Family Activities for Fitness

ERIC Educational Resources Information Center

Grosse, Susan J.

2009-01-01

This article discusses how families can increase family togetherness and improve physical fitness. The author provides easy ways to implement family friendly activities for improving and maintaining physical health. These activities include: walking, backyard games, and fitness challenges.

Engineering Challenges for Closed Ecological System facilities

NASA Astrophysics Data System (ADS)

Dempster, William; Nelson, Mark; Allen, John P.

2012-07-01

Engineering challenges for closed ecological systems include methods of achieving closure for structures of different materials, and developing methods of allowing energy (for heating and cooling) and information transfer through the materially closed structure. Methods of calculating degree of closure include measuring degradation rates of inert trace gases introduced into the system. An allied problem is developing means of locating where leaks are located so that they may be repaired and degree of closure maintained. Once closure is achieved, methods of dealing with the pressure differentials between inside and outside are needed: from inflatable structures which might adjust to the pressure difference to variable volume chambers attached to the life systems component. These issues are illustrated through the engineering employed at Biosphere 2, the Biosphere 2 Test Module and the Laboratory Biosphere and a discussion of methods used by other closed ecological system facility engineers. Ecological challenges include being able to handle faster cycling rates and accentuated daily and seasonal fluxes of critical life elements such as carbon dioxide, oxygen, water, macro- and mico-nutrients. The problems of achieving sustainability in closed systems for life support include how to handle atmospheric dynamics including trace gases, producing a complete human diet and recycling nutrients and maintaining soil fertility, healthy air and water and preventing the loss of crucial elements from active circulation. In biospheric facilities the challenge is also to produce analogue to natural biomes and ecosystems, studying processes of self-organization and adaptation in systems that allow specification or determination of state variables and cycles which may be followed through all interactions from atmosphere to soils.

Electrolytes for solid oxide fuel cells

NASA Astrophysics Data System (ADS)

Fergus, Jeffrey W.

The high operating temperature of solid oxide fuel cells (SOFCs), as compared to polymer electrolyte membrane fuel cells (PEMFCs), improves tolerance to impurities in the fuel, but also creates challenges in the development of suitable materials for the various fuel cell components. In response to these challenges, intermediate temperature solid oxide fuel cells (IT-SOFCs) are being developed to reduce high-temperature material requirements, which will extend useful lifetime, improve durability and reduce cost, while maintaining good fuel flexibility. A major challenge in reducing the operating temperature of SOFCs is the development of solid electrolyte materials with sufficient conductivity to maintain acceptably low ohmic losses during operation. In this paper, solid electrolytes being developed for solid oxide fuel cells, including zirconia-, ceria- and lanthanum gallate-based materials, are reviewed and compared. The focus is on the conductivity, but other issues, such as compatibility with electrode materials, are also discussed.

A Case Study: Using Delmia at Kennedy Space Center to Support NASA's Constellation Program

NASA Technical Reports Server (NTRS)

Kickbusch, Tracey; Humeniuk, Bob

2010-01-01

The presentation examines the use of Delmia (Digital Enterprise Lean Manufacturing Interactive Application) for digital simulation in NASA's Constellation Program. Topics include an overview of the Kennedy Space Center (KSC) Design Visualization Group tasks, NASA's Constellation Program, Ares 1 ground processing preliminary design review, and challenges and how Delmia is used at KSC, Challenges include dealing with large data sets, creating and maintaining KSC's infrastructure, gathering customer requirements and meeting objectives, creating life-like simulations, and providing quick turn-around on varied products,

Whatever Happened to Economic Geography?

ERIC Educational Resources Information Center

Fagan, Robert

1985-01-01

Maintains that economic geography is alive and well. Describes some of the challenges facing research in economic geography and highlights the changing approaches being applied to economic geography. Includes sections on structural change, economic reorganization, and internationalization of manufacturing and finances. (JDH)

The effects of presession manipulations on automatically maintained challenging behavior and task responding.

PubMed

Chung, Yi-Chieh; Cannella-Malone, Helen I

2010-11-01

This study examined the effects of presession exposure to attention, response blocking, attention with response blocking, and noninteraction conditions on subsequent engagement in automatically maintained challenging behavior and correct responding in four individuals with significant intellectual disabilities. Following a functional analysis, the effects of the four presession conditions were examined using multielement designs. Results varied across the 4 participants (e.g., presession noninteraction acted as an abolishing operation for 2 participants, but as an establishing operation for the other 2 participants). As such, both the results replicated and contradicted previous research examining the effects of motivating operations on automatically maintained challenging behavior. Although the results varied across participants, at least one condition resulting in a decrease in challenging behavior and an increase in correct responding were identified for each participant. These findings suggested that presession manipulations resulted in decreases in subsequent automatically maintained challenging behavior and simultaneous increases in correct responding might need to be individually identified when the maintaining contingencies cannot be identified.

The Long Term Agroecosystem Research Network - Shared research strategy

USDA-ARS?s Scientific Manuscript database

Agriculture faces tremendous challenges in meeting multiple societal goals, including a safe and plentiful food supply; climate change adaptation and mitigation; supplying sources of bioenergy; improving water, air, and soil quality; and maintaining biodiversity. The Long Term Agroecosystem Research...

Influence of Motivating Operations and Discriminative Stimuli on Challenging Behavior Maintained by Positive Reinforcement

ERIC Educational Resources Information Center

Edrisinha, Chaturi; O'Reilly, Mark; Sigafoos, Jeff; Lancioni, Giulio; Choi, Ha Young

2011-01-01

We examined the effects of an establishing operation (EO) and abolishing operation (AO) on stimulus control of challenging behavior. Two participants with developmental disabilities and challenging behavior participated. In Phase I, a functional analysis was conducted to identify the consequences maintaining challenging behavior. In Phase II, a…

Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study.

PubMed

Drevhammar, Thomas; Nilsson, Kjell; Zetterström, Henrik; Jonsson, Baldvin

2015-07-01

Nasal CPAP is the most common respiratory support for neonates. Several factors are considered important for effective treatment, including leaks at the patient interface and the delivery of pressure-stable CPAP. Investigations of pressure stability during leaks should include both the change in the mean delivered CPAP and the pressure variation during each breath. The aim of this study was to examine the response of ventilators delivering nasal CPAP when challenged with leaks at the patient interface. Seven ventilators providing nasal CPAP at 4 cm H2O were challenged with leaks during simulated neonatal breathing. Leak was applied for 15 consecutive breaths at a constant level (1-4 L/min). The 2 aspects of pressure stability were evaluated by measuring the mean delivered CPAP and the amplitude of pressure swings before, during, and after leaks. The ability to maintain the delivered CPAP and the amplitude of pressure swings varied greatly among the 7 ventilators before, during, and after leaks. Four of the ventilators tested have built-in leak compensation. There was no simple relationship between maintaining delivered CPAP during leaks and providing CPAP with low pressure swing amplitude. Maintaining the delivered CPAP and providing this without pressure swings are 2 separate aspects of pressure stability, and investigations concerning the clinical importance of pressure stability should address both aspects. This study also shows that compensation for leaks does not necessarily provide pressure-stable CPAP. Copyright © 2015 by Daedalus Enterprises.

Rack 'em, pack 'em and stack 'em: challenges and opportunities in teaching large classes in higher education.

PubMed

Kumar, Saravana

2013-01-01

The higher education sector is undergoing tremendous change, driven by complex driving forces including financial, administrative, and organisational and stakeholder expectations. It is in this challenging environment, educators are required to maintain and improve the quality of teaching and learning outcomes while contending with increasing class sizes. Despite mixed evidence on the effectiveness of large classes on student outcomes, large classes continue to play an important part in higher education. While large classes pose numerous challenges, they also provide opportunities for innovative solutions. This paper provides an overview of these challenges and highlights opportunities for innovative solutions.

Special challenges of maintaining wild animals in captivity in North America.

PubMed

Cambre, R C; Buick, W W

1996-03-01

The maintenance of wild animals in captivity in North America is regulated by a number of different laws and government agencies in each country. Member institutions of zoo and aquarium associations in Canada, the United States of America and Mexico experience an extra tier of regulation in the form of industry standards, which are sometimes stricter than those imposed by government. Climate, natural disasters and harmful pest species all contribute to the challenge of keeping animals in certain locales. Vigilance against zoonotic disease transmission is maintained through industry and government-mandated sanitation standards, which are fortified by reporting regulations of local, regional and Federal health agencies. Current controversies in the keeping of particular taxa in North America include the threat to non-human primate breeding programmes precipitated by strict new import regulations, the fear of herpesvirus B infection, and commercial airline transport bans. Successive human fatalities among elephant handlers have prompted the industry and governments to re-examine the manner in which these potentially dangerous creatures are maintained in captivity.

Does Cultural Adaptation Have a Role in Substance Abuse Treatment?

PubMed Central

Burlew, A. Kathleen; Copeland, Valire Carr; Ahuama-Jonas, Chizara; Calsyn, Donald A.

2013-01-01

The changing ethnic composition of the nation and increasing requirements to use evidence-based treatments (EBTs) challenge mental health professionals to adapt treatments and interventions to be appropriate for their clients. This article applies the available information on cultural adaptation to substance abuse. The authors’ review suggests that the most common approaches for adapting substance use interventions include some combination of either community involvement in the adaptation, existing research and literature, and/or consultation from experts to adapt EBTs. The challenges facing the development of culturally adapted interventions include the need for additional research to determine which specific EBTs warrant adaptation, the responsibility of maintaining the balance between fidelity and adaptation, and the challenge of intragroup diversity. PMID:23731430

Temperament alters the metabolic response to glucose and insulin challenges and feed restriction in steers

USDA-ARS?s Scientific Manuscript database

Recently the dramatic metabolic differences between Temperamental and Calm cattle have been elucidated; Temperamental cattle maintain greater circulating concentrations of non-esterified fatty acids (NEFA) when compared to Calm cattle, which may influence other metabolic parameters including glucos...

Improving feed efficiency in dairy production systems – challenges and possibilities

USDA-ARS?s Scientific Manuscript database

Improving production efficiency has always been a goal of animal agriculture to ensure an abundant food and fiber supply, and to maintain producer profitability. In recent decades, the concept of sustainable agriculture emerged, which includes the additional goals of safeguarding natural resources, ...

Creating a Curriculum for the 21st Century.

ERIC Educational Resources Information Center

Mohr, Wanda K.; Naylor, Mary D.

1998-01-01

Describes a fundamental revision of an undergraduate psychiatric-mental health nursing program that was undertaken to maintain its humanistic focus while rising to the marketplace challenges that confront nurses in constantly changing environments. Includes a chart of core content, psychiatric mental health content, and competencies. (Author/JOW)

PDP-11 Meeting School District Administrative Data Processing Challenges.

ERIC Educational Resources Information Center

Technological Horizons in Education, 1983

1983-01-01

Elmhurst Community Unit School District 205 (Illinois) is currently using a Digital PDP-11/70 computer system and administrative software to handle administrative functions with ease and efficiency. These functions include production of reports and payroll, student scheduling, reporting grades and student progress, and maintaining student…

The Implications of Literacy Teaching Models

ERIC Educational Resources Information Center

Gunawardena, Maya

2017-01-01

First year students often experience a culture shock as certain literacy practices at the university level are different from their experiences in high schools. Some major challenges that students encounter include students' ability to maintain academic integrity practices in their studies, to comprehend complex academic texts to outline key…

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

PubMed

Luk, Andrew Leung; Yau, Adrian Fai To

2018-01-01

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

Candid No. 1 Argentine Hemorrhagic Fever Vaccine Protects against Lethal Junin Virus Challenge in Rhesus Macaques

DTIC Science & Technology

1992-01-01

HeLra Fever Vaccine Anna L. Kuhne Hemorrhagic Joan A. Spisso Protects against Lethal Junin Virus B.G. Mahlandt United States Army Medical Challenge in...live-attenuated vac- cine against Argentine hemorrhagic fever (AH F), was evaluated om in non-human primates. Twenty rhesus macaques immunized 3 months...nees that had received 3 logl,• PFU Candid No. I or fewer: all Argentine hemorrhagic fever others, including those receiving 127,200 PFU, maintained

Turning the Promise of Multicultural Education into Practice.

ERIC Educational Resources Information Center

Sklarz, David P.

1993-01-01

The challenge of maintaining the richness of cultural diversity will be won or lost in the 1990s. Necessary ingredients include revamping curricula; building cadres through staff diversification, new teaching strategies, and teacher retraining; offering teachers incentives for community involvement and second-language study; and fostering parent,…

Transnational Education in Morocco: Current and Future Challenges

ERIC Educational Resources Information Center

Benahnia, Abdellah

2015-01-01

Transnational education (TNE) is becoming a phenomenon in the world of education in many countries. Morocco is included. The flourishing and spreading of many foreign educational institutions, products, and activities is becoming noticeable. As an Islamic nation, Morocco has long maintained its business and educational ties with different foreign…

Off the Wall?

ERIC Educational Resources Information Center

Rittner-Heir, Robbin

2003-01-01

Vandalism is the main problem in maintaining school washrooms. Ways to help schools meet this challenge include designing washrooms with hidden moving parts to cut down on vandalism and making toilet partitions of solid polyethylene plastic which is virtually indestructible, hard to deface, and easy to clean. The article suggests it is worth…

Is the Shine off the A.P. Apple?

ERIC Educational Resources Information Center

Hurwitz, Nina; Hurwitz, Sol

2003-01-01

Describes challenges facing College Board's efforts to expand Advanced Placement (A.P.) courses to provide equal access to previously underserved low-performing urban and rural school students while maintaining the program's high academic standards. Includes list of strategies school boards can use to achieve greater access to A.P. courses while…

Evaluating new products and technology: getting the most value for your organization.

PubMed

Skorup, Thomas E

2008-12-01

The challenges of maintaining effective technology assessment and value analysis committees include: Aligning committee structure. Engaging and retaining physicians. Establishing effective processes. Ensuring the committee has the appropriate clinical expertise. Securing senior-level participation. Addressing organizational fit. Defining the scope of the committee. Strategic posturing.

Data::Downloader

NASA Technical Reports Server (NTRS)

Duggan, Brian

2012-01-01

Downloading and organizing large amounts of files is challenging, and often done using ad hoc methods. This software is capable of downloading and organizing files as an OpenSearch client. It can subscribe to RSS (Really Simple Syndication) feeds and Atom feeds containing arbitrary metadata, and maintains a local content addressable data store. It uses existing standards for obtaining the files, and uses efficient techniques for storing the files. Novel features include symbolic links to maintain a sane directory structure, checksums for validating file integrity during transfer and storage, and flexible use of server-provided metadata.

Aviation infrastructure : challenges associated with building and maintaining runways

DOT National Transportation Integrated Search

2000-10-05

This testimony focuses on challenges associated with building new runways and with ensuring that existing runways are properly maintained. Recent flight delays and cancellations as well as significant media attention to them have heightened public co...

From Our President. Scuds, Sorties, and Yellow Ribbons: The Costs of War for Children.

ERIC Educational Resources Information Center

Hostetler, Lana

1991-01-01

Maintains that early childhood professionals must confront the challenges of alleviating children's fears about the Persian Gulf War. Topics addressed include emotional support for children with parents stationed in the Gulf; effects of the media's war coverage on children; and fiscal and human costs of the war. (BB)

Becoming Embedded: Incorporating Instant Messaging and the Ongoing Evolution of a Virtual Reference Service

ERIC Educational Resources Information Center

Stormont, Sam

2010-01-01

The creation of an instant messaging (IM) service is described. The challenges encountered in developing, launching, and maintaining the project are examined and include technical support, archiving, balancing different formats, privacy, assessment, training, and the effectiveness of the IM channel. The process of choosing an aggregator and a…

First aid provision in nightclubs and other entertainment venues.

PubMed

Dean, R; Mulligan, J

This article discusses the role and responsibilities of the registered nurse in providing first aid in challenging environments, such as crowded nightclubs. Basic assistance for common emergencies, including substance misuse, wounds, choking and anaphylaxis, are discussed. This article emphasises the importance of risk assessment and reminds readers of the need to maintain personal safety.

Maintaining saproxylic insects in Canada's extensively managed boreal forests: a review

Treesearch

David W. Langor; John R. Spence; H.E. James Hammond; Joshua Jacobs; Tyler P. Cobb

2006-01-01

Recent work on saproxylic insect assemblages in western Canadian boreal forests has demonstrated high faunal diversity and variability, and that adequate assessment of these insects involves significant sampling and taxonomic challenges. Some major determinants of assemblage structure include tree species, degree of decay, stand age and cause of tree death. Experiments...

Gotta Have It! Pepsi Challenges Students to Stay in School.

ERIC Educational Resources Information Center

Punsalan, Carla M.

1993-01-01

A program sponsored by Pepsi-Cola Company is designed to provide students in inner-city school districts with reasons for staying in school. Incentives for students include scholarship credit of $250 for each semester in which they maintain a C average; mentor-teachers receive $1,000 for continuing education, classroom enhancement, or the…

Is It Really a Matter of Simple Dualism? Corticotropin-Releasing Factor Receptors in Body and Mental Health

PubMed Central

Janssen, Donny; Kozicz, Tamás

2013-01-01

Physiological responses to stress coordinated by the hypothalamo-pituitary-adrenal axis are concerned with maintaining homeostasis in the presence of real or perceived challenges. Regulators of this axis are corticotrophin releasing factor (CRF) and CRF related neuropeptides, including urocortins 1, 2, and 3. They mediate their actions by binding to CRF receptors (CRFR) 1 and 2, which are located in several stress-related brain regions. The prevailing theory has been that the initiation of and the recovery from an elicited stress response is coordinated by two elements, viz. the (mainly) opposing, but well balanced actions of CRFR1 and CRFR2. Such a dualistic view suggests that CRF/CRFR1 controls the initiation of, and urocortins/CRFR2 mediate the recovery from stress to maintain body and mental health. Consequently, failed adaptation to stress can lead to neuropathology, including anxiety and depression. Recent literature, however, challenges such dualistic and complementary actions of CRFR1 and CRFR2, and suggests that stress recruits CRF system components in a brain area and neuron specific manner to promote adaptation as conditions dictate. PMID:23487366

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

PubMed

Komro, Kelli A; Flay, Brian R; Biglan, Anthony; Wagenaar, Alexander C

2016-03-01

Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

Hydrology Domain Cyberinfrastructures: Successes, Challenges, and Opportunities

NASA Astrophysics Data System (ADS)

Horsburgh, J. S.

