Beyond 50. Challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions.

PubMed

Fragar, Lyn J; Depczynski, Julie C

2011-02-21

The health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers. Nurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions. Eighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex professional roles and a sense of not being valued in the context of greater perceived workload. Older health workers are managing a range of issues, on top of the general challenges of rural practice. Personal health, wellbeing and other realms of life appear to take on increasing importance for older health workers when faced with increasing difficulties at work. Solutions need to address difficulties at personal, workplace and system wide levels. © 2011 Fragar and Depczynski; licensee BioMed Central Ltd.

The Development of the Bilingual Special Education Field: Major Issues, Accomplishments, Future Directions, and Recommendations

ERIC Educational Resources Information Center

Zhang, Chun; Choh, Su-Je

2010-01-01

In this paper, we review various challenges in regard to educating children with and without disabilities from culturally and linguistically diverse (CLD) backgrounds. The challenges discussed include (1) biased assessment that results in mis- or overrepresenting CLD students in special education, (2) difficulty distinguishing between disability…

Crossing the Communication Barrier: Facilitating Communication in Mixed Groups of Deaf and Hearing Students

ERIC Educational Resources Information Center

Marchetti, Carol; Foster, Susan; Long, Gary; Stinson, Michael

2012-01-01

Teachers of introductory technical courses such as statistics face numerous challenges in the classroom, including student motivation and mathematical background, and difficulties in interpreting numerical results in context. Cooperative learning through small groups addresses many such challenges, but students for whom spoken English is not their…

Challenges of Designing Interdisciplinary Postgraduate Curricula: Case Studies of Interdisciplinary Master's Programmes at a Research-Intensive UK University

ERIC Educational Resources Information Center

Gantogtokh, Orkhon; Quinlan, Kathleen M.

2017-01-01

This study, based on case study analyses of two interdisciplinary programmes in a research-intensive university in the UK, focuses on the challenges involved in designing, coordinating, and leading interdisciplinary postgraduate curricula, including workload, student heterogeneity, and difficulties in achieving coherence. Solutions and approaches…

Informal Caregiver Challenges for Advanced Cancer Patients During End-of-Life Care in Johannesburg, South Africa and Distinctions Based on Place of Death.

PubMed

O'Neil, Daniel S; Prigerson, Holly G; Mmoledi, Keletso; Sobekwa, Mfanelo; Ratshikana-Moloko, Mpho; Tsitsi, Jacob M; Cubasch, Herbert; Wong, Michelle L; Omoshoro-Jones, Jones A O; Sackstein, Paul E; Blinderman, Craig D; Jacobson, Judith S; Joffe, Maureen; Ruff, Paul; Neugut, Alfred I; Blanchard, Charmaine L

2018-03-28

In sub-Saharan Africa, late diagnosis with cancer is common. Many dying patients rely on family members for care; little is known about the challenges African informal caregivers face. To better understand the challenges of informal caregivers at the end of life in South Africa, both at home and in inpatient facilities. We included advanced cancer patients and caregivers from a public hospital in Johannesburg, South Africa. Study nurses interviewed patients and caregivers about their experiences. Using univariate and multivariate analyses, we determined the factors associated with greater caregiver difficulty, focusing on patients dying at home vs. in inpatient facilities. Among 174 informal caregivers, 62 (36%) reported "a lot" of challenges. These caregivers struggled most with keeping the patient clean (16%) and with patient interactions (34%). Symptoms associated with greater difficulty included pain (odds ratio [OR] 2.4 [95% CI 1.2-4.7]), urinary incontinence (OR 2.3 [95% CI 1.1-4.9]), fecal incontinence (OR 2.4 [95% CI 1.0-5.7]), insomnia (OR 2.9 [95% CI 1.3-6.9]), fatigue (OR 6.3 [95% CI 1.8-21.6]), extremity weakness (OR 2.9 [95% CI 1.3-6.9]), shame (OR 4.2 [95% CI 1.5-12.0]), and sadness (OR 2.3 [95% CI 1.1-4.8]). Caregivers of patients dying at home reported the greatest difficulty with patients' physical symptoms; caregivers of those dying in facilities reported the greatest difficulty with emotional symptoms. Informal caregivers of patients dying at home reported challenges with practical functional care; this effect was reduced in the inpatient setting. Skills training for these caregivers could relieve some of this burden. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences

PubMed Central

Carbonaro, Theresa M; Bradstreet, Matthew P; Barrett, Frederick S; MacLean, Katherine A; Jesse, Robert; Johnson, Matthew W; Griffiths, Roland R

2017-01-01

Acute and enduring adverse effects of psilocybin have been reported anecdotally, but have not been well characterized. For this study, 1993 individuals (mean age 30 yrs; 78% male) completed an online survey about their single most psychologically difficult or challenging experience (worst “bad trip”) after consuming psilocybin mushrooms. Thirty-nine percent rated it among the top five most challenging experiences of his/her lifetime. Eleven percent put self or others at risk of physical harm; factors increasing the likelihood of risk included estimated dose, duration and difficulty of the experience, and absence of physical comfort and social support. Of the respondents, 2.6% behaved in a physically aggressive or violent manner and 2.7% received medical help. Of those whose experience occurred >1 year before, 7.6% sought treatment for enduring psychological symptoms. Three cases appeared associated with onset of enduring psychotic symptoms and three cases with attempted suicide. Multiple regression analysis showed degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. Difficulty of experience was positively associated with dose. Despite difficulties, 84% endorsed benefiting from the experience. The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants. PMID:27578767

Using Etherpads as Platforms for Collaborative Learning in a Distance Education LIS Course

ERIC Educational Resources Information Center

Pymm, Bob; Hay, Lyn

2014-01-01

Distance education, by definition, creates a number of challenges for lecturer and student in building and maintaining connection and commitment. The challenges that need to be overcome include communication difficulties, lack of student motivation, high drop out from courses, provision of support at a distance and a sense of isolation or lack of…

Don't Make Me Laugh: People Are Funny in "Wall-E" and "Tropic Thunder"

ERIC Educational Resources Information Center

Beck, Bernard

2009-01-01

The current difficulties of making challenging humor while respecting the legitimate sensibilities of stigmatized people are discussed. Two very different movie comedies include jokes about people. One is received with outrage on behalf of the group that is made the butt of the jokes, people who are "mentally challenged"; the other, about…

Cognitive Difficulty and Format of Exams Predicts Gender and Socioeconomic Gaps in Exam Performance of Students in Introductory Biology Courses

ERIC Educational Resources Information Center

Wright, Christian D.; Eddy, Sarah L.; Wenderoth, Mary Pat; Abshire, Elizabeth; Blankenbiller, Margaret; Brownell, Sara E.

2016-01-01

Recent reform efforts in undergraduate biology have recommended transforming course exams to test at more cognitively challenging levels, which may mean including more cognitively challenging and more constructed-response questions on assessments. However, changing the characteristics of exams could result in bias against historically underserved…

Challenges to Providing Fetal Anomaly Testing in a Cross-Cultural Environment: Experiences of Practitioners Caring for Aboriginal Women.

PubMed

Rumbold, Alice R; Wild, Kayli J; Maypilama, Elaine Lawurrpa; Kildea, Sue V; Barclay, Lesley; Wallace, Euan M; Boyle, Jacqueline A

2015-12-01

Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs. © 2015 Wiley Periodicals, Inc.

Design Challenges in Converting a Paper Checklist to Digital Format for Dynamic Medical Settings

PubMed Central

Sarcevic, Aleksandra; Rosen, Brett J.; Kulp, Leah J.; Marsic, Ivan; Burd, Randall S.

2016-01-01

We describe a mobile digital checklist that we designed and developed for trauma resuscitation—a dynamic, fast-paced medical process of treating severely injured patients. The checklist design was informed by our analysis of user interactions with a paper checklist that was introduced to improve team performance during resuscitations. The design process followed an iterative approach and involved several medical experts. We discuss design challenges in converting a paper checklist to its digital counterpart, as well as our approaches for addressing those challenges. While we show that using a digital checklist during a fast-paced medical event is feasible, we also recognize several design constraints, including limited display size, difficulties in entering notes about the medical process and patient, and difficulties in replicating user experience with paper checklists. PMID:28480116

Standard Setting in a Small Scale OSCE: A Comparison of the Modified Borderline-Group Method and the Borderline Regression Method

ERIC Educational Resources Information Center

Wood, Timothy J.; Humphrey-Murto, Susan M.; Norman, Geoffrey R.

2006-01-01

When setting standards, administrators of small-scale OSCEs often face several challenges, including a lack of resources, a lack of available expertise in statistics, and difficulty in recruiting judges. The Modified Borderline-Group Method is a standard setting procedure that compensates for these challenges by using physician examiners and is…

Peer Mentoring: Encouraging Persistence in Native American Postsecondary Students

ERIC Educational Resources Information Center

Lee, Susan D.

2013-01-01

Native Americans have endured historical and contemporary challenges that have adversely affected their achievement, including in the realm of postsecondary education. The difficulties have included, but are not limited to, the problems inherent in the process of assimilation into Caucasian culture, the repercussions of Indian Boarding Schools,…

Flying the nest: a challenge for young adults with cystic fibrosis and their parents

PubMed Central

Bregnballe, Vibeke; Boisen, Kirsten A; Schiøtz, Peter Oluf; Pressler, Tacjana; Lomborg, Kirsten

2017-01-01

Objectives As young patients with cystic fibrosis (CF) grow up, they are expected to take increasing responsibility for the treatment and care of their disease. The aim of this study was to explore the disease-related challenges faced by young adults with CF and their parents, when they leave home. Materials and methods A questionnaire survey of Danish patients with CF aged 18–25 years and their parents was conducted. The questionnaires were based on focus-group interviews with young adults with CF and their parents, and addressed challenges faced in the transition phase between childhood and adulthood, including different areas of disease management in everyday life. Results Among all of the patients invited, 62% (n=58/94) of young adults and 53% (n=99/188) of their parents participated in the study. In total, 40% of the 18- to 25-year-olds were living with their parents, and the parents continued to play an active role in the daily care of their offspring’s disease. Among the young adults who had left home, both the patients and their parents reported many difficulties regarding disease management; the young adults reported difficulties in contacting social services and in affording and preparing sufficient CF-focused meals, and their parents reported difficulties in answering questions concerning social rights and CF in general, and in knowing how to give their offspring the best help, how much to interfere, and how to relinquish control of managing their offspring’s disease. Conclusion Young adults with CF who have left home have difficulties in handling the disease and their parents have difficulties in knowing how to give them the best help. There is an urgent need for holistic CF transitional care, including ensuring that young adults master the essential skills for self-management as they leave their parents. PMID:28243066

Conducted electrical weapons within healthcare: a comprehensive use of force model.

PubMed

Ho, Jeffrey D; Williams, Martin F; Coplen, Michael J

2014-01-01

Healthcare settings are experiencing increased amounts of violent activity that are challenging to the health care security profession. There is difficulty in addressing this issue completely. Some of this difficulty is because of factors that include inexperienced and untrained clinicians and administrators that are often the decision-makers in the health care setting. As part of an effective solution, we propose that a security plan, including a comprehensive use of force program incorporating conducted electrical weapons, is a necessary and best-practice goal. This paper outlines the background of the problem and discusses the challenges we encountered in reaching this goal as well as the benefits we have discovered along the way. This paper will be beneficial to any healthcare security professional that is interested in enhancing or improving their current health care security use of force model to further counter the increasing violent activity in their respective healthcare setting.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

PubMed

King, Emily C; Holliday, Pamela J; Andrews, Gavin J

2018-04-01

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences.

PubMed

Carbonaro, Theresa M; Bradstreet, Matthew P; Barrett, Frederick S; MacLean, Katherine A; Jesse, Robert; Johnson, Matthew W; Griffiths, Roland R

2016-12-01

Acute and enduring adverse effects of psilocybin have been reported anecdotally, but have not been well characterized. For this study, 1993 individuals (mean age 30 yrs; 78% male) completed an online survey about their single most psychologically difficult or challenging experience (worst "bad trip") after consuming psilocybin mushrooms. Thirty-nine percent rated it among the top five most challenging experiences of his/her lifetime. Eleven percent put self or others at risk of physical harm; factors increasing the likelihood of risk included estimated dose, duration and difficulty of the experience, and absence of physical comfort and social support. Of the respondents, 2.6% behaved in a physically aggressive or violent manner and 2.7% received medical help. Of those whose experience occurred >1 year before, 7.6% sought treatment for enduring psychological symptoms. Three cases appeared associated with onset of enduring psychotic symptoms and three cases with attempted suicide. Multiple regression analysis showed degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. Difficulty of experience was positively associated with dose. Despite difficulties, 84% endorsed benefiting from the experience. The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants. © The Author(s) 2016.

Ethical Issues and Practical Challenges in Suicide Research.

PubMed

Hom, Melanie A; Podlogar, Matthew C; Stanley, Ian H; Joiner, Thomas E

2017-03-01

Research with human subjects represents a critical avenue for suicide prevention efforts; however, such research is not without its ethical and practical challenges. Specifically, given the nature of research with individuals at elevated risk for suicide (e.g., increased concerns regarding participant safety, adverse events, liability, difficulties often arise during the institutional review board (IRB) evaluation and approval process. This paper aims to discuss IRB-related issues associated with suicide prevention research, including researcher and IRB panel member responsibilities, suicide risk assessment and management ethics and procedures, informed consent considerations, preparation of study protocols, and education and training. Points to consider and components to potentially include in an IRB application for suicide-related research are additionally provided. Literature relevant to ethics in suicide research and suicide risk assessment and management was reviewed and synthesized. Suicide research can be conducted in accordance with ethical principles while also furthering the science of suicide prevention. Despite the challenging nature of suicide prevention research, empirically informed solutions exist to address difficulties that may emerge in interfacing with IRBs. There remain areas for improvement in the IRB approval process that warrant further investigation and work.

Applying health economics for policy decision making: do devices differ from drugs?

PubMed

Sorenson, Corinna; Tarricone, Rosanna; Siebert, Markus; Drummond, Michael

2011-05-01

Medical devices pose unique challenges for economic evaluation and associated decision-making processes that differ from pharmaceuticals. We highlight and discuss these challenges in the context of cardiac device therapy, based on a systematic review of relevant economic evaluations. Key challenges include practical difficulties in conducting randomized clinical trials, allowing for a 'learning curve' and user characteristics, accounting for the wider organizational impacts of introducing new devices, and allowing for variations in product characteristics and prices over time.

Overcoming the Challenges of Co-creation

NASA Astrophysics Data System (ADS)

Pandya, R.; Udu-gama, N.; Goodwin, M.; Otellini, P.

2016-12-01

There is growing interest in co-creation, especially for community-related issues like climate change, resilience, pollution, and environmental justice. Nevertheless, co-creation is still not mainstream practice in either geosciences or the world of decision-makers. This presents many challenges. On the science side, challenges include a paucity of training opportunities, lack of funding for co-creation, difficulty publishing or otherwise getting credit for the effort, and a perceived lack of prestige compared to theoretical research. On the community side, parallel challenges include a lack of experience working with scientists or thinking about geoscience's relevance to community issues, tight budgets and competing priorities, the need for outputs beyond publications, and the difficulty including science among a range of factors. Additionally, scientists and community leaders often work across public and private sectors and must navigate different approaches to data, privacy, and accountability. We'll use this session to explore opportunities to overcome the challenges of co-creation. Systems thinking suggests a range of approaches: enabling individuals, reducing specific challenges, changing the relationship between the elements of the systems, and changing the goals or mindsets of the systems - each more powerful than the last. For example, mentoring and coaching enables individuals, and pro-bono work eases the challenge of getting professional credit. New modes of output, like plain language abstracts, change the relationship between publications and other outputs. We can work on changing mindsets by publicizing and celebrating individual successes. With more effort and impact, we can build collaborations in the collective impact model, where we bring scientific and community organizations together around a common agenda and shared measurement. Building on these examples, we will use this session to collect strategies and opportunities from all participants.

Challenges and issues facing lithium metal for solid-state rechargeable batteries

NASA Astrophysics Data System (ADS)

Mauger, A.; Armand, M.; Julien, C. M.; Zaghib, K.

2017-06-01

The commercial use of lithium metal batteries was delayed because of dendrite formation on the surface of the lithium electrode, and the difficulty finding a suitable electrolyte that has both the mechanical strength and ionic conductivity required for solid electrolytes. Recently, strategies have developed to overcome these difficulties, so that these batteries are currently an option for different applications, including electric cars. In this work, we review these strategies, and discuss the different routes that are promising for progress in the near future.

Internationalization of traditional Chinese medicine: current international market, internationalization challenges and prospective suggestions.

PubMed

Lin, Annie Xianghong; Chan, Ging; Hu, Yuanjia; Ouyang, Defang; Ung, Carolina Oi Lam; Shi, Luwen; Hu, Hao

2018-01-01

Through reviewing the current international market for traditional Chinese medicine (TCM), this paper identified the internationalization challenges for TCM, including unclear therapeutic material basis and mechanism, difficulty of quality control, low preparation level, registration/policy barriers, and shortage of intellectual property. To deal with these challenges, suggestions were given including: (1) product innovation of TCM (study the TCM by using the methods and means of western medicine; innovate the basic theory of TCM; develop TCM health product); (2) standard innovation of TCM; (3) building big data platform of Chinese medicine (big data platform of TCM preparation; big data platform on the quality of TCM).

Model-based and Model-free Machine Learning Techniques for Diagnostic Prediction and Classification of Clinical Outcomes in Parkinson's Disease.

PubMed

Gao, Chao; Sun, Hanbo; Wang, Tuo; Tang, Ming; Bohnen, Nicolaas I; Müller, Martijn L T M; Herman, Talia; Giladi, Nir; Kalinin, Alexandr; Spino, Cathie; Dauer, William; Hausdorff, Jeffrey M; Dinov, Ivo D

2018-05-08

In this study, we apply a multidisciplinary approach to investigate falls in PD patients using clinical, demographic and neuroimaging data from two independent initiatives (University of Michigan and Tel Aviv Sourasky Medical Center). Using machine learning techniques, we construct predictive models to discriminate fallers and non-fallers. Through controlled feature selection, we identified the most salient predictors of patient falls including gait speed, Hoehn and Yahr stage, postural instability and gait difficulty-related measurements. The model-based and model-free analytical methods we employed included logistic regression, random forests, support vector machines, and XGboost. The reliability of the forecasts was assessed by internal statistical (5-fold) cross validation as well as by external out-of-bag validation. Four specific challenges were addressed in the study: Challenge 1, develop a protocol for harmonizing and aggregating complex, multisource, and multi-site Parkinson's disease data; Challenge 2, identify salient predictive features associated with specific clinical traits, e.g., patient falls; Challenge 3, forecast patient falls and evaluate the classification performance; and Challenge 4, predict tremor dominance (TD) vs. posture instability and gait difficulty (PIGD). Our findings suggest that, compared to other approaches, model-free machine learning based techniques provide a more reliable clinical outcome forecasting of falls in Parkinson's patients, for example, with a classification accuracy of about 70-80%.

Patient engagement in patient-centered outcomes research: challenges, facilitators and actions to strengthen the field.

PubMed

Ellis, Lauren E; Kass, Nancy E

2017-06-01

To describe challenges to and facilitators of patient engagement to inform future strategies and suggested actions to strengthen engagement. Interviews with 19 principal investigators of projects funded by the Patient-Centered Outcomes Research Institute and with 33 patients from 18 of the 19 projects. Facilitators included using existing resources, having clear goals, educating patients and treating patients respectfully. Logistical challenges included extra time and work, institutional barriers and difficulty having meetings. Substantive challenges to selecting, educating and engaging patients, and incorporating feedback were also reported. To bolster the infrastructure for engagement, we suggest funders, institutions and researchers focus on resources and training for researchers and patients, networks and programs to connect stakeholders and model policies.

Resourceful Campus Solutions to IT Staff Challenges.

ERIC Educational Resources Information Center

Burmeister, Charles W.; Martinez, Ernest A.; Biggerstaff, Diana; Coppernoll, Susanna; Sylvest, Onedia H.; Ganzert, Robin; Greenwood, Tamara; Hoppe, Betsy; Turner, Lauren; Yuochunas, Nancy L.; Duwe, Jack; Caruso, Judy; Jezwinski, Marcia

1998-01-01

Describes creative responses of six colleges and universities to the information-technology personnel shortage, salary differentials with marketplace, recruitment and retention difficulties, and the need to support institution-wide technology growth. Institutions include: Alamo Community College District (Texas); Texas A&M University; Wake…

Group Counseling with International Students: Practical, Ethical, and Cultural Considerations

ERIC Educational Resources Information Center

Yakunina, Elena S.; Weigold, Ingrid K.; McCarthy, Alannah S.

2011-01-01

International students in higher education represent a diverse population with unique mental health needs. Foreign students commonly experience a host of adjustment issues, including acculturative stress, language difficulties, cultural misunderstandings, racial discrimination, and loss of social support. Despite their challenges, few…

Integration of internationally educated nurses into the U.S. Workforce.

PubMed

Wolcott, Krista; Llamado, Suzanne; Mace, Denise

2013-01-01

This study describes the integration experiences of internationally educated nurses, managers, and educators working in Northern California. The purpose of this qualitative pilot study was to explore the experiences of internationally educated nurses and the nurse managers and educators working with them, to understand the issues, and to highlight potential solutions for addressing integration challenges. Through interviews and qualitative analysis, successful strategies and persistent challenges were identified. Major themes identified included communication difficulties; financial challenges; the need for outside social support; and educational orientations focused on culture, nurse role, and communication techniques.

How small is small enough? Role of robotics in paediatric urology

PubMed Central

Ganpule, Arvind P.; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series. PMID:25598599

How small is small enough? Role of robotics in paediatric urology.

PubMed

Ganpule, Arvind P; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.

Interactive Video: Meeting the Ford Challenge.

ERIC Educational Resources Information Center

Copeland, Peter

Many companies using Statistical Process Control (SPC) in their manufacturing processes have found that, despite the training difficulties presented by the technique, the rewards of successful SPC include increased productivity, quality, and market leadership. The Ford Motor Company has developed its SPC training with interactive video, which…

Best Practices in Working with Students with Emotion Dysregulation

ERIC Educational Resources Information Center

Cunningham, Jennifer; Mendez, Linda M. Raffaele; Sundman-Wheat, Ashley N.

2011-01-01

Students with emotion dysregulation have significant difficulty modulating emotional reactions, particularly in response to frustration or challenge. These children can present with a variety of DSM diagnoses in schools, including attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), major depressive disorder (MDD),…

A snapshot of health information exchange across five nations: an investigation of frontline clinician experiences in emergency care.

PubMed

Klapman, Seth; Sher, Emily; Adler-Milstein, Julia

2018-06-01

Ensuring the ability to exchange patient information among disparate electronic health records systems is a top priority and a domain of substantial public investment across countries. However, we know little about the extent to which current capabilities meet the needs of frontline clinicians. We conducted in-person, semistructured interviews with emergency care physicians and nurses in select hospitals in Canada, Denmark, Finland, Germany, and the USA. We characterized the state of health information exchange (HIE) by country and used thematic analysis to identify the perceived benefits of access to complete past medical history (PMH), the conditions under which PMH is sought, and the challenges to accessing and using HIE capabilities. HIE approaches, and the information electronically accessible to clinicians, differed by country. Benefits of access to PMH included safer care, reduced patient length of stay, and fewer lab and imaging orders. Conditions under which PMH was sought included moderate-acuity patients, patients with chronic conditions, and instances where accessing PMH was convenient. Challenges to HIE access and use included difficulty knowing where information is located, delay in receiving information, and difficulty finding information within documents. Even with different HIE approaches across countries, all clinicians reported shortcomings in their country's approach. Notably, challenges were similar and shaped the conditions under which PMH was sought. As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another.

Resilience in Language Learners and the Relationship to Storytelling

ERIC Educational Resources Information Center

Nguyen, Kate; Stanley, Nile; Stanley, Laurel; Wang, Yonghui

2015-01-01

International students, who study a foreign language abroad, experience more adversities than their domestic peers. The social challenges they face include problems with immigration status, isolation, difficulty speaking a new language, and learning unfamiliar customs. There is limited research focused on the coping strategies of these…

Perspectives on next-generation technology for environmental sensor networks

Treesearch

Barbara J. Benson; Barbara J. Bond; Michael P. Hamilton; Russell K. Monson; Richard Han

2009-01-01

Sensor networks promise to transform and expand environmental science. However, many technological difficulties must be overcome to achieve this potential. Partnerships of ecologists with computer scientists and engineers are critical in meeting these challenges. Technological issues include promoting innovation in new sensor design, incorporating power optimization...

Effects of Cognitive Demand on Word Encoding in Adults Who Stutter

ERIC Educational Resources Information Center

Tsai, Pei-Tzu

2011-01-01

The etiology of persistent stuttering is unknown, but stuttering has been attributed to multiple potential factors, including difficulty in processing language-related information, but findings remain inconclusive regarding any "specific" linguistic deficit potentially causing stuttering. One particular challenge in drawing conclusions is the…

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

PubMed Central

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; Lemberger, Thomas; McEntyre, Johanna; Polson, Shawn; Xenarios, Ioannis; Arighi, Cecilia; Lu, Zhiyong

2016-01-01

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to the increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. Finally, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators. PMID:28025348

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

DOE PAGES

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; ...

2016-12-26

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to themore » increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. In conclusion, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators.« less

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singhal, Ayush; Leaman, Robert; Catlett, Natalie

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to themore » increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. In conclusion, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators.« less

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

PubMed

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

2017-04-01

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

Narrative in Exergames: Thoughts on Procedure, Mechanism, and Others

PubMed Central

2015-01-01

Abstract Narratives are stories with a beginning, middle, and end that provide information about the characters and plot. Exergames are videogames that require players to move or exercise. Narratives and exergames have seldom been examined together. Based on my review of the literature, there are five potential opportunities narratives could bring to exergames: Enhanced engagement with characters and with the plot, increased motivation, repeated play sessions, and better behavioral consequence. However, the rewards offered by these possibilities may be offset by the challenges they pose. These challenges include the difficulty in fully integrating narratives into the gameplay, the players' limited information processing capacity, difficulty in measurement, the lack of full understanding of the player–character identification process, and the narrative saturation effects. Innovative research is needed to bridge the two potentially important domains. PMID:26181676

Instruction and Assessment for Struggling Writers Evidence-Based Practices

ERIC Educational Resources Information Center

Troia, Gary A., Ed.

2009-01-01

This book focuses on how to provide effective instruction to K-12 students who find writing challenging, including English language learners and those with learning disabilities or language impairments. Prominent experts illuminate the nature of writing difficulties and offer practical suggestions for building students' skills at the word,…

Nursing Home Social Workers and Allied Professionals: Enhancing Geriatric Mental Health Knowledge

ERIC Educational Resources Information Center

Bonifas, Robin P.

2011-01-01

Research has highlighted the challenges social services professionals face in providing quality psychosocial care to persons living in skilled nursing facilities (SNFs). A primary area of difficulty is addressing the needs of persons with mental health conditions, including problematic behaviors associated with dementia. This study evaluated the…

Factors Influencing the Research Participation of Adults with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Haas, Kaaren; Costley, Debra; Falkmer, Marita; Richdale, Amanda; Sofronoff, Kate; Falkmer, Torbjörn

2016-01-01

Recruiting adults with autism spectrum disorders (ASD) into research poses particular difficulties; longitudinal studies face additional challenges. This paper reports on a mixed methods study to identify factors influencing the participation in longitudinal autism research of adults with ASD, including those with an intellectual disability, and…

Meeting Learning Challenges: Working with the Child Who Has ADD

ERIC Educational Resources Information Center

Greenspan, Stanley I.

2006-01-01

The terms ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are applied to several symptoms, including: difficulty in paying attention, distractibility, having a hard time following through on things, and sometimes over-activity and impulsivity. There are many different reasons why children have these symptoms.…

Instructional Math Technology in Secondary Special Education: Teacher-Reported Practices and Perceptions

ERIC Educational Resources Information Center

Higa, Joice M.

2017-01-01

Students with disabilities often have difficulty meeting established math proficiency levels. Without these skills, students may face increased challenges in transitioning to adulthood, including fewer post-secondary educational opportunities, limited career options, and decreased long-term income. Addressing low math skills is important to…

Using Acceptance and Commitment Therapy to Treat Infertility Stress

ERIC Educational Resources Information Center

Peterson, Brennan D.; Eifert, Georg H.

2011-01-01

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to…

Stress, Sleep, Grief: Are College Students Receiving Information That Interests Them?

ERIC Educational Resources Information Center

Wagner, Meredith; Rhee, Yeong

2013-01-01

Problem: College life brings with it many challenges for students' well-being including stress, trouble sleeping, anxiety, and difficulties with relationships. However, evidence of substantial variation in organization and availability of health-focused resources on college campuses has been documented and students' interest in health-related…

A study of a museum-school partnership

NASA Astrophysics Data System (ADS)

Wojton, Mary Ann

Partnerships between museums and schools never have been more important than they are today. Schools, especially urban schools, are facing challenges, including low student achievement and difficulty obtaining funding. Partners can help schools overcome these challenges by sharing educational and financial resources. Nearly 11,000 American museums spend more than $1 billion annually to provide over 18 million instructional hours for k-12 educational programs such as professional development for teachers, guided field trips, and staff visits to schools. Museums would seem like natural partners for challenged urban schools. Yet museums and schools struggle to establish and maintain effective partnerships. This study examined a partnership between a science center and an urban elementary school to provide additional knowledge and resources for those in the field to overcome these challenges in order to create relationships that help students. Using qualitative methods with interpretive descriptive purposes (Erickson, 1986; Glesne, 1999; Lincoln & Guba, 2000), the research design is based on several methods of data collection, including face-to-face, semi-structured interviews; observations; written text; and field notes. Participants in this study included students, parents, teachers, school administrators and museum educators. In addition, adult representatives of community organizations were interviewed to determine the impact of the partnership on the community. The study found that an effective partnership will have four basic elements: mutual goals, communication plan, key leader support, planning and research, and four interpersonal elements: personal responsibility, honesty, communication at the intimate level, and trust. Partners may have difficulty developing these to their fullest extent due to time limitations. No partnership is perfect. By creating strong interpersonal relationships, partners can mitigate challenges caused by limited basic elements and increase the likelihood that their partnership will be effective.

Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

PubMed

Fryatt, Robert; Mills, Anne; Nordstrom, Anders

2010-01-30

Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

The therapeutic value of adolescents' blogging about social-emotional difficulties.

PubMed

Boniel-Nissim, Meyran; Barak, Azy

2013-08-01

Research shows that writing a personal diary is a valuable therapeutic means for relieving emotional distress and promoting well-being, and that diary writing during adolescence helps in coping with developmental challenges. Current technologies and cultural trends make it possible and normative to publish personal diaries on the Internet through blogs--interactive, online forms of the traditional personal diary. We examined the therapeutic value of blogging for adolescents who experience social-emotional difficulties. The field experiment included randomly assigned adolescents, preassessed as having social-emotional difficulties, to 6 groups (26-28 participants in each): Four groups were assigned to blogging (writing about their difficulties or free writing; either open or closed to responses), a group assigned to writing a diary on personal computers, and a no-treatment control group. Participants in the 5 writing groups were instructed to post messages at least twice a week over 10 weeks. Outcome measures included scales of social-emotional difficulties and self-esteem, a social activities checklist, and textual analyses of participants' posts. Measurement took place at pre- and postintervention and at follow-up 2 months later. Results showed that participants maintaining a blog significantly improved on all measures. Participants writing about their difficulties in blogs open to responses gained the most. These results were consistent in the follow-up evaluation. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies

PubMed Central

Clarke, David

2017-01-01

Objective To review and synthesise qualitative literature relating to the longer-term needs of community dwelling stroke survivors with communication difficulties including aphasia, dysarthria and apraxia of speech. Design Systematic review and thematic synthesis. Method We included studies employing qualitative methodology which focused on the perceived or expressed needs, views or experiences of stroke survivors with communication difficulties in relation to the day-to-day management of their condition following hospital discharge. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, International Bibliography of the Social Sciences and AMED and undertook grey literature searches. Studies were assessed for methodological quality by two researchers independently and the findings were combined using thematic synthesis. Results Thirty-two studies were included in the thematic synthesis. The synthesis reveals the ongoing difficulties stroke survivors can experience in coming to terms with the loss of communication and in adapting to life with a communication difficulty. While some were able to adjust, others struggled to maintain their social networks and to participate in activities which were meaningful to them. The challenges experienced by stroke survivors with communication difficulties persisted for many years poststroke. Four themes relating to longer-term need were developed: managing communication outside of the home, creating a meaningful role, creating or maintaining a support network and taking control and actively moving forward with life. Conclusions Understanding the experiences of stroke survivors with communication difficulties is vital for ensuring that longer-term care is designed according to their needs. Wider psychosocial factors must be considered in the rehabilitation of people with poststroke communication difficulties. Self-management interventions may be appropriate to help this subgroup of stroke survivors manage their condition in the longer-term; however, such approaches must be designed to help survivors to manage the unique psychosocial consequences of poststroke communication difficulties. PMID:28988185

Neurodevelopmental Profile, Growth, and Psychosocial Environment of Preterm Infants with Difficult Feeding Behavior at Age 2 Years.

PubMed

Crapnell, Tara L; Woodward, Lianne J; Rogers, Cynthia E; Inder, Terrie E; Pineda, Roberta G

2015-12-01

To examine the association of difficult feeding behaviors in very preterm infants at age 2 years with growth and neurodevelopmental outcomes and family factors and functioning. Eighty children born ≤30 weeks gestation were studied from birth until age 2 years. Feeding difficulties were assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment at age 2 years, along with growth measurement and developmental testing. Maternal mental health and family factors were assessed using standardized questionnaires. ANOVA and χ(2) analyses were performed to determine associations between feeding difficulties and growth, neurodevelopmental outcomes, and family characteristics. Twenty-one children (26%) were at risk for feeding difficulties, and an additional 18 (23%) had definite feeding difficulties at age 2 years. Those with feeding difficulties were more likely to be subject to a range of neurodevelopmental problems, including impaired cognition (P = .02), language (P = .04), motor (P = .01), and socioemotional (P < .007) skills. Compared with the parents of children with fewer feeding difficulties, parents of the children with feeding difficulties had higher parenting stress (P = .02) and reported more difficulty managing their child's behavior (P = .002) and more frequent parent-child interaction problems (P = .002). No associations were found between difficult feeding behaviors and growth, maternal mental health, or family factors. Difficult feeding behaviors in children born very preterm appear to be highly comorbid with other developmental and family challenges, including neurodevelopmental impairment and parent-child interaction difficulties. Focusing on improving feeding skills, in conjunction with supporting positive parent-child interactions, may be beneficial for improving outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Neurodevelopmental Profile, Growth, and Psychosocial Environment of Preterm Infants with Difficult Feeding Behavior at Two Years of Age

PubMed Central

Crapnell, Tara L.; Woodward, Lianne J.; Rogers, Cynthia E.; Inder, Terrie E.; Pineda, Roberta G.

2015-01-01

Objectives To examine the association of difficult feeding behaviors in very preterm infants at two years of age with growth and neurodevelopmental outcomes and family factors and functioning. Study design Eighty children born ≤30 weeks gestation were studied from birth until two years of age. Feeding difficulties were assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment at age two years alongside growth and developmental testing. Maternal mental health and family factors were assessed using standardized questionnaires. ANOVA and chi-square analyses were used to determine associations between feeding difficulties and growth, neurodevelopmental outcomes, and family characteristics. Results Twenty-one (26%) of the cohort were at risk for feeding difficulties, and an additional 18 (23%) had definite feeding difficulties at age two years. Those with feeding difficulties were more likely to be subject to a range of neurodevelopmental problems including impaired cognition (p=0.02), language (p=0.04), motor (p=0.01) and socio-emotional (p<0.007) skills. Parents of very preterm born children with feeding difficulties had higher parenting stress (p=0.02) and reported more difficulty managing their child’s behavior (p=0.002) and more frequent parent-child interaction problems (p=0.002) than parents of children with fewer feeding difficulties. No associations were found between difficult feeding behaviors and growth, maternal mental health, and family factors. Conclusions Difficult feeding behaviors in children born very preterm appear to be highly comorbid with other developmental and family challenges, including neurodevelopmental impairment and parent-child interaction difficulties. Focusing on improving feeding skills, in conjunction with supporting positive parent-child interactions, may be beneficial for improving outcomes. PMID:26490123

Control Engineering, System Theory and Mathematics: The Teacher's Challenge

ERIC Educational Resources Information Center

Zenger, K.

2007-01-01

The principles, difficulties and challenges in control education are discussed and compared to the similar problems in the teaching of mathematics and systems science in general. The difficulties of today's students to appreciate the classical teaching of engineering disciplines, which are based on rigorous and scientifically sound grounds, are…

A pilot feasibility study of neurofeedback for children with autism.

PubMed

Steiner, Naomi J; Frenette, Elizabeth; Hynes, Caitlin; Pisarik, Elizabeth; Tomasetti, Kathryn; Perrin, Ellen C; Rene, Kirsten

2014-06-01

Neurofeedback (NFB) is an emerging treatment for children with autism spectrum disorder (ASD). This pilot study examined the feasibility of NFB for children with ASD. Ten children ages 7-12 with high functioning ASD and attention difficulties received a NFB attention training intervention. A standardized checklist captured feasibility, including focus during exercises and academic tasks, as well as off-task behaviors. Active behaviors and vocalizations were the most frequent off-task behaviors. Positive reinforcement and breaks including calm breathing exercises were the most common supports. Low motivation was associated with higher feasibility challenges, yet parental involvement and accommodations were helpful. This pilot study shows that it is feasible to conduct NFB sessions with children with high functioning autism and attention difficulties.

Challenges in Recruiting Aging Women Holocaust Survivors to a Case Control Study of Breast Cancer.

PubMed

Vin-Raviv, Neomi; Dekel, Rachel; Barchana, Micha; Linn, Shai; Keinan-Boker, Lital

2015-01-01

Older adults are underrepresented in medical research for many reasons, including recruitment difficulties. Recruitment of older adults for research studies is often a time-consuming process and can be more challenging when the study involves older adults with unique exposures to traumatic events and from minority groups. The current article provides a brief overview of (a) challenges encountered while recruiting aging women Holocaust survivors for a case control study and (b) strategies used for meeting those challenges. The case group comprised women Holocaust survivors who were recently diagnosed with breast cancer and the control group comprised healthy women from a Holocaust-survivor community in Israel. Copyright 2015, SLACK Incorporated.

Lessons from Peer Support Among Individuals with Mental Health Difficulties: A Review of the Literature

PubMed Central

Miyamoto, Yuki; Sono, Tamaki

2012-01-01

We conducted a comprehensive narrative review and used a systematic search strategy to identify studies related to peer support among adults with mental health difficulties. The purposes of this review were to describe the principles, effects and benefits of peer support documented in the published literature, to discuss challenging aspects of peer support and to investigate lessons from peer support. Fifty-one studies, including 8 review articles and 19 qualitative studies, met the inclusion criteria for this review. Most of the challenges for peer support were related to “role” and “relationship” issues; that is, how peer support providers relate to people who receive peer support and how peer support providers are treated in the system. The knowledge gained from peer support relationships, such as mutual responsibility and interdependence, might be a clue toward redefining the helper-helper relationship as well as the concepts of help and support. PMID:22563347

Dose addition models based on biologically-relevant reductions in fetal testosterone accurately predict postnatal reproductive tract alterations by a phthalate mixture in rats

EPA Science Inventory

Challenges in cumulative risk assessment of anti-androgenic phthalate mixtures include a lack of data on all the individual phthalates and difficulty determining the biological relevance of reduction in fetal testosterone (T) on postnatal development. The objectives of the curren...

Grandparent Headed Families and Head Start: Developing Effective Services.

ERIC Educational Resources Information Center

Dannison, Linda L.; Smith, Andrea B.

Numerous challenges face the growing number of grandparent-headed households, including isolation from friends and social supports, and difficulties in caring for grandchildren exhibiting multiple needs. This paper describes a pilot program in which a university and a large county-wide Head Start program formed a partnership to focus on serving…

Impact of Parental Severe Mental Illness: Ethical and Clinical Issues for Counselors

ERIC Educational Resources Information Center

Spiegelhoff, Sarah F.; Ahia, C. Emmanuel

2011-01-01

This article draws attention to the issue of parental severe mental illness and the ethical and clinical implications for counselors who work with this population. Parents with mental illness face a multitude of life challenges including, but not limited to, parenting difficulties, medication and hospitalization, custody and placement of their…

Informational Text Comprehension: Its Challenges and How Collaborative Strategic Reading Can Help

ERIC Educational Resources Information Center

McCown, Margaret Averill; Thomason, Gina B.

2014-01-01

With the increased emphasis on informational text with Common Core State Standards and the difficulty many students have with this type of text, this study examined the effects of Collaborative Strategic Reading (CSR) on informational text comprehension and metacognitive awareness of fifth grade students. Participating students included a…

Developing "Reflective" Development Practitioners through an Action-Learning Curriculum: Problems and Challenges in a South African Context.

ERIC Educational Resources Information Center

Luckett, S.; Luckett, K.

1999-01-01

A South African university's community development program attempted to integrate Checkland's soft-systems method into Kolb's learning-cycle theory. Evaluation revealed shortcomings in the curriculum design, including the assumption of learner autonomy, necessity of assessing students individually, and difficulty of allowing learners to construct…

Rural Community College Student Perceptions of Barriers to College Enrollment

ERIC Educational Resources Information Center

Scott, Shanda; Miller, Michael T.; Morris, Adam A.

2016-01-01

Rural community college students face unique difficulties in higher education for many reasons, including the resources they typically have access to, their collective histories, and in many cases, the preparation they received in high school. These challenges might be low-performing secondary schools, a lack of tradition and precedence in…

The Impact of Different Teaching Approaches and Languages on Student Learning of Introductory Programming Concepts

ERIC Educational Resources Information Center

Kunkle, Wanda M.

2010-01-01

Many students experience difficulties learning to program. They find learning to program in the object-oriented paradigm particularly challenging. As a result, computing educators have tried a variety of instructional methods to assist beginning programmers. These include developing approaches geared specifically toward novices and experimenting…

Kick the Ball or Kicked the Ball? Perception of the Past Morpheme "-ed" by Second Language Learners

ERIC Educational Resources Information Center

Bell, Philippa; Trofimovich, Pavel; Collins, Laura

2015-01-01

Explanations for the well-documented second language (L2) learning challenge of the English regular past include verb semantics (Bardovi-Harlig, 2000), phonetic properties (Goad, White, & Steele, 2003), and frequency factors (Collins, Trofimovich, White, Cardoso, & Horst, 2009). Difficulty perceiving past-tense morphology (i.e., hearing…

From the Margins to the Mainstream: Potential Impact of Early Colleges on Traditional High Schools

ERIC Educational Resources Information Center

Smith, Robert; Fischetti, John; Fort, Deron; Gurley, Tilly; Kelly, Mike

2012-01-01

Early colleges are one alternative to the traditional comprehensive high school. This article describes the establishment of an early college in partnership with a university, including the experiences for students, the challenges for teachers, and the difficulties in bridging higher and kindergarten through Grade-12 educations. The article…

Language, Literacy, and the Older Refugee in America: Research Agenda for the 90s.

ERIC Educational Resources Information Center

Weinstein-Shr, Gail; Lewis, Nora E.

As the large immigrant/refugee population in the United States ages, mainstream institutions, such as schools, workplaces, and social services, are increasingly challenged to meet the needs of elders. Certain themes and difficulties in acculturation emerge repeatedly, including financial insecurities, health issues, loneliness and isolation,…

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges.

PubMed

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; Lemberger, Thomas; McEntyre, Johanna; Polson, Shawn; Xenarios, Ioannis; Arighi, Cecilia; Lu, Zhiyong

2016-01-01

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system 'accuracy' remains a challenge and identify several additional common difficulties and potential research directions including (i) the 'scalability' issue due to the increasing need of mining information from millions of full-text articles, (ii) the 'interoperability' issue of integrating various text-mining systems into existing curation workflows and (iii) the 'reusability' issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. Finally, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators. Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the US.

Challenges and Difficulties to Teaching Engineering to Generation Z: A Case Research

ERIC Educational Resources Information Center

Correia Barreiro, Suamit; Bozutti, Daniel Fernando

2017-01-01

Many people from generation Z are at the beginning of their academic activities. This generation has peculiar characteristics that might be a challenge in the labor market. Thus, instructors have a great role in their preparation. However, professors might face difficulties dealing with their specific characteristics. The research aims to carry…

Coming home: A prospective study of family reintegration following deployment to a war zone.

PubMed

Balderrama-Durbin, Christina; Cigrang, Jeffrey A; Osborne, Laura J; Snyder, Douglas K; Talcott, G Wayne; Slep, Amy M Smith; Heyman, Richard E; Tatum, JoLyn; Baker, Monty; Cassidy, Daniel; Sonnek, Scott

2015-08-01

The consequences of deployment extend beyond the service member to impact the entire family. The current investigation evaluated the unique challenges of family reintegration for partnered service members using a prospective design. In total, 76 partnered service members who deployed on a year-long, high-risk mission to Iraq were assessed across the entirety of the deployment cycle, i.e., pre-, during, and postdeployment. At follow-up, nearly 1 in 5 partnered service members reported moderate to severe difficulties in multiple aspects of family reintegration. Prospective interpersonal indicators such as preparations for deployment as a couple, shared commitment to the military, and predeployment relationship distress predicted postdeployment family reintegration difficulties. Significant interpersonal risk factors were medium to large in their effect sizes. Airmen's willingness to disclose deployment- and combat-related experiences, and postdeployment relationship distress served as concurrent interpersonal correlates of difficulties with family reintegration. Intrapersonal factors, including posttraumatic stress symptoms and alcohol misuse were concurrently related to challenges with family reintegration; predeployment alcohol misuse also predicted subsequent family reintegration difficulties. Additional analyses indicated that pre- and postdeployment relationship distress, combat disclosure, and postdeployment alcohol misuse each contributed to family reintegration when controlling for other intra- and interpersonal risk factors. Implications for prevention and early intervention strategies as well as future research are discussed. (c) 2015 APA, all rights reserved).

Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation.

PubMed

Petersen, I; Bhana, A; Myeza, N; Alicea, S; John, S; Holst, H; McKay, M; Mellins, C

2010-08-01

While the roll-out of antiretroviral therapy in South Africa should lead to a reduction in mother to child transmission, mortality and orphaning, it will also be accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease. Adolescence is a particularly vulnerable period for HIV-infected people in relation to mental health problems and engagement in high-risk behaviours, including non-compliance with medical treatment. The goal of this qualitative study was to develop an understanding of the psychosocial challenges as well as protective influences promoting socio-emotional coping in HIV+ adolescents in order to inform mental health promotion and HIV prevention programming for this population in South Africa. In-depth qualitative interviews were conducted with HIV+ adolescents (25) and caregivers of HIV+ children (15) at a large HIV/AIDS Clinic in South Africa. Data were analysed thematically using NVivo8 software. Psycho-social challenges for adolescents included dealing with loss of biological parents in the case of orphans; coming to terms with their HIV+ status including identity difficulties; external stigma and discrimination; and disclosure difficulties. For caregivers, disclosure and lack of financial, family and social support emerged as key challenges. Medication, HIV information, a future orientation and social support was identified as important for coping and general well-being of adolescents, with financial and social support emerging as key for promoting supportive caregiving contexts. While HIV+ adolescents in South Africa experience similar concerns to those in high-income countries, socio-emotional coping may be compromised by increased levels of loss due to the late roll-out of ARVS and challenges to caregiving contexts including poverty, stigma and minimally supported foster care arrangements. There is a need for mental health promotion programmes for adolescents to adopt an ecological approach, strengthening protective influences at the individual, interpersonal, community and policy levels.

Relationship Education for Military Couples: Recommendations for Best Practice.

PubMed

Bakhurst, Melissa G; Loew, Benjamin; McGuire, Annabel C L; Halford, W Kim; Markman, Howard J

2017-06-01

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs. © 2016 Family Process Institute.

Challenges and opportunities in healthcare volunteer management: insights from volunteer administrators.

PubMed

Rogers, Sean E; Rogers, Carmen M; Boyd, Karen D

2013-01-01

Volunteer administrators from 105 hospitals in five states in the northeast and southern United States provided open-ended survey responses about what they perceived to be the most pressing challenges and opportunities facing healthcare volunteer management. Taken together, these 105 hospitals used a total of 39,008 volunteers and 5.3 million volunteer hours during a 12-month period between 2010 and 2011. A qualitative content analysis of administrator responses suggests that primary challenges include volunteer recruitment and retention, administrative issues, and operational difficulties brought about by the current economic crisis. Key opportunities include more explicitly linking the volunteer function to hospital outcomes and community impact, expanding volunteer recruitment pools and roles and jobs, and developing organizational support for volunteers and making the volunteer management function more efficient and effective.

