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

  1. 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)

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. Computer Face Scale for Measuring Pediatric Pain and Mood

    PubMed Central

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

    2009-01-01

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

  7. 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…

  8. 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…

  9. Childhood fever management program for Korean pediatric nurses: A comparison between blended and face-to-face learning method.

    PubMed

    Jeong, Yong Sun; Kim, Jin Sun

    2014-01-01

    A blended learning can be a useful learning strategy to improve the quality of fever and fever management education for pediatric nurses. This study compared the effects of a blended and face-to-face learning program on pediatric nurses' childhood fever management, using theory of planned behavior. A nonequivalent control group pretest-posttest design was used. A fever management education program using blended learning (combining face-to-face and online learning components) was offered to 30 pediatric nurses, and 29 pediatric nurses received face-to-face education. Learning outcomes did not significantly differ between the two groups. However, learners' satisfaction was higher for the blended learning program than the face-to-face learning program. A blended learning pediatric fever management program was as effective as a traditional face-to-face learning program. Therefore, a blended learning pediatric fever management-learning program could be a useful and flexible learning method for pediatric nurses.

  10. 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.

  11. Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?

    PubMed

    Marchac, Alexandre; Kuschner, Tomasine; Paris, John; Picard, Arnaud; Vazquez, Marie Paule; Lantieri, Laurent

    2016-08-01

    In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults. The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation. Children's youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant. After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.

  12. Challenges and Changes Faced by Rural Superintendents

    ERIC Educational Resources Information Center

    Lamkin, Marcia L.

    2006-01-01

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

  13. 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.

  14. Persistent Challenges in Pediatric Pulmonary Hypertension.

    PubMed

    Hopper, Rachel K; Abman, Steven H; Ivy, D Dunbar

    2016-07-01

    Pulmonary hypertension and related pulmonary vascular diseases cause significant morbidities and high mortality and present many unique challenges toward improving outcomes in neonates, infants, and children. Differences between pediatric and adult disease are reflected in controversies regarding etiologies, classification, epidemiology, diagnostic evaluations, and therapeutic interventions. This brief review highlights several key topics reflecting recent advances in the field and identifies persistent gaps in our understanding of clinical pediatric pulmonary hypertension. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  15. 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.

  16. Telemedicine and face-to-face care for pediatric obesity.

    PubMed

    Lipana, Lawrence Santiago; Bindal, Deepika; Nettiksimmons, Jasmine; Shaikh, Ulfat

    2013-10-01

    The University of California Davis Medical Center (Sacramento, CA) has pioneered the use of telemedicine in its approach to childhood obesity to cover more than 20 rural clinics in California. In our study, we compared the outcomes of the Telemedicine Weight Management Clinic (TM) with those of its face-to-face (FTF) Weight Management Clinic counterpart over the last 5 years, predicting the results to be equivalent or in favor of TM. All children seen in the TM from June 2006 to June 2011 were included (n=121), and encounter notes in medical records were reviewed. For comparison, an equivalent sample of FTF patients was selected from that time frame (n=122). Data that were also abstracted from the medical record included age at first visit, gender, race, referral site, and comorbid diagnoses. Forty-two percent of TM patients compared with 52% of FTF patients received a change in diagnosis. Thirty-nine percent of TM patients received a change in diagnostic evaluation compared with 67% of patients in FTF. When comparing patients who received more than one visit with either form of consultation, the TM group demonstrated substantially more improvement than the FTF group in improving nutrition (88% versus 65%), increasing activity (76% versus 49%), and decreasing screen time (33% versus 8%). Substantially more TM patients were successful with a combined outcome of any one of the weight parameters that included weight loss, weight maintenance, or slowing of weight gain (69% TM versus 44% FTF). Our study suggests that telemedicine can serve as a feasible strategy to increase access to medical care for childhood obesity in rural communities and promote changes in lifestyle with the goal of maintaining a healthy weight.

  17. Challenges of training and delivery of pediatric surgical services in Africa.

    PubMed

    Chirdan, Lohfa B; Ameh, Emmanuel A; Abantanga, Francis A; Sidler, Daniel; Elhalaby, Essam A

    2010-03-01

    The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa. A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL). Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty. The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international

  18. Homeland Security. Management Challenges Facing Federal Leadership

    DTIC Science & Technology

    2002-12-01

    including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi...Plan and Guidelines to include operational and logistical considerations associated with implementing a large-scale voluntary vaccination program in... Hospital Preparedness Program to help state and local hospitals develop plans to respond to bioterrorism events and other public health emergencies

  19. 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…

  20. 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…

  1. 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,…

  2. Fiber quality challenges facing the cotton industry

    USDA-ARS?s Scientific Manuscript database

    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...

  3. 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,…

  4. 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…

  5. 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…

  6. 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,…

  7. 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…

  8. 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…

  9. 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,…

  10. Pediatric sepsis: challenges and adjunctive therapies.

    PubMed

    Hanna, William; Wong, Hector R

    2013-04-01

    Sepsis remains an important challenge in pediatric critical care medicine. This review provides an appraisal of adjunctive therapies for sepsis and highlights opportunities for meeting selected challenges in the field. Future clinical studies should address long-term and functional outcomes as well as acute outcomes. Potential adjunctive therapies such as corticosteroids, hemofiltration, hemoadsorption, and plasmapheresis may have important roles, but still require formal and more rigorous testing by way of clinical trials. Finally, the design of future clinical trials should consider novel approaches for stratifying outcome risks as a means of improving the risk-to-benefit ratio of experimental therapies. Published by Elsevier Inc.

  11. Pediatric sepsis: challenges and adjunctive therapies

    PubMed Central

    Hanna, William; Wong, Hector R.

    2012-01-01

    SYNOPSIS Sepsis remains an important challenge in pediatric critical care medicine. The current review intends to provide an appraisal of adjunctive therapies for sepsis and to highlight opportunities for meeting selected challenges in the field. Future clinical studies should address long-term and functional outcomes, as well as acute outcomes. Potential adjunctive therapies such as corticosteroids, hemofiltration, hemoadsorption, and plasmapheresis may have important roles, but still require formal and more rigorous testing by way of clinical trials. Finally, the design of future clinical trials should consider novel approaches for stratifying outcome risks as a means of improving the risk to benefit ratio of experimental therapies. PMID:23537672

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

    PubMed Central

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

    2014-01-01

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

  14. An emerging field of research: challenges in pediatric decision making.

    PubMed

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

    2015-04-01

    There is growing interest in pediatric decision science, spurred by policies advocating for children's involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making. Much work has been done to address gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum. © The Author(s) 2014.

  15. 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.

  16. Challenges Facing Early Career Academic Cardiologists

    PubMed Central

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

    2014-01-01

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

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. Compulsive exercise: links, risks and challenges faced

    PubMed Central

    Lichtenstein, Mia Beck; Hinze, Cecilie Juul; Emborg, Bolette; Thomsen, Freja; Hemmingsen, Simone Daugaard

    2017-01-01

    Compulsive exercise is a condition described since 1970s. It is characterized by a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations. It has not been accepted as a mental disorder in either International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The aim of this literature review was to critically examine the research on links (comorbidity), risks (negative consequences), and challenges faced (problems in a treatment context). This review found that compulsive exercise is associated with eating disorder pathology, perfectionism, neuroticism, narcissism, and obsessive compulsive traits. The most prominent negative consequences were injuries, social impairment, and depression, but more research is needed to uncover the potential dysfunction resulting from compulsive exercise. As the condition is not recognized as a psychiatric disorder, studies on treatment interventions are sparse. Problems with compliance have been reported; therefore, motivational interviewing has been proposed as a treatment approach, in combination with cognitive behavioral therapy. This review summarizes and discusses findings on links/comorbidity, risks/negative consequences, and treatment challenges. We suggest that future studies should pay attention to both prevention and counseling in sports settings, where compulsive exercise appears, as the condition may be associated with harmful consequences. PMID:28435339

  3. Challenges facing the Australian coal industry

    SciTech Connect

    McLeod, A.

    1982-09-01

    Coal is expected to play a major role in energy supply in the next 20 years. Oil is a convenient and still reasonably abundant fuel. However, its major sources of supply are regions where there is nervousness about political stability. Uranium is a more efficient fuel - but there is a continuing community apprehension regarding its use. What coal may lack in efficiency, it makes up in long term availability and competitive overall cost. Moreover, diversity of source ensures stable long-term supply. In this way, a major role for coal in the world energy scene is assured. Cyclical considerations aside, demand for coal will increase significantly and it will meet a substantial share of new energy demand, replacing oil and gas in major industrial and electric utility markets. By around the year 2000, coal's share of world energy could reach 30% and rival oil as the largest single source of energy. This expectation implies a major expansion of the international trade of coal, especially thermal coal. Australia with its significant coal resources is likely to play an important role in this trade. Both Australia and the United States have the resource base to be the top coal exporters for the remainder of this century. In 1982, world economic recession has deepened and uncertainty about the timing of future energy demand will result in delays in consumer and producer investment decisions. This uncertainty provides a challenge to us all. This paper looks at the challenges facing the Australian coal industry.

  4. 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.

  5. 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

  6. 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

  7. Four Challenges That Global Health Networks Face.

    PubMed

    Shiffman, Jeremy

    2017-02-08

    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. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  8. 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.

  9. 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

  10. 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

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

    PubMed Central

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

    2012-01-01

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

  12. A ten-year experience with pediatric face grafts.

    PubMed

    Greenhalgh, David G; Hinchcliff, Katharine; Sen, Soman; Palmieri, Tina L

    2013-01-01

    The authors reviewed their 10-year experience of performing face grafts in children with burns. They sought to compare different methods for aesthetic outcome and need for reconstruction. In addition, they determined the efficacy of using allograft skin or Integra as temporary covers. They performed a review of 160 pediatric patients who underwent acute facial excision and grafting for burns between 2000 and 2010. Of the 160 patients with a mean age of 5.8 ± 4.8 years, 96 were males. The mean burn size was 39.4 ± 24.61%, of which 36.5 ± 25.4% was third degree. Overall length of stay was 72.1 days, intensive care unit length of stay was 44.2 days, and the mortality rate was 13.75%. Ninety patients had their entire face burned, 42 burned half, 15 burned their foreheads, and seven had other combinations. The interval between injury and grafting was 13.9 ± 13.19 days. Sixty-three percent patients required one face graft, 23% had two, 8% had three, and 6% four or more. For their initial procedure, 105 patients underwent autografting, 28 had allografting, and 23 received Integra. The authors performed a two-stage procedure in 20.4% and a 1-day procedure in 79.6%. Ten patients had a contiguous "U-shaped" graft wrapped around the face. At least partial regrafting was performed in 21.1%. Allograft and Integra were used for massive burns (69.9 ± 14.5%, 62.6 ± 18.3%, respectively). Of these, 39% died, 17% developed an Integra infection, and 43% required regrafting before autografting. Overall, 24.5% of patients underwent facial reconstruction during their first admission, and 57.1% during subsequent admissions. No difference in the rate of reconstructive surgery was noted between patients receiving Integra or autografting. Autografting face burns as an initial, one-stage procedure works well. The "wrap-around" autograft leads to excellent cosmetic results. When there is a shortage of autograft, allograft or Integra are good options but Integra does not reduce the need

  13. Pediatric Gastroenterology in Cuba: Evolution and Challenges.

    PubMed

    Castañeda-Guillot, Carlos

    2016-10-01

    INTRODUCTION The professional practice of pediatric gastroenterology arose in Cuba as an expression of the specialty's development internationally and Cuba's new strategies in public health, and in response to national needs for health care expertise in digestive diseases of infants, older children and adolescents. OBJECTIVES Describe the history of pediatric gastroenterology's development in Cuba since its inception at the National Gastroenterology Institute in the early 1970s, its contributions, and efforts to extend it to pediatric hospitals throughout Cuba. EVIDENCE ACQUISITION This is a historical review based on document analysis. Institutional sources from the National Gastroenterology Institute and Ministry of Public Health were reviewed, as well as international and national literature on the history of pediatric gastroenterology and unpublished texts since its emergence in 1972. DEVELOPMENT Although pediatric gastroenterology has not been formally recognized as a medical specialty in Cuba, there have been important achievements in establishing a network of specialized health care services for digestive diseases of children and adolescents. Gastrointestinal endoscopy and other auxiliary diagnostic modalities have been introduced for children and play a major role in clinical trials and research. This article describes the international context that promoted the specialty's development in Cuba. Reference is made to specialized training from its initial stages in 1972, its consolidation as an emerging discipline in Cuban medicine, and its diffusion in Latin American and Caribbean countries. Professional development and specialized training to meet health human resource needs in pediatric hospitals are described, as well as Cuban participation in the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition. National and international milestones, publications, awards and recognitions that indicate advances despite difficulties are also

  14. 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

  15. Psychosocial challenges facing physicians of today.

    PubMed

    Arnetz, B B

    2001-01-01

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

  16. Challenges and opportunities facing medical education.

    PubMed

    Densen, Peter

    2011-01-01

    Medical education is at a crossroads. Although unique features exist at the undergraduate, graduate, and continuing education levels, shared aspects of all three levels are especially revealing, and form the basis for informed decision-making about the future of medical education.This paper describes some of the internal and external challenges confronting undergraduate medical education. Key internal challenges include the focus on disease to the relative exclusion of behavior, inpatient versus outpatient education, and implications of a faculty whose research is highly focused at the molecular or submolecular level. External factors include the exponential growth in knowledge, associated technologic ("disruptive") innovations, and societal changes. Addressing these challenges requires decisive institutional leadership with an eye to 2020 and beyond--the period in which current matriculants will begin their careers. This paper presents a spiral-model format for a curriculum of medical education, based on disease mechanisms, that addresses many of these challenges and incorporates sound educational principles.

  17. 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…

  18. 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…

  19. 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…

  20. 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…

  1. 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…

  2. 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…

  3. 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…

  4. 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.

  5. 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…

  6. 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…

  7. 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…

  8. 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.

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

    PubMed

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

    2015-01-01

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

  10. Facing Global Challenges with Materials Innovation

    NASA Astrophysics Data System (ADS)

    Rizzo, Fernando

    2017-10-01

    The path of society evolution has long been associated with a growing demand for natural resources and continuous environmental degradation. During the last decades, this pace has accelerated considerably, despite the general concern with the legacy being left for the next generations. Looking ahead, the predicted growth of the world population, and the improvement of life conditions in most regions, point to an increasing demand for energy generation, resulting in additional pressure on the Earth's sustainability. Materials have had a key role in decreasing the use of natural resources, by either improving efficiency of existing technologies or enabling the development of radical new ones. The greenhouse effect (CO2 emissions) and the energy crisis are global challenges that can benefit from the development of new materials for the successful implementation of promising technologies and for the imperative replacement of fossil fuels by renewable sources.

  11. Facing Global Challenges with Materials Innovation

    NASA Astrophysics Data System (ADS)

    Rizzo, Fernando

    2017-08-01

    The path of society evolution has long been associated with a growing demand for natural resources and continuous environmental degradation. During the last decades, this pace has accelerated considerably, despite the general concern with the legacy being left for the next generations. Looking ahead, the predicted growth of the world population, and the improvement of life conditions in most regions, point to an increasing demand for energy generation, resulting in additional pressure on the Earth's sustainability. Materials have had a key role in decreasing the use of natural resources, by either improving efficiency of existing technologies or enabling the development of radical new ones. The greenhouse effect (CO2 emissions) and the energy crisis are global challenges that can benefit from the development of new materials for the successful implementation of promising technologies and for the imperative replacement of fossil fuels by renewable sources.

  12. Pediatric Cervical Spine Injuries: A Rare But Challenging Entity.

    PubMed

    Baumann, Florian; Ernstberger, Toni; Neumann, Carsten; Nerlich, Michael; Schroeder, Gregory D; Vaccaro, Alexander R; Loibl, Markus

    2015-08-01

    Injuries to the cervical spine in pediatric patients are uncommon. A missed injury can have devastating consequences in this age group. Because of the lack of routine in diagnosis and management of pediatric cervical spine injuries (PCSI), each of these cases represents a logistic and personal challenge. By means of clinical cases, we demonstrate key points in diagnostics and treatment of pediatric spine injuries. We highlight typical pediatric injury patterns and more adult-like injuries. The most common cause of injury is blunt trauma. There is an age-related pattern of injuries in pediatric patients. Children under the age of 8 frequently sustain ligamentous injuries in the upper cervical spine. After the age of 8, the biomechanics of the cervical spine are similar to adults, and therefore, bony injuries of the subaxial cervical spine are most likely to occur. Clinical presentation of PCSI is heterogeneous. Younger children can neither interpret nor communicate neurological abnormalities, which make timely and accurate diagnosis difficult. Plain radiographs are often misinterpreted. We find different types of injuries at different locations, because of different biomechanical properties of the immature spine. We outline that initial management is crucial for long-term outcome. Knowledge of biomechanical properties and radiographic presentation of the immature spine can improve the awareness for PCSI. Diagnosis and management of pediatric patients after neck trauma can be demanding. Level IV.

  13. 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

  14. Challenges Facing Rural Schools: Implications for Gifted Students

    ERIC Educational Resources Information Center

    Howley, Aimee; Rhodes, Megan; Beall, Jimmie

    2009-01-01

    In this paper, we discuss the implications for gifted students of challenges facing rural schools. We explore 4 challenges with particular relevance to rural schools: (a) declining population, (b) persistent poverty, (c) changing demographics, and (d) ongoing accountability requirements. Recommendations positioned to address these challenges…

  15. 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,…

  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. 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…

  18. 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…

  19. 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.

  20. Heart Transplantation: Challenges Facing the Field

    PubMed Central

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

    2014-01-01

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

  1. 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.