2015-12-01

Anticipated changes to climate, human population, land use, and urban form will alter the hydrology and availability of water within the water systems on which the world's population relies. Understanding the effects of these changes will be paramount in sustainably managing water resources, as well as maintaining associated capacity to provide ecosystem services (e.g., regulating flooding, maintaining instream flow during dry periods, cycling nutrients, and maintaining water quality). It will require better information characterizing both natural and human mediated hydrologic systems and enhanced ability to generate, manage, store, analyze, and share growing volumes of observational data. Over the past several years, a number of hydrology domain cyberinfrastructures have emerged or are currently under development that are focused on providing integrated access to and analysis of data for cross-domain synthesis studies. These include the Consortium of Universities for the Advancement of Hydrologic Science, Inc. (CUAHSI) Hydrologic Information System (HIS), the Critical Zone Observatory Information System (CZOData), HyroShare, the BiG CZ software system, and others. These systems have focused on sharing, integrating, and analyzing hydrologic observations data. This presentation will describe commonalities and differences in the cyberinfrastructure approaches used by these projects and will highlight successes and lessons learned in addressing the challenges of big and complex data. It will also identify new challenges and opportunities for next generation cyberinfrastructure and a next generation of cyber-savvy scientists and engineers as developers and users.

A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs

PubMed Central

Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.

2016-01-01

Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927

'Big data' in pharmaceutical science: challenges and opportunities.

PubMed

Dossetter, Al G; Ecker, Gerhard; Laverty, Hugh; Overington, John

2014-05-01

Future Medicinal Chemistry invited a selection of experts to express their views on the current impact of big data in drug discovery and design, as well as speculate on future developments in the field. The topics discussed include the challenges of implementing big data technologies, maintaining the quality and privacy of data sets, and how the industry will need to adapt to welcome the big data era. Their enlightening responses provide a snapshot of the many and varied contributions being made by big data to the advancement of pharmaceutical science.

Exploring the Human Fabric through an Analyst's Eyes

NASA Astrophysics Data System (ADS)

Belov, Nadya; Patti, Jeff; Wilcox, Saki; Almanzar, Rafael; Kim, Janet; Kellogg, Jennifer; Dang, Steven

The nature and type of conflicts drastically changed in the last half of the twentieth century. Wars are no longer limited to the field; they are supplemented with guerrilla warfare and other asymmetric warfare tactics including domestic terrorism. Domestic terrorism has demonstrated a need for improved homeland security capabilities. Establishing and maintaining the understanding of the key players and the underlying social networks is essential to combating asynchronous warfare tactics. Herein, we identify the key challenges addressed by our Collection/Exploitation Decision System (CEDS) that assist analysts in maintaining an up-to-date understanding of dynamic human networks.

The Effects of Presession Manipulations on Automatically Maintained Challenging Behavior and Task Responding

ERIC Educational Resources Information Center

Chung, Yi-Chieh; Cannella-Malone, Helen I.

2010-01-01

This study examined the effects of presession exposure to attention, response blocking, attention with response blocking, and noninteraction conditions on subsequent engagement in automatically maintained challenging behavior and correct responding in four individuals with significant intellectual disabilities. Following a functional analysis, the…

Keeping Ourselves Well: Strategies for Promoting and Maintaining Counselor Wellness

ERIC Educational Resources Information Center

Cummins, Paige N.; Massey, Linda; Jones, Anita

2007-01-01

This article describes challenges to wellness that counselors face when working with clients. Autobiographical reflections are used to illustrate the personal nature of some of these challenges and how this affects counselor effectiveness and wellness. Additionally, assessment measures and theoretical models for promoting and maintaining wellness…

Challenges in Shifting Management Responsibility From Parents to Adolescents With Sickle Cell Disease.

PubMed

Kayle, Mariam; Tanabe, Paula; Shah, Nirmish R; Baker-Ward, Lynne; Docherty, Sharron L

This study explored the challenges faced by adolescents with sickle cell disease (SCD) and their parents and the work they engage in to progressively shift from parent management to independent adolescent self-management. A qualitative descriptive focus-group design with semi-structured interviews was used with adolescents (11-18 years) with SCD (HbSS genotype) and their parents/primary caregivers. Interviews were analyzed using content analysis. Two adolescent focus groups, with a total of 14 adolescents, and two parent focus groups, with a total of 15 parents, described adaptive challenges. Adolescents' adaptive challenges included mastering complex symptom management, communicating about SCD and symptoms, and maintaining control. Parents' adaptive challenges included giving over the complex management, communicating the management with the adolescent, balancing protection against risk with fostering independence, changing a comfortable rhythm, and releasing the adolescent into an "SCD-naive" world. Adolescents' adaptive work included pushing back at parents, defaulting back to parental care, stepping up with time, learning how SCD affects them, and educating friends about SCD. Parents' adaptive work included engaging the adolescent in open dialogue and co-managing with the adolescent. Shifting management responsibility from parents to adolescents imposes adaptive challenges for both. Future research is needed to develop and test interventions that improve adaptive capacity in adolescents and parents. Health care providers need to assess the parent-child relationship and their progress in shifting the management responsibility, facilitate discussions to arrive at a shared understanding of the challenges, and collaborate on adaptive work to address these challenges. Copyright © 2016 Elsevier Inc. All rights reserved.

Experiences of burnout and coping strategies utilized by occupational therapists.

PubMed

Gupta, Sangeeta; Paterson, Margo L; Lysaght, Rosemary M; von Zweck, Claudia M

2012-04-01

Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.

Geropsychology training in a specialist geropsychology doctoral program.

PubMed

Qualls, Sara Honn; Segal, Daniel L; Benight, Charles C; Kenny, Michael P

2005-01-01

The first PhD specialty program in Geropsychology that launched in fall, 2004 at CU-Colorado Springs is described. Consistent with a scientist-practitioner model, the curriculum sequence builds systematically from basic to complex knowledge and skills across the domains of scientific psychology, research methodology, general clinical, geropsychology science, and clinical geropsychology. Practicum experiences also build skills in core clinical competencies needed by geropsychologists, including assessment, psychotherapy, neuropsychological evaluations, caregiver consultation and counseling, health psychology, and outreach/prevention. Research mentoring prepares students with the skills needed to conduct independent research useful to the clinical practice of geropsychology. Challenges faced in the process of developing the program include the development of a training clinic, balancing specialty and generalized training, building a specialty culture while maintaining faculty integration, attracting faculty and students during a start-up phase, and defining an identity within the field. The mental health services center that was launched to meet training needs while addressing a services niche in the community contributes substantially to the essence of this program, and is described in some detail. Future opportunities and challenges include program funding, heavy demands of specialty training on top of generalist training, maintaining congruence between expectations of clinical and non-clinical faculty, providing interdisciplinary experience, and expansion of practicum opportunities.

WebCIS: large scale deployment of a Web-based clinical information system.

PubMed

Hripcsak, G; Cimino, J J; Sengupta, S

1999-01-01

WebCIS is a Web-based clinical information system. It sits atop the existing Columbia University clinical information system architecture, which includes a clinical repository, the Medical Entities Dictionary, an HL7 interface engine, and an Arden Syntax based clinical event monitor. WebCIS security features include authentication with secure tokens, authorization maintained in an LDAP server, SSL encryption, permanent audit logs, and application time outs. WebCIS is currently used by 810 physicians at the Columbia-Presbyterian center of New York Presbyterian Healthcare to review and enter data into the electronic medical record. Current deployment challenges include maintaining adequate database performance despite complex queries, replacing large numbers of computers that cannot run modern Web browsers, and training users that have never logged onto the Web. Although the raised expectations and higher goals have increased deployment costs, the end result is a far more functional, far more available system.

Maintaining Global Citizenship Education in Schools: A Challenge for Australian Educators and Schools

ERIC Educational Resources Information Center

Buchanan, John; Burridge, Nina; Andrew Chodkiewicz

2018-01-01

Teaching students about global citizenship remains a critical challenge for schools and communities, especially in a developed country like Australia. With increasingly difficult national and international contexts and its marginal place in the school curriculum, there is an urgent need to help maintain support for global citizenship education.…

Dune Management Challenges on Developed Coasts

DTIC Science & Technology

2016-10-01

provide essential ecosys- tem services, including habitat for en- dangered species such as piping plovers, sites of high tourism value, groundwater...maintaining the physical environment’s ability to support urban, commercial, and tourism uses, can lead to management approaches which do not...Beach nourishment and restoration is also valued by many stakeholders who recognize that tourism can decline where beach widths have decreased

A community of practice: librarians in a biomedical research network.

PubMed

De Jager-Loftus, Danielle P; Midyette, J David; Harvey, Barbara

2014-01-01

Providing library and reference services within a biomedical research community presents special challenges for librarians, especially those in historically lower-funded states. These challenges can include understanding needs, defining and communicating the library's role, building relationships, and developing and maintaining general and subject specific knowledge. This article describes a biomedical research network and the work of health sciences librarians at the lead intensive research institution with librarians from primarily undergraduate institutions and tribal colleges. Applying the concept of a community of practice to a collaborative effort suggests how librarians can work together to provide effective reference services to researchers in biomedicine.

Cancer Immunotherapy and Breaking Immune Tolerance-New Approaches to an Old Challenge

PubMed Central

Makkouk, Amani; Weiner, George

2014-01-01

Cancer immunotherapy has proven to be challenging as it depends on overcoming multiple mechanisms that mediate immune tolerance to self-antigens. A growing understanding of immune tolerance has been the foundation for new approaches to cancer immunotherapy. Adoptive transfer of immune effectors such as antitumor monoclonal antibodies and Chimeric Antigen Receptor T cells bypasses many of the mechanisms involved in immune tolerance by allowing for expansion of tumor specific effectors ex vivo. Vaccination with whole tumor cells, protein, peptide, or dendritic cells has proven challenging, yet may be more useful when combined with other cancer immunotherapeutic strategies. Immunomodulatory approaches to cancer immunotherapy include treatment with agents that enhance and maintain T cell activation. Recent advances in the use of checkpoint blockade to block negative signals and so maintain the antitumor response are particularly exciting. With our growing knowledge of immune tolerance and ways to overcome it, combination treatments are being developed, tested and have particular promise. One example is in situ immunization that is designed to break tolerance within the tumor microenvironment. Progress in all these areas is continuing based on clear evidence that cancer immunotherapy designed to overcome immune tolerance can be useful for a growing number of cancer patients. PMID:25524899

The public health impact of food-related illness.

PubMed

O'Brien, Sarah J

2012-10-01

The purpose of this review is to provide an update on the public health impact of food-related illness in light of recent high-profile outbreaks and advances in the methodology to estimate illness burden. It includes mainly literature from high-income countries, as burden of illness estimations have been focussed in these countries. The public health burden of food-related illness is very high, no matter what method is used to measure it. Outbreaks provide only a partial insight because they represent a small proportion of all cases of food-related illness. Recent outbreaks have demonstrated a very wide variety of contaminated food vehicles and illustrated the challenges in investigations when the contaminated foodstuff is an ingredient of many other food items. Outbreaks will continue to challenge public health responses so that maintaining capacity to respond rapidly is crucial. Technological advances, such as whole genome sequencing, pave the way for identifying food-related illness much more rapidly than at present. There is a need to improve diagnostic yield in clinical laboratories and culturing organisms will remain important. Perhaps one of the greatest challenges, though, is to maintain the interest and support of the public when investigating food-related illness.

Dietary supplementation with a combination of alpha-lipoic acid, acetyl-L-carnitine, glycerophosphocoline, docosahexaenoic acid, and phosphatidylserine reduces oxidative damage to murine brain and improves cognitive performance.

PubMed

Suchy, James; Chan, Amy; Shea, Thomas B

2009-01-01

Alzheimer disease has a complex etiology composed of nutritional and genetic risk factors and predispositions. Moreover, genetic risk factors for cognitive decline may remain latent pending age-related decline in nutrition, suggesting the potential importance of early nutritional intervention, including preventative approaches. We hypothesized that a combination of multiple nutritional additives may be able to provide neuroprotection. We demonstrate herein that dietary supplementation with a mixture of ALA, ALCAR, GPC, DHA, and PS reduced reactive oxygen species in normal mice by 57% and prevented the increase in reactive oxygen species normally observed in mice lacking murine ApoE when maintained on a vitamin-free, iron-enriched, oxidative-challenge diet. We further demonstrate that supplementation with these agents prevented the marked cognitive decline otherwise observed in normal mice maintained on this challenge diet. These findings add to the growing body of research indicating that key dietary supplementation may delay the progression of age-related cognitive decline.

Gut Health of Pigs: Challenge Models and Response Criteria with a Critical Analysis of the Effectiveness of Selected Feed Additives - A Review.

PubMed

Adewole, D I; Kim, I H; Nyachoti, C M

2016-07-01

The gut is the largest organ that helps with the immune function. Gut health, especially in young pigs has a significant benefit to health and performance. In an attempt to maintain and enhance intestinal health in pigs and improve productivity in the absence of in-feed antibiotics, researchers have evaluated a wide range of feed additives. Some of these additives such as zinc oxide, copper sulphate, egg yolk antibodies, mannan-oligosaccharides and spray dried porcine plasma and their effectiveness are discussed in this review. One approach to evaluate the effectiveness of these additives in vivo is to use an appropriate disease challenge model. Over the years, researchers have used a number of challenge models which include the use of specific strains of enterotoxigenic Escherichia coli, bacteria lipopolysaccharide challenge, oral challenge with Salmonella enteric serotype Typhimurium, sanitation challenge, and Lawsonia intercellularis challenge. These challenge models together with the criteria used to evaluate the responses of the animals to them are also discussed in this review.

Gut Health of Pigs: Challenge Models and Response Criteria with a Critical Analysis of the Effectiveness of Selected Feed Additives — A Review

PubMed Central

Adewole, D. I.; Kim, I. H.; Nyachoti, C. M.

2016-01-01

The gut is the largest organ that helps with the immune function. Gut health, especially in young pigs has a significant benefit to health and performance. In an attempt to maintain and enhance intestinal health in pigs and improve productivity in the absence of in-feed antibiotics, researchers have evaluated a wide range of feed additives. Some of these additives such as zinc oxide, copper sulphate, egg yolk antibodies, mannan-oligosaccharides and spray dried porcine plasma and their effectiveness are discussed in this review. One approach to evaluate the effectiveness of these additives in vivo is to use an appropriate disease challenge model. Over the years, researchers have used a number of challenge models which include the use of specific strains of enterotoxigenic Escherichia coli, bacteria lipopolysaccharide challenge, oral challenge with Salmonella enteric serotype Typhimurium, sanitation challenge, and Lawsonia intercellularis challenge. These challenge models together with the criteria used to evaluate the responses of the animals to them are also discussed in this review. PMID:26954144

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.

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

Distribution System Pricing with Distributed Energy Resources

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

Hledik, Ryan; Lazar, Jim; Schwartz, Lisa

Technological changes in the electric utility industry bring tremendous opportunities and significant challenges. Customers are installing clean sources of on-site generation such as rooftop solar photovoltaic (PV) systems. At the same time, smart appliances and control systems that can communicate with the grid are entering the retail market. Among the opportunities these changes create are a cleaner and more diverse power system, the ability to improve system reliability and system resilience, and the potential for lower total costs. Challenges include integrating these new resources in a way that maintains system reliability, provides an equitable sharing of system costs, and avoidsmore » unbalanced impacts on different groups of customers, including those who install distributed energy resources (DERs) and low-income households who may be the least able to afford the transition.« less

Challenges in conducting a community-based influenza vaccine trial in a rural community in northern India.

PubMed

Kumar, Rakesh; Amarchand, Ritvik; Narayan, Venkatesh Vinayak; Saha, Siddhartha; Lafond, Kathryn E; Kapoor, Suresh K; Dar, Lalit; Jain, Seema; Krishnan, Anand

2018-04-04

Evidence on influenza vaccine effectiveness from low and middle countries (LMICs) is limited due to limited institutional capacities; lack of adequate resources; and lack of interest by ministries of health for influenza vaccine introduction. There are concerns that the highest ethical standards will be compromised during trials in LMICs leading to mistrust of clinical trials. These factors pose regulatory and operational challenges to researchers in these countries. We conducted a community-based vaccine trial to assess the efficacy of live attenuated influenza vaccine and inactivated influenza vaccine in rural north India. Key regulatory challenges included obtaining regulatory approvals, reporting of adverse events, and compensating subjects for trial-related injuries; all of which were required to be completed in a timely fashion. Key operational challenges included obtaining audio-visual consent; maintaining a low attrition rate; and administering vaccines during a narrow time period before the influenza season, and under extreme heat. We overcame these challenges through advanced planning, and sustaining community engagement. We adapted the trial procedures to cope with field conditions by conducting mock vaccine camps; and planned for early morning vaccination to mitigate threats to the cold chain. These lessons may help investigators to confront similar challenges in other LMICs.

EVATS: a proactive solution to improve surgical education and maintain flexibility in the new training era.

