Sea Turtles and Strategies for Language Skills.

ERIC Educational Resources Information Center

Tippins, Deborah; And Others

1993-01-01

Describes teaching strategies, including science activities, for challenging students' misconceptions about turtles and helping limited-English-proficiency students enhance their language proficiency. (PR)

Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa

PubMed Central

Hosek, Sybil; Celum, Connie; Wilson, Craig M; Kapogiannis, Bill; Delany-Moretlwe, Sinead; Bekker, Linda-Gail

2016-01-01

Introduction Adolescents and young adults aged <25 are a key population in the HIV epidemic, with very high HIV incidence rates in many geographic settings and a large number who have limited access to prevention services. Thus, any biomedical HIV prevention approach should prepare licensure and implementation strategies for young populations. Oral pre-exposure prophylaxis (PrEP) is the first antiretroviral-based prevention intervention with proven efficacy across many settings and populations, and regulatory and policy approvals at global and national levels are occurring rapidly. We discuss available data from studies in the United States and South Africa on the use of oral PrEP for HIV prevention in adolescent minors, along with some of the implementation challenges. Discussion Ongoing studies in the United States and South Africa among youth under the age of 18 should provide the safety data needed by the end of 2016 to contribute to licensure of Truvada as daily PrEP in adolescents. The challenges of completing these studies as well as foreseeable broader challenges highlighted by this work are presented. Adherence to daily PrEP is a greater challenge for younger populations, and poor adherence was associated with decreased efficacy in all PrEP trials. Individual-level barriers include limited familiarity with antiretroviral-based prevention, stigma, product storage, and social support. Structural challenges include healthcare financing for PrEP, clinician acceptability and comfort with PrEP delivery, and the limited youth-friendly health services available. These challenges are discussed in the context of the work done to date in the United States and South Africa, but will likely be magnified in the setting of limited resources in many other countries that are heavily impacted by HIV. Conclusions Adolescent populations are particularly vulnerable to HIV, and oral PrEP in these populations is likely to have an impact on population-level HIV incidence. The challenges of disseminating an HIV biomedical prevention tool requiring daily usage in adolescents are formidable, but addressing these issues and starting dialogues will lay the groundwork for the many other HIV prevention tools now being developed and tested. PMID:27760684

Adult English Language Learners with Limited Literacy

ERIC Educational Resources Information Center

Bigelow, Martha; Schwarz, Robin Lovrien

2010-01-01

Adult English language learners who lack print literacy or experience with formal education encounter a unique set of challenges in their lives and their efforts to learn English. Educators and policymakers are similarly challenged by how best to help these adults acquire English literacy. This paper reviews a variety of research, including that…

Building an Agricultural Extension Services System Supported by ICTs in Tanzania: Progress Made, Challenges Remain

ERIC Educational Resources Information Center

Sanga, C.; Kalungwizi, V. J.; Msuya, C. P.

2013-01-01

The conventional agricultural extension service in Tanzania is mainly provided by extension officers visiting farmers to provide agricultural advisory service. This system of extension service provision faces a number of challenges including the few number of extension officers and limited resources. This article assesses the effectiveness of an…

Ethics of birth at the limits of viability: the risky business of prediction.

PubMed

Shinwell, Eric S

2015-01-01

Infants born at the limits of viability present neonatologists in particular and society in general with difficult challenges. Ethical and legal considerations establish a framework for action, although this varies between countries, departments and individuals and shows dynamic changes over time. This brief review includes a vignette telling a familiar story. In this case, the parents ask searching questions and the caring, knowledgeable neonatologist uses up-to-date information to offer empathic and thoughtful guidance - a challenge for all. © 2015 S. Karger AG, Basel.

Empirical Evaluation of Advanced Electromagnetic Induction Systems - Factors Affecting Classification Effectiveness in Challenging Geologic Environments

DTIC Science & Technology

2017-02-01

because of a variety of challenging conditions including (but not limited to) dense woods, long travel times to and from the site, and TEMTADS software...the following reasons: • Approximately 1.5 hours of travel time was needed after reaching the site each day to access the collection grids. • Daily...estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining

Optimizing Institutional Approaches to Enable Research

ERIC Educational Resources Information Center

Grieb, Teri; Horon, Jeffrey R.; Wong, Cassandra; Durkin, Jessica; Kunkel, Steven L.

2014-01-01

Challenges that face the academic research enterprise are numerous. These concerns include, but are not limited to: declines in extramural funding for investigatorinitiated research, an aging faculty workforce (the average age of securing a faculty's first R01 is over 42), insufficient funds to support faculty laboratories, and limited access to…

Healthcare-associated infections: challenges to public health in Brazil.

PubMed

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-12-01

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Shifting Challenges in Teacher-Education Research and Accreditation: Lessons Learned from Limitations on Studying Program Impact

ERIC Educational Resources Information Center

Contopidis, Ellen; DaBoll-Lavoie, Kathleen; Dunn, Kerry; Darling, Deana; Wieczorek, Kim

2017-01-01

A critical issue in educator preparation is how to ascertain if program graduates are sufficiently prepared to be effective through the acquisition of meaningful evidence of graduates' impact on their students. Challenges to proving specific impact of educator-preparation programs on student learning include identifying and following program…

The main challenges that remain in applying high-throughput sequencing to clinical diagnostics.

PubMed

Loeffelholz, Michael; Fofanov, Yuriy

2015-01-01

Over the last 10 years, the quality, price and availability of high-throughput sequencing instruments have improved to the point that this technology may be close to becoming a routine tool in the diagnostic microbiology laboratory. Two groups of challenges, however, have to be resolved in order to move this powerful research technology into routine use in the clinical microbiology laboratory. The computational/bioinformatics challenges include data storage cost and privacy concerns, requiring analysis to be performed without access to cloud storage or expensive computational infrastructure. The logistical challenges include interpretation of complex results and acceptance and understanding of the advantages and limitations of this technology by the medical community. This article focuses on the approaches to address these challenges, such as file formats, algorithms, data collection, reporting and good laboratory practices.

Challenges to Health During Deep Space Exploration Missions

NASA Technical Reports Server (NTRS)

Watkins, S.; Leveton, L.; Norsk, P.; Huff, J.; Shah, R.

2014-01-01

Long duration missions outside of low Earth orbit will present unique challenges to the maintenance of human health. Stressors with physiologic and psychological impacts are inherent in exploration missions, including reduced gravity, increased radiation, isolation, limited habitable volume, circadian disruptions, and cabin atmospheric changes. Operational stressors such as mission timeline and extravehicular activities must also be considered, and these varied stressors may act in additive or synergistic fashions. Should changes to physiology or behavior manifest as a health condition, the rendering of care in an exploration environment must also be considered. Factors such as the clinical background of the crew, inability to evacuate to Earth in a timely manner, communication delay, and limitations in available medical resources will have an impact on the assessment and treatment of these conditions. The presentations associated with this panel will address these unique challenges from the perspective of several elements of the NASA Human Research Program, including Behavioral Health and Performance, Human Health Countermeasures, Space Radiation, and Exploration Medical Capability.

Physical Activity Parenting Measurement and Research: Challenges, Explanations, and Solutions

PubMed Central

Mâsse, Louise C.; Timperio, Anna; Frenn, Marilyn D.; Saunders, Julie; Mendoza, Jason A.; Gobbi, Erica; Hanson, Phillip; Trost, Stewart G.

2013-01-01

Abstract Physical activity (PA) parenting research has proliferated over the past decade, with findings verifying the influential role that parents play in children's emerging PA behaviors. This knowledge, however, has not translated into effective family-based PA interventions. During a preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity annual meeting, a PA parenting workgroup met to: (1) Discuss challenges in PA parenting research that may limit its translation, (2) identify explanations or reasons for such challenges, and (3) recommend strategies for future research. Challenges discussed by the workgroup included a proliferation of disconnected and inconsistently measured constructs, a limited understanding of the dimensions of PA parenting, and a narrow conceptualization of hypothesized moderators of the relationship between PA parenting and child PA. Potential reasons for such challenges emphasized by the group included a disinclination to employ theory when developing measures and examining predictors and outcomes of PA parenting as well as a lack of agreed-upon measurement standards. Suggested solutions focused on the need to link PA parenting research with general parenting research, define and adopt rigorous standards of measurement, and identify new methods to assess PA parenting. As an initial step toward implementing these recommendations, the workgroup developed a conceptual model that: (1) Integrates parenting dimensions from the general parenting literature into the conceptualization of PA parenting, (2) draws on behavioral and developmental theory, and (3) emphasizes areas which have been neglected to date including precursors to PA parenting and effect modifiers. PMID:23944918

The challenges of sequencing by synthesis.

PubMed

Fuller, Carl W; Middendorf, Lyle R; Benner, Steven A; Church, George M; Harris, Timothy; Huang, Xiaohua; Jovanovich, Stevan B; Nelson, John R; Schloss, Jeffery A; Schwartz, David C; Vezenov, Dmitri V

2009-11-01

DNA sequencing-by-synthesis (SBS) technology, using a polymerase or ligase enzyme as its core biochemistry, has already been incorporated in several second-generation DNA sequencing systems with significant performance. Notwithstanding the substantial success of these SBS platforms, challenges continue to limit the ability to reduce the cost of sequencing a human genome to $100,000 or less. Achieving dramatically reduced cost with enhanced throughput and quality will require the seamless integration of scientific and technological effort across disciplines within biochemistry, chemistry, physics and engineering. The challenges include sample preparation, surface chemistry, fluorescent labels, optimizing the enzyme-substrate system, optics, instrumentation, understanding tradeoffs of throughput versus accuracy, and read-length/phasing limitations. By framing these challenges in a manner accessible to a broad community of scientists and engineers, we hope to solicit input from the broader research community on means of accelerating the advancement of genome sequencing technology.

Demonstration of the Health Literacy Universal Precautions Toolkit

PubMed Central

Mabachi, Natabhona M.; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G.; Albright, Karen; Weiss, Barry D.; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements. PMID:27232681

Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for Quality Improvement.

PubMed

Mabachi, Natabhona M; Cifuentes, Maribel; Barnard, Juliana; Brega, Angela G; Albright, Karen; Weiss, Barry D; Brach, Cindy; West, David

2016-01-01

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements.

Implementation of an inter-agency transition model for youth with spina bifida.

PubMed

Lindsay, S; Cruickshank, H; McPherson, A C; Maxwell, J

2016-03-01

To address gaps in transfer of care and transition support, a paediatric hospital and adult community health care centre partnered to implement an inter-agency transition model for youth with spina bifida. Our objective was to understand the enablers and challenges experienced in the implementation of the model. Using a descriptive, qualitative design, we conducted semi-structured interviews, in-person or over the phone, with 12 clinicians and nine key informants involved in implementing the spina bifida transition model. We recruited all 21 participants from an urban area of Ontario, Canada. Clinicians and key informants experienced several enablers and challenges in implementing the spina bifida transition model. Enablers included dedicated leadership, advocacy, funding, inter-agency partnerships, cross-appointed staff and gaps in co-ordinated care to connect youth to adult services. Challenges included gaps in the availability of adult specialty services, limited geographical catchment of adult services, limited engagement of front-line staff, gaps in communication and role clarity. Although the transition model has realized some initial successes, there are still many challenges to overcome in transferring youth with spina bifida to adult health care and transitioning to adulthood. © 2015 John Wiley & Sons Ltd.

Hepatitis B Virus Infection in Tanzania: Current Status and Challenges

PubMed Central

Bakshi, Fatma A.; Jaka, Hyasinta

2018-01-01

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention. PMID:29666656

PHM for Ground Support Systems Case Study: From Requirements to Integration

NASA Technical Reports Server (NTRS)

Teubert, Chris

2015-01-01

This session will detail the experience of members of the NASA Ames Prognostic Center of Excellence (PCoE) producing PHM tools for NASA Advanced Ground Support Systems, including the challenges in applying their research in a production environment. Specifically, we will 1) go over the systems engineering and review process used; 2) Discuss the challenges and pitfalls in this process; 3) discuss software architecting, documentation, verification and validation activities and 4) discuss challenges in communicating the benefits and limitations of PHM Technologies.

Challenges and Strategies in Thermal Processing of Amorphous Solid Dispersions: A Review.

PubMed

LaFountaine, Justin S; McGinity, James W; Williams, Robert O

2016-02-01

Thermal processing of amorphous solid dispersions continues to gain interest in the pharmaceutical industry, as evident by several recently approved commercial products. Still, a number of pharmaceutical polymer carriers exhibit thermal or viscoelastic limitations in thermal processing, especially at smaller scales. Additionally, active pharmaceutical ingredients with high melting points and/or that are thermally labile present their own specific challenges. This review will outline a number of formulation and process-driven strategies to enable thermal processing of challenging compositions. These include the use of traditional plasticizers and surfactants, temporary plasticizers utilizing sub- or supercritical carbon dioxide, designer polymers tailored for hot-melt extrusion processing, and KinetiSol® Dispersing technology. Recent case studies of each strategy will be described along with potential benefits and limitations.

Healthcare-associated infections: challenges to public health in Brazil

PubMed Central

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-01-01

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges. PMID:26039403

Prospects and Limits of Energy Storage in Batteries.

PubMed

Abraham, K M

2015-03-05

Energy densities of Li ion batteries, limited by the capacities of cathode materials, must increase by a factor of 2 or more to give all-electric automobiles a 300 mile driving range on a single charge. Battery chemical couples with very low equivalent weights have to be sought to produce such batteries. Advanced Li ion batteries may not be able to meet this challenge in the near term. The state-of-the-art of Li ion batteries is discussed, and the challenges of developing ultrahigh energy density rechargeable batteries are identified. Examples of ultrahigh energy density battery chemical couples include Li/O2, Li/S, Li/metal halide, and Li/metal oxide systems. Future efforts are also expected to involve all-solid-state batteries with performance similar to their liquid electrolyte counterparts, biodegradable batteries to address environmental challenges, and low-cost long cycle-life batteries for large-scale energy storage. Ultimately, energy densities of electrochemical energy storage systems are limited by chemistry constraints.

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,…

Nitrogen limitation on land: how can it occur in Earth system models?

PubMed

Thomas, R Quinn; Brookshire, E N Jack; Gerber, Stefan

2015-05-01

The representation of the nitrogen (N) cycle in Earth system models (ESMs) is strongly motivated by the constraint N poses on the sequestration of anthropogenic carbon (C). Models typically implement a stoichiometric relationship between C and N in which external supply and assimilation by organisms are adjusted to maintain their internal stoichiometry. N limitation of primary productivity thus occurs if the N supply from uptake and fixation cannot keep up with the construction of tissues allowed by C assimilation. This basic approach, however, presents considerable challenges in how to faithfully represent N limitation. Here, we review how N limitation is currently implemented and evaluated in ESMs and highlight challenges and opportunities in their future development. At or near steady state, N limitation is governed by the magnitude of losses from the plant-unavailable pool vs. N fixation and there are considerable differences in how models treat both processes. In nonsteady-state systems, the accumulation of N in pools with slow turnover rates reduces N available for plant uptake and can be challenging to represent when initializing ESM simulations. Transactional N limitation occurs when N is incorporated into various vegetation and soil pools and becomes available to plants only after it is mineralized, the dynamics of which depends on how ESMs represent decomposition processes in soils. Other challenges for ESMs emerge when considering seasonal to interannual climatic oscillations as they create asynchronies between C and N demand, leading to transient alternations between N surplus and deficit. Proper evaluation of N dynamics in ESMs requires conceptual understanding of the main levers that trigger N limitation, and we highlight key measurements and observations that can help constrain these levers. Two of the biggest challenges are the mechanistic representation of plant controls on N availability and turnover, including N fixation and organic matter decomposition processes. © 2015 John Wiley & Sons Ltd.

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

PubMed

Chao, Tiffany E; Mandigo, Morgan; Opoku-Anane, Jessica; Maine, Rebecca

2016-01-01

Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.

Looking for Solutions: Gender Differences in Relationship and Parenting Challenges Among Low-Income, Young Parents

PubMed Central

Albritton, Tashuna; Angley, Meghan; Grandelski, Valen; Hansen, Nathan; Kershaw, Trace

2015-01-01

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes. PMID:24980026

Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings.

PubMed

Mtove, George; Kimani, Joshua; Kisinza, William; Makenga, Geofrey; Mangesho, Peter; Duparc, Stephan; Nakalembe, Miriam; Phiri, Kamija S; Orrico, Russell; Rojo, Ricardo; Vandenbroucke, Pol

2018-03-22

Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the "Sponsoring Entities" for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Engagement with key stakeholders at international and national levels enabled the Sponsoring Entities to address challenges by aligning the study design with the requirements of health and regulatory agencies and to understand and address healthcare infrastructure needs prior to trial initiation. Local stakeholder engagement, including community members, study participants, and family enabled the investigators to address challenges by ensuring that study design and conduct were adapted to local considerations and ensuring accurate information about the study aims was shared with the public. ClinicalTrials.gov, ID: NCT01103063 . Registered on 7 April 2010.

Retaining Low-Income Residents in the Workforce: Lessons from the Annie E. Casey Jobs Initiative.

ERIC Educational Resources Information Center

Giloth, Bob; Gewirtz, Susan

Annie E. Casey Jobs Initiative sites recognize the challenge that long-term retention poses in today's labor market for low-income residents. They have developed key elements of an operational definition of retention, including the following: no limitation to one job, but only very limited gaps between jobs; and jobs in construction or other…

11 CFR 111.35 - If the respondent decides to challenge the alleged violation or proposed civil money penalty...

Code of Federal Regulations, 2013 CFR

2013-01-01

... not limited to, the committee was not required to file the report, or the committee timely filed the report in accordance with 11 CFR 100.19; (2) The Commission improperly calculated the civil money penalty... respondent include, but are not limited to: (1) A failure of Commission computers or Commission-provided...

11 CFR 111.35 - If the respondent decides to challenge the alleged violation or proposed civil money penalty...

Code of Federal Regulations, 2014 CFR

2014-01-01

... not limited to, the committee was not required to file the report, or the committee timely filed the report in accordance with 11 CFR 100.19; (2) The Commission improperly calculated the civil money penalty... respondent include, but are not limited to: (1) A failure of Commission computers or Commission-provided...

11 CFR 111.35 - If the respondent decides to challenge the alleged violation or proposed civil money penalty...

Code of Federal Regulations, 2011 CFR

2011-01-01

... not limited to, the committee was not required to file the report, or the committee timely filed the report in accordance with 11 CFR 100.19; (2) The Commission improperly calculated the civil money penalty... respondent include, but are not limited to: (1) A failure of Commission computers or Commission-provided...

11 CFR 111.35 - If the respondent decides to challenge the alleged violation or proposed civil money penalty...

Code of Federal Regulations, 2012 CFR

2012-01-01

... not limited to, the committee was not required to file the report, or the committee timely filed the report in accordance with 11 CFR 100.19; (2) The Commission improperly calculated the civil money penalty... respondent include, but are not limited to: (1) A failure of Commission computers or Commission-provided...

Implementing the World Report on Disability in West Africa: challenges and opportunities for Ghana.

PubMed

Tuakli-Wosornu, Yetsa A; Haig, Andrew J

2014-01-01

Disability issues have taken a prominent role on international stages in recent years. Beginning with the May 2005 World Health Assembly Resolution 58.23 and culminating in the June 2011 World Bank and World Health Organization World Report on Disability, comprehensive disability analyses from nations at various stages of development can now be accessed and used by relevant stakeholders in health, policy, and aide arenas. The implementation of this landmark report is critical for the advancement of social inclusion in diverse countries, including those with limited resources. However, activating the World Report on Disability in resource-limited countries remains a significant challenge because of threadbare data and cultural, institutional, and physical barriers to social inclusion. This review summarizes current national disability data and describes challenges and opportunities for the implementation of the World Report on Disability in Ghana. As a structural point of departure, the article uses the three broad categories of challenges outlined by the World Health Organization: attitudinal, physical, and institutional.

Advances in metabolome information retrieval: turning chemistry into biology. Part II: biological information recovery.

PubMed

Tebani, Abdellah; Afonso, Carlos; Bekri, Soumeya

2018-05-01

This work reports the second part of a review intending to give the state of the art of major metabolic phenotyping strategies. It particularly deals with inherent advantages and limits regarding data analysis issues and biological information retrieval tools along with translational challenges. This Part starts with introducing the main data preprocessing strategies of the different metabolomics data. Then, it describes the main data analysis techniques including univariate and multivariate aspects. It also addresses the challenges related to metabolite annotation and characterization. Finally, functional analysis including pathway and network strategies are discussed. The last section of this review is devoted to practical considerations and current challenges and pathways to bring metabolomics into clinical environments.

Characteristic interviews, different strategies: Methodological challenges in qualitative interviewing among respondents with mild intellectual disabilities.

PubMed

Sigstad, Hanne Marie Høybråten

2014-06-01

Conducting qualitative research interviews among individuals with intellectual disabilities, including cognitive limitations and difficulties in communication, presents particular research challenges. One question is whether the difficulties that informants encounter affect interviews to such an extent that the validity of the results is weakened. This article focuses on voluntary informed consent and the specific challenges with the greatest effects on such interviews. The discussion shows that complementary and meaningful descriptions from informants imply the need to employ alternative strategies and methods that may, in other contexts, challenge the traditional understanding of what is acceptable in research. © The Author(s) 2014.

Tuberculosis control in prisons: current situation and research gaps.

PubMed

Dara, Masoud; Acosta, Colleen D; Melchers, Natalie V S Vinkeles; Al-Darraji, Haider A A; Chorgoliani, Dato; Reyes, Hernan; Centis, Rosella; Sotgiu, Giovanni; D'Ambrosio, Lia; Chadha, Sarabjit S; Migliori, Giovanni Battista

2015-03-01

Tuberculosis (TB) in penitentiary services (prisons) is a major challenge to TB control. This review article describes the challenges that prison systems encounter in TB control and provides solutions for the more efficient use of limited resources based on the three pillars of the post-2015 End TB Strategy. This paper also proposes research priorities for TB control in prisons based on current challenges. Articles (published up to 2011) included in a recent systematic review on TB control in prisons were further reviewed. In addition, relevant articles in English (published 1990 to May 2014) were identified by searching keywords in PubMed and Google Scholar. Article bibliographies and conference abstracts were also hand-searched. Despite being a serious cause of morbidity and mortality among incarcerated populations, many prison systems encounter a variety of challenges that hinder TB control. These include, but are not limited to, insufficient laboratory capacity and diagnostic tools, interrupted supply of medicines, weak integration between civilian and prison TB services, inadequate infection control measures, and low policy priority for prison healthcare. Governmental commitment, partnerships, and sustained financing are needed in order to facilitate improvements in TB control in prisons, which will translate to the wider community. Copyright © 2015 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Mental health challenges among adolescents living with HIV.

PubMed

Vreeman, Rachel C; McCoy, Brittany M; Lee, Sonia

2017-05-16

Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.

Mental health challenges among adolescents living with HIV

PubMed Central

Vreeman, Rachel C.; McCoy, Brittany M.; Lee, Sonia

2017-01-01

Abstract Introduction: Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. Methods: For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Results and Discussion: Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Conclusions: Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed. PMID:28530045

ASSESSMENT AND MANAGEMENT OF WATERSHED MICROBIAL CONTAMINANTS

EPA Science Inventory

Numerous sources of infectious disease causing microorganisms exist in watersheds and can impact recreational and drinking water quality. Organisms of concern include bacteria, viruses, and parasites. The watershed manager is challenged to limit human contact with pathogens, limi...

Radiation Testing, Characterization and Qualification Challenges for Modern Microelectronics and Photonics Devices and Technologies

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.; Cohn, Lewis M.

2008-01-01

At GOMAC 2007, we discussed a selection of the challenges for radiation testing of modern semiconductor devices focusing on state-of-the-art memory technologies. This included FLASH non-volatile memories (NVMs) and synchronous dynamic random access memories (SDRAMs). In this presentation, we extend this discussion in device packaging and complexity as well as single event upset (SEU) mechanisms using several technology areas as examples including: system-on-a-chip (SOC) devices and photonic or fiber optic systems. The underlying goal is intended to provoke thought for understanding the limitations and interpretation of radiation testing results.

Case Study: The Role of eLearning in Midwifery Pre-Service Education in Ghana.

PubMed

Appiagyei, Martha; Trump, Alison; Danso, Evans; Yeboah, Alex; Searle, Sarah; Carr, Catherine

The issues and challenges of implementing eLearning in pre-service health education were explored through a pilot study conducted in six nurse-midwifery education programs in Ghana. Case-based, interactive computer mediated eLearning modules, targeted to basic emergency and obstetrical signal functions, were delivered both online and offline using a free-for-use eLearning platform, skoool HE(®). Key success factors included broad stakeholder support, an established curriculum and student and tutor interest. Challenges included infrastructure limitations, large class sizes and added workloads for tutors and information technology staff. National scale up is planned.

Hospital Decontamination: What Nurses Need to Know.

PubMed

Cox, Brent

2016-12-01

Incidents involving the release of hazardous materials challenge medical providers with safely, quickly, and correctly removing contaminants from the victim. While doing so, the safety of the first receiver, current patients, bystanders, as well as the victim all have to be considered. Key challenges with hospital decontamination include, but are not limited to, selection of team members, training protocols, employee turnover, and funding. Best practices, based on the available literature and evidence, include administration buy-in and support; strong policy and procedure documentation; equipment maintenance programs; and team member recruitment, retention, and education. Copyright © 2016 Elsevier Inc. All rights reserved.

Poliovirus Studies during the Endgame of the Polio Eradication Program.

PubMed

Arita, Minetaro

2017-01-24

Since the beginning of Global Polio Eradication Initiative in 1988, poliomyelitis cases caused by wild poliovirus (PV) have been drastically reduced, with only 74 cases reported in 2 endemic countries in 2015. The current limited PV transmission suggests that we are in the endgame of the polio eradication program. However, specific challenges have emerged in the endgame, including tight budget, switching of the vaccines, and changes in biorisk management of PV. To overcome these challenges, several PV studies have been implemented in the eradication program. Some of the responses to the emerging challenges in the polio endgame might be valuable in other infectious diseases eradication programs. Here, I will review challenges that confront the polio eradication program and current research to address these challenges.

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.

Pneumonia: challenges in the definition, diagnosis, and management of disease.

PubMed

Ottosen, Julie; Evans, Heather

2014-12-01

Defining health care-associated pneumonia, which includes both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), is problematic and controversial. Aspiration pneumonia is often included as a subtype of HAP but may be related to community-acquired aspiration events. Scoring systems exist and new surveillance guidelines have been implemented to make early recognition of pneumonia more precise and objective. Management and prevention should follow recommendations, including early empirical therapy, targeted therapy, and limited duration of treatment. Patients with trauma present a challenge to the diagnosis and management of pneumonia, because of increased risk for aspiration and underlying chest and pulmonary injury. Copyright © 2014 Elsevier Inc. All rights reserved.

Restorative and periodontal challenges in adults with dystrophic epidermolysis bullosa.

PubMed

Puliyel, Divya; Chiu, Ching Hsiu Ketty; Habibian, Mina

2014-05-01

Oral manifestations of dystrophic epidermolysis bullosa (DEB) include blistering of the oral mucosa, scarring, limited mouth opening, decreased mobility of the tongue, restrictions in oral functions and a high incidence of caries. Adult oral health management is challenging and requires unique strategies, which have not been well described in the published literature. We present a case of DEB focusing on the obstacles encountered during restorative and periodontal care and recommendations for appropriate treatment.

Looking for solutions: gender differences in relationship and parenting challenges among low-income, young parents.

PubMed

Albritton, Tashuna; Angley, Meghan; Grandelski, Valen; Hansen, Nathan; Kershaw, Trace

2014-12-01

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes. © 2014 Family Process Institute.

Research on asset management for safety and operations.

DOT National Transportation Integrated Search

2011-11-01

The Texas Department of Transportation (TxDOT) is challenged with managing a wide range of : transportation safety and operations assets in order to respond to public and other outside interests. These : assets include, but are not limited to pavemen...

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.

Health literacy, health communication challenges, and cancer screening among rural native Hawaiian and Filipino women.

PubMed

Sentell, Tetine; Dela Cruz, May Rose; Heo, Hyun-Hee; Braun, Kathryn L

2013-06-01

Native Hawaiians and Filipinos are disproportionately impacted by cancer and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included "big" words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination, (2) the key role women play in interpreting health information for others, (3) the importance of personal experience and relationships to the salience of health information, and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy.

Health literacy, health communication challenges, and cancer screening among rural Native Hawaiian and Filipino Women

PubMed Central

Sentell, Tetine; Cruz, May Rose Dela; Heo, Hyun Hee; Braun, Kathryn

2013-01-01

Native Hawaiians and Filipinos are disproportionately impacted by cancer, and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+ years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included “big” words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination; (2) the key role women play in interpreting health information for others; (3) the importance of personal experience and relationships to the salience of health information; and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy. PMID:23536194

Mapping Malaria Risk in Low Transmission Settings: Challenges and Opportunities.

PubMed

Sturrock, Hugh J W; Bennett, Adam F; Midekisa, Alemayehu; Gosling, Roly D; Gething, Peter W; Greenhouse, Bryan

2016-08-01

As malaria transmission declines, it becomes increasingly focal and prone to outbreaks. Understanding and predicting patterns of transmission risk becomes an important component of an effective elimination campaign, allowing limited resources for control and elimination to be targeted cost-effectively. Malaria risk mapping in low transmission settings is associated with some unique challenges. This article reviews the main challenges and opportunities related to risk mapping in low transmission areas including recent advancements in risk mapping low transmission malaria, relevant metrics, and statistical approaches and risk mapping in post-elimination settings. Copyright © 2016. Published by Elsevier Ltd.

Problem-Based Learning in Biomechanics: Advantages, Challenges, and Implementation Strategies.

PubMed

Clyne, Alisa Morss; Billiar, Kristen L

2016-07-01

Problem-based learning (PBL) has been shown to be effective in biomedical engineering education, particularly in motivating student learning, increasing knowledge retention, and developing problem solving, communication, and teamwork skills. However, PBL adoption remains limited by real challenges in effective implementation. In this paper, we review the literature on advantages and challenges of PBL and present our own experiences. We also provide practical guidelines for implementing PBL, including two examples of PBL modules from biomechanics courses at two different institutions. Overall, we conclude that the benefits for both professors and students support the use of PBL in biomedical engineering education.

Cross-cultural healthcare challenges: an insight into small American community hospitals.

PubMed

Kothari, M P; Kothari, V

1997-01-01

The healthcare industry in the United States is faced with many strategic challenges, because of the nation's growing culturally diverse population. Growing cultural diversity now calls for better trained medical staff that is capable of handling language, religious and cultural differences. In the rural communities, where cultural diversity is rapidly becoming a demographic fact, small hospitals with limited resources are especially confronted with medical challenges for which they seem to be least prepared. Based on an exploratory research that includes a study of small town hospitals, this paper provides insights into cross-cultural problems facing healthcare professionals in small communities. The paper highlights also the ways in which hospitals are responding to such challenges.

Global Health: Pediatric Neurology.

PubMed

Bearden, David R; Ciccone, Ornella; Patel, Archana A

2018-04-01

Neurologic disorders contribute significantly to both morbidity and mortality among children in resource-limited settings, but there are a few succinct studies summarizing the epidemiology of neurologic disorders in these settings. A review of available literature was performed to identify data on the prevalence, etiology, outcomes, and treatment of neurologic disorders in children in resource-limited settings. The burden of neurologic disorders in children is high in resource-limited settings. Barriers to optimal care include lack of trained personnel, limited access to diagnostic technology, and limited availability of drugs used to treat common conditions. Several solutions have been suggested to deal with these challenges including increased collaborations to train neurologists willing to practice in resource-limited settings and increased training of physician extenders or community health workers. Further studies are necessary to improve our understanding of the epidemiology of neurologic disorders in resource-limited settings. Future epidemiologic studies should incorporate multiple countries in resource-limited settings and utilize standardized definitions and methodologies to enable comparison across regions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Point-of-care diagnostics: extending the laboratory network to reach the last mile.

PubMed

Drain, Paul K; Rousseau, Christine

2017-03-01

More point-of-care (POC) diagnostic tests are becoming available for HIV diagnosis and treatment in resource-limited settings. These novel technologies have the potential to foster decentralized HIV care and treatment for the benefit of clinical laboratories, HIV clinics, and HIV-infected patients. There continue to be many business, technological, and operational challenges that limit product development and regulatory approval, which limits products available for the required operational and cost-effectiveness studies and delays policy adoption and implementation. Although the rapid HIV diagnostic test has been widely successful, the pathways for POC CD4 cell count and HIV viral load assay analyzers have been more challenging. We describe significant hurdles for product development, approval, and implementation, which include the business case, technical development, clinical impact, and integrating laboratory and clinical networks. The objective of this review is to highlight the obstacles for developing and implementing appropriate strategies for POC HIV testing assays to improve the clinical services for HIV-infected patients in resource-limited settings.

Health challenges in Kazakhstan and Central Asia.

PubMed

Adambekov, Shalkar; Kaiyrlykyzy, Aiym; Igissinov, Nurbek; Linkov, Faina

2016-01-01

The Central Asian region, which encompasses Kazakhstan, Uzbekistan, Tajikistan, Turkmenistan and Kyrgyzstan, is an interesting geographic region with a rich history dating back to the Silk Road, Mongol conquests and expansion of the Russian Empire. However, from a public health viewpoint, the Central Asian region is under-investigated, and many public health challenges exist, as countries of Central Asia inherited the centralised medical systems practiced in the Soviet Union, and are currently undergoing rapid transitions. A large number of low and middle-income countries around the world, including countries of Central Asia, face a double burden of chronic and infectious disease. This essay focuses on the exploration of the most important public health challenges in the Central Asian region, including limited scientific productivity, the double burden of chronic and infectious disease, the need for healthcare reform and the reduction in care variation. Central Asia has a large number of medical schools, medical centres, and emerging research institutes that can be used to foster a change in medical and public health practice in the region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Student Teachers' Approaches to Teaching Biological Evolution

ERIC Educational Resources Information Center

Borgerding, Lisa A.; Klein, Vanessa A.; Ghosh, Rajlakshmi; Eibel, Albert

2015-01-01

Evolution is fundamental to biology and scientific literacy, but teaching high school evolution is often difficult. Evolution teachers face several challenges including limited content knowledge, personal conflicts with evolution, expectations of resistance, concerns about students' conflicts with religion, and curricular constraints. Evolution…

Psychological treatments in intellectual disability: the challenges of building a good evidence base.

PubMed

Bhaumik, Sabyasachi; Gangadharan, Satheesh; Hiremath, Avinash; Russell, Paul Swamidhas Sudhakar

2011-06-01

Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

A Double Whammy: Health Promotion Among Cancer Survivors with Pre-Existing Functional Limitations

PubMed Central

Volker, Deborah L.; Becker, Heather; Kang, Sook Jung; Kullberg, Vicki

2012-01-01

Purpose/Objectives To explore the experience of living with a cancer diagnosis within the context of a pre-existing functional disability and to identify strategies to promote health in this growing population of cancer survivors. Research Approach Qualitative descriptive Setting Four sites in the United States Participants 19 female cancer survivors with pre-existing disabling conditions Methodologic Approach Four focus groups were conducted. The audiotapes were transcribed and analyzed using content analysis techniques. Main Research Variables cancer survivor, disability, health promotion Findings Analytic categories included living with a cancer diagnosis, health promotion strategies, and wellness program development for survivors with pre-existing functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies they used to maintain their health and topics to be included in health promotion programs tailored for this unique group of cancer survivors. Conclusions The “double whammy” of a cancer diagnosis for persons with pre-existing functional limitations requires modification of health promotion strategies and programs to promote wellness in this group of cancer survivors. Interpretation Nurses and other health care providers must attend to patients’ pre-existing conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. PMID:23269771

Detainee Healthcare in Theater Hospitals: Are Air Force Medics Prepared for the Challenge

DTIC Science & Technology

2009-04-01

hostility could include not having same sex medical personnel for detainees, which can be challenging, due to staffing limitations. Muslim males, and...set of problems called ethnocentrism . What it boils down to is the belief that your own culture is the normal and right way of doing things and...population itself, but more so with first identifying our own preconceptions, ethnocentrisms , as well as our propensity to push our own cultural

Could Wind or Solar Energy Replace Diesel Generators for Aviation Ground Maintenance Operations?

DTIC Science & Technology

2013-04-17

power. Both of these systems depend on the sun to produce energy. Wind turbines depend on wind which results from the uneven heating of the earth...inefficient. In addition to these limitations, both systems are costly and their installation brings a number of challenges. For the wind turbines ...these challenges include: the obstruction created by the height of the turbines near airfields, the amount of land necessary for a 7 turbines wind farm

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

PubMed

Johnston, Brenda J; Peppard, Lora; Newton, Marian

2015-08-01

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

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

PubMed

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

2015-01-01

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

Robotics in neurosurgery: state of the art and future technological challenges.

PubMed

Zamorano, L; Li, Q; Jain, S; Kaur, G

2004-06-01

The use of robotic technologies to assist surgeons was conceptually described almost thirty years ago but has only recently become feasible. In Neurosurgery, medical robots have been applied to neurosurgery for over 19 years. Nevertheless this field remains unknown to most neurosurgeons. The intrinsic characteristics of robots, such as high precision, repeatability and endurance make them ideal surgeon's assistants. Unfortunately, limitations in the current available systems make its use limited to very few centers in the world. During the last decade, important efforts have been made between academic and industry partnerships to develop robots suitable for use in the operating room environment. Although some applications have been successful in areas of laparoscopic surgery and orthopaedics, Neurosurgery has presented a major challenge due to the eloquence of the surrounding anatomy. This review focuses on the application of medical robotics in neurosurgery. The paper begins with an overview of the development of the medical robotics, followed by the current clinical applications in neurosurgery and an analysis of current limitations. We discuss robotic applications based in our own experience in the field. Next, we discuss the technological challenges and research areas to overcome those limitations, including some of our current research approaches for future progress in the field. Copyright 2004 Robotic Publications Ltd.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

PubMed Central

Chan, Lenny L. S.; Fouts, Michelle M.; Murphy, Elizabeth J.

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations. PMID:28197420

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations.

PubMed

Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M; Murphy, Elizabeth J

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

Issues surrounding the health economic evaluation of genomic technologies

PubMed Central

Buchanan, James; Wordsworth, Sarah; Schuh, Anna

2014-01-01

Aim Genomic interventions could enable improved disease stratification and individually tailored therapies. However, they have had a limited impact on clinical practice to date due to a lack of evidence, particularly economic evidence. This is partly because health economists are yet to reach consensus on whether existing methods are sufficient to evaluate genomic technologies. As different approaches may produce conflicting adoption decisions, clarification is urgently required. This article summarizes the methodological issues associated with conducting economic evaluations of genomic interventions. Materials & methods A structured literature review was conducted to identify references that considered the methodological challenges faced when conducting economic evaluations of genomic interventions. Results Methodological challenges related to the analytical approach included the choice of comparator, perspective and timeframe. Challenges in costing centered around the need to collect a broad range of costs, frequently, in a data-limited environment. Measuring outcomes is problematic as standard measures have limited applicability, however, alternative metrics (e.g., personal utility) are underdeveloped and alternative approaches (e.g., cost–benefit analysis) underused. Effectiveness data quality is weak and challenging to incorporate into standard economic analyses, while little is known about patient and clinician behavior in this context. Comprehensive value of information analyses are likely to be helpful. Conclusion Economic evaluations of genomic technologies present a particular challenge for health economists. New methods may be required to resolve these issues, but the evidence to justify alternative approaches is yet to be produced. This should be the focus of future work in this field. PMID:24236483

Developing an Inpatient Group Psychotherapy Program: Challenges and Lessons Learnt

PubMed Central

Razaghi, Emran Mohammad; Tabatabaee, Maryam; Pourramzani, Ali; Shirali Mohammadpour, Reza; Mousazade Moghaddam, Arezou; Yahyavi, Seyyed Taha

2015-01-01

In Iran, inpatient group psychotherapy has been limited to transient practices for research purposes or fulfilling personal interest of therapists. The goal of this paper is to share and explain the experience of developing an inpatient group psychotherapy program in Roozbeh Psychiatric Hospital, Tehran, Iran. After theoretical delineation and preparation of a draft of the program guideline, two pilot sessions were held. Based on this initial experience a final treatment guideline was prepared. Afterwards, the program was continued for more than 1 year in a female ward at Roozbeh Psychiatric Hospital. The output of this exercise was a guideline that covers important topics in development of inpatient group psychotherapy. It is concluded that inpatient group psychotherapy has its unique challenges. Of the most important challenges that can be mentioned in this regard are the participation of patients with significant differences in levels of psychopathology and psychiatric signs and symptoms, and high comorbidity with specific personality traits or disorders. Other challenges relevant to the structure of the group include items such as very limited time for working through and inevitable out-of-group contacts. PMID:26576176

Exploration Rover Concepts and Development Challenges

NASA Technical Reports Server (NTRS)

Zakrajsek, James J.; McKissock, David B.; Woytach, Jeffrey M.; Zakrajsek, June F.; Oswald, Fred B.; McEntire, Kelly J.; Hill, Gerald M.; Abel, Phillip; Eichenberg, Dennis J.; Goodnight, Thomas W.

2005-01-01

This paper presents an overview of exploration rover concepts and the various development challenges associated with each as they are applied to exploration objectives and requirements for missions on the Moon and Mars. A variety of concepts for surface exploration vehicles have been proposed since the initial development of the Apollo-era lunar rover. This paper provides a brief description of the rover concepts, along with a comparison of their relative benefits and limitations. In addition, this paper outlines, and investigates a number of critical development challenges that surface exploration vehicles must address in order to successfully meet the exploration mission vision. These include: mission and environmental challenges, design challenges, and production and delivery challenges. Mission and environmental challenges include effects of terrain, extreme temperature differentials, dust issues, and radiation protection. Design methods are discussed that focus on optimum methods for developing highly reliable, long-life and efficient systems. In addition, challenges associated with delivering a surface exploration system is explored and discussed. Based on all the information presented, modularity will be the single most important factor in the development of a truly viable surface mobility vehicle. To meet mission, reliability, and affordability requirements, surface exploration vehicles, especially pressurized rovers, will need to be modularly designed and deployed across all projected Moon and Mars exploration missions.

The pain of chronic pancreatitis: a persistent clinical challenge

PubMed Central

2013-01-01

The pain of chronic pancreatitis represents a major challenge to those working in the field, including pain specialists, gastroenterologists and surgeons. This article describes the different aetiologies of chronic pancreatitis and lists the models for the pathogenesis of pain, including novel ideas such as the role of the immune system in the modulation of pain. The patient profile in chronic pancreatitis is discussed along with the social impact of the disease in relation to alcohol misuse. The range of treatment strategies including medical, endoscopic and surgical approaches are evaluated. Common analgesic regimes and their limitations are reviewed. The pain of chronic pancreatitis remains refractory to effective treatment in many cases and further study and understanding of the underlying pathophysiology are required. PMID:26516493

Plenary Round Table: The Main Challenges of Space Propulsion Industry for the Coming Ten Years

NASA Technical Reports Server (NTRS)

Wood, Byron K.; Hopson, George (Technical Monitor)

2002-01-01

This viewgraph presentation provides limited information on the Space Shuttle Main Engine. Topics covered include reusability levels for individual parts, the relation between the number of certification tests and average risk factor for first flights.

Recruitment and Retention of Assessment Personnel

ERIC Educational Resources Information Center

Simpson, Cynthia G.; Lynch, Sharon A.; Spencer, Vicky G.

2007-01-01

With a national shortage of special education personnel, including assessment personnel (Caranikas-Walker; Shapley, Cordeau, 2006; Karr, 2005), rural communities face serious challenges in retaining and recruiting highly qualified special education staff due to limited access to university training programs (Hausman & Hausman, 2003; Knapczyk,…

Second Chances

ERIC Educational Resources Information Center

Boyd, Karen Anne

2007-01-01

Accommodating change in existing buildings on a college campus or in a school district is challenging, but manageable. The key to successful adaptive reuse is thoughtful and thorough decision-making. Why consider recycling existing buildings? There are many reasons, including limited institutional resources, the increasing cost of new…

The Diverse Roles of Hydrogel Mechanics in Injectable Stem Cell Transplantation.

PubMed

Foster, Abbygail A; Marquardt, Laura M; Heilshorn, Sarah C

2017-02-01

Stem cell delivery by local injection has tremendous potential as a regenerative therapy but has seen limited clinical success. Several mechanical challenges hinder therapeutic efficacy throughout all stages of cell transplantation, including mechanical forces during injection and loss of mechanical support post-injection. Recent studies have begun exploring the use of biomaterials, in particular hydrogels, to enhance stem cell transplantation by addressing the often-conflicting mechanical requirements associated with each stage of the transplantation process. This review explores recent biomaterial approaches to improve the therapeutic efficacy of stem cells delivered through local injection, with a focus on strategies that specifically address the mechanical challenges that result in cell death and/or limit therapeutic function throughout the stages of transplantation.

Use of Genetic Testing for Primary Immunodeficiency Patients.

PubMed

Heimall, Jennifer R; Hagin, David; Hajjar, Joud; Henrickson, Sarah E; Hernandez-Trujillo, Hillary S; Tan, Yuval; Kobrynski, Lisa; Paris, Kenneth; Torgerson, Troy R; Verbsky, James W; Wasserman, Richard L; Hsieh, Elena W Y; Blessing, Jack J; Chou, Janet S; Lawrence, Monica G; Marsh, Rebecca A; Rosenzweig, Sergio D; Orange, Jordan S; Abraham, Roshini S

2018-04-01

Genetic testing plays a critical role in diagnosis for many primary immunodeficiency diseases. The goals of this report are to outline some of the challenges that clinical immunologists face routinely in the use of genetic testing for patient care. In addition, we provide a review of the types of genetic testing used in the diagnosis of PID, including their strengths and limitations. We describe the strengths and limitations of different genetic testing approaches for specific clinical contexts that raise concern for specific PID disorders in light of the challenges reported by the clinical immunologist members of the CIS in a recent membership survey. Finally, we delineate the CIS's recommendations for the use of genetic testing in light of these issues.

Opportunities and challenges in conducting secondary analysis of HIV programmes using data from routine health information systems and personal health information.

PubMed

Gloyd, Stephen; Wagenaar, Bradley H; Woelk, Godfrey B; Kalibala, Samuel

2016-01-01

HIV programme data from routine health information systems (RHIS) and personal health information (PHI) provide ample opportunities for secondary data analysis. However, these data pose unique opportunities and challenges for use in health system monitoring, along with process and impact evaluations. Analyses focused on retrospective case reviews of four of the HIV-related studies published in this JIAS supplement. We identify specific opportunities and challenges with respect to the secondary analysis of RHIS and PHI data. Challenges working with both HIV-related RHIS and PHI included missing, inconsistent and implausible data; rapidly changing indicators; systematic differences in the utilization of services; and patient linkages over time and different data sources. Specific challenges among RHIS data included numerous registries and indicators, inconsistent data entry, gaps in data transmission, duplicate registry of information, numerator-denominator incompatibility and infrequent use of data for decision-making. Challenges specific to PHI included the time burden for busy providers, the culture of lax charting, overflowing archives for paper charts and infrequent chart review. Many of the challenges that undermine effective use of RHIS and PHI data for analyses are related to the processes and context of collecting the data, excessive data requirements, lack of knowledge of the purpose of data and the limited use of data among those generating the data. Recommendations include simplifying data sources, analysis and reporting; conducting systematic data quality audits; enhancing the use of data for decision-making; promoting routine chart review linked with simple patient tracking systems; and encouraging open access to RHIS and PHI data for increased use.

Exploring family physician stress

PubMed Central

Lee, F. Joseph; Brown, Judith Belle; Stewart, Moira

2009-01-01

ABSTRACT OBJECTIVE To explore the nature of professional stress and the strategies used by family physicians to deal with this stress. DESIGN Qualitative study. SETTING Kitchener-Waterloo, Ont. PARTICIPANTS Ten key-informant family physicians. METHODS In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used. MAIN FINDINGS The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns. CONCLUSION Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels. PMID:19282541

Thermal Analysis of Iodine Satellite (iSAT) from Preliminary Design Review (PDR) to Critical Design Review (CDR)

NASA Technical Reports Server (NTRS)

Mauro, Stephanie

2016-01-01

The Iodine Satellite (iSAT) is a 12U cubesat with a primary mission to demonstrate the iodine fueled Hall Effect Thruster (HET) propulsion system. The spacecraft (SC) will operate throughout a one year mission in an effort to mature the propulsion system for use in future applications. The benefit of the HET is that it uses a propellant, iodine, which is easy to store and provides a high thrust-to-mass ratio. This paper will describe the thermal analysis and design of the SC between Preliminary Design Review (PDR) and Critical Design Review (CDR). The design of the satellite has undergone many changes due to a variety of challenges, both before PDR and during the time period discussed in this paper. Thermal challenges associated with the system include a high power density, small amounts of available radiative surface area, localized temperature requirements of the propulsion components, and unknown orbital parameters. The thermal control system is implemented to maintain component temperatures within their respective operational limits throughout the mission, while also maintaining propulsion components at the high temperatures needed to allow gaseous iodine propellant to flow. The design includes heaters, insulation, radiators, coatings, and thermal straps. Currently, the maximum temperatures for several components are near to their maximum operation limit, and the battery is close to its minimum operation limit. Mitigation strategies and planned work to solve these challenges will be discussed.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

PubMed

Rabbani, Fauziah; Shipton, Leah; White, Franklin; Nuwayhid, Iman; London, Leslie; Ghaffar, Abdul; Ha, Bui Thi Thu; Tomson, Göran; Rimal, Rajiv; Islam, Anwar; Takian, Amirhossein; Wong, Samuel; Zaidi, Shehla; Khan, Kausar; Karmaliani, Rozina; Abbasi, Imran Naeem; Abbas, Farhat

2016-09-07

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

Cryptosporidiosis: Environmental, therapeutic, and preventive challenges

PubMed Central

Collinet-Adler, Stefan; Ward, Honorine D.