  2. 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

  3. Challenges and Opportunities Facing Technology Education in Taiwan

    ERIC Educational Resources Information Center

    Lee, Lung-Sheng Steven

    2009-01-01

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

  4. Challenges Facing 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…

  5. 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…

  6. 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.…

  7. 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…

  8. 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…

  9. 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…

  10. 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…

  11. 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…

  12. Challenges and climate of business environment and resources to support pediatric device development.

    PubMed

    Iqbal, Corey W; Wall, James; Harrison, Michael R

    2015-06-01

    The incidence of pediatric disease conditions pales in comparison to adult disease. Consequently, many pediatric disorders are considered orphan diseases. Resources for the development of devices targeting orphan diseases are scarce and this poses a unique challenge to the development of pediatric devices. This article outlines these challenges and offers solutions.

  13. 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

  14. Dental laboratory technology in crisis: the challenges facing the industry.

    PubMed

    Christensen, Gordon J; Yancey, William

    2005-05-01

    Undoubtedly, the four challenges facing dental technology we have described in this article are not the only ones, but they are the major ones as identified by the participants in the Dental Technology Summit. The attendees conducted active discussion on all of these points and developed potential solutions. It was gratifying to see the various political and organizational factions agree on the challenges, and the participants felt at the conclusion of the conference that the described challenges are, in fact, those that need immediate attention. We will discuss suggested potential solutions in a column in the June issue of JADA.

  15. Challenges in translating vascular tissue engineering to the pediatric clinic.

    PubMed

    Duncan, Daniel R; Breuer, Christopher K

    2011-10-14

    The development of tissue-engineered vascular grafts for use in cardiovascular surgery holds great promise for improving outcomes in pediatric patients with complex congenital cardiac anomalies. Currently used synthetic grafts have a number of shortcomings in this setting but a tissue engineering approach has emerged in the past decade as a way to address these limitations. The first clinical trial of this technology showed that it is safe and effective but the primary mode of graft failure is stenosis. A variety of murine and large animal models have been developed to study and improve tissue engineering approaches with the hope of translating this technology into routine clinical use, but challenges remain. The purpose of this report is to address the clinical problem and review recent advances in vascular tissue engineering for pediatric applications. A deeper understanding of the mechanisms of neovessel formation and stenosis will enable rational design of improved tissue-engineered vascular grafts.

  16. 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…

  17. 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…

  18. 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".

  19. Communication Challenges of Oncologists and Intensivists Caring for Pediatric Oncology Patients: A Qualitative Study.

    PubMed

    Odeniyi, Folasade; Nathanson, Pamela G; Schall, Theodore E; Walter, Jennifer K

    2017-08-11

    The families of oncology patients requiring intensive care often face increasing complexity in communication with their providers, particularly when patients are cared for by providers from different disciplines. To describe experiences and challenges faced by pediatric oncologists and intensivists and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions (GCDs). We conducted semi-structured interviews with a convenience sample of ten physicians, including pediatric oncology and intensive care attendings and fellows. We identified key themes (3 barriers, 4 facilitators) to having GCDs with families of oncology patients who have received intensive care. Barriers included challenges to communication within teams because of hierarchy and between teams due to incomplete sharing of information and confusion about who should initiate GCDs; provider experiences of internal conflict about how to engage parents in decision making and about the "right thing to do" for patients; and lack of education and training in communication. Facilitators included team preparation for family meetings; skills for partnering with families; the presence of palliative care specialists; and informal education in communication and willingness for further training in communication. Notably, the education theme was identified as both a barrier and a resource. We identified barriers to communication with families both within and between teams and for individual physicians. Formal communication training and processes that standardize communication to ensure completeness and role delineation between clinical teams may improve oncologists' and intensivists' ability to initiate GCDs, thereby fulfilling their ethical obligations of decision support. Copyright © 2017. Published by Elsevier Inc.

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2000-01-01

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

  4. 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. © 2016 by Kerman University of Medical Sciences.

  5. 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

  6. 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.

  7. Educational challenges faced by international medical graduates in the UK

    PubMed Central

    Hashim, Ahmed

    2017-01-01

    Introduction International medical graduates (IMGs) in the UK constitute approximately one-quarter of the total number of doctors registered in the General Medical Council (GMC). The transition of IMGs into the health care system in the UK is accompanied by significant sociocultural and educational challenges. This study aims to explore the views of IMGs in medical training on the educational challenges they face. Methods This study was conducted in the Kent, Surrey and Sussex region in 2015. All IMGs who work in medical (physicianly) training programs were included. Data were collected through a questionnaire and semi-structured interviews. Thematic approach was used to analyze the qualitative data. Results Of the total 61 IMGs included, 17 responded to the survey and 3 were interviewed. The common educational barriers faced by IMGs were related to lack of appreciation of the values and structure of the National Health Service (NHS), ethical and medicolegal issues, receiving feedback from colleagues and the different learning strategies in the UK. IMGs suggested introduction of a mandatory dedicated induction program in the form of formal teaching sessions. They also believed that a supervised shadowing period prior in the first job in the UK would be beneficial. Further assessment areas should be incorporated into the prequalifying examinations to address specific educational needs such as NHS structure and hospital policies. Other measures such as buddying schemes with senior IMGs and educating NHS staff on different needs of IMGs should also be considered. Conclusion This study highlighted important educational challenges faced by IMGs and generated relevant solutions. However, the opinions of the supervisors and other health care professionals need to be explored. PMID:28721119

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

    PubMed

    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

    2017-03-13

    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.

  9. Challenges faced by inpatient child/adolescent psychiatric nurses.

    PubMed

    Delaney, Kathleen R; Hardy, Lyons

    2008-02-01

    Inpatient nurses work to engineer an environment in which patients and staff are physically and psychologically safe. A recent research study on an adult psychiatric unit examined the dimensions involved in keeping the unit safe. The four dimensions included ideology, people (staff and patients), space, and time. In this article, we discuss how these dimensions apply to real-world efforts to keep child and adolescent inpatient units safe. We also discuss the challenges nurses face within each of these safety dimensions, including those arising from fluctuating acuity, staffing formulas, surveillance of physical space, and entrenched unit cultures.

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 48 CFR 1480.903 - Award in the face of challenge.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. 48 CFR 1480.903 - Award in the face of challenge.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  17. 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.

  18. Challenges facing PBL tutors: 12 tips for successful group facilitation.

    PubMed

    Azer, Samy A

    2005-12-01

    One of the main tasks of a problem-based learning (PBL) tutor is to facilitate group discussion. Group facilitation is about process rather than content. In this process, a tutor helps the group increase their skills and progress in their discussion. Several studies have highlighted strategies and training used in preparing PBL tutors. However, PBL tutors usually feel that it is not that easy to change their teaching style to the PBL format. They are sometimes unsure about their role or what strategy they might use to facilitate their students' discussion. This article in the '12 Tips' series is a detailed description of, and provides answers to, common challenges faced by PBL tutors. The tips provided in this manuscript should help tutors with practical answers. The article may be useful to PBL tutors, medical and health educators and those responsible for PBL training workshops.

  19. 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

  20. 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

  1. 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.

  2. 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

  3. Use of 3-dimensional printing technology and silicone modeling in surgical simulation: development and face validation in pediatric laparoscopic pyeloplasty.

    PubMed

    Cheung, Carling L; Looi, Thomas; Lendvay, Thomas S; Drake, James M; Farhat, Walid A

    2014-01-01

    Pediatric laparoscopy poses unique training challenges owing to smaller workspaces, finer sutures used, and potentially more delicate tissues that require increased surgical dexterity when compared with adult analogs. We describe the development and face validation of a pediatric pyeloplasty simulator using a low-cost laparoscopic dry-laboratory model developed with 3-dimensional (3D) printing and silicone modeling. The organs (the kidney, renal pelvis, and ureter) were created in a 3-step process where molds were created with 3D modeling software, printed with a Spectrum Z510 3D printer, and cast with Dragon Skin 30 silicone rubber. The model was secured in a laparoscopy box trainer. A pilot study was conducted at a Canadian Urological Association meeting. A total of 24 pediatric urology fellows and 3 experienced faculty members then assessed our skills module during a minimally invasive surgery training course. Participants had 60 minutes to perform a right-side pyeloplasty using laparoscopic tools and 5-0 VICRYL suture. Face validity was demonstrated on a 5-point Likert scale. The dry-laboratory model consists of a kidney, a replaceable dilated renal pelvis and ureter with an obstructed ureteropelvic junction, and an overlying peritoneum with an inscribed fundamentals of laparoscopic surgery pattern-cutting exercise. During initial validation at the Canadian Urological Association, participants rated (out of 5) 4.75 ± 0.29 for overall impression, 4.50 ± 0.41 for realism, and 4.38 ± 0.48 for handling. During the minimally invasive surgery course, 22 of 24 fellows and all the faculty members completed the scoring. Usability was rated 4 or 5 by 14 participants (overall, 3.6 ± 1.22 by novices and 3.7 ± 0.58 by experts), indicating that they would use the model in their own training and teaching. Esthetically, the model was rated 3.5 ± 0.74 (novices) and 3.3 ± 0.58 (experts). We developed a pediatric pyeloplasty simulator by applying a low-cost reusable model

  4. 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.

  5. Family medicine in Iran: facing the health system challenges.

    PubMed

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

    2014-11-30

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

  6. Challenges facing academic urology training programs: an impending crisis.

    PubMed

    Gonzalez, Chris M; McKenna, Patrick

    2013-03-01

    To determine the most pressing issues facing academic urology training centers. The supply of urologists per capita in the United States continues to decrease. Stricter resident requirements, restriction of resident duty hours, and a Graduate Medical Education (GME) funding cap on resident education has led to significant challenges for academic centers. A 32-question survey was sent to Society of University Urologists members. Respondents defined themselves as academic faculty tenure track, program director, academic chair, program director and academic chair, clinical faculty nontenure track, and community faculty member. A total of 143 of 446 members(32%) responded. A lack of funding was indicated as an obstacle to adding new residency positions (65% respondents) and recruiting new faculty (60% respondents). Residency positions not funded by GME (40% respondents) required either clinical or hospital dollars to support these slots. Most respondents (51%) indicated resident research rotations are funded with clinical dollars. Surgical skills laboratories are commonly used (85% respondents) and are supported mostly with hospital or clinical dollars. The majority of respondents (84%) indicated they would expand simulation laboratories if they had better funding. Other than urodynamics and ultrasound, urology residency training programs reported little income from ancillary dollars. There is a significant workforce shortage within urology training programs. Clinical revenue and hospital funding seem to be the main financial support engines to supplement the GME funding shortage, proficiency training, and faculty salary support for teaching. The current system of GME funding for urology residency programs is not sustainable. Published by Elsevier Inc.

  7. Neural Reactivity to Angry Faces Predicts Treatment Response in Pediatric Anxiety.

    PubMed

    Bunford, Nora; Kujawa, Autumn; Fitzgerald, Kate D; Swain, James E; Hanna, Gregory L; Koschmann, Elizabeth; Simpson, David; Connolly, Sucheta; Monk, Christopher S; Phan, K Luan

    2017-02-01

    Although cognitive-behavioral psychotherapy (CBT) and pharmacotherapy are evidence-based treatments for pediatric anxiety, many youth with anxiety disorders fail to respond to these treatments. Given limitations of clinical measures in predicting treatment response, identifying neural predictors is timely. In this study, 35 anxious youth (ages 7-19 years) completed an emotional face-matching task during which the late positive potential (LPP), an event-related potential (ERP) component that indexes sustained attention towards emotional stimuli, was measured. Following the ERP measurement, youth received CBT or selective serotonin reuptake inhibitor (SSRI) treatment, and the LPP was examined as a predictor of treatment response. Findings indicated that, accounting for pre-treatment anxiety severity, neural reactivity to emotional faces predicted anxiety severity post- CBT and SSRI treatment such that enhanced electrocortical response to angry faces was associated with better treatment response. An enhanced LPP to angry faces may predict treatment response insofar as it may reflect greater emotion dysregulation or less avoidance and/or enhanced engagement with environmental stimuli in general, including with treatment.

  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. 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…

  10. 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

  11. Challenges in implementing a pediatric cardiovascular home telehealth project.

    PubMed

    Black, Allison K; Sadanala, Usha K; Mascio, Christopher E; Hornung, Carlton A; Keller, Bradley B

    2014-09-01

    Infants with "single ventricle" congenital heart disease are at high risk for sudden death following palliative surgical management. We developed a pilot telemedicine project to evaluate the feasibility of using Web-based daily reporting of clinical data with the goal of reducing unexpected admissions and sudden death. We enrolled 9 subjects (enrolled subjects [ES]) following surgical palliation over 12 months. Parents electronically transmitted ES daily weight and oxygen saturation and then completed an automated 10-point phone questionnaire on nutrition, activity, and distress. Subject enrollment continued until a second surgical palliative procedure (n=5), sudden death (n=2), or disenrollment (n=2). We collected clinical data on all ES and 9 historical controls (HC) from the preceding 18 months and analyzed clinical management, including outpatient telephone surveillance success, scheduled and unscheduled office and emergency department visits, hospitalizations, procedures, and adverse events, including death. Subject recruitment was more difficult than expected. Weight transmission success was high, but there was poor correlation between telemedicine system-measured oxygen saturation and a commercial monitor. The outpatient clinical telephone surveillance success rate for HC and ES was approximately 30%. After technical adjustments, parents of all ES (100%) were able to transmit questionnaire data. There were 9 emergency room visits for ES versus 11 unscheduled emergency room visits for HC. Sudden death occurred in 1 of 9 HC and 2 of 9 ES. Telemedicine monitoring for high-risk congenital heart disease patients is feasible but challenging, may reduce unscheduled visits, but may not impact the primary end point of preventing sudden death in this high-risk pediatric population.

  12. 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.

  13. 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.

  14. 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.

  15. Pediatric drug formulations: a review of challenges and progress.

    PubMed

    Ivanovska, Verica; Rademaker, Carin M A; van Dijk, Liset; Mantel-Teeuwisse, Aukje K

    2014-08-01

    Children differ from adults in many aspects of pharmacotherapy, including capabilities for drug administration, medicine-related toxicity, and taste preferences. It is essential that pediatric medicines are formulated to best suit a child's age, size, physiologic condition, and treatment requirements. To ensure adequate treatment of all children, different routes of administration, dosage forms, and strengths may be required. Many existing formulations are not suitable for children, which often leads to off-label and unlicensed use of adult medicines. New regulations, additional funding opportunities, and innovative collaborative research initiatives have resulted in some recent progress in the development of pediatric formulations. These advances include a paradigm shift toward oral solid formulations and a focus on novel preparations, including flexible, dispersible, and multiparticulate oral solid dosage forms. Such developments have enabled greater dose flexibility, easier administration, and better acceptance of drug formulations in children. However, new pediatric formulations address only a small part of all therapeutic needs in children; moreover, they are not always available. Five key issues need to be addressed to stimulate the further development of better medicines for children: (1) the continued prioritization of unmet formulation needs, particularly drug delivery in neonates and treatment gaps in pediatric cancers and childhood diseases in developing countries; (2) a better use of existing data to facilitate pediatric formulation development; (3) innovative technologies in adults that can be used to develop new pediatric formulations; (4) clinical feedback and practice-based evidence on the impact of novel formulations; and (5) improved access to new pediatric formulations. Copyright © 2014 by the American Academy of Pediatrics.

  16. 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

  17. 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

  18. 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)

  19. [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.

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

    ERIC Educational Resources Information Center

    Silvernail, David L.; Linet, Sarah R.

    2014-01-01

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

  1. Pediatric neuroimaging in early childhood and infancy: challenges and practical guidelines

    PubMed Central

    Raschle, Nora; Zuk, Jennifer; Ortiz-Mantilla, Silvia; Sliva, Danielle D.; Franceschi, Angela; Grant, P. Ellen; Benasich, April A.; Gaab, Nadine

    2012-01-01

    Structural and functional magnetic resonance imaging (fMRI) has been used increasingly to investigate typical and atypical brain development. However, in contrast to studies in school-aged children and adults, MRI research in young pediatric age groups is less common. Practical and technical challenges occur when imaging infants and children, which presents clinicians and research teams with a unique set of problems. These include procedural difficulties (e.g., participant anxiety or movement restrictions), technical obstacles (e.g., availability of child-appropriate equipment or pediatric MR head coils), and the challenge of choosing the most appropriate analysis methods for pediatric imaging data. Here, we summarize and review pediatric imaging and analysis tools and present neuroimaging protocols for young nonsedated children and infants, including guidelines and procedures that have been successfully implemented in research protocols across several research sites. PMID:22524338

  2. 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. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. 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…

  4. 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…

  5. The effect of preoperative nutritional face-to-face counseling about child's fasting on parental knowledge, preoperative need-for-information, and anxiety, in pediatric ambulatory tonsillectomy.

    PubMed

    Klemetti, Seija; Kinnunen, Ilpo; Suominen, Tarja; Antila, Heikki; Vahlberg, Tero; Grenman, Reidar; Leino-Kilpi, Helena

    2010-07-01

    The objective of this study was to define how preoperative nutritional face-to-face counseling on child's fasting affects parental knowledge, preoperative need-for-information, and anxiety, in pediatric ambulatory tonsillectomy. The participants in the prospective, randomly allocated study were parents (intervention 62/control 62) with children (4-10 years) admitted for ambulatory tonsillectomy. Data were collected by the knowledge test designed for the study and with The Amsterdam preoperative anxiety and information scale (APAIS). The intervention group was invited to a preoperative visit to receive written and verbal face-to-face counseling. They were initiated into the child's active preoperative nutrition. The parents of the control group received current information without face-to-face counseling. The parents followed the instructions. Their knowledge about the child's fast increased (p=0.003), and need-for-information and anxiety decreased (p<0.0001) significantly. The preoperative face-to-face counseling with written information improves parental knowledge about the child's fasting and active preoperative nutrition, and relieves their need-for-information and anxiety. The primary responsibility remains with the health care professionals when the active preoperative nutrition of the child and counseling on it are introduced into nursing practice. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  6. The mighty oak faces challenges in the Pacific West

    Treesearch

    Gail Wells

    2010-01-01

    In popular imagination, the oak tree stands for strength, endurance, and longevity. But in the coastal lowlands and central valleys of British Columbia, Washington, Oregon, and California, oaks face a battery of natural and human-induced threats. Sudden oak death, caused by a virulent pathogen identified in 2000, has killed millions of tanoaks, California black oaks,...