PubMed

Horvath, Karen D; Mann, Gary N; Pellegrini, Carlos

2006-01-01

To describe the development of the EVATS rotation. Descriptive document. University teaching hospital. Faculty and residents of the University of Washington. In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave). An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care. The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

California's “Bridge to Reform”: Identifying Challenges and Defining Strategies for Providers and Policymakers Implementing the Affordable Care Act in Low-Income HIV/AIDS Care and Treatment Settings

PubMed Central

Hazelton, Patrick T.; Steward, Wayne T.; Collins, Shane P.; Gaffney, Stuart; Morin, Stephen F.; Arnold, Emily A.

2014-01-01

Background In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved. Methods 30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses. Results Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients. Conclusions California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people living with HIV experiencing these transitions demonstrate the importance of setting effective policies in anticipation of full ACA implementation in 2014. PMID:24599337

California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

PubMed

Hazelton, Patrick T; Steward, Wayne T; Collins, Shane P; Gaffney, Stuart; Morin, Stephen F; Arnold, Emily A

2014-01-01

In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved. 30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses. Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients. California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people living with HIV experiencing these transitions demonstrate the importance of setting effective policies in anticipation of full ACA implementation in 2014.

Exploring challenges to telehealth communication by specialists in poison information.

PubMed

Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

2012-01-01

The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

Long-range strategic planning: a case study.

PubMed

Moller-Tiger, D

1999-05-01

In highly competitive healthcare markets, integrated delivery systems (IDSs) that have exhausted traditional means of maintaining market competitiveness are challenged to identify effective new strategies that will ensure market success in an uncertain future. Finding itself facing this challenge, Legacy Health System, a Portland, Oregon-based IDS, undertook an innovative, long-range, strategic-planning initiative based on an evaluation of key market trends. Legacy discovered that it might benefit from making some changes in the way it approached its mission. These changes included focusing on specific customer segments, developing products and services aimed at those customers, and broadening physician and insurer relationships to enhance service and improve customers' access to health care.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

PubMed

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists.

PubMed

Rivera, F; Andres, R; Felip, E; Garcia-Campelo, R; Lianes, P; Llombart, A; Piera, J M; Puente, J; Rodriguez, C A; Vera, R; Virizuela, J A; Martin, M; Garrido, P

2017-04-01

The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.

The Future Role of the United States in Global Health: Emphasis on Cardiovascular Disease.

PubMed

Fuster, Valentin; Frazer, Jendayi; Snair, Megan; Vedanthan, Rajesh; Dzau, Victor

2017-12-26

U.S. global health investment has focused on detection, treatment, and eradication of infectious diseases such as tuberculosis, malaria, and human immunodeficiency virus/acquired immunodeficiency syndrome, with significant results. Although efforts should be maintained and expanded to provide ongoing therapy for chronic infectious disease, there is a pressing need to meet the challenge of noncommunicable diseases, which constitute the highest burden of diseases globally. A Committee of the National Academies of Sciences, Engineering, and Medicine has made 14 recommendations that require ongoing commitments to eradication of infectious disease and increase the emphasis on chronic diseases such as cardiovascular disease. These include improving early detection and treatment, mitigating disease risk factors, shifting global health infrastructure to include management of cardiovascular disease, developing global partners and private-public ventures to meet infrastructure and funding challenges, streamlining medical product development and supply, increasing research and development capacity, and addressing gaps in global political and institutional leadership to meet the shifting challenge. Copyright © 2017. Published by Elsevier Inc.

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.

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.

[Internet research methods: advantages and challenges].

PubMed

Liu, Yi; Tien, Yueh-Hsuan

2009-12-01

Compared to traditional research methods, using the Internet to conduct research offers a number of advantages to the researcher, which include increased access to sensitive issues and vulnerable / hidden populations; decreased data entry time requirements; and enhanced data accuracy. However, Internet research also presents certain challenges to the researcher. In this article, the advantages and challenges of Internet research methods are discussed in four principle issue areas: (a) recruitment, (b) data quality, (c) practicality, and (d) ethics. Nursing researchers can overcome problems related to sampling bias and data truthfulness using creative methods; resolve technical problems through collaboration with other disciplines; and protect participant's privacy, confidentiality and data security by maintaining a high level of vigilance. Once such issues have been satisfactorily addressed, the Internet should open a new window for Taiwan nursing research.

Access to hospitals in the wake of terrorism: challenges and needs for maintaining public confidence.

PubMed

May, Thomas; Aulisio, Mark P

2006-01-01

The problem of surge capacity in the wake of a terror-related emergency has lead to a number of interesting proposals designed to mitigate the effects of crowds as well as deficiencies in patient care capacities. The most controversial of these is a proposal to close hospital doors in the wake of a mass casualty terror event. However, several specific challenges posed by mass casualty events make closing hospitals doors undesirable. These include the need for efficient movement of resources, maintenance of social order, and providing the moral reassurance needed by the general public in times of crisis. Importantly, these challenges are related to features of terrorist events that distinguish such events from circumstances of "normal" surge that might result in, for example, closure of emergency rooms.

Training Educators to Teach the Sun and Space Weather Using a Kit of Tools

NASA Astrophysics Data System (ADS)

Keesee, A. M.; Ensign, T.

2014-12-01

NASA provides a wealth of data from Heliospheric missions to the public, but educators face several challenges to using such data in the classroom. These include the knowledge of what is available and how to use it, a full understanding of the science concepts the data demonstrate, ability to obtain and maintain products to access data, and access to technology (such as computer labs) for anything other than testing. To surmount these challenges, the Educator Resource Center at the NASA Independent Validation and Verification (IV&V) Center in Fairmont, WV has developed an operational model that focuses on housing, maintaining, and lending out kits of necessary equipment along with training educators in the science concepts and use of kit materials. Following this model, we have developed a Sun and Space Weather kit and an educator professional development course that we have presented several times. The kit includes a classroom set of iPads utilized to access data from NASA missions and other sources as well as create video reports for project based outcomes, a set of telescopes for safe solar viewing, and materials to explore magnetic fields and the electromagnetic spectrum. We will present an overview of the training course, the kit materials, and lessons learned.

Treatment of challenging behavior exhibited by children with prenatal drug exposure.

PubMed

Kurtz, Patricia F; Chin, Michelle D; Rush, Karena S; Dixon, Dennis R

2008-01-01

A large body of literature exists describing the harmful effects of prenatal drug exposure on infant and child development. However, there is a paucity of research examining strategies to ameliorate sequelae such as externalizing behavior problems. In the present study, functional analysis procedures were used to assess challenging behavior exhibited by two children who were prenatally exposed to drugs of abuse. Results for both children indicated that challenging behavior was maintained by access to positive reinforcement (adult attention and tangible items). For one child, challenging behavior was also maintained by negative reinforcement (escape from activities of daily living). Function-based interventions were effective in reducing challenging behavior for both children. Implications for utilizing methods of applied behavior analysis in research with children with prenatal drug exposure are discussed.

Best practices for using natural experiments to evaluate retail food and beverage policies and interventions.

PubMed

Taillie, Lindsey Smith; Grummon, Anna H; Fleischhacker, Sheila; Grigsby-Toussaint, Diana S; Leone, Lucia; Caspi, Caitlin Eicher

2017-12-01

Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Data Integration for Dynamic and Sustainable Systems Biology Resources: Challenges and Lessons Learned

PubMed Central

Gabbard, Joseph L.; Shukla, Maulik; Sobral, Bruno

2010-01-01

Systems biology and infectious disease (host-pathogen-environment) research and development is becoming increasingly dependent on integrating data from diverse and dynamic sources. Maintaining integrated resources over long periods of time presents distinct challenges. This paper describes experiences and lessons learned from integrating data in two five-year projects focused on pathosystems biology: the Pathosystems Resource Integration Center (PATRIC, http://patric.vbi.vt.edu/), with a goal of developing bioinformatics resources for the research and countermeasures development communities based on genomics data, and the Resource Center for Biodefense Proteomics Research (RCBPR, http://www.proteomicsresource.org/), with a goal of developing resources based on the experiment data such as microarray and proteomics data from diverse sources and technologies. Some challenges include integrating genomic sequence and experiment data, data synchronization, data quality control, and usability engineering. We present examples of a variety of data integration problems drawn from our experiences with PATRIC and RBPRC, as well as open research questions related to long term sustainability, and describe the next steps to meeting these challenges. Novel contributions of this work include (1) an approach for addressing discrepancies between experiment results and interpreted results and (2) expanding the range of data integration techniques to include usability engineering at the presentation level. PMID:20491070

Influence of motivating operations and discriminative stimuli on challenging behavior maintained by positive reinforcement.

PubMed

Edrisinha, Chaturi; O'Reilly, Mark; Sigafoos, Jeff; Lancioni, Giulio; Choi, Ha Young

2011-01-01

We examined the effects of an establishing operation (EO) and abolishing operation (AO) on stimulus control of challenging behavior. Two participants with developmental disabilities and challenging behavior participated. In Phase I, a functional analysis was conducted to identify the consequences maintaining challenging behavior. In Phase II, a discrimination between SD and SΔ was trained. In Phase III, pre-session MOs (i.e., EO and AO conditions) were arranged to assess their effects on challenging behavior. Finally in Phase IV, in addition to manipulating pre-session MOs the challenging behavior was evaluated under extinction in both SD and SΔ conditions. Results indicated that in the context of extinction when pre-session EO and AO conditions were manipulated, responding not only became differentiated but was higher in both SD and SΔ conditions in the pre-session EO condition when compared to the pre-session AO condition. Published by Elsevier Ltd.

Design requirements, challenges, and solutions for high-temperature falling particle receivers

NASA Astrophysics Data System (ADS)

Christian, Joshua; Ho, Clifford

2016-05-01

Falling particle receivers (FPR) utilize small particles as a heat collecting medium within a cavity receiver structure. Previous analysis for FPR systems include computational fluid dynamics (CFD), analytical evaluations, and experiments to determine the feasibility and achievability of this CSP technology. Sandia National Laboratories has fabricated and tested a 1 MWth FPR that consists of a cavity receiver, top hopper, bottom hopper, support structure, particle elevator, flux target, and instrumentation. Design requirements and inherent challenges were addressed to enable continuous operation of flowing particles under high-flux conditions and particle temperatures over 700 °C. Challenges include being able to withstand extremely high temperatures (up to 1200°C on the walls of the cavity), maintaining particle flow and conveyance, measuring temperatures and mass flow rates, filtering out debris, protecting components from direct flux spillage, and measuring irradiance in the cavity. Each of the major components of the system is separated into design requirements, associated challenges and corresponding solutions. The intent is to provide industry and researchers with lessons learned to avoid pitfalls and technical problems encountered during the development of Sandia's prototype particle receiver system at the National Solar Thermal Test Facility (NSTTF).

Art, science, or both? Keeping the care in nursing.

PubMed

Jasmine, Tayray

2009-12-01

Nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is ongoing as professional nurses strive to maintain the concept, art, and act of caring as the moral center of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviors during each nurse-patient interaction. This article discusses the profession of nursing as an art and a science, and it explores the challenges associated with keeping the care in nursing.

Promoting interdisciplinary education - the Vienna Doctoral Programme on Water Resource Systems

NASA Astrophysics Data System (ADS)

Blöschl, G.; Carr, G.; Bucher, C.; Farnleitner, A. H.; Rechberger, H.; Wagner, W.; Zessner, M.

2011-11-01

The Vienna Doctoral Programme on Water Resource Systems (DK-WRS) is a programme that aims to educate students in interdisciplinary water science through cutting edge research at an international level. It is funded by the Austrian Science Fund and designed to run over a period of 12 yr during which 80 doctoral students are anticipated to graduate. This paper reports on our experiences of setting up and implementing the Programme. We identify three challenges: integrating the disciplines, maintaining depth in an interdisciplinary programme, and teaching subjects remote to each student's core expertise. To address these challenges we adopted a number of approaches. We use three levels of instruments to foster integration across the disciplines: joint groups (e.g. a joint study programme), joint science questions (e.g. developed in annual symposia), and joint study sites. To maintain depth we apply a system of quality control including regular feedback sessions, theses by journal publications and international study exchange. For simultaneously teaching students from civil and environmental engineering, biology, geology, chemistry, mathematics we use visually explicit teaching, learning by doing, extra mentoring and by cross relating associated subjects. Our initial assessment of the Programme shows some very positive outcomes. Joint science questions formed between students from various disciplines indicate integration is being achieved. The number of successful publications in top journals suggests that depth is maintained. Positive feedback from the students on the variety and clarity of the courses indicates the teaching strategy is working well. Our experiences have shown that implementing and running an interdisciplinary doctoral programme has its challenges and is demanding in terms of time and human resources but seeing interactions progress and watching people grow and develop their way of thinking in an interdisciplinary environment is a valuable reward.

Promoting interdisciplinary education - the Vienna Doctoral Programme on Water Resource Systems

NASA Astrophysics Data System (ADS)

Blöschl, G.; Carr, G.; Bucher, C.; Farnleitner, A. H.; Rechberger, H.; Wagner, W.; Zessner, M.

2012-02-01

The Vienna Doctoral Programme on Water Resource Systems (DK-WRS) is a programme that aims to educate students in interdisciplinary water science through cutting edge research at an international level. It is funded by the Austrian Science Fund and designed to run over a period of 12 yr during which 80 doctoral students are anticipated to graduate. This paper reports on our experiences of setting up and implementing the Programme. We identify three challenges: integrating the disciplines, maintaining depth in an interdisciplinary programme, and teaching subjects remote to each student's core expertise. To address these challenges we adopt a number of approaches. We use three levels of instruments to foster integration across the disciplines: joint groups (e.g. a joint study programme), joint science questions (e.g. developed in annual symposia), and joint study sites. To maintain depth we apply a system of quality control including regular feedback sessions, theses by journal publications and international study exchange. For simultaneously teaching students from civil and environmental engineering, biology, geology, chemistry, mathematics we use visually explicit teaching, learning by doing, extra mentoring and by cross relating associated subjects. Our initial assessment of the Programme shows some very positive outcomes. Joint science questions formed between students from various disciplines indicate integration is being achieved. The number of successful publications in top journals suggests that depth is maintained. Positive feedback from the students on the variety and clarity of the courses indicates the teaching strategy is working well. Our experiences have shown that implementing and running an interdisciplinary doctoral programme has its challenges and is demanding in terms of time and human resources but seeing interactions progress and watching people grow and develop their way of thinking in an interdisciplinary environment is a valuable reward.

Space Nutrition: Effects on Bone and Potential Nutrition Countermeasures

NASA Technical Reports Server (NTRS)

Smith, Scott M.

2008-01-01

Optimal nutrition will be critical for crew members who embark on space exploration missions. Nutritional assessment provides an opportunity to ensure that crewmembers begin their missions in optimal nutritional status, to document changes during a mission and , if necessary, to provide intervention to maintain that status throughout the mission, and to assesses changes after landing in order to facilitate the return to their normal status as soon as possible after landing. We report here the findings from our nutritional assessment of the US astronauts who participated in the first eight International Space Station (ISS) missions. Bone loss during space flight remains one of the most critical challenges to astronaut health on space exploration missions. An increase in bone resorption of ISS crew members after flight was indicated by several markers. Vitamin D status also remains a challenge for long-duration space travelers, who lack ultraviolet light exposure in the shielded craft. Many nutrients affect bone, including calcium, protein, fatty acids, sodium, and others. Data supporting their potential as countermeasures for space flight, as published in many papers, will be reviewed in this presentation. Defining nutrient requirements, and being able to provide and maintain those nutrients on exploration missions, will be critical for maintaining crew member health. Please note, this abstract is not required for the meeting. A presentation on the topics described above will be given. This abstract is for travel documentation only.

Studying physician-adolescent patient communication in community-based practices: recruitment challenges and solutions.

PubMed

Bodner, Michael E; Bilheimer, Alicia; Gao, Xiaomei; Lyna, Pauline; Alexander, Stewart C; Dolor, Rowena J; Østbye, Truls; Bravender, Terrill; Tulsky, James A; Graves, Sidney; Irons, Alexis; Pollak, Kathryn I

2015-11-13

Practice-based studies are needed to assess how physicians communicate health messages about weight to overweight/obese adolescent patients, but successful recruitment to such studies is challenging. This paper describes challenges, solutions, and lessons learned to recruit physicians and adolescents to the Teen Communicating Health Analyzing Talk (CHAT) study, a randomized controlled trial of a communication skills intervention for primary care physicians to enhance communication about weight with overweight/obese adolescents. A "peer-to-peer" approach was used to recruit physicians, including the use of "clinic champions" who liaised between study leaders and physicians. Consistent rapport and cooperative working relationships with physicians and clinic staff were developed and maintained. Adolescent clinic files were reviewed (HIPAA waiver) to assess eligibility. Parents could elect to opt-out for their children. To encourage enrollment, confidentiality of audio recordings was emphasized, and financial incentives were offered to all participants. We recruited 49 physicians and audio-recorded 391 of their overweight/obese adolescents' visits. Recruitment challenges included 1) physician reticence to participate; 2) variability in clinic operating procedures; 3) variability in adolescent accrual rates; 4) clinic open access scheduling; and 5) establishing communication with parents and adolescents. Key solutions included the use of a "clinic champion" to help recruit physicians, pro-active, consistent communication with clinic staff, and adapting calling times to reach parents and adolescents. Recruiting physicians and adolescents to audio-recorded, practice-based health communication studies can be successful. Anticipated challenges to recruiting can be met with advanced planning; however, optimal solutions to challenges evolve as recruitment progresses.