2014-01-01

Cryptosporidium spp. are responsible for endemic and epidemic disease worldwide. Clinical manifestations may include acute, persistent, or chronic diarrhea, biliary, and pulmonary disease. Disease severity ranges from asymptomatic or mild to severe, intractable diarrhea with wasting depending on immune status, nutrition, and age. Transmission is fecal-oral with both human and animal reservoirs. Disease is often self limited in healthy individuals, but therapy remains a challenge in the immune-compromised. Prevention currently depends on appropriate hygiene and proper water management and treatment. PMID:20521158

Black swans, wicked problems, and science during crises

USGS Publications Warehouse

Machlis, G.E.; McNutt, M.K.

2011-01-01

Oceanic resources face challenges that are significant and widespread, including (but not limited to) overharvesting, climate change, selected stock collapse, coral reef decline, species extinction, pollution, and more. These challenges are the focus of much ocean science, which is helping to inform policy and guide management actions. The steady growth of research results and the emergence of new research needs have been systematically reviewed through periodic assessments, such as those of the Intergovernmental Oceanographic Commission (Valdés et al., 2010).

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.

Learning Analytics: Challenges and Limitations

ERIC Educational Resources Information Center

Wilson, Anna; Watson, Cate; Thompson, Terrie Lynn; Drew, Valerie; Doyle, Sarah

2017-01-01

Learning analytic implementations are increasingly being included in learning management systems in higher education. We lay out some concerns with the way learning analytics--both data and algorithms--are often presented within an unproblematized Big Data discourse. We describe some potential problems with the often implicit assumptions about…

Physics-based distributed snow models in the operational arena: Current and future challenges

NASA Astrophysics Data System (ADS)

Winstral, A. H.; Jonas, T.; Schirmer, M.; Helbig, N.

2017-12-01

The demand for modeling tools robust to climate change and weather extremes along with coincident increases in computational capabilities have led to an increase in the use of physics-based snow models in operational applications. Current operational applications include the WSL-SLF's across Switzerland, ASO's in California, and USDA-ARS's in Idaho. While the physics-based approaches offer many advantages there remain limitations and modeling challenges. The most evident limitation remains computation times that often limit forecasters to a single, deterministic model run. Other limitations however remain less conspicuous amidst the assumptions that these models require little to no calibration based on their foundation on physical principles. Yet all energy balance snow models seemingly contain parameterizations or simplifications of processes where validation data are scarce or present understanding is limited. At the research-basin scale where many of these models were developed these modeling elements may prove adequate. However when applied over large areas, spatially invariable parameterizations of snow albedo, roughness lengths and atmospheric exchange coefficients - all vital to determining the snowcover energy balance - become problematic. Moreover as we apply models over larger grid cells, the representation of sub-grid variability such as the snow-covered fraction adds to the challenges. Here, we will demonstrate some of the major sensitivities of distributed energy balance snow models to particular model constructs, the need for advanced and spatially flexible methods and parameterizations, and prompt the community for open dialogue and future collaborations to further modeling capabilities.

Monitoring biological diversity: strategies, tools, limitations, and challenges

USGS Publications Warehouse

Beever, E.A.

2006-01-01

Monitoring is an assessment of the spatial and temporal variability in one or more ecosystem properties, and is an essential component of adaptive management. Monitoring can help determine whether mandated environmental standards are being met and can provide an early-warning system of ecological change. Development of a strategy for monitoring biological diversity will likely be most successful when based upon clearly articulated goals and objectives and may be enhanced by including several key steps in the process. Ideally, monitoring of biological diversity will measure not only composition, but also structure and function at the spatial and temporal scales of interest. Although biodiversity monitoring has several key limitations as well as numerous theoretical and practical challenges, many tools and strategies are available to address or overcome such challenges; I summarize several of these. Due to the diversity of spatio-temporal scales and comprehensiveness encompassed by existing definitions of biological diversity, an effective monitoring design will reflect the desired sampling domain of interest and its key stressors, available funding, legal requirements, and organizational goals.

Caring for Refugee Youth in the School Setting.

PubMed

Johnson, Jennifer Leigh; Beard, Joyce; Evans, Dena

2017-03-01

Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.

DMDs for multi-object near-infrared spectrographs in astronomy

NASA Astrophysics Data System (ADS)

Smee, Stephen A.; Barkhouser, Robert; Hope, Stephen; Conley, Devin; Gray, Aidan; Hope, Gavin; Robberto, Massimo

2018-02-01

The Digital Micromirror Device (DMD), typically used in projection screen technology, has utility in instrumentation for astronomy as a digitally programmable slit in a spectrograph. When placed at an imaging focal plane the device can be used to selectively direct light from astronomical targets into the optical path of a spectrograph, while at the same time directing the remaining light into an imaging camera, which can be used for slit alignment, science imaging, or both. To date the use of DMDs in astronomy has been limited, especially for instruments that operate in the near infrared (1 - 2.5 μm). This limitation is due in part to a host of technical challenges with respect to DMDs that, to date, have not been thoroughly explored. Those challenges include operation at cryogenic temperature, control electronics that facilitate DMD use at these temperatures, window coatings properly coated for the near infrared bandpass, and scattered light. This paper discusses these technical challenges and presents progress towards understanding and mitigating them.

Impact of the increased adoption of prenatal cfDNA screening on non-profit patient advocacy organizations in the United States.

PubMed

Meredith, Stephanie; Kaposy, Christopher; Miller, Victoria J; Allyse, Megan; Chandrasekharan, Subhashini; Michie, Marsha

2016-08-01

The 'Stakeholder Perspectives on Noninvasive Prenatal Genetic Screening' Symposium was held in conjunction with the 2015 annual meeting of the International Society for Prenatal Diagnosis. During the day-long meeting, a panel of patient advocacy group (PAG) representatives discussed concerns and challenges raised by prenatal cell-free DNA (cfDNA) screening, which has resulted in larger demands upon PAGs from concerned patients receiving prenatal cfDNA screening results. Prominent concerns included confusion about the accuracy of cfDNA screening and a lack of patient education resources about genetic conditions included in cfDNA screens. Some of the challenges faced by PAGs included funding limitations, lack of consistently implemented standards of care and oversight, diverse perspectives among PAGs and questions about neutrality, and lack of access to training and genetic counselors. PAG representatives also put forward suggestions for addressing these challenges, including improving educational and PAG funding and increasing collaboration between PAGs and the medical community. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Extensively Drug-resistant Tuberculosis (XDR-TB): A daunting challenge to the current End TB Strategy and policy recommendations.

PubMed

Rahman, Md Arifur; Sarkar, Atanu

2017-07-01

Extensively Drug-resistant Tuberculosis (XDR-TB) has emerged as one of the most formidable challenges to the End TB Strategy that has targeted a 95% reduction in TB deaths and 90% reduction in cases by 2035. Globally, there were an estimated 55,100 new XDR-TB cases in 2015 in 117 countries. However, only one in 30 XDR-TB cases had been reported so far. Drug susceptibility test (DST) is the mainstay for diagnosing XDR-TB, but the lack of laboratory facilities in the resource-limited endemic countries limit its uses. A few new drugs including bedaquiline and delamanid, have the potential to improve the efficiency of XDR-TB treatment, but the drugs have been included in 39 countries only. The costs of XDR-TB treatment are several folds higher than that of the MDR-TB. Despite the financing from the donors, there is an urgent need to fill the current funding gap of US$ 2 billion to ensure effective treatment and robust surveillance. In the review article we have addressed current update on XDR-TB, including surveillance, diagnosis and the interventions needed to treat and limit its spread, emphasis on extensive financial support for implementing of current recommendations to meet the goals of End TB Strategy. Copyright © 2017 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

Application of a framework for extrapolating chemical effects across species in pathways controlled by estrogen receptor-á

EPA Science Inventory

Cross-species extrapolation of toxicity data from limited surrogate test organisms to all wildlife with potential of chemical exposure remains a key challenge in ecological risk assessment. A number of factors affect extrapolation, including the chemical exposure, pharmacokinetic...

Unique challenges facing Southwestern tribes: Chapter 17

USGS Publications Warehouse

Hiza, Margaret; Chief, Karletta; Bemis, Kirk; Gautam, Mahesh; Middleton, Beth Rose; Tsosie, Rebecca

2013-01-01

•\tTribes are taking action to address climate change by instituting climate-change mitigation initiatives, including utility-scale, alternative-energy projects, and energy-conservation projects. Tribes are also evaluating their existing capacity to engage in effective adaptation planning, even though financial and social capital is limited.

Challenges in Delivering Library Services for Distance Learning.

ERIC Educational Resources Information Center

Swaine, Cynthia Wright

The first section of this paper on library services for distance education discusses the status of distance learning in higher education. What distance learning means for libraries is addressed in the second section, including considerations related to diverse locations, agreements with participating institutions, delivery limitations, librarian…

Poverty and Disability: Addressing the Challenge of Inequality

ERIC Educational Resources Information Center

Hughes, Carolyn

2013-01-01

Living in poverty increases the likelihood that students with disabilities will experience poor postschool outcomes, including unemployment, underemployment, and limited postsecondary education. The effects of the intersection of poverty and disability persist into adulthood where the employment rate for adults with disabilities is only one fourth…

The pebbles that started the tea and ohelo berry projects in Hawaii

USDA-ARS?s Scientific Manuscript database

Hawaii farmers face many challenges in production including high cost of operation, limitation of affordable land, infra-structure, energy and human resources. After World War II, success in agricultural research into new crops contributed to the economic development and stability in Hawaii. Some...

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…

A multi-site community randomized trial of community health workers to provide counseling and support for patients newly entering HIV care in rural Ethiopia: study design and baseline implementation.

PubMed

Lifson, Alan R; Workneh, Sale; Hailemichael, Abera; MacLehose, Richard F; Horvath, Keith J; Hilk, Rose; Fabian, Lindsey; Sites, Anne; Shenie, Tibebe

2018-06-01

Although HIV therapy is delivered to millions globally, treatment default (especially soon after entering care) remains a challenge. Community health workers (CHWs) can provide many services for people with HIV, including in rural and resource-limited settings. We designed and implemented a 32 site community randomized trial throughout southern Ethiopia to assess an intervention using CHWs to improve retention in HIV care. Sixteen district hospital and 16 local health center HIV clinics were randomized 1:1 to be intervention or control sites. From each site, we enrolled adults newly entering HIV care. Participants at intervention sites were assigned a CHW who provided: HIV and health education; counseling and social support; and facilitated communication with HIV clinics. All participants are followed through three years with annual health surveys, plus HIV clinic record abstraction including clinic visit dates. CHWs record operational data about their client contacts. 1799 HIV patients meeting inclusion criteria were enrolled and randomized: 59% were female, median age = 32 years, median CD4 + count = 263 cells/mm 3 , and 41% were WHO Stage III or IV. A major enrollment challenge was fewer new HIV patients initiating care at participating sites due to shortage of HIV test kits. At intervention sites, 71 CHWs were hired, trained and assigned to clients. In meeting with clients, CHWs needed to accommodate to various challenges, including HIV stigma, distance, and clients lacking cell phones. This randomized community HIV trial using CHWs in a resource-limited setting was successfully launched, but required flexibility to adapt to unforeseen challenges.

Rehabilitation in Madagascar: Challenges in implementing the World Health Organization Disability Action Plan.

PubMed

Khan, Fary; Amatya, Bhasker; Mannan, Hasheem; Burkle, Frederick M; Galea, Mary P

2015-09-01

To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach, new partnerships, strategic collaboration, provision of technical assistance, future policy directions, and research and development. Other challenges for many basic policies included: access to rehabilitation services, geographical coverage, shortage of skilled work-force, limited info-technology systems; lack of care-models and facility/staff accreditation standards; limited health services infrastructure and "disconnect" between acute and community-based rehabilitation. The DAP summary actions were useful planning tools to improve access, strengthen rehabilitation services and community-based rehabilitation, and collate data for outcome research.

Where Is Current Research on Blockchain Technology?—A Systematic Review

PubMed Central

Yli-Huumo, Jesse; Ko, Deokyoon; Park, Sooyong; Smolander, Kari

2016-01-01

Blockchain is a decentralized transaction and data management technology developed first for Bitcoin cryptocurrency. The interest in Blockchain technology has been increasing since the idea was coined in 2008. The reason for the interest in Blockchain is its central attributes that provide security, anonymity and data integrity without any third party organization in control of the transactions, and therefore it creates interesting research areas, especially from the perspective of technical challenges and limitations. In this research, we have conducted a systematic mapping study with the goal of collecting all relevant research on Blockchain technology. Our objective is to understand the current research topics, challenges and future directions regarding Blockchain technology from the technical perspective. We have extracted 41 primary papers from scientific databases. The results show that focus in over 80% of the papers is on Bitcoin system and less than 20% deals with other Blockchain applications including e.g. smart contracts and licensing. The majority of research is focusing on revealing and improving limitations of Blockchain from privacy and security perspectives, but many of the proposed solutions lack concrete evaluation on their effectiveness. Many other Blockchain scalability related challenges including throughput and latency have been left unstudied. On the basis of this study, recommendations on future research directions are provided for researchers. PMID:27695049

Where Is Current Research on Blockchain Technology?-A Systematic Review.

PubMed

Yli-Huumo, Jesse; Ko, Deokyoon; Choi, Sujin; Park, Sooyong; Smolander, Kari

2016-01-01

Blockchain is a decentralized transaction and data management technology developed first for Bitcoin cryptocurrency. The interest in Blockchain technology has been increasing since the idea was coined in 2008. The reason for the interest in Blockchain is its central attributes that provide security, anonymity and data integrity without any third party organization in control of the transactions, and therefore it creates interesting research areas, especially from the perspective of technical challenges and limitations. In this research, we have conducted a systematic mapping study with the goal of collecting all relevant research on Blockchain technology. Our objective is to understand the current research topics, challenges and future directions regarding Blockchain technology from the technical perspective. We have extracted 41 primary papers from scientific databases. The results show that focus in over 80% of the papers is on Bitcoin system and less than 20% deals with other Blockchain applications including e.g. smart contracts and licensing. The majority of research is focusing on revealing and improving limitations of Blockchain from privacy and security perspectives, but many of the proposed solutions lack concrete evaluation on their effectiveness. Many other Blockchain scalability related challenges including throughput and latency have been left unstudied. On the basis of this study, recommendations on future research directions are provided for researchers.

Antimicrobial resistance in Saudi Arabia

PubMed Central

Zowawi, Hosam M.

2016-01-01

Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country. Actions should include active surveillance to monitor the emergence and spread of AMR. Infection prevention and control precautions should also be optimized to limit further spread. Raising awareness is essential to limit inappropriate antibiotics use, and the antibiotic stewardship programs in hospital settings, outpatients, and community pharmacies, should regulate the ongoing use of antimicrobials. PMID:27570847

Benefits and challenges of international clinical education from a US-based physiotherapist faculty perspective.

PubMed

Pechak, Celia; Black, Jill D

2013-12-01

The influence of internationalization on physiotherapist education in at least North American-based programmes has become more apparent. Faculty and students have been involved in various international activities. One category of activities includes international clinical education (ICE), where students earn clinical education credit for their learning activities at international sites. Although this educational strategy appears to be increasingly used in at least the United States and Canada, the related literature is limited in scope. The purpose of this portion of the present study was to investigate the benefits and challenges of ICE for US-based students, US-based physiotherapy programmes and international partners from the perspective of US-based faculty sending students for clinical education internationally. Content analysis was used for this qualitative study. Fifteen US-based faculty members who had experience in sending physiotherapist students for ICE were recruited. The primary researcher conducted semi-structured phone interviews, averaging approximately 60 minutes in length. The primary and secondary researchers completed data analysis using NVivo 8 software (QSR International Inc., Cambridge, MA). Benefits of ICE to the students included exposure to alternate health systems, broadening of student perspectives and clinical competence. Challenges consisted of funding and possible language barrier. Increased visibility, expanded global perspective and faculty collaborations were benefits to the programme. Ensuring a quality learning experience was the greatest programme challenge. Benefits to the international site included education and faculty collaborations/exchanges; challenges were language, student clinical preparation and unfamiliarity with the student evaluation tool. Because the sample was limited to 15 US-based faculty members, the results may not be relevant to all programmes inside or outside of the United States. Additionally, the study lacked perspectives from the students or international sites. The present study is an early step in the important examination of the impact of this emerging educational trend on physiotherapy education and practice. Copyright © 2013 John Wiley & Sons, Ltd.

Crowdsourcing in biomedicine: challenges and opportunities

PubMed Central

Khare, Ritu; Good, Benjamin M.; Leaman, Robert; Su, Andrew I.

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. PMID:25888696

Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes.

PubMed

Dumyati, Ghinwa; Stone, Nimalie D; Nace, David A; Crnich, Christopher J; Jump, Robin L P

2017-04-01

Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors.

Life Support Requirements and Challenges for NASA's Constellation Program

NASA Technical Reports Server (NTRS)

Carasquillo, Robyn

2007-01-01

NASA's Constellation Program, which includes the mission objectives of establishing a permanently-manned lunar Outpost, and the exploration of Mars, poses new and unique challenges for human life support systems that will require solutions beyond the Shuttle and International Space Station state of the art systems. In particular, the requirement to support crews for 210 days duration at the lunar outpost with limited resource resupply capability wilt require closed-loop regenerative life support systems with minimal expendables. Planetary environmental conditions such as lunar dust and extreme temperatures, as well as the capability to support frequent and extended-duration EVA's will be particularly challenging. This presentation will summarize the key program and mission life support requirements for the Constellation Program and the unique challenges they present for technology and architecture development.

Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective.

PubMed

Yeom, Hye A; Fleury, Julie; Keller, Colleen

2008-01-01

Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.

77 FR 51805 - Office of the National Coordinator for Health Information Technology; Announcement of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-27

... cancer types and are often amplified in women's health when we look at breast cancer and gynecologic... screening services for breast and gynecologic cancers--including, but not limited to, benefits, timing... Technology; Announcement of Requirements and Registration for Reducing Cancer Among Women of Color Challenge...

Feasibility and Preliminary Outcomes of a Yoga and Mindfulness Intervention for School Teachers

ERIC Educational Resources Information Center

Ancona, Matthew R.; Mendelson, Tamar

2014-01-01

Many public school teachers face formidable challenges, including overcrowded classrooms, limited administrative resources, and high numbers of students with behavioral and emotional problems. Mindfulness-based strategies are a potentially promising means of reducing teachers' stress and enhancing their ability to handle job demands effectively.…

An Interactive Online Approach to Small-Group Student Presentations and Discussions

ERIC Educational Resources Information Center

Thor, Der; Xiao, Nan; Zheng, Meixun; Ma, Ruidan; Yu, Xiao Xi

2017-01-01

Student presentations had been widely implemented across content areas, including health sciences education. However, due to various limitations, small-group student presentations in the classroom may not reach their full potential for student learning. To address challenges with presentations in the classroom, we redesigned the assignment by…

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…

The AIDS Challenge: Prevention Education for Young People.

ERIC Educational Resources Information Center

Quackenbush, Marcia, Ed.; And Others

This book on Acquired Immune Deficiency Syndrome (AIDS) education was developed by national and international experts to aid educators, professionals, parents, and youth leaders in developing and implementing AIDS education programs. Included are: (1) "Living with AIDS" (Jack Martin Balcer); (2) "The AIDS Epidemic: Problems in Limiting Its Impact"…

Child-Centered Group Play Therapy with African American Boys at the Elementary School Level

ERIC Educational Resources Information Center

Baggerly, Jennifer; Parker, Max

2005-01-01

African American boys face numerous challenges in society within the United States, including prejudice, discrimination, racism, economic hardship, limited access to support services, educational biases, and community violence. According to Pierce (1988), the psychic assault of subtle racism against African American boys erode their…

Yokoi's Theory of Lateral Innovation: Applications for Learning Game Design

ERIC Educational Resources Information Center

Warren, Scott J.; Jones, Greg

2008-01-01

There are several major challenges for instructional designers seeking to design learning games. These include the lack of access, the cost of rapidly advancing/expensive technology tools that make developing games uneconomical, the institutional time constraints limiting game use, and the concerns that schools lack sufficiently robust computer…

Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

USDA-ARS?s Scientific Manuscript database

Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...

Coping with Economic Uncertainty: Focus on Key Risks Essential

ERIC Educational Resources Information Center

Sander, Laura

2009-01-01

During this period of continued economic uncertainty, higher-education institutions are facing a variety of challenges that by now are very familiar to governing boards and institutional leaders, including poor investment returns, reduced liquidity, limited choices in how they structure debt issues, and threats to flexibility in tuition pricing.…

Designing for Learning Engagement in Remote Communities: Narratives from North of Sixty

ERIC Educational Resources Information Center

Doering, Aaron; Henrickson, Jeni

2014-01-01

There are multiple challenges to designing learning experiences for schools in remote communities, including technology and infrastructure limitations, high teacher and administrator turnover, and conflicting interests between local culture and school curricula. In this paper, we offer a brief history of educational initiatives in remote Arctic…

A Chinese Teacher's Perspective on Professional Development in Literacy Education

ERIC Educational Resources Information Center

Syed, Khalida Tanvir

2008-01-01

This paper presents the teaching and learning experiences of a Chinese literacy teacher in narrative form. The participant's story is presented in his own voice, as constructed from interview transcripts. Challenges and struggles faced by the participant include limited professional autonomy in a hierarchal school system, awareness of conflict…

Reflections on Developing an Employment Mentoring Program for College Students Who Are Blind

ERIC Educational Resources Information Center

O'Mally, Jamie; Steverson, Anne

2017-01-01

In a competitive employment climate, college graduates with visual impairments (that is, those who are blind or have low vision) face challenges securing work. Employment barriers among visually impaired individuals include: limited early work experience, negative employer attitudes, transportation issues, lack of exposure to successful role…

Special Educators and Mathematics Phobia: An Initial Qualitative Investigation

ERIC Educational Resources Information Center

Humphrey, Michael; Hourcade, Jack J.

2010-01-01

Special educators are uniquely challenged to be content experts in all curricular areas, including mathematics, because students in their caseloads may require academic instruction in any area. However, special educators with math phobia may be limited in their ability to provide effective instruction to their students with mathematical deficits…

75 FR 27406 - Airworthiness Directives; Bombardier, Inc. Model BD-100-1A10 (Challenger 300) Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

... BD- 100 Time Limits/Maintenance Checks. The actions described in this service information are... Challenger 300 BD-100 Time Limits/Maintenance Checks. (1) For the new tasks identified in Bombardier TR 5-2... Requirements,'' in Part 2 of Chapter 5 of Bombardier Challenger 300 BD-100 Time Limits/ Maintenance Checks...

Searching for grey literature for systematic reviews: challenges and benefits.

PubMed

Mahood, Quenby; Van Eerd, Dwayne; Irvin, Emma

2014-09-01

There is ongoing interest in including grey literature in systematic reviews. Including grey literature can broaden the scope to more relevant studies, thereby providing a more complete view of available evidence. Searching for grey literature can be challenging despite greater access through the Internet, search engines and online bibliographic databases. There are a number of publications that list sources for finding grey literature in systematic reviews. However, there is scant information about how searches for grey literature are executed and how it is included in the review process. This level of detail is important to ensure that reviews follow explicit methodology to be systematic, transparent and reproducible. The purpose of this paper is to provide a detailed account of one systematic review team's experience in searching for grey literature and including it throughout the review. We provide a brief overview of grey literature before describing our search and review approach. We also discuss the benefits and challenges of including grey literature in our systematic review, as well as the strengths and limitations to our approach. Detailed information about incorporating grey literature in reviews is important in advancing methodology as review teams adapt and build upon the approaches described. Copyright © 2013 John Wiley & Sons, Ltd.

Sensory-Challenge Balance Exercises Improve Multisensory Reweighting in Fall-Prone Older Adults.

PubMed

Allison, Leslie K; Kiemel, Tim; Jeka, John J

2018-04-01

Multisensory reweighting (MSR) deficits in older adults contribute to fall risk. Sensory-challenge balance exercises may have value for addressing the MSR deficits in fall-prone older adults. The purpose of this study was to examine the effect of sensory-challenge balance exercises on MSR and clinical balance measures in fall-prone older adults. We used a quasi-experimental, repeated-measures, within-subjects design. Older adults with a history of falls underwent an 8-week baseline (control) period. This was followed by an 8-week intervention period that included 16 sensory-challenge balance exercise sessions performed with computerized balance training equipment. Measurements, taken twice before and once after intervention, included laboratory measures of MSR (center of mass gain and phase, position, and velocity variability) and clinical tests (Activities-specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, Limits of Stability test, and lower extremity strength and range of motion). Twenty adults 70 years of age and older with a history of falls completed all 16 sessions. Significant improvements were observed in laboratory-based MSR measures of touch gain (P = 0.006) and phase (P = 0.05), Berg Balance Scale (P = 0.002), Sensory Organization Test (P = 0.002), Limits of Stability Test (P = 0.001), and lower extremity strength scores (P = 0.005). Mean values of vision gain increased more than those for touch gain, but did not reach significance. A balance exercise program specifically targeting multisensory integration mechanisms improved MSR, balance, and lower extremity strength in this mechanistic study. These valuable findings provide the scientific rationale for sensory-challenge balance exercise to improve perception of body position and motion in space and potential reduction in fall risk.

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia.

PubMed

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012-2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only). Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities.

Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

PubMed

Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

2014-09-01

HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

Quantitation of lead-210 (210Pb) using lead-203 (203Pb) as a "Massless" yield tracer.

PubMed

May, D; Nelson, A N; Schultz, M K

2017-05-01

Determination of Pb-210 ( 210 Pb) in aqueous solution is a common radioanalytical challenge in environmental science. Widely used methods for undertaking these analyses (e.g., ASTM D7535) rely on the use of stable lead (Pb) as a yield tracer that takes into account losses of 210 Pb that inevitably occur during elemental/radiochemical separations of the procedures. Although effective, these methods introduce technical challenges that can be difficult to track and potentially introduce uncertainty that can be difficult to quantify. Examples of these challenges include interference from endogenous stable Pb in complex sample matrices; contamination of stable Pb carrier with 210 Pb; and high detection limits due to counting efficiency limitations. We hypothesized that many of these challenges could be avoided by the use of the electron-capture, gamma-emitting isotope, 203 Pb as a chemical yield tracer in the analysis of 210 Pb. A series of experiments were performed to evaluate the efficacy of 203 Pb as a tracer. Four different matrices were analyzed, including a complex matrix (hydraulic-fracturing produced fluids); and samples comprising less complicated matrices (i.e., river water, deionized water, and tap water). Separation techniques and counting methodologies were also compared and optimized. Due to a relatively short-half life (52 h), 203 Pb tracer is effectively massless for the purposes of chemical separations, allowing for reduced chromatography column resin bed volumes. Because 203 Pb is a gamma emitter (279 keV; 81% intensity), recovery can be determined non-destructively in a variety of matrices, including liquid scintillation cocktail. The use of liquid scintillation as a counting methodology allowed for determination of 210 Pb activities via 210 Pb or 210 Po; and recoveries of greater than 90% are routinely achievable using this approach. The improved method for the analysis of 210 Pb in aqueous matrices allows for the analysis of complex matrices, at reduced cost, while providing greater counting flexibility in achieving acceptable detections limits. Copyright © 2017 Elsevier Ltd. All rights reserved.

The application of system dynamics modelling to environmental health decision-making and policy - a scoping review.

PubMed

Currie, Danielle J; Smith, Carl; Jagals, Paul

2018-03-27

Policy and decision-making processes are routinely challenged by the complex and dynamic nature of environmental health problems. System dynamics modelling has demonstrated considerable value across a number of different fields to help decision-makers understand and predict the dynamic behaviour of complex systems in support the development of effective policy actions. In this scoping review we investigate if, and in what contexts, system dynamics modelling is being used to inform policy or decision-making processes related to environmental health. Four electronic databases and the grey literature were systematically searched to identify studies that intersect the areas environmental health, system dynamics modelling, and decision-making. Studies identified in the initial screening were further screened for their contextual, methodological and application-related relevancy. Studies deemed 'relevant' or 'highly relevant' according to all three criteria were included in this review. Key themes related to the rationale, impact and limitation of using system dynamics in the context of environmental health decision-making and policy were analysed. We identified a limited number of relevant studies (n = 15), two-thirds of which were conducted between 2011 and 2016. The majority of applications occurred in non-health related sectors (n = 9) including transportation, public utilities, water, housing, food, agriculture, and urban and regional planning. Applications were primarily targeted at micro-level (local, community or grassroots) decision-making processes (n = 9), with macro-level (national or international) decision-making to a lesser degree. There was significant heterogeneity in the stated rationales for using system dynamics and the intended impact of the system dynamics model on decision-making processes. A series of user-related, technical and application-related limitations and challenges were identified. None of the reported limitations or challenges appeared unique to the application of system dynamics within the context of environmental health problems, but rather to the use of system dynamics in general. This review reveals that while system dynamics modelling is increasingly being used to inform decision-making related to environmental health, applications are currently limited. Greater application of system dynamics within this context is needed before its benefits and limitations can be fully understood.

Enabling X-ray free electron laser crystallography for challenging biological systems from a limited number of crystals

DOE PAGES

Uervirojnangkoorn, Monarin; Zeldin, Oliver B.; Lyubimov, Artem Y.; ...

2015-03-17

There is considerable potential for X-ray free electron lasers (XFELs) to enable determination of macromolecular crystal structures that are difficult to solve using current synchrotron sources. Prior XFEL studies often involved the collection of thousands to millions of diffraction images, in part due to limitations of data processing methods. We implemented a data processing system based on classical post-refinement techniques, adapted to specific properties of XFEL diffraction data. When applied to XFEL data from three different proteins collected using various sample delivery systems and XFEL beam parameters, our method improved the quality of the diffraction data as well as themore » resulting refined atomic models and electron density maps. Moreover, the number of observations for a reflection necessary to assemble an accurate data set could be reduced to a few observations. In conclusion, these developments will help expand the applicability of XFEL crystallography to challenging biological systems, including cases where sample is limited.« less

Enabling X-ray free electron laser crystallography for challenging biological systems from a limited number of crystals

DOE PAGES

Uervirojnangkoorn, Monarin; Zeldin, Oliver B.; Lyubimov, Artem Y.; ...

2015-03-17

There is considerable potential for X-ray free electron lasers (XFELs) to enable determination of macromolecular crystal structures that are difficult to solve using current synchrotron sources. Prior XFEL studies often involved the collection of thousands to millions of diffraction images, in part due to limitations of data processing methods. We implemented a data processing system based on classical post-refinement techniques, adapted to specific properties of XFEL diffraction data. When applied to XFEL data from three different proteins collected using various sample delivery systems and XFEL beam parameters, our method improved the quality of the diffraction data as well as themore » resulting refined atomic models and electron density maps. Moreover, the number of observations for a reflection necessary to assemble an accurate data set could be reduced to a few observations. These developments will help expand the applicability of XFEL crystallography to challenging biological systems, including cases where sample is limited.« less

Enabling X-ray free electron laser crystallography for challenging biological systems from a limited number of crystals

PubMed Central

Uervirojnangkoorn, Monarin; Zeldin, Oliver B; Lyubimov, Artem Y; Hattne, Johan; Brewster, Aaron S; Sauter, Nicholas K; Brunger, Axel T; Weis, William I

2015-01-01

There is considerable potential for X-ray free electron lasers (XFELs) to enable determination of macromolecular crystal structures that are difficult to solve using current synchrotron sources. Prior XFEL studies often involved the collection of thousands to millions of diffraction images, in part due to limitations of data processing methods. We implemented a data processing system based on classical post-refinement techniques, adapted to specific properties of XFEL diffraction data. When applied to XFEL data from three different proteins collected using various sample delivery systems and XFEL beam parameters, our method improved the quality of the diffraction data as well as the resulting refined atomic models and electron density maps. Moreover, the number of observations for a reflection necessary to assemble an accurate data set could be reduced to a few observations. These developments will help expand the applicability of XFEL crystallography to challenging biological systems, including cases where sample is limited. DOI: http://dx.doi.org/10.7554/eLife.05421.001 PMID:25781634

First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives.

PubMed

Arch, Joanna J; Craske, Michelle G

2009-09-01

In this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.

Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.

PubMed

Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent

2018-06-05

To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.

Effects of Discussion Constraints, Discourse Maps, and Interactive Intercultural Elaboration in Online Discussions on Students' Knowledge Construction, Critical Thinking, and Intercultural Sensitivity

ERIC Educational Resources Information Center

Nguyen, Hien Thu

2009-01-01

Research shows both benefits and challenges of online discussion as a collaborative learning activity. Online discussion is especially challenging for novice college students who have limited metacognitive skills as well as limited knowledge of the subject domain. With limited metacognitive skills, it can be challenging for novice students to…

Progress in utilisation of graphene for electrochemical biosensors.

PubMed

Lawal, Abdulazeez T

2018-05-30

This review discusses recent graphene (GR) electrochemical biosensor for accurate detection of biomolecules, including glucose, hydrogen peroxide, dopamine, ascorbic acid, uric acid, nicotinamide adenine dinucleotide, DNA, metals and immunosensor through effective immobilization of enzymes, including glucose oxidase, horseradish peroxidase, and haemoglobin. GR-based biosensors exhibited remarkable performance with high sensitivities, wide linear detection ranges, low detection limits, and long-term stabilities. Future challenges for the field include miniaturising biosensors and simplifying mass production are discussed. Copyright © 2018 Elsevier B.V. All rights reserved.

Current limitations and recommendations to improve testing ...

EPA Pesticide Factsheets

In this paper existing regulatory frameworks and test systems for assessing potential endocrine-active chemicals are described, and associated challenges discussed, along with proposed approaches to address these challenges. Regulatory frameworks vary somewhat across organizations, but all basically evaluate whether a chemical possesses endocrine activity and whether this activity can result in adverse outcomes either to humans or the environment. Current test systems include in silico, in vitro and in vivo techniques focused on detecting potential endocrine activity, and in vivo tests that collect apical data to detect possible adverse effects. These test systems are currently designed to robustly assess endocrine activity and/or adverse effects in the estrogen, androgen, and thyroid hormonal pathways; however, there are some limitations of current test systems for evaluating endocrine hazard and risk. These limitations include a lack of certainty regarding: 1)adequately sensitive species and life-stages, 2) mechanistic endpoints that are diagnostic for endocrine pathways of concern, and 3) the linkage between mechanistic responses and apical, adverse outcomes. Furthermore, some existing test methods are resource intensive in regard to time, cost, and use of animals. However, based on recent experiences, there are opportunities to improve approaches to, and guidance for existing test methods, and to reduce uncertainty. For example, in vitro high throughput

What guidance is available for researchers conducting overviews of reviews of healthcare interventions? A scoping review and qualitative metasummary.

PubMed

Pollock, Michelle; Fernandes, Ricardo M; Becker, Lorne A; Featherstone, Robin; Hartling, Lisa

2016-11-14

Overviews of reviews (overviews) compile data from multiple systematic reviews to provide a single synthesis of relevant evidence for decision-making. Despite their increasing popularity, there is limited methodological guidance available for researchers wishing to conduct overviews. The objective of this scoping review is to identify and collate all published and unpublished documents containing guidance for conducting overviews examining the efficacy, effectiveness, and/or safety of healthcare interventions. Our aims were to provide a map of existing guidance documents; identify similarities, differences, and gaps in the guidance contained within these documents; and identify common challenges involved in conducting overviews. We conducted an iterative and extensive search to ensure breadth and comprehensiveness of coverage. The search involved reference tracking, database and web searches (MEDLINE, EMBASE, DARE, Scopus, Cochrane Methods Studies Database, Google Scholar), handsearching of websites and conference proceedings, and contacting overview producers. Relevant guidance statements and challenges encountered were extracted, edited, grouped, abstracted, and presented using a qualitative metasummary approach. We identified 52 guidance documents produced by 19 research groups. Relatively consistent guidance was available for the first stages of the overview process (deciding when and why to conduct an overview, specifying the scope, and searching for and including systematic reviews). In contrast, there was limited or conflicting guidance for the latter stages of the overview process (quality assessment of systematic reviews and their primary studies, collecting and analyzing data, and assessing quality of evidence), and many of the challenges identified were also related to these stages. An additional, overarching challenge identified was that overviews are limited by the methods, reporting, and coverage of their included systematic reviews. This compilation of methodological guidance for conducting overviews of healthcare interventions will facilitate the production of future overviews and can help authors address key challenges they are likely to encounter. The results of this project have been used to identify areas where future methodological research is required to generate empirical evidence for overview methods. Additionally, these results have been used to update the chapter on overviews in the next edition of the Cochrane Handbook for Systematic Reviews of Interventions.

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.

Operational research as implementation science: definitions, challenges and research priorities.

PubMed

Monks, Thomas

2016-06-06

Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront system thinking: structuring implementation problems, prospective evaluation of improvement interventions, and strategic reconfiguration. Case studies from mental health, emergency medicine, and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional, and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users. Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem, prospective evaluation of implementation problems, and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

Automated Rock Identification for Future Mars Exploration Missions

NASA Technical Reports Server (NTRS)

Gulick, V. C.; Morris, R. L.; Gazis, P.; Bishop, J. L.; Alena, R.; Hart, S. D.; Horton, A.

2003-01-01

A key task for human or robotic explorers on the surface of Mars is choosing which particular rock or mineral samples should be selected for more intensive study. The usual challenges of such a task are compounded by the lack of sensory input available to a suited astronaut or the limited downlink bandwidth available to a rover. Additional challenges facing a human mission include limited surface time and the similarities in appearance of important minerals (e.g. carbonates, silicates, salts). Yet the choice of which sample to collect is critical. To address this challenge we are developing science analysis algorithms to interface with a Geologist's Field Assistant (GFA) device that will allow robotic or human remote explorers to better sense and explore their surroundings during limited surface excursions. We aim for our algorithms to interpret spectral and imaging data obtained by various sensors. The algorithms, for example, will identify key minerals, rocks, and sediments from mid-IR, Raman, and visible/near-IR spectra as well as from high resolution and microscopic images to help interpret data and to provide high-level advice to the remote explorer. A top-level system will consider multiple inputs from raw sensor data output by imagers and spectrometers (visible/near-IR, mid-IR, and Raman) as well as human opinion to identify rock and mineral samples.

Health Care in Gulf Cooperation Council Countries: A Review of Challenges and Opportunities

PubMed Central

Khoja, Tawfiq; Rawaf, Salman; Rawaf, David; Nanji, Kashmira; Hamad, Aisha

2017-01-01

This study was undertaken to review the health care status in the Gulf Cooperation Council (GCC) member states, and explore current challenges and future opportunities. Available data was acquired using databases including PubMed, Embase, and Cochrane Library. The data gathered was then combined and the expert authors in the field discussed and propose strategies to overcome the challenges. There is an increase in both population and health care needs of GCC States citizens and migrant workers. The huge emigrant population challenges the capability of the already limited available health care resources. The region is faced with a quadruple disease burden that includes communicable and non-communicable diseases, mental health issues and accidental injuries. Recent advances in technology have made breakthroughs in diagnosis and treatment modalities but with an increase in overall health care cost. Innovative and cost-effective strategies are required to cater the health care needs of people living in the GCC states. Policy makers should emphasize the need to prioritize and strengthen primary care as a matter of urgency. PMID:29062618

Health Care in Gulf Cooperation Council Countries: A Review of Challenges and Opportunities.

PubMed

Khoja, Tawfiq; Rawaf, Salman; Qidwai, Waris; Rawaf, David; Nanji, Kashmira; Hamad, Aisha

2017-08-21

This study was undertaken to review the health care status in the Gulf Cooperation Council (GCC) member states, and explore current challenges and future opportunities. Available data was acquired using databases including PubMed, Embase, and Cochrane Library. The data gathered was then combined and the expert authors in the field discussed and propose strategies to overcome the challenges. There is an increase in both population and health care needs of GCC States citizens and migrant workers. The huge emigrant population challenges the capability of the already limited available health care resources. The region is faced with a quadruple disease burden that includes communicable and non-communicable diseases, mental health issues and accidental injuries. Recent advances in technology have made breakthroughs in diagnosis and treatment modalities but with an increase in overall health care cost. Innovative and cost-effective strategies are required to cater the health care needs of people living in the GCC states. Policy makers should emphasize the need to prioritize and strengthen primary care as a matter of urgency.

Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

PubMed

Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

2017-07-01

Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Technical Challenges for a Comprehensive Test Ban: A historical perspective to frame the future (Invited)

NASA Astrophysics Data System (ADS)

Wallace, T. C.

2013-12-01

In the summer of 1958 scientists from the Soviet block and the US allies met in Geneva to discuss what it would take to monitor a forerunner to a Comprehensive Test Ban Treaty at the 'Conference of Experts to Study the Possibility of Detecting Violations of a Possible Agreement on Suspension of Nuclear Tests'. Although armed with a limited resume of observations, the conference recommended a multi-phenomenology approach (air sampling, acoustics, seismic and electromagnetic) deployed it a network of 170 sites scattered across the Northern Hemisphere, and hypothesized a detection threshold of 1kt for atmospheric tests and 5kt for underground explosions. The conference recommendations spurred vigorous debate, with strong disagreement with the stated detection hypothesis. Nevertheless, the technical challenges posed lead to a very focused effort to improve facilities, methodologies and, most importantly, research and development on event detection, location and identification. In the ensuing 50 years the various challenges arose and were eventually 'solved'; these included quantifying yield determination to enter a Limited Threshold Test Ban, monitoring broad areas of emerging nuclear nations, and after the mid-1990s lowering the global detection threshold to sub-kiloton levels for underground tests. Today there is both an international monitoring regime (ie, the International Monitoring System, or IMS) and a group of countries that have their own national technical means (NTM). The challenges for the international regime are evolving; the IMS has established itself as a very credible monitoring system, but the demand of a CTBT to detect and identify a 'nuclear test' of diminished size (zero yield) poses new technical hurdles. These include signal processing and understanding limits of resolution, location accuracy, integration of heterogeneous data, and accurately characterizing anomalous events. It is possible to extrapolate past technical advances to predict what should be available by 2020; detection of coupled explosions to 100s of tons for all continental areas, as well as a probabilistic assessment of event identification.

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.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Transplantation of Bioprinted Tissues and Organs: Technical and Clinical Challenges and Future Perspectives.

PubMed

Ravnic, Dino J; Leberfinger, Ashley N; Koduru, Srinivas V; Hospodiuk, Monika; Moncal, Kazim K; Datta, Pallab; Dey, Madhuri; Rizk, Elias; Ozbolat, Ibrahim T

2017-07-01

: Three-dimensional (3D) bioprinting is a revolutionary technology in building living tissues and organs with precise anatomic control and cellular composition. Despite the great progress in bioprinting research, there has yet to be any clinical translation due to current limitations in building human-scale constructs, which are vascularized and readily implantable. In this article, we review the current limitations and challenges in 3D bioprinting, including in situ techniques, which are one of several clinical translational models to facilitate the application of this technology from bench to bedside. A detailed discussion is made on the technical barriers in the fabrication of scalable constructs that are vascularized, autologous, functional, implantable, cost-effective, and ethically feasible. Clinical considerations for implantable bioprinted tissues are further expounded toward the correction of end-stage organ dysfunction and composite tissue deficits.

Challenges in detecting drowsiness based on driver’s behavior

NASA Astrophysics Data System (ADS)

Triyanti, V.; Iridiastadi, H.

2017-12-01

Drowsiness while driving has been a critical issue within the context of transportation safety. A number of approaches have been developed to reduce the risks of drowsy drivers. The mechanisms in detecting fatigue and sleepiness while driving has been categorized into three broad approaches, including vehicle-based, physiological-based, and behavior-based approaches. This paper will discuss recent studies in recognizing drowsy drivers based on their behaviors, particularly changes in eyes and facial characteristics. This paper will also address challenges in capturing aspects of natural expressions, driver responses, behavior, and task environment associated with sleepiness. Additionally, a number of technical aspects should be seriously considered, including correctly capturing face and eye characteristics from unwanted movements, unsuitable task environments, technological limitations, and individual differences.

Assessing the Early Literacy Skills of Toddlers: The Development of Four Foundational Measures

ERIC Educational Resources Information Center

Weigel, Daniel J.; Martin, Sally S.; Lowman, Jennifer L.

2017-01-01

Several challenges arise when researchers or practitioners attempt to assess the literacy skills of toddlers, including a lack of developmentally appropriate measures, toddlers' more limited communication ability, and how literacy is defined in the years before age three. This paper describes four new measures of early literacy development and…

Polling on a Budget: Implementing Telephone Surveys in Introductory and Advanced American Politics Courses

ERIC Educational Resources Information Center

Williamson, Jonathan

2011-01-01

Research suggests that student learning is enhanced when students are engaged through active learning strategies. In studying public opinion and polling, challenges include the provision of meaningful active learning environments when resources are limited. In this article, I discuss the design and implementation of telephone surveys as a teaching…

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…

Extension Professionals' Perspectives on Supporting Feedstock Production for Biofuels: Concerns, Challenges, and Opportunities

ERIC Educational Resources Information Center

Townsend, Patricia A.; Haider, Nora M.; Asah, Stanley T.; Zobrist, Kevin W.

2016-01-01

The development of successful bioenergy programs will depend on informed and prepared Extension professionals who are willing and equipped to provide technical support. A survey of Extension professionals in the Pacific Northwest revealed barriers to program development, including limits on time and knowledge and concerns about economic returns…

Grandparents' Experience of Autism Spectrum Disorder: Identifying Primary Themes and Needs

ERIC Educational Resources Information Center

Hillman, Jennifer L.; Wentzel, Michele C.; Anderson, Connie M.

2017-01-01

Limited information is available regarding the first person perspective of grandparents of children with Autism Spectrum Disorders (ASD). In the present study, 1870 grandparents of a child with ASD participated in a nationwide, online, anonymous, 30-minute survey and responded to open-ended questions including their "greatest challenges and…

Developing School Leaders: What the U.S. Can Learn from England's Model

ERIC Educational Resources Information Center

Toner, Mark

2015-01-01

The myriad challenges facing school principals in the United States have been well documented, including limited opportunities for distributed leadership, inadequate training, and a lackluster pipeline for new leaders. Recently, the Fordham Institute teamed up with the London-based Education Foundation to seek a better understanding of England's…

Reluctantly Recognizing Resistance: An Analysis of Representations of Critical Literacy in "English Journal"

ERIC Educational Resources Information Center

Petrone, Robert; Bullard, Lisa

2012-01-01

In addition to the successes the author (Robert) experienced as a high school English teacher, he faced many challenges and frustrations, including student motivation and attendance, "helicopter parents," finding time and energy to grade papers, and limited resources. However, as an educator committed to teaching English to help students develop…

Financing Washington's Schools in the New Millennium: Sorting through the Mixed Messages.

ERIC Educational Resources Information Center

Plecki, Margaret L.

Washington State faces the challenge of balancing a number of conflicting economic and political conditions that impact K-12 education either directly or indirectly. These include reduced vehicle license fees, an existing statewide spending limit, a state revenue surplus, proposals to provide property-tax relief, proposed voter initiatives to…

Including People with Intellectual Disabilities in Qualitative Research

ERIC Educational Resources Information Center

Hall, Sarah A.

2013-01-01

The voice of people with intellectual disabilities (ID) is needed in the literature to best understand their unique experiences and perspectives. Researchers face challenges in conducting interviews with people with ID who are limited in conceptual and verbal language skills. It can also be difficult to obtain participants with ID because of…

Between-Site Differences in the Scale of Dispersal and Gene Flow in Red Oak

Treesearch

Emily V Moran; James S. Clark

2012-01-01

Background: Nut-bearing trees, including oaks (Quercus spp.), are considered to be highly dispersal limited, leading to concerns about their ability to colonize new sites or migrate in response to climate change. However, estimating seed dispersal is challenging in species that are secondarily dispersed by animals, and differences in...