  7. Economic Development: A Community College Faces the Challenge.

    ERIC Educational Resources Information Center

    Crowley, Jackie; Boatright, Joyce

    1988-01-01

    Faced with a changing economy, the Houston Community College System (Texas) set goals and objectives to pull together its resources in response to the crisis in the Houston area. This article describes successful strategies and approaches used to network, market, and develop company partnerships and training activities to meet local needs. (Author)

  8. Dental laboratory technology in crisis, part II: Potential solutions to the challenges facing the industry.

    PubMed

    Christensen, Gordon J; Yancey, William

    2005-06-01

    The dental laboratory industry appears to need immediate change to face many challenges, the four most significant of which are described in this column and in our column in May JADA. The first article on this subject described the current challenges facing the laboratory industry, as determined by conference attendees representing all aspects of the dental industry and related professions. This article reports on the suggestions made by attendees of this conference to solve the identified challenges.

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

    PubMed

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

    2012-09-01

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

  10. Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): Design and Methods

    PubMed Central

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

    2012-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Detomo, R.

    2005-05-01

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

  12. 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…

  13. 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…

  14. A Challenging Giant Dermatofibrosarcoma Protuberans on the Face

    PubMed Central

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

    2016-01-01

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

  15. 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…

  16. 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.

  17. 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.

  18. Challenges Facing Chinese International Students Studying in the United States

    ERIC Educational Resources Information Center

    Ching, Yuerong; Renes, Susan L.; McMurrow, Samantha; Simpson, Joni; Strange, Anthony T.

    2017-01-01

    Chinese international students often find it challenging to adjust to attending college in the United States (US). There is limited research addressing Chinese international college students' adjustment in the US. Drawing on what literature exists combined with research addressing Chinese immigrants' transition and international students'…

  19. Issues and Challenges Facing the Minority Woman Dentist.

    ERIC Educational Resources Information Center

    Sinkford, Jeanne C.

    1992-01-01

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

  20. Community Services Programs Face Legal and Financial Challenges.

    ERIC Educational Resources Information Center

    Travis, Tom

    2000-01-01

    States that, while community colleges have expanded their programs and services over the past 20 years, certain federal agencies have begun issuing regulations that challenge the rights of colleges to conduct some activities as part of their nonprofit status. Urges institutions to examine the legal and financial implications that might confront…

  1. 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…

  2. 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…

  3. Challenges Facing Educational Research: Educational Review Guest Lecture 2005

    ERIC Educational Resources Information Center

    Pollard, Andrew

    2006-01-01

    This article draws on the author's experience as Director of the Teaching and Learning Research Programme (TLRP), the UK's largest coordinated educational research initiative, to review some recent developments in the field and, in particular, some major contemporary challenges. In response to critiques of educational research of the late 1990s,…

  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. 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.)

  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. 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…

  8. 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.

  9. Expert opinion: the therapeutic challenges faced by statin intolerance.

    PubMed

    Patel, Jaideep; Martin, Seth S; Banach, Maciej

    2016-08-01

    Statin intolerance is largely defined by muscle related symptoms, leading to intolerability and cessation. The nocebo effect coupled with the challenges of diagnosing statin myopathy undermines drug adherence that is critical for achieving the benefits of lipid-lowering and cardiovascular risk reduction. A temporal relationship should be made between the initiation of therapy and development of symptoms to aid in diagnosis. The mainstay of treatment is statin cessation or statin dose reduction and evaluation of alternative causes for muscle related symptoms. Most symptoms usually resolve within 2 weeks of discontinuing therapy. The patient can be re-challenged with the same statin at a lower dose or an alternative statin. Non-statin lipid lowering therapies offer an alternative to patients who cannot tolerate statins. We discuss current guideline-focused management of patients with statin intolerance. When initiating statin therapy, attention to risk factors for statin intolerance is strongly recommended. Most patients will tolerate some degree of statin therapy; thus statin re-challenge is advisable. If alternative dosing regimens are not tolerated, non-statin medications are acceptable alternatives. To limit errors in the diagnosis of statin intolerance, improvements in clinician-patient communication about the side effects and benefits of statins should be attempted.

  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. 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%…

  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. Facing and Overcoming Sensitivity Challenges in Biomolecular NMR Spectroscopy.

    PubMed

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

    2015-08-03

    In the Spring of 2013, NMR spectroscopists convened at the Weizmann Institute in Israel to brainstorm on approaches to improve the sensitivity of NMR experiments, particularly when applied in biomolecular settings. This multi-author interdisciplinary Review presents a state-of-the-art description of the primary approaches that were considered. Topics discussed included the future of ultrahigh-field NMR systems, emerging NMR detection technologies, new approaches to nuclear hyperpolarization, and progress in sample preparation. All of these are orthogonal efforts, whose gains could multiply and thereby enhance the sensitivity of solid- and liquid-state experiments. While substantial advances have been made in all these areas, numerous challenges remain in the quest of endowing NMR spectroscopy with the sensitivity that has characterized forms of spectroscopies based on electrical or optical measurements. These challenges, and the ways by which scientists and engineers are striving to solve them, are also addressed. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Issue and challenges facing rechargeable thin film lithium batteries

    SciTech Connect

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

    2008-08-04

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

  16. Chronic pediatric diseases into adulthood and the challenge of adolescence.

    PubMed

    Sommelet, Danièle

    2013-01-01

    One of the priorities of public health is to improve the equity of access to a continuous interdisciplinary medical and social survey of patients with chronic complex conditions, and, notably, the switch from pediatric to adult-oriented healthcare, including the specific issues of adolescence. In spite of the many barriers related to the patients, their family, pediatricians, and even adult health providers, the concept of a planned, dynamic, multidisciplinary transition program has to be designed around the adolescent with the aim of reinforcing his autonomy, coordinating medical care, and addressing his educational/professional and psychosocial needs. The primary care physician is the pivot of adult heathcare, and should have a close relationship with the private or hospital referent specialist and paramedical structures. A key worker may make an important contribution to the coordination, the registration, and the follow-up of some cohorts. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. 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.

  18. Raising the social yield of research: challenge facing biotechnology.

    PubMed

    Grimaud, J A

    2001-12-01

    The biological revolution is the latest in a series of scientific revolutions that have ushered in a new era in physics, chemistry, industry, and composite materials. The latest instruments of life - bioengineering for and by the living - challenge mankind with a number of fundamental questions, while offering an unprecedented series of opportunities. Alternative biotechnologies, biological agriculture for the environment, genomics applied to preventive medicine, genetic engineering are just a few of the benefits mankind may reap from bioengineering. Modern society demands more knowledge, and it is up to public authorities to invest in outreach programs to make public the latest scientific activities and findings. In the case of biotechnologies, it is particularly true that the product of research is not complete until its benefits are returned to society.

  19. 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.

  20. Facing the challenges in human resources for humanitarian health.

    PubMed

    Mowafi, Hani; Nowak, Kristin; Hein, Karen

    2007-01-01

    The human resources crisis in humanitarian health care parallels that seen in the broader area of health care. This crisis is exacerbated by the lack of resources in areas in which humanitarian action is needed--difficult environments that often are remote and insecure--and the requirement of specific skill sets is not routinely gained during traditional medical training. While there is ample data to suggest that health outcomes improve when worker density is increased, this remains an area of critical under-investment in humanitarian health care. In addition to under-investment, other factors limit the availability of human resources for health (HRH) in humanitarian work including: (1) over-reliance on degrees as surrogates for specific competencies; (2) under-development and under-utilization of national staff and beneficiaries as humanitarian health workers; (3) lack of standardized training modules to ensure adequate preparation for work in complex emergencies; (4) and the draining of limited available HRH from countries with low prevalence and high need to wealthier, developed nations also facing HRH shortages. A working group of humanitarian health experts from implementing agencies, United Nations agencies, private and governmental financiers, and members of academia gathered at Hanover, New Hampshire for a conference to discuss elements of the HRH problem in humanitarian health care and how to solve them. Several key elements of successful solutions were highlighted, including: (1) the need to develop a set of standards of what would constitute "adequate training" for humanitarian health work; (2) increasing the utilization and professional development of national staff; (3) "training with a purpose" specific to humanitarian health work (not simply relying on professional degrees as surrogates); (4) and developing specific health task-based competencies thereby increasing the pool of potential workers. Such steps would accomplish several key goals, such as

  1. Challenges Faced by Pre-Service Chemistry Teachers Teaching in a Laboratory and Their Solution Proposals

    ERIC Educational Resources Information Center

    Yalcin-Celik, Ayse; Kadayifci, Hakki; Uner, Sinem; Turan-Oluk, Nurcan

    2017-01-01

    This study examines the challenges faced by pre-service chemistry teachers teaching in a laboratory and their proposed solutions to these challenges. The study was conducted in a 13-week-long methodology course. Written statements from participants and observations from researchers were used as data sources. From these data, it was found that the…

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. Disposable sensors: technical and operational challenges facing military employment

    NASA Astrophysics Data System (ADS)

    Nocita, Shawn K.; Bales, Jason M.

    2005-05-01

    Advances in technologies are providing opportunities to increase situational awareness in military operations. One application of these technologies is small disposable sensor systems that have the potential to enhance the war-fighter's lethality and survivability. Considering that the sensors must be disposable, cost constraints increase the complexity of solving the technical and operational challenges. This paper will address two areas of consideration when designing disposable sensor systems: technical and operational. Technical design considerations: Sensor communication networks are a hot area of development, with a multitude of standards and protocols to choose from. Miniaturization is providing a multitude of sensor modalities that can be considered for a disposable sensor. Decisions must be made between factors such as cost, size, and power requirements. Power management through hardware and software, coupled with more efficient batteries, is giving extended life to sensor systems. Environmental issues must be addressed in a disposable system. Operational design considerations: For systems monitored and managed directly by soldiers, one of the most important elements is the user interface, and its affect on overall system ease-of-use. System usefulness is also affected by the capability to autonomously monitor the area where sensors are deployed without a soldier present. The packaging of sensors will be affected by the current state of technology integrated into the sensors, as well as requirements for emplacement. These emplacement requirements and constraints will impact the operational effectiveness of the overall system.

  8. Towards Lead-Free Piezoceramics: Facing a Synthesis Challenge

    PubMed Central

    Villafuerte-Castrejón, María Elena; Morán, Emilio; Reyes-Montero, Armando; Vivar-Ocampo, Rodrigo; Peña-Jiménez, Jesús-Alejandro; Rea-López, Salvador-Oliver; Pardo, Lorena

    2016-01-01

    The search for electroceramic materials with enhanced ferro-pyro-piezoelectric properties and revealing the perovskite type structure has been the objective of a significant number of manuscripts reported in the literature. This has been usually carried out by proposing the synthesis and processing of new compounds and solid solution series. In this work, several methods to obtain ferro-pyro-piezoelectric families of materials featuring the well-known ABO3 perovskite structure (or related) such as BaTiO3, Ba1–xCaxTi1–yZryO3, (Bi0.5Na0.5)TiO3, (K0.5Na0.5)NbO3 and their solid solutions with different cations either in the A or B positions, are presented. For this kind of materials, the challenge for obtaining a single phase compound with a specific grain size and morphology and, most importantly, with the adequate stoichiometry, will also be discussed. The results reviewed herein will be discussed in terms of the tendency of working with softer conditions, i.e., lower temperature and shorter reaction times, also referred to as soft-chemistry. PMID:28787822

  9. 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.

  10. 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

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

    PubMed

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

    2014-03-01

    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. 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 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. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  13. Challenges Facing a Deaf Family Member Concerning a Loved One’s Dying

    PubMed Central

    Kehl, Karen A.; Gartner, Constance M.

    2010-01-01

    Individuals who are Deaf face challenges both similar and unique from those faced by hearing individuals when a family member is dying. This study was guided by the question “What are the challenges faced by a Deaf family member when a loved one is dying?” Methods - This qualitative study is guided by critical theory and an interpretive perspective. Robert, a college-educated older adult who has been Deaf from birth was interviewed in American Sign Language using a death history format. Results – There are challenges for Deaf family members that affect communication with both the dying person and health care professionals. Patient-family communication issues included physical challenges and financial challenges. Lack of cultural competence concerning the Deaf community created challenges communicating with professionals. Decision-making was also a challenge. Conclusions These findings provide a framework for future research concerning the needs of Deaf individuals facing the end of life and provide guidance for clinicians. PMID:19910395

  14. Challenges facing primary care practices aiming to implement patient-centered medical homes.

    PubMed

    Farmer, Melissa M; Rose, Danielle E; Rubenstein, Lisa V; Canelo, Ismelda A; Schectman, Gordon; Stark, Richard; Yano, Elizabeth M

    2014-07-01

    While the potential of patient-centered medical homes (PCMH) is promising, little is known empirically about the frontline challenges that primary care (PC) leaders face before making the decision to implement PCMH, let alone in making it a reality. Prior to the design and implementation of the Veterans Health Administration's (VA) national PCMH model--Patient Aligned Care Teams (PACT)--we identified the top challenges faced by PC directors and examined the organizational and area level factors that influenced those challenges. A national cross-sectional key informant organizational survey was fielded to the census of PC directors at VA medical centers and large community-based outpatient clinics (final sample n = 229 sites). PC directors were asked to rate the degree to which they faced 48 management challenges in eight PCMH-related domains (access, preventive care, chronic diseases requiring care in PC, challenging medical conditions, mental health/substance abuse, special populations, PC coordination of care, and clinical informatics). Responses were dichotomized as moderately-to-extremely challenging versus somewhat-slightly-not at all challenging. Items were rank ordered; chi square or regression techniques were used to examine variations in facility size, type, urban/rural location, and region. On average, VA PC directors reported 16 moderate-to-extreme challenges, and the top 20 challenges spanned all eight PCMH domains. Four of the top 20 challenges, including the top two challenges, were from the clinical informatics domain. Management of chronic non-malignant pain requiring opiate therapy was the third most reported challenge nationwide. Significant organizational and area level variations in reported challenges were found especially for care coordination. Better understanding of PC challenges ahead of PCMH implementation provides important context for strategic planning and redesign efforts. As a national healthcare system, the VA provides a unique

  15. Preclinical safety evaluations supporting pediatric drug development with biopharmaceuticals: strategy, challenges, current practices.

    PubMed

    Morford, LaRonda L; Bowman, Christopher J; Blanset, Diann L; Bøgh, Ingrid B; Chellman, Gary J; Halpern, Wendy G; Weinbauer, Gerhard F; Coogan, Timothy P

    2011-08-01

    Evaluation of pharmaceutical agents in children is now conducted earlier in the drug development process. An important consideration for this pediatric use is how to assess and support its safety. This article is a collaborative effort of industry toxicologists to review strategies, challenges, and current practice regarding preclinical safety evaluations supporting pediatric drug development with biopharmaceuticals. Biopharmaceuticals include a diverse group of molecular, cell-based or gene therapeutics derived from biological sources or complex biotechnological processes. The principles of preclinical support of pediatric drug development for biopharmaceuticals are similar to those for small molecule pharmaceuticals and in general follow the same regulatory guidances outlined by the Food and Drug Administration and European Medicines Agency. However, many biopharmaceuticals are also inherently different, with limited species specificity or immunogenic potential which may impact the approach taken. This article discusses several key areas to aid in the support of pediatric clinical use, study design considerations for juvenile toxicity studies when they are needed, and current practices to support pediatric drug development based on surveys specifically targeting biopharmaceutical development. © 2011 Wiley-Liss, Inc.

  16. Pediatric Hearing Aid Management: Challenges among Hispanic Families.

    PubMed

    Caballero, Ana; Muñoz, Karen; White, Karl; Nelson, Lauri; Domenech-Rodriguez, Melanie; Twohig, Michael

    2017-09-01

    Hearing aid fitting in infancy has become more common in the United States as a result of earlier identification of hearing loss. Consistency of hearing aid use is an area of concern for young children, as well as other hearing aid management challenges parents encounter that may contribute to less-than-optimal speech and language outcomes. Research that describes parent hearing aid management experiences of Spanish-speaking Hispanic families, or the extent of their needs, is not available. To effectively support parent learning, in a culturally sensitive manner, providers may benefit from having a better understanding of the needs and challenges Hispanic families experience with hearing aid management. The purpose of the current study was to describe challenges with hearing aid management and use for children from birth to 5 yr of age, as reported by Spanish-speaking parents in the United States, and factors that may influence hearing aid use. This study used a cross-sectional survey design. Forty-two Spanish-speaking parents of children up to 5 yr of age who had been fitted with hearing aids. Responses were obtained from surveys mailed to parents through early intervention programs and audiology clinics. Descriptive statistics were used to describe frequencies and variance in responses. Forty-seven percent of the parents reported the need for help from an interpreter during audiology appointments. Even though parents received information and were taught skills by their audiologist, many wanted to receive more information. For example, 59% wanted to know how to meet other parents of children who have hearing loss, although 88% had previously received this information; 56% wanted to know how to do basic hearing aid maintenance, although 71% had previously received instruction. The two most frequently reported hearing aid use challenges were fear of losing the hearing aids, and not seeing benefit from the hearing aids. Hearing aid use during all waking hours was

  17. Challenges in treating pediatric asthma in developing countries.

    PubMed

    Zar, Heather J; Levin, Michael E

    2012-12-01

    Asthma is the most common chronic disease in children in many low- and middle-income countries. In these settings, the burden of childhood asthma is increasing and is associated with severe disease. There are a number of challenges to providing optimal management of childhood asthma in such settings. These include under-diagnosis of childhood asthma, access to care, ability of healthcare workers to manage asthma, availability and affordability of inhaled therapy, environmental control of potential triggers, education of healthcare providers and of the public, and cultural or language issues. International and national guidelines for childhood asthma have been produced, but implementation remains a real challenge. Access to and affordability of essential inhaled asthma drugs, especially low-dose inhaled corticosteroids and short-acting bronchodilators, are major challenges to effective asthma control in many countries. A low-cost spacer made from a plastic bottle is effective for use with a metered-dose inhaler, but use must be included in asthma educational initiatives. Educational programs for healthcare personnel and for the public that are culturally and language appropriate are needed for effective implementation of asthma guidelines. Socioeconomic and structural barriers to care within health services remain obstacles to achieving optimal treatment of asthma for many children.