Adaptive Transcutaneous Power Transfer to Implantable Devices: A State of the Art Review

PubMed Central

Bocan, Kara N.; Sejdić, Ervin

2016-01-01

Wireless energy transfer is a broad research area that has recently become applicable to implantable medical devices. Wireless powering of and communication with implanted devices is possible through wireless transcutaneous energy transfer. However, designing wireless transcutaneous systems is complicated due to the variability of the environment. The focus of this review is on strategies to sense and adapt to environmental variations in wireless transcutaneous systems. Adaptive systems provide the ability to maintain performance in the face of both unpredictability (variation from expected parameters) and variability (changes over time). Current strategies in adaptive (or tunable) systems include sensing relevant metrics to evaluate the function of the system in its environment and adjusting control parameters according to sensed values through the use of tunable components. Some challenges of applying adaptive designs to implantable devices are challenges common to all implantable devices, including size and power reduction on the implant, efficiency of power transfer and safety related to energy absorption in tissue. Challenges specifically associated with adaptation include choosing relevant and accessible parameters to sense and adjust, minimizing the tuning time and complexity of control, utilizing feedback from the implanted device and coordinating adaptation at the transmitter and receiver. PMID:26999154

Adaptive Transcutaneous Power Transfer to Implantable Devices: A State of the Art Review.

PubMed

Bocan, Kara N; Sejdić, Ervin

2016-03-18

Wireless energy transfer is a broad research area that has recently become applicable to implantable medical devices. Wireless powering of and communication with implanted devices is possible through wireless transcutaneous energy transfer. However, designing wireless transcutaneous systems is complicated due to the variability of the environment. The focus of this review is on strategies to sense and adapt to environmental variations in wireless transcutaneous systems. Adaptive systems provide the ability to maintain performance in the face of both unpredictability (variation from expected parameters) and variability (changes over time). Current strategies in adaptive (or tunable) systems include sensing relevant metrics to evaluate the function of the system in its environment and adjusting control parameters according to sensed values through the use of tunable components. Some challenges of applying adaptive designs to implantable devices are challenges common to all implantable devices, including size and power reduction on the implant, efficiency of power transfer and safety related to energy absorption in tissue. Challenges specifically associated with adaptation include choosing relevant and accessible parameters to sense and adjust, minimizing the tuning time and complexity of control, utilizing feedback from the implanted device and coordinating adaptation at the transmitter and receiver.

One for All: Maintaining a Single Schedule Database for Large Development Projects

NASA Technical Reports Server (NTRS)

Hilscher, R.; Howerton, G.

1999-01-01

Efficiently maintaining and controlling a single schedule database in an Integrated Product Team environment is a significant challenge. It's accomplished effectively with the right combination of tools, skills, strategy, creativity, and teamwork. We'll share our lessons learned maintaining a 20,000 plus task network on a 36 month project.

Hale and Hearty Policies: How Psychological Science Can Create and Maintain Healthy Habits.

PubMed

Rothman, Alexander J; Gollwitzer, Peter M; Grant, Adam M; Neal, David T; Sheeran, Paschal; Wood, Wendy

2015-11-01

Strategies are needed to ensure that the U.S. Government meets its goals for improving the health of the nation (e.g., Healthy People 2020). To date, progress toward these goals has been undermined by a set of discernible challenges: People lack sufficient motivation, they frequently fail to translate healthy intentions into action, their efforts are undermined by the persistence of prior unhealthy habits, and they have considerable difficulty maintaining new healthy patterns of behavior. Guided by advances in psychological science, we provide innovative, evidence-based policies that address each of these challenges and, if implemented, will enhance people's ability to create and maintain healthy behavioral practices. © The Author(s) 2015.

Partners in Research: Developing a Model for Undergraduate Faculty-Student Collaboration.

PubMed

Reitmaier Koehler, Amy; Reveling Smith, Linda; Davies, Susan; Mangan-Danckwart, Deborah

2015-10-09

Maintaining scholarship while delivering an undergraduate nursing program is a challenge for nursing faculty. In this paper, we describe an approach that involves undergraduate nursing students in a program of faculty research, which evaluates new approaches to teaching and learning. Students work with faculty to develop a research proposal, identifying specific questions and exploring relevant literature. Projects may include original data collection with faculty supervision, or secondary analysis of existing datasets. Foci have included partnership learning between nursing students and older adults, models of sustainability for a traveling health clinic, and experiences of aging. Findings and recommendations feed into the broader faculty research agenda, provide a foundation for subsequent projects, and inform further development of educational programs. Students have presented at local and national conferences and developed papers for publication based on this joint work. We describe the benefits and challenges of these partnerships, drawing upon student and faculty reflections.

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

PubMed

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

2018-04-01

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

Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia.

PubMed

Sajith, Sreedharan Geetha; Liew, Siew Fai; Tor, Phern Chern

2017-03-01

There are several reports of electroconvulsive therapy (ECT) used in autism spectrum disorder (ASD) in the context of catatonic symptoms. We describe response to ECT in two adults with ASD and intellectual disability with intractable aggression and self-injurious behaviors associated with catatonic symptoms who had not responded to standard interventions. Unilateral ECT at a frequency of 3 times a week was given followed by weekly maintenance ECT. Patients' catatonic symptoms included episodes of agitation and echophenomena. Electroconvulsive therapy resulted in significant improvement in their behavior problems but 1 patient relapsed when the ECT was discontinued or frequency of treatment reduced. The second patient required 2 courses of ECT before improvement which was maintained on weekly ECT. Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.

Ethical challenges in social media engagement and research: considerations for code of engagement practices.

PubMed

Gehner, Monika; Oughton, Deborah

2016-06-01

Social media have great potential for effectively communicating about public health risks so people make healthier and safer choices. If used appropriately, social media can strengthen trust between the public and the institution. If used inappropriately, it may also create distrust. This note addresses some of the ethical challenges in using social media for communication and research. It reflects on opportunities in social media risk communication based on experience from the World Health Organization (WHO) and suggests a code of engagement be included in corporate social media policies that contain guidance as to what conduct is or is not appropriate with a view to maintaining public trust in the institution. The note concludes with considerations about the ethical use of social media in research, which is particularly relevant for entities communicating about ionizing radiation, including during emergency situations.

Getting Australia more active: challenges and opportunities for health promotion.

PubMed

Hills, A P; Street, S J; Harris, N

2014-04-01

A growing body of evidence demonstrates that regular physical activity promotes health and assists in the prevention of non-communicable diseases but this is presently curtailed by low and unhealthy participation rates in Australia and comparable industrialised countries. Compounding the problem is knowledge that physical inactivity is independently associated with poor health outcomes. Despite physical activity being described as public health's 'best bet' or 'best buy', motivating individuals and groups to adopt and maintain physical activity continues to be a major challenge for health professionals. Global advocacy for prevention efforts must be operationalised through national to local strategies to promote and support physical activity in multiple settings including the home, schools and workplace. The Australian health promotion community has and continues to play a leadership role in physical activity promotion. However, there is an urgent need to continue to promote the importance of physical activity, along with its pivotal role in the prevention of non-communicable diseases, alongside related agendas including healthy diets, tobacco control and environmental sustainability. This commentary overviews the contemporary status of physical activity promotion in Australia and identifies key challenges and opportunities moving forward.

Monitoring challenges and innovative ideas

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

O'Neill, R.V.; Hunsaker, C.T.; Levine, D.A.

1990-01-01

Monitoring programs are difficult to design even when they focus on specific problems. Ecosystems are complex, and it is often impossible to predetermine what aspects of system structure or dynamics will respond to a specific insult. It is equally difficult to interpret whether a response is a stabilizing compensatory mechanism or a real loss of capacity to maintain the ecosystem. The problems are compounded in a broad monitoring program designed to assess ecosystem health'' at regional and continental scales. It is challenging in the extreme to monitor ecosystem response, at any scale, to past insults as well as an unknownmore » future array of impacts. The present paper will examine some of the fundamental issues and challenges raised by large-scale monitoring efforts. The challenges will serve as a framework and as an excuse to discuss several important topics in more detail. Following the discussion of challenges, we suggest some basic innovations that could be important across a range of monitoring programs. The innovations include integrative measures, innovative methodology, and creative interpretation. 59 refs., 1 tab.« less

A Design for Maintaining Maritime Superiority. Version 1.0

DTIC Science & Technology

2016-01-01

global force is the traffic on the oceans, seas, and waterways, including the sea floor – the classic maritime system. For millennia, the seas have...turn driving an accelerating rate of change – from music to medicine, from microfinance to missiles. 2 The third interrelated force is the...continues to grow. Why a “Design?” The scope and complexity of the challenges we face demand a different approach than that offered by a classic

Decline in Radiation Hardened Microcircuit Infrastructure

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.

2015-01-01

Two areas of radiation hardened microcircuit infrastructure will be discussed: 1) The availability and performance of radiation hardened microcircuits, and, and 2) The access to radiation test facilities primarily for proton single event effects (SEE) testing. Other areas not discussed, but are a concern include: The challenge for maintaining radiation effects tool access for assurance purposes, and, the access to radiation test facilities primarily for heavy ion single event effects (SEE) testing. Status and implications will be discussed for each area.

Redo thoracic endovascular aortic repair due to endoleak with celiac artery snorkeling.

PubMed

Planer, David; Bliagos, Dimitrios; Gray, William A

2011-10-01

Reintervention due to endoleak of aortic endograft repair is often challenging. Herein, we report endovascular endoleak repair in a patient with previous thoracic and abdominal endovascular grafts with extensive coverage of the aorta. The present technique included snorkeling of the celiac trunk to preserve antegrade flow in the celiac artery and to maintain future options for reintervention. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

The Chandra X-ray Center data system: supporting the mission of the Chandra X-ray Observatory

NASA Astrophysics Data System (ADS)

Evans, Janet D.; Cresitello-Dittmar, Mark; Doe, Stephen; Evans, Ian; Fabbiano, Giuseppina; Germain, Gregg; Glotfelty, Kenny; Hall, Diane; Plummer, David; Zografou, Panagoula

2006-06-01

The Chandra X-ray Center Data System provides end-to-end scientific software support for Chandra X-ray Observatory mission operations. The data system includes the following components: (1) observers' science proposal planning tools; (2) science mission planning tools; (3) science data processing, monitoring, and trending pipelines and tools; and (4) data archive and database management. A subset of the science data processing component is ported to multiple platforms and distributed to end-users as a portable data analysis package. Web-based user tools are also available for data archive search and retrieval. We describe the overall architecture of the data system and its component pieces, and consider the design choices and their impacts on maintainability. We discuss the many challenges involved in maintaining a large, mission-critical software system with limited resources. These challenges include managing continually changing software requirements and ensuring the integrity of the data system and resulting data products while being highly responsive to the needs of the project. We describe our use of COTS and OTS software at the subsystem and component levels, our methods for managing multiple release builds, and adapting a large code base to new hardware and software platforms. We review our experiences during the life of the mission so-far, and our approaches for keeping a small, but highly talented, development team engaged during the maintenance phase of a mission.

Measure Today, Here Tomorrow: Exploring IR's Role in Producing Indicators that Will Help Assure Sustainable Institutions and a Sustainable Society

ERIC Educational Resources Information Center

Litten, Larry; Newport, David

2004-01-01

Colleges and universities face a variety of challenges that come from our use of natural resources (e.g., energy, waste production)--the sustainability challenge--and maintaining trust among stakeholders--the accountability challenge. Corporations are adopting standardized reporting to address these challenges. We submit that Institutional…

Bovine Genome Database: supporting community annotation and analysis of the Bos taurus genome

PubMed Central

2010-01-01

Background A goal of the Bovine Genome Database (BGD; http://BovineGenome.org) has been to support the Bovine Genome Sequencing and Analysis Consortium (BGSAC) in the annotation and analysis of the bovine genome. We were faced with several challenges, including the need to maintain consistent quality despite diversity in annotation expertise in the research community, the need to maintain consistent data formats, and the need to minimize the potential duplication of annotation effort. With new sequencing technologies allowing many more eukaryotic genomes to be sequenced, the demand for collaborative annotation is likely to increase. Here we present our approach, challenges and solutions facilitating a large distributed annotation project. Results and Discussion BGD has provided annotation tools that supported 147 members of the BGSAC in contributing 3,871 gene models over a fifteen-week period, and these annotations have been integrated into the bovine Official Gene Set. Our approach has been to provide an annotation system, which includes a BLAST site, multiple genome browsers, an annotation portal, and the Apollo Annotation Editor configured to connect directly to our Chado database. In addition to implementing and integrating components of the annotation system, we have performed computational analyses to create gene evidence tracks and a consensus gene set, which can be viewed on individual gene pages at BGD. Conclusions We have provided annotation tools that alleviate challenges associated with distributed annotation. Our system provides a consistent set of data to all annotators and eliminates the need for annotators to format data. Involving the bovine research community in genome annotation has allowed us to leverage expertise in various areas of bovine biology to provide biological insight into the genome sequence. PMID:21092105

A review of design issues specific to hypersonic flight vehicles

NASA Astrophysics Data System (ADS)

Sziroczak, D.; Smith, H.

2016-07-01

This paper provides an overview of the current technical issues and challenges associated with the design of hypersonic vehicles. Two distinct classes of vehicles are reviewed; Hypersonic Transports and Space Launchers, their common features and differences are examined. After a brief historical overview, the paper takes a multi-disciplinary approach to these vehicles, discusses various design aspects, and technical challenges. Operational issues are explored, including mission profiles, current and predicted markets, in addition to environmental effects and human factors. Technological issues are also reviewed, focusing on the three major challenge areas associated with these vehicles: aerothermodynamics, propulsion, and structures. In addition, matters of reliability and maintainability are also presented. The paper also reviews the certification and flight testing of these vehicles from a global perspective. Finally the current stakeholders in the field of hypersonic flight are presented, summarizing the active programs and promising concepts.

Analysis of Behavioral Indicators as a Measure of Satiation.

PubMed

Scalzo, Rachel; Davis, Tonya N

2017-03-01

Providing noncontingent access to a stimulus until an individual displays behavioral indicators of satiation has been used to determine when an abolishing operation is in effect, but there has been variation in its application in the literature. Four males diagnosed with autism spectrum disorder with tangibly maintained challenging behavior participated in this study. Individualized behavioral indicators were identified and verified to determine when each participant was finished playing with his/her preferred item. Three presession conditions were manipulated including restricted access to the tangible stimulus for 30 min, access to the tangible stimulus until the display of one behavioral indicator, and access to the tangible stimulus until the display of three behavioral indicators. Each presession condition was followed by a tangible condition of the functional analysis to measure challenging behavior. Results indicated that presession access to a tangible stimulus until the display of three behavioral indicators produced a greater abative effect on challenging behavior than one behavioral indicator.

Health disparities among health care workers.

PubMed

Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann

2010-01-01

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Presidential Green Chemistry Challenge: 2008 Small Business Award

EPA Pesticide Factsheets

Presidential Green Chemistry Challenge 2008 award winner, SiGNa Chemistry, stabilized highly reactive sodium and lithium by encapsulating them in porous, sand-like powder, maintaining their usefulness in synthetic reactions.

An assessment of maintainability of elevator system to improve facilities management knowledge-base

NASA Astrophysics Data System (ADS)

Siti, N. A.; Asmone, A. S.; Chew, M. Y. L.

2018-02-01

Elevator system is a highly specialized machinery that requires technicians that have a wider array of knowledge in maintaining the system to be safe and reliable. While attaining reliable data of elevator malfunction become challenges, this study has filled the gap by gathering the management-maintenance issues and operational defects of elevator system. Forty-three types of operation defects were found and the consequence defects and their possible causes of occurrences were discussed. To respond to the prime challenges of maintaining elevator system provided by the industry players’ perspective, a theoretical framework is established as a recommendation to improve knowledge base of defects in elevator system which comprises good practices, and solutions to rectify each defects found. Hence, this research paper has theoretically improved the knowledge base of maintainability of elevator system and provide meaningful guidelines in practical senses to the industry professionals.

Perceptions of the value of traditional ecological knowledge to formal school curricula: opportunities and challenges from Malekula Island, Vanuatu

PubMed Central

2011-01-01

Background The integration of traditional ecological knowledge (TEK) into formal school curricula may be a key tool for the revitalisation of biocultural diversity, and has the potential to improve the delivery of educational objectives. This paper explores perceptions of the value of TEK to formal education curricula on Malekula Island, Vanuatu. We conducted 49 interviews with key stakeholders (local TEK experts, educators, and officials) regarding the use of the formal school system to transmit, maintain, and revitalise TEK. Interviews also gathered information on the areas where TEK might add value to school curricula and on the perceived barriers to maintaining and revitalising TEK via formal education programs. Results Participants reported that TEK had eroded on Malekula, and identified the formal school system as a principal driver. Most interviewees believed that if an appropriate format could be developed, TEK could be included in the formal education system. Such an approach has potential to maintain customary knowledge and practice in the focus communities. Participants identified several specific domains of TEK for inclusion in school curricula, including ethnomedical knowledge, agricultural knowledge and practice, and the reinforcement of respect for traditional authority and values. However, interviewees also noted a number of practical and epistemological barriers to teaching TEK in school. These included the cultural diversity of Malekula, tensions between public and private forms of knowledge, and multiple values of TEK within the community. Conclusions TEK has potential to add value to formal education systems in Vanuatu by contextualising the content and process of curricular delivery, and by facilitating character development and self-awareness in students. These benefits are congruent with UNESCO-mandated goals for curricular reform and provide a strong argument for the inclusion of TEK in formal school systems. Such approaches may also assist in the maintenance and revitalisation of at-risk systems of ethnobiological knowledge. However, we urge further research attention to the significant epistemological challenges inherent in including TEK in formal school, particularly as participants noted the potential for such approaches to have negative consequences. PMID:22112326

Perceptions of the value of traditional ecological knowledge to formal school curricula: opportunities and challenges from Malekula Island, Vanuatu.