Identifying the Challenges and Opportunities to Meet the Needs of Children with Speech, Language and Communication Difficulties

ERIC Educational Resources Information Center

Dockrell, Julie E.; Howell, Peter

2015-01-01

The views of experienced educational practitioners were examined with respect to the terminology used to describe children with speech, language and communication needs (SLCN), associated problems and the impact of speech and language difficulties in the classroom. Results showed that education staff continue to experience challenges with the…

Challenges in Mentoring Software Development Projects in the High School: Analysis According to Shulman's Teacher Knowledge Base Model

ERIC Educational Resources Information Center

Meerbaum-Salant, Orni; Hazzan, Orit

2009-01-01

This paper focuses on challenges in mentoring software development projects in the high school and analyzes difficulties encountered by Computer Science teachers in the mentoring process according to Shulman's Teacher Knowledge Base Model. The main difficulties that emerged from the data analysis belong to the following knowledge sources of…

Experiences of Public Doctors on Managing Work Difficulties and Maintaining Professional Enthusiasm in Acute General Hospitals: A Qualitative Study.

PubMed

Luk, Andrew Leung; Yau, Adrian Fai To

2018-01-01

Overseas studies suggest that 10-20% of doctors are depressed, 30-45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training. Ten public doctors with reputation were invited respectively from three acute general hospitals for an in-depth interview. Interviews were audio recorded and transcribed. Content analysis was carried out to identify major themes in relation to the research questions. Three themes emerging from difficulties encountered were (1) managing people, mostly are patients, followed by colleagues and then patients' relatives; (2) constraints at work, include time and resources; and (3) managing self with decision-making within a short time. Three themes generating from managing work difficulties included (1) self-adjustment with practicing problem solving and learning good communication appeared more frequently, followed by maintaining a professional attitude and accumulating clinical experiences; (2) seeking help from others; and (3) organizational support is also a theme though it is the least mentioned. Four themes emerging from maintaining work enthusiasm were (1) personal conviction and discipline: believing that they are helping the needy, having the sense of vocation and support from religion; disciplining oneself by continuing education, maintaining harmonious family relationship and volunteer work. (2) Challenging work: different challenging natures of their job. (3) Positive feedback from patients: positive encounters with patients keep a connectedness with their clients. (4) Organization support: working with good colleagues and opportunity for continuous training. Some implications for medical education include, developing good communication skill for medical students and junior doctors, preparing senior doctors to be mentors, and exploring the motivating force of spirituality/religion.

Nominal and functional task difficulty in skill acquisition: Effects on performance in two tests of transfer.

PubMed

Sanli, Elizabeth A; Lee, Timothy D

2015-06-01

The influence of nominal and functional task difficulty during the acquisition of a motor skill was examined in two tests of transfer of learning. The task involved a ballistic, target-directed, finger action. Nominal task difficulty was defined as the distance of the target from the home position. Functional task difficulty was created by manipulating the progression of target distances during practice. Based on the challenge point framework (Guadagnoli & Lee, 2004), we predicted that practice with a set of targets farther away from the performer would benefit from less functional task difficulty, while practice with a closer set of targets would benefit from more functional task difficulty. In single-task transfer tests, learners who practiced using the high nominal task difficulty targets benefitted in terms of persistence of performance over time. In dual-task transfer tests, groups with an intermediate combined (nominal and functional) task difficulty performed with greater persistence over time on tests of transfer than those who practiced with the highest or lowest combined difficulty. Together these findings suggest that the influences of nominal and functional task difficulty during acquisition are weighted differentially depending upon the transfer test context. The challenge point framework does not accurately capture this complex relationship in its current form. Copyright © 2015 Elsevier B.V. All rights reserved.

Assessing college-level learning difficulties and "at riskness" for learning disabilities and ADHD: development and validation of the learning difficulties assessment.

PubMed

Kane, Steven T; Walker, John H; Schmidt, George R

2011-01-01

This article describes the development and validation of the Learning Difficulties Assessment (LDA), a normed and web-based survey that assesses perceived difficulties with reading, writing, spelling, mathematics, listening, concentration, memory, organizational skills, sense of control, and anxiety in college students. The LDA is designed to (a) map individual learning strengths and weaknesses, (b) provide users with a comparative sense of their academic skills, (c) integrate research in user-interface design to assist those with reading and learning challenges, and (d) identify individuals who may be at risk for learning disabilities and attention-deficit/hyperactivity disorder (ADHD) and who should thus be further assessed. Data from a large-scale 5-year study describing the instrument's validity as a screening tool for learning disabilities and ADHD are presented. This article also describes unique characteristics of the LDA including its user-interface design, normative characteristics, and use as a no-cost screening tool for identifying college students at risk for learning disorders and ADHD.

Biowatch South Africa and the Challenges in Enforcing its Constitutional Right to Access to Information

ERIC Educational Resources Information Center

Peekhaus, Wilhelm

2011-01-01

This paper examines the difficulties encountered by Biowatch, a South African civil society environmental organization, in its attempts to obtain access to government information in respect of genetically engineered plants. After establishing the context of South Africa's access to information regime, including a brief discussion of several of its…

Impediments to the Successful Reconstruction of African Immigrant Teachers' Professional Identities in South African Schools

ERIC Educational Resources Information Center

Vandeyar, Saloshna; Vandeyar, Thirusellvan; Elufisan, Kolawole

2014-01-01

The purpose of this study was to explore difficulties and challenges that confront African immigrant teachers as they attempt to reconstruct their professional identities in South African schools. The study was qualitative in nature and utilized narrative inquiry and the case study approach. Data-gathering techniques included a mix of…

Choose to Use: Scaffolding for Technology Learning Needs in a Project-Based Learning Environment

ERIC Educational Resources Information Center

Weimer, Peggy D.

2017-01-01

Project-based learning is one approach used by teachers to meet the challenge of developing more technologically proficient students. This approach, however, requires students to manage a large number of tasks including the mastery of technology. If a student's perception that their capability to perform a task falls below the task's difficulty,…

The Challenges of Teaching EFL Listening in Iraqi (Kurdistan Region) Universities

ERIC Educational Resources Information Center

Avci, Rauf; Doghonadze, Natela

2017-01-01

The article is dedicated to the issue of teaching EFL listening in Kurdistan region of Iraq. The important role of listening skills in a FL learning is presented, and the difficulties of listening are analyzed, including language (vocabulary, grammar) and psychological (low motivation and self-confidence as well as a high level of listening…

What Is Inclusive Didactics? Teachers' Understanding of Inclusive Didactics for Students with EBD in Swedish Mainstream Schools

ERIC Educational Resources Information Center

Gidlund, Ulrika; Boström, Lena

2017-01-01

Including students with emotional and behavioral difficulties (EBD) in general education is one of teachers' greatest challenges and make the dilemma of inclusion displays its most difficult side. This article contributes to the understanding of how teachers in Swedish mainstream schools understand the concept of inclusive didactics for students…

Selecting a Superintendent in a Tight Market: How the Current Superintendent Can Help

ERIC Educational Resources Information Center

Kersten, Thomas

2009-01-01

Selecting a new district leader is always a challenge for school board members. A poor decision can lead to difficulties for everyone associated with the school district including the newly appointed superintendent. By relying on the wisdom and experience of the current superintendent, boards of education enhance their chances of selecting the…

Implementing Applied Behavior Analysis for Effective Orientation and Mobility Instruction of Students with Multiple Disabilities

ERIC Educational Resources Information Center

O'Mea, Melanie L.

2013-01-01

Working with children who have multiple disabilities that include visual impairments can be especially challenging. Many disabling conditions manifest into behavioral difficulties that may take away from learning. Acting out may be a student's way of expressing a lack of healthy coping mechanisms in relation to his or her environment. Implementing…

Validation of Passive Sampling Devices for Monitoring of Munitions Constituents in Underwater Environments

DTIC Science & Technology

2017-09-01

information provided from the GED (Peggy Harris, personal communication ), but unprecedented high rainfall (including 20” of rain April 29–30, 2014...Alexandria, VA, by the Energy and Environmental Sustainability Branch (71760) of the Advanced Systems and Applied Sciences Division (71700), Space ...sampling and analyses. These challenges include a high level of effort or difficulty required to (1) measure MC at very low (ng/L) concentrations; (2

Spintronic logic: from switching devices to computing systems

NASA Astrophysics Data System (ADS)

Friedman, Joseph S.

2017-09-01

Though numerous spintronic switching devices have been proposed or demonstrated, there has been significant difficulty in translating these advances into practical computing systems. The challenge of cascading has impeded the integration of multiple devices into a logic family, and several proposed solutions potentially overcome these challenges. Here, the cascading techniques by which the output of each spintronic device can drive the input of another device are described for several logic families, including spin-diode logic (in particular, all-carbon spin logic), complementary magnetic tunnel junction logic (CMAT), and emitter-coupled spin-transistor logic (ECSTL).

Challenges and strategies for conducting sensitive research with an Arab American population.

PubMed

Timraz, Shahrazad M; Alhasanat, Dalia I; Albdour, Maha M; Lewin, Linda; Giurgescu, Carmen; Kavanaugh, Karen

2017-02-01

Recruiting minority groups such as Arab Americans (Ar-Am) for research studies has been challenging. To date no studies were found that explicitly addressed challenges to recruit Ar-Am for sensitive research. The purpose of this article is to present the challenges across three pilot studies that involved Ar-Am samples and the strategies that were implemented to overcome these challenges. The challenges faced with conducting studies with Ar-Am included difficulty for participants to express emotions, influence of male/female authority to consent for the study, lack of trust to disclose sensitive information, language barrier, and slow recruitment. Having bilingual female recruiters of Arabic descent, engaging the women's family members in the consent process, and addressing the sensitive topics in culturally appropriate language were effective strategies to overcome these challenges. These strategies might be helpful for other researchers who recruit Ar-Am for sensitive research. Copyright © 2016 Elsevier Inc. All rights reserved.

Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place.

PubMed

Kelly, Andrew John; Fausset, Cara Bailey; Rogers, Wendy; Fisk, Arthur D

2014-12-01

This study examined potential issues faced by older adults in managing their homes and their proposed solutions for overcoming hypothetical difficulties. Forty-four diverse, independently living older adults (66-85) participated in structured group interviews in which they discussed potential solutions to manage difficulties presented in four scenarios: perceptual, mobility, physical, and cognitive difficulties. The proposed solutions were classified using the Selection, Optimization, and Compensation (SOC) model. Participants indicated they would continue performing most tasks and reported a range of strategies to manage home maintenance challenges. Most participants reported that they would manage home maintenance challenges using compensation; the most frequently mentioned compensation strategy was using tools and technologies. There were also differences across the scenarios: Optimization was discussed most frequently with perceptual and cognitive difficulty scenarios. These results provide insights into supporting older adults' potential needs for aging-in-place and provide evidence of the value of the SOC model in applied research. © The Author(s) 2012.

Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies.

PubMed

Wray, Faye; Clarke, David

2017-10-06

To review and synthesise qualitative literature relating to the longer-term needs of community dwelling stroke survivors with communication difficulties including aphasia, dysarthria and apraxia of speech. Systematic review and thematic synthesis. We included studies employing qualitative methodology which focused on the perceived or expressed needs, views or experiences of stroke survivors with communication difficulties in relation to the day-to-day management of their condition following hospital discharge. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, International Bibliography of the Social Sciences and AMED and undertook grey literature searches. Studies were assessed for methodological quality by two researchers independently and the findings were combined using thematic synthesis. Thirty-two studies were included in the thematic synthesis. The synthesis reveals the ongoing difficulties stroke survivors can experience in coming to terms with the loss of communication and in adapting to life with a communication difficulty. While some were able to adjust, others struggled to maintain their social networks and to participate in activities which were meaningful to them. The challenges experienced by stroke survivors with communication difficulties persisted for many years poststroke. Four themes relating to longer-term need were developed: managing communication outside of the home, creating a meaningful role, creating or maintaining a support network and taking control and actively moving forward with life. Understanding the experiences of stroke survivors with communication difficulties is vital for ensuring that longer-term care is designed according to their needs. Wider psychosocial factors must be considered in the rehabilitation of people with poststroke communication difficulties. Self-management interventions may be appropriate to help this subgroup of stroke survivors manage their condition in the longer-term; however, such approaches must be designed to help survivors to manage the unique psychosocial consequences of poststroke communication difficulties. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Photosynthesis "In Silico". Overcoming the Challenges of Photosynthesis Education Using a Multimedia CD-ROM

ERIC Educational Resources Information Center

Russell, A. W.; Netherwood, G. M. A.; Robinson, S. A.

2004-01-01

Photosynthesis is a central topic in biology education. It remains one of the most challenging, largely because of a) its conceptual difficulty, leading to lack of interest and misconceptions among students; b) the difficulties students have in visualising the process, or relating it to things they can see, especially when the topic is presented…

What Should a Physical Education Teacher Know? An Analysis of Learning Outcomes for Future Physical Education Teachers in Sweden

ERIC Educational Resources Information Center

Backman, Erik; Larsson, Håkan

2016-01-01

Background: Research indicates that physical education teacher education (PETE) has only limited impact on how physical education (PE) is taught in schools. In this paper, our starting point is that the difficulties of challenging the dominating subject traditions in PE could be due to difficulties of challenging certain epistemological…

High-Stakes Testing in the Warm Heart of Africa: The Challenges and Successes of the Malawi National Examinations Board

ERIC Educational Resources Information Center

Chakwera, Elias; Khembo, Dafter; Sireci, Stephen G.

2004-01-01

In the United States, tests are held to high standards of quality. In developing countries such as Malawi, psychometricians must deal with these same high standards as well as several additional pressures such as widespread cheating, test administration difficulties due to challenging landscapes and poor resources, difficulties in reliably scoring…

Success importance and urge magnitude as determinants of cardiovascular response to a behavioral restraint challenge.

PubMed

Agtarap, Stephanie D; Wright, Rex A; Mlynski, Christopher; Hammad, Rawan; Blackledge, Sabrina

2016-04-01

Decades of research have investigated a conceptual analysis concerned with determinants and cardiovascular correlates of effort in people confronted with performance challenges, that is, opportunities to alter some course of events by acting. One suggestion is that effort and associated cardiovascular responses should be determined jointly by the difficulty of meeting a challenge and the importance of doing so. The present experiment tested this in a context involving behavioral restraint, that is, effortful resistance against a behavioral impulse or urge. Participants were presented a mildly evocative violent film clip (restraint difficulty low) or a strongly evocative violent film clip (restraint difficulty high) with instructions to refrain from showing any facial response. Success was made more or less important through coordinated manipulations of outcome expectancy, ego-involvement and social evaluation. As expected, SBP responses assessed during the work period were proportional to clip evocativeness - i.e., the difficulty of the restraint challenge - when importance was high, but low regardless of clip evocativeness when importance was low. Findings conceptually replicate previous cardiovascular results and support extension of the guiding analysis to the behavioral restraint realm. Copyright © 2016 Elsevier B.V. All rights reserved.

Current Status and Challenges of Atmospheric Data Assimilation

NASA Astrophysics Data System (ADS)

Atlas, R. M.; Gelaro, R.

2016-12-01

The issues of modern atmospheric data assimilation are fairly simple to comprehend but difficult to address, involving the combination of literally billions of model variables and tens of millions of observations daily. In addition to traditional meteorological variables such as wind, temperature pressure and humidity, model state vectors are being expanded to include explicit representation of precipitation, clouds, aerosols and atmospheric trace gases. At the same time, model resolutions are approaching single-kilometer scales globally and new observation types have error characteristics that are increasingly non-Gaussian. This talk describes the current status and challenges of atmospheric data assimilation, including an overview of current methodologies, the difficulty of estimating error statistics, and progress toward coupled earth system analyses.

The Diagnostic Challenges of Autoimmune Pancreatitis

PubMed Central

Papp, Kata; Angst, Eliane; Seidel, Stefan; Flury-Frei, Renata; Hetzer, Franc Heinrich

2015-01-01

Autoimmune pancreatitis is a rare but important differential diagnosis from pancreatic cancer. This autoimmune disease can mimic pancreatic cancer by its clinical symptoms, including weight loss and jaundice. Furthermore imaging findings may include a mass of the pancreas. Here we present the case of a 67-year-old male patient diagnosed with autoimmune pancreatitis but showing the well-known symptoms of pancreatic cancer. This emphasizes the difficulties of histological findings and the importance of the correct diagnostic process. PMID:25802499

Annual Research Review: The nature and classification of reading disorders – a commentary on proposals for DSM-5

PubMed Central

Snowling, Margaret J; Hulme, Charles

2012-01-01

This article reviews our understanding of reading disorders in children and relates it to current proposals for their classification in DSM-5. There are two different, commonly occurring, forms of reading disorder in children which arise from different underlying language difficulties. Dyslexia (as defined in DSM-5), or decoding difficulty, refers to children who have difficulty in mastering the relationships between the spelling patterns of words and their pronunciations. These children typically read aloud inaccurately and slowly, and experience additional problems with spelling. Dyslexia appears to arise principally from a weakness in phonological (speech sound) skills, and there is good evidence that it can be ameliorated by systematic phonic teaching combined with phonological awareness training. The other major form of reading difficulty is reading comprehension impairment. These children read aloud accurately and fluently, but have difficulty understanding what they have read. Reading comprehension impairment appears to arise from weaknesses in a range of oral language skills including poor vocabulary knowledge, weak grammatical skills and difficulties in oral language comprehension. We suggest that the omission of reading comprehension impairment from DSM-5 is a serious one that should be remedied. Both dyslexia and reading comprehension impairment are dimensional in nature, and show strong continuities with other disorders of language. We argue that recognizing the continuities between reading and language disorders has important implications for assessment and treatment, and we note that the high rates of comorbidity between reading disorders and other seemingly disparate disorders (including ADHD and motor disorders) raises important challenges for understanding these disorders. PMID:22141434

Visual Annual Reviews: How to Include Pupils with Learning Difficulties in their Educational Reviews

ERIC Educational Resources Information Center

Hayes, Julia

2004-01-01

The challenge for schools, following the Green Paper Every Child Matters (HM Treasury, 2003) and the Special Educational Needs Code of Practice (DfES, 2001), is to enable young people to give their views about matters affecting their lives. Whilst these recommendations are a welcome step to enable the effective inclusion of all young people,…

"Planning Live": Using a Person-Centred Intervention to Reduce Admissions to and Length of Stay in Learning Disability Inpatient Facilities

ERIC Educational Resources Information Center

Bartle, Janet; Crossland, Tom; Hewitt, Olivia

2016-01-01

Background: Recent government policy has focused on reducing the number of people with a learning disability receiving treatment for challenging behaviour or mental health difficulties in hospitals (including in assessment and treatment units; ATU). People with a learning disability should be supported to remain in their community when receiving…

Transition to work: Perspectives from the autism spectrum.

PubMed

Hedley, Darren; Cai, Ru; Uljarevic, Mirko; Wilmot, Mathilda; Spoor, Jennifer R; Richdale, Amanda; Dissanayake, Cheryl

2017-03-01

To improve employment outcomes for adults with autism spectrum disorder, it is necessary to identify factors associated with successful transition to work from the perspectives of the individual and from those who work with or support them. This study involved focus groups with adults with autism spectrum disorder ( n = 9) participating in a 3-year employment and training programme, as well as focus groups with family members ( n = 6), support staff ( n = 7) and co-workers ( n = 6). The aim was to gain better understanding of the experience of transition to work, barriers and also the factors that promote workplace success. Main themes included factors that facilitated success at work ( Enablers), barriers to success ( Challenges) and programme outcomes ( Outcomes). Organisation support, advice from co-workers, supportive leadership, allowance of environmental modifications and presence of a consultant were identified as enablers that most facilitated success at work. Challenges included task-related difficulties, individual factors, social difficulties and distractibility, not managing work-related stress, and being perceived to be too frank. Outcomes were rated as positive and encompassed work-related outcomes, as well as outcomes related to sense of purpose, achieving personal independence and improvements in social relationships, both with work colleagues and within families.

The challenges in defining and measuring diagnostic error.

PubMed

Zwaan, Laura; Singh, Hardeep

2015-06-01

Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.

Heart rate and pulmonary function while wearing the launch-entry crew escape suit (LES) during + Gx acceleration and simulated Shuttle launch

NASA Technical Reports Server (NTRS)

Krutz, Robert W., Jr.; Bagian, James P.; Burton, Russell R.; Meeker, Larry J.

1990-01-01

Space shuttle crewmembers have been equipped with a launch-entry crew escape system (LES) since the Challenger accident in 1986. Some crewmembers, wearing the new pressure suit, have reported breathing difficulties and increased effort to achieve the desired range of motion. This study was conducted to quantify the reported increased physical workloads and breathing difficulty associated with wearing the LES. Both veteran astronauts and centrifuge panel members were exposed to various + Gx profiles (including simulated shuttle launch) + Gx on the USAF School of Aerospace Medicine (USAFSAM) human-use centrifuge. Maximum heart rate data showed no increased workload associated with arm and head movement in the LES when compared to the flight suit/helmet ensemble (LEH). However, the LES did impose a significant increase in breathing difficulty beginning at +2.5 Gx which was demonstrated by a decrease in forced vital capacity and subjected questionnaries.

Collaboration challenges in systematic reviews: a survey of health sciences librarians

PubMed Central

Nicholson, Joey; McCrillis, Aileen; Williams, Jeff D.

2017-01-01

Objective: While many librarians have been asked to participate in systematic reviews with researchers, often these researchers are not familiar with the systematic review process or the appropriate role for librarians. The purpose of this study was to identify the challenges and barriers that librarians face when collaborating on systematic reviews. To take a wider view of the whole process of collaborating on systematic reviews, the authors deliberately focused on interpersonal and methodological issues other than searching itself. Methods: To characterize the biggest challenges that librarians face while collaborating on systematic review projects, we used a web-based survey. The thirteen-item survey included seventeen challenges grouped into two categories: methodological and interpersonal. Participants were required to indicate the frequency and difficulty of the challenges listed. Open-ended questions allowed survey participants to describe challenges not listed in the survey and to describe strategies used to overcome challenges. Results: Of the 17 challenges listed in the survey, 8 were reported as common by over 40% of respondents. These included methodological issues around having too broad or narrow research questions, lacking eligibility criteria, having unclear research questions, and not following established methods. The remaining challenges were interpersonal, including issues around student-led projects and the size of the research team. Of the top 8 most frequent challenges, 5 were also ranked as most difficult to handle. Open-ended responses underscored many of the challenges included in the survey and revealed several additional challenges. Conclusions: These results suggest that the most frequent and challenging issues relate to development of the research question and general communication with team members. Clear protocols for collaboration on systematic reviews, as well as a culture of mentorship, can help librarians prevent and address these challenges. PMID:28983202

Collaboration challenges in systematic reviews: a survey of health sciences librarians.

PubMed

Nicholson, Joey; McCrillis, Aileen; Williams, Jeff D

2017-10-01

While many librarians have been asked to participate in systematic reviews with researchers, often these researchers are not familiar with the systematic review process or the appropriate role for librarians. The purpose of this study was to identify the challenges and barriers that librarians face when collaborating on systematic reviews. To take a wider view of the whole process of collaborating on systematic reviews, the authors deliberately focused on interpersonal and methodological issues other than searching itself. To characterize the biggest challenges that librarians face while collaborating on systematic review projects, we used a web-based survey. The thirteen-item survey included seventeen challenges grouped into two categories: methodological and interpersonal. Participants were required to indicate the frequency and difficulty of the challenges listed. Open-ended questions allowed survey participants to describe challenges not listed in the survey and to describe strategies used to overcome challenges. Of the 17 challenges listed in the survey, 8 were reported as common by over 40% of respondents. These included methodological issues around having too broad or narrow research questions, lacking eligibility criteria, having unclear research questions, and not following established methods. The remaining challenges were interpersonal, including issues around student-led projects and the size of the research team. Of the top 8 most frequent challenges, 5 were also ranked as most difficult to handle. Open-ended responses underscored many of the challenges included in the survey and revealed several additional challenges. These results suggest that the most frequent and challenging issues relate to development of the research question and general communication with team members. Clear protocols for collaboration on systematic reviews, as well as a culture of mentorship, can help librarians prevent and address these challenges.

Does Initial Learning about the Meaning of Fractions Present Similar Challenges for Students with and without Adequate Whole-Number Skill?

PubMed

Namkung, Jessica M; Fuchs, Lynn S; Koziol, Natalie

2018-01-01

The purposes of this study were to (a) explore whether early fractions understanding at 4 th grade is differentially challenging for students with versus without adequate whole-number competence and (b) identify specific whole-number skill associated with difficulty in fractions understanding. Based on initial whole-number competence, 1,108 4 th graders were classified as having (a) adequate whole-number competence ( n = 775), (b) less severe whole-number difficulty ( n = 201), and (c) severe whole-number difficulty ( n = 132). At the end of 4 th grade, they were assessed on fractions understanding and further classified as with versus without difficulty in fractions understanding. Multi-level logistic regression indicated that compared to students with adequate whole-number competence, those with less severe whole-number difficulty were almost 5 times as likely to experience difficulty with fractions understanding whereas those with severe whole-number difficulty were about 32 times as likely to experience difficulty with fractions understanding. Students with severe whole-number difficulty were about 7 times as likely to experience difficulty with fractions understanding compared to those with less severe whole-number difficulty. Among students with adequate whole-number competence, the pretest whole-number skill distinguishing those with versus without difficulty in fractions understanding was basic division facts (i.e., 2-digit dividend ÷ 1-digit divisor) and simple multiplication (i.e., 3-digit × 1-digit without regrouping). The role of whole-number competence in developing initial fractions understanding and implications for instruction are discussed.

Does Initial Learning about the Meaning of Fractions Present Similar Challenges for Students with and without Adequate Whole-Number Skill?

PubMed Central

Namkung, Jessica M.; Fuchs, Lynn S.; Koziol, Natalie

2017-01-01

The purposes of this study were to (a) explore whether early fractions understanding at 4th grade is differentially challenging for students with versus without adequate whole-number competence and (b) identify specific whole-number skill associated with difficulty in fractions understanding. Based on initial whole-number competence, 1,108 4th graders were classified as having (a) adequate whole-number competence (n = 775), (b) less severe whole-number difficulty (n = 201), and (c) severe whole-number difficulty (n = 132). At the end of 4th grade, they were assessed on fractions understanding and further classified as with versus without difficulty in fractions understanding. Multi-level logistic regression indicated that compared to students with adequate whole-number competence, those with less severe whole-number difficulty were almost 5 times as likely to experience difficulty with fractions understanding whereas those with severe whole-number difficulty were about 32 times as likely to experience difficulty with fractions understanding. Students with severe whole-number difficulty were about 7 times as likely to experience difficulty with fractions understanding compared to those with less severe whole-number difficulty. Among students with adequate whole-number competence, the pretest whole-number skill distinguishing those with versus without difficulty in fractions understanding was basic division facts (i.e., 2-digit dividend ÷ 1-digit divisor) and simple multiplication (i.e., 3-digit × 1-digit without regrouping). The role of whole-number competence in developing initial fractions understanding and implications for instruction are discussed. PMID:29276363

Men with Learning Difficulties Doing Research: Challenging Views of Learning Difficulties

ERIC Educational Resources Information Center

Inglis, Pamela A.; Swain, John

2012-01-01

This paper explores the views of men with learning difficulties living in a secure environment. Reflecting findings from a doctoral thesis based upon a research project where the participants looked at the processes and concepts of research, the dialogues within the study were analysed using critical discourse analysis. Thesis aims relevant here…

Who helps the leaders? Difficulties experienced by cancer support group leaders.

PubMed

Kirsten, Laura; Butow, Phyllis; Price, Melanie; Hobbs, Kim; Sunquist, Kendra

2006-07-01

Cancer support groups are an important source of support for cancer patients, yet little is known about the challenges and training needs of both professionally trained and untrained leaders. The aim of this study was to discover the difficulties experienced and training desired by cancer support group leaders. Twenty-seven leaders of 34 cancer support groups participated in focus groups or individual interviews. Groups were purposively selected as representative of 173 support groups identified in New South Wales which were for adults with cancer and/or their adult carers and were not therapeutic or education-only groups. Difficulties identified included dealing with people's different communication styles and needs; dealing with recurrence, metastases and death; practical issues, including resources, setting the programme and funding security; maintaining personal balance and preventing burn out; establishing group credibility; dealing with group cycles; and leading groups in rural areas. Leaders also identified benefits and rewards from group leadership such as contributing to others' well-being, self-development and insight into others' lives. Non-professionally trained leaders experienced more difficulties, particularly in dealing with group process and practical issues. Difficulties identified were related both to working with a cancer population specifically and to working with groups in general. While some issues were common to both health professionals and non-health professionals, non-health professionals reported greater supportive needs. Clear guidelines, targeted training and development of better methods of support to reduce the stress and burn out experienced by group leaders are needed.

Planning strategies for the avoidance of pitfalls in intervention research.

PubMed

Pruitt, R H; Privette, A B

2001-08-01

With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.

Exploring design features for enhancing players' challenge in strategy games.

PubMed

Hsu, Shang Hwa; Wen, Ming-Hui; Wu, Muh-Cherng

2007-06-01

This paper examines how to make a player feel more challenged in a strategic computer game. It is hypothesized that information availability and resource advantage affect play difficulty, which in turn affects the challenge experienced. The difficulty of play can be defined in terms of the mental workload that players experience and the physical effort that players exert. Forty-five male college and graduate students participated in a 3 x 3 (information availability x resource advantage) between-subjects factorial design experiment. This experiment measured player mental workload, physical effort, and challenge. The results indicate that information availability affects player mental workload, and resource advantage affects levels of player physical effort, respectively. Moreover, the relationship between mental workload and challenge was found to be an inverted U-shaped curve; in other words, too much or too little mental workload may decrease player challenge. The relationship between physical effort and challenge exhibited similar characteristics.

Technology Challenges in Small UAV Development

NASA Technical Reports Server (NTRS)

Logan, Michael J.; Vranas, Thomas L.; Motter, Mark; Shams, Qamar; Pollock, Dion S.

2005-01-01

Development of highly capable small UAVs present unique challenges for technology protagonists. Size constraints, the desire for ultra low cost and/or disposable platforms, lack of capable design and analysis tools, and unique mission requirements all add to the level of difficulty in creating state-of-the-art small UAVs. This paper presents the results of several small UAV developments, the difficulties encountered, and proposes a list of technology shortfalls that need to be addressed.

The Challenges of Chinese: A Preliminary Study of UK Learners' Perceptions of Difficulty

ERIC Educational Resources Information Center

Hu, Bo

2010-01-01

This study aims to highlight aspects of difficulty encountered by Chinese as a Foreign Language (CFL) learners and to explore the factors underlying these aspects. Data were gathered through a Chinese Language Learning Difficulty Survey from 164 CFL learners, mostly in British higher education. The survey data provided useful exploratory findings.…

Predicting Item Difficulty of Science National Curriculum Tests: The Case of Key Stage 2 Assessments

ERIC Educational Resources Information Center

El Masri, Yasmine H.; Ferrara, Steve; Foltz, Peter W.; Baird, Jo-Anne

2017-01-01

Predicting item difficulty is highly important in education for both teachers and item writers. Despite identifying a large number of explanatory variables, predicting item difficulty remains a challenge in educational assessment with empirical attempts rarely exceeding 25% of variance explained. This paper analyses 216 science items of key stage…

A Case Study on Learning Difficulties and Corresponding Supports for Learning in cMOOCs

ERIC Educational Resources Information Center

Li, Shuang; Tang, Qi; Zhang, Yanxia

2016-01-01

cMOOCs, which are based on connectivist learning theory, bring challenges for learners as well as opportunities for self-inquiry. Previous studies have shown that learners in cMOOCs may have difficulties learning, but these studies do not provide any in-depth, empirical explorations of student difficulties or support strategies. This paper…

Managing Resource Dependence Difficulties in African Higher Education: The Case of Multiple Exchange Relationships

ERIC Educational Resources Information Center

Wangenge-Ouma, Gerald

2011-01-01

The paper has a twofold structure and focus. The first part is an examination of the funding challenges facing African universities resulting mainly from public finance difficulties, and the second part is a case study of how some Kenyan and South African public universities have attempted to mitigate resource dependence difficulties through…

Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.

PubMed

Bower, Peter; Macdonald, Wendy; Harkness, Elaine; Gask, Linda; Kendrick, Tony; Valderas, Jose M; Dickens, Chris; Blakeman, Tom; Sibbald, Bonnie

2011-10-01

Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions. To explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making. A qualitative interview study with primary care professionals in practices in Greater Manchester, U.K. Interviews were conducted with 15 GPs and 10 practice nurses. Primary care professionals identified tensions between delivering care to meet quality targets and fulfilling the patient's agenda, tensions which are exacerbated in multimorbidity. They were aware of the inconvenience suffered by patients through attendance at multiple clinic appointments when care was structured around individual conditions. They reported difficulties managing patients with multimorbidity in limited consultation time, which led to adoption of an 'additive-sequential' decision-making model which dealt with problems in priority order until consultation resources were exhausted, when further management was deferred. Other challenges included the need for patients to co-ordinate their care, the difficulties of self-management support in multimorbidity and problems of making sense of the relationships between physical and mental health. Doctor and nurse accounts included limited consideration of multimorbidity in terms of the interactions between conditions or synergies between management of different conditions. Primary care professionals identify a number of challenges in care for multimorbidity and adopt a particular model of decision making to deliver care for multiple individual conditions. However, they did not describe specific decision making around managing multimorbidity per se.

Challenges of Integrating Affordable and Sustainable Housing in Malaysia

NASA Astrophysics Data System (ADS)

Syed Jamaludin, S. Z. H.; Mahayuddin, S. A.; Hamid, S. H. A.

2018-04-01

Developing countries including Malaysia have begun to comprehend the needs for affordable and sustainable housing development. The majority of the population is still aspiring for a comfortable, safe and reasonably priced house. Households in the low-middle income range face difficulties to find housing that can satisfy their needs and budget. Unfortunately, most of the housing development programs are considering affordability rather than sustainable aspects. Furthermore, developers are more interested in profit and neglect sustainability issues. Thus, the aim of this paper is to review the challenges in integrating affordable housing and sustainable practices in Malaysia. This paper is produced based on an extensive literature review as a basis to develop strategies of integrated affordable and sustainable housing in Malaysia. The challenges are divided into four sections, namely market challenges, professional challenges, societal challenges and technological challenges. The outcomes of this paper will assist in the decision making involving housing development and in enhancing quality of life for sustainable communities.

Frequent behavioural challenges in children with fetal alcohol spectrum disorder: a needs-based assessment reported by caregivers and clinicians.

PubMed

Green, Courtney R; Roane, Jessica; Hewitt, Amy; Muhajarine, Nazeem; Mushquash, Christopher; Sourander, Andre; Lingley-Pottie, Patricia; McGrath, Patrick; Reynolds, James N

2014-01-01

Despite substantial research characterizing the brain injury, a significant gap still exists in providing timely and effective care for children with Fetal Alcohol Spectrum Disorder (FASD). The objective of this study was to conduct a needs assessment that could help inform intervention programs and appropriate strategies to manage challenging behaviours targeted to families impacted by FASD. Sixty caregivers and 26 clinicians from across Canada completed a semi-structured telephone interview. Caregivers reported that the most challenging behaviour categories were "Externalizing Behaviours", "Cognitive Difficulties", and "Social Difficulties/Maladjustment", whereas the most successful parenting strategies were "Parental Reflection", "Routine/Structure/Consistency", and "Environmental Modification". Clinicians reported that "Insufficient Support/Knowledge from Health and Social Professionals and Agencies" and "Behavioural Difficulties/Challenges" were the most common concerns from caregivers of children with FASD. The number and extent of challenges reported make it evident that there are many unmet needs that compromise the quality of life for these caregivers, their children, and their families. These data will be used to inform the development of an intervention program that will provide a family-centered approach to training, education, and support for children with FASD and their families.

Annual research review: the nature and classification of reading disorders--a commentary on proposals for DSM-5.

PubMed

Snowling, Margaret J; Hulme, Charles

2012-05-01

This article reviews our understanding of reading disorders in children and relates it to current proposals for their classification in DSM-5. There are two different, commonly occurring, forms of reading disorder in children which arise from different underlying language difficulties. Dyslexia (as defined in DSM-5), or decoding difficulty, refers to children who have difficulty in mastering the relationships between the spelling patterns of words and their pronunciations. These children typically read aloud inaccurately and slowly, and experience additional problems with spelling. Dyslexia appears to arise principally from a weakness in phonological (speech sound) skills, and there is good evidence that it can be ameliorated by systematic phonic teaching combined with phonological awareness training. The other major form of reading difficulty is reading comprehension impairment. These children read aloud accurately and fluently, but have difficulty understanding what they have read. Reading comprehension impairment appears to arise from weaknesses in a range of oral language skills including poor vocabulary knowledge, weak grammatical skills and difficulties in oral language comprehension. We suggest that the omission of reading comprehension impairment from DSM-5 is a serious one that should be remedied. Both dyslexia and reading comprehension impairment are dimensional in nature, and show strong continuities with other disorders of language. We argue that recognizing the continuities between reading and language disorders has important implications for assessment and treatment, and we note that the high rates of comorbidity between reading disorders and other seemingly disparate disorders (including ADHD and motor disorders) raises important challenges for understanding these disorders. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.

Echoes of the Past, Glimpses of the Future - Ongoing Trends in Assurance of EEE Parts for Spaceflight

NASA Technical Reports Server (NTRS)

Sampson, Michael J.

2017-01-01

This presentation will review some past NASA presentations that had identified challenges and future trends in the assurance of Electrical, Electronic and Electromechanical (EEE) parts for spaceflight applications. It will contrast the concerns expressed in those presentations with the challenges of today and identify trends that give insight into the future. Common themes include the use of commercial parts, limited technical and physical resources, the pace of technology change and the difficulties in handling and testing individual parts as they become smaller and more complex. Some options for dealing with these challenges will be suggested to accommodate increasing numbers of smallsats, cubesats, constellations and other disruptive concepts, as space becomes more and more commercialized.

State experiences implementing youth sports concussion laws: challenges, successes, and lessons for evaluating impact.

PubMed

Lowrey, Kerri McGowan; Morain, Stephanie R

2014-01-01

While provisions of youth sports concussion laws are very similar, little is known as to how they are being implemented, factors that promote or impede implementation, or the level of compliance in each jurisdiction. We aimed to describe state experiences with implementation in order to inform ongoing efforts to reduce the harm of sports-related traumatic brain injury and to guide future evaluations of the laws' impacts and the development of future public health laws. We conducted key-informant interviews in 35 states with recently enacted concussion legislation. States varied considerably in their readiness and capacity for implementation. Factors facilitating implementation included existing partnerships, procedures, and resources; centralized implementation authority; prior related efforts; and involvement in the policymaking process by those now charged with implementation. Inhibitors included ambiguous statutory language, unclear delegation of authority, and compliance difficulties. Ongoing challenges persist, including primary prevention; determining which providers are qualified to make return-to-play assessments and contents of those assessments; compliance difficulties in rural and under-served areas; and unclear responsibility for enforcement. Despite the similarity of youth sports concussion laws, early evidence suggests there is considerable variation in their implementation. These findings are critical for ongoing empirical investigations to accurately evaluate the laws' provisions and to identify successful legal approaches to protecting young athletes. © 2014 American Society of Law, Medicine & Ethics, Inc.

Researchers' perspectives on pediatric obesity research participant recruitment.

PubMed

Parikh, Yasha; Mason, Maryann; Williams, Karen

2016-12-01

Childhood obesity prevalence has tripled over the last three decades. Pediatric obesity has important implications for both adult health as well as the United States economy. In order to combat pediatric obesity, exploratory studies are necessary to create effective interventions. Recruitment is an essential part of any study, and it has been challenging for all studies, especially pediatric obesity studies. The objective of this study was to understand barriers to pediatric obesity study recruitment and review facilitators to overcome recruitment difficulties. Twenty four childhood obesity researchers were contacted. Complete data for 11 researchers were obtained. Interviews were transcribed and analyzed using content analysis. Grounded Theory methodological approach was used, as this was an exploratory study. Investigators YP and MM coded the interviews using 28 codes. Barriers to recruitment included: family and study logistics, family economics, lack of provider interest, invasive protocols, stigma, time restraints of clinicians, lack of patient motivation/interest, groupthink of students in a classroom, and participants who do not accept his or her own weight status. Facilitators to enhance recruitment practices included accommodating participants outside of regular clinic hours, incentivizing participants, cultivating relationships with communities, schools and clinics prior to study recruitment, emphasizing benefits of a study for the patient, and shifting language to focus on health rather than obesity. Pediatric obesity researchers face many standard and some unique challenges to recruitment, reflecting challenges common to clinical research as well as some specific to pediatrics and some specific to obesity research. Both pediatric studies as well as obesity studies are an added challenge to the already-difficult task of general study recruitment. Our findings can be used to make researchers more aware of potential difficulties, approaches and on-going needs for enhancing recruitment and enrollment practices, and in turn if applied, may result in increased study efficiency.

Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study.

PubMed

Mutumba, Massy; Bauermeister, José A; Musiime, Victor; Byaruhanga, Judith; Francis, Kiweewa; Snow, Rachel C; Tsai, Alexander C

2015-02-01

Although more than 90% of youth perinatally infected with HIV live in sub-Saharan Africa, little is known about the psychosocial factors that impact their wellbeing, or how these youth cope with these challenges. The purpose of this study was to identify the psychosocial challenges and coping strategies among perinatal HIV-infected adolescents in Uganda. In-depth interviews were conducted with a purposive sample of 38 HIV-infected adolescents aged 12-19 years at a large HIV treatment center in Kampala. Data were analyzed thematically to identify themes and domains related to stressors and specific coping strategies. Psychosocial challenges included stigma/discrimination, relationship challenges such as HIV status disclosure, and medication difficulties. Coping strategies included medication adherence, concealment or limited disclosure of HIV status, treatment optimism, social support, rationalizing, social comparison, spirituality/religiosity, avoidance, and distraction. Age and gender differences also emerged: younger participants generally lacked specific coping strategies; compared to females, male adolescents reported greater use of avoidance/distraction techniques. Findings underscore the need to address stigma within homes and schools, and to equip adolescents with the comprehensive knowledge and skills to address their varied challenges.

Post-traumatic stress disorder diagnosis in children: challenges and promises

PubMed Central

Cohen, Judith A.; Scheeringa, Michael S.

2009-01-01

Children and adolescents experience high rates of potentially traumatic experiences. Many children subsequently develop mental health problems, including post-traumatic stress disorder (PTSD) symptoms. Accurately diagnosing PTSD in children is challenging. This paper reviews the following important issues: (i) the specificity of the PTSD diagnosis; (ii) children who are symptomatic and impaired but do not have enough symptoms for the diagnosis of PTSD; (iii) developmental considerations for preschool and schooi-age children; and (iv) a variety of assessment challenges that reflect the difficulty and complexity of interviewing children and caregivers about these symptoms. Despite these challenges, PTSD remains the best construct for clinical and research work with trauma survivors. Pediatric PTSD criteria are valuable for identifying children at risk and in need of treatment and can be even more helpful when developmentally modified in ways that are discussed. PMID:19432391

Medical students’ perceptions and understanding of their specific learning difficulties

PubMed Central

Abbott, Stephen; Bevere, Grazia; Roberts, Christopher M.

2013-01-01

Objectives The purpose of this study is to explore how medical students with Specific Learning Difficulties perceive and understand their Specific Learning Difficulty and how it has impacted on their experience of medical training. Method A purposive sample of fifteen students from one medical school was interviewed. Framework Analysis was used to identify and organise themes emerging from the data. An interpretation of the data was made capturing the essence of what had been learned. The concept of ‘reframing’ was then used to re-analyse and organise the data. Results Students reported having found ways to cope with their Specific Leaning Difficulty in the past, some of which proved inadequate to deal with the pressures of medical school. Diagnosis was a mixed experience: many felt relieved to understand their difficulties better, but some feared discrimination. Practical support was available in university but not in placement. Students focused on the impact of their Specific Learning Difficulty on their ability to pass undergraduate exams. Most did not contemplate difficulties post-qualification. Conclusions The rigours of the undergraduate medical course may reveal undisclosed Specific Learning Difficulties. Students need help to cope with such challenges, psychologically and practically in both classroom and clinical practice. University services for students with Specific Learning Difficulties should become familiar with the challenges of clinical placements, and ensure that academic staff has access to information about the needs of these students and how these can be met.

Evaluating the User Experience of Exercising Reaching Motions With a Robot That Predicts Desired Movement Difficulty.

PubMed

Shirzad, Navid; Van der Loos, H F Machiel

2016-01-01

The notion of an optimal difficulty during practice has been articulated in many areas of cognitive psychology: flow theory, the challenge point framework, and desirable difficulties. Delivering exercises at a participant's desired difficulty has the potential to improve both motor learning and users' engagement in therapy. Motivation and engagement are among the contributing factors to the success of exercise programs. The authors previously demonstrated that error amplification can be used to introduce levels of challenge into a robotic reaching task, and that machine-learning algorithms can dynamically adjust difficulty to the desired level with 85% accuracy. Building on these findings, we present the results of a proof-of-concept study investigating the impacts of practicing under desirable difficulty conditions. A control condition with a predefined random order for difficulty levels was deemed more suitable for this study (compared to constant or continuously increasing difficulty). By practicing the task at their desirable difficulties, participants in the experimental group perceived their performance at a significantly higher level and reported lower required effort to complete the task, in comparison to a control group. Moreover, based on self-reports, participants in the experimental group were willing, on average, to continue the training session for 4.6 more training blocks (∼45 min) compared to the control group's average. This study demonstrates the efficiency of delivering the exercises at the user's desired difficulty level to improve the user's engagement in exercise tasks. Future work will focus on clinical feasibility of this approach in increasing stroke survivors' engagement in their therapy programs.

Challenging situations when teaching children with autism spectrum disorders in general physical education.

PubMed

Obrusnikova, Iva; Dillon, Suzanna R

2011-04-01

As the first step of an instrument development, teaching challenges that occur when students with autism spectrum disorders are educated in general physical education were elicited using Goldfried and D'Zurilla's (1969) behavioral-analytic model. Data were collected from a convenience sample of 43 certified physical educators (29 women and 14 men) using a demographic questionnaire and an elicitation questionnaire. Participants listed 225 teaching challenges, 46% related to cooperative, 31% to competitive, and 24% to individualistic learning situations. Teaching challenges were categorized into nine themes: inattentive and hyperactive behaviors, social impairment, emotional regulation difficulties, difficulties understanding and performing tasks, narrow focus and inflexible adherence to routines and structure, isolation by classmates, negative effects on classmates' learning, and need for support.

Brief Report: Difficulty in Understanding Social Acting (But Not False Beliefs) Mediates the Link between Autistic Traits and Ingroup Relationships

ERIC Educational Resources Information Center

Yang, Daniel Y.-J.; Baillargeon, Renée

2013-01-01

Why do individuals with more autistic traits experience social difficulties? Here we examined the hypothesis that these difficulties stem in part from a challenge in understanding social acting, the prosocial pretense that adults routinely produce to maintain positive relationships with their ingroup. In Study 1, we developed a self-administered…

Testing strategies for building member loyalty in a managed care organization serving Medicare beneficiaries.

PubMed

Ervin, S L

1999-01-01

Member retention has been a challenge for Medicare HMOs. This article describes how a hybrid Medicare HMO is testing methods of strengthening member loyalty and member retention. Methods include managing member expectations and involving sales representatives and Personal Care Planner in outreach to new members. An early problem detection project yielded information that was used to resolve member difficulties and preempt disenrollment.

Low Vision Aids in Glaucoma

PubMed Central

Khanna, Anjani

2012-01-01

A large number of glaucoma patients suffer from vision impairments that qualify as low vision. Additional difficulties associated with low vision include problems with glare, lighting, and contrast, which can make daily activities extremely challenging. This article elaborates on how low vision aids can help with various tasks that visually impaired glaucoma patients need to do each day, to take care of themselves and to lead an independent life. PMID:27990068

Health promotion in Kenya: a volunteer nurse's experience.

PubMed

Kater, Vered; Liebergall, Michal

2010-01-01

This article presents a case study describing how nurses can improve the health behaviors of people living in developing countries. Difficulties and potential solutions are presented. Health promotion allows people to exert control over their health to improve it. A primary difficulty of health promotion in developing countries is communication between care providers and patients. One solution is the utilization of an interpreter; however, in the present study, no professional interpreters were available, thereby complicating the comprehension of new health-related concepts. Another challenge is to understand the patients' perspectives as related to healthcare values. Additionally, as a result of a dearth of evidence-based research in developing countries, difficulties arise in implementing, assessing, and evaluating health promotion programs. Despite these obstacles, nurses continue to travel to developing countries to promote health. Recommendations include respect for a community's health values and incorporation of these values into healthcare planning. To be accepted as a teacher by the local population, the nurse must be able to set aside his/her personal beliefs relating to healthcare, well-being, and disease. Health promotion initiatives should include the means for implementation, thereby enabling the local population to develop skills that will allow them to carry out health promotion projects.

International Atomic Energy Agency Safeguards: Challenge and response

NASA Astrophysics Data System (ADS)

Spector, Leonard S.