  18. Pediatric hearing aid use: parent-reported challenges.

    PubMed

    Muñoz, Karen; Olson, Whitney A; Twohig, Michael P; Preston, Elizabeth; Blaiser, Kristina; White, Karl R

    2015-01-01

    The aim of this study was to investigate parent-reported challenges related to hearing aid management and parental psychosocial characteristics during the first 3 years of the child's life. Using a cross-sectional survey design, surveys were distributed to parents of children with hearing loss via state Early Intervention programs in Utah and Indiana. Packets contained one family demographic form and two sets of three questionnaires to obtain responses from mothers and fathers separately: the Parent Hearing Aid Management Inventory explored parent access to information, parent confidence in performing skills, expectations, communication with the audiologist, and hearing aid use challenges. The Acceptance and Action Questionnaire measured psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual's ability to take value-based actions. The Patient Health Questionnaire identified symptoms of depression. Thirty-seven families completed questionnaires (35 mothers and 20 fathers). Most responses were parents of toddlers (M = 22 months) who had been wearing binaural hearing aids for an average of 15 months. Both mothers and fathers reported that even though the amount of information they received was overwhelming, most (84%) preferred to have all the information at the beginning, rather than to receive it over an extended time period. Parents reported an array of challenges related to hearing aid management, with the majority related to daily management, hearing aid use, and emotional adjustment. Sixty-six percent of parents reported an audiologist taught them how to complete a listening check using a stethoscope, however, only one-third reported doing a daily hearing aid listening check. Both mothers and fathers reported a wide range of variability in their confidence in performing activities related to hearing aid management, and most reported minimal confidence in their ability to

  19. Challenges in pediatric ambulatory anesthesia: kids are different.

    PubMed

    Collins, Corey E; Everett, Lucinda L

    2010-06-01

    The care of the child having ambulatory surgery presents a specific set of challenges to the anesthesia provider. This review focuses on areas of clinical distinction that support the additional attention children often require, and on clinical controversies that require providers to have up-to-date information to guide practice and address parental concerns. These include perioperative risk; obstructive sleep apnea; obesity; postoperative nausea and vomiting; neurocognitive outcomes; and specific concerns regarding common ear, nose, and throat procedures. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  20. Top 10 health care ethics challenges facing the public: views of Toronto bioethicists.

    PubMed

    Breslin, Jonathan M; MacRae, Susan K; Bell, Jennifer; Singer, Peter A

    2005-06-26

    There are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, Ontario, Canada, the purpose of which was to identify the top ethical challenges facing patients and their families in health care. A modified Delphi study was conducted with twelve clinical bioethicist members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. The panel was asked the question, what do you think are the top ten ethical challenges that Canadians may face in health care? The panel was asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds. The top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions. The second highest ranked challenge was waiting lists. The third ranked challenge was access to needed resources for the aged, chronically ill, and mentally ill. Although many of the challenges listed by the panel have received significant public attention, there has been very little attention paid to the top ranked challenge. We propose several steps that can be taken to help address this key challenge.

  1. DOD Personnel Clearances. DOD Faces Multiple Challenges in Its Efforts to Improve Clearance Processes for Industry Personnel

    DTIC Science & Technology

    2008-02-13

    Services, House of Representatives DOD PERSONNEL CLEARANCES DOD Faces Multiple Challenges in Its Efforts to Improve Clearance Processes for Industry...Personnel Clearances . DOD Faces Multiple Challenges in Its Efforts to Improve Clearance Processes for Industry Personnel 5a. CONTRACT NUMBER 5b...Accountability Office Why GAO Did This Study Highlights Accountability Integrity Reliability February 13, 2008 DOD PERSONNEL CLEARANCES DOD Faces Multiple

  2. Facing Challenges.

    ERIC Educational Resources Information Center

    Spoor, Dana L.

    1998-01-01

    Examines how the Dallas Independent School District (Texas) has been successful in passing new bond issues for school construction and renovation. The school district's strategic methodology is discussed, as are its management tactics in meeting diverse student needs, school safety, and student overcrowding. (GR)

  3. Challenges facing early infant diagnosis of HIV among infants in resource poor settings.

    PubMed

    Adebimpe, Wasiu O

    2013-03-01

    The number of children who have HIV continues to grow. Studies have confirmed dramatic survival benefits and mortality reduction for infants confirmed and managed as early as possible after diagnosis. With the advent of the Polymerase Chain Reaction technology, early infant diagnosis of HIV among children is easier and more reliable worldwide. Most HIV programmes in developing countries are donor dependent with less encouraging moves towards sustainability drive by the local health authority. The health systems also face a lot of challenges while implementing these programmes that would promptly identify HIV exposed babies as well as enrolment into care. This review examined challenges facing early infant diagnosis of HIV among infants in Nigeria.

  4. Challenges and potential solutions to educating learners about pediatric complex care.

    PubMed

    Bogetz, Jori F; Bogetz, Alyssa L; Bergman, David; Turner, Teri; Blankenburg, Rebecca; Ballantine, Allison

    2014-01-01

    To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators. Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory. Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners. Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  5. 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…

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

    PubMed

    Logie, Carmen; Dimaras, Helen; Fortin, Anny; Ramón-García, Santiago

    2014-04-15

    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. 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. 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. We propose a more balanced way forward

  7. 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

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

    PubMed Central

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

    2015-01-01

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

  9. 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.

  10. 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

  11. 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

  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. 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.

  14. Examining the Challenging Hindrances facing in the Construction Projects: South India’s Perspective

    NASA Astrophysics Data System (ADS)

    Subramanyam, K.; Haridharan, M. K.

    2017-07-01

    Developing countries like India require a huge infrastructure to facilitate needs of the people. Construction industry provides several opportunities to the individuals. Construction manager work is to supervise and organize the construction activities in construction projects. Now a day construction manager facing challenges. This paper aimed to study the challenges facing by the construction manager in the perception of construction professionals. 39 variables were taken from the literature review which found to be severe impact on construction managers’ performance. Construction manager, project manager and site engineers are the respondents for this survey. Using SPSS, regression analysis was done and recognized significant challenges. These challenges were classified into 5 domains. In management challenges, resource availability and allocation, risks and uncertainties existing in the project onsite, top management support and cost constraints are the most significant variables. In skills requirement of a construction manager challenges, technical skills required to learn and adapt new technology in the project, decision making and planning according to the situation in site are the most significant variables. In performance challenges, implementation of tasks according to the plan is the important variable whereas in onsite challenges, manage project risks, develop project policies and procedures are the most important.

  15. 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

  16. 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…

  17. 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…

  18. 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…

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

    ERIC Educational Resources Information Center

    Broskoske, Stephen L.; Harvey, Francis A.

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

  20. 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…

  1. The Challenges Facing the Implementation of Early Childhood Development and Education Policy in Bungoma County, Kenya

    ERIC Educational Resources Information Center

    Wangila, Violet Muyoka

    2017-01-01

    This paper scrutinises the challenges facing the implementation of Early Childhood Development and Education policy in Bungoma County, Kenya. The study used a mixed research design and study population comprised of the QASOs, the Head teachers, ECDE teachers and the non-teaching staff in respective ECDCs. The sample size of the study comprised of…

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

    ERIC Educational Resources Information Center

    Stevenson, Kenel

    2009-01-01

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

  3. 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…

  4. 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…

  5. 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…

  6. "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…

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

    ERIC Educational Resources Information Center

    Coope, Caroline M.; Theobald, Sally

    2006-01-01

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

  8. Rural Teachers' Views: What Are Gender-Based Challenges Facing Free Primary Education in Lesotho?

    ERIC Educational Resources Information Center

    Morojele, Pholoho

    2013-01-01

    This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use of the data generated from…

  9. 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…

  10. 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…

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

    ERIC Educational Resources Information Center

    Al-Jaradat, Mahmoud Khaled Mohammad

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  13. 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…

  14. 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…

  15. 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…

  16. 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…

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

    ERIC Educational Resources Information Center

    Lenth, Charles S.

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

  18. 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…

  19. Challenges Pre-Service Teachers Face When Implementing a 5E Inquiry Model of Instruction

    ERIC Educational Resources Information Center

    Enugu, Ramya; Hokayem, Hayat

    2017-01-01

    This study examined the challenges that pre-service teachers faced when implementing inquiry and their perspective on how to overcome them. The data sample was 55 pre-service teachers (PSTs) enrolled into two sections of a science methods course in a private university in North Texas. The data sources consisted of inquiry-based lesson plans, PST…

  20. 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…

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  2. 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…

  3. "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…

  4. 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…

  5. 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.…

  6. 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…

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

    ERIC Educational Resources Information Center

    Gagliardi, Frank

    2010-01-01

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

  8. [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.

  9. 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. © 2013 Pharmacotherapy Publications, Inc.

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

    PubMed Central

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

    2013-01-01

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

  11. 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.

  12. Challenges and opportunities to advance pediatric neuro-oncology care in the developing world.

    PubMed

    Chan, Michael H; Boop, Frederick; Qaddoumi, Ibrahim

    2015-08-01

    As the morbidity and mortality associated with communicable diseases continue to decrease in the developing world, the medical burden of childhood cancer continues to expand. Although international aid and relief groups such as the World Health Organization recognize the importance of childhood cancer, their main emphasis is on the more easily treated malignancies, such as leukemias and lymphomas, and not pediatric brain tumors, which are the second most common malignancy in children and the leading cause of cancer-related deaths in the pediatric population. Addressing the needs of these children is a growing concern of several professional neuro-oncology-related societies. Thus, the goal of this review is to describe the current state of pediatric neuro-oncology care in the developing world, address the current and future needs of the field, and help guide professional societies' efforts to contribute in a more holistic and multidisciplinary manner. We reviewed the literature to compare the availability of neuro-oncology care in various regions of the developing world with that in higher income nations, to describe examples of successful initiatives, and to present opportunities to improve care. The current challenges, previous successes, and future opportunities to improve neuro-oncology care are presented. The multidisciplinary nature of neuro-oncology depends on large teams of highly specialized individuals, including neuro-oncologists, neurosurgeons, neurologists, radiologists, radiation oncologists, pathologists, palliative care specialists, oncology nurses, physical therapists, occupational therapists, speech therapists, pediatric intensivists, and social workers, among others. Pediatric neuro-oncology is one of the most complex types of medical care to deliver, as it relies on numerous specialists, subspecialists, support staff, and physical resources and infrastructure. However, with increasing collaboration and advancing technologies, developed nations

  13. 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

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

    PubMed

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

    2009-01-01

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

  15. 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

  16. A qualitative evaluation of the challenges faced by dieticians when interviewing children.

    PubMed

    Sharman, Stefanie J; Powell, Martine B; Skouteris, Helen

    2016-05-01

    Investigative interviewing is a critical and challenging skill involved in the assessment and design of appropriate interventions for children's dietary problems. The current study provided an evaluation of the challenges faced by professional dieticians when conducting child investigative interviews, in the hope that this would provide a framework for the development of further guidance and resources in this important area. Fourteen professional dieticians were interviewed; they were asked about the information that they needed to elicit from children in particular situations and the questions that they would ask to do so. They were also asked to describe the strengths and limitations of the techniques that they used. The results revealed that professionals faced three main challenges. The first challenge was eliciting information from children who did not want to answer questions. The second challenge was determining the level of accuracy in children's (and caregivers') responses. The third challenge was eliciting very specific information in particular situations, such as determining the cause of an allergic reaction. Overall, professionals had difficulty articulating the questions that they would use to elicit the information that they required; indeed, their responses focused more on the content that they wanted to elicit (such as specific details) rather than the overall process that they would use to do so. Professionals may benefit from the development of guidelines to assist them in their interviews with children, based on what is currently known about interviewing children generally. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The organisational and human resource challenges facing primary care trusts: protocol of a multiple case study

    PubMed Central

    2001-01-01

    Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development. PMID:11737883

  18. Common Challenges Faced by Women of Color in Physics, and Actions Faculty Can Take to Minimize Those Challenges

    NASA Astrophysics Data System (ADS)

    Johnson, Angela; Ong, Maria; Ko, Lily T.; Smith, Janet; Hodari, Apriel

    2017-09-01

    Women of color are deeply underrepresented in physics. Between 2002 and 2012, only 1% of graduating physics majors were Black women and another 1% were Latinas; only 61 American Indian women total completed degrees in physics in those years (out of 48,000 physics majors). This isolation can lead to additional obstacles that women of color majoring in physics must face above and beyond the challenging material. In this article we draw on qualitative findings to describe common obstacles women of color face. However, departments can take deliberate steps so that underrepresentation need not turn into loneliness and isolation. We describe the characteristics of a department where women of color report that they are thriving. We end with concrete steps physics faculty can take to support women physics majors of color.

  19. 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

  20. 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.

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

    PubMed Central

    2011-01-01

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

  2. 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…

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

    PubMed

    McLeigh, Jill D; Melton, Gary B

    2015-09-01

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

  4. 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.

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

    PubMed Central

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

    2012-01-01

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

  6. 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

  7. Defense Acquisitions: Navy Faces Challenges Constructing the Aircraft Carrier Gerald R. Ford within Budget

    DTIC Science & Technology

    2007-08-01

    the nuclear propulsion and electric plant, three systems—the electromagnetic aircraft launch system ( EMALS ), the dual band radar, and the advanced...Technologies’ Impact on Ship Capability 14 Table 5: Matrix of the Impact of Critical Technologies 15 Table 6: Schedule of Key Events Relating to EMALS 17...Table 7: Challenges Faced by the EMALS Program in Meeting Program Requirements 18 Table 8: Schedule of Key Events Relating to Dual Band Radar 20

  8. 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

  9. Challenges faced by former child soldiers in the aftermath of war in Uganda.

    PubMed

    Vindevogel, Sofie; De Schryver, Maarten; Broekaert, Eric; Derluyn, Ilse

    2013-06-01

    Warfare takes a profound toll of all layers of society, creating multiple and multilevel challenges that impinge on the psychosocial well-being of affected individuals. This study aims to assess the scope and salience of challenges confronting former child soldiers and at identifying additional challenges they face compared to non-recruited young people in war-affected northern Uganda. The study was carried out with a stratified random sample of northern Ugandan adolescents (n = 1,008), of whom a third had formerly been recruited (n = 330). The mixed-method comparison design consisted of a constrained free listing task to determine the challenges; a free sorting task to categorize them into clusters; and statistical analysis of their prevalence among formerly recruited youth and of how they compare with those of nonrecruited youth. Altogether, 237 challenges were identified and clustered into 15 categories, showing that formerly recruited participants mainly identified "emotional" and "training and skills"-related challenges. Compared with nonrecruited counterparts, they reported significantly more "emotional" and fewer "social and relational" challenges, with the exception of stigmatization. Overall, there was similarity between the challenges reported by both groups. The challenges confronting formerly recruited youths reach well beyond the effects of direct war exposure and emerge mainly from multiple influence spheres surrounding them. These challenges are largely shared in common with nonrecruited youths. This multidimensional and collective character of challenges calls for comprehensive psychosocial interventions through which healing the psychological wounds of war is complemented by mending the war-affected surroundings at all levels and in all life areas. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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

    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

    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. 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. 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. 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 rheumatology and for adaptation to other chronic

  15. 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

  16. 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.

  17. 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.

  18. 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)…

  19. 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)…

  20. [Cross merging promoting innovative development: a discussion on challenges and opportunities that burn surgery faces].

    PubMed

    Hu, D H; Liu, J Q

    2016-01-01

    Burn surgery in the 21st century is now facing both serious challenges and opportunities for development. Interlacing of different disciplines is not only the source of scientific innovation and development in science of burn surgery, but also the trend of advancement of the discipline in the future. Therefore, it is imperative that burn surgery should strengthen multidisciplinary cooperation in order to develop new treatment concept and technology, widen and deepen basic researches with interdisciplinary methodology, and combine the translational medicine, integration medicine, and precision medicine, in order to form the salient feature of discipline of burn surgery.

  1. Critical care for pediatric asthma: wide care variability and challenges for study.

    PubMed

    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

    2012-07-01

    To describe pediatric severe asthma care, complications, and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network. Retrospective cohort study. : Pediatric intensive care units in the United States that submit administrative data to the Pediatric Health Information System. Children 1-18 yrs old treated in a Pediatric Health Information System pediatric intensive care unit for asthma during 2004-2008. None. Thirteen-thousand five-hundred fifty-two children were studied; 2,812 (21%) were treated in a Collaborative Pediatric Critical Care Research Network and 10,740 (79%) were treated in a non-Collaborative Pediatric Critical Care Research Network pediatric intensive care unit. Medication use in individual Collaborative Pediatric Critical Care Research Network 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 Collaborative Pediatric Critical Care Research Network centers were representative of pediatric asthma care at non-Collaborative Pediatric Critical Care Research Network pediatric intensive care units. Median length of pediatric intensive care unit stay at Collaborative Pediatric Critical Care Research Network centers was 1 to 2 days and death was rare (0.1%-3%). Ten percent of children treated at Collaborative Pediatric Critical Care Research Network centers received invasive mechanical ventilation compared to 12% at non-Collaborative Pediatric Critical Care Research Network centers. Overall 44% of patients who received invasive mechanical ventilation were intubated in the pediatric intensive care unit. Children intubated outside the pediatric intensive care unit had significantly shorter median ventilation days (1 vs. 3), pediatric intensive care unit days (2

  2. Understanding what residents want and what residents need: the challenge of cultural training in pediatrics.

    PubMed

    Macdonald, Mary Ellen; Carnevale, Franco A; Razack, Saleem

    2007-06-01

    There is increasing recognition of the need for sophistication in the way culture is understood and taught in medicine. A two-phase study designed to understand how best to approach cultural training with pediatric residents was conducted. A needs assessment, consisting of resident and faculty focus groups, was carried out from which a workshop was developed for pediatric residents. The aims were to increase knowledge of local cultures and resources as well as to encourage self-reflection and awareness of cultural issues. Focus group participants were consistent in identifying needs for training in: (1) a specific knowledge base of local cultural groups; (2) skills to better negotiate cultural encounters; (3) reconciling general cultural knowledge with an understanding of individual patient/family beliefs and practices. Analysis of focus group and workshop data suggests that culture is seen as both an obstacle and challenge. Cultural training in medicine uncovers a clash of epistemologies: the promotion of culturally-centered medicine is 'strange' to learners situated within a pedagogical tradition based on a 'familiar' reductionistic view of health. Reconciling these divergent epistemologies requires a paradigm shift in how medicine understands culture and cultural training. These findings raise questions for consideration in other residency programs.