PubMed

McCarter, Joe; Gavin, Michael C

2011-11-23

The integration of traditional ecological knowledge (TEK) into formal school curricula may be a key tool for the revitalisation of biocultural diversity, and has the potential to improve the delivery of educational objectives. This paper explores perceptions of the value of TEK to formal education curricula on Malekula Island, Vanuatu. We conducted 49 interviews with key stakeholders (local TEK experts, educators, and officials) regarding the use of the formal school system to transmit, maintain, and revitalise TEK. Interviews also gathered information on the areas where TEK might add value to school curricula and on the perceived barriers to maintaining and revitalising TEK via formal education programs. Participants reported that TEK had eroded on Malekula, and identified the formal school system as a principal driver. Most interviewees believed that if an appropriate format could be developed, TEK could be included in the formal education system. Such an approach has potential to maintain customary knowledge and practice in the focus communities. Participants identified several specific domains of TEK for inclusion in school curricula, including ethnomedical knowledge, agricultural knowledge and practice, and the reinforcement of respect for traditional authority and values. However, interviewees also noted a number of practical and epistemological barriers to teaching TEK in school. These included the cultural diversity of Malekula, tensions between public and private forms of knowledge, and multiple values of TEK within the community. TEK has potential to add value to formal education systems in Vanuatu by contextualising the content and process of curricular delivery, and by facilitating character development and self-awareness in students. These benefits are congruent with UNESCO-mandated goals for curricular reform and provide a strong argument for the inclusion of TEK in formal school systems. Such approaches may also assist in the maintenance and revitalisation of at-risk systems of ethnobiological knowledge. However, we urge further research attention to the significant epistemological challenges inherent in including TEK in formal school, particularly as participants noted the potential for such approaches to have negative consequences.

Overview of Variable-Speed Power-Turbine Research

NASA Technical Reports Server (NTRS)

Welch, Gerard E.

2011-01-01

The vertical take-off and landing (VTOL) and high-speed cruise capability of the NASA Large Civil Tilt-Rotor (LCTR) notional vehicle is envisaged to enable increased throughput in the national airspace. A key challenge of the LCTR is the requirement to vary the main rotor speeds from 100% at take-off to near 50% at cruise as required to minimize mission fuel burn. The variable-speed power-turbine (VSPT), driving a fixed gear-ratio transmission, provides one approach for effecting this wide speed variation. The key aerodynamic and rotordynamic challenges of the VSPT were described in the FAP Conference presentation. The challenges include maintaining high turbine efficiency at high work factor, wide (60 deg.) of incidence variation in all blade rows due to the speed variation, and operation at low Reynolds numbers (with transitional flow). The PT -shaft of the VSPT must be designed for safe operation in the wide speed range required, and therefore poses challenges associated with rotordynamics. The technical challenges drive research activities underway at NASA. An overview of the NASA SRW VSPT research activities was provided. These activities included conceptual and preliminary aero and mechanical (rotordynamics) design of the VSPT for the LCTR application, experimental and computational research supporting the development of incidence tolerant blading, and steps toward component-level testing of a variable-speed power-turbine of relevance to the LCTR application.

Systems Integration Fact Sheet

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

None

2016-06-01

This fact sheet is an overview of the Systems Integration subprogram at the U.S. Department of Energy SunShot Initiative. The Systems Integration subprogram enables the widespread deployment of safe, reliable, and cost-effective solar energy technologies by addressing the associated technical and non-technical challenges. These include timely and cost-effective interconnection procedures, optimal system planning, accurate prediction of solar resources, monitoring and control of solar power, maintaining grid reliability and stability, and many more. To address the challenges associated with interconnecting and integrating hundreds of gigawatts of solar power onto the electricity grid, the Systems Integration program funds research, development, and demonstrationmore » projects in four broad, interrelated focus areas: grid performance and reliability, dispatchability, power electronics, and communications.« less

Supporting Parents' Pain Care Involvement With Their Children With Acute Lymphoblastic Leukemia: A Qualitative Interpretive Description.

PubMed

Bettle, Amanda; Latimer, Margot; Fernandez, Conrad; Hughes, Jean

Children with acute lymphoblastic leukemia experience pain from the disease, treatment, and procedures. Parents can be effective in managing their child's pain, but little is systematically known about how they do this. Appreciative inquiry was used to frame the study within a strengths-based lens and interpretive descriptive methods were used to describe pain sources, parents' pain care role, and key structures supporting parents pain care involvement. Eight paediatric oncology clinic nurses and 10 parents participated. Six key themes per group were identified. Parent themes included establishing therapeutic relationships, relearning how to care for my child, overcoming challenges and recognizing pain, learning parent specific strategies, empowering to take active pain care role, and maintaining relationships. Nurse themes included establishing therapeutic relationships, preparing parents to care for their child, facilitating pain assessment, teaching parents best pain care, empowering parents, and maintaining relationships. These findings can be used to guide clinical practice and future research.

Effects of Activity Schedules on Challenging Behavior for Children with Autism

ERIC Educational Resources Information Center

Scalzo, Rachel; Davis, Tonya N.; Weston, Regan; Dukes, Elizabeth; Leeper, Dana; Min, Nandar; Mom, Allen; Stone, Jessica; Weber, Alex

2017-01-01

This study examined activity schedules as an intervention to decrease challenging behavior and increase academic engagement during work tasks scheduled after free play activities in three boys diagnosed with autism spectrum disorder (ASD). Functional analysis results indicated all participants' challenging behavior was maintained, at least in…

A dietary cholesterol challenge study to assess Chlorella supplementation in maintaining healthy lipid levels in adults: a double-blinded, randomized, placebo-controlled study.

PubMed

Kim, Sangmi; Kim, Joohee; Lim, Yeni; Kim, You Jin; Kim, Ji Yeon; Kwon, Oran

2016-05-13

Previous animal studies suggested that Chlorella, a unicellular green alga, has a preventive role in maintaining serum cholesterol levels against excess dietary cholesterol intake. This study aimed to conduct a pioneering investigation to clarify this issue in healthy subjects by adopting a dietary cholesterol challenge, which has not been used previously in similar studies of Chlorella in hypercholesterolemia. In this double blind, randomized, placebo-controlled study, 34 participants ingested 510 mg of dietary cholesterol from three eggs concomitantly with a usual dose of Chlorella (5 g/d) or a matched placebo for 4 weeks. The dietary cholesterol challenge induced consistently higher concentrations of serum total cholesterol (TC, P < 0.001), LDL-C (P = 0.004), and HDL-C (P = 0.010) compared with baseline values, suggesting that the challenge was reliable. Thus, we observed a preventive action of Chlorella in maintaining serum TC versus placebo levels (3.5 % versus 9.8 %, respectively; P = 0.037) and LDL-C versus placebo levels (1.7 % versus 14.3 %, respectively; P = 0.012) against excessive dietary cholesterol intake and in augmenting HDL-C versus placebo levels (8.3 % versus 3.8 %, respectively). Furthermore, serum α-carotene showed the best separation between the placebo and Chlorella groups (R(2)X and R(2)Y > 0.5; Q(2) > 0.4). The results suggest that a fully replicated dietary cholesterol challenge may be useful in assessing the effectiveness of dietary supplements in maintaining the serum lipid profiles of adults whose habitual diets are high in cholesterol. WHO International Clinical Trials Registry Platform ( KCT0000258 ).

Improving Gram stain proficiency in hospital and satellite laboratories that do not have microbiology.

PubMed

Guarner, Jeannette; Street, Cassandra; Matlock, Margaret; Cole, Lisa; Brierre, Francoise

2017-03-01

Consolidation of laboratories has left many hospitals and satellite laboratories with minimal microbiologic testing. In many hospitals and satellite laboratories, Gram stains on primary specimens are still performed despite difficultly in maintaining proficiency. To maintain Gram stain proficiency at a community 450-bed hospital with an active emergency room we designed bimonthly challenges that require reporting Gram staining and morphology of different organisms. The challenges consist of five specimens prepared by the reference microbiology laboratory from cultures and primary specimens. Twenty to 23 medical laboratory scientists participate reading the challenges. Results from the challenges are discussed with each medical laboratory scientists. In addition, printed images from the challenges are presented at huddle to add microbiology knowledge. On the first three challenges, Gram staining was read correctly in 71%-77% of the time while morphology 53%-66%. In the last six challenges correct answers for Gram stain were 77%-99% while morphology 73%-96%. We observed statistically significant improvement when reading Gram stains by providing frequent challenges to medical laboratory scientists. The clinical importance of Gram stain results is emphasized during huddle presentations increasing knowledge and motivation to perform the test for patients.

A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team.

PubMed

Green, Beverly B; Fuller, Sharon; Anderson, Melissa L; Mahoney, Christine; Mendy, Peter; Powell, Susan L

2017-01-01

Multiple randomized controlled trials have demonstrated that mailed fecal testing programs are effective in increasing colorectal cancer screening participation. However, few healthcare organization in the US have Implemented such programs. Stakeholders from one clinic in an integrated healthcare system in Washington State initiated collaboration with researchers with expertise in CRC screening, aiming to increase screening rates at their clinic. Age-eligible individuals who were overdue for CRC screening and had previously completed a fecal test were randomized to receive mailed fecal immunochemical test kits (FIT) at the start of the project (Early) or 6 months later (Late). Outcomes included comparing FIT completion at 6 months by randomization group, and overall CRC screening rates at 12 months. We also assessed implementation facilitators and challenges. Overall 2,421 FIT tests were mailed at a cost of $10,739. At 6 months, FIT completion was significantly higher among the Early compared to the Late group (62% vs.47%, p <0.001). By 12 months, after both groups had received mailings, 71% in each group had completed a FIT. The clinic's overall CRC screening rate was 75.1% at baseline and 78.0% 12 months later. Key constructs associated with successful program implementation included strong stakeholder involvement, use of evidence-based strategies, simplicity, and low cost. Challenges included lack of a plan for maintaining the program. Collaboration between clinic stakeholders and researchers led to a successful project that rapidly increased CRC screening rates. However, institutional normalization of the program would be required to maintain it.

A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team

PubMed Central

Green, Beverly B.; Fuller, Sharon; Anderson, Melissa L.; Mahoney, Christine; Mendy, Peter; Powell, Susan L.

2017-01-01

Background Multiple randomized controlled trials have demonstrated that mailed fecal testing programs are effective in increasing colorectal cancer screening participation. However, few healthcare organization in the US have Implemented such programs. Methods Stakeholders from one clinic in an integrated healthcare system in Washington State initiated collaboration with researchers with expertise in CRC screening, aiming to increase screening rates at their clinic. Age-eligible individuals who were overdue for CRC screening and had previously completed a fecal test were randomized to receive mailed fecal immunochemical test kits (FIT) at the start of the project (Early) or 6 months later (Late). Outcomes included comparing FIT completion at 6 months by randomization group, and overall CRC screening rates at 12 months. We also assessed implementation facilitators and challenges. Results Overall 2,421 FIT tests were mailed at a cost of $10,739. At 6 months, FIT completion was significantly higher among the Early compared to the Late group (62% vs.47%, p <0.001). By 12 months, after both groups had received mailings, 71% in each group had completed a FIT. The clinic’s overall CRC screening rate was 75.1% at baseline and 78.0% 12 months later. Key constructs associated with successful program implementation included strong stakeholder involvement, use of evidence-based strategies, simplicity, and low cost. Challenges included lack of a plan for maintaining the program. Discussion Collaboration between clinic stakeholders and researchers led to a successful project that rapidly increased CRC screening rates. However, institutional normalization of the program would be required to maintain it. PMID:29399669

Hospital agenda to prioritize. Interview by Donald E. Johnson..

PubMed

Forsyth, J D

1991-09-01

How does a teaching hospital balance the needs of patient care with its educational mission? What changes in focus must the CEO make to accommodate reductions in federal funding while maintaining academic excellence? In the following interview with Health Care Strategic Management's Donald E. L. Johnson, John D. Forsyth, executive director of the University of Michigan Hospitals, discusses the challenges facing his institution. The interview focuses on many topics including setting priorities, funding researchers and countering any "anti-science" perceptions.

Low-fat and delicious: can we break the taste barrier?

PubMed

Kostas, G

1997-07-01

No matter how healthy a food or recipe might be, if it does not taste good, people will not eat it. The professional and personal challenge is to find ways to cook favorite foods in a low-fat and delicious style to maintain health while enjoying foods without guilt. A number of strategies can be employed to reach that goal, including ingredient choices, low-fat product substitutes, cookware, cooking techniques, seasonings, basic cooking and recipe modifications, and the creation of new recipes.

Detector sustainability improvements at LCLS

NASA Astrophysics Data System (ADS)

Browne, Michael C.; Carini, Gabriella; DePonte, Daniel P.; Galtier, Eric C.; Hart, Philip A.; Koralek, J. D.; Mitra, Ankush; Nakahara, Kazutaka

2017-06-01

The Linac Coherent Light Source (LCLS) poses a number of daunting and often unusual challenges to maintaining X-ray detectors, such as proximity to liquid-sample injectors, complex setups with moving components, intense X-ray and optical laser light, and Electromagnetic Pulse (EMP). The Detector and Sample Environment departments at LCLS are developing an array of engineering, monitoring, and administrative controls solutions to better address these issues. These include injector improvements and monitoring methods, fast online damage recognition algorithms, EMP mapping and protection, actively cooled filters, and more.

Laboratory Directed Research and Development Annual Report - Fiscal Year 2000

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

Fisher, Darrell R.; Hughes, Pamela J.; Pearson, Erik W.

The projects described in this report represent the Laboratory's investment in its future and are vital to maintaining the ability to develop creative solutions for the scientific and technical challenges faced by DOE and the nation. In accordance with DOE guidelines, the report provides, a) a director's statement, b) an overview of the laboratory's LDRD program, including PNNL's management process and a self-assessment of the program, c) a five-year project funding table, and d) project summaries for each LDRD project.

Global Power Requires a Global, Persistent Air-to-Air Capability

DTIC Science & Technology

2010-01-01

anywhere on the high seas, and in most coastal waters as well, and sink them if necessary by using guns, missiles, or tor- pedoes . Current Air Force...apparently a number of so-far-undisclosed challenges remain, perhaps including the air refuel- ing of an RPA and maintaining the data link with it in...will remain relatively short- range systems.31 With regard to the data link , a remote pi- lot flies the Predator—our primary opera- tional, fighter-sized

Climate change, cranes, and temperate floodplain ecosystems

USGS Publications Warehouse

King, Sammy L.

2010-01-01

Floodplain ecosystems provide important habitat to cranes globally. Lateral, longitudinal, vertical, and temporal hydrologic connectivity in rivers is essential to maintaining the functions and values of these systems. Agricultural development, flood control, water diversions, dams, and other anthropogenic activities have greatly affected hydrologic connectivity of river systems worldwide and altered the functional capacity of these systems. Although the specific effects of climate change in any given area are unknown, increased intensity and frequency of flooding and droughts and increased air and water temperatures are among many potential effects that can act synergistically with existing human modifications in these systems to create even greater challenges in maintaining ecosystem productivity. In this paper, I review basic hydrologic and geomorphic processes of river systems and use three North American rivers (Guadalupe, Platte, and Rio Grande) that are important to cranes as case studies to illustrate the challenges facing managers tasked with balancing the needs of cranes and people in the face of an uncertain climatic future. Each river system has unique natural and anthropogenic characteristics that will affect conservation strategies. Mitigating the effects of climate change on river systems necessitates an understanding of river/floodplain/landscape linkages, which include people and their laws as well as existing floodplain ecosystem conditions.

Meeting the challenge of new fatherhood during the early weeks.

PubMed

St John, Winsome; Cameron, Catherine; McVeigh, Carol

2005-01-01

To explore new/subsequent Australian fathers' perspectives on the experiences, processes, and life changes in the early weeks of fatherhood. Interpretive study using in-depth interviews and grounded theory analysis techniques, based on a symbolic interactionist framework. Participants were recruited from the postnatal wards of a major public hospital, early discharge program, and early childhood centers in southeast Queensland, Australia. Eighteen first-time/subsequent fathers interviewed 6 to 12 weeks after the birth. Although rewarding, fathers found new or expanding fatherhood to be a significant challenge and time of change. Major themes included making a commitment, taking responsibility, negotiating responsibilities, developing and maintaining relationships, maintaining family integrity, balancing activities, and perceiving the self as father. Work had a major impact on fathers' ability to participate with their family and newborn. To manage, fathers sought to balance the demands of work and home, deal with stressors, manage their time, develop routines, and reprioritize. Fathers developed a sense of themselves as fathers over time, building confidence and deriving satisfaction from their fathering role. A range of competing factors affected fathers' ability to participate in the home with their newborn in the early weeks after birth.

Challenges of service-dog ownership for families with autistic children: lessons for veterinary practitioners.

PubMed

Burrows, Kristen E; Adams, Cindy L

2008-01-01

The purpose of this paper is to describe the challenges of service-dog ownership for families with autistic children. Through a qualitative interview process, this study has found that the integration of a service dog into a home environment is a highly dynamic and interactive process with numerous benefits and challenges. Public-access issues, learning to interpret dog behavior, the time constraints of increased social interactions, and the time of year the dog is placed into the family are important components affecting parental satisfaction. Parent, family, and child challenges included the dog being extra work, finding added time to maintain training, financing care for the dog, and the impact on family dynamics. These factors and challenges were appraised in order to understand the impact that they could have on the perceived success of the placement, parental satisfaction, and the dog itself. Despite the effects and consequences of these challenges, the parents overwhelmingly reported that having a service dog to keep their child safe and to provide companionship was well worth the many inconveniences of service-dog ownership. Most importantly, attention needs to be drawn to these challenges to promote the safety of both the child and the dog, minimize stress on the family, and encourage veterinary support of these highly dynamic relationships.

Durable protection of rhesus macaques immunized with a replicating adenovirus-SIV multigene prime/protein boost vaccine regimen against a second SIVmac251 rectal challenge: role of SIV-specific CD8+ T cell responses.