2017-11-01

This article provides a critical review of the nuclear accounting and inspection system of the International Atomic Energy Agency (IAEA), known as "IAEA safeguards." The article focuses on the multiple challenges the Agency confronts in verifying that all nuclear activities in the countries under its safeguards system are being pursued for exclusively peaceful purposes. The principal challenges noted are those posed by: undeclared facilities, the development of enrichment and reprocessing capabilities, illicit procurement activities, denial of inspector access, difficulties in verifying absence of weaponization activities, and difficulties in establishing that all nuclear-relevant activities in a state are peaceful. The article is in the form of annotated PowerPoint briefing slides.

Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study.

PubMed

Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn

2015-08-27

The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia. 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach. PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data. 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen. PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Strategies used by nurses, academics and students to overcome intercultural communication challenges.

PubMed

Henderson, Saras; Barker, Michelle; Mak, Anita

2016-01-01

Nurse clinicians and academics need to understand intercultural communication challenges to improve their communication skills and better support students' learning. Gaps exist in the literature regarding intercultural communication resources for students, academics and clinicians. The aim of this study was to explore the experiences of clinical nurses, nurse academics, and student nurses regarding intercultural communication challenges. Data were collected using focus group interviews with nineteen clinical facilitators (nurses who supervise nursing students in clinical practice), five clinical nurses, and ten nursing students. Seven nurse academics were interviewed via telephone. The purposive sample was drawn from a tertiary hospital and a university in Australia. Participants were invited to discuss challenging intercultural scenarios they had experienced including strategies they used to overcome such challenges. Using qualitative content analysis data were analysed resulting in four categories which were: 1) prejudice based on cultural diversity; 2) unfamiliarity with cultural boundaries; 3) stereotyping cultural behaviours; and 4) difficulty understanding English. Strategies participants used to mitigate challenges included resorting to cultural validation through alliance building, proactively seeking clarification, and acquiring cultural awareness knowledge. This study highlights intercultural challenges students, clinicians and academics face and signpost the way forward with useful strategies to better inform nurse education. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Challenges of the right to health in the Colombian model].

PubMed

Bernal, Oscar; Barbosa, Samuel

2015-01-01

Health in Colombia is now a fundamental right that has to be provided and protected by the government. We evaluated the strengths and difficulties of the health system with respect to the statutory law enacted in February 2015, using methodologies for analysis of health systems proposed by the WHO and the World Bank. The challenges include the fragmentation and specialization of services, access barriers and incentives that are not aligned with the quality, weak governance, multiple actors with little coordination and information system that does not measure results. The government needs to find a necessary social agreement, a balance between the particular and the collective benefit.

Easier said than done!: methodological challenges with conducting maternal death review research in Malawi.

PubMed

Combs Thorsen, Viva; Sundby, Johanne; Meguid, Tarek; Malata, Address

2014-02-21

Maternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi. Critical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation. Challenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses. Conducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized.

Learning Self-Evaluation: Challenges for Students.

ERIC Educational Resources Information Center

MacGregor, Jean

1993-01-01

Self-evaluation is unfamiliar to most college students. Teachers can use varied approaches to support students in overcoming unfamiliarity with self-evaluation, lack of confidence in describing learning, writing difficulties, evaluation difficulties, discomfort discussing academic problems, cultural bias against self-evaluation, emotional…

The Challenge of Maintaining a Healthy Microbiome During Long-Duration Space Missions.

NASA Astrophysics Data System (ADS)

Voorhies, Alexander; Lorenzi, Hernan

2016-07-01

Astronauts will face a host of challenges on long-duration space missions like a human expedition to Mars, including the difficulty of maintaining a balanced and healthy microbiome. The human microbiome is the collection of all microorganisms residing in and on a human host, and it plays an essential role in keeping humans healthy. However, imbalances in the microbiome have also been linked to many human diseases. Space travel has been shown to alter the microbiome of astronauts in ways that are not yet completely understood. Here we review past and current microbiology and microbiome research with the aim of determining the extent of change to the human microbiome caused by space travel and implications for astronaut health. We also address several challenges that will need to be overcome in order to facilitate long-duration human exploration missions. These challenges include maintaining environmental conditions that favor healthy microbiomes, controlling the microbial organisms astronauts are exposed to, the impact of galactic cosmic radiation on the microbiome, and medical interventions that can potentially damage the microbiome.

Conceptualizing the multidimensional nature of self-efficacy: assessment of situational context and level of behavioral challenge to maintain safer sex. National Institute of Mental Health Multisite HIV Prevention Trial Group.

PubMed

Murphy, D A; Stein, J A; Schlenger, W; Maibach, E

2001-07-01

A. Bandura (1991) argued that self-efficacy measurement should be specific both to the situation in which the behavior occurs and level of challenge in that situation. Measures consistent with the 2 dimensions were developed with graded challenge levels and differing gender-appropriate situations. Participants were 1,496 controls in the National Institute of Mental Health Multisite HIV Prevention Trial recruited from STD clinics and health service centers (925 women and 571 men). The authors tested 4 separate-sex confirmatory factor analysis models as follows: (a) Condom negotiation efficacy as a unitary construct across situations and gradation of difficulty; (b) situation as preeminent, which transfers across skills whatever the gradation of difficulty; (c) skill as predominant, irrespective of situation; and (d) a multidimensional design that simultaneously accounts for both situation and graded difficulty. Consistent with Bandura's theory, the multidimensional model provided the best fit for both samples.

Challenges in Implementing Strategies for Gender-Aware Teaching.

ERIC Educational Resources Information Center

Gilbert, Melissa C.; Gilbert, Lucia Albino

2002-01-01

Discusses the negative consequences of gender stereotyping in the mathematics classroom, especially for girls. Addresses possible challenges associated with creating a safe learning environment and combating gender stereotypes. Describes difficulties in various settings in the mathematics classroom and explores challenges associated with…

Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life.

PubMed

Polack, Sarah; Adams, Mel; O'banion, David; Baltussen, Marjolein; Asante, Sandra; Kerac, Marko; Gladstone, Melissa; Zuurmond, Maria

2018-05-07

To assess feeding difficulties and nutritional status among children with cerebral palsy (CP) in Ghana, and whether severity of feeding difficulties and malnutrition are independently associated with caregiver quality of life (QoL). This cross-sectional survey included 76 children with CP (18mo-12y) from four regions of Ghana. Severity of CP was classified using the Gross Motor Function Classification System and anthropometric measures were taken. Caregivers rated their QoL (using the Pediatric Quality of Life Inventory Family Impact Module) and difficulties with eight aspects of child feeding. Logistic regression analysis explored factors (socio-economic characteristics, severity of CP, and feeding difficulties) associated with being underweight. Linear regression was undertaken to assess the relationship between caregiver QoL and child malnutrition and feeding difficulties. Poor nutritional status was common: 65% of children aged under 5 years were categorized as underweight, 54% as stunted, and 58% as wasted. Reported difficulties with child's feeding were common and were associated with the child being underweight (odds ratio 10.7, 95% confidence interval 2.3-49.6) and poorer caregiver QoL (p<0.001). No association between caregiver QoL and nutritional status was evident. Among rural, low resource populations in Ghana, there is a need for appropriate, accessible caregiver training and support around feeding practices of children with CP, to improve child nutritional status and caregiver well-being. What this paper adds Malnutrition is very common among children with cerebral palsy in this rural population in Ghana. Feeding difficulties in this population were strongly associated with being underweight. Feeding difficulties were associated with poorer caregiver quality of life (QoL). Child nutritional status was not associated with caregiver QoL. © 2018 Mac Keith Press.

Feeding difficulties in children with food protein-induced gastrointestinal allergies.

PubMed

Meyer, Rosan; Rommel, Nathalie; Van Oudenhove, Lukas; Fleming, Catharine; Dziubak, Robert; Shah, Neil

2014-10-01

There is paucity of data on the prevalence of feeding difficulties in Food Protein-Induced Gastrointestinal Allergies (FPIGA) and their clinical characteristics. However, it is a commonly reported problem by clinicians. We set out to establish the occurrence of feeding difficulties in children with FPIGA, the association with gastrointestinal and extra-intestinal symptoms and number of foods eliminated from the diet. This retrospective observational analysis was performed in patients seen between 2002 and 2009 at Great Ormond Street Children's Hospital, Gastroenterology Department, London. Medical records where FPIGA was documented using the terms from the National Institute of Allergy and Infectious Disease and National Institute of Clinical Excellence and confirmed using an elimination diet, followed by a challenge were included. Feeding difficulties were assessed using a criteria previously used in healthy toddlers in the UK. Data from 437 children (203 female) were collected. Significantly more children with feeding difficulties presented with abdominal distention and bloating (P = 0.002), vomiting (P < 0.0001), weight loss (P < 0.0001), rectal bleeding (P = 0.025), and constipation (P < 0.0001). We also found that having extra-intestinal manifestations were significantly (P < 0.0001) associated with the presence of feeding difficulties. Additionally, a significantly higher number of foods eliminated from the diet in the children with/without feeding difficulties (P = 0.028). Clinical manifestations like vomiting, constipation, rectal bleeding, weight loss, and the presence of extra-intestinal manifestations in addition to the number of foods avoided are in our FPIGA population linked to feeding difficulties. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Perceived challenges of working in a fertility clinic: a qualitative analysis of work stressors and difficulties working with patients.

PubMed

Boivin, Jacky; Bunting, Laura; Koert, Emily; Ieng U, Chin; Verhaak, Christianne

2017-02-01

What are some of the challenges of working in a fertility clinic? The most frequently mentioned challenges were workload (e.g. high time pressure) and patient-related sources (e.g. unrealistic expectations). One study showed a too high workload, worry about handling human material and low success rates were main stressors in fertility clinics. An online open-ended survey inviting participants to respond to seven questions was distributed to 5902 members of the European Society for Human Reproduction and Embryology (ESHRE, October 2010). Questions asked participants to describe the top three factors that made (i) their work stressful (hereafter 'Work stressors') and (ii) working with patients difficult (hereafter 'Perceived sources of difficulties'), and (iii) to choose from these factors which top three issues they would be willing to attend a workshop to resolve (hereafter 'Workshops'). A qualitative content analysis using inductive coding for each question was used to extract meaningful themes from the text replies, at three levels of increasing abstraction (lower and higher categories, general themes). The final sample comprised 526 respondents (8.9% participation rate). Respondents were predominantly clinicians (41.3%, n = 216) or embryologists (35.5%, n = 186) from European countries (73.0%, n = 386). The number of text replies generated for each question was 1421, 1208 and 907 for the 'Work Stressors', 'Perceived sources of difficulties' and 'Workshop' questions, respectively. The most often reported higher-order categories of Work Stressors were 'Time and Workload' (61.6%, e.g. time pressure), 'Organisation, Team and management issues' (60.4%, e.g. team conflicts) and 'Job content and work environment' (50.3%, e.g. burdensome administration). For 'Perceived sources of difficulties' these were 'Patient-related sources' (66.7%, e.g. unrealistic expectations), 'Communication and Counselling with patients' (33.7%, e.g. strained information giving) and 'Misinformation and lack of knowledge' (27.8%, e.g. Dr Google). Finally, the topics participants would be willing to address in Workshops were 'Communicating and Counselling with Patients' (24.9%), 'Dealing with Patient-related sources' (19.6%) and 'Clinical topics' (19.6%). Three general themes emerged. First, a theme of 'time and time trade-offs' expressed the oft-mentioned need to trade-off time spent on one activity (e.g. managing patient demands) against another activity (e.g. clinical workload, administration) with stress level dependent on the efficacy of trading-off. Second, the theme of 'multifactorial causes' of challenging patient interactions that embodied the many sources of difficulties working with patients. What staff would be willing to address in workshops was indicated by the final general theme of 'a little of everything', which linked to the need for multiple workshops addressing the multifactorial nature of challenges in fertility clinics. Only about 10% of members receiving the survey participated. The work was limited to the stressful and difficult aspects of working in fertility clinics, which may give a more negative impression than if questions about the rewards and benefits had also been included. The nature of stressors and difficulties of working in a fertility clinic are consistent with models of occupational stress and patient complexity. Specialized psychologists, management consultants and other occupational experts could assist fertility teams in overcoming many of the challenges. More research is required on the effect of encountered work stressors and perceived sources of difficulties in working with patients on staff and patient outcomes. None declared. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Measurement of functional task difficulty during motor learning: What level of difficulty corresponds to the optimal challenge point?

PubMed

Akizuki, Kazunori; Ohashi, Yukari

2015-10-01

The relationship between task difficulty and learning benefit was examined, as was the measurability of task difficulty. Participants were required to learn a postural control task on an unstable surface at one of four different task difficulty levels. Results from the retention test showed an inverted-U relationship between task difficulty during acquisition and motor learning. The second-highest level of task difficulty was the most effective for motor learning, while learning was delayed at the most and least difficult levels. Additionally, the results indicate that salivary α-amylase and the performance dimension of the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) are useful indices of task difficulty. Our findings suggested that instructors may be able to adjust task difficulty based on salivary α-amylase and the performance dimension of the NASA-TLX to enhance learning. Copyright © 2015 Elsevier B.V. All rights reserved.

The Relationship between Older Adults’ Risk for a Future Fall and Difficulty Performing Activities of Daily Living

PubMed Central

Mamikonian-Zarpas, Ani; Laganá, Luciana

2016-01-01

Functional status is often defined by cumulative scores across indices of independence in performing basic and instrumental activities of daily living (ADL/IADL), but little is known about the unique relationship of each daily activity item with the fall outcome. The purpose of this retrospective study was to examine the level of relative risk for a future fall associated with difficulty with performing various tasks of normal daily functioning among older adults who had fallen at least once in the past 12 months. The sample was comprised of community-dwelling individuals 70 years and older from the 1984–1990 Longitudinal Study of Aging by Kovar, Fitti, and Chyba (1992). Risk analysis was performed on individual items quantifying 6 ADLs and 7 IADLs, as well as 10 items related to mobility limitations. Within a subsample of 1,675 older adults with a history of at least one fall within the past year, the responses of individuals who reported multiple falls were compared to the responses of participants who had a single fall and reported 1) difficulty with walking and/or balance (FRAIL group, n = 413) vs. 2) no difficulty with walking or dizziness (NDW+ND group, n = 415). The items that had the strongest relationships and highest risk ratios for the FRAIL group (which had the highest probabilities for a future fall) included difficulty with: eating (73%); managing money (70%); biting or chewing food (66%); walking a quarter of a mile (65%); using fingers to grasp (65%); and dressing without help (65%). For the NDW+ND group, the most noteworthy items included difficulty with: bathing or showering (79%); managing money (77%); shopping for personal items (75%); walking up 10 steps without rest (72%); difficulty with walking a quarter of a mile (72%); and stooping/crouching/kneeling (70%). These findings suggest that individual items quantifying specific ADLs and IADLs have substantive relationships with the fall outcome among older adults who have difficulty with walking and balance, as well as among older individuals without dizziness or difficulty with walking. Furthermore, the examination of the relationships between items that are related to more challenging activities and the fall outcome revealed that higher functioning older adults who reported difficulty with the 6 items that yielded the highest risk ratios may also be at elevated risk for a fall. PMID:27200366

"I Smoke Like This to Suppress These Issues That Are Flaws of My Character": Challenges and Facilitators of Cessation Among Smokers With Bipolar Disorder.

PubMed

Heffner, Jaimee L; Watson, Noreen L; McClure, Jennifer B; Anthenelli, Robert M; Hohl, Sarah; Bricker, Jonathan B

2018-01-01

Smokers with bipolar disorder (BD) have low rates of successful quitting, yet no prior studies have evaluated the process of quitting among these smokers in the context of a current quit attempt. To facilitate development of more effective interventions, we conducted a qualitative exploration of challenges and facilitators of quitting in an intervention study for smokers with BD. Participants were adult daily smokers with BD (n = 10) who completed a 10-week smoking cessation intervention consisting of Acceptance and Commitment Therapy (ACT) and nicotine patch. We administered semistructured interviews focused on the quitting process at the end of treatment and used inductive content analysis to extract themes. Emergent themes representing challenges of quitting included social impediments, lack of awareness, avoidance, maladaptive beliefs, ambivalence, benefits of smoking, and difficulties with nicotine replacement. Themes representing change facilitators included positive treatment effects (ACT-specific, nonspecific, and nicotine patch-related), coping behaviors, reasons to quit, changes in self-perception, and social benefits. Results suggest a need for assistance with obtaining social support and handling social impediments, interrupting the automaticity of smoking, expanding the behavioral repertoire to handle aversive internal states that tend to be avoided by smoking, preventing maladaptive beliefs from interfering with quitting, taking meaningful action toward change while experiencing ambivalence, either replacing the benefits of smoking or accepting their loss, and troubleshooting difficulties with nicotine replacement. Findings regarding facilitators of quitting supported previous quantitative findings that the ACT intervention impacted theory-based targets and highlighted the importance of the counseling relationship.

Health, Social, and Economic Outcomes Experienced by Families as a Result of Receiving Assistance from a Community-Based Diaper Bank.

PubMed

Massengale, Kelley E C; Erausquin, Jennifer Toller; Old, Michelle

2017-10-01

Objectives This paper aims to describe low-income recipients of a community-based diaper bank and the multiple daily challenges they face. Our paper seeks to document the health, social, and financial outcomes recipients experienced after receiving assistance. Methods We surveyed families (n = 150) about their experiences receiving diapers from a diaper bank in the southeastern United States. Additionally, we conducted short, focused interviews with families (n = 15) about outcomes after receiving diapers. Results Families experience regularly a range of challenges meeting basic needs. These difficulties include high unmet needs for transportation, food, and nonfood essentials such as personal hygiene items. Families experiencing the greatest difficulty in paying utility or medical bills were significantly more likely to have a high level of diaper need compared to families facing these challenges less often (AORs ranging from 3.40 to 9.39). As a result of receiving diapers, families reported positive health, social, and economic outcomes. Families reported positive changes in parental mood; improved child health and happiness; increased opportunities for childcare, work, and school attendance; and the ability to divert household finances toward other basic needs, including utilities and medical care. Conclusions for Practice The monetary value of the supplemental provision of diapers is a small investment in affected families' economic, social, and health outcomes. The positive effects continue far longer than the diapers provided. We demonstrate the social value of such an operation, and recommend the expansion of federal, state, and local safety net programs to help low-income families secure a steady supply of diapers.

Invited Commentary on Bigby & Frawley's Reflections on the Challenges of Doing Inclusive Research as Part of the "Making Life Good in the Community" Study

ERIC Educational Resources Information Center

Alm, Norman

2010-01-01

The project described in this paper included a bold attempt to involve a person with learning difficulties as a co-researcher. The authors are uncompromisingly honest in their appraisal of how this initiative did not work out as well as they had hoped, and blame themselves for not setting up the infrastructure for it sufficiently well. One point…

Improving Reading Outcomes for Students with or at Risk for Reading Disabilities: A Synthesis of the Contributions from the Institute of Education Sciences Research Centers. NCSER 2014-3000

ERIC Educational Resources Information Center

Connor, Carol M.; Alberto, Paul A.; Compton, Donald L.; O'Connor, Rollanda E.

2014-01-01

Reading difficulties and disabilities present serious and potentially lifelong challenges. Children who do not read well are more likely to be retained a grade in school, drop out of high school, become a teen parent, or enter the juvenile justice system. Building on the extant research and seminal studies, including the National Reading Panel and…

Measures of Risk for Challenging Behaviors: A Comparison between the CBC and BDI

ERIC Educational Resources Information Center

Wert, Barbara Yingling; Bauman, Dona C.; Nottis, Katharyn Ellen Ketter

2010-01-01

A growing body of evidence indicates that for some children, early incidences of challenging behaviors are predictors of later difficulties. These incidences of challenging behaviors may predict mental health issues, social adjustment issues and/or increased challenging behaviors that will impede school success and impact transition to adult life…

A risk-management approach for effective integration of biomarkers in clinical trials: perspectives of an NCI, NCRI, and EORTC working group.

PubMed

Hall, Jacqueline Anne; Salgado, Roberto; Lively, Tracy; Sweep, Fred; Schuh, Anna

2014-04-01

Clinical cancer research today often includes testing the value of biomarkers to direct treatment and for drug development. However, the practical challenges of integration of molecular information into clinical trial protocols are increasingly appreciated. Inherent difficulties include evidence gaps in available biomarker data, a paucity of robust assay methods, and the design of appropriate studies within the constraints of feasible trial operations, and finite resources. Scalable and proportionate approaches are needed to systematically cope with these challenges. Therefore, we assembled international experts from three clinical trials organisations to identify the common challenges and common solutions. We present a practical risk-assessment framework allowing targeting of scarce resources to crucial issues coupled with a library of useful resources and a simple actionable checklist of recommendations. We hope that these practical methods will be useful for running biomarker-driven trials and ultimately help to develop biomarkers that are ready for integration in routine practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social challenges and supports from the perspective of individuals with Asperger syndrome and other autism spectrum disabilities.

PubMed

Müller, Eve; Schuler, Adriana; Yates, Gregory B

2008-03-01

The study describes the perspectives of individuals with Asperger syndrome and other autism spectrum disabilities (ASDs) regarding social challenges and supports. Eighteen adults with ASDs were individually interviewed. They were asked to describe their experiences navigating their social worlds, and recommend effective social supports and strategies for improving social connectedness. Qualitative analyses of the interview transcripts revealed a number of common experiences including a profound sense of isolation, difficulty initiating social interactions, challenges relating to communication, longing for greater intimacy, desire to contribute to one's community, and effort to develop greater social/self-awareness. Commonly recommended social supports included external supports (e.g. activities based on shared interests, highly structured or scripted social activities, and small groups or dyads); communication supports (e.g. alternative modes of communication, explicit communication, and instruction in interpreting and using social cues); and self-initiated strategies for handling social anxiety (e.g. creative/improvisational outlets, physical activity, spiritual practice/organized religion, and time spent alone).

Cardiothoracic surgery at a crossroads: the impact of disruptive technologic change.

PubMed

Cohen, David J

2007-08-08

At the beginning of the twenty-first century, cardiothoracic surgery is arguably the most successful of all medical specialties. There are effective treatments including transplantation, for almost all cardiac and thoracic diseases that can be performed with low morbidity and mortality. Cardiothoracic surgeons have mastered technical difficulties through innovation, hard work, planning and skill. Yet in the past decade, the primacy of cardiothoracic surgery has been challenged by new technologies. This paper applies business school theories to examine how cardiothoracic surgeons might best respond to such "disruptive technologies". Otherwise well-managed business and industrial enterprises have had difficulty dealing with disruptive technological change because of well-recognized organizational impediments. Cardiothoracic surgeons must understand the characteristics of disruptive technologies and consider organizational changes that will allow the profession to better adapt to them.

Brainstem Correlates of Speech-in-Noise Perception in Children

PubMed Central

Anderson, Samira; Skoe, Erika; Chandrasekaran, Bharath; Zecker, Steven; Kraus, Nina

2010-01-01

Children often have difficulty understanding speech in challenging listening environments. In the absence of peripheral hearing loss, these speech perception difficulties may arise from dysfunction at more central levels in the auditory system, including subcortical structures. We examined brainstem encoding of pitch in a speech syllable in 38 school-age children. In children with poor speech-in-noise perception, we find impaired encoding of the fundamental frequency and the second harmonic, two important cues for pitch perception. Pitch, an important factor in speaker identification, aids the listener in tracking a specific voice from a background of voices. These results suggest that the robustness of subcortical neural encoding of pitch features in time-varying signals is an important factor in determining success with speech perception in noise. PMID:20708671

Hypnosis for Asthma and Vocal Cord Dysfunction in a Patient With Autism.

PubMed

Kaslovsky, Robert; Gottsegen, David

2015-10-01

Wheezing in children often is the result of asthma, but vocal cord dysfunction (VCD) may cause stridor or sounds that sometimes are misattributed to the wheezing of asthma. The frequent comorbidity of asthma and VCD also adds to the difficulty in making a clear diagnosis. The challenges of evaluating and treating wheezing are complicated further in children with developmental disorders, such as autism, because of the difficulties of obtaining an adequate history and assessing the clinical response to treatment. This article presents a patient with multiple psychiatric problems, including autism, with severe recurrent wheezing as a result of vocal cord dysfunction and asthma. Hypnosis has previously proven efficacious for treating vocal cord dysfunction, and in this case, hypnotic techniques were major factors in successful symptom control.

The dumbest experiment in space. [problems in laboratory apparatus adaption to space environment

NASA Technical Reports Server (NTRS)

Prouty, C. R.

1981-01-01

A simple conceptual experiment is used to illustrate (1) the fundamentals of performing an experiment, including the theoretical concept, the experiment design, the performance of the experiment, and the recording of observations; (2) the increasing challenges posed by performance of the same experiment in a location remote from the experimenter, such as additional planning and equipment and their associated cost increases; and (3) the significant growth of difficulties to be overcome when the simple experiment is performed in a highly restrictive environment, such as a spacecraft in orbit, with someone else remotely operating the experiment. It is shown that performing an experiment in the remote, hostile environment of space will pose difficulties equaling or exceeding those of the experiment itself, entailing mastery of a widening range of disciplines.

Difficulties with emotion regulation moderate the association between childhood history of maltreatment and cortisol reactivity to psychosocial challenge in postpartum women.

PubMed

England-Mason, Gillian; Kimber, Melissa; Khoury, Jennifer; Atkinson, Leslie; MacMillan, Harriet; Gonzalez, Andrea

2017-09-01

Exposure to child maltreatment can lead to long-term emotional difficulties and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. However, no prior work has examined emotion regulation as a moderator of the association between childhood history of maltreatment and cortisol response to psychosocial challenge. Amongst a sample of 140 postpartum women, associations between childhood maltreatment, emotion regulation, and cortisol response to a computerized Emotional Stroop paradigm were examined using structural equation modeling. Three saliva samples (baseline, 20- and 40-min post-challenge) were collected and later assayed for cortisol. Stepwise regression analyses revealed that difficulties with emotion regulation significantly moderated the association between maternal history of child maltreatment and cortisol reactivity (β=-0.17, CI .95 =-0.31, -0.04, t=-2.51, p=0.01). Specifically, women with higher child maltreatment scores and greater difficulties with emotion regulation displayed reduced cortisol reactivity. This finding suggests that diminished emotion regulation capacity may uniquely contribute to blunted physiological reactivity in postpartum women exposed to higher levels of child maltreatment. As the postpartum period has significant implications for maternal well-being and infant development, these findings are discussed in terms of adaptive responsivity, maternal behaviour, and clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Navigating Difficulty in Classroom-Community Outreach Projects

ERIC Educational Resources Information Center

Rosenberg, Lauren

2017-01-01

Sustainability in community engagement projects depends on careful attention to the ways we navigate complex, often challenging relationships with our partners, our students, agencies, and the institutions in which we occupy multiple, sometimes competing roles. This article considers the difficulty inherent in developing and maintaining…

Adaptive Design of Confirmatory Trials: Advances and Challenges

PubMed Central

Lai, Tze Leung; Lavori, Philip W.; Tsang, Ka Wai

2015-01-01

The past decade witnessed major developments in innovative designs of confirmatory clinical trials, and adaptive designs represent the most active area of these developments. We give an overview of the developments and associated statistical methods in several classes of adaptive designs of confirmatory trials. We also discuss their statistical difficulties and implementation challenges, and show how these problems are connected to other branches of mainstream Statistics, which we then apply to resolve the difficulties and bypass the bottlenecks in the development of adaptive designs for the next decade. PMID:26079372

Educational provision for children with specific speech and language difficulties: perspectives of speech and language therapy service managers.

PubMed

Dockrell, Julie E; Lindsay, Geoff; Letchford, Becky; Mackie, Clare

2006-01-01

Children with specific speech and language difficulties (SSLD) pose a challenge to the education system, and to speech and language therapists who support them, as a result of their language needs and associated educational and social-behavioural difficulties. The development of inclusion raises questions regarding appropriate provision, whether the tradition of language units or full inclusion into mainstream schools. To gather the views of speech and language therapy service managers in England and Wales regarding approaches to service delivery, terminology and decision-making for educational provision, and the use of direct and indirect (consultancy) models of intervention. The study reports on a national survey of speech and language therapy (SLT) services in England and Wales (129 respondents, 72.1% response rate) and interviews with 39 SLT service managers. Provision varied by age group with support to children in the mainstream common from pre-school to the end of Key Stage 2 (up to 11 years), and to those in designated specialist provision, common at Key Stages 1/2 (ages 5-11 years), but less prevalent at Key Stages 3/4 (11-16 years). Decision-making regarding provision was influenced by the lack of common terminology, with SSLD and specific language impairment (SLI) the most common, and criteria, including the use of the discrepancy model for defining SSLD. Practice was influenced by the difficulties in distinguishing children with SSLD from those with autistic spectrum disorder, and difficulties translating policies into practice. The implications of the study are discussed with reference to SLT practice, including consultancy models, and the increasingly prevalent policy in local education authorities of inclusion of children with special educational needs.

Physical education issues for students with autism: school nurse challenges.

PubMed

Rutkowski, Elaine M; Brimer, Debbie

2014-08-01

Extant studies indicate persons with autism have difficulties in social interaction, verbal and nonverbal communication, repetitive behaviors, and poor ability to generalize learned skills. Obesity has also been identified as significantly affecting children with autism spectrum disorders (ASD). Negative experience in physical education (PE) may be the antecedent behavior to lack of activities that are mediators to sedentary lifestyles and contributors to the chronic illnesses associated with overweight and obesity. Students with ASD often cannot perform required activities to meet required PE standards. It is imperative school nurses be aware of the many challenges students with ASD bring into a PE class. School nurses provide education for the members of the school community, including the Individualized Education Plan team, regarding the need for attention to limitations, including physical activity, of students with ASD. © The Author(s) 2013.

A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations.

PubMed

Jones, Christine D; Vu, Maihan B; O'Donnell, Christopher M; Anderson, Mary E; Patel, Snehal; Wald, Heidi L; Coleman, Eric A; DeWalt, Darren A

2015-04-01

Care coordination between adult hospitalists and primary care providers (PCPs) is a critical component of successful transitions of care from hospital to home, yet one that is not well understood. The purpose of this study was to understand the challenges in coordination of care, as well as potential solutions, from the perspective of hospitalists and PCPs in North Carolina. We conducted an exploratory qualitative study with 58 clinicians in four hospitalist focus groups (n = 32), three PCP focus groups (n = 19), and one hybrid group with both hospitalists and PCPs (n = 7). Interview guides included questions about care coordination, information exchange, follow-up care, accountability, and medication management. Focus group sessions were recorded, transcribed verbatim, and analyzed in ATLAS.ti. The constant comparative method was used to evaluate differences between hospitalists and PCPs. Hospitalists and PCPs were found to encounter similar care coordination challenges, including (1) lack of time, (2) difficulty reaching other clinicians, (3) lack of personal relationships with other clinicians, (4) lack of information feedback loops, (5) medication list discrepancies, and (6) lack of clarity regarding accountability for pending tests and home health. Hospitalists additionally noted difficulty obtaining timely follow-up appointments for after-hours or weekend discharges. PCPs additionally noted (1) not knowing when patients were hospitalized, (2) not having hospital records for post-hospitalization appointments, (3) difficulty locating important information in discharge summaries, and (4) feeling undervalued when hospitalists made medication changes without involving PCPs. Hospitalists and PCPs identified common themes of successful care coordination as (1) greater efforts to coordinate care for "high-risk" patients, (2) improved direct telephone access to each other, (3) improved information exchange through shared electronic medical records, (4) enhanced interpersonal relationships, and (5) clearly defined accountability. Hospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting.

Oral care experiences and challenges in children with autism spectrum disorders.

PubMed

Stein, Leah I; Polido, José C; Najera, Sandy Oliver Lopez; Cermak, Sharon A

2012-01-01

The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care. Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables. Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders-including age, gender, Hispanic status, and paternal education level-all previously significant variables remained significant. This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.

Improving Challenge/Skill Ratio in a Multimodal Interface by Simultaneously Adapting Game Difficulty and Haptic Assistance through Psychophysiological and Performance Feedback

PubMed Central

Rodriguez-Guerrero, Carlos; Knaepen, Kristel; Fraile-Marinero, Juan C.; Perez-Turiel, Javier; Gonzalez-de-Garibay, Valentin; Lefeber, Dirk

2017-01-01

In order to harmonize robotic devices with human beings, the robots should be able to perceive important psychosomatic impact triggered by emotional states such as frustration or boredom. This paper presents a new type of biocooperative control architecture, which acts toward improving the challenge/skill relation perceived by the user when interacting with a robotic multimodal interface in a cooperative scenario. In the first part of the paper, open-loop experiments revealed which physiological signals were optimal for inclusion in the feedback loop. These were heart rate, skin conductance level, and skin conductance response frequency. In the second part of the paper, the proposed controller, consisting of a biocooperative architecture with two degrees of freedom, simultaneously modulating game difficulty and haptic assistance through performance and psychophysiological feedback, is presented. With this setup, the perceived challenge can be modulated by means of the game difficulty and the perceived skill by means of the haptic assistance. A new metric (FlowIndex) is proposed to numerically quantify and visualize the challenge/skill relation. The results are contrasted with comparable previously published work and show that the new method afforded a higher FlowIndex (i.e., a superior challenge/skill relation) and an improved balance between augmented performance and user satisfaction (higher level of valence, i.e., a more enjoyable and satisfactory experience). PMID:28507503

School-based interventions for elementary school students with ADHD.

PubMed

DuPaul, George J; Gormley, Matthew J; Laracy, Seth D

2014-10-01

Children with attention-deficit/hyperactivity disorder (ADHD) experience significant difficulties with behavior, social functioning, and academic performance in elementary school classrooms. Although psychotropic medication may enhance classroom behavior, pharmacologic treatment is rarely sufficient in addressing the many challenges encountered by individuals with ADHD in school settings. This article describes 3 evidence-based strategies including behavioral, academic, and self-regulation interventions. Future directions for research on school-based interventions are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Challenges for Cooperative Learning Implementation: Reports from Elementary School Teachers

ERIC Educational Resources Information Center

Buchs, Céline; Filippou, Dimitra; Pulfrey, Caroline; Volpé, Yann

2017-01-01

Despite the well-established benefits of cooperative learning, implementation remains a challenge. This research aims to document these challenges at the elementary school level, drawing on teachers' beliefs regarding learning as well as the difficulties teachers report. Results indicate that the most frequent instructional strategies reported are…

A review of Integrated Vehicle Health Management tools for legacy platforms: Challenges and opportunities

NASA Astrophysics Data System (ADS)

Esperon-Miguez, Manuel; John, Philip; Jennions, Ian K.

2013-01-01

Integrated Vehicle Health Management (IVHM) comprises a set of tools, technologies and techniques for automated detection, diagnosis and prognosis of faults in order to support platforms more efficiently. Specific challenges are faced when IVHM tools are to be retrofitted into legacy vehicles since major modifications are much more challenging than with platforms whose design can still be modified. The topics covered in this Review Paper include the state of the art of IVHM tools and how their characteristics match the requirements of legacy aircraft, a summary of problems faced in the past trying to retrofit IVHM tools both from a technical and organisational perspective and the current level of implementation of IVHM in industry. Although the technology has not reached the level necessary to implement IVHM to its full potential on every kind of component, significant progress has been achieved on rotating equipment, structures or electronics. Attempts to retrofit some of these tools in the past faced both technical difficulties and opposition by some stakeholders, the later being responsible for the failure of technically sound projects in more than one occasion. Nevertheless, despite these difficulties, products and services based on IVHM technology have started to be offered by the manufacturers and, what is more important, demanded by the operators, providing guidance on what the industry would demand from IVHM on legacy aircraft.

Increased Difficulties in Managing Stairs in Visually Impaired Older Adults: A Community-Based Survey.

PubMed

Pan, Chen-Wei; Liu, Hu; Sun, Hong-Peng; Xu, Yong

2015-01-01

Managing stairs is a challenging aspect of daily activities of living for older people. We assessed whether older adults with visual impairment (VI) have greater difficulties of managing stairs in daily lives. The study was designed as a community-based cross-sectional study based on a Chinese cohort aged 60 years and older in rural China. Visual acuity (VA) was measured in both eyes using a retro-illuminated Snellen chart with tumbling-E optotypes. VI (including blindness) was defined as presenting VA of worse than 20/60 in either eye. Having any difficulties in managing stairs was self-reported based on a question drawn from the Barthel Index. Information on participants' socioeconomic status, lifestyle-related factors, diseases histories and medication intake was collected using a questionnaire. The Barthel Index, Activities of Daily Living questionnaire was completed by 4597 (99.7%) participants including 2218 men and 2379 women. The age of the participants ranged from 60 to 93 years with a mean of 67.6 ± 6.3 years. In age and gender adjusted models, adults with VI had a higher likelihood of having difficulties in managing stairs (odds ratio [OR] = 2.7; 95% confidence interval [CI] 2.0, 3.7) compared with those without. The association of VI with the likelihood of having difficulties in managing stairs was stronger in older adults who lived alone (OR = 3.2; 95%CI 1.8, 4.5) compared with those who lived with other family members (OR = 2.0; 95%CI 1.3, 4.3). Compared with hypertension, diabetes, obesity and cognitive dysfunction, VI had the greatest impact on people's abilities of managing stairs. VI was associated with an increased likelihood of having difficulties in managing stairs, especially in those who lived alone. However, whether the finding could be extrapolated to other populations warrants further studies as different environmental exposures such as illumination and types of stairs may alter the association observed in this study.

Challenging patient deaths in pediatric oncology.

PubMed

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

2015-08-01

Pediatric oncologists look after patients and their families for extended periods of time when they are diagnosed and treated for cancer. Twenty percent of these children will die while under their care. The purpose of this study was to explore what makes patient deaths challenging for pediatric oncologists. Twenty-one Canadian pediatric oncologists were interviewed about their experiences with patient death and were probed about the factors that make patient deaths particularly challenging. Data were analyzed using the grounded theory method. Challenging factors pertaining to patient death were categorized into three main domains. Relational factors included dealing with families perceived as challenging; identifying with parents; and having long-term relationships and special connections with patients and their caregivers. The second domain captured the process of death and dying and included death after curative treatment was stopped; death caused by complications; and unexpected deaths. The third domain encompassed patient factors that included suffering of the child, and the sense that no child should die. The types of relationships pediatric oncologists have with patients and caregivers, and the process by which children die affects pediatric oncologists' perceived level of difficulty in coping with the death. The findings point to the complexity of working with children where parents are included in the decision-making processes around a child's treatment. Implementation of structured review opportunities around patient death and associated decision-making within a multidisciplinary healthcare team may alleviate some of the emotional burden associated with patient deaths.

The Expected Adjustment and Academic Outcomes of Honors College Students

ERIC Educational Resources Information Center

Washington, Christina R.

2012-01-01

The transition to an institution of higher education can present challenges and difficulties, but it is a student's expectations that can ultimately predict adjustment (Jackson, Pancer, Pratt, & Hunsberger, 2000). A larger number of students who experience difficulties in their adjustment end up withdrawing from the institution (Baker…

More than Meets the Eye--Infrared Cameras in Open-Ended University Thermodynamics Labs

ERIC Educational Resources Information Center

Melander, Emil; Haglund, Jesper; Weiszflog, Matthias; Andersson, Staffan

2016-01-01

Educational research has found that students have challenges understanding thermal science. Undergraduate physics students have difficulties differentiating basic thermal concepts, such as heat, temperature, and internal energy. Engineering students have been found to have difficulties grasping surface emissivity as a thermal material property.…

Assessing, Understanding, and Supporting Students with ADHD at School: Contemporary Science, Practice, and Policy

ERIC Educational Resources Information Center

DuPaul, George J.; Jimerson, Shane R.

2014-01-01

Students with attention-deficit/hyperactivity disorder (ADHD) exhibit chronic behavior difficulties that deleteriously impact their academic and social functioning in school settings. These difficulties not only impair student performance, but also present significant challenges to teachers, school psychologists, and other school professionals…

Writing Characteristics of Students with Attention Deficit Hyperactive Disorder: A Meta-Analysis

ERIC Educational Resources Information Center

Graham, Steve; Fishman, Evan J.; Reid, Robert; Hebert, Michael

2016-01-01

Students with Attention Deficit Hyperactivity Disorders (ADHD) frequently experience significant difficulty mastering basic academic skills. This meta-analysis focuses on one specific potential area of learning difficulties for these students: namely, writing. To identify the extent and depth of the potential writing challenges faced by students…

Assessment for All

ERIC Educational Resources Information Center

Science Scope, 2005

2005-01-01

There are many ways of assessing students and the work they do, and many ways of getting them ready for those assessments. Special needs students provide an extra challenge to educators because they have difficulty preparing for assessment and often more difficulty communicating what they know. It is not enough to be a thoughtful, lab-focused…

Using Real-Life Experiences to Teach Computer Concepts

ERIC Educational Resources Information Center

Read, Alexis

2012-01-01

Teaching computer concepts to individuals with visual impairments (that is, those who are blind or visually impaired) presents some unique challenges. Students often have difficulty remembering to perform certain steps or have difficulty remembering specific keystrokes when using computers. Many cannot visualize the way in which complex computing…

Designing Project-Based Instruction to Foster Generative and Mechanistic Understandings in Genetics

ERIC Educational Resources Information Center

Duncan, Ravit Golan; Tseng, Katie Ann

2011-01-01

The acquisition of scientific knowledge is fraught with difficulties and challenges for the learner. The very nature of some scientific domains contributes to the learning difficulties students' experience. Phenomena in these domains are composed of multiple organization levels featuring complicated interactions within and across these levels.…

Tackling the Difficulties in Learning Evolution: Effects of Adaptive Self-Explanation Prompts

ERIC Educational Resources Information Center

Neubrand, Charlotte; Harms, Ute

2017-01-01

Teaching and learning evolution is challenging. Biology education research shows that the underlying evolutionary concepts are poorly understood among students. This prevents a meaningful understanding of the central biological concepts. The instructional format of self-explanation prompts seems to be promising to respond to these difficulties.…

Analysis of New Composite Architectures

NASA Technical Reports Server (NTRS)

Whitcomb, John D.

1996-01-01

Efficient and accurate specialty finite elements methods to analyze textile composites were developed and are described. Textile composites present unique challenges to the analyst because of the large, complex 'microstructure'. The geometry of the microstructure is difficult to model and it introduces unusual free surface effects. The size of the microstructure complicates the use of traditional homogenization methods. The methods developed constitute considerable progress in addressing the modeling difficulties. The details of the methods and attended results obtained therefrom, are described in the various chapters included in Part 1 of the report. Specific conclusions and computer codes generated are included in Part 2 of the report.

Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management.

PubMed

Yazdanbakhsh, Karina; Ware, Russell E; Noizat-Pirenne, France

2012-07-19

Red blood cell transfusions have reduced morbidity and mortality for patients with sickle cell disease. Transfusions can lead to erythrocyte alloimmunization, however, with serious complications for the patient including life-threatening delayed hemolytic transfusion reactions and difficulty in finding compatible units, which can cause transfusion delays. In this review, we discuss the risk factors associated with alloimmunization with emphasis on possible mechanisms that can trigger delayed hemolytic transfusion reactions in sickle cell disease, and we describe the challenges in transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication.

Using Biology Education Research and Qualitative Inquiry to Inform Genomic Nursing Education.

PubMed

Ward, Linda D

Decades of research in biology education show that learning genetics is difficult and reveals specific sources of learning difficulty. Little is known about how nursing students learn in this domain, although they likely encounter similar difficulties as nonnursing students. Using qualitative approaches, this study investigated challenges to learning genetics among nursing students. Findings indicate that nursing students face learning difficulties already identified among biology students, suggesting that nurse educators might benefit from biology education research.

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms.

PubMed

Barrett, Frederick S; Bradstreet, Matthew P; Leoutsakos, Jeannie-Marie S; Johnson, Matthew W; Griffiths, Roland R

2016-12-01

Acute adverse psychological reactions to classic hallucinogens ("bad trips" or "challenging experiences"), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the Five-Dimensional Altered States of Consciousness questionnaire) in an Internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire. The stand-alone Challenging Experience Questionnaire was then validated in a separate sample. Seven Challenging Experience Questionnaire factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The Challenging Experience Questionnaire provides a basis for future investigation of predictors and outcomes of challenging experiences with classic hallucinogens. © The Author(s) 2016.

Consumer Health Insurance Shopping Behavior and Challenges: Lessons From Two State-Based Marketplaces.

PubMed

Sinaiko, Anna D; Kingsdale, Jon; Galbraith, Alison A

2017-07-01

Selecting a health plan in a health insurance exchange is a critical decision, yet consumers are known to face challenges with health plan choice. We surveyed new enrollees in two state-based exchanges in 2015 to investigate how a nonelderly, primarily low-income population chose their health plans and the implications of shopping behavior for early experiences in their plans. Financial considerations were most important to enrollees. Prior Medicaid enrollees and the uninsured were more likely to have multiple shopping challenges (e.g., difficulty identifying the best or most affordable plan, fair/poor experience, unmet need for help) than enrollees with prior employer coverage (42.9% vs. 32.5% vs. 16.4%, respectively, p < .01). Shopping challenges were associated with difficulty finding a doctor, understanding coverage, and getting questions answered. Assistance targeting enrollees who previously had Medicaid or lacked insurance could improve both shopping experiences and downstream outcomes in plans.

Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy.

PubMed

Grindlay, Kate; Grossman, Daniel

2016-03-01

Access to contraception is a vital component of preventing unintended pregnancies. This study was conducted to assess the prevalence of and factors associated with U.S. women's difficulty accessing prescription contraception (pill, patch, or ring). We performed a nationally representative survey of adult women at risk of unintended pregnancy (aged 18-44, not pregnant or seeking pregnancy, sexually active, not sterilized) using a probability-based web panel. In November to December 2011, 2046 women completed the survey. Weighted proportions were calculated and logistic regression was used to identify covariates associated with difficulty obtaining or refilling prescription contraception. A total of 1385 (68%) women had ever tried to get a prescription for hormonal contraception. Among this population, 29% reported ever having problems obtaining a prescription or refills. In multivariable regression, uninsured (vs. privately insured) and Spanish-speaking (vs. English-speaking) women were significantly more likely to report difficulties; women with a high school degree and those with some college (vs. a college degree or higher) were significantly less likely to report difficulty. Difficulties included cost barriers or lack of insurance (14%), challenges obtaining an appointment or getting to a clinic (13%), the clinician requiring a clinic visit, exam, or Pap smear (13%), not having a regular doctor/clinic (10%), difficulty accessing a pharmacy (4%), and other reasons (4%). One-third of adult U.S. women who have ever tried to obtain prescription contraception reported access barriers. While the Affordable Care Act may resolve some of these issues, these data indicate that additional factors may still need to be addressed.

Understanding and Improving Recruitment to Randomised Controlled Trials: Qualitative Research Approaches.

PubMed

Elliott, Daisy; Husbands, Samantha; Hamdy, Freddie C; Holmberg, Lars; Donovan, Jenny L

2017-11-01

The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in identifying the key barriers to recruitment, and interventions have been developed to reduce organisational difficulties and support clinicians undertaking recruitment. This article provides an introduction to qualitative research techniques and explains how this approach can be used to understand-and subsequently improve-recruitment and informed consent within a range of clinical trials. A literature search was performed using Medline, Embase, and CINAHL. All studies with qualitative research methods that focused on the recruitment activity of clinicians were included in the review. The majority of studies reported that organisational difficulties and lack of time for clinical staff were key barriers to recruitment. However, a synthesis of qualitative studies highlighted the intellectual and emotional challenges that arise when combining research with clinical roles, particularly in relation to equipoise and patient eligibility. To support recruiters to become more comfortable with the design and principles of randomised controlled trials, interventions have been developed, including the QuinteT Recruitment Intervention, which comprises in-depth investigation of recruitment obstacles in real time, followed by implementation of tailored strategies to address these challenges as the trial proceeds. Qualitative research can provide important insights into the complexities of recruitment to trials and inform the development of interventions, and provide support and training initiatives as required. Investigators should consider implementing such methods in trials expected to be challenging or recruiting below target. Qualitative research is a term used to describe a range of methods that can be implemented to understand participants' perspectives and behaviours. Data are gathered from interviews, focus groups, or observations. In this review, we demonstrate how this approach can be used to understand-and improve-recruitment to clinical trials. Taken together, our review suggests that healthcare professionals can find recruiting to trials challenging and require support with this process. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A general method for assessing brain-computer interface performance and its limitations

NASA Astrophysics Data System (ADS)

Hill, N. Jeremy; Häuser, Ann-Katrin; Schalk, Gerwin

2014-04-01

Objective. When researchers evaluate brain-computer interface (BCI) systems, we want quantitative answers to questions such as: How good is the system’s performance? How good does it need to be? and: Is it capable of reaching the desired level in future? In response to the current lack of objective, quantitative, study-independent approaches, we introduce methods that help to address such questions. We identified three challenges: (I) the need for efficient measurement techniques that adapt rapidly and reliably to capture a wide range of performance levels; (II) the need to express results in a way that allows comparison between similar but non-identical tasks; (III) the need to measure the extent to which certain components of a BCI system (e.g. the signal processing pipeline) not only support BCI performance, but also potentially restrict the maximum level it can reach. Approach. For challenge (I), we developed an automatic staircase method that adjusted task difficulty adaptively along a single abstract axis. For challenge (II), we used the rate of information gain between two Bernoulli distributions: one reflecting the observed success rate, the other reflecting chance performance estimated by a matched random-walk method. This measure includes Wolpaw’s information transfer rate as a special case, but addresses the latter’s limitations including its restriction to item-selection tasks. To validate our approach and address challenge (III), we compared four healthy subjects’ performance using an EEG-based BCI, a ‘Direct Controller’ (a high-performance hardware input device), and a ‘Pseudo-BCI Controller’ (the same input device, but with control signals processed by the BCI signal processing pipeline). Main results. Our results confirm the repeatability and validity of our measures, and indicate that our BCI signal processing pipeline reduced attainable performance by about 33% (21 bits min-1). Significance. Our approach provides a flexible basis for evaluating BCI performance and its limitations, across a wide range of tasks and task difficulties.