Modeling Reading Growth in Grades 3 to 5 with an Alternate Assessment

ERIC Educational Resources Information Center

Farley, Dan; Anderson, Daniel; Irvin, P. Shawn; Tindal, Gerald

2017-01-01

Modeling growth for students with significant cognitive disabilities (SWSCD) is difficult due to a variety of factors, including, but not limited to, missing data, test scaling, group heterogeneity, and small sample sizes. These challenges may account for the paucity of previous research exploring the academic growth of SWSCD. Our study represents…

Discursive Positioning in Norwegian Teacher Education: Shifting from Cross-Curricularity to Skills-Based Subject Specialisation

ERIC Educational Resources Information Center

Braathe, Hans Jorgen

2012-01-01

Late and limited organisational differentiation is a characteristic which has, until now, distinguished the structure of education -- including teacher education - in the Nordic countries from that of the rest of Europe. However, this tradition is now challenged by utilitarian ideologies, supported by international comparison tests such as PISA…

The Allocation of Visual Attention in Multimedia Search Interfaces

ERIC Educational Resources Information Center

Hughes, Edith Allen

2017-01-01

Multimedia analysts are challenged by the massive numbers of unconstrained video clips generated daily. Such clips can include any possible scene and events, and generally have limited quality control. Analysts who must work with such data are overwhelmed by its volume and lack of computational tools to probe it effectively. Even with advances…

Skills Development and Structural Change: Possibilities for and Limitations of Redressing Structural Racial Inequalities in South Africa

ERIC Educational Resources Information Center

Groener, Zelda

2013-01-01

Improving structural racial equality for historically-disadvantaged Black South Africans, including low-skilled and unemployed adults and youths, is a pertinent challenge for the South African government during the ongoing transition from apartheid capitalism to post-apartheid capitalism. Within the framework of the National Skills Development…

Beyond the Four Walls: Examining the Use of Authentic Learning Modules

ERIC Educational Resources Information Center

Jagielski, Donna Marie

2016-01-01

While attempting to provide real world experiences in STEM, educators face numerous challenges including adhering to curriculum requirements and working with potentially limited resources. The purpose of this action research study was to examine how the addition of authentic learning modules to the existing University of Arizona Middle School…

Accepting the Utopian Challenge: A Student Perspective

ERIC Educational Resources Information Center

Carman, Breanna R.

2013-01-01

The scholarship of teaching and learning (SoTL) allows institutions to achieve the goals required for student learning and success. The purpose of this paper is to address recommendations for the implementation of SoTL that should have relevant input from students. These include, but are not limited to, better communication, evaluation, continuing…

Gifted and At Risk: Navigating the Challenges of Life

ERIC Educational Resources Information Center

Castellano, Jaime A.

2007-01-01

In the field of gifted education, those identified as at risk may include student groups who have been historically underrepresented--among them those who are poor, minority, and/or culturally and linguistically diverse. Typically, the most at risk students are considered those in poverty. Living in poverty often limits equity, access, and…

Limit Our Horizons in the Land of Enchantment? The Challenge for Education.

ERIC Educational Resources Information Center

Thomas, Gerald W.

This paper examines the trends in participation in higher education for New Mexico. Statistical data indicated that only 39 percent of the high school graduates in 1973 planned to enter college after graduation. Barriers to advanced education and training are discussed including intellectual barriers, financial barriers, and environmental and…

42 CFR 426.418 - LCD record furnished to aggrieved party.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 426.418 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... development of the LCD, including, but not limited to, the following: (1) The LCD being challenged. (2) Any... the draft LCD). (4) An index of documents considered that are excluded under paragraph (b) of this...

42 CFR 426.418 - LCD record furnished to aggrieved party.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 426.418 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... development of the LCD, including, but not limited to, the following: (1) The LCD being challenged. (2) Any... the draft LCD). (4) An index of documents considered that are excluded under paragraph (b) of this...

Aerobic Exercise Responses and Blood Pressure Measurement of Individuals with Intellectual Disability in Ibadan

ERIC Educational Resources Information Center

Angba, Tessy Onogimesike

2016-01-01

The benefits of physical activities are universal for all, including those with intellectual disability. Individuals with intellectual disability are mostly neglected and hardly exercised. Hence, the opportunities for improved health and wellness are limited. Paucity of data that could guide ameliorative measures also presents another challenge.…

Sounds Affecting the Moments of Stuttering in Multilingualism: A Case Study

ERIC Educational Resources Information Center

Morrish, Taryn; Nesbitt, Amy; le Roux, Mia; Zsilavecz, Ursula; van der Linde, Jeannie

2017-01-01

Research involving stuttering in multilingual individuals is limited. Speech-language therapists face the challenge of treating a diverse client base, which includes multilingual individuals. The aim of this study was to examine the stuttering moments across English, Afrikaans, and German in a multilingual speaker. A single multilingual adult with…

Embracing Non-Tenure Track Faculty: Changing Campuses for the New Faculty Majority

ERIC Educational Resources Information Center

Kezar, Adrianna, Ed.

2012-01-01

The nature of the higher education faculty workforce is radically and fundamentally changing from primarily full-time tenured faculty to non-tenure track faculty. This new faculty majority faces common challenges, including short-term contracts, limited support on campus, and lack of a professional career track. "Embracing Non-Tenure Track…

Grid Integration and the Carrying Capacity of the U.S. Grid to Incorporate Variable Renewable Energy

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

Cochran, Jaquelin; Denholm, Paul; Speer, Bethany

2015-04-23

In the United States and elsewhere, renewable energy (RE) generation supplies an increasingly large percentage of annual demand, including nine U.S. states where wind comprised over 10% of in-state generation in 2013. This white paper summarizes the challenges to integrating increasing amounts of variable RE, identifies emerging practices in power system planning and operation that can facilitate grid integration, and proposes a unifying concept—economic carrying capacity—that can provide a framework for evaluating actions to accommodate higher penetrations of RE. There is growing recognition that while technical challenges to variable RE integration are real, they can generally be addressed via amore » variety of solutions that vary in implementation cost. As a result, limits to RE penetration are primarily economic, driven by factors that include transmission and the flexibility of the power grid to balance supply and demand. This limit can be expressed as economic carrying capacity, or the point at which variable RE is no longer economically competitive or desirable to the system or society.« less

'She's my sister-in-law, my visitor, my friend' -- challenges of staff identity in home follow-up in an HIV trial in Western Kenya.

PubMed

Madiega, Philister Adhiambo; Jones, Gemma; Prince, Ruth Jane; Geissler, Paul Wenzel

2013-04-01

Identities ascribed to research staff in face-to-face encounters with participants have been raised as key ethical challenge in transnational health research. 'Misattributed' identities that do not just deviate from researchers' self-image, but obscure unequivocal aspects of researcher identity - e.g. that they are researchers - are a case of such ethical problem. Yet, the reasonable expectation of unconcealed identity can conflict with another ethical premise: confidentiality; this poses challenges to staff visiting participants at home. We explore these around a case study of 'follow-up' staff, observed during an ethnographic study of a Kenyan HIV 'trial community', which included participant observation, conversations, and interviews with staff (n = 79) and participants (n = 89). We found that because of the need to maintain confidentiality and because of some suspicions towards researchers, research staff drew upon alternative identities - presenting themselves to non-participants as relatives or friends, rather than as researchers. Several staff experienced this as necessary but uncomfortable. Simultaneously, staff and participants forged close relations in line with their fictional identities, which however also posed challenges because they entailed personal responsibilities that were difficult to live up to, due to limited resources, and the trial's limited duration. Similar challenges may arise in transnational HIV treatment programmes and should be explored further in that context. © 2013 Blackwell Publishing Ltd.

Challenges and barriers for implementation of the World Health Organization Global Disability Action Plan in low- and middle- income countries.

PubMed

Khan, Fary; Owolabi, Mayowa Ojo; Amatya, Bhasker; Hamzat, Talhatu Kolapo; Ogunniyi, Adesola; Oshinowo, Helen; Elmalik, Alaeldin; Galea, Mary P

2018-04-18

To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries. A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conducted intensive workshops at medical/academic institutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabilitation facilities. A modified Delphi method identified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia. Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (governmental/policymakers) and micro levels (community/social/individual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabilitation workforce, guidelines and accreditation standards; coordination amongst healthcare sectors; social issues; data and research; legislation and political commitment. Common potential facilitators included: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research. Disability care is an emerging priority in low- and middle-income countries to address the needs of people with disability. The challenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services.

eHealth in cardiovascular medicine: A clinical update.

PubMed

Saner, Hugo; van der Velde, Enno

2016-10-01

Demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations are posing great challenges to our healthcare systems. Rapid progress in computer sciences and information technologies have a great impact on the way healthcare will be delivered in the near future. This article describes opportunities and challenges of eHealth and telemedicine in the framework of our health systems and, in particular, in the context of today's cardiology services. The most promising applications of eHealth and telemedicine include: (a) prevention and lifestyle interventions; (b) chronic disease management including hypertension, diabetes and heart failure; (c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillators and implantable rhythm monitoring devices; (d) telerehabilitation. Major obstacles to the integration of eHealth and telemedicine into daily clinical practice include limited large-scale evidence, in particular, for cost-effectiveness, as well as lack of interoperability, inadequate or fragmented legal frameworks and lack of reimbursement. An important challenge for those involved in these new technologies will be to keep the main focus on patient's individual needs and to carefully evaluate the evidence behind the practice. © The European Society of Cardiology 2016.

Potential Space Applications for Body-Centric Wireless and E-Textile Antennas

NASA Technical Reports Server (NTRS)

Kennedy, Timothy F.; Fink, Patrick W.; Chu, Andrew W.; Studor, George F.

2007-01-01

Space environment benefits of body-centric wireless communications are numerous, particularly in the context of long duration Lunar and Martian outposts that are in planning stages at several space agencies around the world. Since crew time for such missions is a scarce commodity, seamless integration of body-centric wireless from various sources is paramount. Sources include traditional data, such as audio, video, tracking, and biotelemetry. Newer data sources include positioning, orientation, and status of handheld tools and devices, as well as management and status of on-body inventories. In addition to offering lighter weight and flexibility, performance benefits of e-textile antennas are anticipated due to advantageous use of the body s surface area. In creating e-textile antennas and RF devices, researchers are faced with the challenge of transferring conventional and novel designs to textiles. Lack of impedance control, limited conductivity, and the inability to automatically create intricate designs are examples of limitations frequently attributed to e-textiles. Reliable interfaces between e-textiles and conventional hardware also represent significant challenges. Addressing these limitations is critical to the continued development and acceptance of fabric-based circuits for body-centric wireless applications. Here we present several examples of e-textile antennas and RF devices, created using a NASA-developed process, that overcome several of these limitations. The design and performance of an equiangular spiral, miniaturized spiral-loaded slot antenna, and a hybrid coupler are considered, with the e-textile devices showing comparable performance to like designs using conventional materials.

Effect of temperature and radiation damage on the local atomic structure of elemental plutonium and related compounds

DOE PAGES

Booth, Corwin H.; Olive, Daniel Thomas

2016-10-26

This focused review provides an overview and a framework for understanding local structure in metallic plutonium (especially the metastable fcc δ-phase alloyed with Ga) as it relates to self-irradiation damage. Of particular concern is the challenge of understanding self-irradiation damage in plutonium-bearing materials where theoretical challenges of the unique involvement of the 5f electrons in bonding limit the efficacy of molecular dynamics simulations and experimental challenges of working with radioactive material have limited the ability to confirm the results of such simulations and to further push the field forward. The main concentration is on extended X-ray absorption fine-structure measurements ofmore » -phase Pu, but the scope is broadened to include certain studies on plutonium intermetallics and oxides insofar as they inform the physics of damage and healing processes in elemental Pu. Here, the studies reviewed here provide insight into lattice distortions and their production, damage annealing and defect migration, and the importance of understanding and controlling sample morphology when interpreting such experiments.« less

Responding to the Language Challenge: Kaiser Permanente's Approach

PubMed Central

Meyers, Kate; Tang, Gayle; Fernandez, Alicia

2009-01-01

Objective: To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. Study Design: A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. Methods: We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. Results: KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. Conclusions: KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency. PMID:20740094

Comments for A Conference on Verification in the 21st Century

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

Doyle, James E.

2012-06-12

The author offers 5 points for the discussion of Verification and Technology: (1) Experience with the implementation of arms limitation and arms reduction agreements confirms that technology alone has never been relied upon to provide effective verification. (2) The historical practice of verification of arms control treaties between Cold War rivals may constrain the cooperative and innovative use of technology for transparency, veification and confidence building in the future. (3) An area that has been identified by many, including the US State Department and NNSA as being rich for exploration for potential uses of technology for transparency and verification ismore » information and communications technology (ICT). This includes social media, crowd-sourcing, the internet of things, and the concept of societal verification, but there are issues. (4) On the issue of the extent to which verification technologies are keeping pace with the demands of future protocols and agrements I think the more direct question is ''are they effective in supporting the objectives of the treaty or agreement?'' In this regard it is important to acknowledge that there is a verification grand challenge at our doorstep. That is ''how does one verify limitations on nuclear warheads in national stockpiles?'' (5) Finally, while recognizing the daunting political and security challenges of such an approach, multilateral engagement and cooperation at the conceptual and technical levels provides benefits for addressing future verification challenges.« less

Library outreach: overcoming health literacy challenges*

PubMed Central

Parker, Ruth; Kreps, Gary L.

2005-01-01

Objective: This paper examines the powerful influences of consumer health literacy on access to and use of relevant health information. Method: The paper describes how widespread problems with health literacy significantly limit effective dissemination of relevant health information in society, especially to many vulnerable populations where health literacy challenges are especially pervasive. Results: The paper examines strengths and weaknesses of different programs for addressing health literacy problems, including educational programs, message design programs, and strategic communication training and intervention programs. Implications: The paper evaluates strategies that can be implemented throughout the modern health care system to address problems of health literacy by improving health information access, processing, and understanding. It concludes by examining several strategies that libraries can adopt to overcome many health literacy challenges. PMID:16239962

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.

Space Toxicology: Environmental Health Considerations during Spaceflight Operations and Potential Paths for Research

NASA Technical Reports Server (NTRS)

Khan-Mayberry, Noreen N.; Sundaresan, Alemalu

2009-01-01

Space Toxicology is a specialized discipline for spaceflight, space habitation and occupation of celestial bodies including planets, moons and asteroids [1]. Astronaut explorers face unique challenges to their health while working and living with limited resources for rescue and medical care during space operation. At its core the practice of space toxicology to identify, assess and predict potential chemical contaminants and limit the astronaut s exposure to these environmental factors in order to protect crew health. Space toxicologists are also charged with setting safe exposure limits that will protect the astronaut against a multitude of chemical exposures, in a physiologically altered state. In order to maintain sustained occupation in space, toxicological risks are gauged and managed within the context of isolation, continual exposures, reuse of air and water, limited rescue options, and the necessary use of highly toxic compounds required for propulsion. As the space program move towards human presence and exploration other celestial bodies in situ toxicological risks, such as inhalation of unusual and/or reactive mineral dusts must also be analyzed and controlled. Placing humans for long-term presence in space creates several problems and challenges to the long-term health of the crew, such as bone-loss and immunological challenges and has spurred research into acute, chronic and episodic exposure of the pulmonary system to mineral dusts [2]. NASA has demonstrated that lunar soil contains several types of reactive dusts, including an extremely fine respirable component. In order to protect astronaut health, NASA is now investigating the toxicity of this unique class of dusts. Understanding how these reactive components behave "biochemically" in a moisture-rich pulmonary environment will aid in determining how toxic these particles are to humans. The data obtained from toxicological examination of lunar dusts will determine the human risk criteria for lunar dust exposure and produce a lunar health standard.

Overcoming challenges of catastrophe modelling in data poor regions

NASA Astrophysics Data System (ADS)

Grassby, L.; Millinship, I.; Breinl, K.

2012-04-01

There is an increasing demand for loss accumulation tools in expanding international insurance markets such as India, China and Thailand. This reflects the combination of an increase in exposures in these territories as industry intensifies and urban development expands, as well as several notable natural catastrophes affecting these areas over the past few years (e.g. extreme floods in Mumbai in 2006 and in Thailand in 2011). Large, global insurers and reinsurers are embracing the opportunity to underwrite these exposures but only where adequate tools are available to provide understanding of the hazards, exposures and potential losses. Unlike more developed countries, data availability in these regions is typically limited and of poor resolution, but model development is still required in order to analyse the risk. Some of the modelling challenges associated with data limitations include: (1) dealing with a lack of hydrological data which results in greater uncertainty of the flow rate and event frequency; (2) lower DTM resolution than that available across much of Europe, which underlies the hazard component of the catastrophe model; (3) limited accessibility to data that characterises the Built Environment including information on different building types and their susceptibility to damage; and (4) a lack of claims data from previous events or engineering research into the vulnerability of different building types. This is used to generate of country and structure specific vulnerability curves that explain the relationship between hazard intensity and damages. By presenting an industry specific flood model for data-poor India in collaboration with Allianz Re, we illustrate how we have overcome many of these challenges to allow loss accumulations to be made. The resulting model was successfully validated against the floods in Mumbai and Surat in 2006 and is being developed further with the availability of new data.

Improving the management of behaviour that challenges associated with dementia in care homes: protocol for pharmacy-health psychology intervention feasibility study.

PubMed

Maidment, Ian D; Shaw, Rachel L; Killick, Kirsty; Damery, Sarah; Hilton, Andrea; Wilcock, Jane; Barnes, Nigel; Brown, Graeme; Gillespie, Sarah; Fox, Chris; Barton, Garry; Iliffe, Steve; Seare, Nichola

2016-03-23

The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

PubMed Central

2012-01-01

Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings. PMID:23126370

Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children.

PubMed

Schaaf, H Simon; Garcia-Prats, Anthony J; McKenna, Lindsay; Seddon, James A

2018-03-01

New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges. The status of access to current repurposed and novel drugs is presented. Expert commentary: More timely initiation of paediatric trials is needed and paediatric work should happen and be funded in parallel with each phase of adult trials. Better quality data, increased regulator resources and expertise, harmonization of regulatory requirements across borders/organisations and registration fee waivers would improve registration timelines. Improved diagnosis, recording and reporting will establish better demand. Improved systems for procurement and supply chain management would reduce in-country operational barriers to getting medications to children. The challenges must be addressed to ensure timely and equitable access to new drugs and regimens that are urgently needed for effective, safe and shorter treatment of children with MDR-TB.

Challenges in managing elderly people with diabetes in primary care settings in Norway

PubMed Central

2013-01-01

Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

Attachment status and salivary cortisol in a normal day and during simulated interpersonal stress in young men.

PubMed

Rifkin-Graboi, Anne

2008-05-01

Attachment insecurity, as assessed via the adult attachment interview (AAI), may be expected to relate to basal hypothalamic-pituitary-adrenal (HPA) activity because it is retrodictive of stressful early experiences, which may influence HPA development. In addition, because AAI insecurity may reflect limitations on concurrent cognitive, emotional, and behavioral strategies for managing interpersonal distress, insecurity may also relate to cortisol reactivity specifically during inter-personal challenges. Nevertheless, only two studies have examined associations between AAI insecurity and cortisol, and in total only eight non-clinical men were included. To expand upon past research, the current study focused on college aged men and examined relations between attachment status (via categories and continuous scores) and cortisol levels during daily life and during interpersonal laboratory challenges, wherein subjects were asked to visualize and respond to hypothetical situations concerning loss, separation, and abandonment. Unlike prior research, salivary cortisol was measured during cognitive challenges (e.g. non-autobiographical memory tests), so as to inform questions concerning the specificity of effects. Contrary to expectations, only limited evidence suggested a relation between insecurity and basal HPA functioning. However, in keeping with expectations, associations between insecurity, and in particular dismissing idealization, and comparatively higher cortisol values following interpersonal challenges were observed.

Toward a dose reduction strategy using model-based reconstruction with limited-angle tomosynthesis

NASA Astrophysics Data System (ADS)

Haneda, Eri; Tkaczyk, J. E.; Palma, Giovanni; Iordache, Rǎzvan; Zelakiewicz, Scott; Muller, Serge; De Man, Bruno

2014-03-01

Model-based iterative reconstruction (MBIR) is an emerging technique for several imaging modalities and appli- cations including medical CT, security CT, PET, and microscopy. Its success derives from an ability to preserve image resolution and perceived diagnostic quality under impressively reduced signal level. MBIR typically uses a cost optimization framework that models system geometry, photon statistics, and prior knowledge of the recon- structed volume. The challenge of tomosynthetic geometries is that the inverse problem becomes more ill-posed due to the limited angles, meaning the volumetric image solution is not uniquely determined by the incom- pletely sampled projection data. Furthermore, low signal level conditions introduce additional challenges due to noise. A fundamental strength of MBIR for limited-views and limited-angle is that it provides a framework for constraining the solution consistent with prior knowledge of expected image characteristics. In this study, we analyze through simulation the capability of MBIR with respect to prior modeling components for limited-views, limited-angle digital breast tomosynthesis (DBT) under low dose conditions. A comparison to ground truth phantoms shows that MBIR with regularization achieves a higher level of fidelity and lower level of blurring and streaking artifacts compared to other state of the art iterative reconstructions, especially for high contrast objects. The benefit of contrast preservation along with less artifacts may lead to detectability improvement of microcalcification for more accurate cancer diagnosis.

Clean Energy Finance: Challenges and Opportunities of Early-Stage Energy Investing (Presentation)

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

Heap, D.; Pless, J.; Aieta, N.

Characterized by a changing landscape and new opportunities, today's increasingly complex energy decision space will need innovative financing and investment models to appropriately assess risk and profitability. This report provides an overview of the current state of clean energy finance across the entire spectrum but with a focus on early stage investing, and it includes insights from investors across all investment classes. Further, this report aims to provide a roadmap with the mechanisms, limitations, and considerations involved in making successful investments by identifying risks, challenges, and opportunities in the clean energy sector.

The Benefits of Physician Training Programs for Rural Communities: Lessons Learned from the Teaching Health Center Graduate Medical Education Program.

PubMed

Lee, Marshala; Newton, Helen; Smith, Tracey; Crawford, Malena; Kepley, Hayden; Regenstein, Marsha; Chen, Candice

2016-01-01

Rural communities disproportionately face preventable chronic diseases and death from treatable conditions. Health workforce shortages contribute to limited health care access and health disparities. Efforts to address workforce shortages have included establishing graduate medical education programs with the goal of recruiting and retaining physicians in the communities in which they train. However, rural communities face a number of challenges in developing and maintaining successful residency programs, including concerns over financial sustainability and the integration of resident trainees into existing clinical practices. Despite these challenges, rural communities are increasingly interested in investing in residency programs; those that are successful see additional benefits in workforce recruitment, access, and quality of care that have immediate and direct impact on the health of rural communities. This commentary examines the challenges and benefits of rural residency programs, drawing from lessons learned from the Health Resources and Services Administration's Teaching Health Center Graduate Medical Education program.

Advances and challenges in biosensor-based diagnosis of infectious diseases

PubMed Central

Sin, Mandy LY; Mach, Kathleen E; Wong, Pak Kin; Liao, Joseph C

2014-01-01

Rapid diagnosis of infectious diseases and timely initiation of appropriate treatment are critical determinants that promote optimal clinical outcomes and general public health. Conventional in vitro diagnostics for infectious diseases are time-consuming and require centralized laboratories, experienced personnel and bulky equipment. Recent advances in biosensor technologies have potential to deliver point-of-care diagnostics that match or surpass conventional standards in regards to time, accuracy and cost. Broadly classified as either label-free or labeled, modern biosensors exploit micro- and nanofabrication technologies and diverse sensing strategies including optical, electrical and mechanical transducers. Despite clinical need, translation of biosensors from research laboratories to clinical applications has remained limited to a few notable examples, such as the glucose sensor. Challenges to be overcome include sample preparation, matrix effects and system integration. We review the advances of biosensors for infectious disease diagnostics and discuss the critical challenges that need to be overcome in order to implement integrated diagnostic biosensors in real world settings. PMID:24524681

Crowdsourcing in biomedicine: challenges and opportunities.

PubMed

Khare, Ritu; Good, Benjamin M; Leaman, Robert; Su, Andrew I; Lu, Zhiyong

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. Published by Oxford University Press 2015. This work is written by US Government employees and is in the public domain in the US.

Reducing the distance: equity issues in distance learning in public education

NASA Astrophysics Data System (ADS)

Campbell, Patricia B.; Storo, Jennifer

1996-12-01

Distance learning and educational equity both began with an emphasis on access, on providing underserved students with an increased access to education. Today definitions of equity have gone beyond simple access to include equal or equivalent treatment and outcomes while definitions of underserved students have expanded to include girls, children of color, children with limited English proficiency and children with disabilities. At the same time the definition of distance learning has expanded to include new technologies, new audiences and new roles. Based on these new definitions and roles, the article raises a number of equity challenges for distance learning educators centering around who is taught, what is taught and how the teaching is done. To answer these challenges, a series of recommendations are suggested that educators can implement to make distance learning a leader in increasing educational equity for all students. The time to act is now.

Lessons Learned: Newly Hired Nurses' Perspectives on Transition Into Practice.

PubMed

Ziebert, Carolyn; Klingbeil, Carol; Schmitt, Catherine A; Stonek, Alice V; Totka, Joan P; Stelter, Ashley; Schiffman, Rachel F

2016-01-01

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes.

Implementation of genomics research in Africa: challenges and recommendations

PubMed Central

Adebamowo, Sally N.; Francis, Veronica; Tambo, Ernest; Diallo, Seybou H.; Landouré, Guida; Nembaware, Victoria; Dareng, Eileen; Muhamed, Babu; Odutola, Michael; Akeredolu, Teniola; Nerima, Barbara; Ozumba, Petronilla J.; Mbhele, Slee; Ghanash, Anita; Wachinou, Ablo P.; Ngomi, Nicholas

2018-01-01

ABSTRACT Background: There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. Objective: The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. Methods: The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. Results: Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. Conclusions: The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings. PMID:29336236

Implementation of genomics research in Africa: challenges and recommendations.

PubMed

Adebamowo, Sally N; Francis, Veronica; Tambo, Ernest; Diallo, Seybou H; Landouré, Guida; Nembaware, Victoria; Dareng, Eileen; Muhamed, Babu; Odutola, Michael; Akeredolu, Teniola; Nerima, Barbara; Ozumba, Petronilla J; Mbhele, Slee; Ghanash, Anita; Wachinou, Ablo P; Ngomi, Nicholas

2018-01-01

There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.

Development and Sizing of the JWST Integrated Science Instrument Module (ISIM) Metering Structure

NASA Technical Reports Server (NTRS)

Johnston, John; Kunt, Cengiz; Bartoszyk, Andrew; Hendricks, Steve; Cofie, Emmanuel

2006-01-01

The JWST Integrated Science Instrument Module (ISIM) includes a large metering structure (approx. 2m x 2m x 1.5m) that houses the science instruments and guider. Stringent dimensional stability and repeatability requirements combined with mass limitations led to the selection of a composite bonded frame design comprised of biased laminate tubes. Even with the superb material specific stiffness, achieving the required frequency for the given mass allocations in conjunction with severe spatial limitations imposed by the instrument complement has proven challenging. In response to the challenge, the ISIM structure team considered literally over 100 primary structure topology and kinematic mount configurations, and settled on a concept comprised of over 70 m of tubes, over 50 bonded joint assemblies, and a "split bi-pod" kinematic mount configuration. In this paper, we review the evolution of the ISIM primary structure topology and kinematic mount configuration to the current baseline concept.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts.

PubMed

Tacoli, Cecilia

2017-12-11

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space.

Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.

PubMed

Birx, Deborah; de Souza, Mark; Nkengasong, John N

2009-06-01

Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts

PubMed Central

2017-01-01

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space. PMID:29232936

IT Challenges for Space Medicine or How do We Protect Medical Information and Still Get Useful Work Done?

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy A.

2010-01-01

Space Medicine provides healthcare services of various types for astronauts throughout their lifetime starting from the time they are selected as astronauts. IT challenges include: protection of private medical information, access from locations both inside and outside NASA, nearly 24x7 access, access during disasters, international partner access, data archiving, off-region backup, secure communication of medical data to people outside the NASA system (e.g. expert consultants), efficient movement of medical record information between locations, search and retrieval of relevant information, and providing all of these services/capabilities within a limited budget. In Space Medicine, we have provided for these in various ways: limit the amount of private medical information stored locally, utilize encryption mechanisms that the international partners can also use, utilize 2-factor authentication, virtualize servers, employ concept-based search, and use of standardized terminologies (SNOMED) and messaging (HL7).

Eternal 5D data storage by ultrafast laser writing in glass

NASA Astrophysics Data System (ADS)

Zhang, J.; ČerkauskaitÄ--, A.; Drevinskas, R.; Patel, A.; Beresna, M.; Kazansky, P. G.

2016-03-01

Securely storing large amounts of information over relatively short timescales of 100 years, comparable to the span of the human memory, is a challenging problem. Conventional optical data storage technology used in CDs and DVDs has reached capacities of hundreds of gigabits per square inch, but its lifetime is limited to a decade. DNA based data storage can hold hundreds of terabytes per gram, but the durability is limited. The major challenge is the lack of appropriate combination of storage technology and medium possessing the advantages of both high capacity and long lifetime. The recording and retrieval of the digital data with a nearly unlimited lifetime was implemented by femtosecond laser nanostructuring of fused quartz. The storage allows unprecedented properties including hundreds of terabytes per disc data capacity, thermal stability up to 1000 °C, and virtually unlimited lifetime at room temperature opening a new era of eternal data archiving.

Kumaravadivelu's Framework as a Basis for Improving English Language Teaching in Saudi Arabia: Opportunities and Challenges

ERIC Educational Resources Information Center

Ahmad, Afnan Masaoud

2014-01-01

This paper discusses the issues with EFL teaching in Saudi Arabia, including the reliance on traditional teaching methodologies and banning use of first languages in classrooms. As a result, these traditional teaching practices produce less proficient learners who have limited knowledge about proper linguistic use. In order to overcome these…

Advanced energy storage for space applications: A follow-up

NASA Technical Reports Server (NTRS)

Halpert, Gerald; Surampudi, Subbarao

1994-01-01

Viewgraphs on advanced energy storage for space applications are presented. Topics covered include: categories of space missions using batteries; battery challenges; properties of SOA and advanced primary batteries; lithium primary cell applications; advanced rechargeable battery applications; present limitations of advanced battery technologies; and status of Li-TiS2, Ni-MH, and Na-NiCl2 cell technologies.

The identification of new protein kinase inhibitors as targets in modern drug discovery.

PubMed

Akritopoulou-Zanze, Irini

2006-07-01

In recent years there has been great interest in developing protein kinase inhibitors as therapeutic agents for a variety of diseases. This article provides an overview on the history, development and validity of kinases as drug targets, as well as a description of kinase research, including its limitations, challenges and successes.

Choice, Challenge, and Collaboration: Giving Teachers of Gifted Students What They Need in Professional Development

ERIC Educational Resources Information Center

Green, Bonnie Rhyne

2013-01-01

Since the implementation of NCLB initiatives, rural K-12 teachers in Middle Georgia have been working to gain highly qualified status in their area of certification. These educators have faced struggles that are characteristic of rural schools to include: limited resources, isolated geographic locations, and lack of funds. The In-field Gifted…

Educating Students from Immigrant Families: Meeting the Challenge in Secondary Schools. Proceedings of a Conference (Santa Cruz, California, October 22-24, 1992).

ERIC Educational Resources Information Center

Minicucci, Catherine, Ed.; Olsen, Laurie, Ed.

Proceedings of a conference on educating secondary school age children from immigrant families include summaries of papers, discussions, and panel presentations on the following topics: adolescent immigrant age and developmental issues; instructional issues in language development and bilingualism; limited-English-speaking students' access to core…

Selecting the Right Educational Setting for High-Ability TCKS: A Mother's Perspective

ERIC Educational Resources Information Center

Yamada, Sylvia

2015-01-01

Meeting the needs of gifted students is challenging even in traditional contexts and settings. Well-known issues include a limited choice of schools, underrepresentation of certain populations, and, often, the lack of facilities and support for high-ability students. Imagine, then, the further complexities of high-ability Third Culture Kids (TCKs)…

Uncertainty in natural hazards, modeling and decision support: An introduction to this volume [Chapter 1

Treesearch

Karin Riley; Matthew Thompson; Peter Webley; Kevin D. Hyde

2017-01-01

Modeling has been used to characterize and map natural hazards and hazard susceptibility for decades. Uncertainties are pervasive in natural hazards analysis, including a limited ability to predict where and when extreme events will occur, with what consequences, and driven by what contributing factors. Modeling efforts are challenged by the intrinsic...

75 FR 80853 - Designing a Digital Future: Federally Funded Research and Development in Networking and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... general public. Such information includes, but is not limited to: A person's Social Security number; date... innovation is key to strengthening our economy and forming policy that works for the American people. PCAST... challenges are common across all of these sectors? c. What emerging innovations in these or other sectors...

Single Student Parents Face Financial Difficulties, Debt, without Adequate Aid. Fact Sheet #C394

ERIC Educational Resources Information Center

Miller, Kevin

2012-01-01

Parents with dependent children were nearly one quarter of students enrolled for credit at American postsecondary institutions in 2008. These students face significant challenges to remaining enrolled and graduating, including limited access to affordable child care, difficulty balancing the demands of school with the demands of work and family,…

Economic Modeling Considerations for Rare Diseases.

PubMed

Pearson, Isobel; Rothwell, Ben; Olaye, Andrew; Knight, Christopher

2018-05-01

To identify challenges that affect the feasibility and rigor of economic models in rare diseases and strategies that manufacturers have employed in health technology assessment submissions to demonstrate the value of new orphan products that have limited study data. Targeted reviews of PubMed, the National Institute for Health and Care Excellence's (NICE's) Highly Specialised Technologies (HST), and the Scottish Medicines Consortium's (SMC's) ultra-orphan submissions were performed. A total of 19 PubMed studies, 3 published NICE HSTs, and 11 ultra-orphan SMC submissions were eligible for inclusion. In rare diseases, a number of different factors may affect the model's ability to comply with good practice recommendations. Many products for the treatment of rare diseases have an incomplete efficacy and safety profile at product launch. In addition, there is often limited available natural history and epidemiology data. Information on the direct and indirect cost burden of an orphan disease also may be limited, making it difficult to estimate the potential economic benefit of treatment. These challenges can prevent accurate estimation of a new product's benefits in relation to costs. Approaches that can address such challenges include using patient and/or clinician feedback to inform model assumptions; data from disease analogues; epidemiological techniques, such as matching-adjusted indirect comparison; and long-term data collection. Modeling in rare diseases is often challenging; however, a number of approaches are available to support the development of model structures and the collation of input parameters and to manage uncertainty. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Redefining Quality Measurement in Cancer Care.

PubMed

Nardi, Elizabeth A; McCanney, James; Winckworth-Prejsnar, Katy; Schatz, Alyssa A; Adelson, Kerin; Neubauer, Marcus; Smith, Mary Lou; Walters, Ronald; Carlson, Robert W

2018-05-01

Quality measurement in oncology is increasing in significance as payment schemes shift from volume to value. As demand for quality measures increases, challenges in the development of quality measures, standardization across measures, and the limitations of health information technology have become apparent. Moreover, the time and financial burden associated with developing, tracking, and reporting quality measures are substantial. Despite these challenges, best practices and leaders in the field of quality measurement in oncology have emerged. To understand the current challenges and promising practices in quality measurement and to explore future considerations for measure development and measure reporting in oncology, NCCN convened the NCCN Policy Summit: Redefining Quality Measurement in Oncology. The summit included discussion of the current quality landscape and efforts to develop quality measures, use of quality measures in various programs, patient perspective of quality, and challenges and best practices for quality reporting. Copyright © 2018 by the National Comprehensive Cancer Network.

Challenges and benefits of conducting environmental justice research in a school setting.

PubMed

Guidry, Virginia T; Lowman, Amy; Hall, Devon; Baron, Dothula; Wing, Steve

2014-01-01

Environmental justice (EJ) research requires attention to consequences for research participants beyond those typically considered by institutional review boards. The imbalance of power between impacted communities and those who create and regulate pollution creates challenges for participation, yet research can also benefit those involved. Our community-academic partnership designed the Rural Air Pollutants and Children's Health (RAPCH) study to provide positive impacts while measuring health effects at three low-resource public middle schools near concentrated animal feeding operations (CAFOs) in North Carolina. We evaluated perceived benefits and challenges of study involvement by interviewing school staff and community liaisons who facilitated data collection. Reported benefits included enhancement of students' academic environment and increased community environmental awareness; challenges were associated mainly with some participants' immaturity. Leadership from a strong community-based organization was crucial to recruitment, yet our approach entailed minimal focus on EJ, which may have limited opportunities for community education or organizing for environmental health.

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

PubMed Central

Evriviades, Demetrius; Jeffery, Steven; Cubison, Tania; Lawton, Graham; Gill, Martin; Mortiboy, Deborah

2011-01-01

The conflict in Afghanistan has produced injuries similar to those produced from military conflicts for generations. What distinguishes the modern casualty of the conflict in Afghanistan from those of other conflicts is the effectiveness of modern field medical care that has led to individuals surviving with injuries, which would have been immediately fatal even a few years ago. These patients present several challenges to the reconstructive surgeon. These injured individuals present early challenges of massive soft-tissue trauma, unstable physiology, complex bony and soft-tissue defects, unusual infections, limited reconstructive donor sites, peripheral nerve injuries and traumatic amputations. Late challenges to rehabilitation include the development of heterotopic ossification in amputation stumps. This paper outlines the approach taken by the reconstructive team at the Royal Centre for Defence Medicine in managing these most difficult of reconstructive challenges. PMID:21149357

A longitudinal analysis of the impact of childhood stress on weight status among Chinese youth.

PubMed

Tanenbaum, H C; Li, Y; Felicitas-Perkins, J Q; Zhang, M; Palmer, P; Johnson, C A; Xie, B

2017-05-01

Limited research has explored longitudinal impact of stress on negative health outcomes, including overweight and obesity in Asian societies. Using data from a longitudinal school-based health promotion study conducted in Wuhan, China from 1999 to 2004, this study investigated the longitudinal effects of childhood stress exposure, including stressors related to school, family, peers, violence and health on overweight, and obesity risk during the transition to adolescence among 2179 Chinese adolescents. Results showed that health stressors were consistently related to higher BMI Z score for both boys and girls baseline, it also predicted higher likelihood of overweight status over time for girls. This finding highlights a particularly challenging time period for girls, suggesting a particular challenging time they face at the intersection of puberty and demanding school environment.

Implementation of a health data-sharing infrastructure across diverse primary care organizations.

PubMed

Cole, Allison M; Stephens, Kari A; Keppel, Gina A; Lin, Ching-Ping; Baldwin, Laura-Mae

2014-01-01

Practice-based research networks bring together academic researchers and primary care clinicians to conduct research that improves health outcomes in real-world settings. The Washington, Wyoming, Alaska, Montana, and Idaho region Practice and Research Network implemented a health data-sharing infrastructure across 9 clinics in 3 primary care organizations. Following implementation, we identified challenges and solutions. Challenges included working with diverse primary care organizations, adoption of health information data-sharing technology in a rapidly changing local and national landscape, and limited resources for implementation. Overarching solutions included working with a multidisciplinary academic implementation team, maintaining flexibility, and starting with an established network for primary care organizations. Approaches outlined may generalize to similar initiatives and facilitate adoption of health data sharing in other practice-based research networks.

Implementation of a Health Data-Sharing Infrastructure Across Diverse Primary Care Organizations

PubMed Central

Cole, Allison M.; Stephens, Kari A.; Keppel, Gina A.; Lin, Ching-Ping; Baldwin, Laura-Mae

2014-01-01

Practice-based research networks bring together academic researchers and primary care clinicians to conduct research that improves health outcomes in real-world settings. The Washington, Wyoming, Alaska, Montana, and Idaho region Practice and Research Network implemented a health data-sharing infrastructure across 9 clinics in 3 primary care organizations. Following implementation, we identified challenges and solutions. Challenges included working with diverse primary care organizations, adoption of health information data-sharing technology in a rapidly changing local and national landscape, and limited resources for implementation. Overarching solutions included working with a multidisciplinary academic implementation team, maintaining flexibility, and starting with an established network for primary care organizations. Approaches outlined may generalize to similar initiatives and facilitate adoption of health data sharing in other practice-based research networks. PMID:24594564

Single-Cell Microgels: Technology, Challenges, and Applications.

PubMed

Kamperman, Tom; Karperien, Marcel; Le Gac, Séverine; Leijten, Jeroen

2018-04-12

Single-cell-laden microgels effectively act as the engineered counterpart of the smallest living building block of life: a cell within its pericellular matrix. Recent breakthroughs have enabled the encapsulation of single cells in sub-100-μm microgels to provide physiologically relevant microniches with minimal mass transport limitations and favorable pharmacokinetic properties. Single-cell-laden microgels offer additional unprecedented advantages, including facile manipulation, culture, and analysis of individual cell within 3D microenvironments. Therefore, single-cell microgel technology is expected to be instrumental in many life science applications, including pharmacological screenings, regenerative medicine, and fundamental biological research. In this review, we discuss the latest trends, technical challenges, and breakthroughs, and present our vision of the future of single-cell microgel technology and its applications. Copyright © 2018 Elsevier Ltd. All rights reserved.

Introduction: the realities of antiretroviral therapy rollout: overcoming challenges to successful programmatic implementation.

PubMed

Ojikutu, Bisola

2007-12-01

In 2006, 2 million human immunodeficiency virus (HIV)-infected people living in low- to middle-income countries were receiving antiretroviral therapy (ART). Although this is an improvement over previous years, significant operational challenges have inhibited progress toward universal access to HIV care and treatment. Despite these challenges, the intense efforts focused on addressing the HIV epidemic present an opportunity for overall health systems improvement in developing nations. In October 2006, Harvard University's Centers for AIDS Research, the Nelson Mandela School of Medicine, the Department of Health of KwaZulu-Natal, and the Medical Research Council of South Africa held a conference entitled "The Realities of Antiretroviral Therapy Rollout: Challenges to Successful Programmatic Implementation" in Durban, South Africa. The goal of the meeting was to bring together international and local leadership, including policy makers, health care workers, and funders, to propose an agenda that would address the challenges to more expeditious provision of HIV care and treatment in resource-limited settings.

Materials Genome in Action: Identifying the Performance Limits of Physical Hydrogen Storage

PubMed Central

2017-01-01

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacity at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar. PMID:28413259

Efficient Blood-Brain Barrier Opening in Primates with Neuronavigation-Guided Ultrasound and Real-Time Acoustic Mapping.

PubMed

Wu, Shih-Ying; Aurup, Christian; Sanchez, Carlos Sierra; Grondin, Julien; Zheng, Wenlan; Kamimura, Hermes; Ferrera, Vincent P; Konofagou, Elisa E

2018-05-22

Brain diseases including neurological disorders and tumors remain under treated due to the challenge to access the brain, and blood-brain barrier (BBB) restricting drug delivery which, also profoundly limits the development of pharmacological treatment. Focused ultrasound (FUS) with microbubbles is the sole method to open the BBB noninvasively, locally, and transiently and facilitate drug delivery, while translation to the clinic is challenging due to long procedure, targeting limitations, or invasiveness of current systems. In order to provide rapid, flexible yet precise applications, we have designed a noninvasive FUS and monitoring system with the protocol tested in monkeys (from in silico preplanning and simulation, real-time targeting and acoustic mapping, to post-treatment assessment). With a short procedure (30 min) similar to current clinical imaging duration or radiation therapy, the achieved targeting (both cerebral cortex and subcortical structures) and monitoring accuracy was close to the predicted 2-mm lower limit. This system would enable rapid clinical transcranial FUS applications outside of the MRI system without a stereotactic frame, thereby benefiting patients especially in the elderly population.

Materials genome in action: Identifying the performance limits of physical hydrogen storage

DOE PAGES

Thornton, Aaron W.; Simon, Cory M.; Kim, Jihan; ...

2017-03-08

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacitymore » at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Finally, our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar.« less

Optimization strategy for and structural properties of traffic efficiency under bounded information accessibility

NASA Astrophysics Data System (ADS)

Sanghyun, Ahn; Seungwoong, Ha; Kim, Soo Yong

2016-06-01

A vital challenge for many socioeconomic systems is determining the optimum use of limited information. Traffic systems, wherein the range of resources is limited, are a particularly good example of this challenge. Based on bounded information accessibility in terms of, for example, high costs or technical limitations, we develop a new optimization strategy to improve the efficiency of a traffic system with signals and intersections. Numerous studies, including the study by Chowdery and Schadschneider (whose method we denote by ChSch), have attempted to achieve the maximum vehicle speed or the minimum wait time for a given traffic condition. In this paper, we introduce a modified version of ChSch with an independently functioning, decentralized control system. With the new model, we determine the optimization strategy under bounded information accessibility, which proves the existence of an optimal point for phase transitions in the system. The paper also provides insight that can be applied by traffic engineers to create more efficient traffic systems by analyzing the area and symmetry of local sites. We support our results with a statistical analysis using empirical traffic data from Seoul, Korea.

Making sense of genetic uncertainty: the role of religion and spirituality.

PubMed

White, Mary T

2009-02-15

This article argues that to the extent that religious and spiritual beliefs can help people cope with genetic uncertainty, a limited spiritual assessment may be appropriate in genetic counseling. The article opens by establishing why genetic information is inherently uncertain and why this uncertainty can be medically, morally, and spiritually problematic. This is followed by a review of the range of factors that can contribute to risk assessments, including a few heuristics commonly used in responses to uncertainty. The next two sections summarize recent research on the diverse roles of religious and spiritual beliefs in genetic decisions and challenges to conducting spiritual assessments in genetic counseling. Based on these findings, religious and spiritual beliefs are posited as serving essentially as a heuristic that some people will utilize in responding to their genetic risks. In the interests of helping such clients make informed decisions, a limited spiritual assessment is recommended and described. Some of the challenges and risks associated with this limited assessment are discussed. Since some religious and spiritual beliefs can conflict with the values of medicine, some decisions will remain problematic. (c) 2009 Wiley-Liss, Inc.

Materials genome in action: Identifying the performance limits of physical hydrogen storage

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

Thornton, Aaron W.; Simon, Cory M.; Kim, Jihan

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacitymore » at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Finally, our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar.« less

QMI: Rising to the Space Station Design Challenge

NASA Astrophysics Data System (ADS)

Carswell, W. E.; Farmer, J.; Coppens, C.; Breeding, S.; Rose, F.

2002-01-01

The Quench Module Insert (QMI) materials processing furnace is being designed to operate for 8000 hours over four years on the International Space Station as part of the first Materials Science Research Rack of the Materials Science Research Facility. The Bridgman-type furnace is being built for the directional solidification processing of metals and alloys in the microgravity environment of space. Most notably it will be used for processing aluminum and related alloys. Designing for the space station environment presents intriguing design challenges in the form of a ten-year life requirement coupled with both limited opportunities for maintenance and resource constraints in the form of limited power and space. The long life requirement has driven the design of several features in the furnace, including the design of the heater core, the selection and placement of the thermocouples, overall performance monitoring, and the design of the chill block. The power and space limitations have been addressed through a compact furnace design using efficient vacuum insulation. Details on these design features, as well as development test performance results to date, are presented.

QMI: Rising to the Space Station Design Challenge

NASA Technical Reports Server (NTRS)

Carswell, W. E.; Farmer, J.; Coppens, C.; Breeding, S.; Rose, F.; Curreri, Peter A. (Technical Monitor)

2002-01-01

The Quench Module Insert (QMI) materials processing furnace is being designed to operate for 8000 hours over four years on the International Space Station (ISS) as part of the first Materials Science Research Rack (MSRR-1) of the Materials Science Research Facility (MSRF). The Bridgman-type furnace is being built for the directional solidification processing of metals and alloys in the microgravity environment of space. Most notably it will be used for processing aluminum and related alloys. Designing for the space station environment presents intriguing design challenges in the form of a ten-year life requirement coupled with both limited opportunities for maintenance and resource constraints in the form of limited power and space. The long life requirement has driven the design of several features in the furnace, including the design of the heater core, the selection and placement of the thermocouples, overall performance monitoring, and the design of the chill block. The power and space limitations have been addressed through a compact furnace design using efficient vacuum insulation. Details on these design features, as well as development test performance results to date, are presented.

78 FR 9783 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

...) has been made to the Time Limits/ Maintenance Checks (TLMC) manual to introduce a new Airworthiness... have already been done. (g) Time Limits/Maintenance Checks (TLMC) Manual Revision Within 60 days after... Challenger Time Limits/Maintenance Checks Manual, PSP 605. (ii) Canadair Challenger Temporary Revision 5-250...

Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions.