  3. 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.

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

    PubMed

    Parker, Vicki; McMillan, Margaret

    2007-04-01

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

  5. 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.

  6. [Challenges in the Analysis of Health Care Inequalities in Pediatric Rehabilitation].

    PubMed

    Fach, E-M; Schumann, N; Günther, S; Richter, M

    2016-04-01

    Social inequalities on access and utilization of inpatient rehabilitation among adolescents have rarely been studied. Parents of children with chronic health conditions (age of 7-17) were interviewed about access and utilization of inpatient rehabilitation. Parents were recruited through pediatricians as well as rehabilitation centers in Central Germany. Despite of numerous recruitment measures the participation by pediatricians was low. Also expanding the sample did not remedial. Furthermore, fewer adolescents with need of rehabilitation were achieved than expected. The analysis is subject to these restrictions, nevertheless, they still allow explorative statements about access and utilization of pediatric rehabilitation. Despite major challenges in recruitment, pediatricians should be considered into analysis of inequalities in rehabilitation because of their gatekeeper function. © Georg Thieme Verlag KG Stuttgart · New York.

  7. 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

  8. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

    PubMed

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

    2013-01-01

    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. 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. 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. 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 important source of evidence in that effort.

  9. 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

  10. The challenges facing midwifery educators in sustaining a future education workforce.

    PubMed

    Albarran, John W; Rosser, Elizabeth A

    2014-08-01

    national and international trends have identified concerns over the ability of health and social care workforces in meeting the needs of service users. Attention has increasingly been drawn to problems of recruiting and retaining professionals within higher education; however data in relation to the midwifery profession is scant. to examine the perceptions and experiences of midwifery educators, in south-west England, about the challenges facing them sustaining the education workforce of the future. a mixed methodology approach was adopted involving heads of midwifery education and midwife educators. midwifery participants were recruited from three higher education institutions in south west England. Data collection comprised of self-administered questionnaires plus individual qualitative interviews with heads of midwifery education (n=3), and tape recorded focus groups with midwife academics (n=19). Numerical data were analysed using descriptive statistics. Textual data were analysed for themes that represented the experiences and perspectives of participants. Ethics approval was granted by one University Ethics committee. demographic data suggests that within south-west England, there is a clear ageing population and few in possession of a doctorate within midwifery. The six identified sub-themes represented in the data describe challenges and tensions that midwifery academics experienced in their efforts to attract new recruits and retain those in post in a highly changing educational environment which demands more from a contracting workforce. there remain some serious challenges facing midwifery educators in sustaining the future education workforce, which if unresolved may jeopardise standards of education and quality of care women receive. Active succession planning and more radical approaches that embrace flexible careers will enable educational workforce to be sustained and by a clinically credible and scholarly orientated midwifery workforce. Copyright

  11. Challenges facing HIV-positive persons who use drugs and their families in Vietnam.

    PubMed

    Lee, Sung-Jae; Li, Li; Lin, Chunqing; Tuan, Le Anh

    2015-01-01

    It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Thọ Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members' depressive symptoms, tangible support, and caregiver burden.

  12. 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

  13. Thermal challenges facing new-generation light-emitting diodes (LEDs) for lighting applications

    NASA Astrophysics Data System (ADS)

    Petroski, James

    2002-11-01

    Light Emitting Diodes (LEDs) have progressed in recent years from emitting indicator level lighting to emitting enough light for illumination applications. This has opened a new field for LED applications, resulting in significant advantages over conventional light sources and creating some application challenges unique to LEDs. Methods used in the past for packaging LEDs, such as the T 1 3/4 or 5mm through-hole package, were suitable for the indicating lamp industry but have proved poor for high brightness LEDs driven at relatively high power due to temperature rises. Conventional lighting methods provide little guidance for LED thermal problems since these usually involve a very high temperature source, such as a filament or an arc, and radiant heat transfer dissipates the thermal energy. A typical incandescent bulb, for example, radiates 85-95% of the thermal energy away; the remainder is dissipated by conduction to the socket or naturally convected to the atmosphere. LED junction temperatures are limited to much lower values and hence the heat transfer system cannot depend upon radiant energy transfer. This means the cooling methods for lighting now shift from primarily radiation to conduction and natural convection, and this is paradigm shift that lighting designers must recognize when moving to LEDs. In this presentation, the thermal challenges facing LED lighting applications are discussed. Developments in packaging of die into Level 1 products are shown, and the thermal challenges of high brightness LED applications caused by the paradigm shift of heat transfer methods for lighting are discussed.

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

    PubMed

    Guarneri, Erminia; King, Rauni Prittinen

    2015-11-01

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

  15. 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

  16. Small Schools Face the Challenge: A Case Study of a Group of Small Rural Schools in New Zealand.

    ERIC Educational Resources Information Center

    Yates, Russell

    Small rural schools have always had an important place in the educational life of New Zealand, but they have faced a number of challenges in the past decade. These challenges include difficulty in attracting and retaining high quality teachers, changing expectations of parents, decreasing rural population, and the impact of national educational…

  17. 78 FR 15958 - Submission for OMB Review; 30-day Comment Request: Pediatric Palliative Care Campaign Pilot Survey

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-13

    ...: Pediatric Palliative Care Campaign Pilot Survey SUMMARY: Under the provisions of Section 3507(a)(1)(D) of.... Proposed Collection: Pediatric Palliative Care Campaign Pilot Survey, ] 0925-New--National Institute of... developed a Pediatric Palliative Care Campaign to address the communications challenges faced by health...

  18. 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.

  19. Resilient excellence: challenges faced by trailblazing women in U.S. sport psychology.

    PubMed

    Whaley, Diane E; Krane, Vikki

    2012-03-01

    Consistent with other sciences (e.g, Kass-Simon, 1993; Tang 2006), the field of kinesiology has been called a "masculine domain," which has an institutionalized culture biased against women (Brackenridge, Mutrie, & Choi, 2005). This paper represents the second part of a larger project that examined the life histories of eight trailblazing women in sport and exercise psychology. In the first paper (Krane & Whaley, 2010) we made the case for replacing these women into the history of sport psychology, based on their contributions to research, teaching and service to the field. In this study, we explored the experiences of these women with regard to the challenges they faced and how they overcame or coped with them. The specific themes emerging from the data analysis were the trailblazers' graduate school and early professional experiences, general campus climates, departmental politics, gender or discipline, coping and the cost of caring and giving back and moving forward.

  20. Flexray - An Answer to the Challenges Faced by Spacecraft On-Board Communication Protocols

    NASA Astrophysics Data System (ADS)

    Gunes-Lasnet, S.; Furano, G.

    2007-08-01

    The current spacecraft on-board network protocols are facing challenges: They need to consume low power, to handle a high data rate, and eventually need to have real-time capabilities as well as fault-tolerance; all of this at a low cost. Meanwhile, the automotive protocols are showing ever increasing enhanced performances: the automotive industry has shown recent break-throughs in communication networks. Among them, FlexRay targets specifically the next generation of automotive applications allowing Steer-by-Wire and Brake-by- Wire. FlexRay supports a very high data rate, is fault- tolerant, has real-time capabilities, and supports both periodic and aperiodic data transfer on a single bus. Space avionics has benefited from the automotive spin- ins in the past, so could FlexRay answer the space systems demands? This paper aims at demonstrating that space avionics could profit from the use of FlexRay.

  1. Integrating an Aboriginal perspective: Issues and challenges faced by non-Aboriginal biology teachers

    NASA Astrophysics Data System (ADS)

    Blood, Tracy Lynn

    This exploratory case study investigated the ways non-Aboriginal teachers of Biology conceive of incorporating Aboriginal perspectives into their delivery of the Biology curriculum in Alberta. The participants in this study were non-Aboriginal Biology teachers teaching in schools with predominantly non-Aboriginal students. Semi-structured interviews were conducted with each of the teacher participants and explored issues and challenges that they face infusing Aboriginal contexts into their teaching. The qualitative data generated were coded using themes developed from a conceptual framework for curriculum implementation. The majority of the teachers saw value in incorporating Aboriginal perspectives but shared concerns due to: unclear definitions of Aboriginal and Aboriginal perspectives; an inadequate knowledge base; and lack of material resources and professional development opportunities. Recommendations to help non-Aboriginal teachers include: better access to and targeted professional development and resources; greater clarification on the definitions of Aboriginal and Aboriginal perspectives; and greater amounts of administrative and governmental support.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

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

    PubMed

    Anton, Kristin

    2016-08-01

    As surgery for complex congenital heart disease is becoming more advanced, an increasing number of patients are surviving into adulthood, yet many of these adult patients remain in the pediatric hospital system. Caring for adult patients is often a challenge for pediatric nurses, because the nurses have less experience and comfort with adult care, medications, comorbid conditions, and rehabilitation techniques. As these patients age, the increased risk of complications and comorbid conditions from their heart disease may complicate their care further. Although these patients are admitted on a pediatric unit, nurses can aid in promoting their independence and help prepare them to transition into the adult medical system. Nurses, the comprehensive medical teams, and patients' families can all effectively influence the process of preparing these patients for transition to adult care. ©2016 American Association of Critical-Care Nurses.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. From Toques to Tokes: Two challenges facing nationwide legalization of cannabis in Canada.

    PubMed

    Bear, Daniel

    2017-04-01

    In 2015, a new Liberal Government came to power in Canada, elected on a platform that included legalization and regulation of cannabis for recreational purposes. Their legislation, based on recommendations from a Federal Task Force on Marijuana Legalization and Regulation, is due in early April 2017. This commentary utilizes Canadian Federal policy papers, previous literature, and internal and international agreements to examine two key areas critical to the development of a nationwide regulated market for cannabis in Canada; the need to overcome restrictions to legalizing cannabis in United Nations' drug control treaties, and the unique challenges that non-medical cannabis creates for navigating interprovincial trade policies in Canada. Irrespective of UN conventions that appear to prohibit legalization of cannabis the Government is preparing to bring forward legislation as this article goes to print. At the same time significant squabbles impede the selling of even beer and wine inter-provincially in Canada. This paper identifies the challenges facing Canadian legalization efforts, but also shows how the legalization legislation may provide opportunities to engender significant change beyond the simple legalization of a specific drug. This commentary does not argue for any specific course of action for Canada, but rather explores the nuance of legalization absent from the declaration in the Liberal party platform. The paper argues that Canada's efforts may hasten the dismantling of the UN drug control structure, and provide renewed opportunities for intern-provincial trade in Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. 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. © 2015 New York Academy of Sciences.

  14. Challenges facing young African scientists in their research careers: A qualitative exploratory study.

    PubMed

    Kumwenda, Save; Niang, El Hadji A; Orondo, Pauline W; William, Pote; Oyinlola, Lateefah; Bongo, Gedeon N; Chiwona, Bernadette

    2017-03-01

    Africa accounts for 14% of world's population, and the economies of most African countries are considered to be growing, but this is not reflected in the amount of research published by Africans. This study aimed at identifying the challenges that young African scientists face in their career development. This was a qualitative exploratory study involving young researchers who attended the Teaching and Research in Natural Sciences for Development (TReND) in Africa scientific writing and communication workshop, which was held in Malawi in September 2015. A semi-structured questionnaire was sent to all workshop participants who consented to taking part in the survey. In total, 28 questionnaires were sent via email and 15 were returned, representing a response rate of 53.6%. Data were analysed using thematic analysis. Young Africans develop their research interests various ways. The most common career-promoting factors identified by the study participants included formal classroom learning, aspirations to attain academic qualifications, work satisfaction, and the desire to fulfill parents' dreams. Challenges cited by survey respondents included a lack of mentorship, funds, and research and writing skills. Lack of interest in research by policymakers, lack of motivation by peers, and heavy workload (leaving little time for research) were also reported as challenges. Respondents suggested that grants specifically targeting young scientists would be beneficial. Participants also urged for the establishment of mentorship programmes, increasing motivation for research, and more frequent training opportunities. There is need for improved funding for institutional and research network strengthening in Africa, with particular attention given to expanding opportunities for young researchers.

  15. Rewards and unique challenges faced by African-American custodial grandmothers: the importance of future planning.

    PubMed

    Crowther, Martha R; Huang, Chao-Hui Sylvia; Allen, Rebecca S

    2015-01-01

    This exploratory study examined the context and consequences of custodial grandparenting, along with attitudes and preferences regarding future planning among 22 African-American custodial grandmothers. A mixed-method research design was employed. Based on our integration of two theories regarding future planning and health behavior change, caregiving, emotional distress, religiosity and spirituality, and future planning were assessed using questionnaires along with semi-structured interviews. African-American custodial grandmothers (mean age M = 53.64, SD = 9.58) perceived their caregiving role as rewarding (72%) yet challenging (86%). More than 40% reported significant emotional distress (CES-D ≥ 16) that warrants clinical attention. Findings showed that while 64% of study participants had future plans regarding who will substitute in their caregiving role if they become incapacitated, only 9% had completed a living will. Three major themes emerged regarding custodial grandmothers' caregiving role which includes: (1) rewards; (2) challenges including feeling overwhelmed and health concerns; and (3) caregiving decisions including conflicts between 'My plan was…/put self on-hold' for grandchildren and difficulty with future planning. These themes highlighted the dynamics of caregiving across time, including current context and the ongoing process of decision-making. Findings suggest that while African-American custodial grandmothers find caregiving rewarding, they face unique challenges in contemplating and developing future plans. Custodial grandmothers think about substitute caregivers for their grandchildren but need assistance communicating a plan focused on their own needs for future care. Culturally sensitive interventions designed to facilitate effective utilization of future plans within this caregiver population are needed.

  16. 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.

  17. Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

    PubMed

    Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

    2013-04-01

    We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

  18. 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

  19. 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

  20. 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.

  1. Challenges in setting up pediatric and neonatal intensive care units in a resource-limited country.

    PubMed

    Basnet, Sangita; Adhikari, Neelam; Koirala, Janak

    2011-10-01

    In collaboration with a host country and international medical volunteers, a PICU and an NICU were conceptualized and realized in the developing country of Nepal. We present here the challenges that were encountered during and after the establishment of these units. The decision to develop an ICU with reasonable goals in a developing country has to be made with careful assessments of need of that patient population and ethical principles guiding appropriate use of limited resources. Considerations during unit design include space allocation, limited supply of electricity, oxygen source, and clean-water availability. Budgetary challenges might place overall sustainability at stake, which can also lead to attrition of trained manpower and affect the quality of care. Those working in the PICU in resource-poor nations perpetually face the challenges of lack of expert support (subspecialists), diagnostic facilities (laboratory and radiology), and appropriate medications and equipment. Increasing transfer of severely ill patients from other health facilities can lead to space constraints, and lack of appropriate transportation for these critically ill patients increases the severity of illness, which leads to increased mortality rates. The staff in these units must make difficult decisions on effective triage of admissions to the units on the basis of individual cases, futility of care, availability of resources, and financial ability of the family.

  2. Challenge clusters facing LCA in environmental decision-making—what we can learn from biofuels

    DOE PAGES

    McManus, Marcelle C.; Taylor, Caroline M.; Mohr, Alison; ...