Therapeutic Ultrasound Research And Development From An Industrial And Commercial Perspective

NASA Astrophysics Data System (ADS)

Seip, Ralf

2009-04-01

The objective of this paper is to share the challenges and opportunities as viewed from an industrial and commercial perspective that one encounters when performing therapeutic ultrasound research, development, manufacturing, and sales activities. Research in therapeutic ultrasound has become an active field in the last decade, spurred by technological advances in the areas of transducer materials, control electronics, treatment monitoring techniques, an ever increasing number of clinical applications, and private and governmental funding opportunities. The development of devices and methods utilizing therapeutic ultrasound to cure or manage disease is being pursued by startup companies and large established companies alike, driven by the promise of profiting at many levels from this new and disruptive technology. Widespread penetration within the clinical community remains elusive, with current approaches focusing on very specific applications and niche markets. Challenges include difficulties in securing capital to develop the technology and undertake costly clinical trials, a regulatory landscape that varies from country to country, resistance from established practitioners, and difficulties in assembling a team with the right mix of technological savvy and business expertise. Success is possible and increasing, however, as evidenced by several companies, initiatives, and products with measurable benefits to the patient, clinician, and companies alike.

Barriers to medication adherence in poorly controlled diabetes mellitus.

PubMed

Odegard, Peggy Soule; Gray, Shelly L

2008-01-01

The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus (DM) (those with A1c 9% or above) and to identify specific adherence characteristics associated with poor diabetes control. This was a cross-sectional analysis of baseline data from a randomized, controlled diabetes intervention conducted in University of Washington (UW) Medicine Clinics in the greater Seattle, Washington, area. The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months. Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Questionnaire. Specific adherence characteristics associated with poor diabetes control (A1c >9%) were identified using multivariate regression analysis. Seventy-seven subjects (mean A1c, 10.4%; mean duration of DM, 7 years) were studied. The most common adherence challenges included paying for medications (34%), remembering doses (31%), reading prescription labels (21%), and obtaining refills (21%). Taking more than 2 doses of DM medication daily (beta = .78, SE = 0.32, P = .02) and difficulty reading the DM medication prescription label (beta = .76, SE = 0.37, P = .04) were significantly associated with higher hemoglobin A1c. Self-reported adherence was not related to A1c control. In this study, we identified 2 factors that were associated with poorer A1c control. These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control.

Stress and burden among caregivers of patients with Lewy body dementia.

PubMed

Leggett, Amanda N; Zarit, Steven; Taylor, Angela; Galvin, James E

2011-02-01

Patients with Lewy body dementia (LBD) may present a unique set of symptoms and challenges to family caregivers compared with other types of dementia. Prominent difficulties include motor impairment, activities of daily living (ADLs) disability, recurrent behavioral and emotional problems (BEPs), and diagnostic difficulties. These problems are likely to affect caregivers' subjective burden. The present study used data from an Internet survey conducted by the Lewy Body Dementia Association. Respondents were 611 people who indicated that they were currently involved in the care of their relative with LBD. Subjective burden was assessed with a 12-item short version of the Zarit Burden Interview. A factor analysis revealed 3 dimensions of burden: role strain, personal strain, and worry about performance. Multiple regressions were used to examine predictors of these dimensions. BEPs, ADL disability, isolation, caregiver age, and patient gender were significant predictors of specific factors. Falls, formal service use, difficulty finding a physician, and evaluation of the physician had no significant associations with burden. These findings highlight burden experiences by caregivers of patients with LBD and the impact of BEPs, ADL assistance, and awareness about LBD on subjective burden.

Minding the gap: Children's difficulty conceptualizing spatial intervals as linear measurement units.

PubMed

Solomon, Tracy L; Vasilyeva, Marina; Huttenlocher, Janellen; Levine, Susan C

2015-11-01

Understanding measurement units is critical to mathematics and science learning, but it is a topic that American students find difficult. In 3 studies, we investigated the challenges underlying this difficulty in kindergarten and second grade by comparing performance on different versions of a linear measurement task. Children measured crayons that were either aligned or shifted relative to the left edge of either a continuous ruler or a row of discrete units. The alignment (aligned, shifted) and the measuring tool (ruler, discrete units) were crossed to form 4 types of problems. Study 1 showed good performance in both grades on both types of aligned problems as well as on the shifted problems with discrete units. In contrast, performance was at chance on the shifted ruler problems. Study 2 showed that performance on shifted discrete unit problems declined when numbers were placed on the units, particularly for kindergarteners, suggesting that on the shifted ruler problems, the presence of numbers may have contributed to children's difficulty. However, Study 3 showed that the difficulty on the shifted ruler problems persisted even when the numbers were removed from the ruler. Taken together, these findings suggest that there are multiple challenges to understanding measurement, but that a key challenge is conceptualizing the ruler as a set of countable spatial interval units. (c) 2015 APA, all rights reserved).

Cardiothoracic surgery at a crossroads: The impact of disruptive technologic change

PubMed Central

Cohen, David J

2007-01-01

At the beginning of the twenty-first century, cardiothoracic surgery is arguably the most successful of all medical specialties. There are effective treatments including transplantation, for almost all cardiac and thoracic diseases that can be performed with low morbidity and mortality. Cardiothoracic surgeons have mastered technical difficulties through innovation, hard work, planning and skill. Yet in the past decade, the primacy of cardiothoracic surgery has been challenged by new technologies. This paper applies business school theories to examine how cardiothoracic surgeons might best respond to such "disruptive technologies". Otherwise well-managed business and industrial enterprises have had difficulty dealing with disruptive technological change because of well-recognized organizational impediments. Cardiothoracic surgeons must understand the characteristics of disruptive technologies and consider organizational changes that will allow the profession to better adapt to them. PMID:17686151

Field evaluation of a wearable multimodal soldier navigation system.

PubMed

Aaltonen, Iina; Laarni, Jari

2017-09-01

Challenging environments pose difficulties for terrain navigation, and therefore wearable and multimodal navigation systems have been proposed to overcome these difficulties. Few such navigation systems, however, have been evaluated in field conditions. We evaluated how a multimodal system can aid in navigating in a forest in the context of a military exercise. The system included a head-mounted display, headphones, and a tactile vibrating vest. Visual, auditory, and tactile modalities were tested and evaluated using unimodal, bimodal, and trimodal conditions. Questionnaires, interviews and observations were used to evaluate the advantages and disadvantages of each modality and their multimodal use. The guidance was considered easy to interpret and helpful in navigation. Simplicity of the displayed information was required, which was partially conflicting with the request for having both distance and directional information available. Copyright © 2017 Elsevier Ltd. All rights reserved.

Immunotherapy: bewitched, bothered, and bewildered no more.

PubMed

Steinman, Ralph M; Mellman, Ira

2004-07-09

The field of immunotherapy holds clear promise not only for the development of new approaches to cancer and other diseases, but also for providing fundamental insight into the human immune response. In order for this promise to be realized, however, the scientific community must overcome an array of challenges. These challenges reflect not only the difficulties inherent in conducting investigations in human patients, but also difficulties created by the culture and practice of our own institutions, reward structure, and funding mechanisms. We suggest steps to be taken to reinvigorate basic research in human subjects as part of the mainstream of science.

Self-Management and Parents as Interventionists to Improve Homework Independence in Students with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Hampshire, Patricia Korzekwa; Butera, Gretchen D.; Bellini, Scott

2016-01-01

Homework challenges are particularly relevant for students with autism spectrum disorders who demonstrate difficulty maintaining attention, motivation, and developing effective study skills. These challenges are often exacerbated for adolescents with disabilities who face a number of challenges during the middle school years. A multiple baseline…

The Twin Twin Paradox: Exploring Student Approaches to Understanding Relativistic Concepts

ERIC Educational Resources Information Center

Cormier, Sebastien; Steinberg, Richard

2010-01-01

A great deal has long been known about student difficulties connecting real-world experiences with what they are learning in their physics classes, making learning basic ideas of classical physics challenging. Understanding these difficulties has led to the development of many instructional approaches that have been shown to help students make…

Perceived Differences and Preferred Norms: Dutch Physical Educators Constructing Gendered Ethnicity

ERIC Educational Resources Information Center

van Doodewaard, Corina; Knoppers, Annelies

2018-01-01

Many physical education (PE) teachers have been challenged by the shift from teaching in primarily ethnic homogenous contexts to multi-ethnic (ME) classes. Teachers in secondary schools often experience difficulty in class management in such classes. This difficulty may limit their ability to create a positive student--teacher relationship and may…

Emotional Intelligence and Resiliency in Young Adults with Asperger's Disorder: Challenges and Opportunities

ERIC Educational Resources Information Center

Montgomery, Janine M.; Schwean, Vicki L.; Burt, Jo-Anne G.; Dyke, Danielle I.; Thorne, Keoma J.; Hindes, Yvonne L.; McCrimmon, Adam W.; Kohut, Candace S.

2008-01-01

Asperger's disorder (AD) is characterized by sustained and pervasive difficulties with imaginative, social, and communication skills and the presence of repetitive interests and behaviours. A number of models have been proposed to help explain the AD phenotype; however, these theories have not fully accounted for the social difficulties present in…

Minding the Gap: Children's Difficulty Conceptualizing Spatial Intervals as Linear Measurement Units

ERIC Educational Resources Information Center

Solomon, Tracy L.; Vasilyeva, Marina; Huttenlocher, Janellen; Levine, Susan C.

2015-01-01

Understanding measurement units is critical to mathematics and science learning, but it is a topic that American students find difficult. In 3 studies, we investigated the challenges underlying this difficulty in kindergarten and second grade by comparing performance on different versions of a linear measurement task. Children measured crayons…

Time Processing Impairments in Preschoolers at Risk of Developing Difficulties in Mathematics

ERIC Educational Resources Information Center

Tobia, Valentina; Rinaldi, Luca; Marzocchi, Gian Marco

2018-01-01

The occurrence of time processing problems in individuals with Development Dyscalculia (DD) has favored the view of a general magnitude system devoted to both numerical and temporal information. Yet, this scenario has been partially challenged by studies indicating that time difficulties can be attributed to poor calculation or counting skills,…

The Impact of Task Difficulty and Performance Scores on Student Engagement and Progression

ERIC Educational Resources Information Center

Lynch, Raymond; Patten, James Vincent; Hennessy, Jennifer

2013-01-01

Background: This article considers the impact of differential task difficulty on student engagement and progression within an Irish primary school context. Gaining and maintaining student engagement during learning tasks such as homework is a significant and understandable on-going challenge for teachers. The findings of this study hold the…

Diagnosis and management of patients with clefts: a comprehensive and interdisciplinary approach.

PubMed

Hartzell, Larry D; Kilpatrick, Lauren A

2014-10-01

This article reviews the most current practice guidelines in the diagnosis and management of patients born with cleft lip and/or palate. Such patients frequently have multiple medical and social issues that benefit greatly from a team approach. Common challenges include feeding difficulty, nutritional deficiency, speech disorders, hearing problems, ear disease, dental anomalies, and both social and developmental delays, among others. Interdisciplinary evaluation and collaboration throughout a patient's development are essential. Copyright © 2014 Elsevier Inc. All rights reserved.

Personality Disorders in Later Life: Questions about the Measurement, Course, and Impact of Disorders

PubMed Central

Oltmanns, Thomas F.; Balsis, Steve

2011-01-01

Lifespan perspectives have played a crucial role in shaping our understanding of many forms of psychopathology. Unfortunately, little attention has been given to personality disorders in middle adulthood and later life. Several issues are responsible for this deficiency, including difficulty applying the diagnostic criteria for personality disorders to older people and challenges in identifying appropriate samples of older participants. The goal of this review is to explore the benefits of considering older adults in the study of personality disorders. Later life offers a unique opportunity for investigators to consider links between personality pathology and consequential outcomes in people’s lives. Many domains are relevant, including health, longevity, social adjustment, marital relationships, and the experience of major life events. We review each domain and consider ways in which the study of middle-aged and older adults challenges researchers to evaluate how personality disorders in general are defined and measured. PMID:21219195

Economic evaluations and their use in infection prevention and control: a narrative review.

PubMed

Rennert-May, Elissa; Conly, John; Leal, Jenine; Smith, Stephanie; Manns, Braden

2018-01-01

The objective of this review is to provide a comprehensive overview of the different types of economic evaluations that can be utilized by Infection Prevention and Control practitioners with a particular focus on the use of the quality adjusted life year, and its associated challenges. We also highlight existing economic evaluations published within Infection Prevention and Control, research gaps and future directions. Narrative Review. To date the majority of economic evaluations within Infection Prevention and Control are considered partial economic evaluations. Acknowledging the challenges, which include variable utilities within infection prevention and control, a lack of randomized controlled trials, and difficulty in modelling infectious diseases in general, future economic evaluation studies should strive to be consistent with published guidelines for economic evaluations. This includes the use of quality adjusted life years. Further research is required to estimate utility scores of relevance within Infection Prevention and Control.

Do molecules matter more than morphology? Promises and pitfalls in parasites.

PubMed

Perkins, S L; Martinsen, E S; Falk, B G

2011-11-01

Systematics involves resolving both the taxonomy and phylogenetic placement of organisms. We review the advantages and disadvantages of the two kinds of information commonly used for such inferences--morphological and molecular data--as applied to the systematics of metazoan parasites generally, with special attention to the malaria parasites. The problems that potentially confound the use of morphology in parasites include challenges to consistent specimen preservation, plasticity of features depending on hosts or other environmental factors, and morphological convergence. Molecular characters such as DNA sequences present an alternative data source and are particularly useful when not all the parasite's life stages are present or when parasitaemia is low. Nonetheless, molecular data can bring challenges that include troublesome DNA isolation, paralogous gene copies, difficulty in developing molecular markers, and preferential amplification in mixed species infections. Given the differential benefits and shortcomings of both molecular and morphological characters, both should be implemented in parasite taxonomy and phylogenetics.

Recruitment of Refugees for Health Research: A Qualitative Study to Add Refugees' Perspectives.

PubMed

Gabriel, Patricia; Kaczorowski, Janusz; Berry, Nicole

2017-01-29

Research is needed to understand refugees' health challenges and barriers to accessing health services during settlement. However, there are practical and ethical challenges for engaging refugees as participants. Despite this, there have been no studies to date specifically investigating refugee perspectives on factors affecting engagement in health research. Language-concordant focus groups in British Columbia, Canada, with four government-assisted refugee language groups (Farsi/Dari, Somali, Karen, Arabic) inquired about willingness to participate in health research. Twenty-three variables associated with the willingness of refugees to participate in health research were elicited. Variables related to research design included recruitment strategies, characteristics of the research team members and the nature of the research. Variables related to individual participants included demographic features such as gender and education, attitudes towards research and previous experience with research. This research can be used to increase opportunities for refugees' engagement in research and includes recommendations for subgroups of refugees that may have more difficulties engaging in research.

Open heart surgery in Nigeria; a work in progress.

PubMed

Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Animasahun, Barakat; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, Adewale

2013-01-12

There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.

The laboratory workforce shortage: a managerial perspective.

PubMed

Cortelyou-Ward, Kendall; Ramirez, Bernardo; Rotarius, Timothy

2011-01-01

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

The Challenges of Developing a Participatory Arts Intervention for Caregivers of Persons with Dementia

PubMed Central

Gammonley, Denise; Hanna Powell, Gay; Wan, Thomas T

2017-01-01

Objective: We describe the development and challenges in implementing a web-based participatory art intervention specifically designed for caregivers of persons with dementia to use at home with their loved one.   Method: An interprofessional team, including an experienced national panel of artists, developed a participatory arts toolkit consisting of seven web-based modules involving a combination of music, singing, dancing, poetry, and painting. Participants completed a survey of demographics, caregiver needs, and caregiver burden.  Results: Thirty caregivers with high caregiver needs and a high caregiver burden volunteered to pilot the intervention. Difficulties with caregiver recruitment and compliance with lesson plans were noted. Caregivers provided positive and negative qualitative feedback.   Discussion: The challenges and possible solutions to the problems identified in the implementation and assessment of this participatory arts intervention will provide important insights for future studies linking the arts and dementia care.    PMID:28503390

Canadian Academy of Sport and Exercise Medicine position statement: athletes at high altitude.

PubMed

Koehle, Michael S; Cheng, Ivy; Sporer, Benjamin

2014-03-01

Many sports incorporate training at altitude as a key component of their athlete training plan. Furthermore, many sports are required to compete at high altitude venues. Exercise at high altitude provides unique challenges to the athlete and to the sport medicine clinician working with these athletes. These challenges include altitude illness, alterations in training intensity and performance, nutritional and hydration difficulties, and challenges related to the austerity of the environment. Furthermore, many of the strategies that are typically utilized by visitors to altitude may have implications from an anti-doping point of view.This position statement was commissioned and approved by the Canadian Academy of Sport and Exercise Medicine. The purpose of this statement was to provide an evidence-based, best practices summary to assist clinicians with the preparation and management of athletes and individuals travelling to altitude for both competition and training.

The Challenges of Developing a Participatory Arts Intervention for Caregivers of Persons with Dementia.

PubMed

Golden, Adam; Gammonley, Denise; Hanna Powell, Gay; Wan, Thomas T

2017-04-11

We describe the development and challenges in implementing a web-based participatory art intervention specifically designed for caregivers of persons with dementia to use at home with their loved one.   Method: An interprofessional team, including an experienced national panel of artists, developed a participatory arts toolkit consisting of seven web-based modules involving a combination of music, singing, dancing, poetry, and painting. Participants completed a survey of demographics, caregiver needs, and caregiver burden.  Results: Thirty caregivers with high caregiver needs and a high caregiver burden volunteered to pilot the intervention. Difficulties with caregiver recruitment and compliance with lesson plans were noted. Caregivers provided positive and negative qualitative feedback.   Discussion: The challenges and possible solutions to the problems identified in the implementation and assessment of this participatory arts intervention will provide important insights for future studies linking the arts and dementia care.

Lorcaserin: drug profile and illustrative model of the regulatory challenges of weight-loss drug development.

PubMed

Bays, Harold E

2011-03-01

Lorcaserin is a selective 5-hydroxytryptamine receptor 2c agonist developed as a weight-loss drug. Phase II and III clinical trials support lorcaserin as not only reducing adiposity (i.e., fat mass), but also as improving the metabolic diseases commonly associated with adiposopathy (i.e., fat dysfunction). At the time of this writing, regulatory processes continue towards evaluating lorcaserin as a potentially marketed weight-loss and weight-maintenance agent. Some of the challenges facing lorcaserin are similar to the difficulties encountered by all investigational weight-loss therapeutic agents, which include evolving paths towards approval. While important for clinicians to understand approval hurdles for all therapeutics, it is especially critical for researchers and developers to grasp the unique regulatory complexities of anti-obesity agents. This article profiles lorcaserin as an illustrative example of general drug development regulatory processes, and specifically details the unique challenge of weight-loss drug development.

[Interactions between human sexual arousal and sexual desire: a challenge for social neuroscience].

PubMed

Ortigue, Stephanie; Bianchi-Demicheli, Francesco

2007-03-28

The frequent interaction and synergy between sexual arousal and sexual desire occuring during a sexual experience explains the difficulty in disentagling these two phenomena in the human sexual response. Sexual desire is defined as a goal-directed motivational state integrating the other in one's personal sphere on the basis of intentionality, rather than by instinct only. Sexual arousal includes physical manifestations and subjective perception of excitement. Interest in sexual arousal has engendered a growing body of research concerning its nature and function as well as the biological basis of the mechanisms sustaining it. Recent functional imaging has played a key role in seeking to isolate brain regions specific to sexual arousal. This field may represent a new challenge for social neuroscience.

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments

PubMed Central

Lubich, Carol; Krenzelok, Edward P

2009-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms. PMID:21686401

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.

PubMed

Lubich, Carol; Krenzelok, Edward P

2009-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments

PubMed Central

Lubich, Carol; Krenzelok, Edward P

2007-01-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms. PMID:17954846

Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.

PubMed

Lubich, Carol; Krenzelok, Edward P

2007-11-01

Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.

The rhetorical 'turn' in medical education: what have we learned and where are we going?

PubMed

Lingard, Lorelei

2007-05-01

This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with the complexities of distributed teams, and difficulties bridging the epistemologies of rhetoric and psychometrics.

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms

PubMed Central

Barrett, Frederick S.; Bradstreet, Matthew P.; Leoutsakos, Jeannie-Marie S.; Johnson, Matthew W.; Griffiths, Roland R.

2017-01-01

Acute adverse psychological reactions to classic hallucinogens (“bad trips”, or “challenging experiences”), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the 5-Dimensional Altered States of Consciousness questionnaire) in an internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire (CEQ). The stand-alone CEQ was then validated in a separate sample. Seven CEQ factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with the difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The CEQ provides a basis for future investigation of predictors and outcomes of challenging experiences with psilocybin, and should be explored as a measure of challenging experiences with the broad class of classic hallucinogens. PMID:27856683

Mentoring Matters: The Challenge for Teacher Education

ERIC Educational Resources Information Center

McCann, Thomas M.; Ed.; Johannessen, Larry, Ed.

2009-01-01

Beginning teachers face many challenges and difficulties; as a result, one-third will leave the profession in the first three years and nearly half will be gone within their first five years in the profession. The challenge facing university teacher education programs is to fix the hole in the bottom of the bucket and find strategic new ways to…

Ethics challenges and guidance related to research involving adolescent post-abortion care: a scoping review.

PubMed

Zulu, Joseph M; Ali, Joseph; Hallez, Kristina; Kass, Nancy; Michelo, Charles; Hyder, Adnan A

2018-05-02

An increase in post abortion care (PAC) research with adolescents, particularly in low- and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature. Following a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges. The literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers. Addressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international levels. Overall, despite the documentation of challenges in the published literature, guidance on handling several of these ethics challenges is sparse. We encourage further research to clarify the identified challenges and support the development of formal guidance in this area.

Word-Problem-Solving Strategy for Minority Students at Risk for Math Difficulties

ERIC Educational Resources Information Center

Kong, Jennifer E.; Orosco, Michael J.

2016-01-01

Minority students at risk for math difficulties (MD) struggle with word problems for various reasons beyond procedural or calculation challenges. As a result, these students require support in reading and language development in addition to math. The purpose of this study was to assess the effectiveness of a math comprehension strategy based on a…

Using Student Ability and Item Difficulty for Making Defensible Pass/Fail Decisions for Borderline Grades

ERIC Educational Resources Information Center

Shulruf, Boaz; Jones, Phil; Turner, Rolf

2015-01-01

The determination of Pass/Fail decisions over Borderline grades, (i.e., grades which do not clearly distinguish between the competent and incompetent examinees) has been an ongoing challenge for academic institutions. This study utilises the Objective Borderline Method (OBM) to determine examinee ability and item difficulty, and from that…

An Investigation of Difficulties Experienced by Students Developing Unified Modelling Language (UML) Class and Sequence Diagrams

ERIC Educational Resources Information Center

Sien, Ven Yu

2011-01-01

Object-oriented analysis and design (OOAD) is not an easy subject to learn. There are many challenges confronting students when studying OOAD. Students have particular difficulty abstracting real-world problems within the context of OOAD. They are unable to effectively build object-oriented (OO) models from the problem domain because they…

Parental Mediation of the Internet Use of Primary Students: Beliefs, Strategies and Difficulties

ERIC Educational Resources Information Center

Bartau-Rojas, Isabel; Aierbe-Barandiaran, Ana; Oregui-González, Eider

2018-01-01

The use of the Internet by children at an increasingly early age today constitutes a major challenge for families and schools, as well as affecting educational and social policy. This is a qualitative piece of research that analyzes parents' beliefs, everyday practices and the difficulties they face in teaching their children the benefits and…

Self-Emergent Peer Support Using Online Social Networking during Cross-Border Transition

ERIC Educational Resources Information Center

Ding, Feng; Stapleton, Paul

2015-01-01

Transitioning from school to university is a major development for learners, often accompanied by difficulties. When overseas students arrive at university for the first time these challenges are multiplied. It is suggested, however, that these difficulties can be mitigated to a certain extent via the use of online social networks. The present…

What Does a Verbal Test Measure? A New Approach to Understanding Sources of Item Difficulty.

ERIC Educational Resources Information Center

Berk, Eric J. Vanden; Lohman, David F.; Cassata, Jennifer Coyne

Assessing the construct relevance of mental test results continues to present many challenges, and it has proven to be particularly difficult to assess the construct relevance of verbal items. This study was conducted to gain a better understanding of the conceptual sources of verbal item difficulty using a unique approach that integrates…

On Maximizing Item Information and Matching Difficulty with Ability.

ERIC Educational Resources Information Center

Bickel, Peter; Buyske, Steven; Chang, Huahua; Ying, Zhiliang

2001-01-01

Examined the assumption that matching difficulty levels of test items with an examinee's ability makes a test more efficient and challenged this assumption through a class of one-parameter item response theory models. Found the validity of the fundamental assumption to be closely related to the van Zwet tail ordering of symmetric distributions (W.…

Challenges in Designing Appropriate Scaffolding to Improve Students' Representational Consistency: The Case of a Gauss's Law Problem

ERIC Educational Resources Information Center

Maries, Alexandru; Lin, Shih-Yin; Singh, Chandralekha

2017-01-01

Prior research suggests that introductory physics students have difficulty with graphing and interpreting graphs. Here, we discuss an investigation of student difficulties in translating between mathematical and graphical representations for a problem in electrostatics and the effect of increasing levels of scaffolding on students'…

Mathematical Learning Disability in Girls with Turner Syndrome: A Challenge to Defining MLD and Its Subtypes

ERIC Educational Resources Information Center

Mazzocco, Michele M. M.

2009-01-01

Turner syndrome is a common disorder with a prevalence of 1:2,500 live female births. Although not associated with mental retardation, there is an increased risk of learning difficulties in this population. In particular, mathematical learning difficulties among girls with Turner syndrome are prevalent, significant, and persistent. As such, the…

Effects of Varying Text Difficulty Levels on Second Language (L2) Reading Attitudes and Reading Comprehension

ERIC Educational Resources Information Center

Chiang, Min-Hsun

2016-01-01

This study investigated the effects of varying text difficulty on L2 reading attitudes and reading comprehension. To provide the optimal challenge for L2 reading, comprehensible input hypothesis postulates that choosing text slightly harder than the learner's current level will enhance reading comprehension. Fifty-four freshmen from one university…

The Effect of Selected "Desirable Difficulties" on the Ability to Recall Anatomy Information

ERIC Educational Resources Information Center

Dobson, John L.; Linderholm, Tracy

2015-01-01

"Desirable difficulties" is a theory from cognitive science used to promote learning in a variety of contexts. The basic premise is that creating a cognitively challenging environment at the learning acquisition phase, by actively engaging learners in the retrieval of to-be-learned materials, promotes long-term retention. In this study,…

Real Power? An Examination of the Involvement of People with Learning Difficulties in Strategic Service Development in Cambridgeshire

ERIC Educational Resources Information Center

Dearden-Phillips, Craig; Fountain, Rob

2005-01-01

Securing meaningful involvement in service development and provision can be seen as a particular challenge for people with learning difficulties. The National Health Service & Community Care Act [(1990) HMSO, ISBN 0105419907] and more recently Valuing People [Department of Health (2001) "Valuing people: a new strategy for learning…

Inviting Student Engagement with Questioning

ERIC Educational Resources Information Center

Caram, Chris A.; Davis, Patsy B.

2005-01-01

Teaching is about designing, creating, and inventing intellectually challenging work for students--work that engages students and is so compelling that students persist when they experience difficulty and feel satisfaction, indeed delight, when they successfully accomplish the challenge (Schlechty 1997). Whether thinking skills are taught…

Gender differences in quality of life among long-term colorectal cancer survivors with ostomies.

PubMed

Grant, Marcia; McMullen, Carmit K; Altschuler, Andrea; Mohler, M Jane; Hornbrook, Mark C; Herrinton, Lisa J; Wendel, Christopher S; Baldwin, Carol M; Krouse, Robert S

2011-09-01

To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies. Qualitative study using content analysis of focus group content. Oregon, southwestern Washington, and northern California. Four female and four male focus groups (N = 33) selected from 282 quantitative survey participants with health-related quality-of-life (HRQOL) scores in the highest or lowest quartile. Eight focus groups discussed the challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. HRQOL domains of physical, psychological, social, and spiritual well-being. All groups reported avoiding foods that cause gas or rapid transit and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality and intimacy. Coping and adjustment difficulties mostly were discussed by women, with men only discussing these issues to a small extent. Difficulties with sleep primarily were identified by women with low HRQOL. Problems with body image and depression were discussed only by women with low HRQOL. Common issues included diet management, physical activity, social support, and sexuality. Although both genders identified challenges, women described more specific psychological and social issues than men. Application of these gender-based differences can inform educational interventions for colorectal cancer survivors with ostomies.

Effects of Achievement Goals on Challenge Seeking and Feedback Processing: Behavioral and fMRI Evidence

PubMed Central

Lee, Woogul; Kim, Sung-il

2014-01-01

We conducted behavioral and functional magnetic resonance imaging (fMRI) research to investigate the effects of two types of achievement goals—mastery goals and performance-approach goals— on challenge seeking and feedback processing. The results of the behavioral experiment indicated that mastery goals were associated with a tendency to seek challenge, both before and after experiencing difficulty during task performance, whereas performance-approach goals were related to a tendency to avoid challenge after encountering difficulty during task performance. The fMRI experiment uncovered a significant decrease in ventral striatal activity when participants received negative feedback for any task type and both forms of achievement goals. During the processing of negative feedback for the rule-finding task, performance-approach-oriented participants showed a substantial reduction in activity in the dorsolateral prefrontal cortex (DLPFC) and the frontopolar cortex, whereas mastery-oriented participants showed little change. These results suggest that performance-approach-oriented participants are less likely to either recruit control processes in response to negative feedback or focus on task-relevant information provided alongside the negative feedback. In contrast, mastery-oriented participants are more likely to modulate aversive valuations to negative feedback and focus on the constructive elements of feedback in order to attain their task goals. We conclude that performance-approach goals lead to a reluctant stance towards difficulty, while mastery goals encourage a proactive stance. PMID:25251396

Simulating Pelletization Strategies to Reduce the Biomass Supply Risk at America’s Biorefineries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacob J. Jacobson; Shane Carnohan; Andrew Ford

2014-07-01

Demand for cellulosic ethanol and other advanced biofuels has been on the rise, due in part to federal targets enacted in 2005 and extended in 2007. The industry faces major challenges in meeting these worthwhile and ambitious targets. The challenges are especially severe in the logistics of timely feedstock delivery to biorefineries. Logistical difficulties arise from seasonal production that forces the biomass to be stored in uncontrolled field-side environments. In this storage format physical difficulties arise; transportation is hindered by the low bulk density of baled biomass and the unprotected material can decay leading to unpredictable losses. Additionally, uncertain yieldsmore » and contractual difficulties can exacerbate these challenges making biorefineries a high-risk venture. Investors’ risk could limit business entry and prevent America from reaching the targets. This paper explores pelletizer strategies to convert the lignocellulosic biomass into a denser form more suitable for storage. The densification of biomass would reduce supply risks, and the new system would outperform conventional biorefinery supply systems. Pelletizer strategies exhibit somewhat higher costs, but the reduction in risk is well worth the extra cost if America is to grow the advanced biofuels industry in a sustainable manner.« less

Modern Pathologic Diagnosis of Renal Oncocytoma.

PubMed

Wobker, Sara E; Williamson, Sean R

2017-01-01

Oncocytoma is a well-defined benign renal tumor, with classic gross and histologic features, including a tan or mahogany-colored mass with central scar, microscopic nested architecture, bland cytology, and round, regular nuclei with prominent central nucleoli. As a result of variations in this classic appearance, difficulty in standardizing diagnostic criteria, and entities that mimic oncocytoma, such as eosinophilic variant chromophobe renal cell carcinoma and succinate dehydrogenase-deficient renal cell carcinoma, pathologic diagnosis remains a challenge. This review addresses the current state of pathologic diagnosis of oncocytoma, with emphasis on modern diagnostic markers, areas of controversy, and emerging techniques for less invasive diagnosis, including renal mass biopsy and advanced imaging.

Response to Intervention: Preventing and Remediating Academic Difficulties

PubMed Central

Fletcher, Jack M.; Vaughn, Sharon

2009-01-01

We address the advantages and challenges of service delivery models based on student response to intervention (RTI) for preventing and remediating academic difficulties and as data sources for identification for special education services. The primary goal of RTI models is improved academic and behavioral outcomes for all students. We review evidence for the processes underlying RTI, including screening and progress monitoring assessments, evidence-based interventions, and schoolwide coordination of multitiered instruction. We also discuss the secondary goal of RTI, which is to provide data for identification of learning disabilities (LDs). Incorporating instructional response into identification represents a controversial shift away from discrepancies in cognitive skills that have traditionally been a primary basis for LD identification. RTI processes potentially integrate general and special education and suggest new directions for research and public policy related to LDs, but the scaling issues in schools are significant and more research is needed on the use of RTI data for identification. PMID:21765862

Challenges with Electrical, Electronics, and Electromechanical Parts for James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Jah, Muzar A.; Jeffers, Basil S.

2016-01-01

James Webb Space Telescope (JWST) is the space-based observatory that will extend the knowledge gained by the Hubble Space Telescope (HST). Hubble focuses on optical and ultraviolet wavelengths while JWST focuses on the infrared portion of the electromagnetic spectrum, to see the earliest stars and galaxies that formed in the Universe and to look deep into nearby dust clouds to study the formation of stars and planets. JWST, which commenced creation in 1996, is scheduled to launch in 2018. It includes a suite of four instruments, the spacecraft bus, optical telescope element, Integrated Science Instrument Module (ISIM, the platform to hold the instruments), and a sunshield. The mass of JWST is approximately 6200 kg, including observatory, on-orbit consumables and launch vehicle adaptor. Many challenges were overcome while providing the electrical and electronic components for the Goddard Space Flight Center hardware builds. Other difficulties encountered included developing components to work at cryogenic temperatures, failures of electronic components during development and flight builds, Integration and Test electronic parts problems, and managing technical issues with international partners. This paper will present the context of JWST from a EEE (electrical, electronic, and electromechanical) perspective with examples of challenges and lessons learned throughout the design, development, and fabrication of JWST in cooperation with our associated partners including the Canadian Space Agency (CSA), the European Space Agency (ESA), Lockheed Martin and their respective associated partners. Technical challenges and lessons learned will be discussed.

Player Modeling for Intelligent Difficulty Adjustment

NASA Astrophysics Data System (ADS)

Missura, Olana; Gärtner, Thomas

In this paper we aim at automatically adjusting the difficulty of computer games by clustering players into different types and supervised prediction of the type from short traces of gameplay. An important ingredient of video games is to challenge players by providing them with tasks of appropriate and increasing difficulty. How this difficulty should be chosen and increase over time strongly depends on the ability, experience, perception and learning curve of each individual player. It is a subjective parameter that is very difficult to set. Wrong choices can easily lead to players stopping to play the game as they get bored (if underburdened) or frustrated (if overburdened). An ideal game should be able to adjust its difficulty dynamically governed by the player’s performance. Modern video games utilise a game-testing process to investigate among other factors the perceived difficulty for a multitude of players. In this paper, we investigate how machine learning techniques can be used for automatic difficulty adjustment. Our experiments confirm the potential of machine learning in this application.

Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents.

PubMed

Adolphus, Katie; Bellissimo, Nick; Lawton, Clare L; Ford, Nikki A; Rains, Tia M; Totosy de Zepetnek, Julia; Dye, Louise

2017-01-01

Breakfast is purported to confer a number of benefits on diet quality, health, appetite regulation, and cognitive performance. However, new evidence has challenged the long-held belief that breakfast is the most important meal of the day. This review aims to provide a comprehensive discussion of the key methodological challenges and considerations in studies assessing the effect of breakfast on cognitive performance and appetite control, along with recommendations for future research. This review focuses on the myriad challenges involved in studying children and adolescents specifically. Key methodological challenges and considerations include study design and location, sampling and sample section, choice of objective cognitive tests, choice of objective and subjective appetite measures, merits of providing a fixed breakfast compared with ad libitum, assessment and definition of habitual breakfast consumption, transparency of treatment condition, difficulty of isolating the direct effects of breakfast consumption, untangling acute and chronic effects, and influence of confounding variables. These methodological challenges have hampered a clear substantiation of the potential positive effects of breakfast on cognition and appetite control and contributed to the debate questioning the notion that breakfast is the most important meal of the day. © 2017 American Society for Nutrition.

Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents123

PubMed Central

Bellissimo, Nick; Ford, Nikki A; Rains, Tia M

2017-01-01

Breakfast is purported to confer a number of benefits on diet quality, health, appetite regulation, and cognitive performance. However, new evidence has challenged the long-held belief that breakfast is the most important meal of the day. This review aims to provide a comprehensive discussion of the key methodological challenges and considerations in studies assessing the effect of breakfast on cognitive performance and appetite control, along with recommendations for future research. This review focuses on the myriad challenges involved in studying children and adolescents specifically. Key methodological challenges and considerations include study design and location, sampling and sample section, choice of objective cognitive tests, choice of objective and subjective appetite measures, merits of providing a fixed breakfast compared with ad libitum, assessment and definition of habitual breakfast consumption, transparency of treatment condition, difficulty of isolating the direct effects of breakfast consumption, untangling acute and chronic effects, and influence of confounding variables. These methodological challenges have hampered a clear substantiation of the potential positive effects of breakfast on cognition and appetite control and contributed to the debate questioning the notion that breakfast is the most important meal of the day. PMID:28096143

Teaching about Water Relations in Plant Cells: An Uneasy Struggle

PubMed Central

Malińska, Lilianna; Rybska, Eliza; Sobieszczuk-Nowicka, Ewa; Adamiec, Małgorzata

2016-01-01

University students often struggle to understand the role of water in plant cells. In particular, osmosis and plasmolysis appear to be challenging topics. This study attempted to identify student difficulties (including misconceptions) concerning osmosis and plasmolysis and examined to what extent the difficulties could be revised during a plant physiology course. A questionnaire was developed to monitor university students’ conceptual knowledge before and after a course, and both qualitative and quantitative data were obtained. The data were analyzed using the constant comparison technique and descriptive statistics. Students were found to come to university with many misconceptions that had accumulated during their education. These misconceptions are extremely difficult to change during the traditional course, which comprises lectures and practical exercises. Students’ misconceptions originate from commonly used sources such as textbooks, which are perceived as being reliable. Effective teaching of water relations in plant cells could include such didactic methods as “questioning the author,” which allow teachers to monitor students’ knowledge and help students acquire a more scientific understanding of key concepts. PMID:27909028

The Current State of Sensing, Health Management, and Control for Small-To-Medium-Sized Manufacturers

PubMed Central

Helu, Moneer; Weiss, Brian

2017-01-01

The development of digital technologies for manufacturing has been challenged by the difficulty of navigating the breadth of new technologies available to industry. This difficulty is compounded by technologies developed without a good understanding of the capabilities and limitations of the manufacturing environment, especially within small-to-medium enterprises (SMEs). This paper describes industrial case studies conducted to identify the needs, priorities, and constraints of manufacturing SMEs in the areas of performance measurement, condition monitoring, diagnosis, and prognosis. These case studies focused on contract and original equipment manufacturers with less than 500 employees from several industrial sectors. Solution and equipment providers and National Institute of Standards and Technology (NIST) Hollings Manufacturing Extension Partnership (MEP) centers were also included. Each case study involved discussions with key shop-floor personnel as well as site visits with some participants. The case studies highlight SME's strong need for access to appropriate data to better understand and plan manufacturing operations. They also help define industrially-relevant use cases in several areas of manufacturing operations, including scheduling support, maintenance planning, resource budgeting, and workforce augmentation. PMID:28736773

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

ERIC Educational Resources Information Center

Babalola, Shade

2015-01-01

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

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

ERIC Educational Resources Information Center

Inoue, Noriyuki

2007-01-01

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

Teaching Facial Expressions of Emotion

ERIC Educational Resources Information Center

Lierheimer, Kristin; Stichter, Janine

2011-01-01

Many students with exceptionalities, such as Aaron, display challenging behaviors that have a substantial impact on their quality of life and greatly disrupt the educational process (Matson, Wilkins, & Macken, 2009; Westling, 2010). Challenging behavior often causes academic and social difficulties for the students displaying the behavior,…

The Use of a Bar Model Drawing to Teach Word Problem Solving to Students with Mathematics Difficulties

ERIC Educational Resources Information Center

Morin, Lisa L.; Watson, Silvana M. R.; Hester, Peggy; Raver, Sharon

2017-01-01

For students with mathematics difficulties (MD), math word problem solving is especially challenging. The purpose of this study was to examine the effects of a problem-solving strategy, bar model drawing, on the mathematical problem-solving skills of students with MD. The study extended previous research that suggested that schematic-based…

Improving School Attendance: Can Participation in Outdoor Learning Influence Attendance for Young People with Social, Emotional and Behavioural Difficulties?

ERIC Educational Resources Information Center

Price, Alan

2015-01-01

The link between good attendance in school and academic performance has been acknowledged for some time now. However, improving school attendance for young people with social, emotional and behavioural difficulties (SEBD) or pupils at risk of exclusion can be a challenging task for educational leaders. This paper begins with a discussion of…

Treating the Whole Person: A Counseling, Psychology and Support Model for Learners with Learning Difficulty and Disabilities

ERIC Educational Resources Information Center

Lee, Larry

2014-01-01

Concerned about traditional practice that attempted to manage the challenging behavior of learners with learning difficulty and disabilities (LLDD) in learning and social environments, I questioned the extent to which they could manage themselves. From 265 students, 15 males, median age of 19, were invited to participate in 12 weekly one-hour…

Principles for Predicting RNA Secondary Structure Design Difficulty.

PubMed

Anderson-Lee, Jeff; Fisker, Eli; Kosaraju, Vineet; Wu, Michelle; Kong, Justin; Lee, Jeehyung; Lee, Minjae; Zada, Mathew; Treuille, Adrien; Das, Rhiju

2016-02-27

Designing RNAs that form specific secondary structures is enabling better understanding and control of living systems through RNA-guided silencing, genome editing and protein organization. Little is known, however, about which RNA secondary structures might be tractable for downstream sequence design, increasing the time and expense of design efforts due to inefficient secondary structure choices. Here, we present insights into specific structural features that increase the difficulty of finding sequences that fold into a target RNA secondary structure, summarizing the design efforts of tens of thousands of human participants and three automated algorithms (RNAInverse, INFO-RNA and RNA-SSD) in the Eterna massive open laboratory. Subsequent tests through three independent RNA design algorithms (NUPACK, DSS-Opt and MODENA) confirmed the hypothesized importance of several features in determining design difficulty, including sequence length, mean stem length, symmetry and specific difficult-to-design motifs such as zigzags. Based on these results, we have compiled an Eterna100 benchmark of 100 secondary structure design challenges that span a large range in design difficulty to help test future efforts. Our in silico results suggest new routes for improving computational RNA design methods and for extending these insights to assess "designability" of single RNA structures, as well as of switches for in vitro and in vivo applications. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Current challenges in optimizing systemic therapy for patients with pancreatic cancer: expert perspectives from the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty.

PubMed

Segelov, Eva; Lordick, Florian; Goldstein, David; Chantrill, Lorraine A; Croagh, Daniel; Lawrence, Ben; Arnold, Dirk; Chau, Ian; Obermannova, Radka; Price, Timothy Jay

2017-10-01

Despite recent progress, the outlook for most patients with pancreatic cancer remains poor. There is variation in how patients are managed globally due to differing interpretations of the evidence, partly because studies in this disease are challenging to undertake. This article collates the evidence upon which current best practice is based and offers an expert opinion from an international faculty on how latest developments should influence current treatment paradigms. Areas covered: Optimal chemotherapy for first and subsequent lines of therapy; optimal management of locally advanced, non-metastatic cancer including the role of neoadjuvant chemo(radio)therapy, current evidence for adjuvant chemotherapy, major advances in pancreatic cancer genomics and challenges in supportive care particularly relevant to patients with pancreatic cancer. For each section, literature was reviewed by comprehensive search techniques, including clinical trial websites and abstracts from international cancer meetings. Expert commentary: For each section, a commentary is provided. Overall the challenges identified were: difficulties in diagnosing pancreatic cancer early, challenges for performing randomised clinical trials in all stages of the disease, some progress in systemic therapy with new agents and in identifying molecular subtypes that may be clinically relevant and move towards personalized therapy, but still, pancreatic cancer remains a very poor prognosis cancer with significant palliative care needs.

Perceived Challenges in Primary Literature in a Master’s Class: Effects of Experience and Instruction

PubMed Central

Lie, Richard; Abdullah, Christopher; He, Wenliang; Tour, Ella

2016-01-01

Primary literature offers rich opportunities to teach students how to “think like a scientist,” but the challenges students face when they attempt to read research articles are not well understood. Here, we present an analysis of what master’s students perceive as the most challenging aspects of engaging with primary literature. We examined 69 pairs of pre- and postcourse responses from students enrolled in a master’s-level course that offered a structured analysis of primary literature. On the basis of these responses, we identified six categories of challenges. Before instruction, “techniques” and “experimental data” were the most frequently identified categories of challenges. The majority of difficulties students perceived in the primary literature corresponded to Bloom’s lower-order cognitive skills. After instruction, “conclusions” were identified as the most difficult aspect of primary literature, and the frequency of challenges that corresponded to higher-order cognitive skills increased significantly among students who reported less experience with primary literature. These changes are consistent with a more competent perception of the primary literature, in which these students increasingly focus on challenges requiring critical thinking. Students’ difficulties identified here can inform the design of instructional approaches aimed to teach students how to critically read scientific papers. PMID:27909027

Online Assessment and Measurement: Foundations and Challenges

ERIC Educational Resources Information Center

Hricko, Mary; Howell, Scott

2006-01-01

Online learning is one of the most important topics in distance learning, but practitioners and researchers have experienced difficulty in defining the process. "Online Assessment and Measurement: Foundations and Challenges" approaches the topic by finding a common ground to properly analyze online assessment and measurement. "Online Assessment…

In-Situ Measurement of Shock-Induced Reactive Flow in a Series of Related Hydrocarbons

NASA Astrophysics Data System (ADS)

Sheffield, S. A.; Dattelbaum, D. M.; Stahl, D. B.

2009-12-01

Understanding of the chemistry that occurs under extreme, high-pressure, high-temperature shock environments poses both a significant scientific challenge, due to the difficulty of direct experimental observations, and an opportunity for discovery of new materials and bonding constructs. The combined high pressure, high temperature conditions induced by shock loading results in prompt reactions that may include dynamic bond breaking, dimerization and polymerization, and dissociation to small molecules. Understanding of the evolution of different reaction pathways as a function of shock input remains a significant challenge, due to both the very short shock timescales, and difficulty in measurement of reaction intermediates and products. We have used in-situ multiple magnetic gauges to measure changes in mechanical variables (such as particle velocity waveforms) resulting from the shock-induced chemistry. This allows us to gain some understanding of the shock input conditions necessary to start chemical reaction. Seven experiments have been completed on a set of related organic liquids; 1-3 cyclohexadiene was found to react at 4.9 GPa, 1-4 cyclohexadiene at 7 GPa, cyclohexene between 10 and 12 GPa, and cyclopentene results were inconclusive. Since 1-3 cyclohexadiene could dimerize by a Diels-Alder reaction, it was expected to react at the lowest pressure.

The Scientific Value and Technical Challenge of Chang'E-4 Landing on the Far-side of the Moon

NASA Astrophysics Data System (ADS)

Li, Fei; Zhang, He; Wu, Xueying; Ma, Jinan; Zhou, Wenyan

2016-07-01

The mission of Chang'E-4 probe is landing on the far-side of the moon for the first time in human history. Compared with the near-side, far-side landing has unique scientific value and more challenging technology implementation. The scientific significance of the exploration of far-side of the moon and the technical difficulties and solution approach of the Chang'E-4 were discussed in this paper. In science, the far-side of the Moon is an ideal scientific platform in that it is shielded from terrestrial radio-frequency interference. The terrane that records the formation of the primordial crust is located largely on the far-side hemisphere, and there is the largest and oldest recognized impact basin in our Solar System, the South Pole-Aitken basin. In technology, the difficulties mainly includes the analysis of the influence of lunar topography of far-side on the landing descent strategy, the study of relay orbit and operating modes for the relay satellite in the Earth-Moon L2(Lagrange point 2), and the requirement analysis of autonomous management due to the relay communication. It will provide the reference for landing exploration of the far-side of the moon.