PubMed

Malkevitch, Nina V; Patterson, L Jean; Aldrich, M Kristine; Wu, Yichen; Venzon, David; Florese, Ruth H; Kalyanaraman, V S; Pal, Ranajit; Lee, Eun Mi; Zhao, Jun; Cristillo, Anthony; Robert-Guroff, Marjorie

2006-09-15

Previously, priming with replication-competent adenovirus-SIV multigenic vaccines and boosting with envelope subunits strongly protected 39% of rhesus macaques against rectal SIV(mac251) challenge. To evaluate protection durability, eleven of the protected and two SIV-infected unimmunized macaques that controlled viremia were re-challenged rectally with SIV(mac251). Strong protection was observed in 8/11 vaccinees, including two exhibiting <50 SIV RNA copies. Decreased viremia compared to naïve controls was observed in the other three. The SIV-infected unimmunized macaques modestly controlled viremia but exhibited CD4 counts < or =200, unlike the protected macaques. Durable protection was associated with significantly increased SIV-specific ELISPOT responses and lymphoproliferative responses to p27 at re-challenge. After CD8 depletion, 2 of 8 re-challenged, protected vaccinees maintained <50 SIV RNA copies; SIV RNA emerged in 6. Re-appearance of CD8 cells and restoration of SIV-specific cellular immunity coincided with viremia suppression. Overall, cellular immunity induced by vaccination and/or low-level, inapparent viremia post-first SIV(mac251) challenge, was associated with durable protection against re-challenge.

Design and Application of the Exploration Maintainability Analysis Tool

NASA Technical Reports Server (NTRS)

Stromgren, Chel; Terry, Michelle; Crillo, William; Goodliff, Kandyce; Maxwell, Andrew

2012-01-01

Conducting human exploration missions beyond Low Earth Orbit (LEO) will present unique challenges in the areas of supportability and maintainability. The durations of proposed missions can be relatively long and re-supply of logistics, including maintenance and repair items, will be limited or non-existent. In addition, mass and volume constraints in the transportation system will limit the total amount of logistics that can be flown along with the crew. These constraints will require that new strategies be developed with regards to how spacecraft systems are designed and maintained. NASA is currently developing Design Reference Missions (DRMs) as an initial step in defining future human missions. These DRMs establish destinations and concepts of operation for future missions, and begin to define technology and capability requirements. Because of the unique supportability challenges, historical supportability data and models are not directly applicable for establishing requirements for beyond LEO missions. However, supportability requirements could have a major impact on the development of the DRMs. The mass, volume, and crew resources required to support the mission could all be first order drivers in the design of missions, elements, and operations. Therefore, there is a need for enhanced analysis capabilities to more accurately establish mass, volume, and time requirements for supporting beyond LEO missions. Additionally, as new technologies and operations are proposed to reduce these requirements, it is necessary to have accurate tools to evaluate the efficacy of those approaches. In order to improve the analysis of supportability requirements for beyond LEO missions, the Space Missions Analysis Branch at the NASA Langley Research Center is developing the Exploration Maintainability Analysis Tool (EMAT). This tool is a probabilistic simulator that evaluates the need for repair and maintenance activities during space missions and the logistics and crew requirements to support those activities. Using a Monte Carlo approach, the tool simulates potential failures in defined systems, based on established component reliabilities, and then evaluates the capability of the crew to repair those failures given a defined store of spares and maintenance items. Statistical analysis of Monte Carlo runs provides probabilistic estimates of overall mission safety and reliability. This paper will describe the operation of the EMAT, including historical data sources used to populate the model, simulation processes, and outputs. Analysis results are provided for a candidate exploration system, including baseline estimates of required sparing mass and volume. Sensitivity analysis regarding the effectiveness of proposed strategies to reduce mass and volume requirements and improve mission reliability is included in these results.

Examination of an Antecedent Communication Intervention to Reduce Tangibly Maintained Challenging Behavior: A Controlled Analog Analysis

ERIC Educational Resources Information Center

O'Reilly, Mark; Fragale, Christina; Gainey, Summer; Kang, Soyeon; Koch, Heather; Shubert, Jennifer; El Zein, Farah; Longino, Deanna; Chung, Moon; Xu, Ziwei; White, Pamela; Lang, Russell; Davis, Tonya; Rispoli, Mandy; Lancioni, Giulio; Didden, Robert; Healy, Olive; Kagohara, Deborah; van der Meer, Larah; Sigafoos, Jeff

2012-01-01

We examined the influence of an antecedent communication intervention on challenging behavior for three students with developmental disorders. Students were taught to request tangible items that were identified as reinforcers for challenging behavior in a prior functional analysis. Individual participant multielement and reversal designs were used…

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

ERIC Educational Resources Information Center

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

2016-01-01

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

Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain.

PubMed

Elfhag, K; Rössner, S

2005-02-01

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.

Promoting weight maintenance with electronic health record tools in a primary care setting: Baseline results from the MAINTAIN-pc trial.

PubMed

Conroy, Molly B; Bryce, Cindy L; McTigue, Kathleen M; Tudorascu, Dana; Gibbs, Bethany Barone; Comer, Diane; Hess, Rachel; Huber, Kimberly; Simkin-Silverman, Laurey R; Fischer, Gary S

2017-03-01

Maintaining weight loss is a significant challenge in combating obesity. The goal of Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) is to evaluate the use of tools delivered through an electronic health record (EHR) and patient portal, with or without health coach support, to help primary care patients maintain weight loss. EHR tools include flowsheets, standardized surveys, and secure patient messaging. Inclusion criteria were age 18-75years, voluntary 5% weight loss in the past 2years with prior BMI≥25kg/m 2 , and no bariatric procedures in past 5years. Participants were randomized 1:1 to tailored online coaching with EHR tracking tools (CC) or EHR tracking tools alone (TO). We screened 721 individuals between October 2013 and February 2015; 194 participants enrolled (98 CC; 96 TO). The most common reasons for not enrolling included lack of interest (56%), not meeting age or weight loss criteria (17%), and no verified prior weight loss (10%). At baseline, participants were 53.4 (SD 12.2) years old, 74% female, and 88% White; 95% reported moderate physical activity. Average weight and BMI at baseline were 189.1 (SD 42.1) lbs and 30.4 (5.9) kg/m 2 , respectively. Pre-weight loss BMI was 34.4 (SD 6.5) kg/m 2 . Participants lost an average of 11.3% (SD 6.6) of their body weight before enrolling. Demographic and clinical characteristics did not differ by randomized group. The study successfully identified and recruited primary care patients with recent voluntary weight loss for participation in a weight maintenance program that uses EHR-based tools. Copyright © 2017 Elsevier Inc. All rights reserved.

Hyponatremia-associated rhabdomyolysis following exercise in an adolescent with cystic fibrosis.

PubMed

Kaskavage, Jillian; Sklansky, Daniel

2012-07-01

Adolescents with well-controlled cystic fibrosis, including good lung function and appropriate growth, commonly participate in competitive athletic activities. We present the case of an adolescent male with cystic fibrosis, hyponatremia, dehydration, and rhabdomyolysis after participating in football practice on a summer morning. The patient presented with severe myalgia and serum sodium of 129 mmol/L, chloride 90 mmol/L, and creatine phosphokinase 1146 U/L. Aggressive hydration with intravenous 0.9% saline resulted in clinical improvement with no renal or muscular sequelae. Health care providers need to educate patients with cystic fibrosis about maintaining adequate hydration and sodium repletion during exercise. Research is needed regarding the appropriate amount and composition of oral rehydration fluids in exercising individuals with cystic fibrosis, as the physiology encountered in these patients provides a unique challenge to maintaining electrolyte balance and stimulation of thirst.

Challenges and strategies for cohort retention and data collection in an indigenous population: Australian Aboriginal Birth Cohort.

PubMed

Lawrance, Megan; Sayers, Susan M; Singh, Gurmeet R

2014-02-26

Longitudinal prospective birth cohort studies are pivotal to identifying fundamental causes and determinants of disease and health over the life course. There is limited information about the challenges, retention, and collection strategies in the study of Indigenous populations. The aim is to describe the follow-up rates of an Australian Aboriginal Birth Cohort study and how they were achieved. Participants were 686 babies enrolled between January 1987 and March 1990, born to a mother recorded in the Delivery Suite Register of the Royal Darwin Hospital (RDH) as a self-identified Aboriginal. The majority of the participants (70%) resided in Northern Territory within rural, remote and very remote Aboriginal communities that maintain traditional connections to their land and culture. The Aboriginal communities are within a sparsely populated (0.2 people/ km2) area of approximately 900,000 km² (347 sq miles), with poor communication and transport infrastructures. Follow-ups collecting biomedical and lifestyle data directly from participants in over 40 locations were conducted at 11.4 years (Wave-2) and 18.2 years (Wave-3), with Wave-4 follow-up currently underway. Follow-ups at 11 and 18 years of age successfully examined 86% and 72% of living participants respectively. Strategies addressing logistic, cultural and ethical challenges are documented. Satisfactory follow-up rates of a prospective longitudinal Indigenous birth cohort with traditional characteristics are possible while maintaining scientific rigor in a challenging setting. Approaches included flexibility, respect, and transparent communication along with the adoption of culturally sensitive behaviours. This work should inform and assist researchers undertaking or planning similar studies in Indigenous and developing populations.

Challenged but not threatened: Managing health in advanced age.

PubMed

Wiles, Janine; Miskelly, Philippa; Stewart, Oneroa; Kerse, Ngaire; Rolleston, Anna; Gott, Merryn

2018-06-20

In this paper we reflect on discussions with people of advanced age in Āotearoa New Zealand, and draw on theoretical frameworks of resilience and place in old age, to explore insights about the ways older people maintain quality of life and health. Twenty community-dwelling people of advanced age (85+) were recruited in 2015-16 from a large multidisciplinary longitudinal study of advanced age. These twenty participated in interviews about health in advanced age, impact of illnesses, interactions with clinicians, access to information, support for managing health, and perceptions of primary care, medications, and other forms of assistance. We use a positioning theory framework drawing on thematic and narrative analysis to understand the dynamic ways people in advanced age position themselves and the ways they age well through speech acts and storylines. People in advanced age saw themselves as challenged, rather than threatened, by adversities, and positioned themselves as able to draw on a lifetime of experience and resourcefulness and collaborations with supporters to deal with challenges. Key strategies include downplaying illness and resisting biomedical discourses of complexity, positioning embodied selves as having agency, and creative adaptation in the face of loss. People in advanced age exhibit resilience, maintaining wellbeing, autonomy and good physical and mental quality of life even while living with challenges such as functional decline and multi-morbidities. These findings have significance for supporters of older people, emphasising the need to move away from a narrow focus on problems to working together WITH people in advanced age to offer a more holistic approach that encourages and enhances adaptation and flexibility, rather than rigid and counterproductive coping patterns. Copyright © 2018 Elsevier Ltd. All rights reserved.

The decay of Redox-stress Response Capacity is a substantive characteristic of aging: Revising the redox theory of aging.

PubMed

Meng, Jiao; Lv, Zhenyu; Qiao, Xinhua; Li, Xiaopeng; Li, Yazi; Zhang, Yuying; Chen, Chang

2017-04-01

Aging is tightly associated with redox events. The free radical theory of aging indicates that redox imbalance may be an important factor in the aging process. Most studies about redox and aging focused on the static status of oxidative stress levels, there has been little research investigating differential responses to redox challenge during aging. In this study, we used Caenorhabditis elegans and human fibroblasts as models to compare differential responses to oxidative stress challenge in young and old individuals. In response to paraquat stress, young individuals generated more ROS and activated signaling pathways including p-ERK, p-AKT and p-AMPKα/β. After the initial response, young individuals then promoted NRF2 translocation and induced additional antioxidant enzymes and higher expression of phase II enzymes, including SOD, CAT, GPX, HO-1, GSTP-1and others, to maintain redox homeostasis. Moreover, young individuals also demonstrated a better ability to degrade damaged proteins by up-regulating the expression of chaperones and improving proteasome activity. Based on these data, we propose a new concept "Redox-stress Response Capacity (RRC)", which suggests cells or organisms are capable of generating dynamic redox responses to activate cellular signaling and maintain cellular homeostasis. The decay of RRC is the substantive characteristic of aging, which gives a new understand of the redox theory of aging. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

The Advantages and Challenges of Unannounced Standardized Patients Methodology to Assess Healthcare Communication

PubMed Central

Siminoff, Laura A.; Rogers, Heather L.; Waller, Allison C.; Harris-Haywood, Sonja; Esptein, Ronald M.; Borrell Carrio, Francesc; Gliva-McConvey, Gayle; Longo, Daniel R.

2011-01-01

Objective This paper provides an overview of the implementation of using Unannounced Standardized Patients (USPs) to conduct health communication research in clinical settings. Methods Certain types of health communication situations are difficult to capture because of their rarity or unpredictable nature. In primary care the real reasons for a visit are frequently unknown until the consultation is well under way. Therefore, it is logistically difficult for communication studies to capture many real-time communications between patients and their physicians. Although the USP methodology is ideal for capturing these communication behaviors, challenges to using this method include developing collaborative relationships with clinical practices, logistical issues such as safeguarding the identity of the USP, training USPs and creating their identities, maintaining fidelity to the role, and analyzing the resultant data. Results This paper discusses the challenges and solutions to USP implementation. We provide an example of how to implement a USP study using an on-going study being conducted in primary care practices. Conclusion This paper explores the advantages and challenges as well as strategies to overcome obstacles to implementing a USP study. Practice Implications Despite the challenges, USP methodology can contribute much to our understanding of health communication and practice. PMID:21316182

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

PubMed

Stroud, Karla; O'Doherty, Kieran C

2015-12-01

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

Hydrogen-related challenges for the steelmaker: the search for proper testing

NASA Astrophysics Data System (ADS)

Thiessen, R. G.

2017-06-01

The modern steelmaker of advanced high-strength steels has always been challenged with the conflicting targets of increased strength while maintaining or improving ductility. These new steels help the transportation sector, including the automotive sector, to achieve the goals of increased passenger safety and reduced emissions. With increasing tensile strengths, certain steels exhibit an increased sensitivity towards hydrogen embrittlement (HE). The ability to characterize the material's sensitivity in an as-delivered condition has been developed and accepted (SEP1970), but the complexity of the stress states that can induce an embrittlement together with the wide range of applications for high-strength steels make the development of a standardized test for HE under in-service conditions extremely challenging. Some proposals for evaluating the material's sensitivity give an advantage to materials with a low starting ductility. Despite this, newly developed materials can have a higher original elongation with only a moderate reduction in elongation due to hydrogen. This work presents a characterization of new materials and their sensitivity towards HE. This article is part of the themed issue 'The challenges of hydrogen and metals'.

Hydrogen-related challenges for the steelmaker: the search for proper testing.

PubMed

Thiessen, R G

2017-07-28

The modern steelmaker of advanced high-strength steels has always been challenged with the conflicting targets of increased strength while maintaining or improving ductility. These new steels help the transportation sector, including the automotive sector, to achieve the goals of increased passenger safety and reduced emissions. With increasing tensile strengths, certain steels exhibit an increased sensitivity towards hydrogen embrittlement (HE). The ability to characterize the material's sensitivity in an as-delivered condition has been developed and accepted (SEP1970), but the complexity of the stress states that can induce an embrittlement together with the wide range of applications for high-strength steels make the development of a standardized test for HE under in-service conditions extremely challenging. Some proposals for evaluating the material's sensitivity give an advantage to materials with a low starting ductility. Despite this, newly developed materials can have a higher original elongation with only a moderate reduction in elongation due to hydrogen. This work presents a characterization of new materials and their sensitivity towards HE.This article is part of the themed issue 'The challenges of hydrogen and metals'. © 2017 The Author(s).

Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

PubMed

Hopwood, Nick

2015-01-01

Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed.

ARPA-E LITECAR Challenge

ScienceCinema

Liu, Ping; Salvi, Ashwin

2018-01-16

With more than 250 conceptual designs submitted, we are pleased to highlight the winners of the LIghtweighting Technologies Enabling Comprehensive Automotive Redesign (LITECAR) Challenge. These innovative conceptual designs seek to lightweight a vehicle while maintaining or exceeding current U.S. automotive safety standards.

Falling off the bandwagon? Exploring the challenges to sustained digital engagement by older people.

PubMed

Damodaran, L; Olphert, C W; Sandhu, J

2014-01-01

This study examines older people's use of information and communication technologies (ICTs) and identifies the factors which can prevent or promote their sustained use. A mixed methods approach was adopted. Quantitative and qualitative data were collected by a survey of 323 older ICT users (aged ≥50 years) between 2011 and 2012. These data were supplemented by qualitative data obtained through in-depth interviews, focus groups and storytelling. Quantitative data were analysed using PASW including bivariate and multivariate analyses. Qualitative data were analysed using an inductive, thematic approach. The findings show that, contrary to some stereotypes, many older people are enthusiastic, competent and confident users of ICTs. However, they report a range of challenges in reaching and maintaining this situation. These include technological complexity and change, age-related capability changes and a lack of learning and support mechanisms. Intrinsic motivation and social support are important in enabling older people to overcome these challenges. Getting older people online has been a high priority in many countries over the past decade. However, little attention has been paid to whether and how their usage can be sustained over time. We discuss the implications of the findings for policy and practice.

Contributions and challenges for worldwide vaccine safety: The Global Advisory Committee on Vaccine Safety at 15 years.