    2015-08-07

    Purpose: Bioenergy is increasingly used to help meet greenhouse gas (GHG) and renewable energy targets. However, bioenergy’s sustainability has been questioned, resulting in increasing use of life cycle assessment (LCA). Bioenergy systems are global and complex, and market forces can result in significant changes, relevant to LCA and policy. The goal of this paper is to illustrate the complexities associated with LCA, with particular focus on bioenergy and associated policy development, so that its use can more effectively inform policymakers. Methods: The review is based on the results from a series of workshops focused on bioenergy life cycle assessment. Expertmore » submissions were compiled and categorized within the first two workshops. Over 100 issues emerged. Accounting for redundancies and close similarities in the list, this reduced to around 60 challenges, many of which are deeply interrelated. Some of these issues were then explored further at a policy-facing workshop in London, UK. The authors applied a rigorous approach to categorize the challenges identified to be at the intersection of biofuels/bioenergy LCA and policy. Results and discussion: The credibility of LCA is core to its use in policy. Even LCAs that comply with ISO standards and policy and regulatory instruments leave a great deal of scope for interpretation and flexibility. Within the bioenergy sector, this has led to frustration and at times a lack of obvious direction. This paper identifies the main challenge clusters: overarching issues, application and practice and value and ethical judgments. Many of these are reflective of the transition from application of LCA to assess individual products or systems to the wider approach that is becoming more common. Uncertainty in impact assessment strongly influences planning and compliance due to challenges in assigning accountability, and communicating the inherent complexity and uncertainty within bioenergy is becoming of greater

  3. Challenge clusters facing LCA in environmental decision-making—what we can learn from biofuels

    SciTech Connect

    McManus, Marcelle C.; Taylor, Caroline M.; Mohr, Alison; Whittaker, Carly; Scown, Corinne D.; Borrion, Aiduan Li; Glithero, Neryssa J.; Yin, Yao

    2015-08-07

    Purpose: Bioenergy is increasingly used to help meet greenhouse gas (GHG) and renewable energy targets. However, bioenergy’s sustainability has been questioned, resulting in increasing use of life cycle assessment (LCA). Bioenergy systems are global and complex, and market forces can result in significant changes, relevant to LCA and policy. The goal of this paper is to illustrate the complexities associated with LCA, with particular focus on bioenergy and associated policy development, so that its use can more effectively inform policymakers. Methods: The review is based on the results from a series of workshops focused on bioenergy life cycle assessment. Expert submissions were compiled and categorized within the first two workshops. Over 100 issues emerged. Accounting for redundancies and close similarities in the list, this reduced to around 60 challenges, many of which are deeply interrelated. Some of these issues were then explored further at a policy-facing workshop in London, UK. The authors applied a rigorous approach to categorize the challenges identified to be at the intersection of biofuels/bioenergy LCA and policy. Results and discussion: The credibility of LCA is core to its use in policy. Even LCAs that comply with ISO standards and policy and regulatory instruments leave a great deal of scope for interpretation and flexibility. Within the bioenergy sector, this has led to frustration and at times a lack of obvious direction. This paper identifies the main challenge clusters: overarching issues, application and practice and value and ethical judgments. Many of these are reflective of the transition from application of LCA to assess individual products or systems to the wider approach that is becoming more common. Uncertainty in impact assessment strongly influences planning and compliance due to challenges in assigning accountability, and communicating the inherent complexity and uncertainty within bioenergy is becoming of greater importance

  4. Challenge clusters facing LCA in environmental decision-making-what we can learn from biofuels.

    PubMed

    McManus, Marcelle C; Taylor, Caroline M; Mohr, Alison; Whittaker, Carly; Scown, Corinne D; Borrion, Aiduan Li; Glithero, Neryssa J; Yin, Yao

    Bioenergy is increasingly used to help meet greenhouse gas (GHG) and renewable energy targets. However, bioenergy's sustainability has been questioned, resulting in increasing use of life cycle assessment (LCA). Bioenergy systems are global and complex, and market forces can result in significant changes, relevant to LCA and policy. The goal of this paper is to illustrate the complexities associated with LCA, with particular focus on bioenergy and associated policy development, so that its use can more effectively inform policymakers. The review is based on the results from a series of workshops focused on bioenergy life cycle assessment. Expert submissions were compiled and categorized within the first two workshops. Over 100 issues emerged. Accounting for redundancies and close similarities in the list, this reduced to around 60 challenges, many of which are deeply interrelated. Some of these issues were then explored further at a policy-facing workshop in London, UK. The authors applied a rigorous approach to categorize the challenges identified to be at the intersection of biofuels/bioenergy LCA and policy. The credibility of LCA is core to its use in policy. Even LCAs that comply with ISO standards and policy and regulatory instruments leave a great deal of scope for interpretation and flexibility. Within the bioenergy sector, this has led to frustration and at times a lack of obvious direction. This paper identifies the main challenge clusters: overarching issues, application and practice and value and ethical judgments. Many of these are reflective of the transition from application of LCA to assess individual products or systems to the wider approach that is becoming more common. Uncertainty in impact assessment strongly influences planning and compliance due to challenges in assigning accountability, and communicating the inherent complexity and uncertainty within bioenergy is becoming of greater importance. The emergence of LCA in bioenergy governance is

  5. 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.

  6. 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

  7. Challenges facing the veterinary profession in Ireland: 1. clinical veterinary services.

    PubMed

    Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

    2017-01-01

    The provision of veterinary clinical services is known to elicit a range of challenges which require an ethical appraisal. In a recent Policy Delphi study, referrals/second opinions and 24 h emergency care were identified as matters of key concern by veterinary professionals in Ireland. In this case study (the first in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate the on-farm use of veterinary antimicrobials and emergency/casualty slaughter certification) we aim to provide a value-based reflection on the constraints and possible opportunities for two prominent veterinary clinical services in Ireland: referrals/second opinions and 24 h emergency care. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely referral and referring veterinarians, clients, animal charities, and the regulatory body. Six overarching, interrelated constraints emerged from the thematic analysis: the need to improve current guidance, managing clients' expectations, concerns with veterinarian well-being, financial issues, timeliness of referral, and conflicts between veterinary practices. Possible solutions to improve veterinary referral and out-of-hours clinical services included clarifying the terms used in current norms and regulations (namely 'referral', 'second opinion', '24 h emergency care' and '24 h cover'), improved communication (making the client aware of the different levels of veterinary care that are being offered, and transparent and full disclosure of clinical records), and the promotion of Continuing Veterinary Education in communication, business management and ethical decision-making. These findings may help inform the Veterinary Council of Ireland about future recommendations and regulatory measures.

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. Challenges faced by the pharmaceutical industry: training graduates for employment in pharmaceutical R&D.

    PubMed

    Mooney, K G

    2001-02-01

    There is a shortfall between output from universities and demand by the pharmaceutical and health care industries for science and engineering graduates able to rapidly contribute to success in the business environment. Against a changing infrastructure of pharmaceutical research, the development of new chemical entities by major companies accounts for a high proportion of R&D expenditure. Allocation of staff is divided fairly evenly between discovery, non-clinical and clinical research activities and in all categories the new sciences are likely to be used extensively. In dealing with the shortfall the challenge comes from balancing education in basic science with training in the emerging areas of science and technology. There is a need for a 'partnership' that includes not only industry and academia but also government, since these three bodies have both synergistic and diverging interests in scientific education. On the education-training continuum, industry should recognise what it most values from academia and provide as much input and support as possible. At the same time universities must question their ability to fulfil their traditional educational role in the face of current rates of adoption of new sciences and technology. While disciplinary excellence remains vital for PhD students, multi-disciplinary programmes are becoming increasingly important to enable graduates to function effectively in the modern, globalised pharmaceutical industry.

  13. 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.

  14. 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.

  15. Preclinical models for pediatric solid tumor drug discovery: current trends, challenges and the scopes for improvement.

    PubMed

    Kumar, Sushil; Mokhtari, Reza Bayat; Yeger, Herman; Baruchel, Sylvain

    2012-11-01

    The enhancement in pediatric cancer survival achieved in the past few decades has been confined to low- and moderate-risk cancers, whereas no notable improvement in survival was observed in high-risk and advanced-stage childhood cancers. High attrition rate of candidate drugs in clinical trials is a major hurdle in the development of effective therapies for pediatric solid tumors. In order to reduce the failure rate of candidate drugs in clinical trials, more effective strategies are needed to enhance the predictability of preclinical testing. The authors have described the current trends in preclinical drug development for treating pediatric solid tumors. Furthermore, the authors review their limitations and the available remedies, with regards to choice of models, pharmacokinetic considerations and the criteria for assessing the long-term efficacy of a candidate drug. In many solid tumors, common differences between pediatric and adult cancers have been observed, and therefore, clinical trials for pediatric solid tumors must be conducted on the basis of preclinical observations in pediatric solid tumor models. There is a need to invest in extensive preclinical testing on pediatric solid tumor models. None of the preclinical models can fully recapitulate the human cancers. Therefore, these limitations must be considered while conducting a preclinical trial. The dose and schedule of drugs used for preclinical testing must be clinically relevant. While testing the efficacy of drugs, the markers of apoptosis, drug resistance, hypoxia and tumor-initiating cells can inform us about the long-term therapeutic response of a cancer.

  16. Unconventional combinations of prospective parents: ethical challenges faced by IVF providers.

    PubMed

    Klitzman, Robert

    2017-02-28

    Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements. Thirty-seven ART providers and 10 patients were interviewed in-depth for approximately 1 h each. Interviews were systematically analyzed. Providers faced a range of challenges and ethical dilemmas concerning both the content and the process of decisions about requests for unconventional interfamilial and other reproductive combinations. Providers vary in how they respond - what they decide, who exactly decides (e.g., an ethics committee or not), and how - often undergoing complex decision-making processes. These combinations can involve creating or raising the child, and can shift over time - from initial ART treatment through to the child's birth. Patients' requests can vary from fully established to mere possibilities. Arrangements may also be unstable, fluid, or unexpected, posing challenges. Difficulties emerge concerning not only familial but social, combinations (e.g., between friends). These arrangements can involve blurry and confusing roles, questions about the welfare of the unborn child, and unanticipated and unfamiliar questions about how to weigh competing moral and scientific concerns - e.g., the autonomy of the individuals involved, and the potential risks and benefits. Clinicians may feel that these requests do not "smell right"; and at first respond with feelings of "yuck," and only later, carefully and explicitly consider the ethical principles involved. Proposed arrangements may, for instance, initially be felt to involve consanguineous individuals, but not in fact do so. Obtaining and verifying full and appropriate informed consent can be difficult, given implicit familial and/or cultural expectations and senses of duty. Social attitudes are changing, yet patients

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

    NASA Astrophysics Data System (ADS)

    Maletzky, Monica; Mhopjeni, Kombada

    2014-05-01

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

  18. Overcoming challenges to meaningful informed consent for whole genome sequencing in pediatric cancer research.

    PubMed

    Oberg, Jennifer A; Glade Bender, Julia L; Cohn, Elizabeth G; Morris, Marilyn; Ruiz, Jenny; Chung, Wendy K; Appelbaum, Paul S; Kung, Andrew L; Levine, Jennifer M

    2015-08-01

    Introducing whole genome sequencing (WGS) into pediatric cancer research at diagnosis poses unique challenges related to informed consent. WGS requires tissue obtained prior to initiating treatment, when families may be overwhelmed with uncertainty and fear. Motivation to participate may be high without fully understanding the range of possible results, including secondary findings. Little is known about parental knowledge, attitudes, and beliefs about this type of research. A qualitative study was conducted to investigate parental knowledge about genetic concepts and WGS, thoughts about the informed consent process, and preferences for secondary findings. Focus groups were conducted with parents/guardians of children with cancer and semi-structured interviews were conducted in a control group without cancer. All transcripts were analyzed using content analysis. Four focus groups included 15 participants; eight semi-structured interviews included 10 participants. Basic knowledge about genetics was limited to heredity. Some knowledge of genomic analysis was present in 3/15 focus group participants. Major factors related to participation in WGS research were: (i) hope for their child and future children; (ii) no additional procedures; (iii) and protection of privacy. All favored a two-step consent process, first to store extra tissue from a diagnostic biopsy/resection, followed by consenting to WGS research, one-to-two months later. The desire to receive secondary findings was high among both groups, but there were individuals who did not want these results, fearing increased anxiety. Parents/guardians of children with cancer have limited knowledge about WGS. A two-step consent process may improve their ability to provide meaningful informed consent. © 2015 Wiley Periodicals, Inc.

  19. 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

  20. Using an Iterative Mixed-Methods Research Design to Investigate Schools Facing Exceptionally Challenging Circumstances within Trinidad and Tobago

    ERIC Educational Resources Information Center

    De Lisle, Jerome; Seunarinesingh, Krishna; Mohammed, Rhoda; Lee-Piggott, Rinnelle

    2017-01-01

    In this study, methodology and theory were linked to explicate the nature of education practice within schools facing exceptionally challenging circumstances (SFECC) in Trinidad and Tobago. The research design was an iterative quan>QUAL-quan>qual multi-method research programme, consisting of 3 independent projects linked together by overall…

  1. 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…

  2. 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'…

  3. The Education Challenges Facing Small Nation States in the Increasingly Competitive Global Economy of the Twenty-First Century

    ERIC Educational Resources Information Center

    Bacchus, Mohammed Kazim

    2008-01-01

    Publication of this piece is intended as a tribute to the late Professor M. Kazim Bacchus who passed away in March 2007. The paper provides a general discussion concerning the social and educational challenges faced by small nation states in an age characterised by globalisation. The analysis first identifies some of the basic features of small…

  4. 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'…

  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. Facing the Challenges of Today and the Future: Ensuring Successful Outcomes for Students from Culturally and Linguistically Diverse Backgrounds

    ERIC Educational Resources Information Center

    Bullock, Lyndal M.; Gable, Robert A.; Carrero, Kelly; Lewis, Calli; Collins, Emerald; Zolkowski, Staci; Lusk, Mandy

    2014-01-01

    American schools are witnessing the increasing cultural heterogeneity of our nation's population. Educators are faced with the challenge of ensuring positive educational outcomes for all students, despite the lack of empirical understanding of how to effectively educate culturally and linguistically diverse learners. The purpose of this paper is…

  7. 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…

  8. 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…

  9. Challenges Faced by Development Partners in Supporting the Growth and Development of Commercial Enterprises in Lira District, Northern Uganda

    ERIC Educational Resources Information Center

    Eton, Marus; Mwirumubi, Richard; Edaku, Charles

    2017-01-01

    Entrepreneurship is defined as the process where an individual discovers, evaluates and exploit opportunities independently. Most countries have embraced entrepreneurship development as ways of creating employment and economic growth and development. The objective of the study was to examine the challenges faced by commercial enterprises in Lira…

  10. 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…

  11. 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…

  12. 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…

  13. Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale.

    PubMed

    Shen, Jiabin; Giles, Sheila A; Kurtovic, Kelli; Fabia, Renata; Besner, Gail E; Wheeler, Krista K; Xiang, Huiyun; Groner, Jonathan I

    2017-02-01

    Accurate pain assessment is essential for proper analgesia during medical procedures in pediatric patients. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale has previously been shown to be a valid and reliable tool for assessing pediatric procedural pain in research labs. However, no study has investigated how rater factors (gender, number of dressing changes performed/week, burn history, having children, nursing experience, stress at home/work) and patient factors (pain intensity) affect the accuracy of FLACC ratings for procedural pain when implemented by bedside care providers. Twenty-four nurses in an ABA verified Pediatric Burn Center watched four videos of dressing changes for pediatric burn patients in random order three times and rated the children's procedural pain using the FLACC scale. The four videos had standard FLACC scores established by an interdisciplinary panel. Descriptive and mixed modeling analysis was conducted to explore nurse rating accuracy and to evaluate the rater and patient factors that influenced the rating accuracy. The highest accuracy was reached when rating high procedural pain (with a FLACC of 6). Nurses underrated both mild and severe procedural pain. Nurses who had less nursing experience demonstrated significantly higher accuracy than those with more experience. The present study is the first study in the literature to systematically examine the factors influencing the accuracy of FLACC rating for pediatric procedural pain among bedside care providers. The findings suggest that nurse clinical experience and patient pain intensity are two significant contributors to rating accuracy. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  14. Challenges facing the veterinary profession in Ireland: 3. emergency and casualty slaughter certification.

    PubMed

    Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

    2017-01-01

    Veterinarians are faced with significant conflicts of interest when issuing certificates for the transport and slaughter of acutely injured and casualty livestock. In a recent Policy Delphi study, emergency and casualty slaughter certification was a key concern identified by veterinary professionals in Ireland. In this case study (the third in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and the on-farm use of veterinary antimicrobials), we aim to provide a value-based reflection on the constraints and opportunities for best practice in emergency and casualty slaughter certification in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely a representative from the regulatory body, local authority veterinarians with research experience in emergency slaughter, an animal welfare research scientist, official veterinarians from the competent authority, a private veterinary practitioner, and a member of a farming organisation. Results revealed a conflict between the responsibility of private veterinary practitioners (PVPs) to safeguard the welfare of acutely injured bovines on-farm and the client's commercial concerns. As a consequence, some PVPs may feel under pressure to certify, for example, an acutely injured animal for casualty slaughter instead of recommending either on-farm emergency slaughter or disposal by the knackery service. Among Official Veterinarians, there are concerns about the pressure within processing plants to accept acutely injured livestock as casualty animals. Confusion pertaining to legislation and definition of fitness to travel also contribute to these dilemmas. Conflicts of interest arise due to the gap between governance and provision to facilitate on-farm emergency slaughter of livestock. Increased availability and acceptance of on

  15. Challenges newly-arrived migrant women in Montreal face when needing maternity care: Health care professionals' perspectives.

    PubMed

    Peláez, Sandra; Hendricks, Kristin N; Merry, Lisa A; Gagnon, Anita J

    2017-01-25

    People who leave their country of origin, or the country of habitual residence, to establish themselves permanently in another country are usually referred to as migrants. Over half of all births in Montreal, Canada are to migrant women. To understand healthcare professionals' attitudes towards migrants that could influence their delivery of care, our objective was to explore their perspectives of challenges newly-arrived migrant women from non-Western countries face when needing maternity care. In this qualitative multiple case study, we conducted face-to-face interviews with 63 health care professionals from four teaching hospitals in Montreal, known for providing maternity care to a high volume of migrant women. Interviews were transcribed and thematically analysed. Physicians, nurses, social workers, and therapists participated; 90% were female; and 17% were themselves migrants from non-Western countries. According to participants, newly-arrived migrant women face challenges at two levels: (a) direct care (e.g., understanding Canadian health care professionals' expectations, communicating effectively with health care professionals), and (b) organizational (e.g., access to appropriate health care). Challenges women face are strongly influenced by the migrant woman's background as well as social position (e.g., general education, health literacy, socio-cultural integration) and by how health care professionals balance women's needs with perceived requirement to adhere to standard procedures and regulations. Health care professionals across institutions agreed that maternity care-related challenges faced by newly-arrived migrant women often are complex in that they are simultaneously driven by conflicting values: those based on migrant women's sociocultural backgrounds versus those related to the implementation of Canadian guidelines for maternity care in which consideration of migrant women's particular needs are not priority.

  16. Confidentiality in Pediatric and Adolescent Gynecology: When We Can, When We Can't, and When We're Challenged.

    PubMed

    Alderman, Elizabeth M

    2017-04-01

    Maintaining confidentiality is an important aspect of adolescent health care. Different states and provinces have laws around the provision of confidential health care to minors for specific health concerns such as reproductive health, mental health and substance abuse. However, there are situations where confidentiality cannot be assured, particularly if the adolescent is being abused. Educating teens and parents about the circumstances in which confidentiality is necessary is sometimes challenging for the clinician. Moreover, with the advent of electronic medical records, patient portals and other requirements to share health information with parents and the adolescent patient, confidentiality is sometimes not easy to assure. The following is the Elsevier Lecture from the 2015 Meeting of the North American Society for Pediatric and Adolescent Gynecology. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Challenges facing the veterinary profession in Ireland: 2. On-farm use of veterinary antimicrobials.