Quality assurance of herbal raw materials in supply chain: challenges and opportunities.

PubMed

Govindaraghavan, Suresh

2008-01-01

The herbal medicine industry is presently adopting modern scientific tools to substantiate the guarantee of efficacy that, in the past, rested only on anecdotal evidence derived from traditional knowledge systems. This is particularly true for the processes of identification of herbal raw materials adopting modern tools for phytochemical fingerprinting. The successful adaptation of available technologies and practices depends on an understanding of the phytochemical complexity and variability innate in biological material. It challenges the "mainstream medicinal mindset" that "tend(s) to reject …. therapies for which mechanisms of action do not fit within Newtonian, biochemical orientation" (Dumoff, 2003). The herbal medicinal industry is independently evolving its own rigid quality assurance and control systems using Good Manufacturing Practice (GMP) and Good Laboratory Practice (GLP) guidelines, but it faces unique difficulties. These include lack of Good Agricultural and Collection Practice (GACP), lack of transparency in the raw material supply chain so as to preclude the use of unsafe practices, problems in the authentication of herbal raw materials, and a general lack of understanding of the need to reduce phytochemical variability in these materials. This paper explores these difficulties and outlines strategies to overcome them, but these strategies will require coordinated international government regulations to be fully effective.

Issues in Developing and Evaluating a Culturally Tailored Internet Cancer Support Group

PubMed Central

Im, Eun-Ok; Ji, Xiaopeng; Zhang, Jingwen; Kim, Sangmi; Lee, Yaelim; Chee, Eunice; Chee, Wonshik; Tsai, Hsiu-Min; Nishigaki, Masakazu; Yeo, Seon Ae; Schapira, Marilyn; Mao, Jun James

2016-01-01

The purpose of this paper is to explore practical issues in developing and implementing a culturally tailored Internet Cancer Support Group for a group of ethnic minority cancer patients—Asian American cancer patients. Throughout the research process of the original study testing the Internet cancer support group, research team made written records of practical issues and plausible rationales for the issues. Weekly group discussion among research team members was conducted, and the discussion records were evaluated and analyzed using a content analysis (with individual words as the unit of analysis). The codes from the analysis process were categorized into idea themes, through which the issues were extracted. The issues included those in: (a) difficulties in using multiple languages; (b) collaboration with the IT department and technical challenges (c) difficulties in recruitment; (d) difficulties in retention; (e) optimal timing; and (f) characteristics of the users. Based on the findings, we suggested researchers to plan a workable translation process, check technical needs in advance, use multiple strategies to recruit and retain research participants, plan the right time for data collection, and consider characteristics of the users in the study design. PMID:27379523

Current Challenges in Neurotoxicity Risk Assessment ...

EPA Pesticide Factsheets

Neurotoxicity risk assessment must continue to evolve in parallel with advances in basic research. Along with this evolution is an expansion in the scope of neurotoxicity assessments of environmental health risks. Examples of this expansion include an increasing emphasis on complex animal models that better replicate human behavior and a wider array of molecular and mechanistic data relevant to interpreting the underlying cause(s) of toxicity. However, modern neurotoxicology studies are often more nuanced and complicated than traditional studies, and they often vary considerably in evaluation methods from one study to the next, impeding comparisons. This can pose particular difficulties for risk assessors, especially given the recent demand for chemical risk assessments to be more systematic and transparent. This presentation will introduce and provide some examples of specific challenges in neurotoxicity assessments of environmental chemicals. Some of these challenges are relatively new to the field, such as the incorporation of data on neuron-supportive glial cells into hazard characterization, while other challenges have persisted for several decades, but only recently are studies being designed to evaluate them, including analyses of latent neurotoxicity. The examples provided illustrate some future research areas of interest for scientists and risk assessors examining human neurotoxicity risk. This abstract will be presented to internal U.S. Food and Drug A

Psychological research with Muslim Americans in the age of Islamophobia: trends, challenges, and recommendations.

PubMed

Amer, Mona M; Bagasra, Anisah

2013-04-01

Like other minority groups in North America, Muslim Americans have been largely ignored in the psychological literature. The overwhelming pressures faced by this group, including surveillance, hate crimes, and institutional discrimination, stimulate an urgent need for psychologists to better understand and ensure the well-being of this population. This article reviews challenges in conducting research with Muslim Americans in order to offer recommendations for culturally sensitive approaches that can enhance the growth of future scholarship. We first contextualize this endeavor by assessing trends in psychological scholarship pertinent to Muslims in North America over the past two decades. A total of 559 relevant publications were identified through a PsycINFO database search. The 10 years post 9/11 saw a more than 900% increase in the annual number of publications, paralleling a national interest in the Muslim American community subsequent to the World Trade Center attacks. Researchers who conducted these studies faced numerous barriers, including unclear definition of the target sample, unavailability of culturally sensitive measures, sampling difficulties, and obstacles to participant recruitment. To navigate these challenges, we provide a framework for effective research design along the continuum of the research process from study conceptualization to dissemination of results. The challenges and recommendations are illustrated with examples from previous studies.

Model-based nonlinear control of hydraulic servo systems: Challenges, developments and perspectives

NASA Astrophysics Data System (ADS)

Yao, Jianyong

2018-06-01

Hydraulic servo system plays a significant role in industries, and usually acts as a core point in control and power transmission. Although linear theory-based control methods have been well established, advanced controller design methods for hydraulic servo system to achieve high performance is still an unending pursuit along with the development of modern industry. Essential nonlinearity is a unique feature and makes model-based nonlinear control more attractive, due to benefit from prior knowledge of the servo valve controlled hydraulic system. In this paper, a discussion for challenges in model-based nonlinear control, latest developments and brief perspectives of hydraulic servo systems are presented: Modelling uncertainty in hydraulic system is a major challenge, which includes parametric uncertainty and time-varying disturbance; some specific requirements also arise ad hoc difficulties such as nonlinear friction during low velocity tracking, severe disturbance, periodic disturbance, etc.; to handle various challenges, nonlinear solutions including parameter adaptation, nonlinear robust control, state and disturbance observation, backstepping design and so on, are proposed and integrated, theoretical analysis and lots of applications reveal their powerful capability to solve pertinent problems; and at the end, some perspectives and associated research topics (measurement noise, constraints, inner valve dynamics, input nonlinearity, etc.) in nonlinear hydraulic servo control are briefly explored and discussed.

Multiple choice questions can be designed or revised to challenge learners' critical thinking.

PubMed

Tractenberg, Rochelle E; Gushta, Matthew M; Mulroney, Susan E; Weissinger, Peggy A

2013-12-01

Multiple choice (MC) questions from a graduate physiology course were evaluated by cognitive-psychology (but not physiology) experts, and analyzed statistically, in order to test the independence of content expertise and cognitive complexity ratings of MC items. Integration of higher order thinking into MC exams is important, but widely known to be challenging-perhaps especially when content experts must think like novices. Expertise in the domain (content) may actually impede the creation of higher-complexity items. Three cognitive psychology experts independently rated cognitive complexity for 252 multiple-choice physiology items using a six-level cognitive complexity matrix that was synthesized from the literature. Rasch modeling estimated item difficulties. The complexity ratings and difficulty estimates were then analyzed together to determine the relative contributions (and independence) of complexity and difficulty to the likelihood of correct answers on each item. Cognitive complexity was found to be statistically independent of difficulty estimates for 88 % of items. Using the complexity matrix, modifications were identified to increase some item complexities by one level, without affecting the item's difficulty. Cognitive complexity can effectively be rated by non-content experts. The six-level complexity matrix, if applied by faculty peer groups trained in cognitive complexity and without domain-specific expertise, could lead to improvements in the complexity targeted with item writing and revision. Targeting higher order thinking with MC questions can be achieved without changing item difficulties or other test characteristics, but this may be less likely if the content expert is left to assess items within their domain of expertise.

Infant Regulatory Disorders: Temperamental, Physiological, and Behavioral Features

PubMed Central

Dale, Lourdes P.; O‘Hara, Emily A.; Keen, Julie; Porges, Stephen W.

2010-01-01

Successful development during the first year of life is dependent on the infant’s ability to regulate behavioral and physiological state in response to unpredictable environmental challenges. While most infants develop skills to self-soothe and regulate behavior, a subset lacks these skills and develops regulatory disorders (RD). Objectives To evaluate the component features of RD by determining if infants with RD differ from typically developing infants on measures of temperament, respiratory sinus arrhythmia, heart rate, and mother-infant interactions. Methods Parents of 50 9-month old infants completed behavioral questionnaires that provided information necessary to complete the Regulatory Disorders Checklist, which evaluates for difficulties in self-regulation and hypersensitivities. Infants with difficulties in both domains were assigned to the RD group. Mothers and their infants were videotaped interacting for 10 minutes. Infant heart rate was monitored before and during the mental development test. Results The RD group (n=10) was more temperamentally difficult and exhibited atypical physiological regulation relative to infants with difficulties in either self-regulation or hypersensitivity (n=25) or infants with no difficulties (n=15). During the mother-infant interactions, the RD group exhibited more high-level withdrawal behaviors, including verbal and physical protests, although there were no differences in the quantity and quality of the maternal approaches. Conclusion Infants with RD have both temperamental and physiological regulation difficulties, and may be in a physiologically state that makes it difficult to moderate behavior in response to social demands. Mothers of RD infants might be taught to modify their behavior to help their infants regulate behavioral and physiological state. PMID:21057324

Adolescent Development of Value-Guided Goal Pursuit.

PubMed

Davidow, Juliet Y; Insel, Catherine; Somerville, Leah H

2018-06-04

Adolescents are challenged to orchestrate goal-directed actions in increasingly independent and consequential ways. In doing so, it is advantageous to use information about value to select which goals to pursue and how much effort to devote to them. Here, we examine age-related changes in how individuals use value signals to orchestrate goal-directed behavior. Drawing on emerging literature on value-guided cognitive control and reinforcement learning, we demonstrate how value and task difficulty modulate the execution of goal-directed action in complex ways across development from childhood to adulthood. We propose that the scope of value-guided goal pursuit expands with age to include increasingly challenging cognitive demands, and scaffolds on the emergence of functional integration within brain networks supporting valuation, cognition, and action. Copyright © 2018 Elsevier Ltd. All rights reserved.

High-risk Trans-Catheter Aortic Valve Replacement in a Failed Freestyle Valve with Low Coronary Height: A Case Report.

PubMed

Karimi, Ashkan; Pourafshar, Negiin; Dibu, George; Beaver, Thomas M; Bavry, Anthony A

2017-06-01

A 55-year-old male with a history of two prior cardiac surgeries presented with decompensated heart failure due to severe bioprosthetic aortic valve insufficiency. A third operation was viewed prohibitively high risk and valve-in-valve trans-catheter aortic valve replacement was considered. There were however several high-risk features and technically challenging aspects including low coronary ostia height, poor visualization of the aortic sinuses, and difficulty in identification of the coplanar view due to severe aortic insufficiency, and a highly mobile aortic valve mass. After meticulous peri-procedural planning, trans-catheter aortic valve replacement was carried out with a SAPIEN 3 balloon-expandable valve without any complication. Strategies undertaken to navigate the technically challenging aspects of the case are discussed.

Integrated Care for Pediatric Substance Abuse.

PubMed

Barclay, Rebecca P; Hilt, Robert J

2016-10-01

Integrated care is a way to improve the prevention, identification, and treatment of mental health difficulties, including substance abuse, in pediatric care. The pediatrician's access, expertise in typical development, focus on prevention, and alignment with patients and families can allow successful screening, early intervention, and referral to treatment. Successful integrated substance abuse care for youth is challenged by current reimbursement systems, information exchange, and provider role adjustment issues, but these are being addressed as comfort with this care form and resources to support its development grow. Copyright © 2016 Elsevier Inc. All rights reserved.

New developments in the management of speech and language disorders.

PubMed

Harding, Celia; Gourlay, Sara

2008-05-01

Speech and language disorders, which include swallowing difficulties, are usually managed by speech and language therapists. Such a diverse, complex and challenging clinical group of symptoms requires practitioners with detailed knowledge and understanding of research within those areas, as well as the ability to implement appropriate therapy strategies within many environments. These environments range from neonatal units, acute paediatric wards and health centres through to nurseries, schools and children's homes. This paper summarises the key issues that are fundamental to our understanding of this client group.

Generics, Supergenerics and Patent Strategies--SMi's 13th Annual Meeting.

PubMed

Edwards, Catherine

2010-07-01

SMi's 13th Annual Meeting on Generics, Supergenerics and Patent Strategies, held in London, included topics covering new trends in the generics field, the difficulties faced by companies in entering the generics market and recent developments in IP. This conference report highlights selected presentations on generics in India, protecting pharmaceutical products in China, changes in generics law and litigation in the US and Europe, challenges for market selection and entry for generics companies, the influence of changes in the healthcare market on the generics industry, supergenerics, and biosimilars.

Team Resilience as a Second-Order Emergent State: A Theoretical Model and Research Directions

PubMed Central

Bowers, Clint; Kreutzer, Christine; Cannon-Bowers, Janis; Lamb, Jerry

2017-01-01

Resilience has been recognized as an important phenomenon for understanding how individuals overcome difficult situations. However, it is not only individuals who face difficulties; it is not uncommon for teams to experience adversity. When they do, they must be able to overcome these challenges without performance decrements.This manuscript represents a theoretical model that might be helpful in conceptualizing this important construct. Specifically, it describes team resilience as a second-order emergent state. We also include research propositions that follow from the model. PMID:28861013

Understanding the Impact of Brain Disorders: Towards a ‘Horizontal Epidemiology’ of Psychosocial Difficulties and Their Determinants

PubMed Central

Cieza, Alarcos; Anczewska, Marta; Ayuso-Mateos, Jose Luis; Baker, Mary; Bickenbach, Jerome; Chatterji, Somnath; Hartley, Sally; Leonardi, Matilde; Pitkänen, Tuuli

2015-01-01

Objective To test the hypothesis of ‘horizontal epidemiology’, i.e. that psychosocial difficulties (PSDs), such as sleep disturbances, emotional instability and difficulties in personal interactions, and their environmental determinants are experienced in common across neurological and psychiatric disorders, together called brain disorders. Study Design A multi-method study involving systematic literature reviews, content analysis of patient-reported outcomes and outcome instruments, clinical input and a qualitative study was carried out to generate a pool of PSD and environmental determinants relevant for nine different brain disorders, namely epilepsy, migraine, multiple sclerosis, Parkinson’s disease, stroke, dementia, depression, schizophrenia and substance dependency. Information from these sources was harmonized and compiled, and after feedback from external experts, a data collection protocol including PSD and determinants common across these nine disorders was developed. This protocol was implemented as an interview in a cross-sectional study including a convenience sample of persons with one of the nine brain disorders. PSDs endorsed by at least 25% of patients with a brain disorder were considered associated with the disorder. PSD were considered common across disorders if associated to 5 out of the 9 brain disorders and if among the 5 both neurological and psychiatric conditions were represented. Setting The data collection protocol with 64 PSDs and 20 determinants was used to collect data from a convenience sample of 722 persons in four specialized health care facilities in Europe. Results 57 of the PSDs and 16 of the determinants included in the protocol were found to be experienced across brain disorders. Conclusion This is the first evidence that supports the hypothesis of horizontal epidemiology in brain disorders. This result challenges the brain disorder-specific or vertical approach in which clinical and epidemiological research about psychosocial difficulties experienced in daily life is commonly carried in neurology and psychiatry and the way in which the corresponding health care delivery is practiced in many countries of the world. PMID:26352911

Maintaining data integrity in a rural clinical trial.

PubMed

Van den Broeck, Jan; Mackay, Melanie; Mpontshane, Nontobeko; Kany Kany Luabeya, Angelique; Chhagan, Meera; Bennish, Michael L

2007-01-01

Clinical trials conducted in rural resource-poor settings face special challenges in ensuring quality of data collection and handling. The variable nature of these challenges, ways to overcome them, and the resulting data quality are rarely reported in the literature. To provide a detailed example of establishing local data handling capacity for a clinical trial conducted in a rural area, highlight challenges and solutions in establishing such capacity, and to report the data quality obtained by the trial. We provide a descriptive case study of a data system for biological samples and questionnaire data, and the problems encountered during its implementation. To determine the quality of data we analyzed test-retest studies using Kappa statistics of inter- and intra-observer agreement on categorical data. We calculated Technical Errors of Measurement of anthropometric measurements, audit trail analysis was done to assess error correction rates, and residual error rates were calculated by database-to-source document comparison. Initial difficulties included the unavailability of experienced research nurses, programmers and data managers in this rural area and the difficulty of designing new software tools and a complex database while making them error-free. National and international collaboration and external monitoring helped ensure good data handling and implementation of good clinical practice. Data collection, fieldwork supervision and query handling depended on streamlined transport over large distances. The involvement of a community advisory board was helpful in addressing cultural issues and establishing community acceptability of data collection methods. Data accessibility for safety monitoring required special attention. Kappa values and Technical Errors of Measurement showed acceptable values. Residual error rates in key variables were low. The article describes the experience of a single-site trial and does not address challenges particular to multi-site trials. Obtaining and maintaining data integrity in rural clinical trials is feasible, can result in acceptable data quality and can be used to develop capacity in developing country sites. It does, however, involve special challenges and requirements.

The second Sandia Fracture Challenge. Predictions of ductile failure under quasi-static and moderate-rate dynamic loading

DOE PAGES

Boyce, B. L.; Kramer, S. L. B.; Bosiljevac, T. R.; ...

2016-03-14

Ductile failure of structural metals is relevant to a wide range of engineering scenarios. Computational methods are employed to anticipate the critical conditions of failure, yet they sometimes provide inaccurate and misleading predictions. Challenge scenarios, such as the one presented in the current work, provide an opportunity to assess the blind, quantitative predictive ability of simulation methods against a previously unseen failure problem. Instead of evaluating the predictions of a single simulation approach, the Sandia Fracture Challenge relied on numerous volunteer teams with expertise in computational mechanics to apply a broad range of computational methods, numerical algorithms, and constitutive modelsmore » to the challenge. This exercise is intended to evaluate the state of health of technologies available for failure prediction. In the first Sandia Fracture Challenge, a wide range of issues were raised in ductile failure modeling, including a lack of consistency in failure models, the importance of shear calibration data, and difficulties in quantifying the uncertainty of prediction [see Boyce et al. (Int J Fract 186:5–68, 2014) for details of these observations]. This second Sandia Fracture Challenge investigated the ductile rupture of a Ti–6Al–4V sheet under both quasi-static and modest-rate dynamic loading (failure in ~ 0.1 s). Like the previous challenge, the sheet had an unusual arrangement of notches and holes that added geometric complexity and fostered a competition between tensile- and shear-dominated failure modes. The teams were asked to predict the fracture path and quantitative far-field failure metrics such as the peak force and displacement to cause crack initiation. Fourteen teams contributed blind predictions, and the experimental outcomes were quantified in three independent test labs. In addition, shortcomings were revealed in this second challenge such as inconsistency in the application of appropriate boundary conditions, need for a thermomechanical treatment of the heat generation in the dynamic loading condition, and further difficulties in model calibration based on limited real-world engineering data. As with the prior challenge, this work not only documents the ‘state-of-the-art’ in computational failure prediction of ductile tearing scenarios, but also provides a detailed dataset for non-blind assessment of alternative methods.« less

The second Sandia Fracture Challenge. Predictions of ductile failure under quasi-static and moderate-rate dynamic loading

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boyce, B. L.; Kramer, S. L. B.; Bosiljevac, T. R.

Ductile failure of structural metals is relevant to a wide range of engineering scenarios. Computational methods are employed to anticipate the critical conditions of failure, yet they sometimes provide inaccurate and misleading predictions. Challenge scenarios, such as the one presented in the current work, provide an opportunity to assess the blind, quantitative predictive ability of simulation methods against a previously unseen failure problem. Instead of evaluating the predictions of a single simulation approach, the Sandia Fracture Challenge relied on numerous volunteer teams with expertise in computational mechanics to apply a broad range of computational methods, numerical algorithms, and constitutive modelsmore » to the challenge. This exercise is intended to evaluate the state of health of technologies available for failure prediction. In the first Sandia Fracture Challenge, a wide range of issues were raised in ductile failure modeling, including a lack of consistency in failure models, the importance of shear calibration data, and difficulties in quantifying the uncertainty of prediction [see Boyce et al. (Int J Fract 186:5–68, 2014) for details of these observations]. This second Sandia Fracture Challenge investigated the ductile rupture of a Ti–6Al–4V sheet under both quasi-static and modest-rate dynamic loading (failure in ~ 0.1 s). Like the previous challenge, the sheet had an unusual arrangement of notches and holes that added geometric complexity and fostered a competition between tensile- and shear-dominated failure modes. The teams were asked to predict the fracture path and quantitative far-field failure metrics such as the peak force and displacement to cause crack initiation. Fourteen teams contributed blind predictions, and the experimental outcomes were quantified in three independent test labs. In addition, shortcomings were revealed in this second challenge such as inconsistency in the application of appropriate boundary conditions, need for a thermomechanical treatment of the heat generation in the dynamic loading condition, and further difficulties in model calibration based on limited real-world engineering data. As with the prior challenge, this work not only documents the ‘state-of-the-art’ in computational failure prediction of ductile tearing scenarios, but also provides a detailed dataset for non-blind assessment of alternative methods.« less

Challenges in Ocean Data Assimilation for the US West Coast

NASA Astrophysics Data System (ADS)

Li, Z.; Chao, Y.; Farrara, J.; Wang, X.

2006-12-01

A three-dimensional variational data assimilation (3DVAR) system has been developed for the Regional Ocean Modeling System (ROMS), and it is called ROMS-DAS. This system provides a capability of predicting meso- to small-scale variations with temporal scales from hours to days in the coastal oceans. To cope with the particular difficulties that result from complex coastlines and bottom topography, unbalanced flows and sparse observations, ROMS-DAS utilizes several novel strategies. These strategies include the implementation of three-dimensional anisotropic and inhomogeneous error correlations, application of particular weak dynamic constraints, and implementation of efficient and reliable algorithms for minimizing the cost function. The ROMS-DAS system was applied in field experiments for Monterey Bay during both 2003 (Autonomous Ocean Sampling Network - AOSN) and 2006 (MB06). These two experiments included intensive data collection from a variety of observational platforms, including satellites, airplanes, High Frequency radars, Acoustic Doppler Current Profilers, ships, drifters, buoys, autonomous underwater vehicles (AUV), and particularly a fleet of undersea gliders. Using these data sets, various data assimilation experiments were performed to address several major data assimilation challenges that arise from multi-scales structures, inhomogeneous properties, dynamical imbalance of the flow, and tides. Basing on these experiments, a set of strategies were formulated to deal with those challenges.

Mapping Remote and Multidisciplinary Learning Barriers: Lessons from "Challenge-Based Innovation" at CERN

ERIC Educational Resources Information Center

Jensen, Matilde Bisballe; Utriainen, Tuuli Maria; Steinert, Martin

2018-01-01

This paper presents the experienced difficulties of students participating in the multidisciplinary, remote collaborating engineering design course challenge-based innovation at CERN. This is with the aim to identify learning barriers and improve future learning experiences. We statistically analyse the rated differences between distinct design…

Learning and Teaching Traditional Music in Cambodia: Challenges and Incentives

ERIC Educational Resources Information Center

Grant, Catherine

2017-01-01

Substantial efforts have been made since the Khmer Rouge regime to revitalize traditional Cambodian music genres. While they have met with some success, local circumstances still present many difficulties for the transmission of traditional music to the younger generations. This study explores the challenges in learning and teaching traditional…

Promoting Social and Emotional Growth of Students with Disabilities

ERIC Educational Resources Information Center

Darrow, Alice-Ann

2014-01-01

Students with disabilities are often faced with numerous challenges as they progress through their school years. In addition to disability-related challenges, they may encounter additional difficulties such as bullying in school and lack of social acceptance by their peers. It is important that students with disabilities develop competence in…

Anger and Globalization among Young People in India

ERIC Educational Resources Information Center

Suchday, Sonia

2015-01-01

This article addresses the challenges faced by youth in developing countries. Using India as an example of a fast-globalizing country, this article highlights the experience and challenges faced by adolescents and emerging adults as they search for their interpersonal and professional identities. The difficulties of defining identity in the…

Applications of Augmented Reality-Based Natural Interactive Learning in Magnetic Field Instruction

ERIC Educational Resources Information Center

Cai, Su; Chiang, Feng-Kuang; Sun, Yuchen; Lin, Chenglong; Lee, Joey J.

2017-01-01

Educators must address several challenges inherent to the instruction of scientific disciplines such as physics -- expensive or insufficient laboratory equipment, equipment error, difficulty in simulating certain experimental conditions. Augmented reality (AR) can be a promising approach to address these challenges. In this paper, we discuss the…

Challenges Experienced by Japanese Students with Oral Communication Skills in Australian Universities

ERIC Educational Resources Information Center

Yanagi, Miho; Baker, Amanda A.

2016-01-01

Due to ever-increasing demands to acquire effective communicative abilities in the English language, increasing numbers of international students choose to study in Western tertiary institutions; however, they frequently encounter difficulties in performing satisfactorily in English. This study aims to identify specific challenges that Japanese…

Review of Student Difficulties in Upper-Level Quantum Mechanics

ERIC Educational Resources Information Center

Singh, Chandralekha; Marshman, Emily

2015-01-01

Learning advanced physics, in general, is challenging not only due to the increased mathematical sophistication but also because one must continue to build on all of the prior knowledge acquired at the introductory and intermediate levels. In addition, learning quantum mechanics can be especially challenging because the paradigms of classical…

Ineffective Learning Strategies: A Significant Barrier to Post-Secondary Perseverance

ERIC Educational Resources Information Center

Sauvé, Louise; Fortin, Anne; Viger, Chantal; Landry, France

2018-01-01

Study programme withdrawal and student perseverance in post-secondary education are major challenges for post-secondary institutions, especially in view of the increasing difficulty of retaining the student clientele during the first year of university studies. To analyse the challenges students face in terms of learning strategies, we asked…

A Consideration of the Challenges Involved in Supervising International Masters Students

ERIC Educational Resources Information Center

Brown, Lorraine

2007-01-01

This paper explores the challenges facing supervisors of international postgraduate students at the dissertation stage of the masters programme. The central problems of time pressure, language difficulties, a lack of critical analysis and a prevalence of personal problems among international students are discussed. This paper makes recommendations…

A Review of Parenting Programs in Developing Countries: Opportunities and Challenges for Preventing Emotional and Behavioral Difficulties in Children

ERIC Educational Resources Information Center

Mejia, Anilena; Calam, Rachel; Sanders, Matthew R.

2012-01-01

Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited.…

Management, Analysis, and Visualization of Experimental and Observational Data – The Convergence of Data and Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bethel, E. Wes; Greenwald, Martin; Kleese van Dam, Kerstin

Scientific user facilities—particle accelerators, telescopes, colliders, supercomputers, light sources, sequencing facilities, and more—operated by the U.S. Department of Energy (DOE) Office of Science (SC) generate ever increasing volumes of data at unprecedented rates from experiments, observations, and simulations. At the same time there is a growing community of experimentalists that require real-time data analysis feedback, to enable them to steer their complex experimental instruments to optimized scientific outcomes and new discoveries. Recent efforts in DOE-SC have focused on articulating the data-centric challenges and opportunities facing these science communities. Key challenges include difficulties coping with data size, rate, and complexity inmore » the context of both real-time and post-experiment data analysis and interpretation. Solutions will require algorithmic and mathematical advances, as well as hardware and software infrastructures that adequately support data-intensive scientific workloads. This paper presents the summary findings of a workshop held by DOE-SC in September 2015, convened to identify the major challenges and the research that is needed to meet those challenges.« less

Management, Analysis, and Visualization of Experimental and Observational Data -- The Convergence of Data and Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bethel, E. Wes; Greenwald, Martin; Kleese van Dam, Kersten

Scientific user facilities---particle accelerators, telescopes, colliders, supercomputers, light sources, sequencing facilities, and more---operated by the U.S. Department of Energy (DOE) Office of Science (SC) generate ever increasing volumes of data at unprecedented rates from experiments, observations, and simulations. At the same time there is a growing community of experimentalists that require real-time data analysis feedback, to enable them to steer their complex experimental instruments to optimized scientific outcomes and new discoveries. Recent efforts in DOE-SC have focused on articulating the data-centric challenges and opportunities facing these science communities. Key challenges include difficulties coping with data size, rate, and complexity inmore » the context of both real-time and post-experiment data analysis and interpretation. Solutions will require algorithmic and mathematical advances, as well as hardware and software infrastructures that adequately support data-intensive scientific workloads. This paper presents the summary findings of a workshop held by DOE-SC in September 2015, convened to identify the major challenges and the research that is needed to meet those challenges.« less

The Process of Seeking Psychotherapy and Its Impact on Therapy Expectations and Experiences.

PubMed

Elliott, Katherine P; Westmacott, Robin; Hunsley, John; Rumstein-McKean, Orly; Best, Marlene

2015-01-01

Seeking psychotherapy can be conceptualized as having three stages: deciding that therapy might help, deciding to seek therapy and contacting a therapist. The present study examined the duration and difficulty of clients' decisions to seek psychotherapy and whether these experiences were predictive of expected difficulty and commitment to the therapy process. One-hundred and fifty-five adults seeking individual psychological services from a university training clinic were assessed before intake; 107 of these participants also completed measures between the third and fourth therapy sessions and at post-therapy. Deciding that therapy might help was reported to be the most difficult step and took the longest, with each subsequent step becoming easier and briefer. At each step, the more difficult the decision, the more time participants took to make it. Higher distress was associated with more difficulty in deciding that therapy might help and deciding to seek therapy. Duration and difficulty of decisions to seek therapy were positively correlated with expectations of difficulty in therapy as measured prior to treatment and following the third session but were not associated with participants' commitment to therapy. The implications of these results for clinicians and mental health services are discussed. The most difficult and time-consuming step for those who seek mental health services is recognizing that their distressing experiences are connected to mental health; clinicians may aid this challenge by providing information on the nature of mental disorders and common symptoms of emotional distress on websites or through other means (e.g., physicians' waiting rooms and advertising campaigns). The next most difficult and time-consuming step for those who seek mental health services is deciding that psychotherapy may help; by providing easily accessible information (e.g., on websites) about what psychotherapy entails, including clinicians' expectations of clients and the benefits/challenges of therapy, potential clients may be able to progress through this step more rapidly and with less difficulty. Clients' expectations of the value of psychotherapy and their commitment to engage in therapy do not appear to be affected by how long it took, or how difficult it was, to obtain psychotherapy. Factors such as forming a strong therapeutic alliance and providing support and guidance during the initial sessions of therapy may be more important in helping potential clients commit to therapy than what they experienced in their efforts to receive psychotherapy. Copyright © 2014 John Wiley & Sons, Ltd.

Challenges in Identifying and Determining the Impacts of Infection with Pestiviruses on the Herd Health of Free Ranging Cervid Populations

PubMed Central

Ridpath, Julia F.; Neill, John D.

2016-01-01

Although most commonly associated with the infection of domestic livestock, the replication of pestiviruses, in particular the two species of bovine viral diarrhea virus (BVDV), occurs in a wide range of free ranging cervids including white-tailed deer, mule deer, fallow deer, elk, red deer, roe deer, eland and mousedeer. While virus isolation and serologic analyses indicate that pestiviruses are circulating in these populations, little is known regarding their impact. The lack of regular surveillance programs, challenges in sampling wild populations, and scarcity of tests and vaccines compound the difficulties in detecting and controlling pestivirus infections in wild cervids. Improved detection rests upon the development and validation of tests specific for use with cervid samples and development and validation of tests that reliably detect emerging pestiviruses. Estimation of impact of pestivirus infections on herd health will require the integration of several disciplines including epidemiology, cervid natural history, veterinary medicine, pathology and microbiology. PMID:27379051

Immunology of Bats and Their Viruses: Challenges and Opportunities

PubMed Central

Schountz, Tony

2014-01-01

Bats are reservoir hosts of several high-impact viruses that cause significant human diseases, including Nipah virus, Marburg virus and rabies virus. They also harbor many other viruses that are thought to have caused disease in humans after spillover into intermediate hosts, including SARS and MERS coronaviruses. As is usual with reservoir hosts, these viruses apparently cause little or no pathology in bats. Despite the importance of bats as reservoir hosts of zoonotic and potentially zoonotic agents, virtually nothing is known about the host/virus relationships; principally because few colonies of bats are available for experimental infections, a lack of reagents, methods and expertise for studying bat antiviral responses and immunology, and the difficulty of conducting meaningful field work. These challenges can be addressed, in part, with new technologies that are species-independent that can provide insight into the interactions of bats and viruses, which should clarify how the viruses persist in nature, and what risk factors might facilitate transmission to humans and livestock. PMID:25494448

Immunology of bats and their viruses: challenges and opportunities.

PubMed

Schountz, Tony

2014-12-01

Bats are reservoir hosts of several high-impact viruses that cause significant human diseases, including Nipah virus, Marburg virus and rabies virus. They also harbor many other viruses that are thought to have caused disease in humans after spillover into intermediate hosts, including SARS and MERS coronaviruses. As is usual with reservoir hosts, these viruses apparently cause little or no pathology in bats. Despite the importance of bats as reservoir hosts of zoonotic and potentially zoonotic agents, virtually nothing is known about the host/virus relationships; principally because few colonies of bats are available for experimental infections, a lack of reagents, methods and expertise for studying bat antiviral responses and immunology, and the difficulty of conducting meaningful field work. These challenges can be addressed, in part, with new technologies that are species-independent that can provide insight into the interactions of bats and viruses, which should clarify how the viruses persist in nature, and what risk factors might facilitate transmission to humans and livestock.

Methodological challenges in evaluating the effectiveness of women's crisis houses compared with psychiatric wards: findings from a pilot patient preference RCT.

PubMed

Howard, Louise M; Leese, Morven; Byford, Sarah; Killaspy, Helen; Cole, Laura; Lawlor, Caroline; Johnson, Sonia

2009-10-01

There are several methodological difficulties to address when evaluating acute psychiatric services. This study explored potential methods in evaluating the effectiveness of women's crisis houses compared with psychiatric wards in a pilot patient preference randomized controlled trial. Women requiring voluntary admission to a psychiatric hospital or women's crisis house were asked to enter this pilot and different options for recruitment were explored, including different recruitment sites in the pathway to admission and methods for including women without capacity. Forty-one percent (n = 42) of women entering the study agreed to be randomized and 59% (n = 61) entered patient preference arms. Only 7% of women were recruited before admission and 1 woman without capacity entered the study, despite procedures to facilitate this. Recruitment of patients with acute psychiatric crises is therefore challenging; researchers evaluating acute services should establish a consensus on how ethically and practically to recruit patients in this setting.

Making Time for Dissertation Grants

PubMed Central

Hasche, Leslie K.; Perron, Brian E.; Proctor, Enola K.

2013-01-01

Grant writing is a necessary skill for becoming an independent and successful social work researcher. Since social work dissertation grants are a relatively new trend, students face many challenges in identifying, preparing, and submitting dissertation grants. Lack of resources and experiences, difficulties in protecting time for grant writing, and the uncertainty of success can hinder work on dissertation grants. Thus, this article provides an overview of dissertation grants, including a review of grant mechanisms, suggestions for preparing grants in the context of program milestones, and identifying institutional infrastructure to facilitate submissions. Strategies discussed include how to learn about funding priorities, how to establish timelines to account for grant deadlines, and how to use peer reviews to guide the revision process. PMID:24244078

Engaging health professionals in advocacy against gun violence.

PubMed

Pinto, Andrew D

2008-01-01

Health professionals have long been involved with advocacy around the social determinants of health, including protesting against war and mitigating the production, trade and use of specific weapon systems. Small arms and light weapons are a key area on which to focus, as they are responsible for the majority of injuries and deaths in war and their availability is related to increased levels of crime and suicide. Challenges for health professionals hoping to engage in such advocacy include a lack of adequate data, the need to confront political questions and the gun-lobby, and difficulty in measuring the effectiveness of campaigns. This article discusses some examples of successful advocacy and suggests future directions for health professionals in this area.

Gertrude Scharff-Goldhaber, 1911-1998: Nuclear Physicist Against the Odds

NASA Astrophysics Data System (ADS)

Goldhaber, Michael H.

2016-08-01

The author's mother, Gertrude Scharff-Goldhaber, was a prominent nuclear physicist who had to overcome steep odds to pursue her work. She lived and worked at a time when it was very uncommon for any woman to be a scientist and even more uncommon for a mother of young children. She also faced Nazi persecution and a series of other challenges in growing up in Germany. Drawing on personal conversations and testimony of her friends, this brief account includes a number of intimate details to illustrate some of the difficulties she faced and the zest for life and for understanding the world that pushed her forward anyway. Details of her work and a bibliography are included.

Ethically sustainable governance in the biobanking of eggs and embryos for research.

PubMed

Stroud, Karla; O'Doherty, Kieran C

2015-12-01

Biobanking of human tissues is associated with a range of ethical, legal, and social (ELS) challenges. These include difficulties in operationalising informed consent protocols, protecting donors' privacy, managing the return of incidental findings, conceptualising ownership of tissues, and benefit sharing. Though largely unresolved, these challenges are well documented and debated in academic literature. One common response to the ELS challenges of biobanks is a call for strong and independent governance of biobanks. Theorists who argue along these lines suggest that since fully informed consent to a single research project is often not feasible, research participants should be given the additional protection of being allowed to consent to the governance framework of the biobank. Such governance therefore needs to be transparent and ethically sustainable. In this paper we review the governance challenges of establishing and maintaining human tissue biobanks. We then discuss how the creation of a biobank for eggs and embryos, in particular, may introduce additional or unique challenges beyond those presented by the biobanking of other human tissues. Following previous work on biobank governance, we argue that ethically sustainable governance needs to be participatory, adaptive, and trustworthy.

Challenges to the development of complex virtual reality surgical simulations.

PubMed

Seymour, N E; Røtnes, J S

2006-11-01

Virtual reality simulation in surgical training has become more widely used and intensely investigated in an effort to develop safer, more efficient, measurable training processes. The development of virtual reality simulation of surgical procedures has begun, but well-described technical obstacles must be overcome to permit varied training in a clinically realistic computer-generated environment. These challenges include development of realistic surgical interfaces and physical objects within the computer-generated environment, modeling of realistic interactions between objects, rendering of the surgical field, and development of signal processing for complex events associated with surgery. Of these, the realistic modeling of tissue objects that are fully responsive to surgical manipulations is the most challenging. Threats to early success include relatively limited resources for development and procurement, as well as smaller potential for return on investment than in other simulation industries that face similar problems. Despite these difficulties, steady progress continues to be made in these areas. If executed properly, virtual reality offers inherent advantages over other training systems in creating a realistic surgical environment and facilitating measurement of surgeon performance. Once developed, complex new virtual reality training devices must be validated for their usefulness in formative training and assessment of skill to be established.

Verification Challenges at Low Numbers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benz, Jacob M.; Booker, Paul M.; McDonald, Benjamin S.

2013-07-16

This paper will explore the difficulties of deep reductions by examining the technical verification challenges. At each step on the road to low numbers, the verification required to ensure compliance of all parties will increase significantly. Looking post New START, the next step will likely include warhead limits in the neighborhood of 1000 (Pifer 2010). Further reductions will include stepping stones at 100’s of warheads, and then 10’s of warheads before final elimination could be considered of the last few remaining warheads and weapons. This paper will focus on these three threshold reduction levels, 1000, 100’s, 10’s. For each, themore » issues and challenges will be discussed, potential solutions will be identified, and the verification technologies and chain of custody measures that address these solutions will be surveyed. It is important to note that many of the issues that need to be addressed have no current solution. In these cases, the paper will explore new or novel technologies that could be applied. These technologies will draw from the research and development that is ongoing throughout the national lab complex, and will look at technologies utilized in other areas of industry for their application to arms control verification.« less

Accountability Studies on Air Pollution and Health: the HEI Experience.

PubMed

Boogaard, Hanna; van Erp, Annemoon M; Walker, Katherine D; Shaikh, Rashid

2017-12-01

Assessing health effects of air quality interventions is of ever-increasing interest. Given the prominent role Health Effects Institute (HEI) has played in accountability research, this review focuses on HEI's recent experiences, the challenges it has encountered, and provides possible directions for future research. Most accountability studies to date have focused on effects of relatively short-term, local-scale, and sometimes temporary interventions. Only a few recent accountability studies have sought to investigate large-scale, multiyear regulatory programs. Common challenges encountered include lack of statistical power, how to account appropriately for background trends in air quality and health, and difficulties in direct attribution of changes in air pollution and health to a single intervention among many regulatory actions. New methods have been developed for accountability research that has shown promise addressing some of those challenges, including use of causal inference methods. These and other approaches that would enhance the attribution of changes in air quality and health directly to an intervention should continue to be further explored. In addition, integration of social and behavioral sciences in accountability research is warranted, and climate related co-benefits and dis-benefits may be considered.

Becoming a nurse faculty leader: facing challenges through reflecting, persevering and relating in new ways.

PubMed

Horton-Deutsch, Sara; Young, Patricia K; Nelson, Kristine A

2010-05-01

The aim of the present study was to explore the experience of becoming a nurse faculty leader. In a recent interpretation of 23 interviews conducted with nurse faculty leaders from across the United States about their experiences of becoming a leader three themes were identified: being thrust into leadership, taking risks and facing challenges. This interpretive phenomenological study further explicates three aspects of how nurse educators faced challenges in becoming and serving as a leader. Facing challenges meant reflecting, persevering through difficulties and learning to relate to others in new ways. Exemplars of participant experiences are provided for concreteness, to assist readers in determining how findings resonate with their own experience and how they can actualize this resonance in their own leadership practice. In the present study, reflecting, persevering through difficulties and learning to relate with others in a new way was how leaders faced challenges. Leadership development opportunities that facilitate self-exploration, caring and thoughtful interactions with others and values clarification serve as the foundation for becoming a nurse faculty leader who is, in turn, able to build leadership capacity in other individuals and organizations.

Factors Influencing Provision of Play and Learning Materials among Children with Physical Challenges. A Case Study of Joytown Special School, Kiambu County

ERIC Educational Resources Information Center

Muthoni, Kamau Joyce

2016-01-01

In Kenya there is still a high population of children either born with or who develop physical challenges. These children are often neglected and most do not join school at the expected age. In joining school they encounter several difficulties in their play and learning activities. These children with physical challenges have developmental needs…

Development of the Multiple Use Plug Hybrid for Nanosats (MUPHyN) miniature thruster

NASA Astrophysics Data System (ADS)

Eilers, Shannon

The Multiple Use Plug Hybrid for Nanosats (MUPHyN) prototype thruster incorporates solutions to several major challenges that have traditionally limited the deployment of chemical propulsion systems on small spacecraft. The MUPHyN thruster offers several features that are uniquely suited for small satellite applications. These features include 1) a non-explosive ignition system, 2) non-mechanical thrust vectoring using secondary fluid injection on an aerospike nozzle cooled with the oxidizer flow, 3) a non-toxic, chemically-stable combination of liquid and inert solid propellants, 4) a compact form factor enabled by the direct digital manufacture of the inert solid fuel grain. Hybrid rocket motors provide significant safety and reliability advantages over both solid composite and liquid propulsion systems; however, hybrid motors have found only limited use on operational vehicles due to 1) difficulty in modeling the fuel flow rate 2) poor volumetric efficiency and/or form factor 3) significantly lower fuel flow rates than solid rocket motors 4) difficulty in obtaining high combustion efficiencies. The features of the MUPHyN thruster are designed to offset and/or overcome these shortcomings. The MUPHyN motor design represents a convergence of technologies, including hybrid rocket regression rate modeling, aerospike secondary injection thrust vectoring, multiphase injector modeling, non-pyrotechnic ignition, and nitrous oxide regenerative cooling that address the traditional challenges that limit the use of hybrid rocket motors and aerospike nozzles. This synthesis of technologies is unique to the MUPHyN thruster design and no comparable work has been published in the open literature.

Challenges associated with recruiting multigenerational, multicultural families into a randomised controlled trial: Balancing feasibility with validity.

PubMed

Hughes, Donna; Hutchinson, Amanda; Prichard, Ivanka; Chapman, Janine; Wilson, Carlene

2015-07-01

Recruitment of participants into research studies has become an increasingly difficult task with justifiable criticisms of representativeness of samples. The difficulties of recruitment are exacerbated when the study is longitudinal, requires multiple members from one family and incorporates people from non-dominant ethnic backgrounds. This paper describes a complex trial's recruitment process. Family groups were required for a longitudinal randomised controlled trial investigating links between health and dietary behaviours with an aim to improve primary prevention health messages and initiatives. To be representative of the multi-ethnic composition of the South Australian population, families from three of South Australia's largest ethnic backgrounds were invited to participate. Of these, only families with participating members spanning three generations were enrolled, so that links between health and lifestyle behaviours with possible generational ties could be investigated. Immense difficulties were faced during recruitment and significant modifications to the initial recruitment plan were necessary to enable the enrolment of 96 families. Challenges faced included lack of response to recruitment materials displaying complex eligibility criteria and different response outcomes from different communities. Solutions implemented included simplifying materials and tailoring recruitment activities to specific communities' needs. This trial's recruitment journey will be used as a case study to highlight the practicalities of recruiting for complex trials. Recommendations will be provided for future researchers seeking to recruit multigenerational, multi-ethnic families into the same study, along with issues to consider regarding the implications of the recruitment journey on the integrity of a complex trial and the potential threats to internal validity. Copyright © 2015 Elsevier Inc. All rights reserved.

Alternative Strategies for Exploring Mars and the Moons of Mars

NASA Technical Reports Server (NTRS)

Drake, Bret G.; Baker, John D.; Hoffman, Stephen J.; Landau, Damon; Voels, Stephen A.

2012-01-01

The possible human exploration of Mars represents one of civilization s next major challenges and is an enterprise that would confirm the potential of humans to leave our home planet system and make our way outward into the cosmos. As exploration endeavors begin to set sights beyond low Earth orbit, potential exploration of the surface of Mars continues to serve as the horizon destination to help focus technology development and research efforts. Recent thoughts on exploration follow a flexible path approach beginning with missions that do not extend down into planetary gravity wells including surface exploration. Consistent with that flexible path strategy is the notion of exploring the moons of Mars, namely Phobos and Deimos, prior to exploring the surface. The premise behind this thought is that exploring Mars moons would be less costly and risky since these missions would avoid the difficulties associated with landing on the surface and subsequent ascent back to orbit. A complete assessment of this strategy has not been performed in the context of the flexible path approach and is needed to clearly understand all of the advantages and disadvantages. This paper examines the strategic implications of possible human exploration of the moons of Mars as a potential prelude to surface exploration. Various operational concepts for Phobos and Deimos exploration that include the infusion of different propulsion technologies are assessed in terms of mission duration, technologies required, overall risk and difficulty, and operational construct. Finally, the strategic implications of each concept are assessed to determine the overall key challenges and strategic links to other key flexible path destinations.

Alternative Strategies for Exploring Mars and the Moons of Mars

NASA Technical Reports Server (NTRS)

Drake, Bret G.; Baker, John D.; Hoffman, Stephen J.; Landau, Damon; Voels, Stephen A.

2012-01-01

The human exploration of Mars represents one of civilizations next major challenges and is an enterprise that would confirm the potential of humans to leave our home planet system and make our way outward into the cosmos. As exploration endeavors begin to set sights beyond low-Earth orbit, exploration of the surface of Mars continues to serve as the horizon destination to help focus technology development and research efforts. Recent thoughts on exploration follow a flexible path approach beginning with missions which do not extend down into planetary gravity wells including surface exploration. Consistent with that flexible path strategy is the notion of exploring the moons of Mars, namely Phobos and Deimos, prior to exploring the surface. The premise behind this thought is that exploring Mars moons would be less costly and risky since these missions would avoid the difficulties associated with landing on the surface and subsequent ascent back to orbit. A complete assessment of this strategy has not been performed in the context of the flexible path approach and is needed to clearly understand all of the advantages and disadvantages. This paper examines the strategic implications of human exploration of the moons of Mars as a potential prelude to surface exploration. Various operational concepts for Phobos and Deimos exploration that include the infusion of different propulsion technologies are assessed in terms of mission duration, technologies required, overall risk and difficulty, and operational construct. Finally, the strategic implications of each concept are assessed to determine the overall key challenges and strategic links to other key flexible path destinations.

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review.

PubMed

Rade, Donna Angelina; Crawford, Gemma; Lobo, Roanna; Gray, Corie; Brown, Graham

2018-06-22

The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.

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.