PubMed

Mishra, Sharmistha; Boily, Marie-Claude; Schwartz, Sheree; Beyrer, Chris; Blanchard, James F; Moses, Stephen; Castor, Delivette; Phaswana-Mafuya, Nancy; Vickerman, Peter; Drame, Fatou; Alary, Michel; Baral, Stefan D

2016-08-01

In the context of generalized human immunodeficiency virus (HIV) epidemics, there has been limited recent investment in HIV surveillance and prevention programming for key populations including female sex workers. Often implicit in the decision to limit investment in these epidemic settings are assumptions including that commercial sex is not significant to the sustained transmission of HIV, and HIV interventions designed to reach "all segments of society" will reach female sex workers and clients. Emerging empiric and model-based evidence is challenging these assumptions. This article highlights the frameworks and estimates used to characterize the role of sex work in HIV epidemics as well as the relevant empiric data landscape on sex work in generalized HIV epidemics and their strengths and limitations. Traditional approaches to estimate the contribution of sex work to HIV epidemics do not capture the potential for upstream and downstream sexual and vertical HIV transmission. Emerging approaches such as the transmission population attributable fraction from dynamic mathematical models can address this gap. To move forward, the HIV scientific community must begin by replacing assumptions about the epidemiology of generalized HIV epidemics with data and more appropriate methods of estimating the contribution of unprotected sex in the context of sex work. Copyright © 2016 Elsevier Inc. All rights reserved.

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative systematic review.

PubMed

Parsons, Karen; Gaudine, Alice; Swab, Michelle

2018-03-01

Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes. To identify, evaluate and synthesize the existing qualitative evidence on older nurses' experiences of providing direct care to patients in hospital nursing units. The review considered studies which included registered nurses 45 years and over who work as direct caregivers in any type of in-patient hospital nursing unit. The phenomenon of interest was the experience of older nurses in providing direct nursing care in any type of in-patient hospital nursing unit (i.e. including but not limited to medical/surgical units, intensive care units, critical care units, perioperative units, palliative care units, obstetrical units, emergency departments and rehabilitative care units). The review excluded studies focussing entirely on enrolled nurses, licensed practical nurses and licensed vocational nurses. Qualitative data including, but not limited to the following methodologies: phenomenology, grounded theory, ethnography, action research and feminist research. The databases CINAHL, PubMed, PsycINFO, Embase, AgeLine, Sociological Abstracts and SocINDEX were searched from inception; the search was conducted on October 13, 2017; no date limiters or language limiters were applied. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. Twelve papers were included in the review. Three synthesized findings were extracted from 12 categories and 75 findings. The three synthesized findings extracted from the papers were: (1) Love of nursing: It's who I am and I love it; (2) It's a rewarding but challenging and changing job; it's a different job and it can be challenging; (3) It's a challenging job; can I keep up? Older nurses love nursing and have created an identity around their profession. They view their profession positively and believe their job to be unlike any other, yet they identify many ongoing challenges and changes. Despite their desire to continue in their role they are often faced with hardships that threaten their ability to stay at the bedside. A key role of hospital administrators to keep older nurses in the workplace is to develop programs to prevent work related illness and to promote health. Given the low ConQual scores in the current systematic review, additional research is recommended to understand the older nurses' experience in providing direct care in hospital nursing units as well as predicting health age of retirement and length of bedside nursing.

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia

PubMed Central

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

Introduction Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. Methods We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012–2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. Results Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only). Conclusions Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities. PMID:27443266

Regulatory challenges associated with conducting multicountry clinical trials in resource-limited settings.

PubMed

Ndebele, Paul; Blanchard-Horan, Christina; Shahkolahi, Akbar; Sanne, Ian

2014-01-01

International public health and infectious diseases research has expanded to become a global enterprise transcending national and continental borders in organized networks addressing high-impact diseases. In conducting multicountry clinical trials, sponsors and investigators have to ensure that they meet regulatory requirements in all countries in which the clinical trials will be conducted. Some of these requirements include review and approval by national drug regulatory authorities and recognized research ethics committees. A limiting factor to the efficient conduct of multicountry clinical trials is the regulatory environment in each collaborating country, with significant differences determined by various factors including the laws and the procedures used in each country. The long regulatory processes in resource-limited countries may hinder the efficient implementation of multisite clinical trials, delaying research important to the health of populations in these countries and costing millions of dollars a year.

77 FR 11115 - Mobility Fund Phase I Auction Limited Extension of Deadlines for Comments and Reply Comments on...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

... Limited Extension of Deadlines for Comments and Reply Comments on Census Block Eligibility Challenges... reply comments on census block eligibility challenges in AU Docket No. 12-25. The comment and reply... Block Eligibility Challenges (deadline extended): March 16, 2012. Reply Comments due on Census Block...

Review of methodological challenges in comparing the effectiveness of neoadjuvant chemotherapy versus primary debulking surgery for advanced ovarian cancer in the United States.

PubMed

Cole, Ashley L; Austin, Anna E; Hickson, Ryan P; Dixon, Matthew S; Barber, Emma L

2018-05-11

Randomized trials outside the U.S. have found non-inferior survival for neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) for advanced ovarian cancer (AOC). However, these trials reported lower overall survival and lower rates of optimal debulking than U.S. studies, leading to questions about generalizability to U.S. practice, where aggressive debulking is more common. Consequently, comparative effectiveness in the U.S. remains controversial. We reviewed U.S. comparative effectiveness studies of NACT versus PDS for AOC. Here we describe methodological challenges, compare results to trials outside the U.S., and make suggestions for future research. We identified U.S. studies published in 2010 or later that evaluated the comparative effectiveness of NACT versus PDS on survival in AOC through a PubMed search. Two independent reviewers abstracted data from eligible articles. Nine of 230 articles were eligible for review. Methodological challenges included unmeasured confounders, heterogeneous treatment effects, treatment variations over time, and inconsistent measurement of treatment and survival. Whereas some limitations were unavoidable, several limitations noted across studies were avoidable, including conditioning on mediating factors and immortal time introduced by measuring survival beginning from diagnosis. Without trials in the U.S., non-randomized studies are an important source of evidence for the ideal treatment for AOC. However, several methodological challenges exist when assessing the comparative effectiveness of NACT versus PDS in a non-randomized setting. Future observational studies must ensure that treatment is consistent throughout the study period and that treatment groups are comparable. Rapidly-evolving oncology data networks may allow for identification of treatment intent and other important confounders. Copyright © 2018 Elsevier Ltd. All rights reserved.

Hepatitis B and hepatitis C in southeast and southern Asia: challenges for governments.

PubMed

Wait, Suzanne; Kell, Emily; Hamid, Saeed; Muljono, David H; Sollano, Jose; Mohamed, Rosmawati; Shah, Samir; Mamun-Al-Mahtab; Abbas, Zaigham; Johnston, Jennifer; Tanwandee, Tawesak; Wallace, Jack

2016-11-01

In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis experts from Bangladesh, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand to discuss common challenges to the burden posed by hepatitis B virus (HBV) and hepatitis C virus (HCV), to learn from each other's experience, and identify sustainable approaches. In this report, we summarise these discussions. Countries differ in their policy responses to HBV and HCV; however, substantial systemic, cultural, and financial barriers to achievement of elimination of these infections persist in all countries. Common challenges to elimination include limited availability of reliable epidemiological data; insufficient public awareness of risk factors and modes of transmission, leading to underdiagnosis; high rates of transmission through infected blood products, including in medical settings; limited access to care for people who inject drugs; prevailing stigma and discrimination against people infected with viral hepatitis; and financial barriers to treatment and care. Despite these challenges, promising examples of effective programmes, public-private initiatives, and other innovative approaches are evident in all countries we studied in Asia Pacific. The draft WHO Global Health Sector Strategy on Viral Hepatitis 2016-21 provides a solid framework upon which governments can build their local strategies towards viral hepatitis. However, greater recognition by national governments and the international community of the urgency to comprehensively tackle both HBV and HCV are still needed. In all countries, strategic plans and policy goals need to be translated into resources and concrete actions, with national governments at the helm, to enable a sustainable response to the rising burden of hepatitis B and C in all countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

‘SHE'S MY SISTER-IN-LAW, MY VISITOR, MY FRIEND’ – CHALLENGES OF STAFF IDENTITY IN HOME FOLLOW-UP IN AN HIV TRIAL IN WESTERN KENYA

PubMed Central

Madiega, Philister Adhiambo; Jones, Gemma; Prince, Ruth Jane; Geissler, Paul Wenzel

2013-01-01

Identities ascribed to research staff in face-to-face encounters with participants have been raised as key ethical challenge in transnational health research. ‘Misattributed’ identities that do not just deviate from researchers' self-image, but obscure unequivocal aspects of researcher identity – e.g. that they are researchers – are a case of such ethical problem. Yet, the reasonable expectation of unconcealed identity can conflict with another ethical premise: confidentiality; this poses challenges to staff visiting participants at home. We explore these around a case study of ‘follow-up’ staff, observed during an ethnographic study of a Kenyan HIV ‘trial community’, which included participant observation, conversations, and interviews with staff (n = 79) and participants (n = 89). We found that because of the need to maintain confidentiality and because of some suspicions towards researchers, research staff drew upon alternative identities – presenting themselves to non-participants as relatives or friends, rather than as researchers. Several staff experienced this as necessary but uncomfortable. Simultaneously, staff and participants forged close relations in line with their fictional identities, which however also posed challenges because they entailed personal responsibilities that were difficult to live up to, due to limited resources, and the trial's limited duration. Similar challenges may arise in transnational HIV treatment programmes and should be explored further in that context. PMID:23521821

Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement.

PubMed

Vandenplas, Olivier; Suojalehto, Hille; Aasen, Tor B; Baur, Xaver; Burge, P Sherwood; de Blay, Frederic; Fishwick, David; Hoyle, Jennifer; Maestrelli, Piero; Muñoz, Xavier; Moscato, Gianna; Sastre, Joaquin; Sigsgaard, Torben; Suuronen, Katri; Walusiak-Skorupa, Jolanta; Cullinan, Paul

2014-06-01

This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 s ≥ 15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma. ©ERS 2014.

A Review of Visual Representations of Physiologic Data

PubMed Central

2016-01-01

Background Physiological data is derived from electrodes attached directly to patients. Modern patient monitors are capable of sampling data at frequencies in the range of several million bits every hour. Hence the potential for cognitive threat arising from information overload and diminished situational awareness becomes increasingly relevant. A systematic review was conducted to identify novel visual representations of physiologic data that address cognitive, analytic, and monitoring requirements in critical care environments. Objective The aims of this review were to identify knowledge pertaining to (1) support for conveying event information via tri-event parameters; (2) identification of the use of visual variables across all physiologic representations; (3) aspects of effective design principles and methodology; (4) frequency of expert consultations; (5) support for user engagement and identifying heuristics for future developments. Methods A review was completed of papers published as of August 2016. Titles were first collected and analyzed using an inclusion criteria. Abstracts resulting from the first pass were then analyzed to produce a final set of full papers. Each full paper was passed through a data extraction form eliciting data for comparative analysis. Results In total, 39 full papers met all criteria and were selected for full review. Results revealed great diversity in visual representations of physiological data. Visual representations spanned 4 groups including tabular, graph-based, object-based, and metaphoric displays. The metaphoric display was the most popular (n=19), followed by waveform displays typical to the single-sensor-single-indicator paradigm (n=18), and finally object displays (n=9) that utilized spatiotemporal elements to highlight changes in physiologic status. Results obtained from experiments and evaluations suggest specifics related to the optimal use of visual variables, such as color, shape, size, and texture have not been fully understood. Relationships between outcomes and the users’ involvement in the design process also require further investigation. A very limited subset of visual representations (n=3) support interactive functionality for basic analysis, while only one display allows the user to perform analysis including more than one patient. Conclusions Results from the review suggest positive outcomes when visual representations extend beyond the typical waveform displays; however, there remain numerous challenges. In particular, the challenge of extensibility limits their applicability to certain subsets or locations, challenge of interoperability limits its expressiveness beyond physiologic data, and finally the challenge of instantaneity limits the extent of interactive user engagement. PMID:27872033

Can modeling of HIV treatment processes improve outcomes? Capitalizing on an operations research approach to the global pandemic

PubMed Central

Xiong, Wei; Hupert, Nathaniel; Hollingsworth, Eric B; O'Brien, Megan E; Fast, Jessica; Rodriguez, William R

2008-01-01

Background Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. We describe the application of classic operations research (OR) techniques to address logistical and resource management challenges in HIV treatment scale-up activities in resource-limited countries. Methods We review and categorize several of the major logistical and operational problems encountered over the last decade in the global scale-up of HIV care and antiretroviral treatment for people with AIDS. While there are unique features of HIV care and treatment that pose significant challenges to effective modeling and service improvement, we identify several analogous OR-based solutions that have been developed in the service, industrial, and health sectors. Results HIV treatment scale-up includes many processes that are amenable to mathematical and simulation modeling, including forecasting future demand for services; locating and sizing facilities for maximal efficiency; and determining optimal staffing levels at clinical centers. Optimization of clinical and logistical processes through modeling may improve outcomes, but successful OR-based interventions will require contextualization of response strategies, including appreciation of both existing health care systems and limitations in local health workforces. Conclusion The modeling techniques developed in the engineering field of operations research have wide potential application to the variety of logistical problems encountered in HIV treatment scale-up in resource-limited settings. Increasing the number of cross-disciplinary collaborations between engineering and public health will help speed the appropriate development and application of these tools. PMID:18680594

Music therapy in an integrated pediatric palliative care program.

PubMed

Knapp, Caprice; Madden, Vanessa; Wang, Hua; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth

National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.

Ecologic Momentary Assessment: Perspectives on Applications and Opportunities in Research and Practice Regarding Nutrition Behaviors.

PubMed

Hand, Rosa K; Perzynski, Adam T

2016-09-01

Retrospective self-reported data have limitations, making it important to evaluate alternative forms of measurement for nutrition behaviors. Ecological momentary assessment (EMA) attempts to overcome the challenges of recalled data with real-time data collection in a subject's natural environment, often leveraging technology. This perspective piece 1) introduces the concepts and terminology of EMA, 2) provides an overview of the methodological and analytical considerations, 3) gives examples of past research using EMA, and 4) suggests new opportunities (including combining assessment and intervention) and limitations (including the need for technology) for the application of EMA to research and practice regarding nutrition behaviors. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Challenges for data storage in medical imaging research.

PubMed

Langer, Steve G

2011-04-01

Researchers in medical imaging have multiple challenges for storing, indexing, maintaining viability, and sharing their data. Addressing all these concerns requires a constellation of tools, but not all of them need to be local to the site. In particular, the data storage challenges faced by researchers can begin to require professional information technology skills. With limited human resources and funds, the medical imaging researcher may be better served with an outsourcing strategy for some management aspects. This paper outlines an approach to manage the main objectives faced by medical imaging scientists whose work includes processing and data mining on non-standard file formats, and relating those files to the their DICOM standard descendents. The capacity of the approach scales as the researcher's need grows by leveraging the on-demand provisioning ability of cloud computing.

The intricate relationship between a medical school and a teaching hospital: A case study in Uganda.

PubMed

Mubuuke, Aloysius Gonzaga; Businge, Francis; Mukule, Emmanuel

2014-01-01

The relationship between medical schools and teaching hospitals is full of opportunities but also challenges even though they have complementary goals that could enhance each other. Although medical schools and teaching hospitals may face some similar challenges around the world, there could be context-specific observations that differ in resource-rich versus resource-limited settings. The purpose of this study was to investigate factors that are perceived to have influenced the relationship between a medical school and a teaching hospital in Uganda, a resource-limited setting. This was a cross-sectional, descriptive study in which key informant individual interviews were conducted with senior administrators and senior staff members of the Mulago Hospital and Makerere University Medical School. The interviews explored factors perceived to have favoured the working relationship between the two institutions, challenges faced and likely future opportunities. Both quantitative and qualitative data were generated. Thematic analysis was used with the qualitative data. Respondents reported a strained relationship between the two institutions, with unfavourable factors far outweighing the favourable factors influencing the relationship. Key negative reported factors included having different administrative set-ups, limited opportunities to share funds and to forge research collaborations, unexploited potential of sharing human resources to address staff shortages, as well as a lack of a memorandum of understanding between the two institutions. This study identifies barriers in the existing relationship between a teaching hospital and medical college in a resource-poor country. It proposes a collaborative model, rather than competitive model, for the two institutions that may work in both resource-limited and resource-rich settings.

Flight Dynamics and Controls Discipline Overview

NASA Technical Reports Server (NTRS)

Theodore, Colin R.

2012-01-01

This presentation will touch topics, including but not limited to, the objectives and challenges of flight dynamics and controls that deal with the pilot and the cockpit's technology, the flight dynamics and controls discipline tasks, and the full envelope of flight dynamics modeling. In addition, the LCTR 7x10-ft wind tunnel test will also be included along with the optimal trajectories for noise abatement and its investigations on handling quality. Furthermore, previous experiments and their complying results will also be discussed.

Multiple environmental stressors elicit complex interactive effects in the western fence lizard (Sceloporus occidentalis).

PubMed

McFarland, Craig A; Talent, Larry G; Quinn, Michael J; Bazar, Matthew A; Wilbanks, Mitchell S; Nisanian, Mandana; Gogal, Robert M; Johnson, Mark S; Perkins, Edward J; Gust, Kurt A

2012-11-01

Evaluation of multiple-stressor effects stemming from habitat degradation, climate change, and exposure to chemical contaminants is crucial for addressing challenges to ecological and environmental health. To assess the effects of multiple stressors in an understudied taxon, the western fence lizard (Sceloporus occidentalis) was used to characterize the individual and combined effects of food limitation, exposure to the munitions constituent 2,4,6-trinitrotoluene (TNT), and Plasmodium mexicanum (lizard malaria) infection. Three experimental assays were conducted including: Experiment I--TNT × Food Limitation, Experiment II--Food Limitation × Malaria Infection, and Experiment III--TNT × Malaria Infection. All experiments had a 30 day duration, the malaria treatment included infected and non infected control lizards, food limitation treatments included an ad libitum control and at least one reduced food ration and TNT exposures consisting of daily oral doses of corn oil control or a corn oil-TNT suspension at 5, 10, 20, 40 mg/kg/day. The individual stressors caused a variety of effects including: reduced feeding, reduced testes mass, anemia, increased white blood cell (WBC) concentrations and increased mass of liver, kidney and spleen in TNT exposures; reduced cholesterol, WBC concentrations and whole body, testes and inguinal fat weights given food limitation; and increased WBC concentrations and spleen weights as well as decreased cholesterol and testes mass in malaria infected lizards. Additive and interactive effects were found among certain stressor combinations including elimination of TNT-induced hormesis for growth under food limitation. Ultimately, our study indicates the potential for effects modulation when environmental stressors are combined.

77 FR 20520 - Airworthiness Directives; Bombardier, Inc. Model BD-100-1A10 (Challenger 300) Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

... Bombardier Challenger 300 BD-100 Time Limits/Maintenance Checks Manual. For this task, the initial compliance..., of Part 2, of the Bombardier Challenger 300 BD-100 Time Limits/Maintenance Checks Manual, the general.../Maintenance Checks Manual, provided that the relevant information in the general revision is identical to that...

Religious Beliefs: A Hidden Variable in the Performance of Science Teachers in the Classroom

ERIC Educational Resources Information Center

Mansour, Nasser

2008-01-01

This article focuses on some of the challenges of teaching science in a culture where science and religion sometimes appear to be or are set at odds with each other. Apparent conflicts between scholarly claims and religious claims are not limited to science, however--they occur in almost every subject. Many topics included in science education are…

Data needs for X-ray astronomy satellites

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

Kallman, T.

I review the current status of atomic data for X-ray astronomy satellites. This includes some of the astrophysical issues which can be addressed, current modeling and analysis techniques, computational tools, the limitations imposed by currently available atomic data, and the validity of standard assumptions. I also discuss the future: challenges associated with future missions and goals for atomic data collection.

Standard guide for developing a cost-effective risk mitigation plan for new and existing constructed facilities

Treesearch

Jeffrey Prestemon

2011-01-01

Protecting constructed facilities from damages from natural and man-made hazards in a costeffective manner is a challenging task. Several measures of economic performance are available for evaluating building-related investments. These measures include, but are not limited to, life-cycle cost, present value net savings, savings-to-investment ratio, and adjusted...

Examining Psychometric Dimensions of the Ages and Stages Questionnaires: Inventory: A Cross-Country Comparison between Taiwan and the United States

ERIC Educational Resources Information Center

Chen, Ching-I

2013-01-01

The Taiwanese early intervention/early childhood special education (EI/ECSE) system is modeled after the federal legislation and practices of the U.S., incorporating specific cultural beliefs in Taiwan. Nonetheless, in EI/ECSE assessments, several challenges are presented, including: (a) limited resources and funding, (b) lack of reliable and…

Exploring the Role of Future Perspective in Predicting Turkish University Students' Beliefs about Global Climate Change

ERIC Educational Resources Information Center

Ates, Deniz; Teksöz, Gaye; Ertepinar, Hamide

2017-01-01

Recent studies indicate that limited understanding about causes and its potential impacts of climate change and fault beliefs by people across different countries of the world including Turkey is a real challenge. Acceptance of climate change as a real threat, believing its existence, and knowing causes and consequences are very significant for…

Biodiversidad y ecología de las lombrices de tierra en las islas caribeñas

Treesearch

Carlos Rodriguez; S. Borges; M.A. Martinez; C. Fragoso; S. James; Grizelle Gonzalez

2007-01-01

This chapter presents a synthesis of the ecological and taxonomic studies performed on earthworms in the Caribbean, highlighting the limitations, challenges and perspectives of earthworm research in the region. The records included are from research performed by the authors and from the bibliography. The region has 10 families, 33 genera and 125 earthworm species. The...

Advancing Methods for U.S. Transgender Health Research

PubMed Central

Reisner, Sari L.; Deutsch, Madeline B.; Bhasin, Shalender; Bockting, Walter; Brown, George R.; Feldman, Jamie; Garofalo, Rob; Kreukels, Baudewijntje; Radix, Asa; Safer, Joshua D.; Tangpricha, Vin; T’Sjoen, Guy; Goodman, Michael

2016-01-01

Purpose of Review To describe methodological challenges, gaps, and opportunities in U.S. transgender health research. Recent Findings Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of gender affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities. Summary Transgender health research faces challenges that include standardization of lexicon, agreed-upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population. PMID:26845331

Linkages between public and non-government sectors in healthcare: A case study from Uttar Pradesh, India.

PubMed

Srivastava, Aradhana; Bhattacharyya, Sanghita; Gautham, Meenakshi; Schellenberg, Joanna; Avan, Bilal I

2016-12-01

Effective utilisation of collaborative non-governmental organisation (NGO)-public health system linkages in pluralistic health systems of developing countries can substantially improve equity and quality of services. This study explores level and types of linkages between public health sector and NGOs in Uttar Pradesh (UP), an underprivileged state of India, using a social science model for the first time. It also identifies gaps and challenges for effective linkage. Two NGOs were selected as case studies. Data collection included semi-structured in-depth interviews with senior staff and review of records and reporting formats. Formal linkages of NGOs with the public health system related to registration, participation in district level meetings, workforce linkages and sharing information on government-supported programmes. Challenges included limited data sharing, participation in planning and limited monitoring of regulatory compliances. Linkage between public health system and NGOs in UP was moderate, marked by frequent interaction and some reciprocity in information and resource flows, but weak participation in policy and planning. The type of linkage could be described as 'complementarity', entailing information and resource sharing but not joint action. Stronger linkage is required for sustained and systematic collaboration, with joint planning, implementation and evaluation.

Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

PubMed

Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

2016-02-01

Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Overcoming the Challenges of Unstructured Data in Multisite, Electronic Medical Record-based Abstraction.

PubMed

Polnaszek, Brock; Gilmore-Bykovskyi, Andrea; Hovanes, Melissa; Roiland, Rachel; Ferguson, Patrick; Brown, Roger; Kind, Amy J H

2016-10-01

Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as these data are often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists. As standard abstraction approaches resulted in substandard data reliability for unstructured data elements collected as part of a multisite, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management. We adopted a "fit-for-use" framework to guide the development and evaluation of abstraction methods using a 4-step, phase-based approach including (1) team building; (2) identification of challenges; (3) adaptation of abstraction methods; and (4) systematic data quality monitoring. Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (eg, warfarin initiation) and medical follow-up (eg, timeframe for follow-up). After implementation of the phase-based approach, interrater reliability for all unstructured data elements demonstrated κ's of ≥0.89-an average increase of +0.25 for each unstructured data element. As compared with standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multisite EMR documentation.

[Robotic prostatectomy: The anesthetist's view for robotic urological surgeries, a prospective study].

PubMed

Oksar, Menekse; Akbulut, Ziya; Ocal, Hakan; Balbay, Mevlana Derya; Kanbak, Orhan

2014-01-01

Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room. Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits. Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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.

Formulation, Pretreatment, and Densification Options to Improve Biomass Specifications for Co-Firing High Percentages with Coal

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

Jaya Shankar Tumuluru; J Richard Hess; Richard D. Boardman

2012-06-01

There is a growing interest internationally to use more biomass for power generation, given the potential for significant environmental benefits and long-term fuel sustainability. However, the use of biomass alone for power generation is subject to serious challenges, such as feedstock supply reliability, quality, and stability, as well as comparative cost, except in situations in which biomass is locally sourced. In most countries, only a limited biomass supply infrastructure exists. Alternatively, co-firing biomass alongwith coal offers several advantages; these include reducing challenges related to biomass quality, buffering the system against insufficient feedstock quantity, and mitigating the costs of adapting existingmore » coal power plants to feed biomass exclusively. There are some technical constraints, such as low heating values, low bulk density, and grindability or size-reduction challenges, as well as higher moisture, volatiles, and ash content, which limit the co-firing ratios in direct and indirect co-firing. To achieve successful co-firing of biomass with coal, biomass feedstock specifications must be established to direct pretreatment options in order to modify biomass materials into a format that is more compatible with coal co-firing. The impacts on particle transport systems, flame stability, pollutant formation, and boiler-tube fouling/corrosion must also be minimized by setting feedstock specifications, which may include developing new feedstock composition by formulation or blending. Some of the issues, like feeding, co-milling, and fouling, can be overcome by pretreatment methods including washing/leaching, steam explosion, hydrothermal carbonization, and torrefaction, and densification methods such as pelletizing and briquetting. Integrating formulation, pretreatment, and densification will help to overcome issues related to physical and chemical composition, storage, and logistics to successfully co-fire higher percentages of biomass ( > 40%) with coal.« less

The physicochemical process of bacterial attachment to abiotic surfaces: Challenges for mechanistic studies, predictability and the development of control strategies.

PubMed

Wang, Yi; Lee, Sui Mae; Dykes, Gary

2015-01-01

Bacterial attachment to abiotic surfaces can be explained as a physicochemical process. Mechanisms of the process have been widely studied but are not yet well understood due to their complexity. Physicochemical processes can be influenced by various interactions and factors in attachment systems, including, but not limited to, hydrophobic interactions, electrostatic interactions and substratum surface roughness. Mechanistic models and control strategies for bacterial attachment to abiotic surfaces have been established based on the current understanding of the attachment process and the interactions involved. Due to a lack of process control and standardization in the methodologies used to study the mechanisms of bacterial attachment, however, various challenges are apparent in the development of models and control strategies. In this review, the physicochemical mechanisms, interactions and factors affecting the process of bacterial attachment to abiotic surfaces are described. Mechanistic models established based on these parameters are discussed in terms of their limitations. Currently employed methods to study these parameters and bacterial attachment are critically compared. The roles of these parameters in the development of control strategies for bacterial attachment are reviewed, and the challenges that arise in developing mechanistic models and control strategies are assessed.

High Temperature Ferroelectrics for Actuators: Recent Developments and Challenges

NASA Technical Reports Server (NTRS)

Sehirlioglu, Alp; Kowalski, Benjamin

2014-01-01

A variety of piezoelectric applications have been driving the research in development of new high temperature ferroelectrics; ranging from broader markets such as fuel and gas modulation and deep well oil drilling to very specific applications such as thermoacoustic engines and ultrasonic drilling on the surface of Venus. The focus has been mostly on increasing the Curie temperature. However, greater challenges for high temperature ferroelectrics limit the operating temperature to levels much below the Curie temperature. These include enhanced loss tangent and dc conductivity at high fields as well as depoling due to thermally activated domain rotation. The initial work by Eitel et al. [Jpn. J. Appl. Phys., 40 [10, Part 1] 59996002 (2001)] increased interest in investigation of Bismuth containing perovskites in solid solution with lead titanate. Issues that arise vary from solubility limits to increased tetragonality; the former one prohibits processing of morphotropic phase boundary, while the latter one impedes thorough poling of the polycrystalline ceramics. This talk will summarize recent advances in development of high temperature piezoelectrics and provide information about challenges encountered as well as the approaches taken to improve the high temperature behavior of ferroelectrics with a focus on applications that employ the converse piezoelectric effect.

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals.

PubMed

Kaji, Aiko; Thi, Sein Sein; Smith, Terrence; Charunwatthana, Prakaykaew; Nosten, Francois H

2015-10-09

Myanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border. The study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes. A total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients. Health professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

The Changing Role of the Clinical Microbiology Laboratory in Defining Resistance in Gram-negatives.

PubMed

Endimiani, Andrea; Jacobs, Michael R

2016-06-01

The evolution of resistance in Gram-negatives has challenged the clinical microbiology laboratory to implement new methods for their detection. Multidrug-resistant strains present major challenges to conventional and new detection methods. More rapid pathogen identification and antimicrobial susceptibility testing have been developed for use directly on specimens, including fluorescence in situ hybridization tests, automated polymerase chain reaction systems, microarrays, mass spectroscopy, next-generation sequencing, and microfluidics. Review of these methods shows the advances that have been made in rapid detection of resistance in cultures, but limited progress in direct detection from specimens. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges Encountered by Vietnamese Nurses When Caring for Patients With Cancer.

PubMed

Thuy Nguyen, Ly; Clemenceau Annoussamy, Lourdes; LeBaron, Virginia T

2017-03-01

Providing holistic care is acknowledged as central to providing quality care for patients with cancer, but providing competent nursing care consistent with these approaches remains a challenge for nurses in Vietnam. Obstacles for Vietnamese oncology nurses include their low status, the limited scope of nursing practice, work overload in a hierarchical system, and cultural beliefs that view death and dying as taboo. Additional research to support oncology nurses in Vietnam must acknowledge the merits of improving nursing education as an important strategy for enhancing nursing autonomy, quality of care, and outcomes for the increasing number of patients with cancer in low- and middle-income countries.

Religion and HIV/AIDS stigma in Puerto Rico: a cultural challenge for training future physicians.

PubMed

Varas-Díaz, Nelson; Neilands, Torsten B; Cintrón-Bou, Francheska; Santos-Figueroa, Axel; Marzán-Rodríguez, Melissa; Marques, Domingo

2014-01-01

HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population.

Religion and HIV/AIDS Stigma in Puerto Rico: A Cultural Challenge for Training Future Physicians

PubMed Central

Varas-Díaz, Nelson; Neilands, Torsten B.; Cintrón-Bou, Francheska; Santos-Figueroa, Axel; Marzán-Rodríguez, Melissa; Marques, Domingo

2014-01-01

HIV/AIDS stigma continues to be a challenge for HIV prevention and treatment. When health professionals manifest stigma it can limit access to quality treatment. With an ever-growing epidemic among Latinos, including Puerto Ricans living on the Caribbean Island, the social and structural factors that foster HIV/AIDS stigma need to be understood. In this study, we documented the association of religion with HIV/AIDS stigma in a sample of medical students in Puerto Rico. Findings suggest that importance placed on religion, and participation in religious activities, is associated with HIV/AIDS stigma for this population. PMID:23442492

Tree physiology research in a changing world.

PubMed

Kaufmann, Merrill R.; Linder, Sune

1996-01-01

Changes in issues and advances in methodology have contributed to substantial progress in tree physiology research during the last several decades. Current research focuses on process interactions in complex systems and the integration of processes across multiple spatial and temporal scales. An increasingly important challenge for future research is assuring sustainability of production systems and forested ecosystems in the face of increased demands for natural resources and human disturbance of forests. Meeting this challenge requires significant shifts in research approach, including the study of limitations of productivity that may accompany achievement of system sustainability, and a focus on the biological capabilities of complex land bases altered by human activity.

Compact high-resolution spectrographs for large and extremely large telescopes: using the diffraction limit

NASA Astrophysics Data System (ADS)

Robertson, J. Gordon; Bland-Hawthorn, Joss

2012-09-01

As telescopes get larger, the size of a seeing-limited spectrograph for a given resolving power becomes larger also, and for ELTs the size will be so great that high resolution instruments of simple design will be infeasible. Solutions include adaptive optics (but not providing full correction for short wavelengths) or image slicers (which give feasible but still large instruments). Here we develop the solution proposed by Bland-Hawthorn and Horton: the use of diffraction-limited spectrographs which are compact even for high resolving power. Their use is made possible by the photonic lantern, which splits a multi-mode optical fiber into a number of single-mode fibers. We describe preliminary designs for such spectrographs, at a resolving power of R ~ 50,000. While they are small and use relatively simple optics, the challenges are to accommodate the longest possible fiber slit (hence maximum number of single-mode fibers in one spectrograph) and to accept the beam from each fiber at a focal ratio considerably faster than for most spectrograph collimators, while maintaining diffraction-limited imaging quality. It is possible to obtain excellent performance despite these challenges. We also briefly consider the number of such spectrographs required, which can be reduced by full or partial adaptive optics correction, and/or moving towards longer wavelengths.

Advancing Global Health - The Need for (Better) Social Science Comment on "Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health".

PubMed

Hanefeld, Johanna

2016-02-06

In his perspective "Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health," Ooms argues that actions taken in the field of global health are dependent not only on available resources, but on the normative premise that guides how these resources are spent. This comment sets out how the application of a predominately biomedical positivist research tradition in global health, has potentially limited understanding of the value judgements underlying decisions in the field. To redress this critical social science, including health policy analysis has much to offer, to the field of global health including on questions of governance. © 2016 by Kerman University of Medical Sciences.

Induced Pluripotent Stem Cell-Derived Endothelial Cells in Insulin Resistance and Metabolic Syndrome.

PubMed

Carcamo-Orive, Ivan; Huang, Ngan F; Quertermous, Thomas; Knowles, Joshua W

2017-11-01

Insulin resistance leads to a number of metabolic and cellular abnormalities including endothelial dysfunction that increase the risk of vascular disease. Although it has been particularly challenging to study the genetic determinants that predispose to abnormal function of the endothelium in insulin-resistant states, the possibility of deriving endothelial cells from induced pluripotent stem cells generated from individuals with detailed clinical phenotyping, including accurate measurements of insulin resistance accompanied by multilevel omic data (eg, genetic and genomic characterization), has opened new avenues to study this relationship. Unfortunately, several technical barriers have hampered these efforts. In the present review, we summarize the current status of induced pluripotent stem cell-derived endothelial cells for modeling endothelial dysfunction associated with insulin resistance and discuss the challenges to overcoming these limitations. © 2017 American Heart Association, Inc.

Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population.

PubMed

Nguyen, H D; Chitturi, S; Maple-Brown, L J

2016-11-01

Type 2 diabetes mellitus and other chronic cardio-metabolic conditions are significant contributors to the large disparities in life expectancy between Indigenous and non-Indigenous Australians. Type 2 diabetes is more prevalent from a young age among Indigenous Australians and is often preceded by a cluster of risk factors, including central obesity, dyslipidaemia, albuminuria and socio-economic disadvantage. Management of type 2 diabetes in Australian Indigenous peoples can be challenging in the setting of limited resources and socio-economic disadvantage. Key strategies to address these challenges include working in partnership with patients, communities and primary healthcare services (PHC, Aboriginal community controlled and government services) and working in a multidisciplinary team. Population prevention measures are required within and beyond the health system, commencing as early as possible in the life course. © 2016 Royal Australasian College of Physicians.

Communicating Genetic Risk Information for Common Disorders in the Era of Genomic Medicine

PubMed Central

Lautenbach, Denise M.; Christensen, Kurt D.; Sparks, Jeffrey A.; Green, Robert C.

2013-01-01

Communicating genetic risk information in ways that maximize understanding and promote health is increasingly important given the rapidly expanding availability and capabilities of genomic technologies. A well-developed literature on risk communication in general provides guidance for best practices, including presentation of information in multiple formats, attention to framing effects, use of graphics, sensitivity to the way numbers are presented, parsimony of information, attentiveness to emotions, and interactivity as part of the communication process. Challenges to communicating genetic risk information include deciding how best to tailor it, streamlining the process, deciding what information to disclose, accepting that communications may have limited influence, and understanding the impact of context. Meeting these challenges has great potential for empowering individuals to adopt healthier lifestyles and improve public health, but will require multidisciplinary approaches and collaboration. PMID:24003856

Maternal mortality in developing countries: challenges in scaling-up priority interventions.

PubMed

Prata, Ndola; Passano, Paige; Sreenivas, Amita; Gerdts, Caitlin Elisabeth

2010-03-01

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

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.

The Use of Systematic Reviews and Reporting Guidelines to Advance the Implementation of the 3Rs

PubMed Central

Avey, Marc T; Fenwick, Nicole; Griffin, Gilly

2015-01-01

In 1959, Russell and Burch published The Principles of Humane Experimental Technique, which included concrete advice on factors that they considered would govern progress in the implementation of these principles (enunciated as the 3Rs [Replacement, Reduction, and Refinement in animal-based studies]). One challenge to the implementation of the 3Rs was identified as information retrieval. Here, we further explore this challenge—the need for ‘research on research’—and the role that systematic reviews and reporting guidelines can play in implementation of the 3Rs. First, we examine the 2-fold nature of the challenge of information retrieval: 1) the identification of relevant publications spread throughout a large population of nonrelevant publications and 2) the incomplete reporting of relevant details within those publications. Second, we evaluate how systematic reviews and reporting guidelines can be used generally to address this challenge. Third, we assess the explicit reporting of the 3Rs in a cohort of preclinical animal systematic reviews. Our results show that Reduction methods are the most commonly reported by authors of systematic reviews but that, in general, reporting on how findings relate to the 3Rs is limited at best. Although systematic reviews are excellent tools for resolving the challenge of information retrieval, their utility for making progress in implementation of the 3Rs may be limited unless authors improve their reporting of these principles. PMID:25836961

The challenges of healthcare delivery to people with multiple sclerosis in Iran.

PubMed

Yazdannik, Ahmadreza; Abolhassani, Shahla; Taleghani, Fariba; Zamani, Ahmadreza

2015-01-01

Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients' needs are only partially met. This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran. In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012-2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients' weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis. The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait). Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families.

The American Science Pipeline: Sustaining Innovation in a Time of Economic Crisis

PubMed Central

Hue, Gillian; Sales, Jessica; Comeau, Dawn; Lynn, David G.

2010-01-01

Significant limitations have emerged in America's science training pipeline, including inaccessibility, inflexibility, financial limitations, and lack of diversity. We present three effective programs that collectively address these challenges. The programs are grounded in rigorous science and integrate through diverse disciplines across undergraduate, graduate, and postdoctoral students, and resonate with the broader community. We discuss these models in the context of current economic constraints on higher education and the urgent need for our institutions to recruit and retain diverse student populations and sustain the successful American record in scientific education and innovation. PMID:21123689

Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care.

PubMed

Sader, Elie; Yee, Philip; Hodaie, Mojgan

2017-02-01

Neurosurgery in low-income countries is faced with multiple challenges. Although the most common challenges include infrastructure and physical resource deficits, an underemphasized barrier relates to the methods and components of surgical training. The role of important aspects, including didactic surgical training, surgical decision-making, workshops, conferences, and assessment methods, has not been duly studied. Knowledge of these issues is a crucial step to move closer to strengthening surgical capacity in low-income countries. We designed an online survey to assess self-perceived and objectively measured barriers to neurosurgical training in various Sub-Saharan African countries. Key outcomes included perception toward adequacy of neurosurgery training and barriers to neurosurgical training at each individual site. Only 37% of responders felt that their training program adequately prepared them for handling incoming neurosurgical cases. Top perceived limitations of neurosurgery training included lack of physical resources (25% of all responses), lack of practical workshops (22%), lack of program structure (18%), and lack of topic-specific lectures (10%). Our results show that most responders believe their training program is inadequate and are interested in improving it through international collaborations. This implies that activities directed at strengthening surgical capacity must address this important necessity. One important strategy is the use of online educational tools. In consideration of the observed limitations in care, resources, and training, we recommend a phased approach to neurosurgical growth in low-income settings. Copyright © 2016. Published by Elsevier Inc.

Medical big data: promise and challenges.

PubMed

Lee, Choong Ho; Yoon, Hyung-Jin

2017-03-01

The concept of big data, commonly characterized by volume, variety, velocity, and veracity, goes far beyond the data type and includes the aspects of data analysis, such as hypothesis-generating, rather than hypothesis-testing. Big data focuses on temporal stability of the association, rather than on causal relationship and underlying probability distribution assumptions are frequently not required. Medical big data as material to be analyzed has various features that are not only distinct from big data of other disciplines, but also distinct from traditional clinical epidemiology. Big data technology has many areas of application in healthcare, such as predictive modeling and clinical decision support, disease or safety surveillance, public health, and research. Big data analytics frequently exploits analytic methods developed in data mining, including classification, clustering, and regression. Medical big data analyses are complicated by many technical issues, such as missing values, curse of dimensionality, and bias control, and share the inherent limitations of observation study, namely the inability to test causality resulting from residual confounding and reverse causation. Recently, propensity score analysis and instrumental variable analysis have been introduced to overcome these limitations, and they have accomplished a great deal. Many challenges, such as the absence of evidence of practical benefits of big data, methodological issues including legal and ethical issues, and clinical integration and utility issues, must be overcome to realize the promise of medical big data as the fuel of a continuous learning healthcare system that will improve patient outcome and reduce waste in areas including nephrology.

Medical big data: promise and challenges

PubMed Central

Lee, Choong Ho; Yoon, Hyung-Jin

2017-01-01

The concept of big data, commonly characterized by volume, variety, velocity, and veracity, goes far beyond the data type and includes the aspects of data analysis, such as hypothesis-generating, rather than hypothesis-testing. Big data focuses on temporal stability of the association, rather than on causal relationship and underlying probability distribution assumptions are frequently not required. Medical big data as material to be analyzed has various features that are not only distinct from big data of other disciplines, but also distinct from traditional clinical epidemiology. Big data technology has many areas of application in healthcare, such as predictive modeling and clinical decision support, disease or safety surveillance, public health, and research. Big data analytics frequently exploits analytic methods developed in data mining, including classification, clustering, and regression. Medical big data analyses are complicated by many technical issues, such as missing values, curse of dimensionality, and bias control, and share the inherent limitations of observation study, namely the inability to test causality resulting from residual confounding and reverse causation. Recently, propensity score analysis and instrumental variable analysis have been introduced to overcome these limitations, and they have accomplished a great deal. Many challenges, such as the absence of evidence of practical benefits of big data, methodological issues including legal and ethical issues, and clinical integration and utility issues, must be overcome to realize the promise of medical big data as the fuel of a continuous learning healthcare system that will improve patient outcome and reduce waste in areas including nephrology. PMID:28392994

The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders

PubMed Central

Govender, Samantha; Khan, Nasim

2016-01-01

Audiologists managing children with auditory processing disorders (APD) encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists’ level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049) was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03) to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team. PMID:27380913

"Cancer Put My Life on Hold": Work-Related Challenges Among Middle-aged Adults 12 Months After a Diagnosis of Colorectal Cancer.

PubMed

McGrath, Catherine; Mihala, Gabor; Beesley, Vanessa L; Lynch, Brigid M; Graves, Nicholas; Gordon, Louisa G

Colorectal cancer affects a wide range of working-age people. Little is known about the consequent work limitations. The aim of this study was to understand the extent and changing nature of work-related limitations of middle-aged (45-64 years) people over the first 12 months of colorectal cancer. Surveys were administered to participants recruited via the Queensland Cancer Registry, at 6 and 12 months after diagnosis. Among those who returned to work, the Work Limitations Questionnaire measured 4 job performance domains (time management, physical, mental-interpersonal, and output demands) and an overall productivity score. Open-ended questions supplemented the Work Limitations Questionnaire, and responses were thematically analyzed. Of 239 participants, 8% did not continue in the study, and 20% left employment by 12 months, leaving 171 participants eligible for this analysis. Open-ended responses for why participants stopped work included bowel problems and stoma, loss of strength, and medication adverse effects. At 12 months, 22% to 39% of participants reported work limitations, but there was no overall significant change in work limitations between 6 and 12 months. Qualitative data highlighted the key work-related issues were changes in work functioning, attitudes of employers and colleagues, financial pressures, and emotional responses. While a significant proportion left work because of treatment-related problems, and the majority of participants did not experience workplace limitations, some reported considerable work-related challenges. Discussions with health professionals about the possible impact of treatment adverse effects on employment, good communication with employers, and workplace flexibility may facilitate return to work for this population.

Peritoneal Dialysis in Austere Environments: An Emergent Approach to Renal Failure Management

PubMed Central

Gorbatkin, Chad; Finkelstein, Fredric O.; Gorbatkin, Steven M.

2018-01-01

Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities. PMID:29760854

Artificial Intelligence approaches in hematopoietic cell transplant: A review of the current status and future directions.

PubMed

Muhsen, Ibrahim N; ElHassan, Tusneem; Hashmi, Shahrukh K

2018-06-08

Currently, the evidence-based literature on healthcare is expanding exponentially. The opportunities provided by the advancement in artificial intelligence (AI) tools i.e. machine learning are appealing in tackling many of the current healthcare challenges. Thus, AI integration is expanding in most fields of healthcare, including the field of hematology. This study aims to review the current applications of AI in the field hematopoietic cell transplant (HCT). Literature search was done involving the following databases: Ovid-Medline including in-Process and Other Non-Indexed Citations and google scholar. The abstracts of the following professional societies: American Society of Haematology (ASH), American Society for Blood and Marrow Transplantation (ASBMT) and European Society for Blood and Marrow Transplantation (EBMT) were also screened. Literature review showed that the integration of AI in the field of HCT has grown remarkably in the last decade and confers promising avenues in diagnosis and prognosis within HCT populations targeting both pre and post-transplant challenges. Studies on AI integration in HCT have many limitations that include poorly tested algorithms, lack of generalizability and limited use of different AI tools. Machine learning techniques in HCT is an intense area of research that needs a lot of development and needs extensive support from hematology and HCT societies / organizations globally since we believe that this would be the future practice paradigm. Key words: Artificial intelligence, machine learning, hematopoietic cell transplant.

Understanding the meaning of fatigue at the end of life: an ethnoscience approach.

PubMed

Kirshbaum, Marilynne N; Olson, Kärin; Pongthavornkamol, Kanaungnit; Graffigna, Guendalina

2013-04-01

Fatigue is a devastating state of body and mind associated with distress at the end of life. We report the results of the third in a series of papers outlining a novel approach we have developed for understanding the meaning of fatigue by exploring how this meaning is shaped by beliefs and values. The aims of the study were to examine the perception and experiences of fatigue held by patients attending a hospice in England; identify the behavioural patterns that distinguish fatigue from tiredness and exhaustion; provide conceptual definitions of tiredness, fatigue and exhaustion. An Ethnoscience design was selected. The sample comprised nine people who attended a hospice between May and December 2009. Inclusion criteria included: at least 18 years of age, experiencing fatigue, able to provide informed consent and resident in the selected city in northern England for 10 years. Data were collected from two consecutive semi-structured interviews for each participant. We found that tiredness, fatigue and exhaustion are markers of progressive functional decline. Fatigue had two dimensions: 1) Mental Challenge, which included: emotional effects, cognitive realisation of decline and mental tenacity and 2) Physical Challenge, which included: limitations in leisure activities, limitations in functional roles and re-patterning routines. This study provides evidence that symptom experience is socially constructed, which has potential implications for the development of effective interventions. Copyright © 2012 Elsevier Ltd. All rights reserved.

Dendrimer advances for the central nervous system delivery of therapeutics.

PubMed

Xu, Leyuan; Zhang, Hao; Wu, Yue

2014-01-15

The effectiveness of noninvasive treatment for central nervous system (CNS) diseases is generally limited by the poor access of therapeutic agents into the CNS. Most CNS drugs cannot permeate into the brain parenchyma because of the blood-brain barrier (BBB), and overcoming this has become one of the most significant challenges in the development of CNS therapeutics. Rapid advances in nanotechnology have provided promising solutions to this challenge. This review discusses the latest applications of dendrimers in the treatment of CNS diseases with an emphasis on brain tumors. Dendrimer-mediated drug delivery, imaging, and diagnosis are also reviewed. The toxicity, biodistribution, and transport mechanisms in dendrimer-mediated delivery of CNS therapeutic agents bypassing or crossing the BBB are also discussed. Future directions and major challenges of dendrimer-mediated delivery of CNS therapeutic agents are included.

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

Triggering Events for the First Space Settlement

NASA Astrophysics Data System (ADS)

Gale, Anita E.; Edwards, Richard P.