PubMed

Asturias, Edwin J; Wharton, Melinda; Pless, Robert; MacDonald, Noni E; Chen, Robert T; Andrews, Nicholas; Salisbury, David; Dodoo, Alexander N; Hartigan-Go, Kenneth; Zuber, Patrick L F

2016-06-17

In 1999, the Global Advisory Committee on Vaccine Safety (GACVS) was established by the World Health Organization (WHO) to provide independent scientific advice on issues relating to the safety of vaccines and immunization. Fifteen years onward, we conducted a multi-faceted review to evaluate the impact, reach and challenges facing GACVS, including the role GACVS plays in informing global, regional and WHO member state vaccine policy. The methods included measures of organizational structure, citation impact, themes approached, and a discussion by previous and current members to evaluate past, present and future challenges. Given the increasing range of data sources and the deployment of many new vaccines, the Committee is facing the complex task of identifying the best available evidence for recommendations on vaccine safety. To help meet the increased demand for public transparency in decision making, GACVS-structured methodology for evidence-based decisions is evolving. GACVS also promotes best practices and capacity building for timely and accurate risk assessment; risk communications; outreach to help countries maintain and, if needed, rebuild public trust in vaccines; and advocacy for bridging the major gaps in vaccine safety capacity globally. Copyright © 2016 Elsevier Ltd. All rights reserved.

"Because I am Muslim, I cannot wear a swimsuit": Muslim girls negotiate participation opportunities for physical activity.

PubMed

Hamzeh, Manal; Oliver, Kimberly L

2012-06-01

Drawing on the works of postcolonial critical feminist and Arab Muslim feminist scholars, we discuss in this paper how 4 muslim girls (ages 14- 17 years) negotiated their participation in opportunities for physical activity. Data collection methods included self mapping questionnaires, digital photos, private journal entries, and recordings of informal conversations. We discuss (a) how three discursive challenges emerged in veiling-off opportunities for physical activity, and (b) how the girls uncovered alternative ways of being physically active. To promote active life practices with muslim girls, we need to (a) navigate the diversity of young muslims within the intersecting discourses in their lives that potentially challenge their participation in physical activities, and (b) honor young muslims' choices while negotiating their chances of maintaining physical activities.

How do Parents Manage Irritability, Challenging Behaviour, Non-Compliance and Anxiety in Children with Autism Spectrum Disorders? A Meta-Synthesis.

PubMed

O'Nions, Elizabeth; Happé, Francesca; Evers, Kris; Boonen, Hannah; Noens, Ilse

2018-04-01

Although there is increasing research interest in the parenting of children with ASD, at present, little is known about everyday strategies used to manage problem behaviour. We conducted a meta-synthesis to explore what strategies parents use to manage irritability, non-compliance, challenging behaviour and anxiety in their children with ASD. Approaches included: (1) accommodating the child; (2) modifying the environment; (3) providing structure, routine and occupation; (4) supervision and monitoring; (5) managing non-compliance with everyday tasks; (6) responding to problem behaviour; (7) managing distress; (8) maintaining safety and (9) analysing and planning. Results suggest complex parenting demands in children with ASD and problem behaviour. Findings will inform the development of a new measure to quantify parenting strategies relevant to ASD.

The Synapse Project: Engagement in mentally challenging activities enhances neural efficiency.

PubMed

McDonough, Ian M; Haber, Sara; Bischof, Gérard N; Park, Denise C

2015-01-01

Correlational and limited experimental evidence suggests that an engaged lifestyle is associated with the maintenance of cognitive vitality in old age. However, the mechanisms underlying these engagement effects are poorly understood. We hypothesized that mental effort underlies engagement effects and used fMRI to examine the impact of high-challenge activities (digital photography and quilting) compared with low-challenge activities (socializing or performing low-challenge cognitive tasks) on neural function at pretest, posttest, and one year after the engagement program. In the scanner, participants performed a semantic-classification task with two levels of difficulty to assess the modulation of brain activity in response to task demands. The High-Challenge group, but not the Low-Challenge group, showed increased modulation of brain activity in medial frontal, lateral temporal, and parietal cortex-regions associated with attention and semantic processing-some of which were maintained a year later. This increased modulation stemmed from decreases in brain activity during the easy condition for the High-Challenge group and was associated with time committed to the program, age, and cognition. Sustained engagement in cognitively demanding activities facilitated cognition by increasing neural efficiency. Mentally-challenging activities may be neuroprotective and an important element to maintaining a healthy brain into late adulthood.

The Synapse Project: Engagement in mentally challenging activities enhances neural efficiency

PubMed Central

McDonough, Ian M.; Haber, Sara; Bischof, Gérard N.; Park, Denise C.

2015-01-01

Purpose: Correlational and limited experimental evidence suggests that an engaged lifestyle is associated with the maintenance of cognitive vitality in old age. However, the mechanisms underlying these engagement effects are poorly understood. We hypothesized that mental effort underlies engagement effects and used fMRI to examine the impact of high-challenge activities (digital photography and quilting) compared with low-challenge activities (socializing or performing low-challenge cognitive tasks) on neural function at pretest, posttest, and one year after the engagement program. Methods: In the scanner, participants performed a semantic-classification task with two levels of difficulty to assess the modulation of brain activity in response to task demands. Results: The High-Challenge group, but not the Low-Challenge group, showed increased modulation of brain activity in medial frontal, lateral temporal, and parietal cortex—regions associated with attention and semantic processing—some of which were maintained a year later. This increased modulation stemmed from decreases in brain activity during the easy condition for the High-Challenge group and was associated with time committed to the program, age, and cognition. Conclusions: Sustained engagement in cognitively demanding activities facilitated cognition by increasing neural efficiency. Mentally-challenging activities may be neuroprotective and an important element to maintaining a healthy brain into late adulthood. PMID:26484698

Manipulating the Behavior-Altering Effect of the Motivating Operation: Examination of the Influence on Challenging Behavior during Leisure Activities

ERIC Educational Resources Information Center

O'Reilly, Mark F.; Sigafoos, Jeff; Lancioni, Giulio; Rispoli, Mandy; Lang, Russell; Chan, Jeff; Machalicek, Wendy; Langthorne, Paul

2008-01-01

We examined the behavior-altering effect of the motivating operation on challenging behavior during leisure activities for three individuals with severe disabilities. Prior functional analyses indicated that challenging behavior was maintained by positive reinforcement in the form of attention or tangible items for all participants. During leisure…

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

PubMed

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

2017-04-01

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

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.

Worth the Work

ERIC Educational Resources Information Center

Schaffhauser, Dian

2010-01-01

Even in the age of Google, digital repositories can add tremendous value to an institution. Yet creating and maintaining these collections is no small task. Digital repository advocates will concede that the challenges in building and maintaining these collections can daunt even the most intrepid supporters. Three repository directors share their…

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.

Supporting Children with Developmental Challenges.

ERIC Educational Resources Information Center

Brand, Marie

1998-01-01

Examines strategies for developing challenging but appropriate programs for children with disabilities. Discusses the importance of identifying and understanding the particular needs of individual children; developing appropriate routines; maintaining ongoing communication with, and the involvement of, family members; and playing an active support…

Maintaining data integrity in a rural clinical trial.

PubMed

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

2007-01-01

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

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

PubMed

Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

2010-10-01

In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

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.

Determinants and benefits of physical activity maintenance in hospital employees.

PubMed

Lavoie-Tremblay, Mélanie; Sounan, Charles; Martin, Kara; Trudel, Julie G; Lavigne, Genevieve L; Grover, Steven A; Lowensteyn, Ilka

2014-01-01

This study investigated whether the positive behavioral and anthropometric outcomes of a pedometer-based physical activity 8-week challenge were maintained 6 months after the end of the program. It further investigated the motivational profile of those who maintained their physical activity levels in the months following the end of the program and of those who did not. Hospital employees from a university-affiliated multisite health care center in Canada participated using a questionnaire. Of the 235 participants who completed the 8-week challenge, 157 questionnaires were returned 6 months later. Paired-samples t tests were conducted between the baseline and follow-up scores as well as between the postprogram and follow-up scores to detect significant differences between the measurement points. This study shows that the pedometer-based physical activity helped hospital employees maintain a high level of physical activity as well as maintain a healthy body mass index after 6 months. The results demonstrated that during maintenance the high physical activity group obtained higher scores for identified regulation and intrinsic regulation compared with the other groups. The results of the study revealed that identified and intrinsic regulations are important contributors to maintaining physical activity among hospital employees.

Food hypersensitivity in 20 dogs with skin and gastrointestinal signs.

PubMed

Paterson, S

1995-12-01

Canine food allergy can be defined as a nonseasonal, pruritic skin disorder of dogs that is associated with the ingestion of a substance found in the dog's diet. This study records the use of a proprietary dried fish, corn and soya-based diet for the investigation and maintenance of food allergic dogs when fed initially as a restricted allergen diet and then as a maintenance diet after challenge. All the dogs showed evidence of pruritic skin disease and in addition demonstrated gastrointestinal signs. These included the presence of faecal mucus and blood, tenesmus and increased faecal frequency; all the signs associated with colitis. Both cutaneous and gastrointestinal signs resolved when an elimination diet was fed and could be reproduced when the animal was appropriately challenged. Ten dogs were trialled on a home cooked diet of fish and potato and 10 dogs on the proprietary complete food. All the dogs were challenged to identify their food allergies. Nineteen of the dogs have subsequently been successfully maintained on the proprietary food.

Infection control challenges in deployed US military treatment facilities.

PubMed

Hospenthal, Duane R; Crouch, Helen K

2009-04-01

Personnel sustaining combat-related injuries in current overseas conflicts continue to have their care complicated by infections caused by multidrug-resistant organisms, including Acinetobacter, Klebsiella, and Pseudomonas. Although presumed to be due to multiple factors both within and outside of the combat theater, concern has been raised about the difficulties in establishing and maintaining standard infection control (IC) practices in deployed medical treatment facilities and in the evacuation of the injured back to the United States. Level III facilities (hospitals capable of holding patients >72 hours) in Iraq and Afghanistan and the evacuation system from Iraq to the continental US were reviewed by an expert IC-infectious disease team. All reviewed facilities had established IC programs, but these were staffed by personnel with limited IC experience, often without perceived adequate time dedicated to perform their duties, and without uniform levels of command emphasis or support. Proper hand hygiene between patients was not always ideal. Isolation and cohorting of patients to decrease multidrug-resistant organism colonization and infection varied among facilities. Review of standard operating procedures found variability among institutions and in quality of these documents. Application of US national and theater-specific guidelines and of antimicrobial control measures also varied among facilities. Effective IC practices are often difficult to maintain in modern US hospitals. In the deployed setting, with ever-changing personnel in a less than optimal practice environment, IC is even more challenging. Standardization of practice with emphasis on the basics of IC practice (e.g., hand hygiene and isolation procedures) needs to be emplaced and maintained in the deployed setting.

Factors Associated with Young Children's Opportunities for Maintaining Family Relationships during Maternal Incarceration

ERIC Educational Resources Information Center

Poehlmann, Julie; Shlafer, Rebecca J.; Maes, Elizabeth; Hanneman, Ashley

2008-01-01

Children affected by maternal incarceration experience challenges maintaining continuous family relationships because of changes in caregivers, separation from siblings, and limited contact with mothers. In this mixed-method study, we investigated maternal and contextual factors associated with continuity in family relationships of children living…

Merging building maintainability and sustainability assessment: A multicriteria decision making approach

NASA Astrophysics Data System (ADS)

Asmone, A. S.; Chew, M. Y. L.

2018-02-01

Accurately predicting maintainability has been a challenge due to the complex nature of buildings, yet it is an important research area with a rising necessity. This paper explores the use of multicriteria decision making approach for merging maintainability and sustainability elements into building grading systems to attain long-term sustainability in the building industry. The paper conducts a systematic literature review on multicriteria decision analysis approach and builds on the existing knowledge of maintainability to achieve this. A conceptual framework is developed to bridge the gap between building operations and maintenance with green facilities management by forecasting green maintainability at the design stage.

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

PubMed

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

2018-03-21

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

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

PubMed Central

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

2018-01-01

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

Balancing the professional and personal.

PubMed

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

2009-01-01

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

Targeting of non-dominant antigens as a vaccine strategy to broaden T-cell responses during chronic viral infection.

PubMed

Holst, Peter J; Jensen, Benjamin A H; Ragonnaud, Emeline; Thomsen, Allan R; Christensen, Jan P

2015-01-01

In this study, we compared adenoviral vaccine vectors with the capacity to induce equally potent immune responses against non-dominant and immunodominant epitopes of murine lymphocytic choriomeningitis virus (LCMV). Our results demonstrate that vaccination targeting non-dominant epitopes facilitates potent virus-induced T-cell responses against immunodominant epitopes during subsequent challenge with highly invasive virus. In contrast, when an immunodominant epitope was included in the vaccine, the T-cell response associated with viral challenge remained focussed on that epitope. Early after challenge with live virus, the CD8+ T cells specific for vaccine-encoded epitopes, displayed a phenotype typically associated with prolonged/persistent antigenic stimulation marked by high levels of KLRG-1, as compared to T cells reacting to epitopes not included in the vaccine. Notably, this association was lost over time in T cells specific for the dominant T cell epitopes, and these cells were fully capable of expanding in response to a new viral challenge. Overall, our data suggests a potential for broadening of the antiviral CD8+ T-cell response by selecting non-dominant antigens to be targeted by vaccination. In addition, our findings suggest that prior adenoviral vaccination is not likely to negatively impact the long-term and protective immune response induced and maintained by a vaccine-attenuated chronic viral infection.

Excellence in Ophthalmology: Continuous Certification.

PubMed

Siatkowski, R Michael

2016-09-01

Over the course of a century, American medical specialty boards including the American Board of Ophthalmology (ABO) have developed significant expertise in assessing physician competence on completion of postgraduate training and, more recently, in defining appropriate criteria for continuous learning and quality improvement in practicing physicians. This article explores why maintaining career-long excellence is an evolving challenge, but one that is at the heart of the ABO's mission to protect the public by improving patient care. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The very low angle detector for high-energy inelastic neutron scattering on the VESUVIO spectrometer

NASA Astrophysics Data System (ADS)

Perelli Cippo, E.; Gorini, G.; Tardocchi, M.; Pietropaolo, A.; Andreani, C.; Senesi, R.; Rhodes, N. J.; Schooneveld, E. M.

2008-05-01

The Very Low Angle Detector (VLAD) bank has been installed on the VESUVIO spectrometer at the ISIS spallation neutron source. The new device allows for high-energy inelastic neutron scattering measurements, at energies above 1 eV, maintaining the wave vector transfer lower than 10Å-1. This opens a still unexplored region of the kinematical (q, ω) space, enabling new and challenging experimental investigations in condensed matter. This paper describes the main instrumental features of the VLAD device, including instrument design, detector response, and calibration procedure.

[Nuclear energy and environment: review of the IAEA environmental projects].

PubMed

Fesenko, S; Fogt, G

2012-01-01

The review of the environmental projects of the International Atomic Energy Agency is presented. Basic IAEA documents intended to protect humans and the Environment are considered and their main features are discussed. Some challenging issues in the area of protection of the Environment and man, including the impact of nuclear facilities on the environment, radioactive waste management, and remediation of the areas affected by radiological accidents, nuclear testing and sites of nuclear facilities are also discussed. The need to maintain the existing knowledge in radioecology and protection of the environment is emphasised.

Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships.

PubMed

Tevendale, Heather D; Fuller, Taleria R; House, L Duane; Dee, Deborah L; Koumans, Emilia H

2017-03-01

Seeking to reduce teen pregnancy and births in communities with rates above the national average, the Centers for Disease Control and Prevention, in partnership with the U.S. Department of Health and Human Services Office of Adolescent Health Teen Pregnancy Prevention Program, developed a joint funding opportunity through which grantees worked to implement and test an approach involving community-wide teen pregnancy prevention initiatives. Once these projects had been in the field for 2.5 years, Centers for Disease Control and Prevention staff developed plans for a supplemental issue of the Journal of Adolescent Health to present findings from and lessons learned during implementation of the community-wide initiatives. When the articles included in the supplemental issue are considered together, common themes emerge, particularly those related to initiating, building, and maintaining strong partnerships. Themes seen across articles include the importance of (1) sharing local data with partners to advance initiative implementation, (2) defining partner roles from the beginning of the initiatives, (3) developing teams that include community partners to provide direction to the initiatives, and (4) addressing challenges to maintaining strong partnerships including partner staff turnover and delays in implementation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The process and challenges of obtaining and sustaining clinical placements for nursing and allied health students.

PubMed

Taylor, Christine; Angel, Liz; Nyanga, Lucy; Dickson, Cathy

2017-10-01

To describe the process and challenges from a project that aimed to develop processes, source new placements and place students primarily in the discipline of nursing, but also occupational therapy, physiotherapy, podiatry, social work, and speech therapy. Clinical experience in health facilities is an essential element of health professional education, yet globally, there is a lack of clinical placements to meet demands. Educational providers are seeking placements in nontraditional facilities, yet little has been reported on the challenges in the process of procuring clinical placements. The project used a descriptive approach within a quality implementation framework. The project was guided by the quality implementation framework that included four critical steps: considerations of the host setting, structuring the implementation, supporting the implementation and improving future applications. A total of 115 new student placements were finalised across six health disciplines, including elderly care, nongovernment organisations and general practice. Sixty-two nursing students were placed in the new placements during the project. Challenges included communication, the time-consuming nature of the process and 'gatekeeping' blocks to obtaining placements. Recommendations included the importance of personal interaction in developing and maintaining relationships, and the need for clear communication processes and documentation. Potential areas for research are also given. There is great potential for growth in establishing new placements outside the traditional placement facilities for nursing and allied health and for expanding already existing nonhospital placements. Clinical professional experiences are essential to any nursing or allied health programme. There is an increasing demand for, and global lack of, clinical placements for nursing and allied health students. The results provide nursing and allied health educators and managers a framework for planning clinical placement procurement, and assisting in decision-making and developing strategies and processes for practice. © 2016 John Wiley & Sons Ltd.