A Framework for Understanding the Patterns of Student Difficulties in Quantum Mechanics

NASA Astrophysics Data System (ADS)

Singh, Chandralekha

2015-04-01

Compared with introductory physics, relatively little is known about the development of expertise in advanced physics courses, especially in the case of quantum mechanics. We describe a theoretical framework for understanding the patterns of student reasoning difficulties and how students develop expertise in quantum mechanics. The framework posits that the challenges many students face in developing expertise in quantum mechanics are analogous to the challenges introductory students face in developing expertise in introductory classical mechanics. This framework incorporates the effects of diversity in students' prior preparation, goals and motivation for taking upper-level physics courses in general as well as the ``paradigm shift'' from classical mechanics to quantum mechanics. The framework is based on empirical investigations demonstrating that the patterns of reasoning, problem-solving, and self-monitoring difficulties in quantum mechanics bear a striking resemblance to those found in introductory classical mechanics. Examples from research in quantum mechanics and introductory classical mechanics will be discussed to illustrate how the patterns of difficulties are analogous as students learn to unpack the respective principles and grasp the formalism in each knowledge domain during the development of expertise. Embracing such a theoretical framework and contemplating the parallels between the difficulties in these two knowledge domains can enable researchers to leverage the extensive literature for introductory physics education research to guide the design of teaching and learning tools for helping students develop expertise in quantum mechanics. Support from the National Science Foundation is gratefully acknowledged.

Teaching Thinking Skills in Context-Based Learning: Teachers' Challenges and Assessment Knowledge

NASA Astrophysics Data System (ADS)

Avargil, Shirly; Herscovitz, Orit; Dori, Yehudit Judy

2012-04-01

For an educational reform to succeed, teachers need to adjust their perceptions to the reform's new curricula and strategies and cope with new content, as well as new teaching and assessment strategies. Developing students' scientific literacy through context-based chemistry and higher order thinking skills was the framework for establishing a new chemistry curriculum for Israeli high school students. As part of this endeavor, we developed the Taste of Chemistry module, which focuses on context-based chemistry, chemical understanding, and higher order thinking skills. Our research objectives were (a) to identify the challenges and difficulties chemistry teachers faced, as well as the advantages they found, while teaching and assessing the Taste of Chemistry module; and (b) to investigate how they coped with teaching and assessing thinking skills that include analyzing data from graphs and tables, transferring between multiple representations and, transferring between chemistry understanding levels. Research participants included eight teachers who taught the module. Research tools included interviews, classroom observations, teachers-designed students' assignments, and developers-designed students' assignments. We documented different challenges teachers had faced while teaching the module and found that the teachers developed different ways of coping with these challenges. Developing teachers' assessment knowledge (AK) was found to be the highest stage in teachers' professional growth, building on teachers' content knowledge (CK), pedagogy knowledge (PK), and pedagogical-content knowledge (PCK). We propose the use of assignments designed by teachers as an instrument for determining their professional growth.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

PubMed

Cresswell, Kathrin M; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W; Sheikh, Aziz

2013-01-01

There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs". Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Operational challenges in delivering CD4 diagnostics in sub-Saharan Africa.

PubMed

Thairu, L; Katzenstein, D; Israelski, D

2011-07-01

Access to reliable and low cost CD4 T-cell enumeration to stage illness and monitor anti-retroviral therapy remains elusive in resource-limited settings. We report challenges in delivering CD4 testing using the microcapillary Fluorescence-Activated Cell Sorter (FACS) methodology (Guava EasyCD4 instrument Guava Technologies, Hayward) in Burkina Faso and Zimbabwe. Resources, instruments, reagents, and training were provided to local laboratories within the existing infrastructure and data on CD4 were collected from routine laboratory testing. Challenges encountered included frequent instrument breakdown; poor manufacturer maintenance; difficulties in managing reagent stocks; high technician turnover; reliance on antiquated data management systems; redundant service provision; and lack of repeat testing in male HIV+ patients and in patients with higher CD4 counts after initial staging. While adopting newer, less expensive technologies such as fluorescent platforms and point of care tests can facilitate access to lower cost CD4 testing, our experience suggests that supply chain, corporate commitment to implementation, and community factors also require consideration.

Autism in Brazil: a systematic review of family challenges and coping strategies.

PubMed

Gomes, Paulyane T M; Lima, Leonardo H L; Bueno, Mayza K G; Araújo, Liubiana A; Souza, Nathan M

2015-01-01

To describe the challenges faced by families caring for children with autism spectrum disorder (ASD) in Brazil and the coping strategies employed. Systematic review of articles published until September of 2013, without language restrictions, using quality appraisal (AMSTAR and CASP/Oxford instruments). The literature shows parental emotional overload as one of the main challenges faced by families, especially mothers. The main stressors were diagnostic postponement, difficulty dealing with the diagnosis and associated symptoms, and poor access to health services and social support. The predominant coping strategies found included information exchange between affected families and integrated healthcare network for patient and family support. ASD exerts strong influence on family dynamics, resulting in caregiver overload, especially in mothers. The Brazilian Unified Health System needs to provide comprehensive, continuous, and coordinated care to strengthen the patient-family dyad and promote the full development and societal inclusion of children with ASD. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Brain Metastasis: Unique Challenges and Open Opportunities

PubMed Central

Lowery, Frank J.; Yu, Dihua

2016-01-01

The metastasis of cancer to the central nervous system (CNS) remains a devastating clinical reality, carrying an estimated survival time of less than one year in spite of recent therapeutic breakthroughs for other disease contexts. Advances in brain metastasis research are hindered by a number of reasons, including its complicated nature and the difficulty of modeling metastatic cancer growth in the unique brain microenvironment. In this review, we will discuss the clinical challenge, and compare the values and limitations of the available models for brain metastasis research. Additionally, we will specifically address current knowledge on how brain metastases take advantage of the unique brain environment to benefit their own growth. Finally, we will explore the distinctive metabolic and nutrient characteristics of the brain; how these paradoxically represent barriers to establishment of brain metastasis, but also provide ample supplies for metastatic cells’ growth in the brain. We envision that multi-disciplinary innovative approaches will open opportunities for the field to make breakthroughs in tackling unique challenges of brain metastasis. PMID:27939792

The Twin Epidemics of Tuberculosis and HIV.

PubMed

Varghese, George M; Janardhanan, Jeshina; Ralph, Ravikar; Abraham, Ooriapadickal C

2013-02-01

The deadly combination of tuberculosis (TB) and human immunodeficiency virus (HIV) currently ravaging the world, taking a toll of about 0.35 million people every year, is one of the major public health crises of the decade. Throughout the course of HIV infection, the risk of acquisition, reactivation, and reinfection of TB keeps increasing substantially as the immune deficiency progresses. TB coinfected patients inadvertently facilitate HIV infection by release of the proinflammatory cytokines and overexpression of coreceptors CXCR4 and CCR5; thereby, the progression of each is facilitated. The difficulties in diagnosing active tuberculosis in HIV-infected individuals poses a great challenge that is further complicated by the challenges in identification of latent TB infection, creating a setback to preventive therapy. Furthermore, prescribing antituberculous therapy and antiretroviral therapy together poses several management challenges, including drug interactions, added toxicities, and TB immune reconstitution inflammatory syndrome. The current approach to diagnosis, prevention, and treatment strategies in TB and HIV coinfected individuals, along with epidemiology and overview of pathogenetic interplay of both microbes, is reviewed here.

Attentional Focus Effects as a Function of Task Difficulty

ERIC Educational Resources Information Center

Wulf, Gabriele; Tollner, Thomas; Shea, Charles H.

2007-01-01

The purpose of the present study was to examine whether the advantages of adopting an external focus would be seen primarily for relatively challenging (postural stability) tasks but not less demanding tasks. To examine this, the authors used balance tasks that imposed increased challenges to maintaining stability. The present results support the…

The Teacher Residency: A Practical Path to Recruitment and Retention

ERIC Educational Resources Information Center

Guha, Roneeta; Hyler, Maria E.; Darling-Hammond, Linda

2017-01-01

Recruitment and retention challenges are once again leading to teacher shortages across the nation. Especially in urban and rural school districts, low salaries and poor working conditions often contribute to the difficulties of recruiting and keeping teachers, as can the challenges of the work itself. As a consequence, in many schools--especially…

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…

Evaluation of a Flipped, Large-Enrollment Organic Chemistry Course on Student Attitude and Achievement

ERIC Educational Resources Information Center

Mooring, Suazette R.; Mitchell, Chloe E.; Burrows, Nikita L.

2016-01-01

Organic Chemistry is recognized as a course that presents many difficulties and conceptual challenges for students. To combat the high failure rates and poor student attitudes associated with this challenging course, we implemented a "flipped" model for the first-semester, large-enrollment, Organic Chemistry course. In this flipped…

Re-Thinking Support: The Hidden School-to-Work Challenges for Individuals with Special Needs

ERIC Educational Resources Information Center

Nag, Sonali

2011-01-01

This paper examines the hidden challenges experienced by individuals with special needs during the transition years between school and work. An assessment framework is proposed that covers domains of difficulties, developmental tasks during the transition years, the matrix of support within the home-community-institutions ecosystems, and the…

Challenges in Transdisciplinary, Integrated Projects: Reflections on the Case of Faculty Members' Failure to Collaborate

ERIC Educational Resources Information Center

Vanasupa, Linda; McCormick, Kathryn E.; Stefanco, Carolyn J.; Herter, Roberta J.; McDonald, Margot

2012-01-01

In this article we describe the challenges of transdisciplinary teamwork involving four faculty members from dissimilar epistemological traditions in the process of developing a manuscript on the lessons learned in our teaching collaboration. Our difficulty originated in implicit mental models and assumptions that caused incongruence between our…

Creating Access to Opportunities for Youth in Transition from Foster Care. An AYPF Policy Brief

ERIC Educational Resources Information Center

Russ, Erin; Fryar, Garet

2014-01-01

What happens to youth in foster care when they turn 18? Many face unprecedented challenges like homelessness, lack of financial resources, difficulty accessing educational opportunities, and unemployment. In this issue brief, The American Youth Policy Forum (AYPF) document these challenges and opportunities in three distinct yet overlapping areas…

Family Connections: Visual Supports for Promoting Social Skills in Young Children--A Family Perspective

ERIC Educational Resources Information Center

Moody, Amelia K.

2012-01-01

Family members of children with autism spectrum disorders (ASDs) often face social, emotional, and behavioral challenges in the home. Difficulty communicating with family members, forming relationships with friends, and responding appropriately to others can cause significant challenges in the home (Diagnostic and Statistical Manual of Mental…

Early Childhood Educators and Children with Challenging Behaviors: Implications for Teacher Preparation and Training Programs

ERIC Educational Resources Information Center

Reynolds, Holly Kirkland

2017-01-01

Purpose: The purpose of this study was to determine what beliefs, knowledge, skills, and early childhood education teachers should acquire to effectively teach and work with children who exhibit challenging behaviors. A significant body of literature demonstrates a connection between behavioral difficulties for children and negative academic,…

A Proactive and Responsive Bio-Psychosocial Approach to Managing Challenging Behaviour in Mainstream Primary Classrooms

ERIC Educational Resources Information Center

Madden, Lorraine O. B.; Senior, Joyce

2018-01-01

Research in the area of social, emotional and behavioural difficulties, and teacher's struggle to respond to challenging behaviour in mainstream classrooms, has consistently highlighted the need for proventative and responsive approaches within a continuum of support. This study aims to, firstly, investigate what proactive and reactive strategies…

Tough Teens: The Methodological Challenges of Interviewing Teenagers as Research Participants

ERIC Educational Resources Information Center

Bassett, Raewyn; Beagan, Brenda L.; Ristovski-Slijepcevic, Svetlana; Chapman, Gwen E.

2008-01-01

Encouraging a teenager to have a conversation in a semistructured research interview is fraught with difficulties. The authors discuss the methodological challenges encountered when interviewing adolescents of European Canadian, African Canadian, and Punjabi Canadian families who took part in the Family Food Decision-Making Study in two regions of…

Identifying the Challenging Factors in the Transition from Colleges of Engineering to Employment

ERIC Educational Resources Information Center

Baytiyeh, Hoda; Naja, Mohamad

2012-01-01

The transition from university to a career in engineering is a challenging process. This study examined the perceptions of engineering graduates regarding the difficulties they encountered in their transition from the university to the workplace. Lebanese practising engineers (n=217), living around the world, were surveyed to identify their…

Executive Leadership: Another Lever in the System?

ERIC Educational Resources Information Center

Harris, Alma; Brown, David; Abbott, Ian

2006-01-01

The leadership challenges facing most head teachers can at times be daunting but for those leading schools in difficulty, the challenges are acute. This article draws upon the personal experience of an executive leader in a school facing difficult circumstances. It will firstly, outline and analyse this model of leadership and secondly, look at…

Vocational Education and Training in India: Challenges, Status and Labour Market Outcomes

ERIC Educational Resources Information Center

Agrawal, Tushar

2012-01-01

This paper provides an overview of vocational education and training (VET) system in India, and discusses various challenges and difficulties in the Indian VET system. The paper also examines labour market outcomes of vocational graduates and compares these with those of general secondary graduates using a large-scale nationally representative…

Artists, Creativity and Knowledge: A Challenge for Doctoral Change

ERIC Educational Resources Information Center

Phillips, Maggi

2009-01-01

This paper aims to extrapolate the difficulties and challenges posed by ideas about creativity principally in the context of doctoral theses in which the practices of dance play a prominent, if not, pivotal role. While resisting definitive transparency, creativity is a crucial marker as much for postgraduate scholars as it is for artists. The…

Captions and Reduced Forms Instruction: The Impact on EFL Students' Listening Comprehension

ERIC Educational Resources Information Center

Yang, Jie Chi; Chang, Peichin

2014-01-01

For many EFL learners, listening poses a grave challenge. The difficulty in segmenting a stream of speech and limited capacity in short-term memory are common weaknesses for language learners. Specifically, reduced forms, which frequently appear in authentic informal conversations, compound the challenges in listening comprehension. Numerous…

Conducting health survey research in a deep rural South African community: challenges and adaptive strategies.

PubMed

Casale, Marisa; Lane, Tyler; Sello, Lebo; Kuo, Caroline; Cluver, Lucie

2013-04-24

In many parts of the developing world, rural health requires focused policy attention, informed by reliable, representative health data. Yet there is surprisingly little published material to guide health researchers who face the unique set of hurdles associated with conducting field research in remote rural areas. In this paper we provide a detailed description of the key challenges encountered during health survey field research carried out in 2010 in a deep rural site in KwaZulu-Natal, South Africa. The aim of the field research was to collect data on the health of children aged 10 to 17 years old, and their primary adult caregivers, as part of a larger national health survey; the research was a collaboration between several South African and foreign universities, South African national government departments, and various NGO partners. In presenting each of the four fieldwork challenges encountered on this site, we describe the initial planning decisions made, the difficulties faced when implementing these in the field, and the adaptive strategies we used to respond to these challenges. We reflect on learnings of potential relevance for the research community. Our four key fieldwork challenges were scarce research capacity, staff relocation tensions, logistical constraints, and difficulties related to community buy-in. Addressing each of these obstacles required timely assessment of the situation and adaptation of field plans, in collaboration with our local NGO partner. Adaptive strategies included a greater use of local knowledge; the adoption of tribal authority boundaries as the smallest geopolitical units for sampling; a creative developmental approach to capacity building; and planned, on-going engagement with multiple community representatives. We argue that in order to maintain high scientific standards of research and manage to 'get the job done' on the ground, it is necessary to respond to fieldwork challenges that arise as a cohesive team, with timely, locally-relevant, and often creative, solutions. Budgeting sufficient time and project resources for capacity building and community buy-in processes is also essential when working in remote communities unaccustomed to research. Documenting and sharing field experiences can provide valuable information for other researchers planning to conduct fieldwork in similar contexts.

Use of active video gaming in children with neuromotor dysfunction: a systematic review.

PubMed

Hickman, Robbin; Popescu, Lisa; Manzanares, Robert; Morris, Brendan; Lee, Szu-Ping; Dufek, Janet S

2017-09-01

To examine current evidence on use of active video gaming (AVG) to improve motor function in children with movement disorders including cerebral palsy, developmental coordination disorder, and Down syndrome. Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL were searched. Included papers studied the use of AVG for improving movement-related outcomes in these populations. Parameters studied included health condition, strength of evidence, AVG delivery methods, capacity for individualizing play, outcomes addressed, effectiveness for achieving outcomes, and challenges/limitations. The 20 extracted articles varied in quality. Studies involved children with six different conditions using AVG in clinical, home, or school settings for 49 different motor outcomes. Dosage varied in frequency and duration. Choice of games played and difficulty level were therapist determined (n=6) or child controlled (n=14). The most common study limitations were small sample sizes and difficulty individualizing treatment. All articles showed improvement in outcomes with AVG, although differences were not consistently significant compared with conventional therapy. Heterogeneity of measurement tools and target outcomes prevented meta-analysis or development of formal recommendations. However, AVG is feasible and shows potential for improving outcomes in this population. Additional investigations of dosing variables, utility as a home supplement to clinical care, and outcomes with larger sample sizes are merited. © 2017 Mac Keith Press.

Therapeutic potentials of gene silencing by RNA interference: principles, challenges, and new strategies.

PubMed

Deng, Yan; Wang, Chi Chiu; Choy, Kwong Wai; Du, Quan; Chen, Jiao; Wang, Qin; Li, Lu; Chung, Tony Kwok Hung; Tang, Tao

2014-04-01

During recent decades there have been remarkable advances in biology, in which one of the most important discoveries is RNA interference (RNAi). RNAi is a specific post-transcriptional regulatory pathway that can result in silencing gene functions. Efforts have been done to translate this new discovery into clinical applications for disease treatment. However, technical difficulties restrict the development of RNAi, including stability, off-target effects, immunostimulation and delivery problems. Researchers have attempted to surmount these barriers and improve the bioavailability and safety of RNAi-based therapeutics by optimizing the chemistry and structure of these molecules. This paper aimed to describe the principles of RNA interference, review the therapeutic potential in various diseases and discuss the new strategies for in vivo delivery of RNAi to overcome the challenges. Copyright © 2013 Elsevier B.V. All rights reserved.

Drug delivery strategies for poorly water-soluble drugs.

PubMed

Fahr, Alfred; Liu, Xiangli

2007-07-01

The drug candidates coming from combinatorial chemistry research and/or the drugs selected from biologically based high-throughput screening are quite often very lipophilic, as these drug candidates exert their pharmacological action at or in biological membranes or membrane-associated proteins. This challenges drug delivery institutions in industry or academia to develop carrier systems for the optimal oral and parenteral administration of these drugs. To mention only a few of the challenges for this class of drugs: their oral bioavailability is poor and highly variable, and carrier development for parenteral administration is faced with problems, including the massive use of surface-active excipients for solubilisation. Formulation specialists are confronted with an even higher level of difficulties when these drugs have to be delivered site specifically. This article addresses the emerging formulation designs for delivering of poorly water-soluble drugs.

Challenges in the Management of Geriatric Trauma: A Case Report.

PubMed

Gaebel, Ashley; Keiser, Megan

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.

Digital government and public health.

PubMed

Fountain, Jane E

2004-10-01

Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agency's readiness for digital government includes examination of technical, managerial, and political capabilities. Public health agencies are especially challenged by a lack of funding for technical infrastructure and expertise, by privacy and security issues, and by lack of Internet access for low-income and marginalized populations. Public health agencies understand the difficulties of working across agencies and levels of government, but the development of new, integrated e-programs will require more than technical change - it will require a profound change in paradigm.

Burdens and difficulties experienced by caregivers of children and adolescents with schizophrenia-spectrum disorders: a qualitative study.

PubMed

Knock, Jane; Kline, Emily; Schiffman, Jason; Maynard, Ashley; Reeves, Gloria

2011-11-01

The purpose of this qualitative study was to investigate the burdens and difficulties associated with the experience of caring for youth with schizophrenia-spectrum disorders. Ten caregivers participated in a modified version of the Knowledge about Schizophrenia Illness interview. The most common areas of general difficulties reported by caregivers were emotional burdens and the everyday practical demands and sacrifices required in caring for their dependents. RESULTS also suggested high levels of burden for caregivers concerning difficulties with mental health services. Additional work is needed to learn more about the challenges that caregivers of youth with schizophrenia-spectrum disorders are facing, as well as to develop empirically based strategies for helping these caregivers and their dependents. © 2011 Blackwell Publishing Asia Pty Ltd.

Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior

PubMed Central

2018-01-01

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners’ abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication. PMID:28938250

Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior.

PubMed

Peelle, Jonathan E

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners' abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication.

A Randomized Study Comparing the Sniffing Position with Simple Head Extension for Glottis Visualization and Difficulty in Intubation during Direct Laryngoscopy.

PubMed

Akhtar, Mehmooda; Ali, Zulfiqar; Hassan, Nelofar; Mehdi, Saqib; Wani, Gh Mohammad; Mir, Aabid Hussain

2017-01-01

Proper positioning of the head and neck is important for an optimal laryngeal visualization. Traditionally, sniffing position (SP) is recommended to provide a superior glottic visualization, during direct laryngoscopy, enhancing the ease of intubation. Various studies in the last decade of this belief have challenged the need for sniffing position during intubation. We conducted a prospective study comparing the sniffing head position with simple head extension to study the laryngoscopic view and intubation difficulty during direct laryngoscopy. Five-hundred patients were included in this study and randomly distributed to SP or simple head extension. In the sniffing group, an incompressible head ring was placed under the head to raise its height by 7 cm from the neutral plane followed by maximal extension of the head. In the simple extension group, no headrest was placed under the head; however, maximal head extension was given at the time of laryngoscopy. Various factors as ability to mask ventilate, laryngoscopic visualization, intubation difficulty, and posture of the anesthesiologist during laryngoscopy and tracheal intubation were noted. In the incidence of difficult laryngoscopy (Cormack Grade III and IV), Intubation Difficulty Scale (IDS score) was compared between the two groups. There was no significant difference between two groups in Cormack grades. The IDS score differed significantly between sniffing group and simple extension group ( P = 0.000) with an increased difficulty during intubation in the simple head extension. Patients with simple head extension needed more lifting force, increased use of external laryngeal manipulation, and an increased use of alternate techniques during intubation when compared to SP. We conclude that compared to the simple head extension position, the SP should be used as a standard head position for intubation attempts under general anesthesia.

Bio-Terrorism: Steps to Effective Public Health Risk Communication and Fear Management

DTIC Science & Technology

2004-06-01

outline the challenges of communicating risk prior to, during and following a bio-terrorism event as well as the relationship between the content of...particularly challenging for a system based on thorough research and data analysis. Risk communication in a bio-terrorism event will involve...Ultimately, the Anthrax events confirmed the difficulty in communicating risk when scientific data is not available. Adding to the challenges imposed by an

Parents' perspectives of life challenges experienced by long-term paediatric brain tumour survivors: work and finances, daily and social functioning, and legal difficulties.

PubMed

Howard, A Fuchsia; Hasan, Haroon; Bobinski, Mary Anne; Nurcombe, Wendy; Olson, Robert; Parkinson, Maureen; Goddard, Karen

2014-09-01

Paediatric brain tumour survivors (PBTS) are at high risk for medical, neurocognitive and psychological sequelea during adulthood. Details illustrating the types and breadth of these chronic sequelae are essential to fully comprehend their impact on daily living. This study describes Canadian parents of PBTS perspectives of life challenges experienced by their now adult son or daughter related to work and finances, daily and social functioning, and legal difficulties. Parents of PBTS completed an anonymous online exploratory survey. Forty-six of 60 invited parents completed the survey. Parents reported that PBTS experienced difficulty gaining or sustaining employment (65 %) because of their health and/or a disability and employers reticence to hire and adequately support PBTS. Independent living was considered unaffordable for PBTS who received a disability allowance (82 %) and those who were employed (50 %). Thirty percent indicated their family experienced hardship because of PBTS medical expenses, which were usually paid for out of pocket (76 %). Although the majority of PBTS were independent with daily tasks and social functioning, a subgroup required continuous support. Forty percent of employed PBTS received limited assistance to accommodate their special needs. Parents indicated their son or daughter had been the victim of theft, fraud or assault (37 %), and commonly considered them vulnerable, in need of protection and feared for their future safety. Research that further illuminates the hardships facing PBTS and informs the development of support and resources to address PBTS vulnerabilities is warranted. PBTS are at risk for unemployment, financial challenges and legal difficulties, which appear to be poorly addressed by health and social programs.

The Same Fish: Creating Space for Therapeutic Relationships, Play, and Development in a School for Children with Special Needs.

PubMed

Alston, Richard; Sosland, Rachel; Tuohy, Anne; Weiler, Nori Anna; Zeitlin, Diane

2015-01-01

This paper represents and attempts to describe psychoanalytically informed work applied in a school setting with children with special needs. While many therapists at the Parkside School are trained in analytic techniques and principles, these ideas have not traditionally been applied to children with language-based learning difficulties. Over the years, we have found that analytic ideas such as transference, countertransference, projective identification, containment, and attachment are especially salient to our understanding of these very complex children. Despite being in a school--a nontraditional setting for psychoanalysis--children are seen in individual and group therapy, often more than once a week. We believe that therapeutic relationships and play (sometimes bringing a child to a place of being able to play) are especially mutative with children with language-based learning challenges. Play and relationship provide a holding environment that, over time, allows for the reorganization of a child's often immature developmental capacities into a sense of agency that captures more clearly a child's innate potential. This article includes case studies of children with complex language-based learning difficulties, including autism spectrum disorders.

Implementation of a Reverse Colocation Model: Lessons from Two Community Behavioral Health Agencies in Rural Pennsylvania.

PubMed

Gerolamo, Angela M; Kim, Jung Y; Brown, Jonathan D; Schuster, James; Kogan, Jane

2016-07-01

This qualitative study examined the implementation of a reverse colocation pilot program that sought to integrate medical care in two community behavioral health agencies. To accomplish this, each agency hired a registered nurse, provided training for its staff to function as wellness coaches, and implemented a web-based tool for tracking consumer outcomes. The findings from two rounds of stakeholder discussions and consumer focus groups suggested that agencies successfully trained their staffs in wellness coaching, integrated nurses into agency functions, developed integrated care planning processes, and increased awareness of wellness among staff and consumers. Similar to other complex interventions, the agencies experienced challenges including difficulty establishing new procedures and communication protocols, discomfort among staff in addressing physical health concerns, difficulty building collaborative relationships with primary care providers, and modest uptake of the web-based tool. The study offers insights into the practical aspects of integrating care and makes recommendations for future efforts.

Mental health problems in people living with HIV: changes in the last two decades: the London experience 1990–2014

PubMed Central

Adams, Catherine; Zacharia, Shilpa; Masters, Lisa; Coffey, Caroline; Catalan, Pepe

2016-01-01

ABSTRACT Mental health problems continue to be a significant comorbidity for people with HIV infection, even in the era of effective antiretroviral therapy. Here, we report on the changes in the mental health diagnoses based on clinical case reports amongst people with HIV referred to a specialist psychological medicine department over a 24-year period, which include the relative increase in depressive and anxiety disorders, often of a chronic nature, together with a decline in acute mental health syndromes, mania, and organic brain disorders. In addition, new challenges, like the presence of HIV and Hepatitis C co-infection, and the new problems created by recreational drugs, confirm the need for mental health services to be closely involved with the general medical services. A substantial proportion of people with HIV referred to specialist services suffer complex difficulties, which often require the collaboration of both psychiatrists and psychologists to deal effectively with their difficulties. PMID:26888472

Real-time alerts and reminders using information systems.

PubMed

Wanderer, Jonathan P; Sandberg, Warren S; Ehrenfeld, Jesse M

2011-09-01

Adoption of information systems throughout the hospital environment has enabled the development of real-time physiologic alerts and clinician reminder systems. These clinical tools can be made available through the deployment of anesthesia information management systems (AIMS). Creating usable alert systems requires understanding of technical considerations. Various successful implementations are reviewed, encompassing cost reduction, improved revenue capture, timely antibiotic administration, and postoperative nausea and vomiting prophylaxis. Challenges to the widespread use of real-time alerts and reminders include AIMS adoption rates and the difficulty in choosing appropriate areas and approaches for information systems support. Copyright © 2011 Elsevier Inc. All rights reserved.

Parental health literacy and its impact on patient care.

PubMed

Scotten, Mitzi

2015-03-01

The process of navigating through the modern American health care system is becoming progressively challenging. The range of tasks being asked of patients in the digital age is vast and complex and includes completing intricate insurance applications, signing complex consent forms, and translating medical data and prescription medication directions. Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely offered by medical providers. Mounting evidence now supports a growing awareness that general health literacy is the greatest individual factor affecting a person's health status. Copyright © 2015 Elsevier Inc. All rights reserved.

Design of a High Resolution Hexapod Positioning Mechanism

NASA Technical Reports Server (NTRS)

Britt, Jamie

2001-01-01

This paper describes the development of a high resolution, six-degree of freedom positioning mechanism. This mechanism, based on the Stewart platform concept, was designed for use with the Developmental Comparative Active Optics Telescope Testbed (DCATT), a ground-based technology testbed for the Next Generation Space Telescope (NGST). The mechanism provides active control to the DCATT telescope's segmented primary mirror. Emphasis is on design decisions and technical challenges. Significant issues include undesirable motion properties of PZT-inchworm actuators, testing difficulties, dimensional stability, and use of advanced composite materials. Supporting test data from prototype mechanisms is presented.

Design of a High Resolution Hexapod Positioning Mechanism

NASA Technical Reports Server (NTRS)

Britt, Jamie; Brodeur, Stephen J. (Technical Monitor)

2001-01-01

This paper describes the development of a high resolution, six-degree of freedom positioning mechanism. This mechanism, based on the Stewart platform concept, was designed for use with the Developmental Comparative Active Optics Telescope Testbed (DCATT), a ground-based technology testbed for the Next Generation Space Telescope (NGST). The mechanism provides active control to the DCATT telescope's segmented primary mirror. Emphasis is on design decisions and technical challenges. Significant issues include undesirable motion properties of PZT-inchworm actuators, testing difficulties, dimensional stability and use of advanced composite materials. Supporting test data from prototype mechanisms is presented.

Methodological issues in medical workforce analysis: implications for regional Australia.

PubMed

Hays, R B; Veitch, P C; Franklin, L; Crossland, L

1998-02-01

Medical workforce data have a profound impact on health policy formulation, but derived doctor population ratios (DPR) are often more relevant to plotting national trends than providing a detailed regional or local workforce perspective. Regional workforce data may be more useful if national approaches are augmented by local information. In developing a detailed workforce analysis for one region of Australia, the authors encountered several challenging methodological issues, including the accuracy of medical workforce databases, clarity of definition of community boundaries, interpretation of workforce definitions and the difficulty accounting for local community needs. This paper discusses the implications for regional workforce research.

Assessment of Technologies Used to Characterize Wildlife Populations in the Offshore Environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duberstein, Corey A.; Tagestad, Jerry D.; Larson, Kyle B.

Wind energy development in the offshore environment can have both direct and indirect effects on wildlife, yet little is known about most species that use near-shore and offshore waters due in part to the difficulty involved in studying animals in remote, challenging environments. Traditional methods to characterize offshore wildlife populations include shipboard observations. Technological advances have provided researches with an array of technologies to gather information about fauna from afar. This report describes the use and application of radar, thermal and optical imagery, and acoustic detection technologies for monitoring birds, bats, and marine mammals in offshore environments.

An improved control system for a remotely operated vessel

NASA Astrophysics Data System (ADS)

Bachnak, Rafic; Mendez, Marc; Esparza, Jack; Fahed, Oliver

2006-05-01

Collecting environmental data in coastal bays presents several challenges to the scientist. One of the most pressing issues is how to efficiently and reliably gather data in shallow water areas-environments that often preclude the use of traditional boats. Obstacles that are encountered in such environments include difficulty in covering large territories and the presence of inaccessible areas due to a variety of reasons, such as soft bottoms or contamination. There is also a high probability of disturbing the test area while placing the sensors. This paper outlines the development of a remotely operated boat and its real-time control system.

Big bang or continuous creation: does life have multiple origins?

NASA Astrophysics Data System (ADS)

Konesky, Gregory A.

2012-10-01

The generally accepted notion of a single origin of life from a primordial soup on the early Earth has been challenged recently by the suggestion of a "second life," "shadow life," and even "biological dark matter." The problem in classifying these microorganisms is in the difficulty or complete failure of the 16s genetic fingerprinting process, suggesting a different underlying biochemistry resulting from at least a second origin of life. We consider an extension of this concept to include continuous origination of life throughout Earth's history, up to the present. The consequences for interpreting the "tree of life" are also considered.

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA.

PubMed

Doyle, John T; Kindness, Larry; Realbird, James; Eggers, Margaret J; Camper, Anne K

2018-03-21

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps-especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges.

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA

PubMed Central

Doyle, John T.; Kindness, Larry; Realbird, James; Camper, Anne K.

2018-01-01

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps—especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges. PMID:29561815

Balancing the professional and personal.

PubMed

Armstrong, Alicia Y; Alvero, Ruben J; Dunlow, Susan; Nace, Mary Catherine; Baker, Valerie; Stewart, Elizabeth A

2009-01-01

To review the common roles that physicians pursue away from work and identify related challenges and potential solutions, so that individuals can develop a personalized plan for success in each of the areas. Literature review. University-based and university-affiliated medical centers. No subjects were involved in this literature review. Literature searches in Entrez PubMed and the following Websites: http://www.apgo.org, http://www.psychiatrictimes.com, as well as other data sources. Results of physician surveys and summaries of strategies for achieving work-personal life balance. According to surveys of physicians in various specialties, a majority of physicians have high levels of job, marital, and parental satisfaction. However, professional and personal challenges faced by physicians include struggle with time management, lack of mentorship, and difficulty maintaining intimate relationships. Multiple potentially effective strategies have been described in the literature, including exerting control over hours worked, taking a long view of life that acknowledges the need for changing priorities over time, developing communication skills, seeking counseling services if needed that focus on physician relationships, and simplifying home life whenever possible. Although there are unique challenges in being a physician, partner, and parent, many of the professional challenges faced by physicians are common to many adults in the United States. Self-assessment may help individuals to clarify priorities and develop strategies that can lead to improved personal satisfaction.

Plain Talk about K.I.D.S. (Kids Inclined toward Difficulty in School). A Summit on Educational Change: Transforming Crisis into Success. Proceedings (New Orleans, Louisiana, March 3-5, 1997).

ERIC Educational Resources Information Center

Thomas, Alice P., Ed.

The "Plain Talk about K.I.D.S. (Kids Inclined toward Difficulty in School)" summit is a biennial conference that addresses the challenges of educational change from several strategic directions at once, combining theory and research with concrete strategies and solutions from the educational, medical, judicial, business, and parental professions.…

Effects of noise on speech recognition: Challenges for communication by service members.

PubMed

Le Prell, Colleen G; Clavier, Odile H

2017-06-01

Speech communication often takes place in noisy environments; this is an urgent issue for military personnel who must communicate in high-noise environments. The effects of noise on speech recognition vary significantly according to the sources of noise, the number and types of talkers, and the listener's hearing ability. In this review, speech communication is first described as it relates to current standards of hearing assessment for military and civilian populations. The next section categorizes types of noise (also called maskers) according to their temporal characteristics (steady or fluctuating) and perceptive effects (energetic or informational masking). Next, speech recognition difficulties experienced by listeners with hearing loss and by older listeners are summarized, and questions on the possible causes of speech-in-noise difficulty are discussed, including recent suggestions of "hidden hearing loss". The final section describes tests used by military and civilian researchers, audiologists, and hearing technicians to assess performance of an individual in recognizing speech in background noise, as well as metrics that predict performance based on a listener and background noise profile. This article provides readers with an overview of the challenges associated with speech communication in noisy backgrounds, as well as its assessment and potential impact on functional performance, and provides guidance for important new research directions relevant not only to military personnel, but also to employees who work in high noise environments. Copyright © 2016 Elsevier B.V. All rights reserved.

Overcoming recruitment challenges in construction safety intervention research.

PubMed

Kidd, Pamela; Parshall, Mark; Wojcik, Susan; Struttmann, Tim

2004-03-01

Recruiting workers in small construction companies and securing their participation in voluntary safety programs or safety research poses unique challenges. Worker turnover and worksite changes contribute to difficulties in locating and enrolling participants. Economic pressures and time demands potentially threaten ongoing participation. Six simulation exercises designed to reduce back and fall injuries in small construction companies were developed based on data from focus groups of workers and company owners. Working with a workers' compensation insurer, we had access to owner-operators of general, heavy, and special trade construction companies reporting less than $10,000 in payroll expenses. Recruitment methods included a participation incentive, mailed invitations followed by phone contacts, and follow-up reminders. Despite using recruitment methods recommended in the literature, participation rates were low over a 2-year intervention period. Because of these difficulties, factors affecting participation or nonparticipation became an additional research focus. Owners' perceptions of already having a good safety record and of the time demands of participation were the most commonly cited reasons for not participating. Literature on recruitment emphasizes processes and procedures under investigator control rather than understanding potential participants' judgments about the adequacy of their existing practices and the potential benefits of intervention participation relative to potential time and productivity trade-offs. Greater attention to such judgments may enhance recruitment and participation in under-studied and difficult to access populations. Copyright 2004 Wiley-Liss, Inc.

Challenges for Global Learners: A Qualitative Study of the Concerns and Difficulties of International Students

ERIC Educational Resources Information Center

Gautam, Chetanath; Lowery, Charles L.; Mays, Chance; Durant, Dayan

2016-01-01

The authors in this study seek to inform academia about international students' experiences and challenges while attending universities in Small Town USA. Despite their eagerness to study in the United States (U.S.), international students are faced with setbacks that many universities fail to recognize or realize. The researchers conducted…

Comparing Novice and Expert Perceptions of Interactive Multimedia Tools for Conveying Conceptions of Size and Scale

ERIC Educational Resources Information Center

Magana, Alejandra; Newby, Timothy; Brophy, Sean

2012-01-01

Education in nanotechnology presents major challenges in science literacy. One of these challenges relates to conveying size and scale-related concepts. Because of the potential difficulties in conveying concepts and ideas that are not visible to the naked eye, multimedia for learning could be an appropriate vehicle to deliver curricular materials…

Estimating aboveground net primary productivity in forest-dominated ecosystems

Treesearch

Brian D. Kloeppel; Mark E. Harmon; Timothy J. Fahey

2007-01-01

The measurement of net primary productivity (NPP) in forest ecosystems presents a variety of challenges because of the large and complex dimensions of trees and the difficulties of quantifying several components of NPP. As summarized by Clark et al. (2001a), these methodological challenges can be overcome, and more reliable spatial and temporal comparisons can be...

The Relationship between FL Reading Strategies and FL Reading Proficiency: A Study on Turkish EFL Learners

ERIC Educational Resources Information Center

Gönen, Ipek Kuru

2015-01-01

Reading in FL possesses certain challenges for FL readers such as difficulty in inferring underlying messages in texts and dealing with unfamiliar cultural load. All these challenges may be associated with FL learners' reading proficiency and their use of FL reading strategies especially while reading academic materials. This study aims at…

Perspectives of EFL Doctoral Students on Challenges of Citations in Academic Writing

ERIC Educational Resources Information Center

Jomaa, Nayef Jomaa; Bidin, Siti Jamilah

2017-01-01

Purpose: Citation is vital in academic writing but particularly challenging for novice writers who use English as a second or foreign language. While much is known about citations types and functions, scarce knowledge is available about what makes citing a complicated procedure. Hence, this study explores the difficulties in citing and integrating…

Effects of a Mathematics Fluency Program on Mathematics Performance of Students with Challenging Behaviors

ERIC Educational Resources Information Center

Whitney, Todd; Hirn, Regina G.; Lingo, Amy S.

2016-01-01

In the present study, we examined the effects of a fluency-building mathematics program called Great Leaps Math on fluency of basic addition mathematics facts zero to nine and word problem solving using a multiple probe design across participants. Three elementary students with challenging behaviors and mathematics difficulty participated in the…

Challenges in Fibromyalgia Management: A Study of Anxiety, Depression, and Motivation Using Distance Learning and Social Networking

ERIC Educational Resources Information Center

Caines, Matthew J.

2010-01-01

Patients with fibromyalgia have difficulty managing symptoms (e.g., fatigue, chronic pain). The challenges in fibromyalgia management may vary from patient to patient, from painful physical exercise to pharmaceutical side-effects. Since the management of fibromyalgia greatly varies, there seems to be an individualist or personal component to…

Korean Early Childhood Educators' Perceptions of Importance and Implementation of Strategies to Address Young Children's Social-Emotional Competence

ERIC Educational Resources Information Center

Heo, Kay H.; Cheatham, Gregory A.; Hemmeter, Mary Louise; Noh, Jina

2014-01-01

In South Korea, there has been a rapid increase in challenging behaviors and other social-emotional difficulties at the early childhood level. Korean early childhood educators' perspectives and strategies to address young children's social-emotional competencies and challenging behaviors were investigated. Overall, results suggest that many Korean…

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%…

Design and challenges of a randomized controlled trial for reducing risk factors of metabolic syndrome in Mexican women through water intake

PubMed Central

Hernández-Cordero, Sonia; González-Castell, Dinorah; Rodríguez-Ramírez, Sonia; Villanueva-Borbolla, María Ángeles; Unar, Mishel; Barquera, Simón; de Cossío, Teresita González; Rivera-Dommarco, Juan; Popkin, Barry M

2014-01-01

Objective To describe the design, methods, and challenges encountered during a randomized clinical trial aimed to promote water intake for reducing risks of metabolic syndrome in Mexican women. Materials and methods In a randomized clinical trial in Cuernavaca, Mexico, overweight and obese (body mass index [BMI] ≥ 25 < 39) women, 18 – < 45 years old with an intake of sugar-sweetened beverages ≥ 250 kilocalories per day (kcal/day) were randomly allocated to the water and education provision group (n = 120) or the education provision only group (n = 120). Results We screened 1 756 women. The main difficulties encountered were identifying participants with the recruitment criteria, delivering water to participants, and the time demanded from the study participants. Conclusions The trial’s main challenges were difficulties surrounding recruitment, delivery of the intervention, and the time demanded from the study participants. Modifications were effectively implemented without jeopardizing the original protocol. PMID:24715012

Emerging Careers.

ERIC Educational Resources Information Center

McGregor, Elizabeth

1990-01-01

Fields such as robotics, computer graphics, and health care are fostering the evolution of new occupations. Identifying these occupations is challenging because of the difficulty of distinguishing between new and existing careers. (Author)

Desirable Difficulties in Vocabulary Learning

PubMed Central

BJORK, ROBERT A.; KROLL, JUDITH F.

2016-01-01

In this article we discuss the role of desirable difficulties in vocabulary learning from two perspectives, one having to do with identifying conditions of learning that impose initial challenges to the learner but then benefit later retention and transfer, and the other having to do with the role of certain difficulties that are intrinsic to language processes, are engaged during word learning, and reflect how language is understood and produced. From each perspective we discuss evidence that supports the notion that difficulties in learning and imposed costs to language processing may produce benefits because they are likely to increase conceptual understanding. We then consider the consequences of these processes for actual second-language learning and suggest that some of the domain-general cognitive advantages that have been reported for proficient bilinguals may reflect difficulties imposed by the learning process, and by the requirement to negotiate cross-language competition, that are broadly desirable. As Alice Healy and her collaborators were perhaps the first to demonstrate, research on desirable difficulties in vocabulary and language learning holds the promise of bringing together research traditions on memory and language that have much to offer each other. PMID:26255443

Desirable Difficulties in Vocabulary Learning.

PubMed

Bjork, Robert A; Kroll, Judith F

2015-01-01

In this article we discuss the role of desirable difficulties in vocabulary learning from two perspectives, one having to do with identifying conditions of learning that impose initial challenges to the learner but then benefit later retention and transfer, and the other having to do with the role of certain difficulties that are intrinsic to language processes, are engaged during word learning, and reflect how language is understood and produced. From each perspective we discuss evidence that supports the notion that difficulties in learning and imposed costs to language processing may produce benefits because they are likely to increase conceptual understanding. We then consider the consequences of these processes for actual second-language learning and suggest that some of the domain-general cognitive advantages that have been reported for proficient bilinguals may reflect difficulties imposed by the learning process, and by the requirement to negotiate cross-language competition, that are broadly desirable. As Alice Healy and her collaborators were perhaps the first to demonstrate, research on desirable difficulties in vocabulary and language learning holds the promise of bringing together research traditions on memory and language that have much to offer each other.

Validation of the Episodic Disability Framework with adults living with HIV.

PubMed

O'Brien, Kelly K; Hanna, Steven; Gardner, Sandra; Bayoumi, Ahmed M; Rueda, Sergio; Hart, Trevor A; Cooper, Curtis; Solomon, Patricia; Rourke, Sean B; Davis, Aileen M

2014-01-01

To assess the validity of dimensions of disability in the Episodic Disability Framework, a conceptual framework derived from the perspective of adults living with HIV. We conducted confirmatory factor analyses with 913 adults living with HIV in an observational cohort study called the Ontario HIV Treatment Network Cohort Study (OCS). We tested hypotheses that dimensions of disability in the Episodic Disability Framework were represented by a group of measured variables in the observational database. A model comprised of four latent variables and 43 indicator variables with one cross-loading was superior to models with fewer latent variables and more indicator variables and supported the validity of disability dimensions: physical health symptoms (represented by 21 indicator variables), mental health symptoms (10 variables), difficulties with day-to-day activities (5 variables) and challenges to social inclusion (8 variables). Overall goodness of fit statistics were χ(2 )= 2621.50 (p < 0.001), Comparative Fit Index = 0.912, Tucker Lewis Index = 0.907 and root mean square error of approximation = 0.048. Dimensions of disability correlated with each other ranging from r = 0.44 (between physical symptoms and challenges to social inclusion) to r = 0.81 (between physical symptoms and difficulties with day-to-day activities). This study supports the validity of four disability dimensions in the Episodic Disability Framework. This framework provides a new way to conceptualize disability and can lay the foundation for developing a future HIV disability measure for clinical and health services research. The Episodic Disability Framework is the first known conceptual framework of disability developed from the perspective of adults living with HIV. Results from this confirmatory factor analysis support the validity of four dimensions of disability experienced by adults living with HIV in the Episodic Disability Framework including: physical symptoms and impairments, mental health symptoms and impairments, difficulties carrying out day-to-day activities, and challenges to social inclusion. The Episodic Disability Framework provides a new way to conceptualize disability experienced by adults living with HIV. Clinicians can use this Framework to better understand episodic disability experienced by adults living with HIV. Clinicians can frame their assessments of disability to include physical and mental health symptoms and impairments as well as consider a patient's ability to participate in society, and indicate areas to apply interventions or strategies to prevent or mitigate disability experienced by adults living with HIV.

Framework for understanding the patterns of student difficulties in quantum mechanics

NASA Astrophysics Data System (ADS)

Marshman, Emily; Singh, Chandralekha

2015-12-01

[This paper is part of the Focused Collection on Upper Division Physics Courses.] Compared with introductory physics, relatively little is known about the development of expertise in advanced physics courses, especially in the case of quantum mechanics. Here, we describe a framework for understanding the patterns of student reasoning difficulties and how students develop expertise in quantum mechanics. The framework posits that the challenges many students face in developing expertise in quantum mechanics are analogous to the challenges introductory students face in developing expertise in introductory classical mechanics. This framework incorporates both the effects of diversity in upper-level students' prior preparation, goals, and motivation in general (i.e., the facts that even in upper-level courses, students may be inadequately prepared, have unclear goals, and have insufficient motivation to excel) as well as the "paradigm shift" from classical mechanics to quantum mechanics. The framework is based on empirical investigations demonstrating that the patterns of reasoning, problem-solving, and self-monitoring difficulties in quantum mechanics bear a striking resemblance to those found in introductory classical mechanics. Examples from research in quantum mechanics and introductory classical mechanics are discussed to illustrate how the patterns of difficulties are analogous as students learn to unpack the respective principles and grasp the formalism in each knowledge domain during the development of expertise. Embracing such a framework and contemplating the parallels between the difficulties in these two knowledge domains can enable researchers to leverage the extensive literature for introductory physics education research to guide the design of teaching and learning tools for helping students develop expertise in quantum mechanics.

Improving acute patient flow and resolving emergency department overcrowding in New Zealand hospitals--the major challenges and the promising initiatives.

PubMed

Ardagh, Michael W; Tonkin, Gary; Possenniskie, Clare

2011-10-14

To determine the most common challenges to improving acute patient flow and resolving emergency department (ED) overcrowding in New Zealand hospitals, and to share some of the promising initiatives that have been implemented in response to them. To facilitate progress towards achievement of the Shorter Stays in Emergency Departments Health Target (the Target), the authors visited every District Health Board (DHB) in New Zealand. These visits followed a standardised visit format and subsequent to each visit a report was produced that noted the observed challenges, initiatives and successes in relation to the DHB's pursuit of the Target. Using these reports, the significant challenges and the promising initiatives across all of the DHBs were collated. Access to hospital beds, access to diagnostic tests and inpatient team delays were the most common challenges, followed by increased demand for ED services, ED facility deficiencies, ED staff deficiencies, delay to discharge of inpatients, difficulty engaging hospital clinical staff in changes, difficulty accessing aged care beds, and problems at nights and weekends. Promising initiatives were noted in relation to each of these. To improve acute care, resolve ED overcrowding and achieve the Target we need a comprehensive, whole of system approach and some significant changes to the way we use our physical and human resources. To address common challenges we need to share our experiences and expertise.