2003-01-01

We know where humankind is now in its limited ability to venture into space, and we can envision technologies that include routine space flight and large human populations in space; the challenge is to figure out how to get from where we are now to what we can envision. Although the technical challenges of space infrastructure development will be significant, the factors most responsible for preventing us from surmounting those challenges are politics and economics. Various rationales have been proposed by other authors and are summarized, with assessments of the hurdles involved in each. In an effort to make Space Settlement Design Competitions for high school students as realistic as possible, the co-authors developed a compelling rationale for building the first community in space and the infrastructure required to support it, which passes the tests of economic necessity and political appeal.

Dendrimer Advances for the Central Nervous System Delivery of Therapeutics

PubMed Central

2013-01-01

The effectiveness of noninvasive treatment for central nervous system (CNS) diseases is generally limited by the poor access of therapeutic agents into the CNS. Most CNS drugs cannot permeate into the brain parenchyma because of the blood-brain barrier (BBB), and overcoming this has become one of the most significant challenges in the development of CNS therapeutics. Rapid advances in nanotechnology have provided promising solutions to this challenge. This review discusses the latest applications of dendrimers in the treatment of CNS diseases with an emphasis on brain tumors. Dendrimer-mediated drug delivery, imaging, and diagnosis are also reviewed. The toxicity, biodistribution, and transport mechanisms in dendrimer-mediated delivery of CNS therapeutic agents bypassing or crossing the BBB are also discussed. Future directions and major challenges of dendrimer-mediated delivery of CNS therapeutic agents are included. PMID:24274162

Assessing Species Diversity Using Metavirome Data: Methods and Challenges.

PubMed

Herath, Damayanthi; Jayasundara, Duleepa; Ackland, David; Saeed, Isaam; Tang, Sen-Lin; Halgamuge, Saman

2017-01-01

Assessing biodiversity is an important step in the study of microbial ecology associated with a given environment. Multiple indices have been used to quantify species diversity, which is a key biodiversity measure. Measuring species diversity of viruses in different environments remains a challenge relative to measuring the diversity of other microbial communities. Metagenomics has played an important role in elucidating viral diversity by conducting metavirome studies; however, metavirome data are of high complexity requiring robust data preprocessing and analysis methods. In this review, existing bioinformatics methods for measuring species diversity using metavirome data are categorised broadly as either sequence similarity-dependent methods or sequence similarity-independent methods. The former includes a comparison of DNA fragments or assemblies generated in the experiment against reference databases for quantifying species diversity, whereas estimates from the latter are independent of the knowledge of existing sequence data. Current methods and tools are discussed in detail, including their applications and limitations. Drawbacks of the state-of-the-art method are demonstrated through results from a simulation. In addition, alternative approaches are proposed to overcome the challenges in estimating species diversity measures using metavirome data.

The affordances of using a flipped classroom approach in the teaching of mathematics: a case study of a grade 10 mathematics class

NASA Astrophysics Data System (ADS)

Muir, Tracey; Geiger, Vince

2016-03-01

Teaching secondary mathematics has a number of challenges, including the expectations that teachers cover the prescribed curriculum, help students learn difficult concepts, prepare students for future studies, and, increasingly, that they do so incorporating digital technologies. This study investigates a teacher's, and his students', perceptions of the benefits or otherwise of a flipped classroom approach in meeting these challenges, within a prescribed curriculum context. Data collection instruments included a survey designed to investigate the nature of students' engagement with the flipped approach and semi-structured student and teacher interviews. Analysis of these data indicated that the teacher and students were positive about their experiences with a flipped classroom approach and that students were motivated to engage with the teacher-created online mathematics resources. The study adds to the limited research literature related to student and teacher perceptions of the affordances of the flipped classroom approach and has implications for secondary mathematics teachers who face the challenge of the twin demands of covering the prescribed curriculum and catering for a range of students' learning needs.

The National Heart, Lung, and Blood Institute Small Business Program

PubMed Central

Marek, Kurt W.

2016-01-01

SUMMARY Small companies working to develop products in the cardiovascular space face numerous challenges, from regulatory, intellectual property, and reimbursement barriers to securing funds to keep the lights on and reach the next development milestone. Most small companies that spin out from universities have the scientific knowledge, but product development expertise and business acumen are also needed to be successful. Other challenges include reduced interest in early stage technologies (Pharma & Biotech 2015 in Review, EP Vantage) and limited deal flow for cardiovascular products (Gormley B., Wall Street Journal, September 15, 2014). The NHLBI small business program is a comprehensive ecosystem designed to address these critical challenges and to provide resources and expertise to assist early stage companies developing cardiovascular and other products within the institute’s mission. This article describes steps that NHLBI has taken to enhance our small business program to more effectively translate basic discoveries into commercial products to benefit patients and public health, including enhancing internal expertise and developing non-financial resources to assist small businesses as they develop their products and seek private sector investment and partnership. PMID:28580435

Parameters for determining inoculated pack/challenge study protocols.

PubMed

2010-01-01

The National Advisory Committee on Microbiological Criteria for Foods developed guidelines for conducting challenge studies on pathogen inhibition and inactivation studies in a variety of foods. The document is intended for use by the food industry, including food processors, food service operators, and food retailers; federal, state, and local food safety regulators; public health officials; food testing laboratories; and process authorities. The document is focused on and limited to bacterial inactivation and growth inhibition and does not make specific recommendations with respect to public health. The Committee concluded that challenge studies should be designed considering the most current advances in methodologies, current thinking on pathogens of concern, and an understanding of the product preparation, variability, and storage conditions. Studies should be completed and evaluated under the guidance of an expert microbiologist in a qualified laboratory and should include appropriate statistical design and data analyses. This document provides guidelines for choice of microorganisms for studies, inoculum preparation, inoculum level, methods of inoculation, incubation temperatures and times, sampling considerations, and interpreting test results. Examples of appropriately designed growth inhibition and inactivation studies are provided.

The National Heart, Lung, and Blood Institute Small Business Program: A Comprehensive Ecosystem for Biomedical Product Development.

PubMed

Marek, Kurt W

2016-12-01

Small companies working to develop products in the cardiovascular space face numerous challenges, from regulatory, intellectual property, and reimbursement barriers to securing funds to keep the lights on and reach the next development milestone. Most small companies that spin out from universities have the scientific knowledge, but product development expertise and business acumen are also needed to be successful. Other challenges include reduced interest in early stage technologies (Pharma & Biotech 2015 in Review, EP Vantage) and limited deal flow for cardiovascular products (Gormley B., Wall Street Journal, September 15, 2014). The NHLBI small business program is a comprehensive ecosystem designed to address these critical challenges and to provide resources and expertise to assist early stage companies developing cardiovascular and other products within the institute's mission. This article describes steps that NHLBI has taken to enhance our small business program to more effectively translate basic discoveries into commercial products to benefit patients and public health, including enhancing internal expertise and developing non-financial resources to assist small businesses as they develop their products and seek private sector investment and partnership.

Microbial Diagnostic Microarrays for the Detection and Typing of Food- and Water-Borne (Bacterial) Pathogens

PubMed Central

Kostić, Tanja; Sessitsch, Angela

2011-01-01

Reliable and sensitive pathogen detection in clinical and environmental (including food and water) samples is of greatest importance for public health. Standard microbiological methods have several limitations and improved alternatives are needed. Most important requirements for reliable analysis include: (i) specificity; (ii) sensitivity; (iii) multiplexing potential; (iv) robustness; (v) speed; (vi) automation potential; and (vii) low cost. Microarray technology can, through its very nature, fulfill many of these requirements directly and the remaining challenges have been tackled. In this review, we attempt to compare performance characteristics of the microbial diagnostic microarrays developed for the detection and typing of food and water pathogens, and discuss limitations, points still to be addressed and issues specific for the analysis of food, water and environmental samples. PMID:27605332

School Dropouts or Pushouts? Overcoming Barriers for the Right to Education. CREATE Pathways to Access. Research Monograph No. 40

ERIC Educational Resources Information Center

Reddy, Anugula N.; Sinha, Shantha

2010-01-01

Persistently high dropout rates are one of the biggest challenges to fulfilling the right to education in India. This paper attempts to assess the magnitude of the problem of dropout. The paper critically reviews the evidence on some of the commonly cited reasons for dropout, including poverty, limited to access to credit, child labour, and…

The Idaho dedicated education unit model: cost-effective, high-quality education.

PubMed

Springer, Pamela J; Johnson, Patricia; Lind, Bonnie; Walker, Eldon; Clavelle, Joanne; Jensen, Nancy

2012-01-01

Faculty face many challenges in delivering clinical education, including faculty availability, the complexity of the faculty role, and limited clinical placements. Dedicated education units (DEUs) are being explored as alternatives to traditional clinical placement models. The authors describe the successful development of a DEU that resulted in positive student outcomes at reduced cost to both the school and the medical center.

Structural Damage Identification in Stiffened Plate Fatigue Specimens Using Piezoelectric Active Sensing

DTIC Science & Technology

2011-09-01

isolated AO mode first arrival, recorded at PZT 2, is shown at 3 different fatigue levels. Figure 5. The area under the PSD curve, calculated twice...Structural Damage Identification in Stiffened Plate Fatigue Specimens Using Piezoelectric Active Sensing B. L. GRISSO, G. PARK, L. W. SALVINO...with several challenges including limited performance knowledge of the materials, aluminum sensitization, structural fatigue performance, and

Freight transportation : strategies needed to address planning and financing limitations

DOT National Transportation Integrated Search

2003-12-01

The General Accounting Office (GAO) was asked to address (1) the challenges to freight mobility, (2) the limitations key stakeholders have encountered in addressing these challenges, and (3) strategies that may aid decision makers in enhancing freigh...

76 FR 477 - Airworthiness Directives; Bombardier, Inc. Model CL-600-2A12 (CL-601) and CL-600-2B16 (CL-601-3A...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... to these aircraft if Bombardier Service Bulletin (SB) 601-0590 [Scheduled Maintenance Instructions... information: Challenger 601 Time Limits/Maintenance Checks, PSP 601-5, Revision 38, dated June 19, 2009. Challenger 601 Time Limits/Maintenance Checks, PSP 601A-5, Revision 34, dated June 19, 2009. Challenger 604...

NASA Extreme Environment Mission Operation (NEEMO) 12: Collaborative Accelerated Medical Technology Development

DTIC Science & Technology

2007-12-01

tremendous opportunity to support telesurgical care using mobile systems, where communication assets are challenging . BODY RESEARCH PLAN This... challenged with constraints of remoteness, limited resources, and limited technical expertise. This telesurgery research, funded by TATRC and reported...utilized iChat (V.2.1.3) for the Apple Macintosh. Technology Summary The challenges of implementing the technology were numerous. Beyond the fact that

Hair restoration surgery: challenges and solutions

PubMed Central

Rose, Paul T

2015-01-01

Hair loss is a common problem affecting both men and women. The most frequent etiology is androgenetic alopecia, but other causes of hair loss such as trauma, various dermatologic diseases, and systemic diseases can cause alopecia. The loss of hair can have profound effects on one’s self esteem and emotional well-being, as one’s appearance plays a role in the work place and interpersonal relationships. It is therefore not surprising that means to remedy hair loss are widely sought. Hair transplant surgery has become increasingly popular, and the results that we are able to create today are quite remarkable, providing a natural appearance when the procedure is performed well. In spite of this, hair transplant surgery is not perfect. It is not perfect because the hair transplant surgeon is still faced with challenges that prevent the achievement of optimal results. Some of these challenges include a limit to donor hair availability, hair survival, and ways to conceal any evidence of a surgical procedure having taken place. This article examines some of the most important challenges facing hair restoration surgery today and possible solutions to these challenges. PMID:26203266

Challenging symptoms in children with rare life-limiting conditions: findings from a prospective diary and interview study with families.

PubMed

Malcolm, C; Hain, R; Gibson, F; Adams, S; Anderson, G; Forbat, L

2012-09-01

The aim was to describe the nature, frequency, severity and management challenges of symptoms in children with two rare life-limiting conditions [Mucopolysaccharide (MPS) and Batten disease]. This was an embedded mixed-method study set in the UK between 2009 and 2011. Twenty-six children from 23 families took part. Seventeen children had an MPS condition [MPS III (Sanfilippo) n = 15; MPS I (Hurler) n = 1; MPS IVA (Morquio); n = 1]. Nine children had Batten disease. Prospective data relating to symptoms were collected over 8 weeks using a symptom diary, and qualitative retrospective interviews with families were conducted. Main outcome measures included frequency, severity rating and identification of most challenging symptoms to manage. The most common and severe symptoms in MPS III were agitation, repetitive behaviours, hyperactivity and disturbed sleep, and in Batten disease were agitation, joint stiffness, secretions, and disturbed sleep. The data highlighted the high prevalence of behavioural symptoms. Distress caused to families by symptoms was not related simply to their occurrence, but to difficulty in management, likelihood of control and extent to which they signalled disease progression and decline. In challenging contrast to the dominant biomedical framing of these rare conditions it was behavioural symptoms, rather than the physical ones, that families documented as most frequent, severe and challenging to manage. The diary developed for this study has potential use in aiding parents and clinicians to document and communicate concerns about symptoms. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

First 25-hydroxyvitamin D assay for general chemistry analyzers.

PubMed

Saida, Fakhri B; Chen, Xiaoru; Tran, Kiet; Dou, Chao; Yuan, Chong

2015-03-01

25-Hydroxyvitamin D [25(OH)D], the predominant circulating form of vitamin D, is an accurate indicator of the general vitamin D status of an individual. Because vitamin D deficiencies have been linked to several pathologies (including osteoporosis and rickets), accurate monitoring of 25(OH)D levels is becoming increasingly important in clinical settings. Current 25(OH)D assays are either chromatographic or immunoassay-based assays. These assays include HPLC, liquid chromatography-tandem mass spectrometry (LC-MS/MS), enzyme-immunosorbent, immunochemiluminescence, immunofluorescence and radioimmunoassay. All these assays use heterogeneous formats that require phase separation and special instrumentations. In this article, we present an overview of these assays and introduce the first homogeneous assay of 25(OH)D for use on general chemistry analyzers. A special emphasis is put on the unique challenges posed by the 25(OH)D analyte. These challenges include a low detection limit, the dissociation of the analyte from its serum transporter and the inactivation of various binding proteins without phase separation steps.

Family psychology: Past and future reflections on the field.

PubMed

Parke, Ross D

2017-04-01

Prominent issues in the field of family psychology during my term as editor (1998-2003) of this journal were briefly noted, including a focus on marital issues, divorce, remarriage and family conflict. Parenting, attachment and parent-child relationships were also significant topics in this period. Special sections of the journal focused on cultural variations, families and the law, families and religion, and family routines and rituals. Several neglected issues that need more attention in the future were noted. These include the need to recognize the embeddedness of families in socioecological contexts, the importance of monitoring the impact of secular changes on families, and the value and limitations of viewing family psychology as a separate field. Other topics for a future agenda include the challenge of defining "family" in the midst of changing family forms, the effects of technological change on families, and the challenges of integrating biological research into the family psychology agenda. A multilevel bio-social approach to family research was recommended. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Working Group Report: Sensors

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

Artuso, M.; et al.,

Sensors play a key role in detecting both charged particles and photons for all three frontiers in Particle Physics. The signals from an individual sensor that can be used include ionization deposited, phonons created, or light emitted from excitations of the material. The individual sensors are then typically arrayed for detection of individual particles or groups of particles. Mounting of new, ever higher performance experiments, often depend on advances in sensors in a range of performance characteristics. These performance metrics can include position resolution for passing particles, time resolution on particles impacting the sensor, and overall rate capabilities. In additionmore » the feasible detector area and cost frequently provides a limit to what can be built and therefore is often another area where improvements are important. Finally, radiation tolerance is becoming a requirement in a broad array of devices. We present a status report on a broad category of sensors, including challenges for the future and work in progress to solve those challenges.« less

Sensor Compendium - A Snowmass Whitepaper-

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

Artuso, M.; Battaglia, M.; Bolla, G.

Sensors play a key role in detecting both charged particles and photons for all three frontiers in Particle Physics. The signals from an individual sensor that can be used include ionization deposited, phonons created, or light emitted from excitations of the material. The individual sensors are then typically arrayed for detection of individual particles or groups of particles. Mounting of new, ever higher performance experiments, often depend on advances in sensors in a range of performance characteristics. These performance metrics can include position resolution for passing particles, time resolution on particles impacting the sensor, and overall rate capabilities. In additionmore » the feasible detector area and cost frequently provides a limit to what can be built and therefore is often another area where improvements are important. Finally, radiation tolerance is becoming a requirement in a broad array of devices. We present a status report on a broad category of sensors, including challenges for the future and work in progress to solve those challenges.« less

The Hazards of Data Mining in Healthcare.

PubMed

Househ, Mowafa; Aldosari, Bakheet

2017-01-01

From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

Preface to the special issue on ;Optical Communications Exploiting the Space Domain;

NASA Astrophysics Data System (ADS)

Wang, Jian; Yu, Siyuan; Li, Guifang

2018-02-01

The demand for high capacity optical communications will continue to be driven by the exponential growth of global internet traffic. Optical communications are about the exploitation of different physical dimensions of light waves, including complex amplitude, frequency (or wavelength), time, polarization, etc. Conventional techniques such as wavelength-division multiplexing (WDM), time-division multiplexing (TDM) and polarization-division multiplexing (PDM) have almost reached their scalability limits. Space domain is the only known physical dimension left and space-division multiplexing (SDM) seems the only option to further scale the transmission capacity and spectral efficiency of optical communications. In recent years, few-mode fiber (FMF), multi-mode fiber (MMF), multi-core fiber (MCF) and few-mode multi-core fiber (FM-MCF) have been widely explored as promising candidates for fiber-based SDM. The challenges for SDM include efficient (de)multiplexer, amplifiers, and multiple-input multiple-output (MIMO) digital signal processing (DSP) techniques. Photonic integration will also be a key technology to SDM. Meanwhile, free-space and underwater optical communications have also exploited the space domain to increase the transmission capacity and spectral efficiency. The challenges include long-distance transmission limited by propagation loss, divergence, scattering and turbulence. Very recently, helically phased light beams carrying orbital angular momentum (OAM) have also seen potential applications both in free-space, underwater and fiber-based optical communications. Actually, different mode bases such as linearly polarized (LP) modes and OAM modes can be employed for SDM. Additionally, SDM could be used in chip-scale photonic interconnects and data center optical interconnects. Quantum processing exploiting the space domain is of great interest. The information capacity limit and physical layer security in SDM optical communications systems are important issues to be addressed.

A public health perspective on the U.S. response to the Fukushima radiological emergency.

PubMed

Whitcomb, Robert C; Ansari, Armin J; Buzzell, Jennifer J; McCurley, M Carol; Miller, Charles W; Smith, James M; Evans, D Lynn

2015-03-01

On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness.

Challenges in diabetes management in Indonesia: a literature review.

PubMed

Soewondo, Pradana; Ferrario, Alessandra; Tahapary, Dicky Levenus

2013-12-03

The expanding diabetes epidemic worldwide could have potentially devastating effects on the development of healthcare systems and economies in emerging countries, both in terms of direct health care costs and loss of working time and disability. This study aims to review evidence on the burden, expenditure, complications, treatment, and outcomes of diabetes in Indonesia and its implications on the current health system developments. We conducted a comprehensive literature review together with a review of unpublished data from the Ministry of Health and a public health insurer (Askes). Studies presenting evidence on prevalence, incidence, mortality, costs, complications and cost of complications, treatment, and outcomes were included in the analysis. A limited number of international, national and local studies on the burden and cost of diabetes in Indonesia were identified. National survey data suggests that in 2007 the prevalence of diabetes was 5.7%, of which more than 70% of cases were undiagnosed. This estimate hides large intracountry variation. There was very limited data available on direct costs and no data on indirect costs. The most commonly-identified complication was diabetic neuropathy. There were a number of limitations in the data retrieved including the paucity of data representative at the national level, lack of a clear reference date, lack of data from primary care, and lack of data from certain regions of the country. If left unaddressed, the growing prevalence of diabetes in the country will pose a tremendous challenge to the Indonesian healthcare system, particularly in view of the Government's 2010 mandate to achieve universal health coverage by 2014. Essential steps to address this issue would include: placing diabetes and non-communicable diseases high on the Government agenda and creating a national plan; identifying disparities and priority areas for Indonesia; developing a framework for coordinated actions between all relevant stakeholders.

Current limitations and recommendations to improve testing for the environmental assessment of endocrine active substances

USGS Publications Warehouse

Coady, Katherine K.; Biever, Ronald C.; Denslow, Nancy D.; Gross, Melanie; Guiney, Patrick D.; Holbech, Henrik; Karouna-Renier, Natalie K.; Katsiadaki, Ioanna; Krueger, Hank; Levine, Steven L.; Maack, Gerd; Williams, Mike; Wolf, Jeffrey C.; Ankley, Gerald T.

2017-01-01

In the present study, existing regulatory frameworks and test systems for assessing potential endocrine active chemicals are described, and associated challenges are discussed, along with proposed approaches to address these challenges. Regulatory frameworks vary somewhat across geographies, but all basically evaluate whether a chemical possesses endocrine activity and whether this activity can result in adverse outcomes either to humans or to the environment. Current test systems include in silico, in vitro, and in vivo techniques focused on detecting potential endocrine activity, and in vivo tests that collect apical data to detect possible adverse effects. These test systems are currently designed to robustly assess endocrine activity and/or adverse effects in the estrogen, androgen, and thyroid hormone signaling pathways; however, there are some limitations of current test systems for evaluating endocrine hazard and risk. These limitations include a lack of certainty regarding: 1) adequately sensitive species and life stages; 2) mechanistic endpoints that are diagnostic for endocrine pathways of concern; and 3) the linkage between mechanistic responses and apical, adverse outcomes. Furthermore, some existing test methods are resource intensive with regard to time, cost, and use of animals. However, based on recent experiences, there are opportunities to improve approaches to and guidance for existing test methods and to reduce uncertainty. For example, in vitro high-throughput screening could be used to prioritize chemicals for testing and provide insights as to the most appropriate assays for characterizing hazard and risk. Other recommendations include adding endpoints for elucidating connections between mechanistic effects and adverse outcomes, identifying potentially sensitive taxa for which test methods currently do not exist, and addressing key endocrine pathways of possible concern in addition to those associated with estrogen, androgen, and thyroid signaling. 

CHALLENGES AND BENEFITS OF CONDUCTING ENVIRONMENTAL JUSTICE RESEARCH IN A SCHOOL SETTING

PubMed Central

GUIDRY, VIRGINIA T.; LOWMAN, AMY; HALL, DEVON; BARON, DOTHULA; WING, STEVE

2015-01-01

Environmental justice (EJ) research requires attention to consequences for research participants beyond those typically considered by institutional review boards. The imbalance of power between impacted communities and those who create and regulate pollution creates challenges for participation, yet research can also benefit those involved. Our community-academic partnership designed the Rural Air Pollutants and Children's Health (RAPCH) study to provide positive impacts while measuring health effects at three low-resource public middle schools near concentrated animal feeding operations (CAFOs) in North Carolina. We evaluated perceived benefits and challenges of study involvement by interviewing school staff and community liaisons who facilitated data collection. Reported benefits included enhancement of students’ academic environment and increased community environmental awareness; challenges were associated mainly with some participants’ immaturity. Leadership from a strong community-based organization was crucial to recruitment, yet our approach entailed minimal focus on EJ, which may have limited opportunities for community education or organizing for environmental health. PMID:25085828

An interview-informed synthesized contingency analysis to inform the treatment of challenging behavior in a young child with autism.

PubMed

Herman, Ciara; Healy, Olive; Lydon, Sinéad

2018-04-01

Experimental Functional analysis (EFA) is considered the "gold standard" of behavioural assessment and its use is predictive of treatment success. However, EFA has a number of limitations including its lengthy nature, the high level of expertise required, and the reinforcement of challenging behaviour. This study aimed to further validate a novel interview-informed synthesised contingency analysis (IISCA). An open-ended interview and brief direct observation informed an IISCA for a young boy with autism who engaged in challenging behaviour. Resulting data supported the hypothesis that the target behaviour was multiply controlled by escape from demands and access to tangible items. An intervention comprised of most-to-least prompting, escape extinction, differential reinforcement and a high-probability instruction sequence was evaluated using a reversal design. This intervention reduced challenging behaviour to low levels and resulted in increased compliance. Findings support the status of the IISCA as a valid, practical, and effective process for designing function-based interventions.

Spirituality, social capital and service: factors promoting resilience among Expert Patients living with HIV in Ethiopia.

PubMed

Hussen, Sophia Ahmed; Tsegaye, Mulugeta; Argaw, Meron Gurji; Andes, Karen; Gilliard, Danielle; del Rio, Carlos

2014-01-01

People living with HIV (PLHIV) in Ethiopia and other developing nations face numerous challenges to their health and well-being, including poverty, limited healthcare infrastructure and high levels of societal stigma. Despite these challenges, resilient trajectories have been observed even within such resource-limited settings. In Ethiopia, such resilience is exemplified by the 'Expert Patients (EPTs)', HIV-positive lay health workers who function as adherence counsellors, health educators, outreach workers and community advocates. We conducted a multi-method qualitative study with 20 EPTs in Addis Ababa, Ethiopia in order to understand pathways to resilience in this selected population. Participants described three key mechanisms of resilient coping: (1) the use of spirituality and faith-based practices to manage psychological difficulties associated with living with HIV; (2) utilisation of social capital from family and community networks as a buffer against the psychological and economic consequences of societal stigma; and (3) serving others as a mechanism for finding optimism and purpose in life. Interventions designed to facilitate and/or augment these social processes in the wider community may be promising strategies for improving health among PLHIV in Ethiopia and other resource-limited settings.

At the cross-roads of participatory research and biomarker discovery in autism: the need for empirical data.

PubMed

Yusuf, Afiqah; Elsabbagh, Mayada

2015-12-15

Identifying biomarkers for autism can improve outcomes for those affected by autism. Engaging the diverse stakeholders in the research process using community-based participatory research (CBPR) can accelerate biomarker discovery into clinical applications. However, there are limited examples of stakeholder involvement in autism research, possibly due to conceptual and practical concerns. We evaluate the applicability of CBPR principles to biomarker discovery in autism and critically review empirical studies adopting these principles. Using a scoping review methodology, we identified and evaluated seven studies using CBPR principles in biomarker discovery. The limited number of studies in biomarker discovery adopting CBPR principles coupled with their methodological limitations suggests that such applications are feasible but challenging. These studies illustrate three CBPR themes: community assessment, setting global priorities, and collaboration in research design. We propose that further research using participatory principles would be useful in accelerating the pace of discovery and the development of clinically meaningful biomarkers. For this goal to be successful we advocate for increased attention to previously identified conceptual and methodological challenges to participatory approaches in health research, including improving scientific rigor and developing long-term partnerships among stakeholders.

Thinking Inside the Box: The Health Cube Paradigm for Health and Wellness Program Evaluation and Design

PubMed Central

Harris, Sharon

2013-01-01

Abstract Appropriately constructed health promotions can improve population health. The authors developed a practical model for designing, evaluating, and improving initiatives to provide optimal value. Three independent model dimensions (impact, engagement, and sustainability) and the resultant three-dimensional paradigm were described using hypothetical case studies, including a walking challenge, a health risk assessment survey, and an individual condition management program. The 3-dimensional model is illustrated and the dimensions are defined. Calculation of a 3-dimensional score for program comparisons, refinements, and measurement is explained. Program 1, the walking challenge, had high engagement and impact, but limited sustainability. Program 2, the health risk assessment survey, had high engagement and sustainability but limited impact. Program 3, the on-site condition management program, had measurable impact and sustainability but limited engagement, because of a lack of program capacity. Each initiative, though successful in 2 dimensions, lacked sufficient evolution along the third axis for optimal value. Calculation of a 3-dimensional score is useful for health promotion program development comparison and refinements, and overall measurement of program success. (Population Health Management 2013;16:291–295) PMID:23869538

Establishing and sustaining a biorepository network in Israel: challenges and progress.

PubMed

Cohen, Yehudit; Almog, Ronit; Onn, Amir; Itzhaki-Alfia, Ayelet; Meir, Karen

2013-12-01

Over the past 5 years, using European and North American biobanks as models, the grass-roots establishment of independently operating biobanks has occurred virtually simultaneously in large Israeli teaching hospitals. The process of establishing a national biorepository network in Israel has progressed slowly, sustained mainly by a few proponents working together on a personal level. Slow progress has been due to limited funding and the lack of a legal framework specific to biobanking activities. Recently, due to increasing pressure from the scientific community, the government has earmarked funds for a national biorepository network, and the structure is now being established. In forming a network, Israel's biobanks face certain difficulties, particularly lack of support. Additional challenges include harmonization of standard operating procedures, database centralization, and use of a common informed consent form. In this article, we highlight some of the issues faced by Israel's biobank managers in establishing and sustaining a functional biobank network, information that could provide guidance for other small countries with limited resources.

Taking older people's rights seriously: the role of international law.

PubMed

Tang, Kwong-leung

2008-01-01

Older people face many difficult challenges that amount to a deplorable violation of their basic human rights (poverty, discrimination, denial of social services, etc.). However, the world has been slow to react. Factors that limit global responses to the challenges of aging include: limited political will, the prevalence of neo-liberalism, and NGOs' longstanding advocacy for other seemingly "more" disadvantaged groups. Such oppression of and discrimination against older people require a concerted world-wide response. We contend that the introduction of an international convention on the human rights of older people is most relevant. Reinforced by a potent international monitoring system, the convention should contain comprehensive and legally binding provisions that require participating states to promote older people's rights. It is argued that international law would be a powerful force in defending and protecting older persons, operating as a baseline for establishing underlying values for national aging policies and linking older persons' concerns with other segments of society.

Teaching of anatomical sciences: A blended learning approach.

PubMed

Khalil, Mohammed K; Abdel Meguid, Eiman M; Elkhider, Ihsan A

2018-04-01

Blended learning is the integration of different learning approaches, new technologies, and activities that combine traditional face-to-face teaching methods with authentic online methodologies. Although advances in educational technology have helped to expand the selection of different pedagogies, the teaching of anatomical sciences has been challenged by implementation difficulties and other limitations. These challenges are reported to include lack of time, costs, and lack of qualified teachers. Easy access to online information and advances in technology make it possible to resolve these limitations by adopting blended learning approaches. Blended learning strategies have been shown to improve students' academic performance, motivation, attitude, and satisfaction, and to provide convenient and flexible learning. Implementation of blended learning strategies has also proved cost effective. This article provides a theoretical foundation for blended learning and proposes a validated framework for the design of blended learning activities in the teaching and learning of anatomical sciences. Clin. Anat. 31:323-329, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

The Importance of Muscular Strength: Training Considerations.

PubMed

Suchomel, Timothy J; Nimphius, Sophia; Bellon, Christopher R; Stone, Michael H

2018-04-01

This review covers underlying physiological characteristics and training considerations that may affect muscular strength including improving maximal force expression and time-limited force expression. Strength is underpinned by a combination of morphological and neural factors including muscle cross-sectional area and architecture, musculotendinous stiffness, motor unit recruitment, rate coding, motor unit synchronization, and neuromuscular inhibition. Although single- and multi-targeted block periodization models may produce the greatest strength-power benefits, concepts within each model must be considered within the limitations of the sport, athletes, and schedules. Bilateral training, eccentric training and accentuated eccentric loading, and variable resistance training may produce the greatest comprehensive strength adaptations. Bodyweight exercise, isolation exercises, plyometric exercise, unilateral exercise, and kettlebell training may be limited in their potential to improve maximal strength but are still relevant to strength development by challenging time-limited force expression and differentially challenging motor demands. Training to failure may not be necessary to improve maximum muscular strength and is likely not necessary for maximum gains in strength. Indeed, programming that combines heavy and light loads may improve strength and underpin other strength-power characteristics. Multiple sets appear to produce superior training benefits compared to single sets; however, an athlete's training status and the dose-response relationship must be considered. While 2- to 5-min interset rest intervals may produce the greatest strength-power benefits, rest interval length may vary based an athlete's training age, fiber type, and genetics. Weaker athletes should focus on developing strength before emphasizing power-type training. Stronger athletes may begin to emphasize power-type training while maintaining/improving their strength. Future research should investigate how best to implement accentuated eccentric loading and variable resistance training and examine how initial strength affects an athlete's ability to improve their performance following various training methods.

Challenges of Obtaining Evidence-Based Information Regarding Medications and Male Fertility.

PubMed

Drobnis, Erma Z; Nangia, Ajay K

2017-01-01

In the clinic, the existing literature is insufficient to counsel our infertile men on medication use. Most studies have flaws that limit their application to evidence-based practice. In this chapter, we discuss the limitations of the current literature and the challenges to designing more useful studies. Among the most important weaknesses of existing studies is lack of power; that is, too few men are included to draw conclusions about the existence and size of medication effects. Adequate power is particularly important when confirming an absence of medication effect. Bias is also a problem in most studies. Early studies were rarely randomized, placebo-controlled, or blinded; a common example is patients receiving different medication regimes based on the severity of their symptoms-making it impossible to attribute differences between treated and untreated men to the medications. Additional bias is introduced by failing to include other factors that influence the outcome in the experimental design. A uniform population amenable to randomization and placebo-control are experimental species, and useful information has been gained from these models. However, application to humans is limited by differences from other species in route of drug administration, absorption of the drug, concentration in the male genital tract tissues, and genital tract physiology. To a lesser degree, there is variation among individual men in their response to drugs. In addition, drugs in the same class may have different effects, limiting the applicability of data across drugs of a single class. Complicating matters further, a toxic medication may seem to improve fertility endpoints by improving a disease condition that diminishes fertility. Finally, drug interactions have not been studied, and actual fertility data (pregnancy/fecundity) in humans are rare. A healthy dose of skepticism is warranted when evaluating studies of medications and male reproductive health.

A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services

PubMed Central

Flink, Dina M.; Sheeder, Jeanelle

2017-01-01

Purpose: The American Society of Clinical Oncology issued practice guidelines in 2006 to provide critical information about fertility impact to adolescents and young adults (AYA) at the time of cancer diagnosis. Survivors continue to express concerns about their long-term reproductive health after cancer therapy even as treatment options for fertility preservation evolve. An underutilization of fertility preservation methods by cancer patients continues to persist. A review of the literature cites barriers and challenges that limit fertility information and preservation options for AYA cancer patients. Methods: A review of medical literature was conducted to examine current practice for patients receiving fertility information and the barriers to patients receiving fertility preservation services. Results: A total of 69 publications were included in this review. The review summarizes (1) patient experiences with receiving fertility information and (2) patient desires, barriers, and challenges to utilizing fertility preservation services. Conclusions: Despite advances in fertility preservation, there are challenges for patients to utilizing fertility preservation services. Barriers include the following: urgency to initiate treatment, inadequate information, clinic time constraints, and perceptions around patients' gender, age, cost, parity, race, relationship, and sociodemographic status influence whether patients receive fertility preservation consultation. Patients report a lack of adequate information to make informed fertility decisions. PMID:27529573

Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

PubMed Central

Oppong, Raymond; Jowett, Sue; Roberts, Tracy E.

2015-01-01

Purpose of the study This study seeks to explore methods for conducting economic evaluations alongside multinational trials by conducting a systematic review of the methods used in practice and the challenges that are typically faced by the researchers who conducted the economic evaluations. Methods A review was conducted for the period 2002 to 2012, with potentially relevant articles identified by searching the Medline, Embase and NHS EED databases. Studies were included if they were full economic evaluations conducted alongside a multinational trial. Results A total of 44 studies out of a possible 2667 met the inclusion criteria. Methods used for the analyses varied between studies, indicating a lack of consensus on how economic evaluation alongside multinational studies should be carried out. The most common challenge appeared to be related to addressing differences between countries, which potentially hinders the generalisability and transferability of results. Other challenges reported included inadequate sample sizes and choosing cost-effectiveness thresholds. Conclusions It is recommended that additional guidelines be developed to aid researchers in this area and that these be based on an understanding of the challenges associated with multinational trials and the strengths and limitations of alternative approaches. Guidelines should focus on ensuring that results will aid decision makers in their individual countries. PMID:26121465

First Amendment Limits on Compulsory Speech.

PubMed

Barrella, Nigel

Government-mandated labeling requirements have a long history, and are used extensively by FDA in regulating the industries under its jurisdiction. All such requirements can be characterized as a form of “compelled speech,” opening the door to First Amendment challenges. And some of these challenges, depending on the nature of the labeling requirement, have even been successful. Under Zauderer v. Office of Disciplinary Counsel of Supreme Court of Ohio, regulations that compel disclosure of information will, in many cases, merit only very limited First Amendment scrutiny—less, even, than most other regulations of commercial speech, which receive a type of “intermediate scrutiny.” The labeling requirement that can best avoid or overcome a First Amendment challenge, therefore, will follow the example of the regulation described in Zauderer. For example, Zauderer applied its lower scrutiny by noting that the compelled speech at issue was a disclosure of “purely factual and uncontroversial information.” Conversely, a successful First Amendment challenge to a labeling requirement will often involve an argument that the labeling requirement is outside the scope of what the Zauderer Court contemplated: so, for example, one may argue that a compelled disclosure is either “not factual” or else “controversial,” putting it beyond Zauderer’s reach. After briefly reviewing the major Supreme Court cases that establish the levels of scrutiny for commercial speech and compelled disclosures, the paper will discuss how the various elements of Zauderer have been analyzed by several lower courts, and how some courts have distinguished Zauderer in the context of labeling and other mandatory disclosure laws. In particular, the paper will focus on cases involving First Amendment challenges to food, tobacco, and drug labeling requirements—some successful, some not, and some ongoing—including cases challenging FDA, USDA, and state-level labeling requirements. The decided cases do not all agree on how to understand the elements of Zauderer—for example, must a disclosure be factually controversial to fall outside of Zauderer’s limited review, or may it be factually unquestionable but relating to a controversial topic? What role, if any, should public acceptance, knowledge, and history play? What sorts of interests may the government invoke to justify a labeling requirement? Although some courts have taken (or at least hinted at) strict limits on the meaning of Zauderer, most courts have read Zauderer as applying somewhat more expansively to circumstances beyond its facts. The paper concludes that generally, courts have read Zauderer more expansively in part because such a reading is consistent with existing, familiar labeling requirements, and a narrow reading of Zauderer limited to its facts would rest on a slippery slope to abolishing many accepted and historically unquestioned labeling requirements. Any future attempts to expand judicial review of labeling requirements would do well to highlight limiting principles that address such concerns.

Exosomes as nanocarriers for siRNA delivery: paradigms and challenges.

PubMed

Shahabipour, Fahimeh; Banach, Maciej; Sahebkar, Amirhossein

2016-12-01

Exosomes are nano-sized vesicles that facilitate intercellular communications through carrying genetic materials and functional biomolecules. Owing to their unique size and structure, exosomes have emerged as a useful tool to overcome the limitations of siRNA delivery. The use of exosomes as siRNA delivery vehicles lacks certain disadvantages of the existing foreign delivery systems such as viruses, polycationic polymers and liposomes, and introduces several advantages including inherent capacity to pass through biological barriers and escape from phagocytosis by the reticuloendothelial system, as well as being biocompatible, non-toxic, and immunologically inert. Different strategies have been employed to harness exosome-based delivery systems, including surface modification with targeting ligands, and using exosome-display technology, virus-modified exosomes, and exosome-mimetic vesicles. The present review provides a capsule summary of the recent advances and current challenges in the field of exosome-mediated siRNA delivery.

Inactivation Strategies for Clostridium perfringens Spores and Vegetative Cells

PubMed Central

Talukdar, Prabhat K.; Udompijitkul, Pathima; Hossain, Ashfaque

2016-01-01

ABSTRACT Clostridium perfringens is an important pathogen to human and animals and causes a wide array of diseases, including histotoxic and gastrointestinal illnesses. C. perfringens spores are crucial in terms of the pathogenicity of this bacterium because they can survive in a dormant state in the environment and return to being live bacteria when they come in contact with nutrients in food or the human body. Although the strategies to inactivate C. perfringens vegetative cells are effective, the inactivation of C. perfringens spores is still a great challenge. A number of studies have been conducted in the past decade or so toward developing efficient inactivation strategies for C. perfringens spores and vegetative cells, which include physical approaches and the use of chemical preservatives and naturally derived antimicrobial agents. In this review, different inactivation strategies applied to control C. perfringens cells and spores are summarized, and the potential limitations and challenges of these strategies are discussed. PMID:27795314

Challenges and strategies for quantitative and qualitative field research in the United Arab Emirates.

PubMed

Aw, Tar-Ching; Zoubeidi, Taoufik; Al-Maskari, Fatma; Blair, Iain

2011-01-01

Clinical and public health research depends on factors including national systems, socio-cultural influences, and access to organisations and individuals. As a 'new' country, the United Arab Emirates (UAE) has yet to develop strong support for population research. However, there is interest in research. The challenges for quantitative and qualitative research include the varied composition and mobility of the UAE population, with limited health records and disease registries. Long-term follow-up of patients, and tracing foreign workers who may only be in the UAE for a few years, are two major obstacles for longitudinal studies. There can also be a reluctance shown by parts of the population to participate in studies, especially those that require responding to what is perceived as sensitive questions. Successful execution of population research in the UAE requires an understanding of socio-cultural aspects of the study population, and good communication between researchers and participants.

Initial evaluation of a student-run fruit and vegetable business in urban high schools.

PubMed

Sikic, Nicholas I; Erbstein, Nancy; Welch, Kearnan; Grundberg, Ethan; Miller, Elizabeth

2012-11-01

This study examined the acceptability and feasibility of Fresh Producers, a student-run fruit and vegetable distribution program at three urban high schools located in low-income neighborhoods, and its potential impact on the nutrition and professional development of participating students. Thirteen focus groups conducted with 72 students explored the program's impact on their dietary habits and professional skill development, and discussed program challenges. Responses were coded for common themes by multiple investigators. Participants reported increased fruit and vegetable consumption, and improved interpersonal, team-building, and organizational skills. Challenges included integration into the school schedule and environment and limited faculty support for business activities. This program is acceptable and feasible for secondary school students in a variety of school settings. Students reported positive changes in professional skills and nutrition. Training and support for students and faculty, including strategies to improve program integration into the school context, could increase participation.

Supplying Democracy? U.S. Security Assistance to Jordan, 1989-2002

DTIC Science & Technology

2003-03-01

effectively helped to limit democratization in Jordan through the empowerment of anti-democratic elements in Jordan. The findings present challenges to... effectively helped to limit democratization in Jordan through the empowerment of anti-democratic elements in Jordan. The findings present challenges...

Overcoming the Challenges of Unstructured Data in Multi-site, Electronic Medical Record-based Abstraction

PubMed Central

Polnaszek, Brock; Gilmore-Bykovskyi, Andrea; Hovanes, Melissa; Roiland, Rachel; Ferguson, Patrick; Brown, Roger; Kind, Amy JH

2014-01-01

Background Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as this data is often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists. Objective As standard abstraction approaches resulted in sub-standard data reliability for unstructured data elements collected as part of a multi-site, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management. Research Design We adopted a “fit-for-use” framework to guide the development and evaluation of abstraction methods using a four step, phase-based approach including (1) team building, (2) identification of challenges, (3) adaptation of abstraction methods, and (4) systematic data quality monitoring. Measures Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (e.g., warfarin initiation) and medical follow-up (e.g., timeframe for follow-up). Results After implementation of the phase-based approach, inter-rater reliability for all unstructured data elements demonstrated kappas of ≥ 0.89 -- an average increase of + 0.25 for each unstructured data element. Conclusions As compared to standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multi-site EMR documentation. PMID:27624585

Assessment of health-care waste management in a humanitarian crisis: A case study of the Gaza Strip.

PubMed

Caniato, Marco; Tudor, Terry Louis; Vaccari, Mentore

2016-12-01

Health-care waste management requires technical, financial and human resources, and it is a challenge for low- and middle income countries, while it is often neglected in protracted crisis or emergency situations. Indeed, when health, safety, security or wellbeing of a community is threatened, solid waste management usually receives limited attention. Using the Gaza Strip as the case study region, this manuscript reports on health-care waste management within the context of a humanitarian crisis. The study employed a range of methods including content analyses of policies and legislation, audits of waste arisings, field visits, stakeholder interviews and evaluation of treatment systems. The study estimated a production from clinics and hospitals of 683kg/day of hazardous waste in the Gaza Strip, while the total health-care waste production was 3357 kg/day. A number of challenges was identified including lack of clear definitions and regulations, limited accurate data on which to base decisions and strategies and poor coordination amongst key stakeholders. Hazardous and non-hazardous waste was partially segregated and treatment facilities hardly used, and 75% of the hazardous waste was left untreated. Recommendations for mitigating these challenges posed to patients, staff and the community in general are suggested. The outputs are particularly useful to support decision makers, and re-organize the system according to reliable data and sound assumptions. The methodology can be replicated in other humanitarian settings, also to other waste flows, and other sectors of environmental sanitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

An impoverished machine: challenges to human learning and instructional technology.

PubMed

Taraban, Roman

2008-08-01

Many of the limitations to human learning and processing identified by cognitive psychologists over the last 50 years still hold true, including computational constraints, low learning rates, and unreliable processing. Instructional technology can be used in classrooms and in other learning contexts to address these limitations to learning. However, creating technological innovations is not enough. As part of psychological science, the development and assessment of instructional systems should be guided by theories and practices within the discipline. The technology we develop should become an object of research like other phenomena that are studied. In the present article, I present an informal account of my own work in assessing instructional technology for engineering thermodynamics to show not only the benefits, but also the limitations, in studying the technology we create. I conclude by considering several ways of advancing the development of instructional technology within the SCiP community, including interdisciplinary research and envisioning learning contexts that differ radically from traditional learning focused on lectures and testing.

Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit.

PubMed

Feltman, D M; Du, H; Leuthner, S R

2012-11-01

To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

The challenges of a home-based nursing consultation business.

PubMed

Schulmeister, L

1999-03-01

The transition from working in a traditional setting to working at home alone can be challenging for new nurse consultants. Home-based consultants can use a variety of strategies to stay focused and connected, such as having a designated work area, limiting distractions, and networking. Nurse consultants can obtain information about business management from community resources, and computer on-line services offer a means of contacting other small-business owners. Ongoing business evaluations, which include professional accomplishments as well as an examination of income and expenses, help in planning. Home-based nurse consultants can increase the likelihood of business success by setting objectives, working diligently, and networking with others in the business community.

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

PubMed Central

Salem, Haitham; Nagpal, Caesa; Pigott, Teresa; Teixeira, Antonio Lucio

2017-01-01

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies. Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. Conclusion: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent. PMID:27928948

"Finding my own time": examining the spatially produced experiences of rural RNs in the rural nursing certificate program.

PubMed

Place, Jessica; MacLeod, Martha; John, Norma; Adamack, Monica; Lindsey, A Elizabeth

2012-07-01

Rural nurses require access to education that exposes them to the most up-to-date information and skill development. However, since most education opportunities are located in urban centers and focused on providing skills to urban nurses, geography effectively acts as a barrier to accessing education that meets the needs of rural nurses. The Rural Nursing Certificate Program is a post-basic education program that addresses these concerns by providing rural-relevant content online, with limited campus sessions. Does online delivery of rural nursing curriculum overcome challenges related to geography? This study employed surveys with some open-ended questions. Analysis included descriptive statistics and content analysis. Students reported that online delivery improved access. Benefits included not having to relocate; being able to continue working; and, flexibility. Challenges included travel for practical experiences and time management related to staffing shortages, personal-professional overlap and family responsibilities. Online learning improved access to nursing education. However, the realities of rural nursing made it impossible to completely overcome geography: sense of obligation to work overtime, cost and time of traveling to workshops and practicums, uneven access to the Internet and computer services, and distance from peer and university support remained challenges. Copyright © 2011 Elsevier Ltd. All rights reserved.

Review of posttraumatic stress disorder and chronic pain: the path to integrated care.

PubMed

Gibson, Carri-Ann

2012-01-01

With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.

Imaging for understanding speech communication: Advances and challenges

NASA Astrophysics Data System (ADS)

Narayanan, Shrikanth

2005-04-01

Research in speech communication has relied on a variety of instrumentation methods to illuminate details of speech production and perception. One longstanding challenge has been the ability to examine real-time changes in the shaping of the vocal tract; a goal that has been furthered by imaging techniques such as ultrasound, movement tracking, and magnetic resonance imaging. The spatial and temporal resolution afforded by these techniques, however, has limited the scope of the investigations that could be carried out. In this talk, we focus on some recent advances in magnetic resonance imaging that allow us to perform near real-time investigations on the dynamics of vocal tract shaping during speech. Examples include Demolin et al. (2000) (4-5 images/second, ultra-fast turbo spin echo) and Mady et al. (2001,2002) (8 images/second, T1 fast gradient echo). A recent study by Narayanan et al. (2004) that used a spiral readout scheme to accelerate image acquisition has allowed for image reconstruction rates of 24 images/second. While these developments offer exciting prospects, a number of challenges lie ahead, including: (1) improving image acquisition protocols, hardware for enhancing signal-to-noise ratio, and optimizing spatial sampling; (2) acquiring quality synchronized audio; and (3) analyzing and modeling image data including cross-modality registration. [Work supported by NIH and NSF.