    PubMed

    Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

    2017-01-01

    Antimicrobial resistance has emerged in recent years as a significant public health threat, which requires both an ethical and a scientific approach. In a recent Policy Delphi study, on-farm use of antimicrobials was a key concern identified by veterinary professionals in Ireland. In this case study (the second in a series of three resulting from a research workshop exploring the challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and emergency/casualty slaughter certification) we aim to provide a value-based reflection on the constraints and possible opportunities for responsible use of veterinary antimicrobials in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely veterinarians working in public and private organisations, a representative from the veterinary regulatory body, a dairy farmer and a general medical practitioner. Three overarching constraints to prudent on-farm use of veterinary antimicrobials emerged from the thematic analysis: 'Defective regulations', 'Lack of knowledge and values' regarding farmers and vets and 'Farm-centred concerns', including economic and husbandry concerns. Conversely, three main themes which reflect possible opportunities to the barriers were identified: 'Improved regulations', 'Education' and 'Herd health management'. Five main recommendations arose from this study based on the perspectives of the study participants including: a) the potential for regulatory change to facilitate an increase in the number of yearly visits of veterinarians to farms and to implement electronic prescribing and shorter validity of prescriptions; b) a 'One Health' education plan; c) improved professional guidance on responsible use of veterinary antimicrobials; d) improved on-farm herd health management practices; and e) the promotion of a 'One Farm-One Vet' policy. These findings may assist Veterinary Council of

  18. Recruiting family dyads facing thoracic cancer surgery: Challenges and lessons learned from a smoking cessation intervention.

    PubMed

    McDonnell, Karen Kane; Hollen, Patricia J; Heath, Janie; Andrews, Jeannette O

    2016-02-01

    Persistent smoking after a cancer diagnosis has adverse effects. Most smoking cessation interventions focus on individual behaviors; however, family members who smoke are major barriers to success. This article describes challenges and lessons learned related to recruitment and retention to a longitudinal, dyadic-centered smoking cessation intervention study for individuals confronting a new diagnosis of thoracic cancer and their family members who smoke. A prospective, one-group repeated measures, mixed-method feasibility study measured recruitment, retention, adherence, and acceptability over a 6-month period in a thoracic surgery clinic at a university cancer center. A multidisciplinary, multi-component decision aid-"Tobacco Free Family"-was used to intervene with the dyads. Study recruitment occurred preoperatively with a thoracic surgery team member assessing smoking status. During the 6-month recruitment period, 50 patients who smoked were screened, and 18 eligible families were approached to participate. Sixteen participants (8 dyads) enrolled. Patients were all male, and participating family members were all female-either spouses or long-term girlfriends. Others types of family members declined participation. Recruitment was lower than anticipated (44%), retention was high (100%), and maximizing convenience was the most important retention strategy. Oncology nurses can assess the smoking status of patients and family members, facilitate understanding about the benefits of cessation, refer those willing to stop to expert resources, and help motivate those unwilling to quit. Research is needed to continue developing strategies to help patients with thoracic cancer and their families facing surgery as an impetus for stopping smoking. Novel intervention delivery and communication need further exploration. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 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)…

  20. 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)…

  1. 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.

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

    PubMed

    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.

  3. 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

  4. 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.

  5. Challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe: The case of Chitungwiza town

    PubMed Central

    Maphosa, France

    2017-01-01

    Background Women with disabilities in Zimbabwe face numerous challenges in accessing sexual and reproductive health. Cultural belief still regards them as not sexually active. The government has also failed to promote policies that facilitate access to sexual and reproductive services by women with disabilities. Objectives The reseach objectives were to explore the challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe. Method The data were gathered using in-depth interviews with 23 purposively selected respondents. Thirteen women had physical disabilities, five were visually impaired, three were deaf and two were stammering. The respondents with physical disabilities were using wheelchairs, walking frames, prosthesis, crutches and caliper shoes. The participants’ ages ranged from 18 to 45 years. All interviews were transcribed and translated verbatim into English, and passages were extracted from the transcripts. Key themes and concepts were identified and coded to offer a rich framework for analysis, comparisons and presentation of the data. Results Negative perceptions of health personnel towards people with disabilities, disability-unfriendly infrastructure at health facilities and absence of trained personnel for people with disabilities (sign language) are some of the challenges involved. Conclusion The government, in partnership with other stakeholders, should address challenges faced by women with disabilities when accessing sexual and reproductive health services. Non-government, private hospitals and profit-making organisations should join hands with government in funding health requirements for women with disabilities. PMID:28730062

  6. Don't assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy.

    PubMed

    Wali, Huda; Grindrod, Kelly

    Low health literacy populations have difficulty understanding health information and making appropriate health decisions. Pharmacists need to ensure patients have a basic understanding of how to take their medications and understand the risks and benefits of their prescriptions. To explore the major challenges low health literate adults face when trying to understand their medication therapy. One-on-one semi-structured interviews were used to gather data on the major challenges low health literate adults face regarding their medication. Each interview began with a verbal health literacy assessment, followed by open-ended questions focused on medication information. After each interview was complete, a written health literacy assessment was given in English, which was later used to compare self-assessed health literacy to written health literacy scores. All interviews were audio-recorded, transcribed and analyzed using thematic analysis. The population sample had an average age of 67 years old and 90% had been education outside of North America. Low health literacy levels were found in 75% of participants based on the S-TOFHLA and demonstrated a generally over estimated self-assessed health literacy levels. After thematic analysis, a flow chart that describes the low health literate population's pharmacy experience with medication information was developed to explain the cause and effect of challenges faced with current pharmacy medication information. Also, the major challenges patients with low health literacy face with current medication information from the pharmacy were limited time with pharmacists, understanding medication information, forgetting to take medication, side effects and food-drug interactions. Future interventions targeted to improving pharmacy medication information for the low health literate population should focus on addressing the challenges with limited time with pharmacists, poor understanding of medication information, forgetting to take

  7. 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)

  8. 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

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

    NASA Astrophysics Data System (ADS)

    Nowicki, S.

    2013-12-01

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

  10. 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

  11. Pediatric pain management: the multidisciplinary approach.

    PubMed

    Odell, Shannon; Logan, Deirdre E

    2013-11-11

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

  12. Diabetes care provider perceptions on family challenges of pediatric type 1 diabetes

    USDA-ARS?s Scientific Manuscript database

    Pediatric healthcare providers' perspectives on barriers to diabetes self-management among youth with type 1 diabetes and strategies to overcome them were explored qualitatively. Family conflict about diabetes care was viewed as a common problem, addressable by behavioral interventions to improve co...

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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

  18. Key Challenges in the Search for Innovative Drug Treatments for Special Populations. Converging Needs in Neonatology, Pediatrics, and Medical Genetics

    PubMed Central

    MacLeod, Stuart

    2017-01-01

    The explosion of knowledge concerning the interplay of genetic and environmental factors determining pathophysiology and guiding therapeutic choice has altered the landscape in pediatric clinical pharmacology and pharmacy. The need for innovative research methods and design expertise for small clinical trials to be undertaken in sparse populations has been accentuated. At the same time, shortfalls in critical human resources represent a key challenge, especially in low- and middle-income countries where the need for new research and education directions is greatest. Unless a specific action plan is urgently developed, there will be a continuing gap in availability of the essential expertise needed to address treatment challenges in special patient populations such as neonates, patients suffering from rare or neglected diseases, and children of all ages. PMID:28777308

  19. Key Challenges in the Search for Innovative Drug Treatments for Special Populations. Converging Needs in Neonatology, Pediatrics, and Medical Genetics.

    PubMed

    MacLeod, Stuart

    2017-08-04

    The explosion of knowledge concerning the interplay of genetic and environmental factors determining pathophysiology and guiding therapeutic choice has altered the landscape in pediatric clinical pharmacology and pharmacy. The need for innovative research methods and design expertise for small clinical trials to be undertaken in sparse populations has been accentuated. At the same time, shortfalls in critical human resources represent a key challenge, especially in low- and middle-income countries where the need for new research and education directions is greatest. Unless a specific action plan is urgently developed, there will be a continuing gap in availability of the essential expertise needed to address treatment challenges in special patient populations such as neonates, patients suffering from rare or neglected diseases, and children of all ages.

  20. Perspective: tectonic shifts in academic pediatrics: changes and adaptation.

    PubMed

    Rivkees, Scott A

    2011-05-01

    Pediatric academia is evolving in the face of many changes: a challenging funding environment, trainees who favor clinical care and part-time careers over biomedical research, and a shrinking pipeline of physician-scientists and clinician-scholars. The trend toward fewer pediatric-based academicians with classical academic interests is the consequence of numerous factors and parallels the decline in MDs entering research careers in other fields. With increasing interest in clinical positions. After fellowship, fewer trainees focus on the rigorous prospective clinical or basic projects which used to dominate fellowship research training. Trainees increasingly choose clinician or clinician-educator career paths. Contributing to this shift are substantial economic pressures that favor the recruitment and development of clinician faculty over research scholars. As these trends continue, there will be a less pluralistic pediatric research base, and high-value pediatric research will become consolidated at institutions with the financial capacity to support pediatric research. The challenge in pediatrics is to anticipate and manage these academic shifts and determine where pediatric academia should move. The author offers several ideas for managing and adapting to the challenges facing academic pediatrics. Copyright © by the Association of American medical Colleges.

  1. 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.

  2. What Challenges Do Nonprofit Hospitals Face in Taking on Community Health Needs Assessments? A Qualitative Study From Appalachian Ohio.

    PubMed

    Skinner, Daniel; Franz, Berkeley; Kelleher, Kelly

    2017-05-24

    The purpose of this study is to understand the experiences of Appalachian hospitals in undertaking Community Health Needs Assessments (CHNAs). Of particular interest is whether new requirements to undertake regular evaluation and public health programming pose challenges for rural, Appalachian hospitals. Using a sample of nonprofit hospitals in Appalachian Ohio, we conducted in-depth qualitative interviews with hospital administrators overseeing community benefit activities and external consultants hired to complete assessments. Following a grounded theory approach, we coded interviews to ascertain major themes. Our findings suggest that there are several challenges faced by nonprofit hospitals that may relate to their status as rural hospitals. In particular, we found that these hospitals struggle to hire staff to oversee CHNAs, often lack the material resources to address needs identified in reports, and seek more concrete guidelines from the IRS on carrying out these new activities in their communities. The results from these interviews suggest that there is significant support for new CHNA activities in Appalachian Ohio, but challenges remain to translate these efforts into improved health outcomes in this region. Because rural Appalachia, in particular, faces significant health disparities and a relative lack of health care providers, there is a potential for hospitals to take on an important role in public and preventive health if initial challenges are addressed. © 2017 National Rural Health Association.

  3. Strategies to Address English Language Writing Challenges Faced by International Graduate Students in the US

    ERIC Educational Resources Information Center

    Ravichandran, Swathi; Kretovics, Mark; Kirby, Kara; Ghosh, Ankita

    2017-01-01

    Since 2000, there has been a 72% increase in the number of international students attending US institutions of higher education. The increase, specifically of international graduate students, has brought to light the writing challenges experienced by this population of students. This study explored specific writing challenges experienced by…

  4. Facing the Triple Challenge: You Can't Do It Alone.

    ERIC Educational Resources Information Center

    Ehrmann, Stephen C.

    1995-01-01

    Discusses the benefits and challenges of technology in the teaching of foreign languages. Benefits include accessibility in time and space and an accessible learning process. Challenges include providing sufficient access to learning for everyone who has adequate preparation, fostering the right kinds of learning outcomes for course graduates, and…

  5. Enhancing Teacher Efficacy for Urban STEM Teachers Facing Challenges to Their Teaching

    ERIC Educational Resources Information Center

    Seals, Christopher; Mehta, Swati; Berzina-Pitcher, Inese; Graves-Wolf, Leigh

    2017-01-01

    This paper explores challenges of teaching in relation to teachers' efficacy for 49 teachers who were part of a year-long teacher development program (PD) called the UrbanSTEM program. This program took place in an urban school district that serves over 300,000 students. This research asked if there are common challenges that urban teachers face…

  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. 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…

  8. 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…

  9. 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

  10. 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

  11. 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…

  12. From Theory to Practice: Facing Ethical Challenges as a Clinical Intern

    ERIC Educational Resources Information Center

    Hambrick, James P.; Pimentel, Sandra; Albano, Anne Marie

    2009-01-01

    Although formal ethics classes provide a basic foundation in managing ethical dilemmas, professionals often point to their experiences on internship as an important training ground for consolidation of their ethical development. Clinical interns face many personal and professional transitions that can lead to a number of ethical dilemmas.…

  13. 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…

  14. Challenges and Pitfalls Facing International Education in a Post-International World

    ERIC Educational Resources Information Center

    Tate, Nicholas

    2012-01-01

    Taking as its starting point that the adjective international is an inadequate, but unavoidable, label to describe the content of a contemporary international education, this article sets out to explore some of the issues facing international education in a post-international world. It draws mainly on writings in French as a deliberate…

  15. 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…

  16. 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…

  17. Creating Linkages between Private and Public: Challenges Facing Woman Principals in South Africa

    ERIC Educational Resources Information Center

    Moorosi, Pontso

    2007-01-01

    In trying to understand some of the gendered discourses that shape the management of schools as organisations in South Africa, I analyse woman principals' experiences as they try to navigate a balance between their home and work responsibilities. After their appointment as principals, some South African women face difficulties in striking the…

  18. 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…

  19. 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…

  20. 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…

  1. Using participant observation in pediatric health care settings: ethical challenges and solutions.

    PubMed

    Carnevale, Franco A; Macdonald, Mary Ellen; Bluebond-Langner, Myra; McKeever, Patricia

    2008-03-01

    Participant observation strategies may be particularly effective for research involving children and their families in health care settings. These techniques, commonly used in ethnography and grounded theory, can elicit data and foster insights more readily than other research approaches, such as structured interviews or quantitative methods. This article outlines recommendations for the ethical conduct of participant observation in pediatric health care settings. This involves a brief overview of the significant contributions that participant observation can bring to our understanding of children and families in health care settings; an examination of the elements of participant observation that are necessary conditions for its effective conduct; an outline of contemporary ethical norms in Canada, the United Kingdom and the United States for research in pediatric health care settings; and a discussion of how participant observation research should be operationalized in order to comply with these norms.

  2. General anesthesia: as a challenge and treatment need option in pediatric dentistry.

    PubMed

    Del Machuca Portillo, María Carmen; Hanke Herrero, Rosana; del López Valle, Lydia; Machuca Portillo, Guillermo; Bullón Fernández, Pedro

    2005-12-01

    The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period. A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions. MR patients made up 59.7% and NMR patients made up 40.3% of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2%), cerebral palsy (14.7%), epileptic (5.9%), mental syndromes (26.9%), hydrocephalic (5.9%), autism (5.9%) and others (2.9%). The NMR were classified into 5 categories: early childhood caries (65.2%), cardiac patients (8.7%), maxillofacial anomalies (4.3%), organic syndromes (13.1%) and others (8.7%). The dental procedures performed were: dental extractions 84%(MR) and 68% (NMR), restorative procedures 87.3%(MR) and 12.7%(NMR). Oral prophylaxis was performed in 76.8%, fissure sealants in 10.7% and topical fluoride applications in 21.8%. Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

  3. 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.

  4. 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

  5. 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

  6. 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

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

    PubMed

    Rangel, Maria Adriana; 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.

  8. 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.

  9. 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.

  10. Factors Influencing Men Entering the Nursing Profession, and Understanding the Challenges Faced by Them: Iranian and Developed Countries’ Perspectives

    PubMed Central

    Zamanzadeh, Vahid; Valizadeh, Leila; Negarandeh, Reza; Monadi, Morteza; Azadi, Arman

    2013-01-01

    Context: Men entering the nursing profession have been investigated from several different perspectives. Due to male gender characteristics and existing public image, nursing is often not considered as a career choice by men. Whether nursing would benefit from increased number of men is a key question in the literature. The purpose of this integrative review of the literature was to identify factors influencing men to enter the nursing profession. In addition, it sought to understand the challenges they are confronted within this profession. Evidence Acquisition: A systematic search of the existing literature was performed using an Internet search with broad keywords to access related articles in both Persian and English databases. Finally, 34 studies (written between 2000 and early 2013) were selected and surveyed. Results: Most of the studies were conducted in developed counties. The review identified reasons why males choose nursing, and other challenges facing men entering and working in nursing. Themes that emerged from the literature include educational and societal barriers experienced by men in nursing, recruitment, career choice, and role strain. Conclusions: Regarding men’s influences on professional development, and also the importance of gender-based caring, policies for recruitment and retention of men in nursing must be followed hastily. However, there is a need for further research regarding the challenges faced by men entering nursing, in both Iran and other developing countries. PMID:25414879

  11. 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

  12. 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…

  13. Communication Challenges: A Qualitative Look at the Relationship Between Pediatric Hospitalists and Primary Care Providers.

    PubMed

    Solan, Lauren G; Sherman, Susan N; DeBlasio, Dominick; Simmons, Jeffrey M

    2016-07-01

    Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus. Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication. Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care

  14. 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

  15. 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.

  16. Rising to the challenge: transforming an adult ICU into an adult and pediatric ICU.

    PubMed

    Comeau, Odette Y; Heffernan, Jamie M; Sheaffer, Jason L; Sayles, Foster M

    2014-01-01

    Published literature on natural disasters describes lessons learned in preparing for disasters, evacuating patients, and caring for patients in the immediate aftermath. Some disasters, however, require longer-term solutions to best meet the health needs of the community during the recovery from the disaster. This article presents an account of one academic medical center's experience in transforming an existing adult burn intensive care unit into an adult and pediatric burn intensive care unit to meet the needs of a community following a hurricane. The process of training 2 groups of specialty nurses and the success of expanding an adult unit are described.