Investigations of student understanding of entropy and of mixed second-order partial derivatives in upper-level thermodynamics

NASA Astrophysics Data System (ADS)

Bucy, Brandon R.

While much of physics education research (PER) has traditionally been conducted in introductory undergraduate courses, researchers have begun to study student understanding of physics concepts at the upper-level. In this dissertation, we describe investigations conducted in advanced undergraduate thermodynamics courses. We present and discuss results pertaining to student understanding of two topics: entropy and the role of mixed second-order partial derivatives in thermodynamics. Our investigations into student understanding of entropy consisted of an analysis of written student responses to researcher-designed diagnostic questions. Data gathered in clinical interviews is employed to illustrate and extend results gathered from written responses. The question sets provided students with several ideal gas processes, and asked students to determine and compare the entropy changes of these processes. We administered the question sets to students from six distinct populations, including students enrolled in classical thermodynamics, statistical mechanics, thermal physics, physical chemistry, and chemical engineering courses, as well as a sample of physics graduate students. Data was gathered both before and after instruction in several samples. Several noteworthy features of student reasoning are identified and discussed. These features include student ideas about entropy prior to instruction, as well as specific difficulties and other aspects of student reasoning evident after instruction. As an example, students from various populations tended to emphasize either the thermodynamic or the statistical definition of entropy. Both approaches present students with a unique set of benefits as well as challenges. We additionally studied student understanding of partial derivatives in a thermodynamics context. We identified specific difficulties related to the mixed second partial derivatives of a thermodynamic state function, based on an analysis of student responses to homework and exam problems. Students tended to set these partial derivatives identically equal to zero. Students also displayed difficulties in relating the physical description of a material property to a corresponding mathematical statement involving partial derivatives. We describe the development of a guided-inquiry tutorial activity designed to address these specific difficulties. This tutorial focused on the graphical interpretation of partial derivatives. Preliminary results suggest that the tutorial was effective in addressing several student difficulties related to partial derivatives.

Stardust Interstellar Preliminary Examination II: Curating the Interstellar Dust Collector, Picokeystones, and Sources of Impact Tracks

NASA Technical Reports Server (NTRS)

Frank, David R.; Westphal, Andrew J.; Zolensky, Michael E.; Gainsforth, Zack; Butterworth, Anna L.; Bastien, Ronald K.; Allen, Carlton; Anderson, David; Bechtel, Hans A.; Sandford, Scott A.

2013-01-01

We discuss the inherent difficulties that arise during "ground truth" characterization of the Stardust interstellar dust collector. The challenge of identifying contemporary interstellar dust impact tracks in aerogel is described within the context of background spacecraft secondaries and possible interplanetary dust particles and beta-meteoroids. In addition, the extraction of microscopic dust embedded in aerogel is technically challenging. Specifically, we provide a detailed description of the sample preparation techniques developed to address the unique goals and restrictions of the Interstellar Preliminary Exam. These sample preparation requirements and the scarcity of candidate interstellar impact tracks exacerbate the difficulties. We also illustrate the role of initial optical imaging with critically important examples, and summarize the overall processing of the collection to date.

Challenges of a community based pragmatic, randomised controlled trial of weight loss maintenance.

PubMed

Randell, Elizabeth; McNamara, Rachel; Shaw, Christine; Espinasse, Aude; Simpson, Sharon Anne

2015-12-18

Randomised controlled trials (RCTs) have a reputation for being inherently difficult to deliver as planned and often face unforeseen challenges and delays, particularly in relation to organisational and governance difficulties, participant interest, constraints due to allocation of costs, local investigator interest and lengthy bureaucracy. Recruitment is often difficult and the challenges faced often impact on the cost and delivery of a successful trial within the funded period. This paper reflects upon the challenges faced in delivering a pragmatic RCT of weight loss maintenance in a community setting and suggests some potential solutions. The weight loss maintenance in adults trial aimed to evaluate the impact of a 12 month, individually tailored weight maintenance intervention on BMI 3 years from randomisation. Participants were recruited primarily from participant identification centres (PICs)-GP surgeries, exercise on referral schemes and slimming world. The intervention was delivered in community settings. A recruitment strategy implementation plan was drafted to address and monitor poor recruitment. Delays in opening and recruitment were experienced early on. Some were beyond the control of the study team such as; disagreement over allocation of national health service costs and PIC classification as well as difficulties in securing support from research networks. That the intervention was delivered in community settings was often at the root of these issues. Key items to address at the design stage of future trials include feasibility of eligibility criteria. The most effective element of the recruitment implementation plan was to refocus sources of recruitment and target only those who could fulfil the eligibility criteria immediately. Learnings from this trial should be kept in mind by those designing similar studies in the future. Considering potential governance, cost and research network support implications at the design stage of pragmatic trials of any community-based complex intervention is paramount. The appropriateness and viability of inclusion criteria also require careful consideration as does use of a targeted advertising strategy. ISRCTN35774128, 12/01/2010.

Persistent Handwriting Difficulties in Children With ADHD After Treatment With Stimulant Medication.

PubMed

Brossard-Racine, Marie; Shevell, Michael; Snider, Laurie; Bélanger, Stacey Ageranioti; Julien, Marilyse; Majnemer, Annette

2015-07-01

Children with ADHD often present with handwriting difficulties. However, the extent to which motor and attention skills influence performance in this group has not yet been explored. The objective of this study was to examine the factors associated with change in handwriting performance. This study examines the factors associated with change in handwriting performance of 49 children newly diagnosed with ADHD (mean age = 8.4 [SD=1.3] years) prior to and 3 months following use of a stimulant medication. Handwriting legibility and speed improved significantly at follow-up evaluation. However, most of the children with legibility difficulties at baseline continued to demonstrate difficulties when evaluated 3 months after initiation of medication. Change in handwriting legibility was best determined by improvements in visual-motor integration skills (β = 0.07-0.10; p < .001), while the change in speed did not appear to be consistently related to a single factor. Handwriting difficulties are common in children with ADHD, and medication alone is not sufficient to resolve these challenges. © 2012 SAGE Publications.

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

PubMed

Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

2010-10-01

In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

Transitions in the communication experiences of tracheostomised patients in intensive care: a qualitative descriptive study.

PubMed

Flinterud, Stine Irene; Andershed, Birgitta

2015-08-01

To describe how tracheostomised patients in intensive care experience acts of communication and to better understand their experiences in the context of the transitions theory. Waking up in an intensive care unit unable to speak because of mechanical ventilation can be challenging. Communication aids are available, but patients still report difficulties communicating. Investigating how mechanically ventilated patients experience communication in the context of the transitions theory might elucidate new ways of supporting them during their transitions while being ventilated. A qualitative, descriptive design. Eleven patients who had previously been tracheostomised in an intensive care unit were included in this quality improvement project conducted in a university hospital in Norway. Participants were tracheostomised from 3-27 days. Semistructured interviews were conducted from June 2013-August 2013, 3-18 months after hospital discharge. Transcripts were analysed using inductive content analysis. Participants reported a great diversity of emotions and experiences attempting to communicate while being tracheostomised. One overarching theme emerging from the analysis was the 'Experience of caring and understanding despite having uncomfortable feelings due to troublesome communication.' The theme consists of three categories. The category 'Emotionally challenging' shows that patients struggled initially. With time, their coping improved, as revealed in the category 'The experience changes with time.' Despite difficulties, participants described positive experiences, as shown in the category 'Successful communication.' The importance of patients experiencing caring and understanding despite their difficult situation constitutes the core finding. The findings suggest that participants went through different transitions. Some reached the end of their transition, experiencing increased stability. Despite challenges with communication, participants reported that caring and safety provided by health care professionals were significant experiences. They viewed nonverbal communication as being very important. © 2015 John Wiley & Sons Ltd.

Project-based learning with international collaboration for training biomedical engineers.

PubMed

Krishnan, Shankar

2011-01-01

Training biomedical engineers while effectively keeping up with the fast paced scientific breakthroughs and the growth in technical innovations poses arduous challenges for educators. Traditional pedagogical methods are employed for coping with the increasing demands in biomedical engineering (BME) training and continuous improvements have been attempted with some success. Project-based learning (PBL) is an academic effort that challenges students by making them carry out interdisciplinary projects aimed at accomplishing a wide range of student learning outcomes. PBL has been shown to be effective in the medical field and has been adopted by other fields including engineering. The impact of globalization in healthcare appears to be steadily increasing which necessitates the inclusion of awareness of relevant international activities in the curriculum. Numerous difficulties are encountered when the formation of a collaborative team is tried, and additional difficulties occur as the collaboration team is extended to international partners. Understanding and agreement of responsibilities becomes somewhat complex and hence the collaborative project has to be planned and executed with clear understanding by all partners and participants. A model for training BME students by adopting PBL with international collaboration is proposed. The results of previous BME project work with international collaboration fit partially into the model. There were many logistic issues and constraints; however, the collaborative projects themselves greatly enhanced the student learning outcomes. This PBL type of learning experience tends to promote long term retention of multidisciplinary material and foster high-order cognitive activities such as analysis, synthesis and evaluation. In addition to introducing the students to experiences encountered in the real-life workforce, the proposed approach enhances developing professional contracts and global networking. In conclusion, despite initial challenges, adopting project-based learning with international collaboration has strong potentials to be valuable in the training of biomedical engineering students.

Indications of Recruitment Challenges in Research with U.S. Military Service Members: A ClinicalTrials.gov Review.

PubMed

Cook, Wendy A; Doorenbos, Ardith Z

2017-03-01

The success of military-relevant health research often depends on recruiting adequate numbers of U.S. military service members as research participants. Researchers have reported difficulties in recruiting service member research participants. Reviews of ClinicalTrials.gov, an online clinical trial registry of publicly and privately sponsored studies, have identified challenges in participant recruitment and barriers to study completion in various research populations. The purpose of this study was to identify indications of difficulty recruiting U.S. military service members as research participants based on data from study records in ClinicalTrials.gov. Records of studies starting between 2005 and 2014 were collected from ClinicalTrials.gov and updated through January 2016. Three hundred and two studies that included ≥25% U.S. military service member research participants were (1) compared to a comparison group of 302 studies, each with <5% service member participants and (2) compared by the proportion of service member participants within studies in the military group ("many" ≥25% but <100% service members and "all" 100% service members). Groups were evaluated and compared for recruitment status; reasons for study withdrawal, termination, or suspension; achievement of ≥85% of the anticipated enrollment; and differences in achieving recruitment goals according to study sponsor. Twelve percent of studies in the military group had been withdrawn, terminated, or suspended; enrollment and funding problems were the most common reasons. The comparison group had 11% of studies withdrawn, terminated, or suspended; the most common reasons were enrollment problems and sponsor decision. All study groups had indications of difficulty adequately achieving participant enrollment goals. Among studies with known anticipated and actual enrollment, approximately half in both the military group (47.9%) and comparison group (50.3%) achieved ≥85% of the anticipated enrollment (p = 0.722). Half of studies with many service members and 44% of studies with all service members achieved ≥85% of the anticipated enrollment (p = 0.600). In comparing the many and all service member subgroups, significant differences were found in the median values for anticipated enrollment and actual enrollment, even when accounting for Bonferroni correction. Evaluations of mean values did not show a statistical difference between the military subgroups. There were no significant differences according to study sponsor (military, academic, Veterans Affairs, National Institutes of Health, nonprofit organization, or industry) for a study achieving or not achieving ≥85% of the anticipated enrollment. This review supports anecdotal reports of difficulty recruiting service members as research participants. However, the findings also indicate that in many regards, there is not much difference in the difficulties recruiting service members versus other research participants. Findings suggest that it is often difficult to recruit research participants regardless of the specific population or type of study sponsor, and that studies with either many or all service member participants have similar achievement of recruitment goals. Findings in this study may be useful for those who design research that includes service members or for those who are apprehensive about including service members in their research. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Transesophageal echocardiography and intracardiac echocardiography differently predict potential technical challenges or failures of interatrial shunts catheter-based closure.

PubMed

Rigatelli, Gianluca; Rigateli, Gianluca; Cardaioli, Paolo; Braggion, Gabriele; Aggio, Silvio; Giordan, Massimo; Magro, Beatrice; Nascimben, Alberto; Favaro, Alberto; Roncon, Loris; Rincon, Loris

2007-02-01

We sought to prospectively assess the role of transesophageal (TEE) and intracardiac echocardiography (ICE) in detecting potential technical difficulties or failures in patients submitted to interatrial shunts percutaneous closure. We prospectively enrolled 46 consecutive patients (mean age 35+/-28, 8 years, 30 female) referred to our center for catheter-based closure of interatrial shunts. All patients were screened with TEE before the intervention. Patients who met the inclusion criteria underwent ICE study before the closure attempt (40 patients). TEE detected potential technical difficulties in 22.5% (9/40) patients, whereas ICE detected technical difficulties in 32.5% (13/40 patients). In patients with positive TEE/ICE the procedural success (92.4% versus 100% and, P = ns) and follow-up failure rate (7.7% versus 0%, P = ns) were similar to patients with negative TEE/ICE, whereas the fluoroscopy time (7 +/- 1.2 versus 5 +/- 0.7 minutes, P < 0.03), the procedural time (41 +/- 4.1 versus 30 +/- 8.2 minutes, P +/- 0.03), and technical difficulties rate (23.1% versus 0%, P = 0.013) were higher. Differences between ICE and TEE in the evaluation of rims, measurement of ASD or fossa ovalis, and detection of venous valve and embryonic septal membrane remnants impacted on technical challenges and on procedural and fluoroscopy times but did not influence the success rate and follow-up failure rate.

Qualitative Analysis of Round-Table Discussions on the Business Case and Procurement Challenges for Hospital Electronic Prescribing Systems

PubMed Central

Cresswell, Kathrin M.; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W.; Sheikh, Aziz

2013-01-01

Objectives There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. Materials and Methods We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. Results We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing “wants” and aspirations from organizational “needs”. Discussion and conclusions Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management. PMID:24260213

Integrative Understanding of Emergent Brain Properties, Quantum Brain Hypotheses, and Connectome Alterations in Dementia are Key Challenges to Conquer Alzheimer's Disease.

PubMed

Kuljiš, Rodrigo O

2010-01-01

The biological substrate for cognition remains a challenge as much as defining this function of living beings. Here, we examine some of the difficulties to understand normal and disordered cognition in humans. We use aspects of Alzheimer's disease and related disorders to illustrate how the wealth of information at many conceptually separate, even intellectually decoupled, physical scales - in particular at the Molecular Neuroscience versus Systems Neuroscience/Neuropsychology levels - presents a challenge in terms of true interdisciplinary integration towards a coherent understanding. These unresolved dilemmas include critically the as yet untested quantum brain hypothesis, and the embryonic attempts to develop and define the so-called connectome in humans and in non-human models of disease. To mitigate these challenges, we propose a scheme incorporating the vast array of scales of the space and time (space-time) manifold from at least the subatomic through cognitive-behavioral dimensions of inquiry, to achieve a new understanding of both normal and disordered cognition, that is essential for a new era of progress in the Generative Sciences and its application to translational efforts for disease prevention and treatment.

Seven challenges in international development assistance for health and ways forward.

PubMed

Sridhar, Devi

2010-01-01

This paper outlines seven challenges in development assistance for health, which in the current financial context, have become even more important to address. These include the following: (1) the proliferation of initiatives, focusing on specific diseases or issues, as well as (2) the lack of attention given to reforming the existing focal health institutions, the WHO and World Bank. (3) The lack of accountability of donors and their influence on priority-setting are part of the reason that there is "initiavitis," and resistance to creating a strong UN system. (4) Other than absolute quantity of aid, three other challenges linked to donors relate to the quality of aid financing particularly the pragmatic difficulties of financing horizontal interventions, (5) the marginal involvement of developing country governments as aid recipients, and (6) the heavy reliance on Northern-based organizations as managers of funds. (7) The final challenge discussed focuses on two unintended consequences of the recent linking of health and foreign policy for international development assistance. The paper then provides three suggestions for ways forward: creating new mechanisms to hold donors to account, developing national plans and strengthening national leadership in health, and South-South collaboration. © 2010 American Society of Law, Medicine & Ethics, Inc.

Achieving the four dimensions of food security for resettled refugees in Australia: A systematic review.

PubMed

Lawlis, Tanya; Islam, Wasima; Upton, Penney

2018-04-01

Food security is defined by four dimensions: food availability, access, utilisation and stability. Resettled refugees face unique struggles securing these dimensions and, thus, food security when moving to a new country. This systematic review aimed to identify the challenges Australian refugees experience in achieving the four dimensions of food security. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed; the SPIDER tool was used to determine eligibility criteria. Three databases were searched using terms relating to food in/security and refugees from 2000 to 20 May 2017. Seven articles were retained for analysis. Studies were categorised against the four dimensions, with four studies identifying challenges against all dimensions. Challenges contributing to high levels of food insecurity in each dimension included: availability and cost of traditional foods, difficulty in accessing preferred food outlets, limited food knowledge and preparation skills and food stability due to low income and social support. Food insecurity adversely impacts refugee health and integration. Methodical research framed by the four dimensions of food security is imperative to address challenges to securing food security in refugee groups and assisting in the development of sustainable interventions. © 2017 Dietitians Association of Australia.

A Systematic Examination of Food Intake and Adaptation to the Food Environment by Refugees Settled in the United States1234

PubMed Central

Wang, Youfa; Min, Jungwon; Harris, Kisa; Khuri, Jacob; Anderson, Laura M

2016-01-01

The United States is the largest refugee resettlement country in the world. Refugees may face health-related challenges after resettlement in the United States, including higher rates of chronic diseases due to problems such as language barriers and difficulty adapting to new food environments. However, reported refugee diet challenges varied, and no systematic examination has been reported. This study examined refugee food intake pre- and postresettlement in the United States and differences in intake across various refugee groups. We systematically reviewed relevant studies that reported on refugee food intake and adaptation to the US food environment. We searched PubMed for literature published between January 1985 and April 2015, including cross-sectional and prospective studies. Eighteen studies met inclusion criteria. Limited research has been conducted, and most studies were based on small convenience samples. In general, refugees increased meat and egg consumption after resettling in the United States. Changes in refugee intake of vegetables, fruits, and dairy products varied by socioeconomic status, food insecurity, past food deprivation experience, length of stay in the United States, region of origin, and age. South Asians were more likely to maintain traditional diets, and increased age was associated with more conservative and traditional diets. Despite the abundance of food in the United States, postresettlement refugees reported difficulty in finding familiar or healthy foods. More research with larger samples and follow-up data are needed to study how refugees adapt to the US food environment and what factors may influence their food- and health-related outcomes. The work could inform future interventions to promote healthy eating and living among refugees and help to reduce health disparities. PMID:28140324

A Systematic Examination of Food Intake and Adaptation to the Food Environment by Refugees Settled in the United States.

PubMed

Wang, Youfa; Min, Jungwon; Harris, Kisa; Khuri, Jacob; Anderson, Laura M

2016-11-01

The United States is the largest refugee resettlement country in the world. Refugees may face health-related challenges after resettlement in the United States, including higher rates of chronic diseases due to problems such as language barriers and difficulty adapting to new food environments. However, reported refugee diet challenges varied, and no systematic examination has been reported. This study examined refugee food intake pre- and postresettlement in the United States and differences in intake across various refugee groups. We systematically reviewed relevant studies that reported on refugee food intake and adaptation to the US food environment. We searched PubMed for literature published between January 1985 and April 2015, including cross-sectional and prospective studies. Eighteen studies met inclusion criteria. Limited research has been conducted, and most studies were based on small convenience samples. In general, refugees increased meat and egg consumption after resettling in the United States. Changes in refugee intake of vegetables, fruits, and dairy products varied by socioeconomic status, food insecurity, past food deprivation experience, length of stay in the United States, region of origin, and age. South Asians were more likely to maintain traditional diets, and increased age was associated with more conservative and traditional diets. Despite the abundance of food in the United States, postresettlement refugees reported difficulty in finding familiar or healthy foods. More research with larger samples and follow-up data are needed to study how refugees adapt to the US food environment and what factors may influence their food- and health-related outcomes. The work could inform future interventions to promote healthy eating and living among refugees and help to reduce health disparities. © 2016 American Society for Nutrition.

Quality of life outcomes in 599 cancer and non-cancer patients with colostomies.

PubMed

Krouse, Robert; Grant, Marcia; Ferrell, Betty; Dean, Grace; Nelson, Rebecca; Chu, David

2007-03-01

A colostomy is known to impact negatively on a patient's quality of life (QOL). Concerns include incontinence, rectal discharge, gas, difficulties in returning to work, decreased sexual activity, and travel and leisure challenges. Reports have described QOL outcomes in cancer patients with colostomies and inflammatory bowel syndrome with colostomies, but little has been written regarding a comparison of cancer and non-cancer populations. The purpose of this study was to describe QOL issues of colostomy patients and compare these issues in cancer and non-cancer participants. A QOL-ostomy questionnaire was mailed to 2455 California members of the United Ostomy Association. Of the 1457 respondents (59%), 599 had a colostomy. Most were results from cancer (517/599), with colorectal cancer being the most common diagnosis. The most common benign diagnoses were inflammatory bowel disease and diverticulitis. Demographics were similar, except for more females in the non-cancer group (76%), and increased length of time with colostomy from the cancer group (mean 135.9 versus 106.4 months, P = 0.03). Common QOL problems included sexual problems, gas, constipation, travel difficulties, and dissatisfaction with appearance. Overall, cancer patients had less difficulty adjusting to their colostomies. Results confirmed the negative impact of a colostomy on QOL. While patients with cancer had a better overall QOL than those with benign processes, concerns were common to all colostomy patients. These results provide health care practitioners with information useful in discussing QOL concerns during pre-operation treatment decisions and post operative teaching and follow-up care.

Challenges in conducting qualitative research in health: A conceptual paper.

PubMed

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Challenges in English Medium of Instruction from the Teachers and Students' Eyes

ERIC Educational Resources Information Center

Cankaya, Pinar

2017-01-01

The main concern of the current paper is to discuss English medium instruction (EMI, henceforth) in all aspects with a particular focus on its challenges and difficulties reported by both students and teachers based on the relevant research studies. As EMI is gaining greatest importance among the researchers, policy makers and educators; it is of…

Preferential Treatment or Unwanted in Mainstream Schools? The Perceptions of Parents and Teachers with Regards to Pupils with Special Educational Needs and Challenging Behaviour

ERIC Educational Resources Information Center

Broomhead, Karen E.

2013-01-01

This study explored the perceptions of parents and teachers regarding the differential treatment or stigma experienced by pupils with challenging behaviour--more specifically, those with behavioural, emotional and social difficulties (BESD), as well as children with visible special educational needs (Down's syndrome and/or profound and multiple…

Constraints, Dangers, and Challenges of the Twenty-First Century. International Commission on Education for the Twenty-First Century.

ERIC Educational Resources Information Center

Blondel, Daniele

This document groups together the ideas about the difficulties, dangers, and challenges of the 21st century expressed by the International Commission on Education for the Twenty-First Century. In discussing constraints created by contemporary world history, the paper suggests that the development of the world economy and society is at present…

The Perceived Benefits and Difficulties in Introducing and Maintaining Supervision Groups in a SEMH Special School

ERIC Educational Resources Information Center

Willis, Jonathan; Baines, Ed

2018-01-01

Supervision groups are often used in professional settings and are introduced to address and provide support in relation to the challenges that arise in everyday practice. Although group supervision is common amongst a range of helping professions, its use in schools is rare. Little research exists as to the merits and challenges of providing…

Challenges for Scientists in Latin America.

PubMed

Kalergis, Alexis M; Lacerda, Marcus; Rabinovich, Gabriel A; Rosenstein, Yvonne

2016-09-01

Despite political turmoil and economical crisis, research in Latin America has considerably advanced over recent decades. The present 'Point of View' outlines our perspectives on the working conditions, successes, difficulties, limitations, and challenges of biomedical scientific communities in four Latin American countries: Argentina (G.A.R.), Brazil (M.L.), Chile (A.K.), and Mexico (Y.R.). Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementing Practical Based Courses under Open and Distance Learning System: A Study of the Perception of Learners and Counsellors

ERIC Educational Resources Information Center

Basantia, Tapan Kumar

2018-01-01

Implementing practical based courses under Open and Distance Learning (ODL) system is a very difficult and challenging task as the teaching of practical based courses involves intensive practical work. For removing the difficulties and challenges in implementing the practical based courses under ODL system, there is a need to study the existing…

Measuring Ability, Speed, or Both? Challenges, Psychometric Solutions, and What Can Be Gained from Experimental Control

ERIC Educational Resources Information Center

Goldhammer, Frank

2015-01-01

The main challenge of ability tests relates to the difficulty of items, whereas speed tests demand that test takers complete very easy items quickly. This article proposes a conceptual framework to represent how performance depends on both between-person differences in speed and ability and the speed-ability compromise within persons. Related…

Special School Headship in Times of Change: Impossible Challenges or Golden Opportunities?

ERIC Educational Resources Information Center

Baker, John

2009-01-01

This article is based on empirical research undertaken by John Baker, headteacher of the largest day special school for pupils with a range of learning difficulties in Essex, as part of his EdD studies at the Institute of Education, University of London. Its focus is on the perceived challenges and opportunities which headteachers of special…

Current challenges and pitfalls in the pharmacological treatment of depression

PubMed Central

Popa-Velea, O; Gheorghe, IR; Truţescu, CI; Purcărea, VL

2015-01-01

The multifactorial etiology of depression obliges needs an individual assessment, the psychopharmacological approach involving a biopsychosocial analysis for each individual case. The rebalancing of the depressive patient, seen as a return to a normal level of psychosocial functioning and reduced risk of relapse is achieved with a prompt and constant support of specialized teams. Treatment should include psychopharmacological and psychosocial approaches, the results being interrelated and contributing to the prognosis of the disorder. Progress in clinical and pharmacological research, vivid dynamics of socio-economic environment, the complexity of diagnostic evaluation and the need for an interdisciplinary approach may cause difficulties in addressing the depressive patient and the ethical controversies. The aim of this paper is to present a brief analysis of challenges encountered in the present psychiatric practice, starting from the heterogeneity of depressive manifestations and finishing with the prioritization of interventional forms. PMID:25866576

Radio frequency analog electronics based on carbon nanotube transistors

PubMed Central

Kocabas, Coskun; Kim, Hoon-sik; Banks, Tony; Rogers, John A.; Pesetski, Aaron A.; Baumgardner, James E.; Krishnaswamy, S. V.; Zhang, Hong

2008-01-01

The potential to exploit single-walled carbon nanotubes (SWNTs) in advanced electronics represents a continuing, major source of interest in these materials. However, scalable integration of SWNTs into circuits is challenging because of difficulties in controlling the geometries, spatial positions, and electronic properties of individual tubes. We have implemented solutions to some of these challenges to yield radio frequency (RF) SWNT analog electronic devices, such as narrow band amplifiers operating in the VHF frequency band with power gains as high as 14 dB. As a demonstration, we fabricated nanotube transistor radios, in which SWNT devices provide all of the key functions, including resonant antennas, fixed RF amplifiers, RF mixers, and audio amplifiers. These results represent important first steps to practical implementation of SWNTs in high-speed analog circuits. Comparison studies indicate certain performance advantages over silicon and capabilities that complement those in existing compound semiconductor technologies. PMID:18227509

From Mars to Media: The Phoenix Mars Mission and the Challenges of Real-Time, Multimedia Science Communication and Public Education

NASA Astrophysics Data System (ADS)

Buxner, S.; Bitter, C.

2008-12-01

Although the Mars Exploration Rovers, Mars Reconnaissance Orbiter, and Mars Odyssey Missions set the standard for science communication and public education about Mars, the Phoenix Mission was presented with robust new communication challenges and opportunities. The new frontier includes Web 2.0, international forums, internal and external blogs, social networking sites, as well as the traditional media and education outlets for communicating science and information. We will explore the highlights and difficulties of managing the 'message from Mars' in our current multimedia saturated world while balancing authentic science discoveries, public expectations, and communication demands. Our goal is to create a more science savvy public and a more communication oriented science community for the future. The key issues are helping the public and our scientists distinguish between information and knowledge and managing the content that connects the two.

A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists.

PubMed

Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean

2017-11-28

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

Mapping remote and multidisciplinary learning barriers: lessons from challenge-based innovation at CERN

NASA Astrophysics Data System (ADS)

Jensen, Matilde Bisballe; Utriainen, Tuuli Maria; Steinert, Martin

2018-01-01

This paper presents the experienced difficulties of students participating in the multidisciplinary, remote collaborating engineering design course challenge-based innovation at CERN. This is with the aim to identify learning barriers and improve future learning experiences. We statistically analyse the rated differences between distinct design activities, educational background and remote vs. co-located collaboration. The analysis is based on a quantitative and qualitative questionnaire (N = 37). Our analysis found significant ranking differences between remote and co-located activities. This questions whether the remote factor might be a barrier for the originally intended learning goals. Further a correlation between analytical and converging design phases was identified. Hence, future facilitators are suggested to help students in the transition from one design phase to the next rather than only teaching methods in the individual design phases. Finally, we discuss how educators address the identified learning barriers when designing future courses including multidisciplinary or remote collaboration.

Health care globalization: a need for virtual leadership.

PubMed

Holland, J Brian; Malvey, Donna; Fottler, Myron D

2009-01-01

As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

Technical challenges and future direction for high-efficiency metal hydride thermal energy storage systems

NASA Astrophysics Data System (ADS)

Ward, Patrick A.; Corgnale, Claudio; Teprovich, Joseph A.; Motyka, Theodore; Hardy, Bruce; Sheppard, Drew; Buckley, Craig; Zidan, Ragaiy

2016-04-01

Recently, there has been increasing interest in thermal energy storage (TES) systems for concentrated solar power (CSP) plants, which allow for continuous operation when sunlight is unavailable. Thermochemical energy storage materials have the advantage of much higher energy densities than latent or sensible heat materials. Furthermore, thermochemical energy storage systems based on metal hydrides have been gaining great interest for having the advantage of higher energy densities, better reversibility, and high enthalpies. However, in order to achieve higher efficiencies desired of a thermal storage system by the US Department of Energy, the system is required to operate at temperatures >600 °C. Operation at temperatures >600 °C presents challenges including material selection, hydrogen embrittlement and permeation of containment vessels, appropriate selection of heat transfer fluids, and cost. Herein, the technical difficulties and proposed solutions associated with the use of metal hydrides as TES materials in CSP applications are discussed and evaluated.

Clinician Perspectives on Challenges to Patient Centered Care at the End of Life.

PubMed

Bardach, Shoshana H; Dunn, Edward J; Stein, J Christopher

2017-04-01

Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

System Identification for the Clipper Liberty C96 Wind Turbine

NASA Astrophysics Data System (ADS)

Showers, Daniel

System identification techniques are powerful tools that help improve modeling capabilities of real world dynamic systems. These techniques are well established and have been successfully used on countless systems in many areas. However, wind turbines provide a unique challenge for system identification because of the difficulty in measuring its primary input: wind. This thesis first motivates the problem by demonstrating the challenges with wind turbine system identification using both simulations and real data. It then suggests techniques toward successfully identifying a dynamic wind turbine model including the notion of an effective wind speed and how it might be measured. Various levels of simulation complexity are explored for insights into calculating an effective wind speed. In addition, measurements taken from the University of Minnesota's Clipper Liberty C96 research wind turbine are used for a preliminary investigation into the effective wind speed calculation and system identification of a real world wind turbine.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

PubMed

Becker, Torben K; Gausche-Hill, Marianne; Aswegan, Andrew L; Baker, Eileen F; Bookman, Kelly J; Bradley, Richard N; De Lorenzo, Robert A; Schoenwetter, David J

2013-10-01

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

'I feel like a salesperson': the effect of multiple-source care funding on the experiences and views of nursing home nurses in England.

PubMed

Thompson, Juliana; Cook, Glenda; Duschinsky, Robbie

2015-06-01

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses' reluctance to work in these settings are determined. This paper considers the influence that multiple-source care funding issues have on nursing home nurses' experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with 'selling beds'; and coping with self-funding residents' changing expectations of care. The findings of the study suggest that multiple-source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention. © 2014 John Wiley & Sons Ltd.

Sharing simulation-based training courses between institutions: opportunities and challenges.

PubMed

Laack, Torrey A; Lones, Ellen A; Schumacher, Donna R; Todd, Frances M; Cook, David A

2017-01-01

Sharing simulation-based training (SBT) courses between institutions could reduce time to develop new content but also presents challenges. We evaluate the process of sharing SBT courses across institutions in a mixed method study estimating the time required and identifying barriers and potential solutions. Two US academic medical institutions explored instructor experiences with the process of sharing four courses (two at each site) using personal interviews and a written survey and estimated the time needed to develop new content vs implement existing SBT courses. The project team spent approximately 618 h creating a collaboration infrastructure to support course sharing. Sharing two SBT courses was estimated to save 391 h compared with developing two new courses. In the qualitative analysis, participants noted the primary benefit of course sharing was time savings. Barriers included difficulty finding information and understanding overall course flow. Suggestions for improvement included establishing a standardized template, clearly identifying the target audience, providing a course overview, communicating with someone familiar with the original SBT course, employing an intuitive file-sharing platform, and considering local culture, context, and needs. Sharing SBT courses between institutions is feasible but not without challenges. An initial investment in a sharing infrastructure may facilitate downstream time savings compared with developing content de novo.

Fathering after military deployment: parenting challenges and goals of fathers of young children.

PubMed

Walsh, Tova B; Dayton, Carolyn J; Erwin, Michael S; Muzik, Maria; Busuito, Alexandra; Rosenblum, Katherine L

2014-02-01

Although often eagerly anticipated, reunification after deployment poses challenges for families, including adjusting to the parent-soldier's return, re-establishing roles and routines, and the potentially necessary accommodation to combat-related injuries or psychological effects. Fourteen male service members, previously deployed to a combat zone, parent to at least one child under seven years of age, were interviewed about their relationships with their young children. Principles of grounded theory guided data analysis to identify key themes related to parenting young children after deployment. Participants reported significant levels of parenting stress and identified specific challenges, including difficulty reconnecting with children, adapting expectations from military to family life, and coparenting. Fathers acknowledged regret about missing an important period in their child's development and indicated a strong desire to improve their parenting skills. They described a need for support in expressing emotions, nurturing, and managing their tempers. Results affirm the need for support to military families during reintegration and demonstrate that military fathers are receptive to opportunities to engage in parenting interventions. Helping fathers understand their children's behavior in the context of age-typical responses to separation and reunion may help them to renew parent-child relationships and reengage in optimal parenting of their young children.

'It makes the patient's spirit weaker': tuberculosis stigma and gender interaction in Dar es Salaam, Tanzania.

PubMed

Miller, C; Huston, J; Samu, L; Mfinanga, S; Hopewell, P; Fair, E

2017-11-01

Dar es Salaam, Tanzania. To describe tuberculosis (TB) related stigma and to understand how it interacts with gender to affect access to care. Eight focus group discussions were held among 48 TB patients and their household members, and a thematic content analysis was carried out. The main components of stigma were fear, self-isolation, ostracization, loss of status in the community, and discrimination by providers. Participants described the cultural context in which stigma operated as characterized by a general lack of health knowledge, cultural beliefs about TB, and engendered beliefs about disease in general. Both genders described some similar effects of stigma, including relationship difficulties and specifically challenges forming new relationships, but many effects of stigma were distinct by gender: women described challenges including assumptions about promiscuity and infidelity, as well as rejection by partners, while men described survival challenges. Stigma acted as a barrier to care through a cyclical pattern of stigma and fear, leading to health-seeking delays, with resulting continued transmission and poor health outcomes that further reinforced stigma. TB-related stigma is prevalent in this setting and operates differently for men and women. Interventions designed to increase case detection must address stigma and its interaction with gender.

Challenging Gait Conditions Predict 1-Year Decline in Gait Speed in Older Adults With Apparently Normal Gait

PubMed Central

Perera, Subashan; VanSwearingen, Jessie M.; Hile, Elizabeth S.; Wert, David M.; Studenski, Stephanie A.

2011-01-01

Background Mobility often is tested under a low challenge condition (ie, over a straight, uncluttered path), which often fails to identify early mobility difficulty. Tests of walking during challenging conditions may uncover mobility difficulty that is not identified with usual gait testing. Objective The purpose of this study was to determine whether gait during challenging conditions predicts decline in gait speed over 1 year in older people with apparently normal gait (ie, gait speed of ≥1.0 m/s). Design This was a prospective cohort study. Methods Seventy-one older adults (mean age=75.9 years) with a usual gait speed of ≥1.0 m/s participated. Gait was tested at baseline under 4 challenging conditions: (1) narrow walk (15 cm wide), (2) stepping over obstacles (15.24 cm [6 in] and 30.48 cm [12 in]), (3) simple walking while talking (WWT), and (4) complex WWT. Usual gait speed was recorded over a 4-m course at baseline and 1 year later. A 1-year change in gait speed was calculated, and participants were classified as declined (decreased ≥0.10 m/s, n=18), stable (changed <0.10 m/s, n=43), or improved (increased ≥0.10 m/s, n=10). Analysis of variance was used to compare challenging condition cost (usual − challenging condition gait speed difference) among the 3 groups. Results Participants who declined in the ensuing year had a greater narrow walk and obstacle walk cost than those who were stable or who improved in gait speed (narrow walk cost=0.43 versus 0.33 versus 0.22 m/s and obstacle walk cost=0.35 versus 0.26 versus 0.13 m/s). Simple and complex WWT cost did not differ among the groups. Limitations The participants who declined in gait speed over time walked the fastest, and those who improved walked the slowest at baseline; thus, the potential contribution of regression to the mean to the findings should not be overlooked. Conclusions In older adults with apparently normal gait, the assessment of gait during challenging conditions appears to uncover mobility difficulty that is not identified by usual gait testing. PMID:22003167

Science-policy challenges for biodiversity, public health and urbanization: examples from Belgium

NASA Astrophysics Data System (ADS)

Keune, H.; Kretsch, C.; De Blust, G.; Gilbert, M.; Flandroy, L.; Van den Berge, K.; Versteirt, V.; Hartig, T.; De Keersmaecker, L.; Eggermont, H.; Brosens, D.; Dessein, J.; Vanwambeke, S.; Prieur-Richard, A. H.; Wittmer, H.; Van Herzele, A.; Linard, C.; Martens, P.; Mathijs, E.; Simoens, I.; Van Damme, P.; Volckaert, F.; Heyman, P.; Bauler, T.

2013-06-01

Internationally, the importance of a coordinated effort to protect both biodiversity and public health is more and more recognized. These issues are often concentrated or particularly challenging in urban areas, and therefore on-going urbanization worldwide raises particular issues both for the conservation of living natural resources and for population health strategies. These challenges include significant difficulties associated with sustainable management of urban ecosystems, urban development planning, social cohesion and public health. An important element of the challenge is the need to interface between different forms of knowledge and different actors from science and policy. We illustrate this with examples from Belgium, showcasing concrete cases of human-nature interaction. To better tackle these challenges, since 2011, actors in science, policy and the broader Belgian society have launched a number of initiatives to deal in a more integrated manner with combined biodiversity and public health challenges in the face of ongoing urbanization. This emerging community of practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges must be built between science and the complex biodiversity/ecosystem-human/public health-urbanization phenomena. (2) Bridges between different professional communities and disciplines are urgently needed. (3) Closer collaboration between science and policy, and between science and societal practice is needed. Moreover, within each of these communities closer collaboration between specialized sections is needed.

Online and offline awareness deficits: Anosognosia for spatial neglect.

PubMed

Chen, Peii; Toglia, Joan

2018-04-12

Anosognosia for spatial neglect (ASN) can be offline or online. Offline ASN is general unawareness of having experienced spatial deficits. Online ASN is an awareness deficit of underestimating spatial difficulties that likely to occur in an upcoming task (anticipatory ASN) or have just occurred during the task (emergent ASN). We explored the relationships among spatial neglect, offline ASN, anticipatory ASN, and emergent ASN. Research Method/Design: Forty-four survivors of stroke answered questionnaires assessing offline and online self-awareness of spatial problems. The online questionnaire was asked immediately before and after each of 4 tests for spatial neglect, including shape cancellation, address and sentence copying, telephone dialing, and indented paragraph reading. Participants were certain they had difficulties in daily spatial tasks (offline awareness), in the task they were about to perform (anticipatory awareness) and had just performed (emergent awareness). Nonetheless, they consistently overestimated their spatial abilities, indicating ASN. Offline and online ASN appeared independent. Online ASN improved after task execution. Neglect severity was not positively correlated with offline ASN. Greater neglect severity correlated with both greater anticipatory and emergent ASN. Regardless of neglect severity, we found task-specific differences in emergent ASN but not in anticipatory ASN. Individuals with spatial neglect acknowledge their spatial difficulty (certainty of error occurrence) but may not necessarily recognize the extent of their difficulty (accuracy of error estimation). Our findings suggest that offline and online ASN are independent. A potential implication from the study is that familiar and challenging tasks may facilitate emergence of self-awareness. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

PubMed Central

de Zambotti, Massimiliano; Colrain, Ian M; Bei, Bei

2018-01-01

A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs) and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment approaches and management options, including combination treatments, ranging from cognitive behavioral therapy for insomnia to hormonal and nonhormonal pharmacological options. Emerging studies suggest that the impact of severe insomnia symptoms could extend beyond immediate health care usage and quality of life issues to long-term mental and physical health, if left untreated in midlife women. Appropriate treatment, therefore, has immediate benefit as well as advantages for maintaining optimal health in the postmenopausal years. PMID:29445307

Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment.

PubMed

Davidson, Claire; O'Hare, Anne; Mactaggart, Fiona; Green, Jonathan; Young, David; Gillberg, Christopher; Minnis, Helen

2015-05-01

Autism Spectrum Disorder (ASD) versus Reactive Attachment Disorder (RAD) is a common diagnostic challenge for clinicians due to overlapping difficulties with social relationships. RAD is associated with neglect or maltreatment whereas ASD is not: accurate differential diagnosis is therefore critical. Very little research has investigated the relationship between the two, and it is unknown if standardised measures are able to discriminate between ASD and RAD. The current study aimed to address these issues. Fifty eight children with ASD, and no history of maltreatment, were group matched on age with 67 children with RAD. Group profiles on multi-informant measures of RAD were investigated and group differences explored. Discriminant function analysis determined assessment features that best discriminated between the two groups. Although, according to parent report, children with ASD presented with significantly fewer indiscriminate friendliness behaviours compared to the RAD group (p<0.001), 36 children with ASD appeared to meet core RAD criteria. However, structured observation clearly demonstrated that features were indicative of ASD and not RAD for all but 1 of these 36 children. Children with RAD and children with ASD may demonstrate similar social relationship difficulties but there appears to be a difference in the social quality of the interactions between the groups. In most cases it was possible to differentiate between children with ASD and children with RAD via structured observation. Nevertheless, for a small proportion of children with ASD, particularly those whose difficulties may be more subtle, our current standardised measures, including structured observation, may not be effective in differentiating RAD from ASD. Copyright © 2015. Published by Elsevier Ltd.

Mechanism for excitation-dependent photoluminescence from graphene quantum dots and other graphene oxide derivates: consensus, debates and challenges

NASA Astrophysics Data System (ADS)

Gan, Zhixing; Xu, Hao; Hao, Yanling

2016-04-01

Luminescent nanomaterials, with wide applications in biosensing, bioimaging, illumination and display techniques, have been consistently garnering enormous research attention. In particular, those with wavelength-controllable emissions could be highly beneficial. Carbon nanostructures, including graphene quantum dots (GQDs) and other graphene oxide derivates (GODs), with excitation-dependent photoluminescence (PL), which means their fluorescence color could be tuned simply by changing the excitation wavelength, have attracted lots of interest. However the intrinsic mechanism for the excitation-dependent PL is still obscure and fiercely debated presently. In this review, we attempt to summarize the latest efforts to explore the mechanism, including the quantum confinement effect, surface traps model, giant red-edge effect, edge states model and electronegativity of heteroatom model, as well as the newly developed synergistic model, to seek some clues to unravel the mechanism. Meanwhile the controversial difficulties for each model are further discussed. Besides this, the challenges and potential influences of the synthetic methodology and development of the materials are illustrated extensively to elicit more thought and constructive attempts toward their application.

Dengue vaccine development: strategies and challenges.

PubMed

Ramakrishnan, Lakshmy; Pillai, Madhavan Radhakrishna; Nair, Radhakrishnan R

2015-03-01

Infection with dengue virus may result in dengue fever or a more severe outcome, such as dengue hemorrhagic syndrome/shock. Dengue virus infection poses a threat to endemic regions for four reasons: the presence of four serotypes, each with the ability to cause a similar disease outcome, including fatality; difficulties related to vector control; the lack of specific treatment; and the nonavailability of a suitable vaccine. Vaccine development is considered challenging due to the severity of the disease observed in individuals who have acquired dengue-specific immunity, either passively or actively. Therefore, the presence of vaccine-induced immunity against a particular serotype may prime an individual to severe disease on exposure to dengue virus. Vaccine development strategies include live attenuated vaccines, chimeric, DNA-based, subunit, and inactivated vaccines. Each of the candidates is in various stages of preclinical and clinical development. Issues pertaining to selection pressures, viral interaction, and safety still need to be evaluated in order to induce a complete protective immune response against all four serotypes. This review highlights the various strategies that have been employed in vaccine development, and identifies the obstacles to producing a safe and effective vaccine.

Animal models of post-ischemic forced use rehabilitation: methods, considerations, and limitations

PubMed Central

2013-01-01

Many survivors of stroke experience arm impairments, which can severely impact their quality of life. Forcing use of the impaired arm appears to improve functional recovery in post-stroke hemiplegic patients, however the mechanisms underlying improved recovery remain unclear. Animal models of post-stroke rehabilitation could prove critical to investigating such mechanisms, however modeling forced use in animals has proven challenging. Potential problems associated with reported experimental models include variability between stroke methods, rehabilitation paradigms, and reported outcome measures. Herein, we provide an overview of commonly used stroke models, including advantages and disadvantages of each with respect to studying rehabilitation. We then review various forced use rehabilitation paradigms, and highlight potential difficulties and translational problems. Lastly, we discuss the variety of functional outcome measures described by experimental researchers. To conclude, we outline ongoing challenges faced by researchers, and the importance of translational communication. Many stroke patients rely critically on rehabilitation of post-stroke impairments, and continued effort toward progression of rehabilitative techniques is warranted to ensure best possible treatment of the devastating effects of stroke. PMID:23343500

Barriers to weight-related health behaviours: a qualitative comparison of the socioecological conditions between pregnant and post-partum low-income women

PubMed Central

Uesugi, Keriann; Olson, Christine

2015-01-01

The association between socio-ecological factors and poor health outcomes for low-income women and their children has been the focus of disparities research for several decades. This research compares the socio-ecological conditions among low-income women from pregnancy to postpartum and highlights the factors that make weight management increasingly difficult after delivery. As part of the formative research for an online health intervention, group and individual interviews were conducted with low-income pregnant and postpartum women. Five pregnancy group interviews (n=15 women), five postpartum group interviews (n=23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, NY. All interviews were audio-recorded. The constant comparative method was used to code interview notes and identify emergent themes. Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy-weight behaviors. These included unemployment, relationship issues, minimal social support, lack of education, limited healthcare access, pre-existing medical conditions and neighborhood disadvantage. Compared to pregnant women, postpartum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and postpartum related to the family’s medical problems and greater environmental constraints. Many factors detracted from women’s capacity to engage in healthy-weight behaviors postpartum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional postpartum challenges need to be considered in designing programs, policies and interventions that promote healthy weight. PMID:25040706

True Confessions.

ERIC Educational Resources Information Center

Zielinski, Dave

2001-01-01

Four "virtual trainers" describe the challenges and successes of providing web-based training and give advice on planning coursework, timing instruction, distinguishing between skills training and information sharing, troubleshooting technology difficulties, and adapting to increased workload. (SK)

Significant Figures in Measurements with Uncertainty: A Working Criterion

NASA Astrophysics Data System (ADS)

Vilchis, Abraham

2017-03-01

Generally speaking, students have difficulty reporting out measurements and estimates of quantities used in the laboratory, and with handling the significant figures associated with them. When required to make calculation involving quantities with different numbers of significant figures, they have difficulty in assigning the corresponding digits to the final result. When in addition, the quantities have uncertainty, the operations entailed pose an even greater challenge. The article advocates for some working rules for students (and teachers) in an effort to combat this problem.

Psychiatry, subjectivity and emotion - deepening the medical model

PubMed Central

Yakeley, Jessica; Hale, Rob; Johnston, James; Kirtchuk, Gabriel; Shoenberg, Peter

2014-01-01

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty. PMID:25237517

Teaching evolution in the Australian classroom

NASA Astrophysics Data System (ADS)

Vozzo, Les

A summary of the key issues of controversy encountered by science teachers in Australian classrooms. Evolution, cloning and gene manipulation, fertility control, artificial intelligence, irradiation of food, the use of nuclear energy, radiation from powerlines are some of the topics discussed and debated in classrooms. What are some of the difficulties encountered by teachers when students ask questions that raise moral dilemmas and challenges entrenched beliefs and views of the world. What are some of the teaching strategies used that deal with these difficulties.