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia.

PubMed

Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M

2018-05-02

Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.

The challenges of healthcare delivery to people with multiple sclerosis in Iran

PubMed Central

Yazdannik, Ahmadreza; Abolhassani, Shahla; Taleghani, Fariba; Zamani, Ahmadreza

2015-01-01

Background: Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients’ needs are only partially met. Aims: This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran. Materials and Methods: In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012–2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients’ weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis. Results: The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait). Conclusion: Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families. PMID:27462625

Measuring Challenge, Fun and Sterility on a "Phunometre" Scale: Evaluating Creative Teaching and Learning with Children and Their Student Teachers in the Primary School

ERIC Educational Resources Information Center

Elton-Chalcraft, Sally; Mills, Kären

2015-01-01

"It was the funnest week in the whole history of funnest weeks": our case study, the second phase in a three-phase research project, evaluates the successes and limitations of creative teaching and learning during the "The Creative and Effective Curriculum" module for PGCE primary student teachers which includes a one-week…

An Overview on Additive Manufacturing of Polymers

NASA Astrophysics Data System (ADS)

Jasiuk, Iwona; Abueidda, Diab W.; Kozuch, Christopher; Pang, Siyuan; Su, Frances Y.; McKittrick, Joanna

2018-03-01

We present an overview on additive manufacturing (AM), also called three-dimensional printing, with a focus on polymers. First, we introduce the AM concept. Next, we outline several AM processes, including their advantages and limitations, and list common polymers that are used in commercial printers. Then, we state various AM applications and present two examples. We conclude with a global view of the AM field, its challenges, and future directions.

Climate change and forest trees in the Pacific Northwest: a vulnerability assessment and recommended actions for national forests

Treesearch

A. Bower; W. Devine; C. Aubry

2017-01-01

Climate change presents new challenges to land managers. At stake is our ability to make thoughtful, science-based decisions and to add climate change considerations to our project and management plans. We also must prioritize among the opportunities that can be included in adaptation strategies because funding and time are limited, now more than ever. In 2012, we...

Quasi-experimental study designs series-paper 11: supporting the production and use of health systems research syntheses that draw on quasi-experimental study designs.

PubMed

Lavis, John N; Bärnighausen, Till; El-Jardali, Fadi

2017-09-01

To describe the infrastructure available to support the production of policy-relevant health systems research syntheses, particularly those incorporating quasi-experimental evidence, and the tools available to support the use of these syntheses. Literature review. The general challenges associated with the available infrastructure include their sporadic nature or limited coverage of issues and countries, whereas the specific ones related to policy-relevant syntheses of quasi-experimental evidence include the lack of mechanism to register synthesis titles and scoping review protocols, the limited number of groups preparing user-friendly summaries, and the difficulty of finding quasi-experimental studies for inclusion in rapid syntheses and research syntheses more generally. Although some new tools have emerged in recent years, such as guidance workbooks and citizen briefs and panels, challenges related to using available tools to support the use of policy-relevant syntheses of quasi-experimental evidence arise from such studies potentially being harder for policymakers and stakeholders to commission and understand. Policymakers, stakeholders, and researchers need to expand the coverage and institutionalize the use of the available infrastructure and tools to support the use of health system research syntheses containing quasi-experimental evidence. Copyright © 2017 Elsevier Inc. All rights reserved.

Setting Occupational Exposure Limits for Chemical Allergens—Understanding the Challenges

PubMed Central

Dotson, G. S.; Maier, A.; Siegel, P. D.; Anderson, S. E.; Green, B. J.; Stefaniak, A. B.; Codispoti, C. D.; Kimber, I.

2015-01-01

Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established. PMID:26583909

Bone Tissue Engineering: Recent Advances and Challenges

PubMed Central

Amini, Ami R.; Laurencin, Cato T.; Nukavarapu, Syam P.

2013-01-01

The worldwide incidence of bone disorders and conditions has trended steeply upward and is expected to double by 2020, especially in populations where aging is coupled with increased obesity and poor physical activity. Engineered bone tissue has been viewed as a potential alternative to the conventional use of bone grafts, due to their limitless supply and no disease transmission. However, bone tissue engineering practices have not proceeded to clinical practice due to several limitations or challenges. Bone tissue engineering aims to induce new functional bone regeneration via the synergistic combination of biomaterials, cells, and factor therapy. In this review, we discuss the fundamentals of bone tissue engineering, highlighting the current state of this field. Further, we review the recent advances of biomaterial and cell-based research, as well as approaches used to enhance bone regeneration. Specifically, we discuss widely investigated biomaterial scaffolds, micro- and nano-structural properties of these scaffolds, and the incorporation of biomimetic properties and/or growth factors. In addition, we examine various cellular approaches, including the use of mesenchymal stem cells (MSCs), embryonic stem cells (ESCs), adult stem cells, induced pluripotent stem cells (iPSCs), and platelet-rich plasma (PRP), and their clinical application strengths and limitations. We conclude by overviewing the challenges that face the bone tissue engineering field, such as the lack of sufficient vascularization at the defect site, and the research aimed at functional bone tissue engineering. These challenges will drive future research in the field. PMID:23339648

Lung Structure and the Intrinsic Challenges of Gas Exchange

PubMed Central

Hsia, Connie C.W.; Hyde, Dallas M.; Weibel, Ewald R.

2016-01-01

Structural and functional complexities of the mammalian lung evolved to meet a unique set of challenges, namely, the provision of efficient delivery of inspired air to all lung units within a confined thoracic space, to build a large gas exchange surface associated with minimal barrier thickness and a microvascular network to accommodate the entire right ventricular cardiac output while withstanding cyclic mechanical stresses that increase several folds from rest to exercise. Intricate regulatory mechanisms at every level ensure that the dynamic capacities of ventilation, perfusion, diffusion, and chemical binding to hemoglobin are commensurate with usual metabolic demands and periodic extreme needs for activity and survival. This article reviews the structural design of mammalian and human lung, its functional challenges, limitations, and potential for adaptation. We discuss (i) the evolutionary origin of alveolar lungs and its advantages and compromises, (ii) structural determinants of alveolar gas exchange, including architecture of conducting bronchovascular trees that converge in gas exchange units, (iii) the challenges of matching ventilation, perfusion, and diffusion and tissue-erythrocyte and thoracopulmonary interactions. The notion of erythrocytes as an integral component of the gas exchanger is emphasized. We further discuss the signals, sources, and limits of structural plasticity of the lung in alveolar hypoxia and following a loss of lung units, and the promise and caveats of interventions aimed at augmenting endogenous adaptive responses. Our objective is to understand how individual components are matched at multiple levels to optimize organ function in the face of physiological demands or pathological constraints. PMID:27065169

Engineering brain-computer interfaces: past, present and future.

PubMed

Hughes, M A

2014-06-01

Electricity governs the function of both nervous systems and computers. Whilst ions move in polar fluids to depolarize neuronal membranes, electrons move in the solid-state lattices of microelectronic semiconductors. Joining these two systems together, to create an iono-electric brain-computer interface, is an immense challenge. However, such interfaces offer (and in select clinical contexts have already delivered) a method of overcoming disability caused by neurological or musculoskeletal pathology. To fulfill their theoretical promise, several specific challenges demand consideration. Rate-limiting steps cover a diverse range of disciplines including microelectronics, neuro-informatics, engineering, and materials science. As those who work at the tangible interface between brain and outside world, neurosurgeons are well placed to contribute to, and inform, this cutting edge area of translational research. This article explores the historical background, status quo, and future of brain-computer interfaces; and outlines the challenges to progress and opportunities available to the clinical neurosciences community.

Towards successful Dissemination of Psychological First Aid: a study of provider training preferences.

PubMed

Hambrick, Erin P; Rubens, Sonia L; Vernberg, Eric M; Jacobs, Anne K; Kanine, Rebecca M

2014-04-01

Dissemination of Psychological First Aid (PFA) is challenging considering the complex nature of disaster response and the various disaster mental health (DMH) trainings available. To understand challenges to dissemination in community mental health centers (CMHCs), interviews were conducted with nine DMH providers associated with CMHCs. Consensual qualitative analysis was used to analyze data. Interviews were targeted toward understanding organizational infrastructure, DMH training requirements, and training needs. Results clarified challenges to DMH training in CMHCs and factors that may promote buy-in for trainings. For example, resources are limited and thus allocated for state and federal training requirements. Therefore, including PFA in these requirements could promote adoption. Additionally, a variety of training approaches that differ in content, style, and length would be useful. To conclude, a conceptual model for ways to promote buy-in for the PFA Guide is proposed.

Turbulent dissipation challenge: a community-driven effort

NASA Astrophysics Data System (ADS)

Parashar, Tulasi N.; Salem, Chadi; Wicks, Robert T.; Karimabadi, H.; Gary, S. Peter; Matthaeus, William H.

2015-10-01

> Many naturally occurring and man-made plasmas are collisionless and turbulent. It is not yet well understood how the energy in fields and fluid motions is transferred into the thermal degrees of freedom of constituent particles in such systems. The debate at present primarily concerns proton heating. Multiple possible heating mechanisms have been proposed over the past few decades, including cyclotron damping, Landau damping, heating at intermittent structures and stochastic heating. Recently, a community-driven effort was proposed (Parashar & Salem, 2013, arXiv:1303.0204) to bring the community together and understand the relative contributions of these processes under given conditions. In this paper, we propose the first step of this challenge: a set of problems and diagnostics for benchmarking and comparing different types of 2.5D simulations. These comparisons will provide insights into the strengths and limitations of different types of numerical simulations and will help guide subsequent stages of the challenge.

Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists.

PubMed

Lindvall, Mialinn Arvidsson; Anderzén Carlsson, Agneta; Forsberg, Anette

2016-01-01

After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control. The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists. This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis. One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing. The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Health promotion: challenges revealed in successful practices

PubMed Central

Silva, Kênia Lara; de Sena, Roseni Rosângela; Belga, Stephanie Marques Moura Franco; Silva, Paloma Morais; Rodrigues, Andreza Trevenzoli

2014-01-01

OBJECTIVE To examine successful practices of health promotion in health, education, culture, welfare and sport, leisure, identifying the elements of success and challenges in the field. METHODS A qualitative study with data obtained from in-depth analysis that included participant observation, interviews with managers, coordinators, professionals and participants from 29 practices reported as successful for promoting health in six municipalities of the metropolitan region of Belo Horizonte, MG, Southeastern Brazil, in 2011. The variables of the study were concept, dimension, dissemination and ease of access, identified in practices guided by content analysis. RESULTS The results indicate a conceptual and methodological uncertainty about health promotion as evidenced by conflicting objects and contradictory purposes. The practices differ in size, coverage and ease of access, determined by inter-sector coordination and political and financial investment. CONCLUSIONS We identified challenges to health promotion focusing on vulnerable populations, limits to financing and intersectoral partnerships. PMID:24789640

Toward Personalized Targeted Therapeutics: An Overview.

PubMed

Weathers, Shiao-Pei S; Gilbert, Mark R

2017-04-01

In neuro-oncology, there has been a movement towards personalized medicine, or tailoring treatment to the individual patient. Ideally, tumor and patient evaluations would lead to the selection of the best treatment (based on tumor characterization) and the right dosing schedule (based on patient characterization). The recent advances in the molecular analysis of glioblastoma have created optimism that personalized targeted therapy is within reach. Although our understanding of the molecular complexity of glioblastoma has increased over the years, the path to developing effective targeted therapeutic strategies is wrought with many challenges, as described in this review. These challenges include disease heterogeneity, clinical and genomic patient variability, limited number of effective treatments, clinical trial inefficiency, drug delivery, and clinical trial support and accrual. To confront these challenges, it will be imperative to devise innovative and adaptive clinical trials in order to accelerate our efforts in improving the outcomes for our patients who have been in desperate need.

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

PubMed

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

2017-01-01

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

Challenges, issues and trends in fall detection systems

PubMed Central

2013-01-01

Since falls are a major public health problem among older people, the number of systems aimed at detecting them has increased dramatically over recent years. This work presents an extensive literature review of fall detection systems, including comparisons among various kinds of studies. It aims to serve as a reference for both clinicians and biomedical engineers planning or conducting field investigations. Challenges, issues and trends in fall detection have been identified after the reviewing work. The number of studies using context-aware techniques is still increasing but there is a new trend towards the integration of fall detection into smartphones as well as the use of machine learning methods in the detection algorithm. We have also identified challenges regarding performance under real-life conditions, usability, and user acceptance as well as issues related to power consumption, real-time operations, sensing limitations, privacy and record of real-life falls. PMID:23829390

Bioavailability Challenges Associated with Development of Anti-Cancer Phenolics

PubMed Central

Gao, Song; Hu, Ming

2010-01-01

Phenolics including many polyphenols and flavonoids have the potentials to become chemoprevention and chemotherapy agents. However, poor bioavailability limits their biological effects in vivo. This paper reviews the factors that affect phenolics absorption and their bioavailabilities from the points of view of their physicochemical properties and disposition in the gastrointestinal tract. The up-to-date research data suggested that solubility and metabolism are the primary reasons that limit phenolic aglycones’ bioavailability although stability and poor permeation may also contribute to the poor bioavailabilities of the glycosides. Future investigations should further optimize phenolics’ bioavailabilities and realize their chemopreventive and chemotherapeutic effects in vivo. PMID:20370701

Rating Correlations Between Customs Codes and Export Control Lists: Assessing the Needs and Challenges

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

Chatelus, Renaud; Heine, Pete

Correlation tables are the linchpins between the customs codes used to classify commodities in international trade and the control lists used for strategic trade control (STC) purposes. While understanding the customs classification system can help the STC community better understand strategic trade flows, better identify which trade operations require permits, and more effectively detect illegal exports, the two systems are different in scope, philosophy, content, and objectives. Many indications point to the limitations of these correlation tables, and it is important to understand the nature of the limitations and the complex underlying reasons to conceive possible improvements. As part ofmore » its Strategic Trade and Supply Chain Analytics Initiative, Argonne National Laboratory supported a study of a subset of the European Union’s TARIC correlation table. The study included development of a methodology and an approach to rating the quality and relevance of individual correlations. The study was intended as a first step to engage the STC community in deflections and initiatives to improve the conception and use of correlations, and its conclusions illustrate the scope and complex nature of the challenges to overcome. This paper presents the two classification systems, analyzes the needs for correlation tables and the complex challenges associated with them, summarizes key findings, and proposes possible ways forward.« less

Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry

PubMed Central

Chamania, Shobha; Potokar, Tom; Ivers, Rebecca

2018-01-01

Objectives This study aimed to identify priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India. Design Qualitative inquiry; data were collected through semistructured in-depth interviews and focus group discussions. Setting Nine sites in urban and rural settings across India, through primary, secondary and tertiary health facilities. Participants Healthcare providers, key informants, burns survivors and/or their carers. Results Participants acknowledged the challenges of burns care and recovery, and identified the need for prolonged rehabilitation. Challenges identified included poor communication between healthcare providers and survivors, limited rehabilitation services, difficulties with transportation to health facility and high cost associated with burns care. Burns survivors and healthcare providers identified the stigma attached with burns as the biggest challenge within the healthcare system, as well as in the community. Systems barriers (eg, limited infrastructure and human resources), lack of economic and social support, and poor understanding of recovery and rehabilitation were identified as major barriers to recovery. Conclusions Though further research is needed for addressing gaps in data, strengthening of health systems can enable providers to address issues such as developing/providing, protocols, capacity building, effective coordination between key organisations and referral networks. PMID:29523568

Beta-lactamases in Enterobacteriaceae infections in children.

PubMed

Moxon, Christopher Alan; Paulus, Stéphane

2016-07-05

Multi-drug resistance in Gram negative bacteria, particularly in Enterobacteriaceae, is a major clinical and public health challenge. The main mechanism of resistance in Enterobacteriaceae is linked to the production of beta-lactamase hydrolysing enzymes such as extended spectrum beta-lactamases (ESBL), AmpC beta-lactamases and carbapenemases (Carbapenemase Producing Enterobacteriaceae (CPE)). ESBL and CPE resistance genes are located on plasmids, which can be transmitted between Enterobacteriaceae, facilitating their spread in hospitals and communities. These plasmids usually harbour multiple additional co-resistance genes, including to trimethoprim-sulfamethoxazole, aminoglycosides, and fluoroquinolones, making these infections challenging to treat. Asymptomatic carriage in healthy children as well as community acquired infections are increasingly reported, particularly with ESBL. Therapeutic options are limited and previously little used antimicrobials such as fosfomycin and colistin have been re-introduced in clinical practice. Paediatric experience with these agents is limited hence there is a need to further examine their clinical efficacy, dosage and toxicity in children. Antimicrobial stewardship along with strict infection prevention and control practices need to be adopted widely in order to preserve currently available antimicrobials. The future development of novel agents effective against beta-lactamases producers and their applicability in children is urgently needed to address the challenge of multi-resistant Gram negative infections. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

A {3,2}-Order Bending Theory for Laminated Composite and Sandwich Beams

NASA Technical Reports Server (NTRS)

Cook, Geoffrey M.; Tessler, Alexander

1998-01-01

A higher-order bending theory is derived for laminated composite and sandwich beams thus extending the recent {1,2}-order theory to include third-order axial effect without introducing additional kinematic variables. The present theory is of order {3,2} and includes both transverse shear and transverse normal deformations. A closed-form solution to the cylindrical bending problem is derived and compared with the corresponding exact elasticity solution. The numerical comparisons are focused on the most challenging material systems and beam aspect ratios which include moderate-to-thick unsymmetric composite and sandwich laminates. Advantages and limitations of the theory are discussed.

The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review.

PubMed

Harper, Sarah K; Webb, Thomas L; Rayner, Kelly

2013-05-01

A number of studies have used mindfulness-based interventions to influence the behavior of people with intellectual disabilities, to improve their quality of life, and to reduce challenging behavior. The present review critically evaluates 18 studies and assesses the clinical and academic impact of their findings. Strengths identified included replicable methodological approaches, use of multiple baseline designs, strong construct and criterion validity, and consideration of the mechanisms by which mindfulness influences behavior change. Limitations included a lack of randomized controlled trials, inclusion of qualitative data without structured analysis, limited use of statistical analyses, and problems with sampling leading to difficulties generalizing findings. There was also a paucity of research investigating the impact of "Dialectical Behavior Therapy" and "Acceptance and Commitment Therapy" and the role of mindfulness within these approaches. Further research is warranted in this regard.

The opportunities and obstacles in developing a vascular birthmark database for clinical and research use.

PubMed

Sharma, Vishal K; Fraulin, Frankie Og; Harrop, A Robertson; McPhalen, Donald F

2011-01-01

Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta. The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented. THE CHALLENGES IDENTIFIED DURING THE DATABASE DEVELOPMENT PROCESS INCLUDED: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database. There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.

Feasibility of an International Multiple Sclerosis Rehabilitation Data Repository: Perceived Challenges and Motivators for Sharing Data.

PubMed

Bradford, Elissa Held; Baert, Ilse; Finlayson, Marcia; Feys, Peter; Wagner, Joanne

2018-01-01

Multiple sclerosis (MS) rehabilitation evidence is limited due to methodological factors, which may be addressed by a data repository. We describe the perceived challenges of, motivators for, interest in participating in, and key features of an international MS rehabilitation data repository. A multimethod sequential investigation was performed with the results of two focus groups, using nominal group technique, and study aims informing the development of an online questionnaire. Percentage agreement and key quotations illustrated questionnaire findings. Subgroup comparisons were made between clinicians and researchers and between participants in North America and Europe. Rehabilitation professionals from 25 countries participated (focus groups: n = 21; questionnaire: n = 166). The top ten challenges (C) and motivators (M) identified by the focus groups were database control/management (C); ethical/legal concerns (C); data quality (C); time, effort, and cost (C); best practice (M); uniformity (C); sustainability (C); deeper analysis (M); collaboration (M); and identifying research needs (M). Percentage agreement with questionnaire statements regarding challenges to, motivators for, interest in, and key features of a successful repository was at least 80%, 85%, 72%, and 83%, respectively, across each group of statements. Questionnaire subgroup analysis revealed a few differences (P < .05), including that clinicians more strongly identified with improving best practice as a motivator. Findings support clinician and researcher interest in and potential for success of an international MS rehabilitation data repository if prioritized challenges and motivators are addressed and key features are included.

Multidisciplinary investigation of the fate, transport, and remediation of chlorinated solvents in fractured rocks at the former Naval Air Warfare Center (NAWC): Scientific and management challenges, and strategies for a successful research program

NASA Astrophysics Data System (ADS)

Tiedeman, C. R.; Goode, D. J.; Shapiro, A. M.; Lacombe, P. J.; Chapelle, F. H.; Bradley, P. M.; Imbrigiotta, T. E.; Williams, J. H.; Curtis, G. P.; Hsieh, P. A.

2008-12-01

At the former Naval Air Warfare Center (NAWC) in West Trenton NJ, the U.S. Geological Survey, in cooperation with the U.S. Navy and under support from the Strategic Environmental Research and Development Program (SERDP), is investigating the fate, transport, and remediation of trichloroethylene (TCE) and its daughter products in dipping, fractured mudstones underlying the site. TCE concentrations in ground water are as high as ~100 mg/L. Objectives of multidisciplinary research at the NAWC include (1) understanding the physical, chemical, and microbiological processes and properties affecting the fate, transport, and removal of chlorinated solvents in fractured rocks, (2) assessing the efficiency of different remediation methods (pump and treat, natural and enhanced biodegradation), and (3) transferring the results to help remediate other contaminated fractured rock aquifers. There are numerous scientific and technical challenges to meeting these goals, including the extreme spatial variability of flow and transport properties at the NAWC and the complex distribution of contaminants, geochemical constituents, and microorganisms in fractures and the rock matrix. In addition, there are management challenges that are equally important to address in order to achieve a successful research program. These include balancing the requirements of the many parties involved at the site, including researchers, the site owner, and regulatory agencies; and ensuring that limited research funds are directed towards work that addresses the most important scientific questions as well as stakeholder concerns. Strategies for the scientific challenges at NAWC include developing a carefully planned program to characterize spatial variability in rock properties and groundwater constituents so that the data obtained are applicable to solving research questions focused on remediation. Strategies for the management challenges include fostering open lines of communication among all parties and conferring with the U.S. Environmental Protection Agency to ensure that our research is relevant to remediation at Superfund and other hazardous waste sites with chlorinated solvent contamination of fractured rocks.

Food restriction promotes signaling effort in response to social challenge in a short-lived electric fish.

PubMed

Gavassa, Sat; Stoddard, Philip K

2012-09-01

Vertebrates exposed to stressful conditions release glucocorticoids to sustain energy expenditure. In most species elevated glucocorticoids inhibit reproduction. However individuals with limited remaining reproductive opportunities cannot afford to forgo reproduction and should resist glucocorticoid-mediated inhibition of reproductive behavior. The electric fish Brachyhypopomus gauderio has a single breeding season in its lifetime, thus we expect males to resist glucocorticoid-mediated inhibition of their sexual advertisement signals. We studied stress resistance in male B. gauderio (i) by examining the effect of exogenous cortisol administration on the signal waveform and (ii) by investigating the effect of food limitation on androgen and cortisol levels, the amplitude of the electric signal waveform, the responsiveness of the electric signal waveform to social challenge, and the amount of feeding activity. Exogenous cortisol administration did reduce signal amplitude and pulse duration, but endogenous cortisol levels did not rise with food limitation or social challenge. Despite food limitation, males responded to social challenges by further increasing androgen levels and enhancing the amplitude and duration of their electric signal waveforms. Food-restricted males increased androgen levels and signal pulse duration more than males fed ad libitum. Socially challenged fish increased food consumption, probably to compensate for their elevated energy expenditure. Previous studies showed that socially challenged males of this species simultaneously elevate testosterone and cortisol in proportion to signal amplitude. Thus, B. gauderio appears to protect its cortisol-sensitive electric advertisement signal by increasing food intake, limiting cortisol release, and offsetting signal reduction from cortisol with signal-enhancing androgens. Copyright © 2012 Elsevier Inc. All rights reserved.

Selecting Sustainability Indicators for Small to Medium Sized Urban Water Systems Using Fuzzy-ELECTRE.

PubMed

Chhipi-Shrestha, Gyan; Hewage, Kasun; Sadiq, Rehan

2017-03-01

  Urban water systems (UWSs) are challenged by the sustainability perspective. Certain limitations of the sustainability of centralized UWSs and decentralized household level wastewater treatments can be overcome by managing UWSs at an intermediate scale, referred to as small to medium sized UWSs (SMUWSs). SMUWSs are different from large UWSs, mainly in terms of smaller infrastructure, data limitation, smaller service area, and institutional limitations. Moreover, sustainability assessment systems to evaluate the sustainability of an entire UWS are very limited and confined only to large UWSs. This research addressed the gap and has developed a set of 38 applied sustainability performance indicators (SPIs) by using fuzzy-Elimination and Choice Translating Reality (ELECTRE) I outranking method to assess the sustainability of SMUWSs. The developed set of SPIs can be applied to existing and new SMUWSs and also provides a flexibility to include additional SPIs in the future based on the same selection criteria.

Challenges in researching violence affecting health service delivery in complex security environments.

PubMed

Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

2016-08-01

Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research collaboration among aid organizations, researchers and multilateral organizations, such as the WHO, is needed to address these challenges. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using smart materials to solve new challenges in the automotive industry

NASA Astrophysics Data System (ADS)

Gath, Kerrie K.; Maranville, Clay; Tardiff, Janice

2018-03-01

Ford has an extensive history of developing and utilizing smart and innovative materials in its vehicles. In this paper, we present new challenges the automotive industry is facing and explore how intelligent uses of smart materials can help provide solutions. We explore which vehicle attributes may provide most advantageous for the use smart materials, and discuss how smart material have had technical challenges that limit their use. We also look at how smart materials such as gecko inspired adhesion is providing opportunities during the vehicle assembly process by improving manufacturing quality, environmental sustainability, and worker safety. An emerging area for deployment of smart materials may involve autonomous vehicles and mobility solutions, where customer expectations are migrating toward a seamless and adaptive experience leading to new expectations for an enhanced journey. Another area where smart materials are influencing change is interior and exterior design including smart textiles, photochromatic dyes, and thermochromatic materials. The key to advancing smart materials in automotive industry is to capitalize on the smaller niche applications where there will be an advantage over traditional methods. Ford has an extensive history of developing and utilizing smart and innovative materials. Magnetorheological fluids, thermoelectric materials, piezoelectric actuators, and shape memory alloys are all in production. In this paper we present new challenges the automotive industry is facing and explore how intelligent uses of smart materials can help provide solutions. We explore which vehicle attributes may provide most advantageous for the use smart materials, and discuss how smart materials have had technical challenges that limit their use. An emerging area for deployment of smart materials may involve autonomous vehicles and mobility solutions, where customer expectations may require a seamless and adaptive experience for users having various expectations.

Measurement of allergen-specific IgG in serum is of limited value for the management of dogs diagnosed with cutaneous adverse food reactions.

PubMed

Hagen-Plantinga, E A; Leistra, M H G; Sinke, J D; Vroom, M W; Savelkoul, H F J; Hendriks, W H

2017-02-01

Conflicting results have been reported in the literature in terms of the usefulness of serological testing for IgG against food allergens in dogs with cutaneous adverse food reaction (CAFR). The aim of the present study was to evaluate the suitability of a commercially available IgG ELISA for identifying food allergens in dogs, by challenging dogs with specific food ingredients, selected on the basis of IgG reactivity in serum samples. A total of 24 adult dogs with CAFR were enrolled into the study and 16 healthy dogs were included as a control group. Blood samples were obtained for measurement of specific IgG antibodies against 39 commonly used pet food ingredients by ELISA. Participating owners were surveyed to obtain information on their pet's dietary history. Eleven healthy control dogs and 12 dogs with CAFR were subsequently challenged in a blinded cross-over design experiment with both positive and negative food ingredients, selected on the basis of the ELISA test results. There was substantial individual variation in ELISA test results to the various food allergens, but no significant difference in IgG reactivity comparing the CAFR and control groups. None of the control dogs developed any clinical signs of an allergic reaction during the dietary challenge study. In the CAFR group, six of 12 dogs developed clinical signs after the negative challenge, and two of nine dogs developed clinical signs after the positive challenge. It was concluded that the ELISA test for dietary allergen-specific IgG is of limited value in the management of dogs with CAFR. Copyright © 2017 Elsevier Ltd. All rights reserved.

Scientific Challenges in the Risk Assessment of Food Contact Materials.

PubMed

Muncke, Jane; Backhaus, Thomas; Geueke, Birgit; Maffini, Maricel V; Martin, Olwenn Viviane; Myers, John Peterson; Soto, Ana M; Trasande, Leonardo; Trier, Xenia; Scheringer, Martin

2017-09-11

Food contact articles (FCAs) are manufactured from food contact materials (FCMs) that include plastics, paper, metal, glass, and printing inks. Chemicals can migrate from FCAs into food during storage, processing, and transportation. Food contact materials' safety is evaluated using chemical risk assessment (RA). Several challenges to the RA of FCAs exist. We review regulatory requirements for RA of FCMs in the United States and Europe, identify gaps in RA, and highlight opportunities for improving the protection of public health. We intend to initiate a discussion in the wider scientific community to enhance the safety of food contact articles. Based on our evaluation of the evidence, we conclude that current regulations are insufficient for addressing chemical exposures from FCAs. RA currently focuses on monomers and additives used in the manufacture of products, but it does not cover all substances formed in the production processes. Several factors hamper effective RA for many FCMs, including a lack of information on chemical identity, inadequate assessment of hazardous properties, and missing exposure data. Companies make decisions about the safety of some food contact chemicals (FCCs) without review by public authorities. Some chemical migration limits cannot be enforced because analytical standards are unavailable. We think that exposures to hazardous substances migrating from FCAs require more attention. We recommend a ) limiting the number and types of chemicals authorized for manufacture and b ) developing novel approaches for assessing the safety of chemicals in FCAs, including unidentified chemicals that form during or after production. https://doi.org/10.1289/EHP644.

Concerns and Responses for Integrating Health Systems Science Into Medical Education.

PubMed

Gonzalo, Jed D; Caverzagie, Kelly J; Hawkins, Richard E; Lawson, Luan; Wolpaw, Daniel R; Chang, Anna

2018-06-01

With the aim of improving the health of individuals and populations, medical schools are transforming curricula to ensure physician competence encompasses health systems science (HSS), which includes population health, health policy, high-value care, interprofessional teamwork, leadership, quality improvement, and patient safety. Large-scale, meaningful integration remains limited, however, and a major challenge in HSS curricular transformation efforts relates to the receptivity and engagement of students, educators, clinicians, scientists, and health system leaders. The authors identify several widely perceived challenges to integrating HSS into medical school curricula, respond to each concern, and provide potential strategies to address these concerns, based on their experiences designing and integrating HSS curricula. They identify two broad categories of concerns: the (1) relevance and importance of learning HSS-including the perception that there is inadequate urgency for change; HSS education is too complex and should occur in later years; early students would not be able to contribute, and the roles already exist; and the science is too nascent-and (2) logistics and practicality of teaching HSS-including limited curricular time, scarcity of faculty educators with expertise, lack of support from accreditation agencies and licensing boards, and unpreparedness of evolving health care systems to partner with schools with HSS curricula. The authors recommend the initiation and continuation of discussions between educators, clinicians, basic science faculty, health system leaders, and accrediting and regulatory bodies about the goals and priorities of medical education, as well as about the need to collaborate on new methods of education to reach these goals.

Engineering nanoparticles to overcome barriers to immunotherapy

PubMed Central

Toy, Randall

2016-01-01

Abstract Advances in immunotherapy have led to the development of a variety of promising therapeutics, including small molecules, proteins and peptides, monoclonal antibodies, and cellular therapies. Despite this wealth of new therapeutics, the efficacy of immunotherapy has been limited by challenges in targeted delivery and controlled release, that is, spatial and temporal control on delivery. Particulate carriers, especially nanoparticles have been widely studied in drug delivery and vaccine research and are being increasingly investigated as vehicles to deliver immunotherapies. Nanoparticle‐mediated drug delivery could provide several benefits, including control of biodistribution and transport kinetics, the potential for site‐specific targeting, immunogenicity, tracking capability using medical imaging, and multitherapeutic loading. There are also a unique set of challenges, which include nonspecific uptake by phagocytic cells, off‐target biodistribution, permeation through tissue (transport limitation), nonspecific immune‐activation, and poor control over intracellular localization. This review highlights the importance of understanding the relationship between a nanoparticle's size, shape, charge, ligand density and elasticity to its vascular transport, biodistribution, cellular internalization, and immunogenicity. For the design of an effective immunotherapy, we highlight the importance of selecting a nanoparticle's physical characteristics (e.g., size, shape, elasticity) and its surface functionalization (e.g., chemical or polymer modifications, targeting or tissue‐penetrating peptides) with consideration of its reactivity to the targeted microenvironment (e.g., targeted cell types, use of stimuli‐sensitive biomaterials, immunogenicity). Applications of this rational nanoparticle design process in vaccine development and cancer immunotherapy are discussed. PMID:29313006

Challenges and Limits: A View from a Chief Student Affairs Office.

ERIC Educational Resources Information Center

Levy, Stanley R.

1990-01-01

Reviews Stone and Archer's article "College and University Counseling Centers in the 1990s: Challenges and Limits." Claims the role of a college counseling center is to help the community at large understand what is happening with students and their problems, concerns, and developmental tasks. (ABL)

30-year International Pediatric Craniofacial Surgery Partnership: Evolution from the “Third World” Forward

PubMed Central

Swanson, Jordan W.; Skirpan, Jan; Stanek, Beata; Kowalczyk, Maciej

2016-01-01

Background: Craniofacial diseases constitute an important component of the surgical disease burden in low- and middle-income countries. The consideration to introduce craniofacial surgery into such settings poses different questions, risks, and challenges compared with cleft or other forms of plastic surgery. We report the evolution, innovations, and challenges of a 30-year international craniofacial surgery partnership. Methods: We retrospectively report a partnership between surgeons at the Uniwersytecki Szpital Dzieciecy in Krakow, Poland, and a North American craniofacial surgeon. We studied patient conditions, treatment patterns, and associated complications, as well as program advancements and limitations as perceived by surgeons, patient families, and hospital administrators. Results: Since partnership inception in 1986, the complexity of cases performed increased gradually, with the first intracranial case performed in 1995. In the most recent 10-year period (2006–2015), 85 patients have been evaluated, with most common diagnoses of Apert syndrome, Crouzon syndrome, and single-suture craniosynostosis. In the same period, 55 major surgical procedures have been undertaken, with LeFort III midface distraction, posterior vault distraction, and frontoorbital advancement performed most frequently. Key innovations have been the employment of craniofacial distraction osteogenesis, the use of Internet communication and digital photography, and increased understanding of how craniofacial morphology may improve in the absence of surgical intervention. Ongoing challenges include prohibitive training pathways for pediatric plastic surgeons, difficulty in coordinating care with surgeons in other institutions, and limited medical and material resources. Conclusion: Safe craniofacial surgery can be introduced and sustained in a resource-limited setting through an international partnership. PMID:27200233

Decision-Making in Management of the Complex Trauma Patient: Changing the Mindset of the non-trauma Surgeon.

PubMed

Sonesson, Linda; Boffard, Kenneth; Lundberg, Lars; Rydmark, Martin; Karlgren, Klas

2018-01-16

European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military. Design-based research using combined methods including interviews, reviews of authentic trauma cases, and video-recorded resuscitations performed at a high-volume civilian academic trauma center. Several educational dilemmas were identified: (1) thinking physiologically, (2) the application of damage control resuscitation and surgery, (3) differing priorities and time management, (4) impact of environment, (5) managing limited resources, (6) lack of general surgical skills, (7) different cultural behavior, and (8) ethical issues. The challenges presented, and the educational domains identified, constitute a basis for improved development of education and training in complex surgical decision-making. This study contributes new knowledge about the mindset required for decision-making in patients with complex multisystem trauma and competing priorities of care. This is, especially important in countries having a low intensity of trauma in both military and civilian environments, and consequential limited skills, and lack of expertise. Guidelines focused on the same decision-making process, using virtual patients and blended learning, can be developed.

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.

Gimbal system configurations and line-of-sight control techniques for small UAV applications

NASA Astrophysics Data System (ADS)

Miller, Rick; Mooty, Greg; Hilkert, J. M.

2013-05-01

The proliferation of small Unmanned Air Vehicles (UAVs) in the past decade has been driven, in part, by the diverse applications that various industries have found for these platforms. Originally, these applications were predominately military in nature but now include law enforcement/security, environmental monitoring/remote sensing, agricultural surveying, movie making and others. Many of these require sensors/payloads such as cameras, laser pointers/ illuminators/rangefinders and other systems that must be pointed and/or stabilized and therefore require a precision miniature gimbal or other means to control their line-of-sight (LOS). Until now, these markets have been served by traditional/larger gimbals; however, the latest class of small UAVs demands much smaller gimbals while maintaining high-performance. The limited size and weight of these gimbaled devices result in design challenges unique to the small-gimbal design field. In the past five years, Ascendant Engineering Solutions has engaged in designing, analyzing and building several small-gimbal systems to meet these challenges and has undertaken a number of trade studies to investigate techniques to achieve optimal performance within the inherent limitations mentioned above. These have included investigating various gimbal configurations, feedback sensors such as gyros, IMUs and encoders, drive train configurations, control system techniques, packaging and interconnect, as well as technology such as fast-steering mirrors and image-stabilization algorithms. This paper summarizes the results of these trade studies, attempts to identify inherent trends and limitations in the various design approaches and techniques, and discusses some practical issues such as test and verification.

Conservation status and recovery strategies for endemic Hawaiian birds

USGS Publications Warehouse

Banko, Paul C.; David, Reginald E.; Jacobi, James D.; Banko, Winston E.

2001-01-01

Populations of endemic Hawaiian birds declined catastrophically following the colonization of the islands by Polynesians and later cultures. Extinction is still occurring, and recovery programs are urgently needed to prevent the disappearance of many other species. Programs to recover the endemic avifauna incorporate a variety of conceptual and practical approaches that are constrained by biological, financial, social, and legal factors. Avian recovery is difficult to implement in Hawai‘i because a variety of challenging biological factors limit bird populations. Hawaiian birds are threatened by alien predatory mammals, introduced mosquitoes that transmit diseases, alien invertebrate parasites and predators that reduce invertebrate food resources, and alien animals and plants that destroy and alter habitats. Life in the remote Hawaiian Archipelago has imposed other biological constraints to avian recovery, including limited geographical distributions and small population sizes. Recovery of the endemic avifauna is also challenging because resources are insufficient to mitigate the many complex, interacting factors that limit populations. Decisions must be made for allocating limited resources to species teetering on the brink of extinction and those in decline. If funds are spent primarily on saving the rarest species, more abundant species will decline and become more difficult to recover. However, critically rare species will disappear if efforts are directed mainly towards restoring species that are declining but not in immediate danger of becoming extinct. Determining priorities is difficult also because management is needed both to supplement bird populations and to restore habitats of many species. Rare species cannot respond quickly to management efforts intended only to improve habitat and reduce limiting factors. Recovery is slow, if it occurs at all, because years or decades are generally required for habitat rehabilitation and because small populations of birds initially increase slowly even when habitat conditions are favorable. Consequently, even as habitat conditions begin to improve, small populations may disappear unless they are supplemented directly. Hawaiian bird conservation is also affected by social and legal factors, including hunting alien game species, commercial land use practices, and lawsuits and policies concerning endangered species and critical habitat. Influenced by this mixture of conflicting and competing issues, Hawaiian bird recovery programs range from management of single species and some components of their habitats to limited forms of community or ecosystem management. Although the effectiveness of most programs is difficult to evaluate because of monitoring limitations, several programs exemplify species and community management. Programs primarily intended to recover single species include Hawaiian Goose or Nene (Branta sandvicensis), Hawaiian Crow or ‘Alala (Corvus hawaiiensis), and Palila (Loxioides bailleui). Programs attempting to manage entire communities of forest birds include Hakalau Forest National Wildlife Refuge and Hawai‘i Volcanoes National Park on Hawai‘i, and Waikamoi Preserve, Hanawi Natural Area Reserve, and Haleakala National Park on Maui.

Paving the road to personalized medicine: recommendations on regulatory, intellectual property and reimbursement challenges

PubMed Central

Knowles, Lori; Luth, Westerly; Bubela, Tania

2017-01-01

Abstract Personalized medicine (PM) aims to harness a wave of ‘omics’ discoveries to facilitate research and discovery of targeted diagnostics and therapies and increase the efficiency of healthcare systems by predicting and treating individual predispositions to diseases or conditions. Despite significant investment, limited progress has been made bringing PM to market. We describe the major perceived regulatory, intellectual property, and reimbursement challenges to the development, translation, adoption, and implementation of PM products into clinical care. We conducted a scoping review to identify (i) primary challenges for the development and implementation of PM identified in the academic literature; (ii) solutions proposed in the academic literature to address these challenges; and (iii) gaps that exist in that literature. We identified regulatory barriers to PM development and recommendations in 344 academic papers. Regulatory uncertainty was a cross-cutting theme that appeared in conjunction with other themes including: reimbursement; clinical trial regulation; regulation of co-development; unclear evidentiary requirements; insufficient incentives for research and development; incompatible information systems; and different regulation of different diagnostics. To fully realize the benefits of PM for healthcare systems and patients, regulatory, intellectual property, and reimbursement challenges need to be addressed in lock step with scientific advances. PMID:29868182

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

PubMed

Sánchez, Veralia Gabriela; Taylor, Ingrid; Bing-Jonsson, Pia Cecilie

2017-01-01

The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. This article reviews reported ethical challenges to implementing smart houses for older adults. A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

Opportunities and Challenges for Practical Training in Public Health: Insights from Practicum Coordinators in Ontario.

PubMed

Wegener, Jessica; Petitclerc, Marilyne

2018-06-12

Dietetic educators and practicum coordinators (PC) play critical roles in preparing students for practice. Dietitians have made significant progress in the development of educational curricula, competencies, and other resources to support knowledge and skill attainment in public health. There are identified gaps in the literature concerning practical training in sustainable food systems and public health, creating barriers in knowledge exchange and improvements in practicum programs in Canada. This paper discusses the potential opportunities and challenges associated with the number of placements for practical training in public health based on interviews with PCs in Ontario. The findings are limited to the perspectives of 7 PCs with experience in practical training and are a starting point for ongoing evaluation. Identified opportunities within traditional and "emerging settings" for practical training in public health included: the uniqueness of the experience, the potential for students to learn outside their comfort zones, and greater possibilities for dietitians in new roles and settings. Challenges included the need for significant PC engagement with nondietetic preceptors and a narrow view of dietetic practice among some dietitians. Interprofessional teams, emerging settings, and flexible learning approaches may create and support practical training opportunities in food systems and public health going forward.

Promoting critical thinking and academic writing skills in nurse education.

PubMed

Borglin, Gunilla

2012-07-01

Although academic skills, conceptualised as writing and critical thinking, are a vital part of university studies, research indicates that many students leave without having mastered these skills effectively. This research also reflects on nursing students. Nursing could also be said to be hampered by a number of complex educational challenges that are likely to impact on the academic socialisation process in general. These challenges include being a relatively 'young' academic discipline, the 'theory-practice' divide, a knowledge bed lying on a complex intersection of two 'antithetical sciences' and, at least in the Scandinavian countries, an increasing number of nurse educators with a PhD in nursing science but with limited time to develop their own teaching skills. In combination, these challenges have the potential to act as stumbling blocks, both from a teaching and learning perspective. I would suggest that a departure in teaching from theoretical educational models, such as Lea and Street's 'academic literacies model,' including skills, socialisation and academic literacy models simultaneously, could be one of several ways forward to create a learning environment that takes these issues into account. Copyright © 2011 Elsevier Ltd. All rights reserved.

Networking and training in palliative care: challenging values and changing practice.

PubMed

Leng, Mhoira Ef

2011-01-01

What make a good doctor is a question posed by the public and profession and is key when designing training programmes. The goal of training is to change practice not simply acquire knowledge yet too often curriculums and assessment focuses on knowledge and skills. Professional practice is underpinned by beliefs and values and therefore training may need to challenge deeply held values in order to result in a change in practice. Palliative care offers an opportunity to challenge values at a deeply personal level as it brings experiences of pain and suffering alongside clinical knowledge and skills. Palliative care is holistic and so real scenarios where physical, psychological, social and spiritual issues are evident can be presented in an interactive, learner centered environment. Training in ethics alongside clinical skills will assist the development of judgment which should also be assessed. Communication skills enable the clinician to hear and understand the needs and wishes of those facing life limiting illness. Training should include aspects of modeling and mentorship to demonstrate and integrate the learning with the realities of clinical practice and include those who lead and influence policy and advocacy.

The challenges of integrating instrumentation with inflatable aerodynamic decelerators

NASA Astrophysics Data System (ADS)

Swanson, Gregory T.; Cassell, Alan M.; Hughes, Stephen J.; Johnson, R. Keith; Calomino, Anthony M.

New Entry, Decent, and Landing (EDL) technologies are being explored to facilitate the landing of high mass vehicles. Current EDL technologies are limited due to mass and volume constraints dictated by launch vehicle fairings. Therefore, past and present technologies are now being considered to provide a mass and volume efficient solution, including Inflatable Aerodynamic Decelerators (IADs). To better define the instrumentation challenges posed by IAD technology development, a survey was conducted to identify valuable measurements for ground and flight testing of the flexible materials and structures used in their design. From this survey many sensing technologies and systems were explored specific to the stacked torus IAD, resulting in a down-selection to the most viable prospects. The majority of these systems, including wireless data acquisition, were then rapid prototyped and evaluated during component level testing to determine the best integration techniques specific to a 3m and 6m diameter stacked toroid IAD. Each sensing system was then integrated in support of the Hypersonic Inflatable Aerodynamic Decelerator ground test campaign. In this paper these IAD instrumentation systems are described along with their challenges in comparison to traditional rigid aeroshell systems. Requirements resulting from the survey are listed and instrumentation integration techniques and data acquisition are discussed.

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.

Big Data in Designing Clinical Trials: Opportunities and Challenges

PubMed Central

Mayo, Charles S.; Matuszak, Martha M.; Schipper, Matthew J.; Jolly, Shruti; Hayman, James A.; Ten Haken, Randall K.

2017-01-01

Emergence of big data analytics resource systems (BDARSs) as a part of routine practice in Radiation Oncology is on the horizon. Gradually, individual researchers, vendors, and professional societies are leading initiatives to create and demonstrate use of automated systems. What are the implications for design of clinical trials, as these systems emerge? Gold standard, randomized controlled trials (RCTs) have high internal validity for the patients and settings fitting constraints of the trial, but also have limitations including: reproducibility, generalizability to routine practice, infrequent external validation, selection bias, characterization of confounding factors, ethics, and use for rare events. BDARS present opportunities to augment and extend RCTs. Preliminary modeling using single- and muti-institutional BDARS may lead to better design and less cost. Standardizations in data elements, clinical processes, and nomenclatures used to decrease variability and increase veracity needed for automation and multi-institutional data pooling in BDARS also support ability to add clinical validation phases to clinical trial design and increase participation. However, volume and variety in BDARS present other technical, policy, and conceptual challenges including applicable statistical concepts, cloud-based technologies. In this summary, we will examine both the opportunities and the challenges for use of big data in design of clinical trials. PMID:28913177

Big Data in Designing Clinical Trials: Opportunities and Challenges.

PubMed

Mayo, Charles S; Matuszak, Martha M; Schipper, Matthew J; Jolly, Shruti; Hayman, James A; Ten Haken, Randall K

2017-01-01

Emergence of big data analytics resource systems (BDARSs) as a part of routine practice in Radiation Oncology is on the horizon. Gradually, individual researchers, vendors, and professional societies are leading initiatives to create and demonstrate use of automated systems. What are the implications for design of clinical trials, as these systems emerge? Gold standard, randomized controlled trials (RCTs) have high internal validity for the patients and settings fitting constraints of the trial, but also have limitations including: reproducibility, generalizability to routine practice, infrequent external validation, selection bias, characterization of confounding factors, ethics, and use for rare events. BDARS present opportunities to augment and extend RCTs. Preliminary modeling using single- and muti-institutional BDARS may lead to better design and less cost. Standardizations in data elements, clinical processes, and nomenclatures used to decrease variability and increase veracity needed for automation and multi-institutional data pooling in BDARS also support ability to add clinical validation phases to clinical trial design and increase participation. However, volume and variety in BDARS present other technical, policy, and conceptual challenges including applicable statistical concepts, cloud-based technologies. In this summary, we will examine both the opportunities and the challenges for use of big data in design of clinical trials.

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

The space shuttle ascent vehicle aerodynamic challenges configuration design and data base development

NASA Technical Reports Server (NTRS)

Dill, C. C.; Young, J. C.; Roberts, B. B.; Craig, M. K.; Hamilton, J. T.; Boyle, W. W.