  17. The structural connectome in children: basic concepts, how to build it, and synopsis of challenges for the developing pediatric brain.

    PubMed

    Meoded, Avner; Huisman, Thierry A G M; Casamassima, Maria Grazia Sacco; Jallo, George I; Poretti, Andrea

    2017-05-01

    The structural connectome is a comprehensive structural description of the network of elements and connections forming the brain. In recent years, this framework has progressively been used to investigate the pediatric brain. We discuss the different steps and emphasize key technical aspects required for the successful reconstruction, analysis, and visualization of the pediatric structural connectome using current state-of-the-art neuroimaging and post-processing techniques. The two key components of structural connectome are a node (a cortical region obtained with high-resolution anatomical imaging) and an edge (structural association between cortical regions, defined with tractography). After delineation of nodes and edges, an association matrix can be generated by compiling all pairwise associations between nodes and applying a threshold to produce a binary adjacency matrix. Several measures can be used to characterize the topological architecture of the brain's networks. Finally, we provide an overview of various visualization methods of the structural connectome in children. The human connectome is the culmination of more than a century of conceptual and methodological innovation. Biological substrates of brain development such as cortical gyration and myelination challenge the acquisition, reconstruction, and analysis of structural connectome in children and require specific considerations compared to adults.

  18. 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

  19. Subspace-based discrete transform encoded local binary patterns representations for robust periocular matching on NIST's face recognition grand challenge.

    PubMed

    Juefei-Xu, Felix; Savvides, Marios

    2014-08-01

    In this paper, we employ several subspace representations (principal component analysis, unsupervised discriminant projection, kernel class-dependence feature analysis, and kernel discriminant analysis) on our proposd discrete transform encoded local binary patterns (DT-LBP) to match periocular region on a large data set such as NIST's face recognition grand challenge (FRGC) ver2 database. We strictly follow FRGC Experiment 4 protocol, which involves 1-to-1 matching of 8014 uncontrolled probe periocular images to 16 028 controlled target periocular images (~128 million pairwise face match comparisons). The performance of the periocular region is compared with that of full face with different illumination preprocessing schemes. The verification results on periocular region show that subspace representation on DT-LBP outperforms LBP significantly and gains a giant leap from traditional subspace representation on raw pixel intensity. Additionally, our proposed approach using only the periocular region is almost as good as full face with only 2.5% reduction in verification rate at 0.1% false accept rate, yet we gain tolerance to expression, occlusion, and capability of matching partial faces in crowds. In addition, we have compared the best standalone DT-LBP descriptor with eight other state-of-the-art descriptors for facial recognition and achieved the best performance. The two general frameworks are our major contribution: 1) a general framework that employs various generative and discriminative subspace modeling techniques for DT-LBP representation and 2) a general framework that encodes discrete transforms with local binary patterns for the creation of robust descriptors.

  20. HIV / AIDS is a challenge we have to face -- Colin Hollis.

    PubMed

    2000-01-01

    On July 21, 2000, the Asian Forum of Parliamentarians on Population and Development (AFPPD) Malaysia, in cooperation with the UN Population Fund and the UN Development Program (Malaysia), organized the National HIV/AIDS Seminar for Parliamentarians in Kuala Lumpur, Malaysia. During the seminar, Mr. Colin Hollis, secretary general of AFPPD, spoke about the challenge posed by HIV/AIDS on the government. He noted that the epidemic is a part of life and these figures should not only challenge the assumptions of legislators but for them to act as well. He further informed that AFPPD would organize the Asia-Africa Meeting of Parliamentarians and Asia European Dialogue.

  1. Ethics, genetics and pediatrics.

    PubMed

    Souza, Ricardo Timm de; Goldim, José Roberto

    2008-08-01

    To reflect on the nature of ethics, from a contemporary perspective, and also on which features of the family relationship have an impact on the interface between genetics and pediatrics. The data used are the fruit of the authors' own intellectual production plus other bibliographic references. Genetics has presented ethics with new challenges. Particularly in pediatrics, where caring for patients is almost indivisible from a continuous relationship with their families, these issues are amplified even further, generating new questions that health professionals have not previously had to face. Based on the reflections outlined here, emphasis can be placed on the importance of actively recognizing the Other in its multiple dimensions and on the repercussions that this perspective has for the physician-patient-family relationship.

  2. 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…

  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. 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.

  5. [Fever of unknown origin: a challenge for the pediatric infectious diseases specialist].

    PubMed

    Sandoval, Carmen; Pinochet, Constanza; Peña, Anamaría; Rabello, Marcela; Prado, Alejandra; Viviani, Tamara

    2014-02-01

    Prolonged febrile syndrome (PFS) is defined as fever 7-10 days, with initial study does not allow etiologic diagnosis. To describe the main causes of the PFS and its temporal behavior in Pediatric Infectious Diseases Unit Outpatient Care of Complejo Asistencial Dr. Sótero del Río (CASR). A descriptive, prospective study between january 2007-december 2012, about 153 patients from 6 weeks to 14 years 11 months old, diagnosed with PFS, tab completing clinical and laboratory monitoring. etiology was obtained in 67.9%, the causes were infection (88.4%), neoplasms (4.8%), rheumatological (4.8%) and Kawasaki disease (2.8%). The most important infectious causes were enteric fevers (typhoid and paratyphoid) (18.4%), urinary tract infection (11.9%), Bartonella henselae infections and adenovirus (8.7%) each one and Epstein Barr virus (7.6%). Ninety eight percent of patients had complete resolution, 60.7% did not require hospitalization and mortality was 0%. As in previous pediatric clinical series the infections were the most frequent causes. Enteric fever persists as principal cause, however, the epidemiological evidence is oscillating in time endorsing the local statistics can count over the years to improve the diagnostic and therapeutic approach.

  6. 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.

  7. 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…

  8. 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…

  9. Challenges Faced by Key Stakeholders Using Educational Online Technologies in Blended Tertiary Environments

    ERIC Educational Resources Information Center

    Tuapawa, Kimberley

    2016-01-01

    Traditional learning spaces have evolved into dynamic blended tertiary environments (BTEs), providing a modern means through which tertiary education institutes (TEIs) can augment delivery to meet stakeholder needs. Despite the significant demand for web-enabled learning, there are obstacles concerning the use of EOTs, which challenge the…

  10. 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…

  11. 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…

  12. 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…

  13. 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…

  14. 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…

  15. 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…

  16. 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…

  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. A Qualitative Study of Challenges Faced by International Doctoral Students in Counselor Education Supervision Courses

    ERIC Educational Resources Information Center

    Jang, Yoo Jin; Woo, Hongryun; Henfield, Malik S.

    2014-01-01

    Using consensual qualitative research methodology, this study examines the challenges doctoral-level international students encountered in counselor education programs, during supervisor training, specifically. Semi-structured interviews were conducted with eight participants and revealed a variety of difficulties. Despite the wide variability in…

  19. 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…

  20. 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…

  1. The Delicate Balancing Act: Challenges and Successes Facing College Student Women in Formal Leadership Roles

    ERIC Educational Resources Information Center

    Haber-Curran, Paige

    2013-01-01

    This qualitative study focused on the successes and challenges experienced by four undergraduate college women while holding top leadership roles in student organizations. Interpretive and descriptive qualitative research methods were employed with aspects of case study and phenomenological approaches of inquiry. Data were collected through…

  2. Facing the challenge of the young, the small, and the dead: Alaska's new frontier.

    Treesearch

    Sally. Duncan

    2000-01-01

    Mandates to harvest, beetle infestations, log export restrictions, pulp mill closures, high transportation costs, ecological versus economic effects--the litany of challenges in the Alaska timber markets is sufficient to stymie land and timber managers. For decades, they have had to confront and make decisions about these conflicting issues without sufficient data...

  3. 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…

  4. 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…

  5. Challenges Faced by Key Stakeholders Using Educational Online Technologies in Blended Tertiary Environments

    ERIC Educational Resources Information Center

    Tuapawa, Kimberley

    2016-01-01

    Traditional learning spaces have evolved into dynamic blended tertiary environments (BTEs), providing a modern means through which tertiary education institutes (TEIs) can augment delivery to meet stakeholder needs. Despite the significant demand for web-enabled learning, there are obstacles concerning the use of EOTs, which challenge the…

  6. 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…

  7. An Exploration of Challenges Facing Principals in Leading Differentiated Teaching Practices

    ERIC Educational Resources Information Center

    Patton Corley, Myrna Loy

    2017-01-01

    The need to improve student academic performance and school reform continue to receive national attention, but there is limited empirical data that explicates the positive impact of programs that are designed to address this phenomenon. Educators are presented with seemingly herculean challenges in meeting the needs of students from cultural…

  8. 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…

  9. 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…

  10. 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…

  11. 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…

  12. 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…

  13. 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…

  14. A qualitative analysis of common concerns about challenges facing pharmacy experiential education programs.

    PubMed

    Danielson, Jennifer; Craddick, Karen; Eccles, Dayl; Kwasnik, Abigail; O'Sullivan, Teresa A

    2015-02-17

    To qualitatively analyze free-text responses gathered as part of a previously published survey in order to systematically identify common concerns facing pharmacy experiential education (EE) programs. In 2011, EE directors at all 118 accredited pharmacy schools in the US were asked in a survey to describe the most pressing issues facing their programs. Investigators performed qualitative, thematic analysis of responses and compared results against demographic data (institution type, class size, number of practice sites, number and type of EE faculty member/staff). Expert and novice investigators identified common themes via an iterative process. To check validity, additional expert and novice reviewers independently coded responses. The Cohen kappa coefficient was calculated and showed good agreement between investigators and reviewers. Seventy-eight responses were received (66% response rate) representing 75% of publicly funded institutions and 71% of schools with class sizes 51-150. Themes identified as common concerns were site capacity, workload/financial support, quality assurance, preceptor development, preceptor stipends, assessment, onboarding, and support/recognition from administration. Good agreement (mean percent agreement 93%, ƙ range=0.59-0.92) was found between investigators and reviewers. Site capacity for student placements continues to be the foremost concern for many experiential education programs. New concerns about preceptor development and procedures for placing and orienting students at individual practice sites (ie, "onboarding") have emerged and must be addressed as new accreditation standards are implemented.

  15. 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. Copyright © 2015 by the National Comprehensive Cancer Network.

  16. Survivorship in Non–Small Cell Lung Cancer: Challenges Faced and Steps Forward

    PubMed Central

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

    2016-01-01

    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. PMID:26358799

  17. 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.

  18. 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…

  19. 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…

  20. 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.

  1. 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

  2. Drug Delivery Innovations to Address Global Health Challenges for Pediatric and Geriatric Populations (Through Improvements in Patient Compliance).

    PubMed

    Boateng, Joshua

    2017-07-20

    Despite significant advances in pharmaceutical and biotechnological drug discovery, the global population is plagued with many challenging diseases. These are further compounded by anticipated explosion in an ageing population, which presents several problems such as polypharmacy, dysphagia, and neurologic conditions, resulting in noncompliance and disease complications. For antibiotics, poor compliance, can result in development of drug-resistant infections which can be fatal. Furthermore, children, especially, in developing countries die unnecessarily from easily treatable diseases (e.g., malaria), due to poor compliance arising from bitter taste and inability to swallow currently available medication. Although some of these challenges require the discovery of new drug compounds, a significant number can be resolved by employing pharmaceutics approaches to reduce the incidence of poor patient compliance. Such solutions are expected to make swallowing easier and reduce the need to swallow several solid medications, which is difficult for vulnerable pediatric and geriatric patients. This commentary will explore the current state of the art in the use of drug delivery innovations to overcome some of these challenges, taking cues from relevant regulatory agencies such as the Food and Drug Administration, the European Medicines Agency, World Health Organization, and the peer-reviewed scientific and clinical literature. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  3. 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.

  4. Inappropriate attitudes, fitness to practise and the challenges facing medical educators

    PubMed Central

    Whiting, Demian

    2007-01-01

    The author outlines a number of reasons why morally inappropriate attitudes may give rise to concerns about fitness to practise. He argues that inappropriate attitudes may raise such concerns because they can lead to harmful behaviours (such as a failure to give proper care or treatment), and because they are often themselves harmful (both because of the offence that they can cause and because of the unhealthy pall that they may cast over relations between healthcare practitioners and patients). He also outlines some of the challenges that the cultivation and assessment of attitudes in students raise for medical educators and some of the ways in which those challenges may be approached and possibly overcome. PMID:17971472

  5. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 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.

  7. 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.

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

    DTIC Science & Technology

    2012-05-01

    kerosene. These energy products (Coal Oil & Kerosene) became the first alternative fuels to Whale oil . Coal oil and Kerosene were cheaper alternatives , but...addiction to oil has intensified the research and development into new forms of alternative fuels. The challenges today are numerous and multi-layered...interrupt the flow of oil . Any alternative fuel that requires a new set of pipeline construction adds a higher premium to the use of that fuel, and that

  9. 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

  10. 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.

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

    PubMed

    Waning, Brenda; Diedrichsen, Ellen; Jambert, Elodie; Bärnighausen, Till; Li, Yun; Pouw, Mieke; Moon, Suerie

    2010-10-17

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

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

    PubMed Central

    2010-01-01

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

  14. Part I: Muslims, social inclusion and the West. Exploring challenges faced by stigmatized groups.

    PubMed

    Hankir, Ahmed; Carrick, Frederick R; Zaman, Rashid

    2017-09-01

    The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' to engage readers and to equip them with facts and the necessary skills to combat Islamophobia. Part I includes a brief introduction of Islam and concludes with a concise description and evaluation of an anti-Islamophobia programme that was piloted in Cambridge University (UK) and delivered as a Keynote Address at the Carrick Institute for Graduate Studies International Symposium of Clinical Neuroscience in Orlando, (USA). Our hope is that through this initiative we can create a critical mass and inspire and empower people, Muslims and non-Muslims alike to stand in solidarity and collectively challenge extremism in any of its many forms. Our hypothesis is that this will result in better outcomes such as reductions in radicalization and Islamophobia.

  15. The 'PEARL' Data Warehouse: Initial Challenges Faced with Semantic and Syntactic Interoperability.

    PubMed

    Mahmoud, Samhar; Boyd, Andy; Curcin, Vasa; Bache, Richard; Ali, Asad; Miles, Simon; Taweel, Adel; Delaney, Brendan; Macleod, John

    2017-01-01

    Data about patients are available from diverse sources, including those routinely collected as individuals interact with service providers, and those provided directly by individuals through surveys. Linking these data can lead to a more complete picture about the individual, to inform either care decision making or research investigations. However, post-linkage, differences in data recording systems and formats present barriers to achieving these aims. This paper describes an approach to combine linked GP records with study observations, and reports initial challenges related to semantic and syntactic interoperability issues.

  16. Challenges facing an understanding of the nature of low-energy excited states in photosynthesis.

    PubMed

    Reimers, Jeffrey R; Biczysko, Malgorzata; Bruce, Douglas; Coker, David F; Frankcombe, Terry J; Hashimoto, Hideki; Hauer, Jürgen; Jankowiak, Ryszard; Kramer, Tobias; Linnanto, Juha; Mamedov, Fikret; Müh, Frank; Rätsep, Margus; Renger, Thomas; Styring, Stenbjörn; Wan, Jian; Wang, Zhuan; Wang-Otomo, Zheng-Yu; Weng, Yu-Xiang; Yang, Chunhong; Zhang, Jian-Ping; Freiberg, Arvi; Krausz, Elmars

    2016-09-01

    While the majority of the photochemical states and pathways related to the biological capture of solar energy are now well understood and provide paradigms for artificial device design, additional low-energy states have been discovered in many systems with obscure origins and significance. However, as low-energy states are naively expected to be critical to function, these observations pose important challenges. A review of known properties of low energy states covering eight photochemical systems, and options for their interpretation, are presented. A concerted experimental and theoretical research strategy is suggested and outlined, this being aimed at providing a fully comprehensive understanding. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Pediatric melanoma.

    PubMed

    Tracy, Elisabeth T; Aldrink, Jennifer H

    2016-10-01

    Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Current challenges facing the determination of product bioequivalence in veterinary medicine.

    PubMed

    Martinez, M N; Hunter, R P

    2010-10-01

    Despite the pharmacological and statistical advances that have occurred since the early days of bioequivalence assessments, there remain many unresolved issues associated with the bioequivalence evaluation of human and veterinary pharmaceuticals. While many of these issues are common to both human and veterinary medicine, there are also challenges specific to veterinary drug products. Examples of complex problems that remain to be resolved include the assessment of drugs associated with complex kinetics (e.g., sustained release formulations that produce multiple peaks), the evaluation of intramammary formulations, uncertainty associated with conditions under which specific enantiomers of metabolites need to be factored into the bioequivalence evaluation, the study design for products and active pharmaceutical ingredients that exhibit highly variable kinetics, equivalence of biomass products, methods for evaluating topical formulations or formulations with very long duration of release, the evaluation of products where destructive sampling is necessary (e.g., aquaculture products), and the evaluation of bioequivalence for Type A medicated articles. This manuscript highlights many of the unresolved challenges currently impacting the evaluation of product bioequivalence in veterinary medicine, and provides a summary of the associated scientific complexities with each of these issues. © 2010 Blackwell Publishing Ltd.

  19. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making.

    PubMed

    Cristancho, Sayra M; Vanstone, Meredith; Lingard, Lorelei; LeBel, Marie-Eve; Ott, Michael

    2013-02-01

    Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. When surgeons face intraoperative challenges: a naturalistic model of surgical decision making

    PubMed Central

    Cristancho, Sayra M.; Vanstone, Meredith; Lingard, Lorelei; LeBel, Marie-Eve; Ott, Michael

    2017-01-01

    BACKGROUND Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. METHODS We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. RESULTS Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. CONCLUSIONS The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room. PMID:23331980