Atmospheric Flux Computations in Complex Terrain

NASA Technical Reports Server (NTRS)

Smith, Paul L.; Kopp, Fred J.; Orville, Harold D.

2000-01-01

The greatest challenges in applying atmospheric water budget expressions are in determining the divergence and evapotranspiration terms. The evapotranspiration problem is ubiquitous, and critical issues of spatial and temporal resolution commonly arise in establishing the divergence term. In complex terrain, further difficulties crop up in using typical data on atmospheric profiles of water vapor and wind to estimate the divergence term. Those difficulties are the subject of this paper; considerations related to topographic variations both along and normal to the flow direction are treated.

Challenges Associated With Applying Physiologically Based Pharmacokinetic Modeling for Public Health Decision-Making.

PubMed

Tan, Yu-Mei; Worley, Rachel R; Leonard, Jeremy A; Fisher, Jeffrey W

2018-04-01

The development and application of physiologically based pharmacokinetic (PBPK) models in chemical toxicology have grown steadily since their emergence in the 1980s. However, critical evaluation of PBPK models to support public health decision-making across federal agencies has thus far occurred for only a few environmental chemicals. In order to encourage decision-makers to embrace the critical role of PBPK modeling in risk assessment, several important challenges require immediate attention from the modeling community. The objective of this contemporary review is to highlight 3 of these challenges, including: (1) difficulties in recruiting peer reviewers with appropriate modeling expertise and experience; (2) lack of confidence in PBPK models for which no tissue/plasma concentration data exist for model evaluation; and (3) lack of transferability across modeling platforms. Several recommendations for addressing these 3 issues are provided to initiate dialog among members of the PBPK modeling community, as these issues must be overcome for the field of PBPK modeling to advance and for PBPK models to be more routinely applied in support of public health decision-making.

SAMPL4 & DOCK3.7: lessons for automated docking procedures

NASA Astrophysics Data System (ADS)

Coleman, Ryan G.; Sterling, Teague; Weiss, Dahlia R.

2014-03-01

The SAMPL4 challenges were used to test current automated methods for solvation energy, virtual screening, pose and affinity prediction of the molecular docking pipeline DOCK 3.7. Additionally, first-order models of binding affinity were proposed as milestones for any method predicting binding affinity. Several important discoveries about the molecular docking software were made during the challenge: (1) Solvation energies of ligands were five-fold worse than any other method used in SAMPL4, including methods that were similarly fast, (2) HIV Integrase is a challenging target, but automated docking on the correct allosteric site performed well in terms of virtual screening and pose prediction (compared to other methods) but affinity prediction, as expected, was very poor, (3) Molecular docking grid sizes can be very important, serious errors were discovered with default settings that have been adjusted for all future work. Overall, lessons from SAMPL4 suggest many changes to molecular docking tools, not just DOCK 3.7, that could improve the state of the art. Future difficulties and projects will be discussed.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

More than Meets the Eye - Infrared Cameras in Open-Ended University Thermodynamics Labs

NASA Astrophysics Data System (ADS)

Melander, Emil; Haglund, Jesper; Weiszflog, Matthias; Andersson, Staffan

2016-12-01

Educational research has found that students have challenges understanding thermal science. Undergraduate physics students have difficulties differentiating basic thermal concepts, such as heat, temperature, and internal energy. Engineering students have been found to have difficulties grasping surface emissivity as a thermal material property. One potential source of students' challenges with thermal science is the lack of opportunity to visualize energy transfer in intuitive ways with traditional measurement equipment. Thermodynamics laboratories have typically depended on point measures of temperature by use of thermometers (detecting heat conduction) or pyrometers (detecting heat radiation). In contrast, thermal imaging by means of an infrared (IR) camera provides a real-time, holistic image. Here we provide some background on IR cameras and their uses in education, and summarize five qualitative investigations that we have used in our courses.

Educator perspectives on the postsecondary transition difficulties of students with autism.

PubMed

Elias, Rebecca; Muskett, Ashley E; White, Susan W

2017-10-01

Addressing the challenges of adolescents and emerging adults with autism spectrum disorder is crucial to improving the outcomes of these students in the postsecondary setting. Although secondary and postsecondary educators and staff are critical to helping these students access services, there has been little investigation into the perspectives of this stakeholder group, with respect to the needs of postsecondary students with autism spectrum disorder. A series of focus groups was conducted with secondary and postsecondary educators to understand educator perspectives related to the challenges faced by postsecondary students with autism spectrum disorder. Competence, autonomy and independence, and the development and sustainment of interpersonal relationships emerged as primary areas of difficulty and corresponding need. Results suggest that targeted interventions addressing these areas should be implemented, prior to and during enrollment in a postsecondary setting, to facilitate transition in a comprehensive manner.

A narrow view: The conceptualization of sexual problems in human sexuality textbooks.

PubMed

Stelzl, Monika; Stairs, Brittany; Anstey, Hannah

2018-02-01

This study examined the ways in which the meaning of 'sexual problems' is constructed and defined in undergraduate human sexuality textbooks. Drawing on feminist and critical discourse frameworks, the dominant as well as the absent/marginalized discourses were identified using critical discourse analysis. Sexual difficulties were largely framed by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Thus, medical discourse was privileged. Alternative conceptualizations and frameworks, such as the New View of Women's Sexual Problems, were included marginally and peripherally. We argue that current constructions of sexuality knowledge reinforce, rather than challenge, existing hegemonic discourses of sexuality.

Skin microbiome: genomics-based insights into the diversity and role of skin microbes

PubMed Central

Kong, Heidi H.

2011-01-01

Recent advances in DNA sequencing methodology have enabled studies of human skin microbes that circumvent difficulties in isolating and characterizing fastidious microbes. Sequence-based approaches have identified greater diversity of cutaneous bacteria than studies using traditional cultivation techniques. However, improved sequencing technologies and analytical methods are needed to study all skin microbes, including bacteria, archaea, fungi, viruses, and mites, and how they interact with each other and their human hosts. This review discusses current skin microbiome research, with a primary focus on bacteria, and the challenges facing investigators striving to understand how skin micro-organisms contribute to health and disease. PMID:21376666

Biodiversity and parasites of wildlife: helminths of Australasian marsupials.

PubMed

Beveridge, Ian; Spratt, David M

2015-04-01

Despite current attempts to document the extent of biodiversity on Earth, significant problems exist in fully documenting the helminth parasites of wildlife. Using the Australasian marsupials as an example, we examine some of these difficulties, including challenges in collecting uncommon host species, the ongoing description of new species of marsupials, the presence of cryptic species, and the decline in taxonomic expertise in Australia. Although optimistic global predictions have been made concerning the rate of discovery and description of new species of animals, these predictions may not apply in the case of specific groups of animals such as the Australasian marsupials. Copyright © 2014 Elsevier Ltd. All rights reserved.

Rethinking the Role of Pedagogical Assistants: Establishing Cooperation between Roma Families and Schools in Serbia

ERIC Educational Resources Information Center

Starcevic, Jelena; Dimitrijevic, Bojana; Macura-Milovanovic, Suncica

2016-01-01

The aim of the present paper is to examine the risks and challenges related to the cooperation of pedagogical assistants (PAs) with Roma parents/families and their work with Roma pupils, as well as to offer further insight into ways to overcome these risks and challenges. Roma pupils and parents/families face numerous difficulties in education,…

New Ethical Challenges within Environmental and Sustainability Education: A Response

ERIC Educational Resources Information Center

Todd, Sharon

2016-01-01

One of the major points to grow out of the four papers presented in this issue is how to think of education in relation to the various challenges facing the biosphere, facing the future of human and other than human life forms, and facing the sheer difficulties of planning what to do about them. The differences in the role of education, of course,…

English Language and Literature in the Post-War Bosnia and Herzegovina: Challenges and Experiences of a Transcultural Academic Adaptation

ERIC Educational Resources Information Center

Bal, Mustafa

2012-01-01

This paper presents an account of the author's firsthand experiences between 2006 and 2010, relating to his involvement in the establishment of the English Language and Literature department at the International University of Sarajevo in Bosnia and Herzegovina, and of the difficulties and challenges of the venture in the post-war country, whose…

Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services.

PubMed

Barron, Diana A; Molosankwe, Iris; Romeo, Renee; Hassiotis, Angela

2013-05-01

Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services. © 2013 Blackwell Publishing Ltd.

Challenging Behavior in Smith-Lemli-Opitz Syndrome: Initial Test of Biobehavioral Influences

PubMed Central

Freeman, Kurt A.; Eagle, Rose; Merkens, Louise S.; Sikora, Darryn; Pettit-Kekel, Kersti; Nguyen-Driver, Mina; Steiner, Robert D.

2013-01-01

Objective To study challenging behavior (destruction, aggression, self-injury, stereotypy) in children with Smith-Lemli-Opitz syndrome (SLOS) using a biobehavioral model that helps distinguish biological from socially mediated variables influencing the behavior. Background SLOS is an autosomal-recessive syndrome of multiple malformations and intellectual disability resulting from a genetic error in cholesterol synthesis in all cells and tissues, including brain. The exact cause of the challenging behavior in SLOS is unclear, but defective brain cholesterol synthesis may contribute. Because the precise genetic and biochemical etiology of SLOS is known, this disorder is a good model for studying biological causes of challenging behavior. Method In a preliminary application of a biobehavioral model, we studied the association between cholesterol levels (as a biochemical indicator of disease severity) and behavior subtype (“biological” vs “learned”) in 13 children with SLOS. Parents completed a questionnaire that categorized challenging behavior as influenced primarily by social or nonsocial (thus, presumably biological) factors. Results The severity of the cholesterol synthesis defect correlated significantly with behavior subtype classification for 1 of 2 challenging behaviors. Greater severity of the cholesterol synthesis defect was associated with behavior being classified as primarily influenced by biological factors. Conclusion The interplay between challenging behavior and defective cholesterol synthesis in SLOS may help explain biological influences on the behavior. Our findings have implications for research on the effectiveness of behavioral and medical treatments for behavioral difficulties in SLOS and other neurodevelopmental disorders. PMID:23538569

Developmental coordination disorders and sensory processing and integration: Incidence, associations and co-morbidities.

PubMed

Allen, Susan; Casey, Jackie

2017-09-01

Children with developmental coordination disorder or sensory processing and integration difficulties face challenges to participation in daily living. To date there has been no exploration of the co-occurrence of developmental coordination disorders and sensory processing and integration difficulties. Records of children meeting Diagnostic and Statistical Manual - V criteria for developmental coordination disorder ( n  = 93) age 5 to 12 years were examined. Data on motor skills (Movement Assessment Battery for Children - 2) and sensory processing and integration (Sensory Processing Measure) were interrogated. Of the total sample, 88% exhibited some or definite differences in sensory processing and integration. No apparent relationship was observed between motor coordination and sensory processing and integration. The full sample showed high rates of some difficulties in social participation, hearing, body awareness, balance and motion, and planning and ideation. Further, children with co-morbid autistic spectrum disorder showed high rates of difficulties with touch and vision. Most, but not all, children with developmental coordination disorder presented with some difficulties in sensory processing and integration that impacted on their participation in everyday activities. Sensory processing and integration difficulties differed significantly between those with and without co-morbid autistic spectrum disorder.

Challenges and Strategies for Proteome Analysis of the Interaction of Human Pathogenic Fungi with Host Immune Cells.

PubMed

Krüger, Thomas; Luo, Ting; Schmidt, Hella; Shopova, Iordana; Kniemeyer, Olaf

2015-12-14

Opportunistic human pathogenic fungi including the saprotrophic mold Aspergillus fumigatus and the human commensal Candida albicans can cause severe fungal infections in immunocompromised or critically ill patients. The first line of defense against opportunistic fungal pathogens is the innate immune system. Phagocytes such as macrophages, neutrophils and dendritic cells are an important pillar of the innate immune response and have evolved versatile defense strategies against microbial pathogens. On the other hand, human-pathogenic fungi have sophisticated virulence strategies to counteract the innate immune defense. In this context, proteomic approaches can provide deeper insights into the molecular mechanisms of the interaction of host immune cells with fungal pathogens. This is crucial for the identification of both diagnostic biomarkers for fungal infections and therapeutic targets. Studying host-fungal interactions at the protein level is a challenging endeavor, yet there are few studies that have been undertaken. This review draws attention to proteomic techniques and their application to fungal pathogens and to challenges, difficulties, and limitations that may arise in the course of simultaneous dual proteome analysis of host immune cells interacting with diverse morphotypes of fungal pathogens. On this basis, we discuss strategies to overcome these multifaceted experimental and analytical challenges including the viability of immune cells during co-cultivation, the increased and heterogeneous protein complexity of the host proteome dynamically interacting with the fungal proteome, and the demands on normalization strategies in terms of relative quantitative proteome analysis.

Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment

PubMed Central

Wilkins, Megan M.; Basseches, Benjamin; Schwartz, Joel B.; Kerman, Karen; Trask, Christine; Brideau, Holly; Crisco, Joseph J.

2016-01-01

Background Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. Objective The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. Design This was a cross-sectional study of 21 children (12 male, 9 female; 4–12 years of age) with UEMIs. Methods All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. Results Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. Limitations The reported results may not be representative of children with more severe UEMIs. Conclusions These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs. PMID:27197824

Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment.

PubMed

Wilcox, Bethany J; Wilkins, Megan M; Basseches, Benjamin; Schwartz, Joel B; Kerman, Karen; Trask, Christine; Brideau, Holly; Crisco, Joseph J

2016-11-01

Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. This was a cross-sectional study of 21 children (12 male, 9 female; 4-12 years of age) with UEMIs. All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. The reported results may not be representative of children with more severe UEMIs. These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs. © 2016 American Physical Therapy Association.

'I still have no idea why this patient was here': An exploration of the difficulties GP trainees experience when gathering information.

PubMed

Giroldi, Esther; Veldhuijzen, Wemke; de Leve, Tijme; van der Weijden, Trudy; Bueving, Herman; van der Vleuten, Cees

2015-07-01

Collecting information during patient encounters is essential for the delivery of patient-centered care. To obtain insight into areas that require more attention in medical communication training, this study explores what difficulties GP trainees encounter when gathering information. In this phenomenological study, we observed a morning clinic of 15 GP trainees. To explore trainees' experiences with information-gathering, we held brief interviews after every consultation and a lengthier interview directly after the morning clinic. The resulting data were analyzed using template analysis. From trainees' reflections, we distilled five difficulties that trainees experience when gathering information: (1) Goal conflicts; (2) Ineffectiveness of trained communication skills in specific situations; (3) Trainees' distress hampers open communication; (4) Untrustworthy information; (5) Tunnel vision. Information-gathering is difficult for GP trainees. Current generic communication skills training does not seem to support trainees sufficiently to handle effectively the challenges they encounter during consultations. Medical communication training needs to support trainees in handling their goal-conflicts and feelings that hamper information-gathering, while also providing them with communication strategies adapted to handling specific challenging situations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Perceived Challenges in Primary Literature in a Master's Class: Effects of Experience and Instruction.

PubMed

Lie, Richard; Abdullah, Christopher; He, Wenliang; Tour, Ella

Primary literature offers rich opportunities to teach students how to "think like a scientist," but the challenges students face when they attempt to read research articles are not well understood. Here, we present an analysis of what master's students perceive as the most challenging aspects of engaging with primary literature. We examined 69 pairs of pre- and postcourse responses from students enrolled in a master's-level course that offered a structured analysis of primary literature. On the basis of these responses, we identified six categories of challenges. Before instruction, "techniques" and "experimental data" were the most frequently identified categories of challenges. The majority of difficulties students perceived in the primary literature corresponded to Bloom's lower-order cognitive skills. After instruction, "conclusions" were identified as the most difficult aspect of primary literature, and the frequency of challenges that corresponded to higher-order cognitive skills increased significantly among students who reported less experience with primary literature. These changes are consistent with a more competent perception of the primary literature, in which these students increasingly focus on challenges requiring critical thinking. Students' difficulties identified here can inform the design of instructional approaches aimed to teach students how to critically read scientific papers. © 2016 R. Lie, C. Abdullah, et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Conducting health survey research in a deep rural South African community: challenges and adaptive strategies

PubMed Central

2013-01-01

Background In many parts of the developing world, rural health requires focused policy attention, informed by reliable, representative health data. Yet there is surprisingly little published material to guide health researchers who face the unique set of hurdles associated with conducting field research in remote rural areas. Methods In this paper we provide a detailed description of the key challenges encountered during health survey field research carried out in 2010 in a deep rural site in KwaZulu-Natal, South Africa. The aim of the field research was to collect data on the health of children aged 10 to 17 years old, and their primary adult caregivers, as part of a larger national health survey; the research was a collaboration between several South African and foreign universities, South African national government departments, and various NGO partners. In presenting each of the four fieldwork challenges encountered on this site, we describe the initial planning decisions made, the difficulties faced when implementing these in the field, and the adaptive strategies we used to respond to these challenges. We reflect on learnings of potential relevance for the research community. Results Our four key fieldwork challenges were scarce research capacity, staff relocation tensions, logistical constraints, and difficulties related to community buy-in. Addressing each of these obstacles required timely assessment of the situation and adaptation of field plans, in collaboration with our local NGO partner. Adaptive strategies included a greater use of local knowledge; the adoption of tribal authority boundaries as the smallest geopolitical units for sampling; a creative developmental approach to capacity building; and planned, on-going engagement with multiple community representatives. Conclusions We argue that in order to maintain high scientific standards of research and manage to ‘get the job done’ on the ground, it is necessary to respond to fieldwork challenges that arise as a cohesive team, with timely, locally-relevant, and often creative, solutions. Budgeting sufficient time and project resources for capacity building and community buy-in processes is also essential when working in remote communities unaccustomed to research. Documenting and sharing field experiences can provide valuable information for other researchers planning to conduct fieldwork in similar contexts. PMID:23618363

Measuring urgency in clinical practice.

PubMed

Dmochowski, Roger R; FitzGerald, Mary P; Wyndaele, Jean-Jacques

2009-12-01

The study of urinary urgency is challenging for a number of reasons, including our lack of understanding of the normal physiology of urinary sensation and the pathophysiology of abnormal sensation. Issues with nomenclature and lack of agreement about the nature of the experience of normal and abnormal urinary sensation add to this difficulty. Review of published literature and critique. Currently available tools for measurement of urgency include validated questionnaires that describe the severity of urgency and its impact on quality of life, modified bladder diaries, body maps of urgency, and measures of urinary sensation during filling cystometry. All these provide some information about the experience of urinary urgency, but no single measure currently captures its multidimensional nature. Measurement of urgency in clinical practice and indeed the optimal treatment strategy has yet to come of age.

The epidemiology of bovine respiratory disease: What is the evidence for preventive measures?

PubMed Central

Taylor, Jared D.; Fulton, Robert W.; Lehenbauer, Terry W.; Step, Douglas L.; Confer, Anthony W.

2010-01-01

Bovine respiratory disease (BRD) is the most common and costly disease of beef cattle in North America. Despite extensive research, industry practices are often more informed by dogma than by fact. Frequently advocated interventions, including vaccination, various processing procedures, and nutritional manipulation, have limited impact on morbidity and mortality. Evidence for use of oral antimicrobials, either in feed or water, appears to be equivocal. In contrast, preconditioning and metaphylaxis have significant scientific evidence of efficacy, with weaning prior to sale potentially being the most important component of preconditioning. The inability to reach more definitive conclusions in preventing BRD may be attributable to difficulties in investigating the disease. Study challenges include potential for extensive confounding, tremendous variability, the multi-factorial nature of the disease, and inadequate methods for diagnosis. PMID:21358927

State Policies on Service Dogs for Military Veterans.

PubMed

Reed, James B

2015-12-01

U.S. service members returning home from combat often face physical, mental and emotional challenges. Providing service dogs to these veterans is one method being used successfully to help address the difficulties they face. Under the federal Americans with Disabilities Act (ADA), a service animal is defined as "any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual or other mental disability." The work the dog undertakes must be directly related to the person's disability. Examples include guiding people who are blind, pulling a wheelchair, alerting a person with hearing loss, protecting a person having a seizure, and calming someone with post-traumatic stress disorder (PTSD) during an anxiety attack or psychiatric episode.

Initiatives to improve feedback culture in the final year of a veterinary program.

PubMed

Warman, Sheena M; Laws, Emma J; Crowther, Emma; Baillie, Sarah

2014-01-01

Despite the recognized importance of feedback in education, student satisfaction with the feedback process in medical and veterinary programs is often disappointing. We undertook various initiatives to try to improve the feedback culture in the final clinical year of the veterinary program at the University of Bristol, focusing on formative verbal feedback. The initiatives included E-mailed guidelines to staff and students, a faculty development workshop, and a reflective portfolio task for students. Following these initiatives, staff and students were surveyed regarding their perceptions of formative feedback in clinical rotations, and focus groups were held to further explore issues. The amount of feedback appeared to have increased, along with improved recognition of feedback by students and increased staff confidence and competence in the process. Other themes that emerged included inconsistencies in feedback among staff and between rotations; difficulties with giving verbal feedback to students, particularly when it relates to professionalism; the consequences of feedback for both staff and students; changes and challenges in students' feedback-seeking behavior; and the difficulties in providing accurate, personal end-of-rotation assessments. This project has helped improve the feedback culture within our clinics; the importance of sustaining and further developing the feedback culture is discussed in this article.

Examining organizational change in primary care practices: experiences from using ethnographic methods.

PubMed

Russell, Grant; Advocat, Jenny; Geneau, Robert; Farrell, Barbara; Thille, Patricia; Ward, Natalie; Evans, Samantha

2012-08-01

Qualitative methods are an important part of the primary care researcher's toolkit providing a nuanced view of the complexity in primary care reform and delivery. Ethnographic research is a comprehensive approach to qualitative data collection, including observation, in-depth interviews and document analysis. Few studies have been published outlining methodological issues related to ethnography in this setting. This paper examines some of the challenges of conducting an ethnographic study in primary care setting in Canada, where there recently have been major reforms to traditional methods of organizing primary care services. This paper is based on an ethnographic study set in primary care practices in Ontario, Canada, designed to investigate changes to organizational and clinical routines in practices undergoing transition to new, interdisciplinary Family Health Teams (FHTs). The study was set in six new FHTs in Ontario. This paper is a reflexive examination of some of the challenges encountered while conducting an ethnographic study in a primary care setting. Our experiences in this study highlight some potential benefits of and difficulties in conducting an ethnographic study in family practice. Our study design gave us an opportunity to highlight the changes in routines within an organization in transition. A study with a clinical perspective requires training, support, a mixture of backgrounds and perspectives and ongoing communication. Despite some of the difficulties, the richness of this method has allowed the exploration of a number of additional research questions that emerged during data analysis.

The IDEA model: A single equation approach to the Ebola forecasting challenge.

PubMed

Tuite, Ashleigh R; Fisman, David N

2018-03-01

Mathematical modeling is increasingly accepted as a tool that can inform disease control policy in the face of emerging infectious diseases, such as the 2014-2015 West African Ebola epidemic, but little is known about the relative performance of alternate forecasting approaches. The RAPIDD Ebola Forecasting Challenge (REFC) tested the ability of eight mathematical models to generate useful forecasts in the face of simulated Ebola outbreaks. We used a simple, phenomenological single-equation model (the "IDEA" model), which relies only on case counts, in the REFC. Model fits were performed using a maximum likelihood approach. We found that the model performed reasonably well relative to other more complex approaches, with performance metrics ranked on average 4th or 5th among participating models. IDEA appeared better suited to long- than short-term forecasts, and could be fit using nothing but reported case counts. Several limitations were identified, including difficulty in identifying epidemic peak (even retrospectively), unrealistically precise confidence intervals, and difficulty interpolating daily case counts when using a model scaled to epidemic generation time. More realistic confidence intervals were generated when case counts were assumed to follow a negative binomial, rather than Poisson, distribution. Nonetheless, IDEA represents a simple phenomenological model, easily implemented in widely available software packages that could be used by frontline public health personnel to generate forecasts with accuracy that approximates that which is achieved using more complex methodologies. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.

GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

PubMed Central

Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

2011-01-01

Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

Challenges and opportunities: using a science-based video game in secondary school settings

NASA Astrophysics Data System (ADS)

Muehrer, Rachel; Jenson, Jennifer; Friedberg, Jeremy; Husain, Nicole

2012-12-01

Simulations and games are not new artifacts to the study of science in secondary school settings (Hug, Kriajcik and Marx 2005), however teachers remain skeptical as to their value, use and appropriateness (Rice 2006). The difficulty is not only the design and development of effective play environments that produce measurable changes in knowledge and/or understanding, but also in their on-the-ground use (Jaipal and Figg 2010). This paper reports on the use of a science-focused video game in five very different secondary school settings in Ontario, Canada. A mixed-methods approach was used in the study, and included data gathered on general gameplay habits and technology use, as well as informal interviews with teachers and students who played the game. In total, 161 participants played a series of games focused on the "life of a plant", and were given both a pre and post quiz to determine if the game helped them retain and/or change what they knew about scientific processes like plant cell anatomy and photosynthesis. Participants showed statistically significant improvement on quizzes that were taken after playing the game for approximately one-hour sessions, despite difficulties in some cases both accessing and playing the game for the full hour. Our findings also reveal the ongoing challenges in making use of technology in a variety of school sessions, even when using a browser-based game, that demanded very little other than a reliable internet connection.

EHRs in primary care practices: benefits, challenges, and successful strategies.

PubMed

Goetz Goldberg, Debora; Kuzel, Anton J; Feng, Lisa Bo; DeShazo, Jonathan P; Love, Linda E

2012-02-01

To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions. Qualitative case study of 6 primary care practices in Virginia. We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership. Physicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrades and difficulty utilizing performance tracking and quality functions were also reported. Facilitators for adopting and using advanced EHR functions include team-based care, adequate technical support, communication and training for employees and physicians, alternative strategies for patient care during transition, and development of new processes and work flow procedures. Small practices experience difficulty with implementation and utilization of advanced EHR functions. Federal and state policies should continue to support practices by providing technical assistance and financial incentives, grants, and/or loans. Small practices should consider using regional extension center services and reaching out to colleagues and other healthcare organizations with similar EHR systems for advice and guidance.

Do you have what it takes for challenging endoscopic submucosal dissection cases?

PubMed Central

Kim, Kyoung-Oh; Kim, Sung Jung; Kim, Tae Hyeon; Park, Jong-Jae

2011-01-01

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), especially in Korea and Japan. The criteria for the therapeutic use of ESD for EGC have been expanded recently. However, attention should be drawn to the technical feasibility of the ESD treatment which depends on a lesion’s location, size or fibrosis level, or operator’s experience. In the case of a lesion with a high level of difficulty, a more experienced operator is required. Thus, the treatment for a lesion with a high level of difficulty should be performed according to the degree of the operator’s experience. In this paper, the authors describe the ESD procedure for lesions with a high level of difficulty. PMID:21987603

Specificity of foot configuration during bipedal stance in ballet dancers.

PubMed

Casabona, Antonino; Leonardi, Giuseppa; Aimola, Ettore; La Grua, Giovanni; Polizzi, Cristina Maria; Cioni, Matteo; Valle, Maria Stella

2016-05-01

Learning highly specialized upright postures may be of benefit for more common as well as for novel stances. In this study, we asked whether this generalization occurs with foot configurations previously trained or depends on a generic increase in balance difficulty. We also explored the possibility that the benefit may concern not only the level of postural performance but also the structural organization of the upright standing. Ten elite professional ballet dancers were compared to ten untrained subjects, measuring the motion of the center of pressure (COP) across a set of five stances with different foot configurations. The balance stability was measured computing the area, the sway path, and the root mean square of the COP motion, whereas the structure of the postural control was assessed by compute approximate entropy, fractal dimension and the mean power frequency. The foot position included common and challenging stances, with the level of difficulty changed across the configurations. Among these conditions, only one foot configuration was familiar to the dancers. Statistically significant differences between the two groups, for all the parameters, were observed only for the stance with the foot position familiar to the dancers. Stability and structural parameters exhibited comparable differences. We concluded that the benefit from classical ballet is limited to a specific foot configuration, regardless of the level of stance difficulty or the component of postural control. Copyright © 2016 Elsevier B.V. All rights reserved.

Quality palliative care for cancer and dementia in five European countries: some common challenges

PubMed Central

Davies, Nathan; Maio, Laura; van Riet Paap, Jasper; Mariani, Elena; Jaspers, Birgit; Sommerbakk, Ragni; Grammatico, Daniela; Manthorpe, Jill; Ahmedzai, Sam; Vernooij-Dassen, Myrra; Iliffe, Steve

2013-01-01

Objectives There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. PMID:24131061

Work-related Mental Health Surveillance in Brazil: characteristics, difficulties, and challenges.

PubMed

Araújo, Tania Maria; Palma, Tarciso de Figueiredo; Araújo, Natália do Carmo

2017-10-01

This paper addresses the challenges and difficulties in Work-related Mental Health (WMH) Surveillance in Brazil, based on a review of the bibliographic literature. From the compilation of identified academic research, it seeks to foster reflections about the current landscape of surveillance actions, its main obstacles, and possibilities for improvement. A survey of national publications was carried out using Scielo, Lilacs and PUBMED databases from 2002 until 2017. Systematizing the results allows us to group the following themes: Epidemiology of WMH in Brazil; Policies for WMH and VISAT; Work Environment for Mental Health; and, Actions and Interventions in the VISAT and WMH. The surveillance actions are still in the early stages; however, there is an effort to strengthen the RENAST, materialized in the creation of protocols and the promotion of national meetings which reflect the construction of a new surveillance model for worker health. We noted a search for new conceptual models of mental illness, a redefinition of the focus of care, and of intervention approaches highlighting the active role of workers, who are essential players in facing the challenges in this area.

Emotion regulation and mental health: recent findings, current challenges, and future directions.

PubMed

Berking, Matthias; Wupperman, Peggilee

2012-03-01

In recent years, deficits in emotion regulation have been studied as a putative maintaining factor and promising treatment target in a broad range of mental disorders. This article aims to provide an integrative review of the latest theoretical and empirical developments in this rapidly growing field of research. Deficits in emotion regulation appear to be relevant to the development, maintenance, and treatment of various forms of psychopathology. Increasing evidence demonstrates that deficits in the ability to adaptively cope with challenging emotions are related to depression, borderline personality disorder, substance-use disorders, eating disorders, somatoform disorders, and a variety of other psychopathological symptoms. Unfortunately, studies differ with regard to the conceptualization and assessment of emotion regulation, thus limiting the ability to compare findings across studies. Future research should systematically work to use comparable methods in order to clarify the following: which individuals have; what kinds of emotion regulation difficulties with; which types of emotions; and what interventions are most effective in alleviating these difficulties. Despite some yet to be resolved challenges, the concept of emotion regulation has a broad and significant heuristic value for research in mental health.

The Challenges of Pharmacy Education in Yemen

PubMed Central

2014-01-01

Pharmacy education in Yemen has faced many challenges since its introduction in the 1980s. Most Yemeni pharmacy schools, especially private ones, are experiencing difficulties in providing the right quality and quantity of clinical educational experiences. Most of these challenges are imbedded in a teaching style and curricula that have failed to respond to the needs of the community and country. The slow shift from traditional drug-dispensing to a patient-centered or focused approach in pharmacy practice requires a fundamental change in the roles and responsibilities of both policymakers and educators. The purpose of this paper is twofold: (1) to discuss the challenges facing the pharmacy education in Yemen; (2) to provided recommendations to overcome challenges. PMID:25386011

Identifying the challenges and facilitators of implementing a COPD care bundle.

PubMed

Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

2014-01-01

Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges.

Ongoing ostomy self-care challenges of long-term rectal cancer survivors.

PubMed

Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Krouse, Robert S

2018-05-29

Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care. We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records. The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges. The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group.

"I can't do this, it's too much": building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers.

PubMed

Treloar, Carla; Gray, Rebecca; Brener, Loren; Jackson, Clair; Saunders, Veronica; Johnson, Priscilla; Harris, Magdalena; Butow, Phyllis; Newman, Christy

2014-04-01

Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.

MODELING LEFT-TRUNCATED AND RIGHT-CENSORED SURVIVAL DATA WITH LONGITUDINAL COVARIATES

PubMed Central

Su, Yu-Ru; Wang, Jane-Ling

2018-01-01

There is a surge in medical follow-up studies that include longitudinal covariates in the modeling of survival data. So far, the focus has been largely on right censored survival data. We consider survival data that are subject to both left truncation and right censoring. Left truncation is well known to produce biased sample. The sampling bias issue has been resolved in the literature for the case which involves baseline or time-varying covariates that are observable. The problem remains open however for the important case where longitudinal covariates are present in survival models. A joint likelihood approach has been shown in the literature to provide an effective way to overcome those difficulties for right censored data, but this approach faces substantial additional challenges in the presence of left truncation. Here we thus propose an alternative likelihood to overcome these difficulties and show that the regression coefficient in the survival component can be estimated unbiasedly and efficiently. Issues about the bias for the longitudinal component are discussed. The new approach is illustrated numerically through simulations and data from a multi-center AIDS cohort study. PMID:29479122

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth.

PubMed

Catania, J A; Dolcini, M M; Harper, G W; Dowhower, D P; Dolcini-Catania, L G; Towner, S L; Timmons, A; Motley, D N; Tyler, D H

2015-12-01

Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15-19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.

Being right is its own reward: load and performance related ventral striatum activation to correct responses during a working memory task in youth.

PubMed

Satterthwaite, Theodore D; Ruparel, Kosha; Loughead, James; Elliott, Mark A; Gerraty, Raphael T; Calkins, Monica E; Hakonarson, Hakon; Gur, Ruben C; Gur, Raquel E; Wolf, Daniel H

2012-07-02

The ventral striatum (VS) is a critical brain region for reinforcement learning and motivation. Intrinsically motivated subjects performing challenging cognitive tasks engage reinforcement circuitry including VS even in the absence of external feedback or incentives. However, little is known about how such VS responses develop with age, relate to task performance, and are influenced by task difficulty. Here we used fMRI to examine VS activation to correct and incorrect responses during a standard n-back working memory task in a large sample (n=304) of healthy children, adolescents and young adults aged 8-22. We found that bilateral VS activates more strongly to correct than incorrect responses, and that the VS response scales with the difficulty of the working memory task. Furthermore, VS response was correlated with discrimination performance during the task, and the magnitude of VS response peaked in mid-adolescence. These findings provide evidence for scalable intrinsic reinforcement signals during standard cognitive tasks, and suggest a novel link between motivation and cognition during adolescent development. Copyright © 2012 Elsevier Inc. All rights reserved.

In-Situ Visualization Experiments with ParaView Cinema in RAGE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kares, Robert John

2015-10-15

A previous paper described some numerical experiments performed using the ParaView/Catalyst in-situ visualization infrastructure deployed in the Los Alamos RAGE radiation-hydrodynamics code to produce images from a running large scale 3D ICF simulation. One challenge of the in-situ approach apparent in these experiments was the difficulty of choosing parameters likes isosurface values for the visualizations to be produced from the running simulation without the benefit of prior knowledge of the simulation results and the resultant cost of recomputing in-situ generated images when parameters are chosen suboptimally. A proposed method of addressing this difficulty is to simply render multiple images atmore » runtime with a range of possible parameter values to produce a large database of images and to provide the user with a tool for managing the resulting database of imagery. Recently, ParaView/Catalyst has been extended to include such a capability via the so-called Cinema framework. Here I describe some initial experiments with the first delivery of Cinema and make some recommendations for future extensions of Cinema’s capabilities.« less

A role for risperidone in the treatment of communication disorder and comorbid mental health problems?

PubMed Central

Moreton, Adam; Imran, Shermin

2015-01-01

This case report describes the co-occurrence of a psychiatric disorder with a specific communication disorder in a teenage girl who presented to youth mental health services in crisis, posing a significant risk of harm to herself and others. Description of this case would be of interest to practitioners in youth mental health in relation to the assessment and treatment of young people with similar difficulties. We present the case of a 17-year-old girl previously admitted to an inpatient adolescent unit. Her diagnosis was reformulated 4 months into her second admission to include a specific communication disorder with both receptive and expressive difficulties, evident from her pragmatic use of language. She was started on risperidone in month eight; following this, a significant improvement was seen and the patient was discharged a month later. Prior to the start of risperidone, a referral had been made to low secure adolescent services for further assessment and advice on management, due to the patient's challenging presentation and poor engagement with treatment. PMID:26607198

Cloud Ice: A Climate Model Challenge With Signs and Expectations of Progress

NASA Astrophysics Data System (ADS)

Li, F.; Waliser, D.; Bacmeister, J.; Chern, J.; Del Genio, T.; Jiang, J.; Kharitondov, M.; Liou, K.; Meng, H.; Minnis, P.; Rossow, B.; Stephens, G.; Sun-Mack, S.; Tao, W.; Vane, D.; Woods, C.; Tompkins, A.; Wu, D.

2007-12-01

Global climate models (GCMs), including those assessed in the IPCC AR4, exhibit considerable disagreement in the amount of cloud ice - both in terms of the annual global mean as well as their spatial variability. Global measurements of cloud ice have been difficult due to the challenges involved in remotely sensing ice water content (IWC) and its vertical profile - including complications associated with multi-level clouds, mixed-phases and multiple hydrometer types, the uncertainty in classifying ice particle size and shape for remote retrievals, and the relatively small time and space scales associated with deep convection. Together, these measurement difficulties make it a challenge to characterize and understand the mechanisms of ice cloud formation and dissipation. Fortunately, there are new observational resources recently established that can be expected to lead to considerable reduction in the observational uncertainties of cloud ice, and in turn improve the fidelity of model representations. Specifically, these include the Microwave Limb Sounder (MLS) on the Earth Observing System (EOS) Aura satellite, and the CloudSat and Calipso satellite missions, all of which fly in formation in what is referred to as the A-Train. Based on radar and limb-sounding techniques, these new satellite measurements provide a considerable leap forward in terms of the information gathered regarding upper-tropospheric cloud IWC as well as other macrophysical and microphysical properties. In this presentation, we describe the current state of GCM representations of cloud ice and their associated uncertainties, the nature of the new observational resources for constraining cloud ice values in GCMs, the challenges in making model-data comparisons with these data resources, and prospects for near-term improvements in model representations.

Ocean OSSEs: recent developments and future challenges

NASA Astrophysics Data System (ADS)

Kourafalou, V. H.

2012-12-01

Atmospheric OSSEs have had a much longer history of applications than OSSEs (and OSEs) in oceanography. Long standing challenges include the presence of coastlines and steep bathymetric changes, which require the superposition of a wide variety of space and time scales, leading to difficulties on ocean observation and prediction. For instance, remote sensing is critical for providing a quasi-synoptic oceanographic view, but the coverage is limited at the ocean surface. Conversely, in situ measurements are capable to monitor the entire water column, but at a single location and usually for a specific, short time. Despite these challenges, substantial progress has been made in recent years and international initiatives have provided successful OSSE/OSE examples and formed appropriate forums that helped define the future roadmap. These will be discussed, together with various challenges that require a community effort. Examples include: integrated (remote and in situ) observing system requirements for monitoring large scale and climatic changes, vs. short term variability that is particularly important on the regional and coastal spatial scales; satisfying the needs of both global and regional/coastal nature runs, from development to rigorous evaluation and under a clear definition of metrics; data assimilation in the presence of tides; estimation of real-time river discharges for Earth system modeling. An overview of oceanographic efforts that complement the standard OSSE methodology will also be given. These include ocean array design methods, such as representer-based analysis and adaptive sampling. Exciting new opportunities for both global and regional ocean OSSE/OSE studies have recently become possible with targeted periods of comprehensive data sets, such as the existing Gulf of Mexico observations from multiple sources in the aftermath of the DeepWater Horizon incident and the upcoming airborne AirSWOT, in preparation for the SWOT (Surface Water and Ocean Topography) mission.

Sedation and Analgesia in Transportation of Acutely and Critically Ill Patients.

PubMed

Johnston, Dawn; Franklin, Kevin; Rigby, Paul; Bergman, Karen; Davidson, Scott B

2016-06-01

Transportation of acutely or critically ill patients is a challenge for health care providers. Among the difficulties that providers face is the balance between adequate sedation and analgesia for the transportation event and maintaining acceptable respiratory and physiologic parameters of the patient. This article describes common challenges in providing sedation and analgesia during various phases of transport. Copyright © 2016 Elsevier Inc. All rights reserved.

Transplanting a Western-Style Journalism Education to the Central Asian Republics of the Former Soviet Union: Experiences and Challenges at the American University of Central Asia in Kyrgyzstan

ERIC Educational Resources Information Center

Skochilo, Elena; Toralieva, Gulnura; Freedman, Eric; Shafer, Richard

2013-01-01

Western standards of journalism education, as well as western professional journalistic practices, have had difficulty taking root in the five independent countries of formerly Soviet Central Asia. This essay examines the experience of one university's Department of Journalism and Mass Communication since 1997 and the challenges it faces,…

Building Evidence-Based Tobacco Treatment in the Eastern Mediterranean Region: Lessons Learned by the Syrian Center for Tobacco Studies

PubMed Central

Asfar, Taghrid; Ward, Kenneth D.; Al-Ali, Radwan; Maziak, Wasim

2016-01-01

The tobacco epidemic in Syria is characterized by high rates of cigarettes smoking in men and dramatic reemergence of waterpipe smoking, especially among youths and women. The Syrian Center for Tobacco Studies (SCTS), an NIH-funded pioneer research and capacity building institution, has developed a research infrastructure and conducted three randomized clinical trials to develop and rigorously test culturally-appropriate tobacco treatment programs integrated into primary healthcare (PHC) centers. This review aimed to discuss challenges and lessons learned from the Syrian experience. Addressing these challenges may inform future cessation research activities in Syria and other developing countries. To develop a research infrastructure, the SCTS has established Syria’s first IRB and trained physicians/medical students in both tobacco treatment and research methods. Main challenges to conduct the cessation trials were difficulties of coordination between the local and international collaborators; high Smoking Rates among PHC providers; lack of pharmacological agents used in tobacco treatment; and difficulties of conducting research in a politically volatile region. Strategies to overcome these challenges were ensuring an active and regular involvement of all investigator; and advocating for a national smoking-cessation plan that involves training health care providers in smoking cessation treatment and make pharmacological agents used in smoking cessation available. PMID:27563356

Cognitive Orientation to daily Occupational Performance (CO-OP) as group therapy for children living with motor coordination difficulties: An integrated literature review.

PubMed

Anderson, Leanne; Wilson, Jessie; Williams, Gary

2017-04-01

Children with Developmental Coordination Disorder (DCD) demonstrate limited participation in daily occupations which negatively impacts their physical and psycho-social wellbeing. The CO-OP approach is strongly supported within the literature as an effective treatment for DCD when delivered as a one-on-one therapy. Group interventions have proven to be effective in increasing self-esteem, decreasing feelings of isolation and are a cost effective way of delivering therapy. The purpose of this review was to explore the evidence for the use of the CO-OP approach in a group format for children with motor coordination difficulties. Searches of CINAHL, MEDLINE, Scopus, Proquest, PsycINFO, ERIC and OTDBase, were conducted from 2000 through until September 30, 2015. Articles included were in English, peer reviewed articles, followed principals of CO-OP and were delivered through a group therapy approach. All articles were critically reviewed and thematically analysed. 192 studies were retrieved with a final number of six articles included in the review. Six themes were highlighted: achieving a new level of perceived competence; feeling a sense of belonging; children learning how the condition affected them and strategies to overcome these challenges; careful formation of intervention groups; the value of following the CO-OP protocols; and the significance of parental involvement. The findings of this review suggest that the CO-OP approach, when administered in a group format, has the potential to benefit children living with motor coordination difficulties in both physical and psycho-social domains. More research is required to confirm these findings and contribute to evidence-based practice. © 2016 Occupational Therapy Australia.

Vertebrate species introductions in the United States and its territories

USGS Publications Warehouse

Witmer, Gary W.; Fuller, Pam L.

2011-01-01

At least 1,065 introduced vertebrate species have been introduced in the United States and its territories, including at least 86 mammalian, 127 avian, 179 reptilian/amphibian, and 673 fish species. Examples in each major taxonomic group include domestic cat, small Indian mongoose, red fox, goat, pig, rabbit, rats, house mouse, gray squirrel, nutria, starling, Indian common myna, red-vented bulbul, brown treesnake, red-eared slider, brown trout, tilapia, and grass carp. We briefly review some of these species and the types of damage they cause. We then review the basic types of methods used for control or eradication of each taxonomic group, including physical, chemical, biological, and cultural methods. We discuss some of the challenges in managing these species, including issues with the use of toxicants, land access, public attitudes, and monitoring difficulties. Finally, we list some ongoing research and future research needs, including improved detection methods, improved attractants, improved barriers, improved capture methods, fertility control, and risk assessment methods.

Perceptual discrimination difficulty and familiarity in the Uncanny Valley: more like a "Happy Valley".

PubMed

Cheetham, Marcus; Suter, Pascal; Jancke, Lutz

2014-01-01

The Uncanny Valley Hypothesis (UVH) predicts that greater difficulty perceptually discriminating between categorically ambiguous human and humanlike characters (e.g., highly realistic robot) evokes negatively valenced (i.e., uncanny) affect. An ABX perceptual discrimination task and signal detection analysis was used to examine the profile of perceptual discrimination (PD) difficulty along the UVH' dimension of human likeness (DHL). This was represented using avatar-to-human morph continua. Rejecting the implicitly assumed profile of PD difficulty underlying the UVH' prediction, Experiment 1 showed that PD difficulty was reduced for categorically ambiguous faces but, notably, enhanced for human faces. Rejecting the UVH' predicted relationship between PD difficulty and negative affect (assessed in terms of the UVH' familiarity dimension), Experiment 2 demonstrated that greater PD difficulty correlates with more positively valenced affect. Critically, this effect was strongest for the ambiguous faces, suggesting a correlative relationship between PD difficulty and feelings of familiarity more consistent with the metaphor happy valley. This relationship is also consistent with a fluency amplification instead of the hitherto proposed hedonic fluency account of affect along the DHL. Experiment 3 found no evidence that the asymmetry in the profile of PD along the DHL is attributable to a differential processing bias (cf. other-race effect), i.e., processing avatars at a category level but human faces at an individual level. In conclusion, the present data for static faces show clear effects that, however, strongly challenge the UVH' implicitly assumed profile of PD difficulty along the DHL and the predicted relationship between this and feelings of familiarity.

Perceptual discrimination difficulty and familiarity in the Uncanny Valley: more like a “Happy Valley”

PubMed Central

Cheetham, Marcus; Suter, Pascal; Jancke, Lutz

2014-01-01

The Uncanny Valley Hypothesis (UVH) predicts that greater difficulty perceptually discriminating between categorically ambiguous human and humanlike characters (e.g., highly realistic robot) evokes negatively valenced (i.e., uncanny) affect. An ABX perceptual discrimination task and signal detection analysis was used to examine the profile of perceptual discrimination (PD) difficulty along the UVH' dimension of human likeness (DHL). This was represented using avatar-to-human morph continua. Rejecting the implicitly assumed profile of PD difficulty underlying the UVH' prediction, Experiment 1 showed that PD difficulty was reduced for categorically ambiguous faces but, notably, enhanced for human faces. Rejecting the UVH' predicted relationship between PD difficulty and negative affect (assessed in terms of the UVH' familiarity dimension), Experiment 2 demonstrated that greater PD difficulty correlates with more positively valenced affect. Critically, this effect was strongest for the ambiguous faces, suggesting a correlative relationship between PD difficulty and feelings of familiarity more consistent with the metaphor happy valley. This relationship is also consistent with a fluency amplification instead of the hitherto proposed hedonic fluency account of affect along the DHL. Experiment 3 found no evidence that the asymmetry in the profile of PD along the DHL is attributable to a differential processing bias (cf. other-race effect), i.e., processing avatars at a category level but human faces at an individual level. In conclusion, the present data for static faces show clear effects that, however, strongly challenge the UVH' implicitly assumed profile of PD difficulty along the DHL and the predicted relationship between this and feelings of familiarity. PMID:25477829

Strengthening and Expanding the Citizen Corps

DTIC Science & Technology

2006-03-01

incident. The dual definitions of “first responder” present strategic issues that cause public confusion, challenge reciprocity, limit professional ... mobility , cause difficulties in quality assurance, and duplicate efforts.79 Therefore, EMS committees are currently proposing the following changes

PDS4 Challenges in the PSA

NASA Astrophysics Data System (ADS)

Saiz, J.; Barbarisi, I.; Docasal, R.; Rios, C.; Montero, A.; Macfarlane, A.; Laantee, C.; Besse, S.; Vallat, C.; Marcos, J.; Arenas, J.; Osinde, J.; Arviset, C.

2018-04-01

The Planetary Science Archive (PSA) stores products from all planetary ESA missions. Adopting PDS4 as the standard for new missions, while being compatible with existing PDS3 products, has driven a design with several difficulties to overcome.