1985-01-01

The phase B Space Shuttle systems definition studies resulted in a generic configuration consisting of a delta wing orbiter, and two solid rocket boosters (SRB) attached to an external fuel tank (ET). The initial challenge facing the aerodynamic community was aerodynamically optimizing, within limits, this configuration. As the Shuttle program developed and the sensitivities of the vehicle to aerodynamics were better understood the requirements of the aerodynamic data base grew. Adequately characterizing the vehicle to support the various design studies exploded the size of the data base to proportions that created a data modeling/management challenge for the aerodynamicist. The ascent aerodynamic data base originated primarily from wind tunnel test results. The complexity of the configuration rendered conventional analytic methods of little use. Initial wind tunnel tests provided results which included undesirable effects from model support tructure, inadequate element proximity, and inadequate plume simulation. The challenge to improve the quality of test results by determining the extent of these undesirable effects and subsequently develop testing techniques to eliminate them was imposed on the aerodynamic community. The challenges to the ascent aerodynamics community documented are unique due to the aerodynamic complexity of the Shuttle launch. Never before was such a complex vehicle aerodynamically characterized. The challenges were met with innovative engineering analyses/methodology development and wind tunnel testing techniques.

Activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda.

PubMed

Urimubenshi, Gerard

2015-09-01

Stroke is a major cause of long-term disability. Information regarding the limitations in activity and participation experienced by patients with stroke in a specific setting such as Musanze district in Rwanda would assist to develop the rehabilitation programmes that would take into consideration the functional challenges experienced post stroke. To explore the activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda. A qualitative phenomenological approach using in-depth face-to-face interviews with 10 participants was employed to gather the data that was analyzed using a qualitative thematic approach. The themes that arose as activity limitations included limitations in walking, self care, and domestic life activities. The themes related to participation restrictions as expressed by the participants were inability to return to previous occupation, decreased social interactions and inability to participate in religious activities. The current study findings highlight the need for interventions to improve the functional status of stroke survivors.

Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

PubMed Central

2014-01-01

Background Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are. Methods To examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional’s perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups. Results We identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals. Conclusions The communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process. PMID:24731478

"It was like reading a detective novel": Using PAR to work together for culture change.

PubMed

Fortune, Darla; McKeown, Janet; Dupuis, Sherry; de Witt, Lorna

2015-08-01

Participatory action research (PAR), with its focus on engagement and collaboration, is uniquely suited to enhancing culture change initiatives in dementia care. Yet, there is limited literature of its application to culture change approaches in care settings, and even less in dementia specific care contexts. To address these gaps in the literature, the purpose of this paper is to examine the complexities of a PAR project aimed at changing the culture of dementia care in two diverse dementia care settings, including a long term care (LTC) and community care setting. Drawing from data gathered throughout the PAR process, we unpack the challenges experienced by participants working together to guide culture change within their respective care settings. These challenges include: overextending selves through culture change participation; fluctuating group membership; feeling uncertainty, confusion and apprehension about the process; frustratingly slow process; and seeking diverse group representation in decision making. We also highlight the potential for appreciative inquiry (AI) to be integrated with PAR to guide a process whereby participants involved in culture change initiatives can develop strategies to mitigate challenges they experience. We view the challenges and strategies shared here as being constructive to would-be culture change agents and hope this paper will move others to consider the use of PAR when engaging in culture change initiatives. Copyright © 2015 Elsevier Inc. All rights reserved.

Promoting wellbeing and improving access to mental health care through community champions in rural India: the Atmiyata intervention approach.

PubMed

Shields-Zeeman, Laura; Pathare, Soumitra; Walters, Bethany Hipple; Kapadia-Kundu, Nandita; Joag, Kaustubh

2017-01-01

There are limited accounts of community-based interventions for reducing distress or providing support for people with common mental disorders (CMDs) in low and middle-income countries. The recently implemented Atmiyata programme is one such community-based mental health intervention focused on promoting wellness and reducing distress through community volunteers in a rural area in the state of Maharashtra, India. This case study describes the content and the process of implementation of Atmiyata and how community volunteers were trained to become Atmiyata champions and mitras ( friends ). The Atmiyata programme trained Atmiyata champions to provide support and basic counselling to community members with common mental health disorders, facilitate access to mental health care and social benefits, improve community awareness of mental health issues, and to promote well-being. Challenges to implementation included logistical challenges (difficult terrain and weather conditions at the implementation site), content-related challenges (securing social welfare benefits for people with CMDs), and partnership challenges (turnover of public health workers involved in referral chain, resistance from public sector mental health specialists). The case study serves as an example for how such a model can be sustained over time at low cost. The next steps of the programme include evaluation of the impact of the Atmiyata intervention through a pre-post study and adapting the intervention for further scale-up in other settings in India.

Genome Editing of the Blood: Opportunities and Challenges

PubMed Central

Porteus, Matthew H.

2015-01-01

The ability to remove blood cells, including hematopoietic stem cells (HSCs), from a person and then re-transplant them (hematopoietic stem cell transplantation (HSCT) is a well-established treatment paradigm that can be used in both the autologous setting or in the allogeneic setting. Using allogeneic HSCT can cure different genetic diseases of the blood but has significant limitations. An alternative to allogeneic HSCT is to transplant genetically modified HSCs instead. A powerful approach to the precision modification of HSCs is to use genome editing whereby the genome is modified with spatial precision (at an exact location) in the genome and sometimes with nucleotide precision (the exact nucleotide changes are introduced). The progress and challenges of genome editing of blood are discussed. PMID:26029496

Molecular neuroanatomy: a generation of progress.

PubMed

Pollock, Jonathan D; Wu, Da-Yu; Satterlee, John S

2014-02-01

The neuroscience research landscape has changed dramatically over the past decade. Specifically, an impressive array of new tools and technologies have been generated, including but not limited to: brain gene expression atlases, genetically encoded proteins to monitor and manipulate neuronal activity, and new methods for imaging and mapping circuits. However, despite these technological advances, several significant challenges must be overcome to enable a better understanding of brain function and to develop cell type-targeted therapeutics to treat brain disorders. This review provides an overview of some of the tools and technologies currently being used to advance the field of molecular neuroanatomy, and also discusses emerging technologies that may enable neuroscientists to address these crucial scientific challenges over the coming decade. Published by Elsevier Ltd.

Challenges in Clinical Management of Radiation-Induced Illnesses in Exploration Spaceflight

NASA Technical Reports Server (NTRS)

Blue, Rebecca; Chancellor, Jeffery; Suresh, Rahul; Carnell, Lisa; Reyes, David; Nowadly, Craig; Antonsen, Erik

2018-01-01

Historical solar particle events (SPEs) provide context for some understanding of acute radiation exposure risk to astronauts traveling outside of low Earth orbit. Modeling of potential doses delivered to exploration crewmembers anticipates limited radiation-induced health impacts, including prodromal symptoms of nausea, emesis, and fatigue, but suggests that more severe clinical manifestations are unlikely. Recent large animal-model research in space-analogs closely mimicking SPEs has identified coagulopathic events independent of the hematopoietic sequelae of higher radiation doses, similar in manifestation to disseminated intravascular coagulation (DIC). We explored the challenges of clinical management of radiation-related clinical manifestations, using currently accepted modeling techniques and anticipated physiological sequelae, to identify medical capabilities needed to successfully manage SPE-induced radiation illnesses during exploration spaceflight.

Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review.

PubMed

Roy, Karine; Gomez-Pulido, Federico; Ernst, Sabine

2016-03-01

In patients with congenital heart disease, challenges to catheter-based arrhythmia interventions are unique and numerous given the complexity of the underlying defects, anatomic and surgical intervention variants including baffles, conduits, patches, and/or shunts. Remote magnetic navigation offers significant advantages in these cases that may present with limited vascular access or difficult access to the target cardiac chambers implicated by the previous surgical interventions. We reviewed the data available on the safety, feasibility, and effectiveness of magnetic navigation for the treatment of arrhythmia in congenital heart disease and discussed the specific challenges related to various congenital defects and repair with the potential advantages offered by magnetic navigation in these circumstances. © 2016 Wiley Periodicals, Inc.

Encouraging consumption of water in school and child care settings: access, challenges, and strategies for improvement.

PubMed

Patel, Anisha I; Hampton, Karla E

2011-08-01

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area.

Data science, learning, and applications to biomedical and health sciences.

PubMed

Adam, Nabil R; Wieder, Robert; Ghosh, Debopriya

2017-01-01

The last decade has seen an unprecedented increase in the volume and variety of electronic data related to research and development, health records, and patient self-tracking, collectively referred to as Big Data. Properly harnessed, Big Data can provide insights and drive discovery that will accelerate biomedical advances, improve patient outcomes, and reduce costs. However, the considerable potential of Big Data remains unrealized owing to obstacles including a limited ability to standardize and consolidate data and challenges in sharing data, among a variety of sources, providers, and facilities. Here, we discuss some of these challenges and potential solutions, as well as initiatives that are already underway to take advantage of Big Data. © 2017 New York Academy of Sciences.

Turning loss into legislation.

PubMed

Labella, Angelena; Singh, Devika

2008-06-01

Same-sex partnerships encounter tremendous challenges in the context of healthcare, including empowerment to act on behalf of loved ones. We share challenges faced by two women who confronted this issue head-on when their same-sex partners were critically, and, in one case, fatally, injured. In both cases, hospitals initially refused to recognize these women as next of kin; one woman endured years of legal battles in her struggle to win the right to care for her partner. The other testified about her heartrending experience before the Washington State Judiciary Committee, helping to inspire legislation regarding rights for visitation and end-of-life decisions on behalf of same-sex partners. We seek to remind health care providers of the limitations of current laws and to inspire them to support change.

Research Collaboration in a Communication Rights Campaign: Lessons Learned.

PubMed

Ryan, Charlotte

2018-01-01

In building public support for social change, activists in communities of color routinely approach broader audiences via news media. Communities of color, however, routinely face disparities that limit their access to media including local news media outlets. This lack of access mirrors inequalities in political, social, and economic arenas and can slow public awareness campaigns to address disparities in health, environmental, and other quality-of-life issues. I describe two community-based collaborative action research studies that documented and challenged how local television newscasts underrepresented and misrepresented three communities of color in Boston. The linkage between communication rights and campaigns to address quality-of-life issues is presented, as well as unresolved challenges in the collaborative research process. The study has implications for environmental health campaigns.

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

Corona, Edmundo

The objective of this memo is to present a brief report of the progress achieved during FY2016 on the investigation of ductile failure in the 2013 Sandia Fracture Challenge specimen. The experimental investigation was conducted with both the original steel A286 material used in the fracture challenge as well as with Al 7075-T651. The new results include further microscopy work for the steel A286 specimens, failure criterion verification for both materials and the implementation of a finite element model containing `material imperfections' to simulate the limit load in the response of the steel A286 specimens. Funding used to conduct themore » work presented here was provided by the ASC V&V program on validation of shear failure (Benjamin Reedlunn, PI) and from Sandia's LDRD program.« less

Caring for children with colorectal disease in the context of limited resources.

PubMed

Poenaru, Dan; Borgstein, Eric; Numanoglu, Alp; Azzie, Georges

2010-05-01

The management of patients with colorectal disease in the pediatric population is challenging. Such management is all the more challenging when facing the constraints imposed by an environment with limited clinical resources. Three types of colorectal problems are highlighted in this article: anorectal malformations, Hirschsprung's disease, and acquired rectovaginal fistula in the human immunodeficiency virus-positive population. Through the use of illustrative cases, the authors discuss the pitfalls and challenges encountered in the diagnosis, treatment, and appropriate disposition of these patients. The bulk of the experience used to write this article was acquired in low- and middle-income countries in Africa. The authors hope that the lessons learned will help others manage such patients in the context of limited resources, but recognize that challenges will vary from place to place. There is no substitute for local, contextual expertise. Copyright 2010 Elsevier Inc. All rights reserved.

Quantitative Live-Cell Confocal Imaging of 3D Spheroids in a High-Throughput Format.

PubMed

Leary, Elizabeth; Rhee, Claire; Wilks, Benjamin T; Morgan, Jeffrey R

2018-06-01

Accurately predicting the human response to new compounds is critical to a wide variety of industries. Standard screening pipelines (including both in vitro and in vivo models) often lack predictive power. Three-dimensional (3D) culture systems of human cells, a more physiologically relevant platform, could provide a high-throughput, automated means to test the efficacy and/or toxicity of novel substances. However, the challenge of obtaining high-magnification, confocal z stacks of 3D spheroids and understanding their respective quantitative limitations must be overcome first. To address this challenge, we developed a method to form spheroids of reproducible size at precise spatial locations across a 96-well plate. Spheroids of variable radii were labeled with four different fluorescent dyes and imaged with a high-throughput confocal microscope. 3D renderings of the spheroid had a complex bowl-like appearance. We systematically analyzed these confocal z stacks to determine the depth of imaging and the effect of spheroid size and dyes on quantitation. Furthermore, we have shown that this loss of fluorescence can be addressed through the use of ratio imaging. Overall, understanding both the limitations of confocal imaging and the tools to correct for these limits is critical for developing accurate quantitative assays using 3D spheroids.

Search for Gravitational Waves from Low Mass Compact Binary Coalescence in LIGO's Sixth Science Run and Virgo's Science Runs 2 and 3

NASA Technical Reports Server (NTRS)

Abadie, J.; Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M.; Accadia, T.; Acernese, F.; Adams, C.; Adhikari, R.; Affeldt, C.;

Search for gravitational waves from low mass compact binary coalescence in LIGO's sixth science run and Virgo's science runs 2 and 3

NASA Astrophysics Data System (ADS)

Abadie, J.; Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M.; Accadia, T.; Acernese, F.; Adams, C.; Adhikari, R.; Affeldt, C.; Agathos, M.; Ajith, P.; Allen, B.; Allen, G. S.; Amador Ceron, E.; Amariutei, D.; Amin, R. S.; Anderson, S. B.; Anderson, W. G.; Arai, K.; Arain, M. A.; Araya, M. C.; Aston, S. M.; Astone, P.; Atkinson, D.; Aufmuth, P.; Aulbert, C.; Aylott, B. E.; Babak, S.; Baker, P.; Ballardin, G.; Ballmer, S.; Barker, D.; Barone, F.; Barr, B.; Barriga, P.; Barsotti, L.; Barsuglia, M.; Barton, M. A.; Bartos, I.; Bassiri, R.; Bastarrika, M.; Basti, A.; Batch, J.; Bauchrowitz, J.; Bauer, Th. S.; Bebronne, M.; Behnke, B.; Beker, M. G.; Bell, A. S.; Belletoile, A.; Belopolski, I.; Benacquista, M.; Berliner, J. M.; Bertolini, A.; Betzwieser, J.; Beveridge, N.; Beyersdorf, P. T.; Bilenko, I. A.; Billingsley, G.; Birch, J.; Biswas, R.; Bitossi, M.; Bizouard, M. A.; Black, E.; Blackburn, J. K.; Blackburn, L.; Blair, D.; Bland, B.; Blom, M.; Bock, O.; Bodiya, T. P.; Bogan, C.; Bondarescu, R.; Bondu, F.; Bonelli, L.; Bonnand, R.; Bork, R.; Born, M.; Boschi, V.; Bose, S.; Bosi, L.; Bouhou, B.; Braccini, S.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brau, J. E.; Breyer, J.; Briant, T.; Bridges, D. O.; Brillet, A.; Brinkmann, M.; Brisson, V.; Britzger, M.; Brooks, A. F.; Brown, D. A.; Brummit, A.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Burguet–Castell, J.; Burmeister, O.; Buskulic, D.; Buy, C.; Byer, R. L.; Cadonati, L.; Cagnoli, G.; Calloni, E.; Camp, J. B.; Campsie, P.; Cannizzo, J.; Cannon, K.; Canuel, B.; Cao, J.; Capano, C. D.; Carbognani, F.; Caride, S.; Caudill, S.; Cavaglià, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C.; Cesarini, E.; Chaibi, O.; Chalermsongsak, T.; Chalkley, E.; Charlton, P.; Chassande-Mottin, E.; Chelkowski, S.; Chen, Y.; Chincarini, A.; Chiummo, A.; Cho, H.; Christensen, N.; Chua, S. S. Y.; Chung, C. T. Y.; Chung, S.; Ciani, G.; Clara, F.; Clark, D. E.; Clark, J.; Clayton, J. H.; Cleva, F.; Coccia, E.; Cohadon, P.-F.; Colacino, C. N.; Colas, J.; Colla, A.; Colombini, M.; Conte, A.; Conte, R.; Cook, D.; Corbitt, T. R.; Cordier, M.; Cornish, N.; Corsi, A.; Costa, C. A.; Coughlin, M.; Coulon, J.-P.; Couvares, P.; Coward, D. M.; Coyne, D. C.; Creighton, J. D. E.; Creighton, T. D.; Cruise, A. M.; Cumming, A.; Cunningham, L.; Cuoco, E.; Cutler, R. M.; Dahl, K.; Danilishin, S. L.; Dannenberg, R.; D'Antonio, S.; Danzmann, K.; Dattilo, V.; Daudert, B.; Daveloza, H.; Davier, M.; Davies, G.; Daw, E. J.; Day, R.; Dayanga, T.; De Rosa, R.; DeBra, D.; Debreczeni, G.; Degallaix, J.; Del Pozzo, W.; del Prete, M.; Dent, T.; Dergachev, V.; DeRosa, R.; DeSalvo, R.; Dhurandhar, S.; Di Fiore, L.; Di Lieto, A.; Di Palma, I.; Di Paolo Emilio, M.; Di Virgilio, A.; Díaz, M.; Dietz, A.; DiGuglielmo, J.; Donovan, F.; Dooley, K. L.; Dorsher, S.; Drago, M.; Drever, R. W. P.; Driggers, J. C.; Du, Z.; Dumas, J.-C.; Dwyer, S.; Eberle, T.; Edgar, M.; Edwards, M.; Effler, A.; Ehrens, P.; Endrőczi, G.; Engel, R.; Etzel, T.; Evans, K.; Evans, M.; Evans, T.; Factourovich, M.; Fafone, V.; Fairhurst, S.; Fan, Y.; Farr, B. F.; Farr, W.; Fazi, D.; Fehrmann, H.; Feldbaum, D.; Ferrante, I.; Fidecaro, F.; Finn, L. S.; Fiori, I.; Fisher, R. P.; Flaminio, R.; Flanigan, M.; Foley, S.; Forsi, E.; Forte, L. A.; Fotopoulos, N.; Fournier, J.-D.; Franc, J.; Frasca, S.; Frasconi, F.; Frede, M.; Frei, M.; Frei, Z.; Freise, A.; Frey, R.; Fricke, T. T.; Friedrich, D.; Fritschel, P.; Frolov, V. V.; Fulda, P. J.; Fyffe, M.; Galimberti, M.; Gammaitoni, L.; Ganija, M. R.; Garcia, J.; Garofoli, J. A.; Garufi, F.; Gáspár, M. E.; Gemme, G.; Geng, R.; Genin, E.; Gennai, A.; Gergely, L. Á.; Ghosh, S.; Giaime, J. A.; Giampanis, S.; Giardina, K. D.; Giazotto, A.; Gill, C.; Goetz, E.; Goggin, L. M.; González, G.; Gorodetsky, M. L.; Goßler, S.; Gouaty, R.; Graef, C.; Granata, M.; Grant, A.; Gras, S.; Gray, C.; Gray, N.; Greenhalgh, R. J. S.; Gretarsson, A. M.; Greverie, C.; Grosso, R.; Grote, H.; Grunewald, S.; Guidi, G. M.; Guido, C.; Gupta, R.; Gustafson, E. K.; Gustafson, R.; Ha, T.; Hage, B.; Hallam, J. M.; Hammer, D.; Hammond, G.; Hanks, J.; Hanna, C.; Hanson, J.; Hardt, A.; Harms, J.; Harry, G. M.; Harry, I. W.; Harstad, E. D.; Hartman, M. T.; Haughian, K.; Hayama, K.; Hayau, J.-F.; Heefner, J.; Heidmann, A.; Heintze, M. C.; Heitmann, H.; Hello, P.; Hendry, M. A.; Heng, I. S.; Heptonstall, A. W.; Herrera, V.; Hewitson, M.; Hild, S.; Hoak, D.; Hodge, K. A.; Holt, K.; Hong, T.; Hooper, S.; Hosken, D. J.; Hough, J.; Howell, E. J.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh-Dinh, T.; Ingram, D. R.; Inta, R.; Isogai, T.; Ivanov, A.; Izumi, K.; Jacobson, M.; Jang, H.; Jaranowski, P.; Johnson, W. W.; Jones, D. I.; Jones, G.; Jones, R.; Ju, L.; Kalmus, P.; Kalogera, V.; Kamaretsos, I.; Kandhasamy, S.; Kang, G.; Kanner, J. B.; Katsavounidis, E.; Katzman, W.; Kaufer, H.; Kawabe, K.; Kawamura, S.; Kawazoe, F.; Kells, W.; Keppel, D. G.; Keresztes, Z.; Khalaidovski, A.; Khalili, F. Y.; Khazanov, E. A.; Kim, B.; Kim, C.; Kim, D.; Kim, H.; Kim, K.; Kim, N.; Kim, Y.-M.; King, P. J.; Kinsey, M.; Kinzel, D. L.; Kissel, J. S.; Klimenko, S.; Kokeyama, K.; Kondrashov, V.; Kopparapu, R.; Koranda, S.; Korth, W. Z.; Kowalska, I.; Kozak, D.; Kringel, V.; Krishnamurthy, S.; Krishnan, B.; Królak, A.; Kuehn, G.; Kumar, R.; Kwee, P.; Lam, P. K.; Landry, M.; Lang, M.; Lantz, B.; Lastzka, N.; Lawrie, C.; Lazzarini, A.; Leaci, P.; Lee, C. H.; Lee, H. M.; Leindecker, N.; Leong, J. R.; Leonor, I.; Leroy, N.; Letendre, N.; Li, J.; Li, T. G. F.; Liguori, N.; Lindquist, P. E.; Lockerbie, N. A.; Lodhia, D.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Luan, J.; Lubinski, M.; Lück, H.; Lundgren, A. P.; Macdonald, E.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Mageswaran, M.; Mailand, K.; Majorana, E.; Maksimovic, I.; Man, N.; Mandel, I.; Mandic, V.; Mantovani, M.; Marandi, A.; Marchesoni, F.; Marion, F.; Márka, S.; Márka, Z.; Markosyan, A.; Maros, E.; Marque, J.; Martelli, F.; Martin, I. W.; Martin, R. M.; Marx, J. N.; Mason, K.; Masserot, A.; Matichard, F.; Matone, L.; Matzner, R. A.; Mavalvala, N.; Mazzolo, G.; McCarthy, R.; McClelland, D. E.; McGuire, S. C.; McIntyre, G.; McIver, J.; McKechan, D. J. A.; Meadors, G. D.; Mehmet, M.; Meier, T.; Melatos, A.; Melissinos, A. C.; Mendell, G.; Menendez, D.; Mercer, R. A.; Meshkov, S.; Messenger, C.; Meyer, M. S.; Miao, H.; Michel, C.; Milano, L.; Miller, J.; Minenkov, Y.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Miyakawa, O.; Moe, B.; Moesta, P.; Mohan, M.; Mohanty, S. D.; Mohapatra, S. R. P.; Moraru, D.; Moreno, G.; Morgado, N.; Morgia, A.; Mori, T.; Mosca, S.; Mossavi, K.; Mours, B.; Mow-Lowry, C. M.; Mueller, C. L.; Mueller, G.; Mukherjee, S.; Mullavey, A.; Müller-Ebhardt, H.; Munch, J.; Murphy, D.; Murray, P. G.; Mytidis, A.; Nash, T.; Naticchioni, L.; Nawrodt, R.; Necula, V.; Nelson, J.; Newton, G.; Nishizawa, A.; Nocera, F.; Nolting, D.; Nuttall, L.; Ochsner, E.; O'Dell, J.; Oelker, E.; Ogin, G. H.; Oh, J. J.; Oh, S. H.; Oldenburg, R. G.; O'Reilly, B.; O'Shaughnessy, R.; Osthelder, C.; Ott, C. D.; Ottaway, D. J.; Ottens, R. S.; Overmier, H.; Owen, B. J.; Page, A.; Pagliaroli, G.; Palladino, L.; Palomba, C.; Pan, Y.; Pankow, C.; Paoletti, F.; Papa, M. A.; Parisi, M.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Patel, P.; Pedraza, M.; Peiris, P.; Pekowsky, L.; Penn, S.; Peralta, C.; Perreca, A.; Persichetti, G.; Phelps, M.; Pickenpack, M.; Piergiovanni, F.; Pietka, M.; Pinard, L.; Pinto, I. M.; Pitkin, M.; Pletsch, H. J.; Plissi, M. V.; Poggiani, R.; Pöld, J.; Postiglione, F.; Prato, M.; Predoi, V.; Price, L. R.; Prijatelj, M.; Principe, M.; Privitera, S.; Prix, R.; Prodi, G. A.; Prokhorov, L.; Puncken, O.; Punturo, M.; Puppo, P.; Quetschke, V.; Raab, F. J.; Rabeling, D. S.; Rácz, I.; Radkins, H.; Raffai, P.; Rakhmanov, M.; Ramet, C. R.; Rankins, B.; Rapagnani, P.; Raymond, V.; Re, V.; Redwine, K.; Reed, C. M.; Reed, T.; Regimbau, T.; Reid, S.; Reitze, D. H.; Ricci, F.; Riesen, R.; Riles, K.; Robertson, N. A.; Robinet, F.; Robinson, C.; Robinson, E. L.; Rocchi, A.; Roddy, S.; Rodriguez, C.; Rodruck, M.; Rolland, L.; Rollins, J.; Romano, J. D.; Romano, R.; Romie, J. H.; Rosińska, D.; Röver, C.; Rowan, S.; Rüdiger, A.; Ruggi, P.; Ryan, K.; Ryll, H.; Sainathan, P.; Sakosky, M.; Salemi, F.; Samblowski, A.; Sammut, L.; Sancho de la Jordana, L.; Sandberg, V.; Sankar, S.; Sannibale, V.; Santamaría, L.; Santiago-Prieto, I.; Santostasi, G.; Sassolas, B.; Sathyaprakash, B. S.; Sato, S.; Saulson, P. R.; Savage, R. L.; Schilling, R.; Schlamminger, S.; Schnabel, R.; Schofield, R. M. S.; Schulz, B.; Schutz, B. F.; Schwinberg, P.; Scott, J.; Scott, S. M.; Searle, A. C.; Seifert, F.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sergeev, A.; Shaddock, D. A.; Shaltev, M.; Shapiro, B.; Shawhan, P.; Shoemaker, D. H.; Sibley, A.; Siemens, X.; Sigg, D.; Singer, A.; Singer, L.; Sintes, A. M.; Skelton, G.; Slagmolen, B. J. J.; Slutsky, J.; Smith, J. R.; Smith, M. R.; Smith, N. D.; Smith, R. J. E.; Somiya, K.; Sorazu, B.; Soto, J.; Speirits, F. C.; Sperandio, L.; Stefszky, M.; Stein, A. J.; Steinert, E.; Steinlechner, J.; Steinlechner, S.; Steplewski, S.; Stochino, A.; Stone, R.; Strain, K. A.; Strigin, S.; Stroeer, A. S.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Sung, M.; Susmithan, S.; Sutton, P. J.; Swinkels, B.; Tacca, M.; Taffarello, L.; Talukder, D.; Tanner, D. B.; Tarabrin, S. P.; Taylor, J. R.; Taylor, R.; Thomas, P.; Thorne, K. A.; Thorne, K. S.; Thrane, E.; Thüring, A.; Titsler, C.; Tokmakov, K. V.; Toncelli, A.; Tonelli, M.; Torre, O.; Torres, C.; Torrie, C. I.; Tournefier, E.; Travasso, F.; Traylor, G.; Trias, M.; Tseng, K.; Tucker, E.; Ugolini, D.; Urbanek, K.; Vahlbruch, H.; Vajente, G.; Vallisneri, M.; van den Brand, J. F. J.; Van Den Broeck, C.; van der Putten, S.; van Veggel, A. A.; Vass, S.; Vasuth, M.; Vaulin, R.; Vavoulidis, M.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P. J.; Veltkamp, C.; Verkindt, D.; Vetrano, F.; Viceré, A.; Villar, A. E.; Vinet, J.-Y.; Vitale, S.; Vitale, S.; Vocca, H.; Vorvick, C.; Vyatchanin, S. P.; Wade, A.; Waldman, S. J.; Wallace, L.; Wan, Y.; Wang, X.; Wang, Z.; Wanner, A.; Ward, R. L.; Was, M.; Wei, P.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Wen, L.; Wen, S.; Wessels, P.; West, M.; Westphal, T.; Wette, K.; Whelan, J. T.; Whitcomb, S. E.; White, D.; Whiting, B. F.; Wilkinson, C.; Willems, P. A.; Williams, H. R.; Williams, L.; Willke, B.; Winkelmann, L.; Winkler, W.; Wipf, C. C.; Wiseman, A. G.; Wittel, H.; Woan, G.; Wooley, R.; Worden, J.; Yablon, J.; Yakushin, I.; Yamamoto, H.; Yamamoto, K.; Yang, H.; Yeaton-Massey, D.; Yoshida, S.; Yu, P.; Yvert, M.; Zadroźny, A.; Zanolin, M.; Zendri, J.-P.; Zhang, F.; Zhang, L.; Zhang, W.; Zhang, Z.; Zhao, C.; Zotov, N.; Zucker, M. E.; Zweizig, J.

2012-04-01

We report on a search for gravitational waves from coalescing compact binaries using LIGO and Virgo observations between July 7, 2009, and October 20, 2010. We searched for signals from binaries with total mass between 2 and 25M⊙; this includes binary neutron stars, binary black holes, and binaries consisting of a black hole and neutron star. The detectors were sensitive to systems up to 40 Mpc distant for binary neutron stars, and further for higher mass systems. No gravitational-wave signals were detected. We report upper limits on the rate of compact binary coalescence as a function of total mass, including the results from previous LIGO and Virgo observations. The cumulative 90% confidence rate upper limits of the binary coalescence of binary neutron star, neutron star-black hole, and binary black hole systems are 1.3×10-4, 3.1×10-5, and 6.4×10-6Mpc-3yr-1, respectively. These upper limits are up to a factor 1.4 lower than previously derived limits. We also report on results from a blind injection challenge.

The profile of diabetes healthcare professionals in Indonesia: a scoping review.

PubMed

Ligita, T; Wicking, K; Harvey, N; Mills, J

2018-01-10

To explore and synthesize evidence of the literature about healthcare professionals involved in the provision of diabetes management within an Indonesian context. Indonesia is challenged to control the major burden of diabetes prevalence rate that requires a multidimensional approach with the aim to optimize existing health services by involving healthcare professionals who can promote access and provide diabetes management. This literature review, which is integrated with a scoping study framework, used the electronic databases including CINAHL, PubMed, Scopus and Web of Science to locate papers particular to the Indonesian context. From the total of 568 papers found, 20 papers were selected. The literature review identified physicians, nurses, pharmacists, dieticians and diabetes educators as the providers of diabetes care and management in Indonesia. Collaborative management involving either interdisciplinary or intradisciplinary teams was mentioned in several papers. Internal challenges included limited skills and knowledge. External challenges included high patient volumes; a shortage of healthcare professionals and reduced funding. Overcoming the challenges cannot be undertaken with a workforce dominated by any one single healthcare professional. Coordinating with the government to improve the implementation of different roles in diabetes management will improve patient outcomes and thus reduce the burden of diabetes. Health policy reform should support nurses and other healthcare professionals in their professional development at all levels of health care. Policy makers can use the review findings to modify the current healthcare system to address key issues in workforce development; funding for services and medications; and fostering multidisciplinary care for diabetes management. © 2018 International Council of Nurses.

Autonomy in Second Language Phonology: Choice vs. Limits

ERIC Educational Resources Information Center

Moyer, Alene

2017-01-01

Learning a new sound system poses challenges of a social, psychological, and cognitive nature, but the learner's decisions are key to ultimate attainment. This presentation focuses on two essential concepts: CHOICE, or how one wants to sound in the target language; and LIMITS, or various challenges to one's goals vis-a-vis accent. Qualitative and…

Developing a modified preservative efficacy testing approach as a predictive tool for the evaluation of preservative systems in liquid home care products under variable test conditions.

PubMed

Hoyt, Anne L; Bushman, Don; Lewis, Nathan; Faber, Robert

2012-01-01

How can a formulator have confidence that a preservative system will perform as expected under adverse conditions? Extreme conditions that can lead to the development of "off odors" in the product can be a serious challenge for companies providing home care products in the global market. Formulation and stability testing occur under controlled parameters that simulate limited environmental conditions and microbial challenges are typically performed with a standard inoculum level. While this is an acceptable and dependable process, it does not necessarily assess how well a preservative system can perform under extreme environmental conditions or against unusually high levels of bacterial challenges. This is especially true when formulations are diluted and stored by the end-user. By modifying microbial challenge testing of a liquid dishwashing product to include unexpected dilution schemes, increased microbial assaults, and elevated temperatures, a pattern of preservative efficacy was established. The resulting approach proved to be a useful tool when developing use directions, recommended dilution levels, the overall surfactant system, preservative type, and storage restrictions.

New Perspectives on the Role of Internal Variability in Regional Climate Change and Climate Model Evaluation

NASA Astrophysics Data System (ADS)

Deser, C.

2017-12-01

Natural climate variability occurs over a wide range of time and space scales as a result of processes intrinsic to the atmosphere, the ocean, and their coupled interactions. Such internally generated climate fluctuations pose significant challenges for the identification of externally forced climate signals such as those driven by volcanic eruptions or anthropogenic increases in greenhouse gases. This challenge is exacerbated for regional climate responses evaluated from short (< 50 years) data records. The limited duration of the observations also places strong constraints on how well the spatial and temporal characteristics of natural climate variability are known, especially on multi-decadal time scales. The observational constraints, in turn, pose challenges for evaluation of climate models, including their representation of internal variability and assessing the accuracy of their responses to natural and anthropogenic radiative forcings. A promising new approach to climate model assessment is the advent of large (10-100 member) "initial-condition" ensembles of climate change simulations with individual models. Such ensembles allow for accurate determination, and straightforward separation, of externally forced climate signals and internal climate variability on regional scales. The range of climate trajectories in a given model ensemble results from the fact that each simulation represents a particular sequence of internal variability superimposed upon a common forced response. This makes clear that nature's single realization is only one of many that could have unfolded. This perspective leads to a rethinking of approaches to climate model evaluation that incorporate observational uncertainty due to limited sampling of internal variability. Illustrative examples across a range of well-known climate phenomena including ENSO, volcanic eruptions, and anthropogenic climate change will be discussed.

Tools to study pathogen-host interactions in bats.

PubMed

Banerjee, Arinjay; Misra, Vikram; Schountz, Tony; Baker, Michelle L

2018-03-15

Bats are natural reservoirs for a variety of emerging viruses that cause significant disease in humans and domestic animals yet rarely cause clinical disease in bats. The co-evolutionary history of bats with viruses has been hypothesized to have shaped the bat-virus relationship, allowing both to exist in equilibrium. Progress in understanding bat-virus interactions and the isolation of bat-borne viruses has been accelerated in recent years by the development of susceptible bat cell lines. Viral sequences similar to severe acute respiratory syndrome corona virus (SARS-CoV) have been detected in bats, and filoviruses such as Marburg virus have been isolated from bats, providing definitive evidence for the role of bats as the natural host reservoir. Although viruses can be readily detected in bats using molecular approaches, virus isolation is far more challenging. One of the limitations in using traditional culture systems from non-reservoir species is that cell types and culture conditions may not be compatible for isolation of bat-borne viruses. There is, therefore, a need to develop additional bat cell lines that correspond to different cell types, including less represented cell types such as immune cells, and culture them under more physiologically relevant conditions to study virus host interactions and for virus isolation. In this review, we highlight the current progress in understanding bat-virus interactions in bat cell line systems and some of the challenges and limitations associated with cell lines. Future directions to address some of these challenges to better understand host-pathogen interactions in these intriguing mammals are also discussed, not only in relation to viruses but also other pathogens carried by bats including bacteria and fungi. Copyright © 2018 Elsevier B.V. All rights reserved.

Challenges and opportunities of using liquid chromatography and mass spectrometry methods to develop complex vaccine antigens as pharmaceutical dosage forms.

PubMed

Hickey, John M; Sahni, Neha; Toth, Ronald T; Kumru, Ozan S; Joshi, Sangeeta B; Middaugh, C Russell; Volkin, David B

2016-10-01

Liquid chromatographic methods, combined with mass spectrometry, offer exciting and important opportunities to better characterize complex vaccine antigens including recombinant proteins, virus-like particles, inactivated viruses, polysaccharides, and protein-polysaccharide conjugates. The current abilities and limitations of these physicochemical methods to complement traditional in vitro and in vivo vaccine potency assays are explored in this review through the use of illustrative case studies. Various applications of these state-of-the art techniques are illustrated that include the analysis of influenza vaccines (inactivated whole virus and recombinant hemagglutinin), virus-like particle vaccines (human papillomavirus and hepatitis B), and polysaccharide linked to protein carrier vaccines (pneumococcal). Examples of utilizing these analytical methods to characterize vaccine antigens in the presence of adjuvants, which are often included to boost immune responses as part of the final vaccine dosage form, are also presented. Some of the challenges of using chromatographic and LC-MS as physicochemical assays to routinely test complex vaccine antigens are also discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

Fat-Soluble Vitamins: Clinical Indications and Current Challenges for Chromatographic Measurement

PubMed Central

Albahrani, Ali A.; Greaves, Ronda F.

2016-01-01

Fat-soluble vitamins, including vitamins A, D and E, are required for a wide variety of physiological functions. Over the past two decades, deficiencies of these vitamins have been associated with increased risk of cancer, type II diabetes mellitus and a number of immune system disorders. In addition, there is increasing evidence of interactions between these vitamins, especially between vitamins A and D. As a result of this enhanced clinical association with disease, translational clinical research and laboratory requests for vitamin measurements have significantly increased. These laboratory requests include measurement of 25-OHD (vitamin D), retinol (vitamin A) and α-tocopherol (vitamin E); the most accepted blood indicators for the assessment of body fat-soluble vitamin (FSV) status. There are significant obstacles to precise FSV measurement in blood. These obstacles include their physical and chemical properties, incomplete standardisation of measurement and limitations in the techniques that are currently used for quantification. The aim of this review is to briefly outline the metabolism and interactions of FSV as a prelude to identifying the current challenges for the quantification of blood vitamins A, D and E. PMID:27057076

Fat-Soluble Vitamins: Clinical Indications and Current Challenges for Chromatographic Measurement.

PubMed

Albahrani, Ali A; Greaves, Ronda F

2016-02-01

Fat-soluble vitamins, including vitamins A, D and E, are required for a wide variety of physiological functions. Over the past two decades, deficiencies of these vitamins have been associated with increased risk of cancer, type II diabetes mellitus and a number of immune system disorders. In addition, there is increasing evidence of interactions between these vitamins, especially between vitamins A and D. As a result of this enhanced clinical association with disease, translational clinical research and laboratory requests for vitamin measurements have significantly increased. These laboratory requests include measurement of 25-OHD (vitamin D), retinol (vitamin A) and α-tocopherol (vitamin E); the most accepted blood indicators for the assessment of body fat-soluble vitamin (FSV) status. There are significant obstacles to precise FSV measurement in blood. These obstacles include their physical and chemical properties, incomplete standardisation of measurement and limitations in the techniques that are currently used for quantification. The aim of this review is to briefly outline the metabolism and interactions of FSV as a prelude to identifying the current challenges for the quantification of blood vitamins A, D and E.

Usability in Mobile Electronic Data Collection Tools: Form Developers' Views.

PubMed

Mugisha, Alice; Babic, Ankica; Wakholi, Peter; Nankabirwa, Victoria; Tylleskar, Thorkild

2017-01-01

Mobile Electronic Data Collection Tools (MEDCTs) are created by form developers to collect data. Usability being one of the top quality attributes is of great concern to developers of any interactive applications. However, little is known about the form developers' understanding of usability, how they measure usability and their limitations in designing for usability. We conducted an empirical study where we aimed at getting the developers' views on usability by interviewing 8 form developers. These are creators of forms used for data collection. We found that developers knew about usability, but it was not their main focus during form development. Challenges included constraining deadlines, software limitations and the insufficient communication with the field users to establish the usability needs. Furthermore, the methods used to evaluate the usability of created forms varied amongst developers and these included in-house evaluations and feedback from piloting sessions with end users.

Current status of palliative care services in Indonesia: a literature review.

PubMed

Rochmawati, Erna; Wiechula, Rick; Cameron, Kate

2016-06-01

To review healthcare literature in relation to the provision of palliative care in Indonesia and to identify factors that may impact on palliative care development. People living with life-limiting illness benefit from access to palliative care services to optimize quality of life. Palliative care services are being expanded in developing countries but in Indonesia such services are in their infancy with many patients with life-limiting illnesses having access to appropriate health care compromised. Relevant healthcare databases including CINAHL, PubMed, Science Direct and Scopus were searched using the combinations of search terms: palliative care, terminal care, end-of-life care, Indonesia and nursing. A search of grey literature including Internet sites was also carried out. Nine articles were included in the review. Facilitating factors supporting the provision of palliative care included: a culture of strong familial support, government policy support, volunteering and support from regional organizations. Identified barriers to palliative care provision were a limited understanding of palliative care among healthcare professionals, the challenging geography of Indonesia and limited access to opioid medications. There are facilitators and barriers that currently impact on the development of palliative care in Indonesia. Strategies that can be implemented to improve palliative care include training of nurses and doctors in the primary care sector, integrating palliative care in undergraduate medical and nursing curriculum and educating family and community about basic care. Nurses and doctors who work in primary care can potentially play a role in supporting and educating family members providing direct care to patients with palliative needs. © 2016 International Council of Nurses.

Geriatrics in family practice residency education: an unmet challenge.

PubMed

Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

2003-01-01

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

Advances in immunotherapy for the treatment of glioblastoma.

PubMed

Tivnan, Amanda; Heilinger, Tatjana; Lavelle, Ed C; Prehn, Jochen H M

2017-01-01

Glioblastoma (GBM) is an aggressive brain tumour, associated with extremely poor prognosis and although there have been therapeutic advances, treatment options remain limited. This review focuses on the use of immunotherapy, harnessing the power of the host's immune system to reject cancer cells. Key challenges in glioma specific immunotherapy as with many other cancers are the limited immunogenicity of the cancer cells and the immunosuppressive environment of the tumour. Although specific antigens have been identified in several cancers; brain tumours, such as GBM, are considered poorly immunogenic. However, as detailed in this review, strategies aimed at circumventing these challenges are showing promise for GBM treatment; including identification of glioma specific antigens and endogenous immune cell activation in an attempt to overcome the immunosuppressive environment which is associated with GBM tumours. An up-to-date summary of current Phase I/II and ongoing Phase III GBM immunotherapy clinical trials is provided in addition to insights into promising preclinical approaches which are focused predominantly on increased induction of Type 1 helper T cell (T h 1) immune responses within patients.

New Age Teaching: Beyond Didactics

PubMed Central

Vlaovic, Peter D.; McDougall, Elspeth M.

2006-01-01

Widespread acceptance of laparoscopic urology techniques has posed many challenges to training urology residents and allowing postgraduate urologists to acquire often difficult new surgical skills. Several factors in surgical training programs are limiting the ability to train residents in the operating room, including limited-hours work weeks, increasing demand for operating room productivity, and general public awareness of medical errors. As such, surgical simulation may provide an opportunity to enhance residency experience and training, and optimize post-graduate acquisition of new skills and maintenance of competency. This review article explains and defines the various levels of validity as it pertains to surgical simulators. The most recently and comprehensively validity tested simulators are outlined and summarized. The potential role of surgical simulation in the formative and summative assessment of surgical trainees, as well as, the certification and recertification process of postgraduate surgeons will be delineated. Surgical simulation will be an important adjunct to the traditional methods of surgical skills training and will allow surgeons to maintain their proficiency in the technically challenging aspects of minimally invasive urologic surgery. PMID:17619704

High Frequency High Spectral Resolution Focal Plane Arrays for AtLAST

NASA Astrophysics Data System (ADS)

Baryshev, Andrey

2018-01-01

Large collecting area single dish telescope such as ATLAST will be especially effective for medium (R 1000) and high (R 50000) spectral resolution observations. Large focal plane array is a natural solution to increase mapping speed. For medium resolution direct detectors with filter banks (KIDs) and or heterodyne technology can be employed. We will analyze performance limits of comparable KID and SIS focal plane array taking into account quantum limit and high background condition of terrestrial observing site. For large heterodyne focal plane arrays, a high current density AlN junctions open possibility of large instantaneous bandwidth >40%. This and possible multi frequency band FPSs presents a practical challenge for spatial sampling and scanning strategies. We will discuss phase array feeds as a possible solution, including a modular back-end system, which can be shared between KID and SIS based FPA. Finally we will discuss achievable sensitivities and pixel co unts for a high frequency (>500 GHz) FPAs and address main technical challenges: LO distribution, wire counts, bias line multiplexing, and monolithic vs. discrete mixer component integration.

Exploring the barriers to rigorous monitoring and evaluation of health systems strengthening activities: qualitative evidence from international development partners.

PubMed

Wisniewski, Janna M; Yeager, Valerie A; Diana, Mark L; Hotchkiss, David R

2016-10-01

The number of health systems strengthening (HSS) programs has increased in the last decade. However, a limited number of studies providing robust evidence for the value and impact of these programs are available. This study aims to identify knowledge gaps and challenges that impede rigorous monitoring and evaluation (M&E) of HSS, and to ascertain the extent to which these efforts are informed by existing technical guidance. Interviews were conducted with HSS advisors at United States Agency for International Development-funded missions as well as senior M&E advisors at implementing partner and multilateral organizations. Findings showed that mission staff do not use existing technical resources, either because they do not know about them or do not find them useful. Barriers to rigorous M&E included a lack suitable of indicators, data limitations, difficulty in demonstrating an impact on health, and insufficient funding and resources. Consensus and collaboration between international health partners and local governments may mitigate these challenges. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Gene therapy for prostate cancer: where are we now?

PubMed

Steiner, M S; Gingrich, J R

2000-10-01

The ability to recombine specifically and alter DNA sequences followed by techniques to transfer these sequences or even whole genes into normal and diseased cells has revolutionized medical research and ushered the clinicians of today into the age of gene therapy. We provide urologists a review of relevant background information, outline current treatment strategies and clinical trials, and delineate current challenges facing the field of gene therapy for advanced prostate cancer. We comprehensively reviewed the literature, including PubMed and recent abstract proceedings from national meetings, relevant to gene therapy and advanced prostate cancer. We selected for review literature representative of the principal scientific background for current gene therapy strategies and National Institutes of Health Recombinant DNA Advisory Committee approved clinical trials. Current prostate cancer gene therapy strategies include correcting aberrant gene expression, exploiting programmed cell death pathways, targeting critical cell biological functions, introducing toxic or cell lytic suicide genes, enhancing the immune system antitumor response and combining treatment with conventional cytotoxic chemotherapy or radiation therapy. Many challenges lie ahead for gene therapy, including improving DNA transfer efficiency to cells locally and at distant sites, enhancing levels of gene expression and overcoming immune responses that limit the time that genes are expressed. Nevertheless, despite these current challenges it is almost certain that gene therapy will be part of the urological armamentarium against prostate cancer in this century.

State-civil society partnerships for HIV/AIDS treatment and prevention in Ghana: exploring factors associated with successes and challenges.

PubMed

Hushie, Martin; Omenyo, Cephas N; van den Berg, Jacob J; Lally, Michelle A

2016-08-02

The past decade has seen an increased number of state-civil society partnerships in the global Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) response of many countries. However, there has been limited research carried out concerning the successes and challenges of these partnerships. In-depth qualitative interviews were conducted with 23 participants from 21 different state-civil society partnerships throughout Ghana including all three major geographical zones (Northern, Middle, and Southern zones) to examine the nature of these partnerships and their positive and negative effects in responding to the national HIV/AIDS epidemic. Major themes included: 1) commitment by the government and civil society organizations to work cooperatively in order to support the development and implementation of HIV/AIDS interventions in Ghana; 2) the role of civil society organizations in facilitating community mobilization; capacity building; and information, resources and skills exchange to increase the efficiency and effectiveness of these partnerships for HIV prevention and treatment; and 3) significant challenges including funding issues and other structural barriers for these partnerships that need to be addressed moving forward. Future research should focus on examining the impact of recommended changes on state-civil partnerships and studying the extent and nature of these partnerships in other countries in order to establish the generalizability of the findings from this study.

Travel Vaccines Enter the Digital Age: Creating a Virtual Immunization Record

PubMed Central

Wilson, Kumanan; Atkinson, Katherine M.; Bell, Cameron P.

2016-01-01

At present, proof of immunization against diseases such as yellow fever is required at some international borders in concordance with the International Health Regulations. The current standard, the International Certificate of Vaccination or Prophylaxis (ICVP), has limitations as a paper record including the possibility of being illegible, misplaced, or damaged. We believe that a complementary, digital record would offer advantages to public health and travelers alike. These include enhanced availability and reliability, potential to include lot specific information, and integration with immunization information systems. Challenges exist in implementation, particularly pertaining to verification at border crossings. We describe a potential course for the development and implementation of a digital ICVP record. PMID:26711516

Thiopeptide Antibiotics: Retrospective and Recent Advances

PubMed Central

Just-Baringo, Xavier; Albericio, Fernando; Álvarez, Mercedes

2014-01-01

Thiopeptides, or thiazolyl peptides, are a relatively new family of antibiotics that already counts with more than one hundred different entities. Although they are mainly isolated from soil bacteria, during the last decade, new members have been isolated from marine samples. Far from being limited to their innate antibacterial activity, thiopeptides have been found to possess a wide range of biological properties, including anticancer, antiplasmodial, immunosuppressive, etc. In spite of their ribosomal origin, these highly posttranslationally processed peptides have posed a fascinating synthetic challenge, prompting the development of various methodologies and strategies. Regardless of their limited solubility, intensive investigations are bringing thiopeptide derivatives closer to the clinic, where they are likely to show their veritable therapeutic potential. PMID:24445304

High power densities from high-temperature materials interactions. [thermionic energy conversion and metallic fluid heat pipes

NASA Technical Reports Server (NTRS)

Morris, J. F.

1981-01-01

Thermionic energy converters and metallic-fluid heat pipes are well suited to serve together synergistically. The two operating cycles appear as simple and isolated as their material problems seem forebodingly deceptive and complicated. Simplified equations verify material properties and interactions as primary influences on the operational effectiveness of both. Each experiences flow limitations in thermal emission and vaporization because of temperature restrictions redounding from thermophysicochemical stability considerations. Topics discussed include: (1) successful limitation of alkali-metal corrosion; (2) protection against external hot corrosive gases; (3) coping with external and internal vaporization; (4) controlling interfacial reactions and diffusion; and (5) meeting other thermophysical challenges; expansion matches and creep.

MBE growth of VCSELs for high volume applications

NASA Astrophysics Data System (ADS)

Jäger, Roland; Riedl, Michael C.

2011-05-01

Mass market applications like laser computer mouse or optical data transmission based on vertical-cavity surface-emitting laser (VCSEL) chips need a high over all yield including epitaxy, processing, dicing, mounting and testing. One yield limitation for VCSEL structures is the emission wavelength variation of the substrate surface area leading to the fraction on laser chips which are below or above the specification limits. For most 850 nm VCSEL products a resonator wavelength variation of ±2 nm is common. This represents an average resonator thickness variation of much less than 1% which is quite challenging to be fulfilled on the entire processed wafer surface area. A high over all yield is demonstrated on MBE grown VCSEL structures.

Progress in satellite quantum key distribution

NASA Astrophysics Data System (ADS)

Bedington, Robert; Arrazola, Juan Miguel; Ling, Alexander

2017-08-01

Quantum key distribution (QKD) is a family of protocols for growing a private encryption key between two parties. Despite much progress, all ground-based QKD approaches have a distance limit due to atmospheric losses or in-fibre attenuation. These limitations make purely ground-based systems impractical for a global distribution network. However, the range of communication may be extended by employing satellites equipped with high-quality optical links. This manuscript summarizes research and development which is beginning to enable QKD with satellites. It includes a discussion of protocols, infrastructure, and the technical challenges involved with implementing such systems, as well as a top level summary of on-going satellite QKD initiatives around the world.

Integrated Multi-process Microfluidic Systems for Automating Analysis

PubMed Central

Yang, Weichun; Woolley, Adam T.

2010-01-01

Microfluidic technologies have been applied extensively in rapid sample analysis. Some current challenges for standard microfluidic systems are relatively high detection limits, and reduced resolving power and peak capacity compared to conventional approaches. The integration of multiple functions and components onto a single platform can overcome these separation and detection limitations of microfluidics. Multiplexed systems can greatly increase peak capacity in multidimensional separations and can increase sample throughput by analyzing many samples simultaneously. On-chip sample preparation, including labeling, preconcentration, cleanup and amplification, can all serve to speed up and automate processes in integrated microfluidic systems. This paper summarizes advances in integrated multi-process microfluidic systems for automated analysis, their benefits and areas for needed improvement. PMID:20514343

Reconsidering community-based health promotion: promise, performance, and potential.

PubMed

Merzel, Cheryl; D'Afflitti, Joanna

2003-04-01

Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.

How 3 rural safety net clinics integrate care for patients: a qualitative case study.

PubMed

Derrett, Sarah; Gunter, Kathryn E; Nocon, Robert S; Quinn, Michael T; Coleman, Katie; Daniel, Donna M; Wagner, Edward H; Chin, Marshall H

2014-11-01

Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients' needs. Currently, little is known about care integration for rural patients. To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Qualitative case study. Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Care integration was supported by 2 fundamental changes to organize and deliver care to patients-(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.

Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design.

PubMed

Lipsman, Nir; Giacobbe, Peter; Bernstein, Mark; Lozano, Andres M

2012-02-01

Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatric context, with its use currently limited to clinical trials and investigative studies. The combination of a patient population at the limits of conventional therapy and a novel technology in a new indication poses interesting challenges to the informed consent process as it relates to clinical trial enrollment. These challenges can be divided into those that relate to the patient, their disease and the technology, with each illustrating how traditional conceptualisations of research consent may be inadequate in the surgical psychiatry context. With specific reference to risk analysis, patient autonomy, voluntariness and the duty of the clinician-researcher, this paper will discuss the unique challenges that clinical trials of surgery for refractory psychiatric disease present to the consent process. Recommendations are also made for an ethical approach to clinical trial consent acquisition in this unique patient population.

Lung Structure and the Intrinsic Challenges of Gas Exchange.

PubMed

Hsia, Connie C W; Hyde, Dallas M; Weibel, Ewald R

2016-03-15

Structural and functional complexities of the mammalian lung evolved to meet a unique set of challenges, namely, the provision of efficient delivery of inspired air to all lung units within a confined thoracic space, to build a large gas exchange surface associated with minimal barrier thickness and a microvascular network to accommodate the entire right ventricular cardiac output while withstanding cyclic mechanical stresses that increase several folds from rest to exercise. Intricate regulatory mechanisms at every level ensure that the dynamic capacities of ventilation, perfusion, diffusion, and chemical binding to hemoglobin are commensurate with usual metabolic demands and periodic extreme needs for activity and survival. This article reviews the structural design of mammalian and human lung, its functional challenges, limitations, and potential for adaptation. We discuss (i) the evolutionary origin of alveolar lungs and its advantages and compromises, (ii) structural determinants of alveolar gas exchange, including architecture of conducting bronchovascular trees that converge in gas exchange units, (iii) the challenges of matching ventilation, perfusion, and diffusion and tissue-erythrocyte and thoracopulmonary interactions. The notion of erythrocytes as an integral component of the gas exchanger is emphasized. We further discuss the signals, sources, and limits of structural plasticity of the lung in alveolar hypoxia and following a loss of lung units, and the promise and caveats of interventions aimed at augmenting endogenous adaptive responses. Our objective is to understand how individual components are matched at multiple levels to optimize organ function in the face of physiological demands or pathological constraints. Copyright © 2016 John Wiley & Sons, Inc.

Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

PubMed

Samele, Chiara; Forrester, Andrew; Urquía, Norman; Hopkin, Gareth

2016-04-01

This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities, and challenges.

PubMed

Schmeler, Mark R; Schein, Richard M; McCue, Michael; Betz, Kendra

2009-01-01

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.

Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care

PubMed Central

Norton, Jenna M.; Boulware, L. Ebony

2016-01-01

Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD. PMID:26536899

Balancing the benefits and risks of public-private partnerships to address the global double burden of malnutrition.

PubMed

Kraak, Vivica I; Harrigan, Paige B; Lawrence, Mark; Harrison, Paul J; Jackson, Michaela A; Swinburn, Boyd

2012-03-01

Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public-private partnerships (PPP) to address the global double burden of malnutrition. We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified. We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes. NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

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

Establishing and sustaining research partnerships in Africa: a case study of the UK-Africa Academic Partnership on Chronic Disease

PubMed Central

2012-01-01

This paper examines the challenges and opportunities in establishing and sustaining north–south research partnerships in Africa through a case study of the UK-Africa Academic Partnership on Chronic Disease. Established in 2006 with seed funding from the British Academy, the partnership aimed to bring together multidisciplinary chronic disease researchers based in the UK and Africa to collaborate on research, inform policymaking, train and support postgraduates and create a platform for research dissemination. We review the partnership’s achievements and challenges, applying established criteria for developing successful partnerships. During the funded period we achieved major success in creating a platform for research dissemination through international meetings and publications. Other goals, such as engaging in collaborative research and training postgraduates, were not as successfully realised. Enabling factors included trust and respect between core working group members, a shared commitment to achieving partnership goals, and the collective ability to develop creative strategies to overcome funding challenges. Barriers included limited funding, administrative support, and framework for monitoring and evaluating some goals. Chronic disease research partnerships in low-income regions operate within health research, practice, funding and policy environments that prioritise infectious diseases and other pressing public health and developmental challenges. Their long-term sustainability will therefore depend on integrated funding systems that provide a crucial capacity building bridge. Beyond the specific challenges of chronic disease research, we identify social capital, measurable goals, administrative support, creativity and innovation and funding as five key ingredients that are essential for sustaining research partnerships. PMID:22897937

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

PubMed

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

2016-11-01

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

Immuno-oncology Clinical Trial Design: Limitations, Challenges, and Opportunities

PubMed Central

Baik, Christina S.; Rubin, Eric H.; Forde, Patrick M.; Mehnert, Janice M.; Collyar, Deborah; Butler, Marcus O.; Dixon, Erica L.; Chow, Laura Q.M.

2017-01-01

Recent advances in immuno-oncology and regulatory approvals have been rapid and paradigm shifting in many difficult-to-treat malignancies. Despite immune checkpoint inhibitor therapy becoming the standard of care across multiple tumor types, there are many unanswered questions that need to be addressed before this therapeutic modality can be fully harnessed. Areas of limitations include treatment of patients not sufficiently represented in clinical trials, uncertainty of the optimal treatment dosing and duration, and lack of understanding regarding long-term immune related toxicities and atypical tumor responses. Patients such as those with autoimmune disease, chronic viral infections, limited performance status, and brain metastases were often excluded from initial trials due to concerns of safety. However, limited data suggest that some of these patients can benefit from therapy with manageable toxicities; thus, future studies should incorporate these patients to clearly define safety and efficacy. There are still controversies regarding the optimal dosing strategy that can vary from weight-based to flat dosing, with undefined treatment duration. Further elucidation of the optimal dosing approach and evaluation of predictive biomarkers should be incorporated in the design of future trials. Finally, there are long-term immune-mediated toxicities, atypical tumor responses such as pseudoprogression and endpoints unique to immuno-oncology that are not adequately captured by traditional trial designs; thus, novel study designs are needed. In this article, we discuss in detail the above challenges and propose needed areas of research for exploration and incorporation in the next generation of immuno-oncology clinical trials. PMID:28864727

Metamaterial, plasmonic and nanophotonic devices

NASA Astrophysics Data System (ADS)

Monticone, Francesco; Alù, Andrea

2017-03-01

The field of metamaterials has opened landscapes of possibilities in basic science, and a paradigm shift in the way we think about and design emergent material properties. In many scenarios, metamaterial concepts have helped overcome long-held scientific challenges, such as the absence of optical magnetism and the limits imposed by diffraction in optical imaging. As the potential of metamaterials, as well as their limitations, become clearer, these advances in basic science have started to make an impact on several applications in different areas, with far-reaching implications for many scientific and engineering fields. At optical frequencies, the alliance of metamaterials with the fields of plasmonics and nanophotonics can further advance the possibility of controlling light propagation, radiation, localization and scattering in unprecedented ways. In this review article, we discuss the recent progress in the field of metamaterials, with particular focus on how fundamental advances in this field are enabling a new generation of metamaterial, plasmonic and nanophotonic devices. Relevant examples include optical nanocircuits and nanoantennas, invisibility cloaks, superscatterers and superabsorbers, metasurfaces for wavefront shaping and wave-based analog computing, as well as active, nonreciprocal and topological devices. Throughout the paper, we highlight the fundamental limitations and practical challenges associated with the realization of advanced functionalities, and we suggest potential directions to go beyond these limits. Over the next few years, as new scientific breakthroughs are translated into technological advances, the fields of metamaterials, plasmonics and nanophotonics are expected to have a broad impact on a variety of applications in areas of scientific, industrial and societal significance.

Interactive Learning with Java Applets: Using Interactive, Web-Based Java Applets to Present Science in a Concrete, Meaningful Manner

ERIC Educational Resources Information Center

Corder, Greg

2005-01-01

Science teachers face challenges that affect the quality of instruction. Tight budgets, limited resources, school schedules, and other obstacles limit students' opportunities to experience science that is visual and interactive. Incorporating web-based Java applets into science instruction offers a practical solution to these challenges. The…

The Joint Logistics Enterprise Enables Operation United Assistance

DTIC Science & Technology

2016-02-24

Sustainment July–August 2015 JLE U.S. service members board a C-130 Hercules aircraft Oct. 22, 2014, in Dakar, Senegal, to travel to Liberia to...including Liberia , as the “least developed in the world.” With numerous governance challenges, harsh weather, limited infrastructure over a... Liberia with the USARAF G–4, who was also the Joint Forces Com- mand ( JFC) J–4, and 7 personnel from his directorate. Because of the global reach of

A Cascaded Self-Similar Rat-Race Hybrid Coupler Architecture and its Compact Ka-Band Implementation

DTIC Science & Technology

2017-03-01

real-estate and limit the system-level performance, including bandwidth, gain, and energy - efficiency. These many challenges are positioning passive...and are used in numerous RF/mm-wave systems for radar and wireless communications. Although a Marchand balun covers a large bandwidth, it is...requires multiple λ/4 transmission lines (t-lines), making its on-chip designs very costly even for RF/mm-wave bands. Reported miniaturized rat-race

Drug Delivery in Cancer Therapy, Quo Vadis?

PubMed

Lu, Zheng-Rong; Qiao, Peter

2018-03-22

The treatment of malignancies has undergone dramatic changes in the past few decades. Advances in drug delivery techniques and nanotechnology have allowed for new formulations of old drugs, so as to improve the pharmacokinetics, to enhance accumulation in solid tumors, and to reduce the significant toxic effects of these important therapeutic agents. Here, we review the published clinical data in cancer therapy of several major drug delivery systems, including targeted radionuclide therapy, antibody-drug conjugates, liposomes, polymer-drug conjugates, polymer implants, micelles, and nanoparticles. The clinical outcomes of these delivery systems from various phases of clinical trials are summarized. The success and limitations of the drug delivery strategies are discussed based on the clinical observations. In addition, the challenges in applying drug delivery for efficacious cancer therapy, including physical barriers, tumor heterogeneity, drug resistance, and metastasis, are discussed along with future perspectives of drug delivery in cancer therapy. In doing so, we intend to underscore that efficient delivery of cancer therapeutics to solid malignancies remains a major challenge in cancer therapy, and requires a multidisciplinary approach that integrates knowledge from the diverse fields of chemistry, biology, engineering, and medicine. The overall objective of this review is to improve our understanding of the clinical fate of commonly investigated drug delivery strategies, and to identify the limitations that must be addressed in future drug delivery strategies, toward the pursuit of curative therapies for cancer.

Challenges in translating endpoints from trials to observational cohort studies in oncology

PubMed Central

Ording, Anne Gulbech; Cronin-Fenton, Deirdre; Ehrenstein, Vera; Lash, Timothy L; Acquavella, John; Rørth, Mikael; Sørensen, Henrik Toft

2016-01-01

Clinical trials are considered the gold standard for examining drug efficacy and for approval of new drugs. Medical databases and population surveillance registries are valuable resources for post-approval observational research, which are increasingly used in studies of benefits and risk of new cancer drugs. Here, we address the challenges in translating endpoints from oncology trials to observational studies. Registry-based cohort studies can investigate real-world safety issues – including previously unrecognized concerns – by examining rare endpoints or multiple endpoints at once. In contrast to clinical trials, observational cohort studies typically do not exclude real-world patients from clinical practice, such as old and frail patients with comorbidity. The observational cohort study complements the clinical trial by examining the effectiveness of interventions applied in clinical practice and by providing evidence on long-term clinical outcomes, which are often not feasible to study in a clinical trial. Various endpoints can be included in clinical trials, such as hard endpoints, soft endpoints, surrogate endpoints, and patient-reported endpoints. Each endpoint has it strengths and limitations for use in research studies. Endpoints used in oncology trials are often not applicable in observational cohort studies which are limited by the setting of standard clinical practice and by non-standardized endpoint determination. Observational studies can be more helpful moving research forward if they restrict focus to appropriate and valid endpoints. PMID:27354827

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: a review of global experience.

PubMed

Dawson, Angela; Turkmani, Sabera; Fray, Shairon; Nanayakkara, Susie; Varol, Nesrin; Homer, Caroline

2015-01-01

to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care. an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014. 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial. professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice. improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interference, focusing and excitation of ultracold atoms

NASA Astrophysics Data System (ADS)

Kandes, M. C.; Fahy, B. M.; Williams, S. R.; Tally, C. H., IV; Bromley, M. W. J.

2011-05-01

One of the pressing technological challenges in atomic physics is to go orders-of-magnitude beyond the limits of photon-based optics by harnessing the wave-nature of dilute clouds of ultracold atoms. We have developed parallelised algorithms to perform numerical calculations of the Gross-Pitaevskii equation in up to three dimensions and with up to three components to simulate Bose-Einstein condensates. A wide-ranging array of the physics associated with atom optics-based systems will be presented including BEC-based Sagnac interferometry in circular waveguides, the focusing of BECs using Laguerre-Gauss beams, and the interactions between BECs and Ince-Gaussian laser beams and their potential applications. One of the pressing technological challenges in atomic physics is to go orders-of-magnitude beyond the limits of photon-based optics by harnessing the wave-nature of dilute clouds of ultracold atoms. We have developed parallelised algorithms to perform numerical calculations of the Gross-Pitaevskii equation in up to three dimensions and with up to three components to simulate Bose-Einstein condensates. A wide-ranging array of the physics associated with atom optics-based systems will be presented including BEC-based Sagnac interferometry in circular waveguides, the focusing of BECs using Laguerre-Gauss beams, and the interactions between BECs and Ince-Gaussian laser beams and their potential applications. Performed on computational resources via NSF grants PHY-0970127, CHE-0947087 and DMS-0923278.

The use of the National Research Council of Canada's Falcon 20 research aircraft as a terrestrial analogue space environment (TASE) for space surgery research: Challenges and suggested solutions

NASA Astrophysics Data System (ADS)

Kirkpatrick, A. W.; Keaney, M. A.; Bentz, K.; Groleau, M.; Tyssen, M.; Keyte, J.; Ball, C. G.; Campbell, M. R.; Grenon, S. M.; McBeth, P.; Broderick, T. J.

2010-03-01

Emergency surgery will be needed to prevent death if humans are used to explore beyond low earth's orbit. Laparoscopic surgery (LS) is envisioned as a less invasive option for space, but will induce further stresses and complicate logistical requirements. Thus, further study into the technology and physiology of LS in weightlessness is required. We recently utilized the National Research Council of Canada's Flight Research Laboratory's Falcon 20 aircraft as a terrestrial analogue space environment (TASE) for space surgery research. The Falcon 20 had never been used for this purpose nor had the involved teams collaborated previously. There were many process challenges including the lack of antecedent surgical studies on this aircraft, a requirement for multiple disciplines who were unfamiliar and geographically distant from each other, flight performance limitations with the Falcon 20, complex animal care requirements, requirements for prototypical in-flight life-support surgical suites, financial limitations, and a need to use non-flight hardened technologies. Stepwise suggested solutions to these challenges are outlined as guidelines for future investigators intending similar research. Overall, the Falcon 20 TASE, backed by the flight resources, especially the design and fabrication capabilities of the NRC-FRL, provide investigators with a versatile and responsive opportunity to pursue research into advanced medical techniques that will be needed to save lives during space exploration.

Advance care planning: challenges and approaches for pediatricians.

PubMed

Heckford, Emma; Beringer, Antonia Jane

2014-09-01

There is increasing recognition of the value of advance care planning for children with life-limiting conditions. It is important that we acknowledge and reflect on the challenges that this work presents in order to optimize practice. Our aim was to review advance care planning for children with life-threatening or life-limiting conditions (LTLLCs) in our local area. We conducted a retrospective case note review. Study subjects were from two National Health Service (NHS) Trusts in Bristol in the United Kingdom. Cases were identified from Child Death Overview Panel data. Forty-two sets of case notes were reviewed in relation to 20 children. Measurements included quantitative and qualitative review of advance care planning in relation to standards set by The Association for Children's Palliative Care (ACT). In 25% of cases there was no documented discussion with families about the approach to end of life (EOL). In 25% of cases there was no evidence of an advance care plan, and the content and accessibility of those that did exist was variable. Forty-five percent of families were not offered a choice with regard to location of care (LOC) in the last months of life and 50% were not offered a choice about location of death (LOD). We hope that acknowledgement of some of the challenges, alongside recognition of the clear benefits, of planning will help pediatricians to deliver this important area of care.

Li- and Mn-Rich Cathode Materials: Challenges to Commercialization

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

Zheng, Jianming; Myeong, Seungjun; Cho, Woongrae

2016-12-14

The lithium- and manganese-rich (LMR) layered structure cathode exhibit one of the highest specific energy (~900 Wh kg-1) among all the cathode materials. However, the practical applications of LMR cathodes are still hindered by several significant challenges including voltage fade, large initial capacity loss, poor rate capability and limited cycle life. Herein, we review the recent progresses and understandings on the application of LMR cathode materials from practical point of view. Several key parameters of LMR cathodes that affect the LMR/graphite full cell operation are systematically analysed. These factors include the first cycle capacity loss, voltage fade, powder tap density,more » electrode density of LMR based cathode etc. New approaches to minimize the detrimental effect of these factors are highlighted in this work. We also provided the perspectives for the future research on LMR cathode materials, focusing on addressing the fundamental problems of LMR cathodes while always keeping practical considerations in mind.« less

Strategies for microbial synthesis of high-value phytochemicals

NASA Astrophysics Data System (ADS)

Li, Sijin; Li, Yanran; Smolke, Christina D.

2018-03-01

Phytochemicals are of great pharmaceutical and agricultural importance, but often exhibit low abundance in nature. Recent demonstrations of industrial-scale production of phytochemicals in yeast have shown that microbial production of these high-value chemicals is a promising alternative to sourcing these molecules from native plant hosts. However, a number of challenges remain in the broader application of this approach, including the limited knowledge of plant secondary metabolism and the inefficient reconstitution of plant metabolic pathways in microbial hosts. In this Review, we discuss recent strategies to achieve microbial biosynthesis of complex phytochemicals, including strategies to: (1) reconstruct plant biosynthetic pathways that have not been fully elucidated by mining enzymes from native and non-native hosts or by enzyme engineering; (2) enhance plant enzyme activity, specifically cytochrome P450 activity, by improving efficiency, selectivity, expression or electron transfer; and (3) enhance overall reaction efficiency of multi-enzyme pathways by dynamic control, compartmentalization or optimization with the host's metabolism. We also highlight remaining challenges to — and future opportunities of — this approach.

Biotechnology Challenges to In Vitro Maturation of Hepatic Stem Cells.

PubMed

Chen, Chen; Soto-Gutierrez, Alejandro; Baptista, Pedro M; Spee, Bart

2018-04-01

The incidence of liver disease is increasing globally. The only curative therapy for severe end-stage liver disease, liver transplantation, is limited by the shortage of organ donors. In vitro models of liver physiology have been developed and new technologies and approaches are progressing rapidly. Stem cells might be used as a source of liver tissue for development of models, therapies, and tissue-engineering applications. However, we have been unable to generate and maintain stable and mature adult liver cells ex vivo. We review factors that promote hepatocyte differentiation and maturation, including growth factors, transcription factors, microRNAs, small molecules, and the microenvironment. We discuss how the hepatic circulation, microbiome, and nutrition affect liver function, and the criteria for considering cells derived from stem cells to be fully mature hepatocytes. We explain the challenges to cell transplantation and consider future technologies for use in hepatic stem cell maturation, including 3-dimensional biofabrication and genome modification. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Cytoreductive nephrectomy vs medical therapy as initial treatment: a rational approach to the sequence question in metastatic renal cell carcinoma.

PubMed

Spiess, Philippe E; Fishman, Mayer N

2010-10-01

Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease. We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC. Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited. The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.

Enhancing metaproteomics-The value of models and defined environmental microbial systems

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

Herbst, Florian-Alexander; Lünsmann, Vanessa; Kjeldal, Henrik

Metaproteomicsthe large-scale characterization of the entire protein complement of environmental microbiota at a given point in timehas provided new features to study complex microbial communities in order to unravel these black boxes. Some new technical challenges arose that were not an issue for classical proteome analytics before that could be tackled by the application of different model systems. Here, we review different current and future model systems for metaproteome analysis. We introduce model systems for clinical and biotechnological research questions including acid mine drainage, anaerobic digesters, and activated sludge, following a short introduction to microbial communities and metaproteomics. Model systemsmore » are useful to evaluate the challenges encountered within (but not limited to) metaproteomics, including species complexity and coverage, biomass availability, or reliable protein extraction. Moreover, the implementation of model systems can be considered as a step forward to better understand microbial community responses and ecological functions of single member organisms. In the future, improvements are necessary to fully explore complex environmental systems by metaproteomics.« less

Enhancing metaproteomics-The value of models and defined environmental microbial systems

DOE PAGES

Herbst, Florian-Alexander; Lünsmann, Vanessa; Kjeldal, Henrik; ...

2016-01-21

Metaproteomicsthe large-scale characterization of the entire protein complement of environmental microbiota at a given point in timehas provided new features to study complex microbial communities in order to unravel these black boxes. Some new technical challenges arose that were not an issue for classical proteome analytics before that could be tackled by the application of different model systems. Here, we review different current and future model systems for metaproteome analysis. We introduce model systems for clinical and biotechnological research questions including acid mine drainage, anaerobic digesters, and activated sludge, following a short introduction to microbial communities and metaproteomics. Model systemsmore » are useful to evaluate the challenges encountered within (but not limited to) metaproteomics, including species complexity and coverage, biomass availability, or reliable protein extraction. Moreover, the implementation of model systems can be considered as a step forward to better understand microbial community responses and ecological functions of single member organisms. In the future, improvements are necessary to fully explore complex environmental systems by metaproteomics.« less

Rigged or rigorous? Partnerships for research and evaluation of complex social problems: Lessons from the field of violence against women and girls.

PubMed

Zimmerman, Cathy; Michau, Lori; Hossain, Mazeda; Kiss, Ligia; Borland, Rosilyne; Watts, Charlotte

2016-09-01

There is growing demand for robust evidence to address complex social phenomena such as violence against women and girls (VAWG). Research partnerships between scientists and non-governmental or international organizations (NGO/IO) are increasingly popular, but can pose challenges, including concerns about potential conflicts of interest. Drawing on our experience collaborating on VAWG research, we describe challenges and contributions that NGO/IO and academic partners can make at different stages of the research process and the effects that collaborations can have on scientific inquiry. Partners may struggle with differing priorities and misunderstandings about roles, limitations, and intentions. Benefits of partnerships include a shared vision of study goals, differing and complementary expertise, mutual respect, and a history of constructive collaboration. Our experience suggests that when investigating multi-faceted social problems, instead of 'rigging' study results, research collaborations can strengthen scientific rigor and offer the greatest potential for impact in the communities we seek to serve.

Inactivation Strategies for Clostridium perfringens Spores and Vegetative Cells.

PubMed

Talukdar, Prabhat K; Udompijitkul, Pathima; Hossain, Ashfaque; Sarker, Mahfuzur R

2017-01-01

Clostridium perfringens is an important pathogen to human and animals and causes a wide array of diseases, including histotoxic and gastrointestinal illnesses. C. perfringens spores are crucial in terms of the pathogenicity of this bacterium because they can survive in a dormant state in the environment and return to being live bacteria when they come in contact with nutrients in food or the human body. Although the strategies to inactivate C. perfringens vegetative cells are effective, the inactivation of C. perfringens spores is still a great challenge. A number of studies have been conducted in the past decade or so toward developing efficient inactivation strategies for C. perfringens spores and vegetative cells, which include physical approaches and the use of chemical preservatives and naturally derived antimicrobial agents. In this review, different inactivation strategies applied to control C. perfringens cells and spores are summarized, and the potential limitations and challenges of these strategies are discussed. Copyright © 2016 American Society for Microbiology.

Seasonal Drought Prediction: Advances, Challenges, and Future Prospects

NASA Astrophysics Data System (ADS)

Hao, Zengchao; Singh, Vijay P.; Xia, Youlong

2018-03-01

Drought prediction is of critical importance to early warning for drought managements. This review provides a synthesis of drought prediction based on statistical, dynamical, and hybrid methods. Statistical drought prediction is achieved by modeling the relationship between drought indices of interest and a suite of potential predictors, including large-scale climate indices, local climate variables, and land initial conditions. Dynamical meteorological drought prediction relies on seasonal climate forecast from general circulation models (GCMs), which can be employed to drive hydrological models for agricultural and hydrological drought prediction with the predictability determined by both climate forcings and initial conditions. Challenges still exist in drought prediction at long lead time and under a changing environment resulting from natural and anthropogenic factors. Future research prospects to improve drought prediction include, but are not limited to, high-quality data assimilation, improved model development with key processes related to drought occurrence, optimal ensemble forecast to select or weight ensembles, and hybrid drought prediction to merge statistical and dynamical forecasts.

Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations.

PubMed

Haberer, Jessica E; Sabin, Lora; Amico, K Rivet; Orrell, Catherine; Galárraga, Omar; Tsai, Alexander C; Vreeman, Rachel C; Wilson, Ira; Sam-Agudu, Nadia A; Blaschke, Terrence F; Vrijens, Bernard; Mellins, Claude A; Remien, Robert H; Weiser, Sheri D; Lowenthal, Elizabeth; Stirratt, Michael J; Sow, Papa Salif; Thomas, Bruce; Ford, Nathan; Mills, Edward; Lester, Richard; Nachega, Jean B; Bwana, Bosco Mwebesa; Ssewamala, Fred; Mbuagbaw, Lawrence; Munderi, Paula; Geng, Elvin; Bangsberg, David R

2017-01-01

Introduction : Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods : In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion : The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

In Vitro Cerebrovascular Modeling in the 21st Century: Current and Prospective Technologies

PubMed Central

Palmiotti, Christopher A.; Prasad, Shikha; Naik, Pooja; Abul, Kaisar MD; Sajja, Ravi K.; Achyuta, Anilkumar H.; Cucullo, Luca

2014-01-01

The blood-brain barrier (BBB) maintains the brain homeostasis and dynamically responds to events associated with systemic and/or rheological impairments (e.g., inflammation, ischemia) including the exposure to harmful xenobiotics. Thus, understanding the BBB physiology is crucial for the resolution of major central nervous system CNS) disorders challenging both health care providers and the pharmaceutical industry. These challenges include drug delivery to the brain, neurological disorders, toxicological studies, and biodefense. Studies aimed at advancing our understanding of CNS diseases and promoting the development of more effective therapeutics are primarily performed in laboratory animals. However, there are major hindering factors inherent to in vivo studies such as cost, limited throughput and translational significance to humans. These factors promoted the development of alternative in vitro strategies for studying the physiology and pathophysiology of the BBB in relation to brain disorders as well as screening tools to aid in the development of novel CNS drugs. Herein, we provide a detailed review including pros and cons of current and prospective technologies for modelling the BBB in vitro including ex situ, cell based and computational (in silico) models. A special section is dedicated to microfluidic systems including micro-BBB, BBB-on-a-chip, Neurovascular Unit-on-a-Chip and Synthetic Microvasculature Blood-Brain Barrier. PMID:25098812

In vitro cerebrovascular modeling in the 21st century: current and prospective technologies.

PubMed

Palmiotti, Christopher A; Prasad, Shikha; Naik, Pooja; Abul, Kaisar M D; Sajja, Ravi K; Achyuta, Anilkumar H; Cucullo, Luca

2014-12-01

The blood-brain barrier (BBB) maintains the brain homeostasis and dynamically responds to events associated with systemic and/or rheological impairments (e.g., inflammation, ischemia) including the exposure to harmful xenobiotics. Thus, understanding the BBB physiology is crucial for the resolution of major central nervous system CNS) disorders challenging both health care providers and the pharmaceutical industry. These challenges include drug delivery to the brain, neurological disorders, toxicological studies, and biodefense. Studies aimed at advancing our understanding of CNS diseases and promoting the development of more effective therapeutics are primarily performed in laboratory animals. However, there are major hindering factors inherent to in vivo studies such as cost, limited throughput and translational significance to humans. These factors promoted the development of alternative in vitro strategies for studying the physiology and pathophysiology of the BBB in relation to brain disorders as well as screening tools to aid in the development of novel CNS drugs. Herein, we provide a detailed review including pros and cons of current and prospective technologies for modelling the BBB in vitro including ex situ, cell based and computational (in silico) models. A special section is dedicated to microfluidic systems including micro-BBB, BBB-on-a-chip, Neurovascular Unit-on-a-Chip and Synthetic Microvasculature Blood-brain Barrier.

Multi-foci beamforming for thermal strain imaging using a single ultrasound linear array transducer

PubMed Central

Nguyen, Man M; Ding, Xuan; Leers, Steven A.; Kim, Kang

2017-01-01

Ultrasound-induced thermal strain imaging (TSI) has been used to successfully identify lipid and water-based tissues in atherosclerotic plaques in some research settings. However, TSI faces several challenges to be realized in clinics. These challenges include motion artifacts, displacement tracking accuracy as well as limited heating capability which contributes to low thermal strain signal-to-noise ratio and a limited field of view. The goal of this paper is to address the challenge in heating tissue in TSI. Current TSI systems use separate heating and imaging transducers, which require physically aligning the heating and imaging beams and result in a bulky setup that limits in vivo operation. This paper proposes and evaluates a new design for heating beams that can be implemented on a linear array imaging transducer and can provide an improved heating area and efficiency as compared to previous implementations. The designed heating beams were implemented with a clinical linear array imaging transducer connected to a research ultrasound platform. In-vitro experiments using tissue mimicking phantoms with no blood flow showed that the new design resulted in an effective heating area of approximately 0.85 cm2 and a 0.3°C temperature rise in 2 seconds of heating, which compared well with in- silico finite element simulations. With the new heating beams, TSI was shown to be able to detect a lipid-mimicking rubber inclusion with a diameter of 1 cm from the water-based gelatin background, with a strain contrast of 2.3 (+0.14% strain in the rubber inclusion and −0.06% strain in the gelatin background). Lastly, lipid-based tissue in a 1-cm diameter human carotid endarterectomy (CEA) sample was identified with good agreement to histology. PMID:28318887

Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: a challenge to success.

PubMed

Hirschhorn, Lisa R; Kaaya, Sylvia F; Garrity, Philip S; Chopyak, Elena; Fawzi, Mary C S

2012-07-31

There is considerable research around the morbidity and mortality related to noncommunicable diseases (NCDs), particularly cardiovascular disease and diabetes, among people living with HIV/AIDS (PLWHA) in resource-richer settings. Less is known about the burden and appropriate management of NCDs, particularly 'other' NCDs including cancer, renal, pulmonary, neurocognitive and mental health conditions, among older PLWHA in resource-limited settings (RLSs). We undertook a literature review of these other NCDs to explore what is currently known about them and identify areas of further research. Systematic literature review of published manuscripts and selected conference abstracts and reports. Although there is growing recognition of the importance of these NCDs among the aging population of PLWHA in RLSs, significant gaps remain in understanding the epidemiology and risk factors among older PLWHA in these settings. Even more concerning is the limited available evidence for effective and feasible approaches to prevention, screening and treatment of these conditions. The burden of these NCDs is related to both the aging of the population of PLWHA and an increased risk due to HIV infection, other comorbidities associated with HIV infection or transmission risk and underlying risk factors in the general community. Results from resource-richer settings and RLSs highlight malignancies, neurocognitive and mental health as well as renal disease as the most significant challenges currently and likely to increase in the future. Although some lessons can be taken from the growing experience with NCDs in older PLWHA in resource-richer settings, additional research is needed to better understand their risk and impact and identify optimal models of care to effectively address this challenge in the areas where the majority of older PLWHA will be receiving care.

Nanoparticle-based delivery of small interfering RNA: challenges for cancer therapy

PubMed Central

Miele, Evelina; Spinelli, Gian Paolo; Miele, Ermanno; Di Fabrizio, Enzo; Ferretti, Elisabetta; Tomao, Silverio; Gulino, Alberto

2012-01-01

During recent decades there have been remarkable advances and profound changes in cancer therapy. Many therapeutic strategies learned at the bench, including monoclonal antibodies and small molecule inhibitors, have been used at the bedside, leading to important successes. One of the most important advances in biology has been the discovery that small interfering RNA (siRNA) is able to regulate the expression of genes, by a phenomenon known as RNA interference (RNAi). RNAi is one of the most rapidly growing fields of research in biology and therapeutics. Much research effort has gone into the application of this new discovery in the treatment of various diseases, including cancer. However, even though these molecules may have potential and strong utility, some limitations make their clinical application difficult, including delivery problems, side effects due to off-target actions, disturbance of physiological functions of the cellular machinery involved in gene silencing, and induction of the innate immune response. Many researchers have attempted to overcome these limitations and to improve the safety of potential RNAi-based therapeutics. Nanoparticles, which are nanostructured entities with tunable size, shape, and surface, as well as biological behavior, provide an ideal opportunity to modify current treatment regimens in a substantial way. These nanoparticles could be designed to surmount one or more of the barriers encountered by siRNA. Nanoparticle drug formulations afford the chance to improve drug bioavailability, exploiting superior tissue permeability, payload protection, and the “stealth” features of these entities. The main aims of this review are: to explain the siRNA mechanism with regard to potential applications in siRNA-based cancer therapy; to discuss the possible usefulness of nanoparticle-based delivery of certain molecules for overcoming present therapeutic limitations; to review the ongoing relevant clinical research with its pitfalls and promises; and to evaluate critically future perspectives and challenges in siRNA-based cancer therapy. PMID:22915840

Withdrawal of anticancer therapy in advanced disease: a systematic literature review.

PubMed

Clarke, G; Johnston, S; Corrie, P; Kuhn, I; Barclay, S

2015-11-11

Current guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop. A systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed. Forty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced 'professional role dissonance' between their self-perception as 'treaters', and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians' personal experience, values, emotions. Some patients continued treatment to maintain 'hope', often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients' decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction. Oncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments.

Challenges in diabetes management in Indonesia: a literature review

PubMed Central

2013-01-01

Background and objectives The expanding diabetes epidemic worldwide could have potentially devastating effects on the development of healthcare systems and economies in emerging countries, both in terms of direct health care costs and loss of working time and disability. This study aims to review evidence on the burden, expenditure, complications, treatment, and outcomes of diabetes in Indonesia and its implications on the current health system developments. Methods We conducted a comprehensive literature review together with a review of unpublished data from the Ministry of Health and a public health insurer (Askes). Studies presenting evidence on prevalence, incidence, mortality, costs, complications and cost of complications, treatment, and outcomes were included in the analysis. Results A limited number of international, national and local studies on the burden and cost of diabetes in Indonesia were identified. National survey data suggests that in 2007 the prevalence of diabetes was 5.7%, of which more than 70% of cases were undiagnosed. This estimate hides large intracountry variation. There was very limited data available on direct costs and no data on indirect costs. The most commonly-identified complication was diabetic neuropathy. Discussion There were a number of limitations in the data retrieved including the paucity of data representative at the national level, lack of a clear reference date, lack of data from primary care, and lack of data from certain regions of the country. Conclusions If left unaddressed, the growing prevalence of diabetes in the country will pose a tremendous challenge to the Indonesian healthcare system, particularly in view of the Government’s 2010 mandate to achieve universal health coverage by 2014. Essential steps to address this issue would include: placing diabetes and non-communicable diseases high on the Government agenda and creating a national plan; identifying disparities and priority areas for Indonesia; developing a framework for coordinated actions between all relevant stakeholders. PMID:24299164

Scientific Challenges in the Risk Assessment of Food Contact Materials

PubMed Central

Backhaus, Thomas; Geueke, Birgit; Maffini, Maricel V.; Martin, Olwenn Viviane; Myers, John Peterson; Soto, Ana M.; Trasande, Leonardo; Trier, Xenia; Scheringer, Martin

2017-01-01

Background: Food contact articles (FCAs) are manufactured from food contact materials (FCMs) that include plastics, paper, metal, glass, and printing inks. Chemicals can migrate from FCAs into food during storage, processing, and transportation. Food contact materials’ safety is evaluated using chemical risk assessment (RA). Several challenges to the RA of FCAs exist. Objectives: We review regulatory requirements for RA of FCMs in the United States and Europe, identify gaps in RA, and highlight opportunities for improving the protection of public health. We intend to initiate a discussion in the wider scientific community to enhance the safety of food contact articles. Discussion: Based on our evaluation of the evidence, we conclude that current regulations are insufficient for addressing chemical exposures from FCAs. RA currently focuses on monomers and additives used in the manufacture of products, but it does not cover all substances formed in the production processes. Several factors hamper effective RA for many FCMs, including a lack of information on chemical identity, inadequate assessment of hazardous properties, and missing exposure data. Companies make decisions about the safety of some food contact chemicals (FCCs) without review by public authorities. Some chemical migration limits cannot be enforced because analytical standards are unavailable. Conclusion: We think that exposures to hazardous substances migrating from FCAs require more attention. We recommend a) limiting the number and types of chemicals authorized for manufacture and b) developing novel approaches for assessing the safety of chemicals in FCAs, including unidentified chemicals that form during or after production. https://doi.org/10.1289/EHP644 PMID:28893723

Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon.

PubMed

Schmitt, Margaret L; Clatworthy, David; Ratnayake, Ruwan; Klaesener-Metzner, Nicole; Roesch, Elizabeth; Wheeler, Erin; Sommer, Marni

2017-01-01

There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management). Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women. Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors. There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

Safety assessment of immunomodulatory biologics: the promise and challenges of regulatory T-cell modulation.

PubMed

Ponce, Rafael A

2011-01-01

Regulatory T-cell (T(reg)) modulation is developing as an important therapeutic opportunity for the treatment of a number of important diseases, including cancer, autoimmunity, infection, and organ transplant rejection. However, as demonstrated with IL-2 and TGN-1412, our understanding of the complex immunological interactions that occur with T(reg) modulation in both non-clinical models and in patients remains limited and appears highly contextual. This lack of understanding will challenge our ability to identify the patient population who might derive the highest benefit from T(reg) modulation and creates special challenges as we transition these therapeutics from non-clinical models into humans. Thus, in vivo testing in the most representative animal model systems, with careful progress in the clinic, will remain critical in developing therapeutics targeting T(reg) and understanding their clinical utility. Moreover, toxicology models can inform some of the potential liabilities associated with T(reg) modulation, but not all, suggesting a continued need to explore and validate predictive models.

Emerging Resistance, New Antimicrobial Agents  …  but No Tests! The Challenge of Antimicrobial Susceptibility Testing in the Current US Regulatory Landscape.

PubMed

Humphries, R M; Hindler, J A

2016-07-01

Accurate and timely performance of antimicrobial susceptibility testing (AST) by the clinical laboratory is paramount to combating antimicrobial resistance. The ability of laboratories in the United States to effectively perform ASTs is challenged by several factors. Some, such as new resistance mechanisms and the associated evolution of testing recommendations and breakpoints, are inevitable. Others are entirely man-made. These include unnecessarily strict US Food and Drug Administration (FDA) limitations on how commercial AST systems can be used for diagnostic testing, the absence of up-to-date performance data on these systems, and the lack of commercially available FDA-cleared tests for newer antimicrobial agents or for older agents with updated breakpoints. This viewpoint will highlight contemporary AST challenges faced by the clinical laboratory, and propose some solutions. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

SSME lifetime prediction and verification, integrating environments, structures, materials: The challenge

NASA Technical Reports Server (NTRS)

Ryan, R. S.; Salter, L. D.; Young, G. M., III; Munafo, P. M.

1985-01-01

The planned missions for the space shuttle dictated a unique and technology-extending rocket engine. The high specific impulse requirements in conjunction with a 55-mission lifetime, plus volume and weight constraints, produced unique structural design, manufacturing, and verification requirements. Operations from Earth to orbit produce severe dynamic environments, which couple with the extreme pressure and thermal environments associated with the high performance, creating large low cycle loads and high alternating stresses above endurance limit which result in high sensitivity to alternating stresses. Combining all of these effects resulted in the requirements for exotic materials, which are more susceptible to manufacturing problems, and the use of an all-welded structure. The challenge of integrating environments, dynamics, structures, and materials into a verified SSME structure is discussed. The verification program and developmental flight results are included. The first six shuttle flights had engine performance as predicted with no failures. The engine system has met the basic design challenges.

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.

Quantifying the probability of record-setting heat events in the historical record and at different levels of climate forcing

NASA Astrophysics Data System (ADS)

Diffenbaugh, N. S.

2017-12-01

Severe heat provides one of the most direct, acute, and rapidly changing impacts of climate on people and ecostystems. Theory, historical observations, and climate model simulations all suggest that global warming should increase the probability of hot events that fall outside of our historical experience. Given the acutre impacts of extreme heat, quantifying the probability of historically unprecedented hot events at different levels of climate forcing is critical for climate adaptation and mitigation decisions. However, in practice that quantification presents a number of methodological challenges. This presentation will review those methodological challenges, including the limitations of the observational record and of climate model fidelity. The presentation will detail a comprehensive approach to addressing these challenges. It will then demonstrate the application of that approach to quantifying uncertainty in the probability of record-setting hot events in the current climate, as well as periods with lower and higher greenhouse gas concentrations than the present.

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

Methodological Challenges in Research on Sexual Risk Behavior: I. Item Content, Scaling, and Data Analytical Options

PubMed Central

Schroder, Kerstin E. E.; Carey, Michael P.; Vanable, Peter A.

2008-01-01

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as “counts”) or with relative frequency measures (e.g., rating scales ranging from “never” to “always”). We discuss these two assessment approaches in the context of research on HIV risk behavior. We conclude that these two approaches yield non-redundant information and, more importantly, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging due to non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data, and discuss limitations of a commonly applied method (viz., ANCOVA using baseline scores as covariates). PMID:14534027

Ethics, the law, and prisoners: protecting society, changing human behavior, and protecting human rights.

PubMed

Trestman, Robert L

2014-09-01

Restricting a person's liberty presents society with many inherent ethical challenges. The historical purposes of confinement have included punishment, penitence, containment, rehabilitation, and habilitation. While the purposes are indeed complex, multifaceted, and at times ambiguous or contradictory, the fact of incarceration intrinsically creates many ethical challenges for psychiatrists working in correctional settings. Role definition of a psychiatrist may be ambiguous, with potential tensions between forensic and therapeutic demands. Privacy may be limited or absent and confidentiality may be compromised. Patient autonomy may be threatened to address real or perceived security concerns. Care delivery may actually have harmful consequences in court cases for pretrial detainees or lethal consequences for those under a death sentence. An absence of data and targeted research hampers the development of evidence-based care delivery for the disenfranchised, understudied, and disproportionately ill prisoner population. In this review paper, I discuss a few of the challenges and dilemmas routinely faced and present a series of questions. Where feasible, proposed resolutions are offered.

Identification of usual interstitial pneumonia pattern using RNA-Seq and machine learning: challenges and solutions.

PubMed

Choi, Yoonha; Liu, Tiffany Ting; Pankratz, Daniel G; Colby, Thomas V; Barth, Neil M; Lynch, David A; Walsh, P Sean; Raghu, Ganesh; Kennedy, Giulia C; Huang, Jing

2018-05-09

We developed a classifier using RNA sequencing data that identifies the usual interstitial pneumonia (UIP) pattern for the diagnosis of idiopathic pulmonary fibrosis. We addressed significant challenges, including limited sample size, biological and technical sample heterogeneity, and reagent and assay batch effects. We identified inter- and intra-patient heterogeneity, particularly within the non-UIP group. The models classified UIP on transbronchial biopsy samples with a receiver-operating characteristic area under the curve of ~ 0.9 in cross-validation. Using in silico mixed samples in training, we prospectively defined a decision boundary to optimize specificity at ≥85%. The penalized logistic regression model showed greater reproducibility across technical replicates and was chosen as the final model. The final model showed sensitivity of 70% and specificity of 88% in the test set. We demonstrated that the suggested methodologies appropriately addressed challenges of the sample size, disease heterogeneity and technical batch effects and developed a highly accurate and robust classifier leveraging RNA sequencing for the classification of UIP.