Applications of multi-spectral imaging: failsafe industrial flame detector

NASA Astrophysics Data System (ADS)

Wing Au, Kwong; Larsen, Christopher; Cole, Barry; Venkatesha, Sharath

2016-05-01

Industrial and petrochemical facilities present unique challenges for fire protection and safety. Typical scenarios include detection of an unintended fire in a scene, wherein the scene also includes a flare stack in the background. Maintaining a high level of process and plant safety is a critical concern. In this paper, we present a failsafe industrial flame detector which has significant performance benefits compared to current flame detectors. The design involves use of microbolometer in the MWIR and LWIR spectrum and a dual band filter. This novel flame detector can help industrial facilities to meet their plant safety and critical infrastructure protection requirements while ensuring operational and business readiness at project start-up.

Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.

PubMed

Staley, S; Romlein, J; Chacko, A K; Wider, R

2000-05-01

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.

An Algorithm for Autonomous Formation Obstacle Avoidance

NASA Astrophysics Data System (ADS)

Cruz, Yunior I.

The level of human interaction with Unmanned Aerial Systems varies greatly from remotely piloted aircraft to fully autonomous systems. In the latter end of the spectrum, the challenge lies in designing effective algorithms to dictate the behavior of the autonomous agents. A swarm of autonomous Unmanned Aerial Vehicles requires collision avoidance and formation flight algorithms to negotiate environmental challenges it may encounter during the execution of its mission, which may include obstacles and chokepoints. In this work, a simple algorithm is developed to allow a formation of autonomous vehicles to perform point to point navigation while avoiding obstacles and navigating through chokepoints. Emphasis is placed on maintaining formation structures. Rather than breaking formation and individually navigating around the obstacle or through the chokepoint, vehicles are required to assemble into appropriately sized/shaped sub-formations, bifurcate around the obstacle or negotiate the chokepoint, and reassemble into the original formation at the far side of the obstruction. The algorithm receives vehicle and environmental properties as inputs and outputs trajectories for each vehicle from start to the desired ending location. Simulation results show that the algorithm safely routes all vehicles past the obstruction while adhering to the aforementioned requirements. The formation adapts and successfully negotiates the obstacles and chokepoints in its path while maintaining proper vehicle separation.

Concept for Sustained Plant Production on ISS Using VEGGIE Capillary Mat Rooting System

NASA Technical Reports Server (NTRS)

Stutte, Gary W.; Newsham, Gerard; Morrow, Robert M.; Wheeler, Raymond M.

2011-01-01

Plant growth in microgravity presents unique challenges associated with maintaining appropriate conditions for seed germination, seedling establishment, maturation and harvest. They include maintaining appropriate soil moisture content, nutrient balance, atmospheric mixing and containment. Sustained production imposes additional challenges of harvesting, replanting, and safety. The VEGGIE is a deployable (collapsible) plant growth chamber developed as part of a NASA SBIR Phase II by Orbitec, Madison, WI. The intent of VEGGIE is to provide a low-resource system to produce fresh vegetables for the crew on long duration missions. The VEGGIE uses and LED array for lighting, an expandable bellows for containment, and a capillary matting system for nutrient and water delivery. The project evaluated a number of approaches to achieve sustained production, and repeated plantings, using the capillary rooting system. A number of different root media, seed containment, and nutrient delivery systems were evaluated and effects on seed germination and growth were evaluated. A number of issues limiting sustained production, such as accumulation of nutrients, uniform water, elevated vapor pressure deficit, and media containment were identified. A concept using pre-planted rooting packs shown to effectively address a number of those issues and is a promising approach for future development as a planting system for microgravity conditions.

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

PubMed

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Work participation and arthritis: a systematic overview of challenges, adaptations and opportunities for interventions.

PubMed

Hoving, Jan L; van Zwieten, Myra C B; van der Meer, Marrit; Sluiter, Judith K; Frings-Dresen, Monique H W

2013-07-01

Understanding the factors that play a role in maintaining people with inflammatory arthritis in the workforce may aid the design of interventions to support work participation. The objective of this systematic overview is to summarize qualitative studies that explore experiences of patients with inflammatory arthritis to remain employed or return to work. Bibliographic databases including MEDLINE, EMBASE and PsycInfo were searched until December 2011 to identify any qualitative studies that focused on experiences, challenges or adaptations of patients with inflammatory arthritis to remain employed. Thematic analyses were used to identify any first or higher order themes for which all data were entered into MAXQDA software. In addition, methodological quality was assessed using an eight-item checklist. Of 6338 citations, 10 studies were included. RA was the condition in eight studies. Individual interviews (six studies) were used more frequently than group interviews (four studies). Methodological quality varied from 2 to 8 points and had no effect on the number of themes identified. Thematic analyses showed seven key concepts important to patients, including disease symptoms, management of the disease, socioeconomic issues, work conditions and adaptations, emotional challenges, interpersonal issues affecting work and family life and meaning of work. By including studies from different countries and settings, we show a comprehensive overview of themes considered important by patients and strengthen our belief that these factors should be considered in interventions that aim to improve work participation for patients with inflammatory arthritis.

Getting to More Effective Weight Management in Antipsychotic-Treated Youth: A Survey of Barriers and Preferences.

PubMed

Nicol, Ginger; Worsham, Elizabeth; Haire-Joshu, Debra; Duncan, Alexis; Schweiger, Julia; Yingling, Michael; Lenze, Eric

2016-02-01

Mentally ill youth are at risk for developing obesity, especially when they require antipsychotic treatment; moreover, they may face unique challenges in adhering to behavioral weight loss interventions. The aims of this project were to characterize the challenges families of youth with psychiatric disorders face when engaging in weight loss treatment and to gather information on attitudes and preferences for weight management interventions in this population. We devised a telephone survey to evaluate caregiver-perceived barriers/challenges to and preferences for behavioral weight loss treatment in overweight or obese mentally ill youth ages 6-18 treated with an antipsychotic agent in an outpatient setting. A total of 26 parents or primary caregivers completed the survey. The most commonly cited barriers to participation in physical activity (PA) and maintaining a healthy diet were child's dislike of PA and child's preference for energy-dense foods, respectively, which were impacted by psychiatric symptoms. Preferences for weight loss treatment included individualized, prescribed meal plans and shopping lists, and exercise support/demonstration, with a preference for Internet or cell phone applications to help with monitoring food intake and exercise. These results suggest that targets for obesity treatment in this population include individualized, specific support that takes into account the child's motivation, which is effected by psychiatric symptoms. Tools for providing support may include the use of telehealth visits and mobile device applications for self-monitoring.

A Rab-centric perspective of bacterial pathogen-occupied vacuoles.

PubMed

Sherwood, Racquel Kim; Roy, Craig R

2013-09-11

The ability to create and maintain a specialized organelle that supports bacterial replication is an important virulence property for many intracellular pathogens. Living in a membrane-bound vacuole presents inherent challenges, including the need to remodel a plasma membrane-derived organelle into a novel structure that will expand and provide essential nutrients to support replication, while also having the vacuole avoid membrane transport pathways that target bacteria for destruction in lysosomes. It is clear that pathogenic bacteria use different strategies to accomplish these tasks. The dynamics by which host Rab GTPases associate with pathogen-occupied vacuoles provide insight into the mechanisms used by different bacteria to manipulate host membrane transport. In this review we highlight some of the strategies bacteria use to maintain a pathogen-occupied vacuole by focusing on the Rab proteins involved in biogenesis and maintenance of these novel organelles. Copyright © 2013 Elsevier Inc. All rights reserved.

Challenges of Generating and Maintaining Protective Vaccine-Induced Immune Responses for Foot-and-Mouth Disease Virus in Pigs

PubMed Central

Lyons, Nicholas A.; Lyoo, Young S.; King, Donald P.; Paton, David J.

2016-01-01

Vaccination can play a central role in the control of outbreaks of foot-and-mouth disease (FMD) by reducing both the impact of clinical disease and the extent of virus transmission between susceptible animals. Recent incursions of exotic FMD virus lineages into several East Asian countries have highlighted the difficulties of generating and maintaining an adequate immune response in vaccinated pigs. Factors that impact vaccine performance include (i) the potency, antigenic payload, and formulation of a vaccine; (ii) the antigenic match between the vaccine and the heterologous circulating field strain; and (iii) the regime (timing, frequency, and herd-level coverage) used to administer the vaccine. This review collates data from studies that have evaluated the performance of foot-and-mouth disease virus vaccines at the individual and population level in pigs and identifies research priorities that could provide new insights to improve vaccination in the future. PMID:27965966

Off-label prescribing of medications for pain: maintaining optimal care at an intersection of law, public policy, and ethics.

PubMed

Ruble, James

2012-06-01

For more than 60 years, regulations limited marketing of medications for off-label uses to very low levels. Some key policy changes in the late 1990s ushered in an era of deregulation of off-label marketing. Policy changes included revised United States federal law as well as modifications of Food and Drug Administration (FDA) regulations. Subsequent investigations documented an explosion in scope off-label prescribing. Attempts to limit off-label advertising by manufacturers were vigorously challenged in the courts. Other modalities are needed to maintain a clinical care environment that places the patients' best interests first. In many circumstances, an off-label medication may be in the patient's best interests; however, where there is a lower level of clinical justification, the informed consent of the patient and shared decision making of the patient is essential to optimize outcome.

Environmental Flow Modeling Challenges for Rapidly Urbanizing Watersheds

EPA Science Inventory

It is a challenge for land use planners and water resource managers to balance water needs that support urban growth and economic development of a growing population and yet maintain ecological flow needs. Urban growth and the associated water resources development in a watershed...

Treatment of Escape-Maintained Challenging Behavior Using Chained Schedules: An Evaluation of the Effects of Thinning Positive plus Negative Reinforcement During Functional Communication Training.

PubMed

Zangrillo, Amanda N; Fisher, Wayne W; Greer, Brian D; Owen, Todd M; DeSouza, Andresa A

2016-01-01

Previous research has supported functional communication training (FCT) as an effective intervention for reducing challenging behavior. Clinicians often program schedule-thinning procedures to increase the portability of the treatment (i.e., reinforcement is provided less frequently). For individuals with escape-maintained problem behavior, chained schedules have proven effective in increasing task completion and supplemental procedures may ameliorate reemergence of challenging behavior as access to reinforcement is decreased. The present study compared the use of a chained schedule-thinning procedure with and without alternative reinforcement (e.g., toys and activities) embedded in an intervention in which escape from the task is provided contingent on a request for a break. Two individuals with escape-maintained challenging behavior participated. We compared two treatment conditions, escape-only and escape-to-tangibles, using a single-subject, alternating treatments design with each treatment implemented in a distinct academic context. With the escape-to-tangibles treatment, we reached the final schedule in both contexts with both participants (4 successes out of 4 applications). We did not reach the final schedule with either participant with the escape-only intervention (0 successes out of 2 applications). The current results provided preliminary confirmation that providing positive plus negative reinforcement would decrease destructive behavior, increase compliance, and facilitate reinforcer-schedule thinning.

Treatment of Escape-Maintained Challenging Behavior Using Chained Schedules: An Evaluation of the Effects of Thinning Positive plus Negative Reinforcement During Functional Communication Training

PubMed Central

Zangrillo, Amanda N.; Fisher, Wayne W.; Greer, Brian D.; Owen, Todd M.; DeSouza, Andresa A.

2016-01-01

Objective Previous research has supported functional communication training (FCT) as an effective intervention for reducing challenging behavior. Clinicians often program schedule-thinning procedures to increase the portability of the treatment (i.e., reinforcement is provided less frequently). For individuals with escape-maintained problem behavior, chained schedules have proven effective in increasing task completion and supplemental procedures may ameliorate reemergence of challenging behavior as access to reinforcement is decreased. The present study compared the use of a chained schedule-thinning procedure with and without alternative reinforcement (e.g., toys and activities) embedded in an intervention in which escape from the task is provided contingent on a request for a break. Method Two individuals with escape-maintained challenging behavior participated. We compared two treatment conditions, escape-only and escape-to-tangibles, using a single-subject, alternating treatments design with each treatment implemented in a distinct academic context. Results With the escape-to-tangibles treatment, we reached the final schedule in both contexts with both participants (4 successes out of 4 applications). We did not reach the final schedule with either participant with the escape-only intervention (0 successes out of 2 applications). Conclusion The current results provided preliminary confirmation that providing positive plus negative reinforcement would decrease destructive behavior, increase compliance, and facilitate reinforcer-schedule thinning. PMID:28626579

Milk fermented by Lactobacillus species from Brazilian artisanal cheese protect germ-free-mice against Salmonella Typhimurium infection.

PubMed

Acurcio, L B; Sandes, S H C; Bastos, R W; Sant'anna, F M; Pedroso, S H S P; Reis, D C; Nunes, Á C; Cassali, G D; Souza, M R; Nicoli, J R

2017-08-24

Ingestion of milks fermented by Lactobacillus strains showing probiotic properties is an important tool to maintain gastrointestinal health. In this study, Lactobacillus rhamnosus D1 and Lactobacillus plantarum B7, isolated from Brazilian artisanal cheese, were used as starters for the functional fermented milks to assess their probiotic properties in a gnotobiotic animal model. Male germ-free Swiss mice received a single oral dose of milk fermented by each sample, and were challenged with Salmonella Typhimurium five days afterwards. Milk fermented by both Lactobacillus strains maintained counts above 10 8 cfu/ml during cold storage. Lactobacillus strains colonised the gut of the germ-free-mice, maintaining their antagonistic effect. This colonisation led to a protective effect against Salmonella challenge, as demonstrated by reduced pathogen translocation and histological lesions, when compared to control group, especially for Lactobacillus rhamnosus D1. Additionally, mRNA expression of inflammatory (interferon gamma, interleukin (IL)-6, tumour necrosis factor alpha) and anti-inflammatory (transforming growth factor β1) cytokines was augmented in animals previously colonised and then challenged, when compared to other experimental groups. Lactobacillus plantarum B7 colonisation also promoted higher expression of IL-17, showing a proper maturation of colonised germ-free-mice immune system. IL-5 was stimulated by both strains' colonisation and not by S. Typhimurium challenge.

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

PubMed

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Reducing liver transplant length of stay: a Lean Six Sigma approach.

PubMed

Toledo, Alexander H; Carroll, Tracy; Arnold, Emily; Tulu, Zeynep; Caffey, Tom; Kearns, Lauren E; Gerber, David A

2013-12-01

Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. To decrease our length of stay for liver transplant by using Lean Six Sigma methods. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. Multiple interventions, including a clinical pathway and enhanced communication, were implemented. Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.

Study of the effect of space cabin environment on susceptibility to disease

NASA Technical Reports Server (NTRS)

1972-01-01

Decreased resistance to infections initiated by respiratory challenge with Klebsiella pneumoniae or influenza virus was observed in mice maintained in a simulated space cabin environment represented by 98% oxygen atmosphere and 27,000 ft altitude (5 psi). The reduced resistance was manifested by increased mortality rates as compared to those seen in mice maintained at ground level condition. However, an adaptation to the stress appeared to be present in mice exposed to the space cabin environment for extended time period, i.e. 36 days, and then challenged with the influenza virus. Reduced resistance was not observed when Salmonella typhimurium was used as the challenge agent. Histopathologic examination of lungs of mice indicated that the severity of damage appeared to be related to the duration of exposure to the simulated space cabin environment.

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.

Clinical challenges in mechanical ventilation.

PubMed

Goligher, Ewan C; Ferguson, Niall D; Brochard, Laurent J

2016-04-30

Mechanical ventilation supports gas exchange and alleviates the work of breathing when the respiratory muscles are overwhelmed by an acute pulmonary or systemic insult. Although mechanical ventilation is not generally considered a treatment for acute respiratory failure per se, ventilator management warrants close attention because inappropriate ventilation can result in injury to the lungs or respiratory muscles and worsen morbidity and mortality. Key clinical challenges include averting intubation in patients with respiratory failure with non-invasive techniques for respiratory support; delivering lung-protective ventilation to prevent ventilator-induced lung injury; maintaining adequate gas exchange in severely hypoxaemic patients; avoiding the development of ventilator-induced diaphragm dysfunction; and diagnosing and treating the many pathophysiological mechanisms that impair liberation from mechanical ventilation. Personalisation of mechanical ventilation based on individual physiological characteristics and responses to therapy can further improve outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Endangered species and nature conservation: science issues and challenges.

PubMed

Szaro, Robert C

2008-06-01

The issues and challenges facing us in ensuring the survival of as many species and ecosystems as possible call for a renewed research focus to address how to improve management strategies and policy making now and into the future. The key issues to be addressed by activities of the International Union of Forest Research Organization's (IUFRO) Task Force on Endangered Species and Nature Conservation include such issues as: (i) preventing species from being listed by maintaining species populations at sufficient levels that they do not require listing; (ii) recovering threatened and endangered species; (iii) developing management practices and strategies; (iv) balancing actions affecting suites of threatened or endangered species; (v) developing conservation strategies for species without definitive taxonomic treatments; (vi) dealing with global change; (vii) dealing with invasive species; and (viii) restoring critical habitats. © 2008 ISZS, Blackwell Publishing and IOZ/CAS.

Kierkegaard and psychology as the science of the "multifarious life".

PubMed

Klempe, Sven Hroar

2013-09-01

The aim of this paper is to demonstrate the actuality of some considerations around psychology made by the Danish philosopher Søren Kierkegaard (1813-1855). According to him psychology is about the "multifarious" life, which is a term that pinpoints the challenges psychology still have when it comes to including changes and genetic perspectives on its understanding of actual living. Yet Kierkegaard discusses psychology in relationship to metaphysics, which is an almost forgotten perspective. His understanding opens up for narrowing the definition of psychology down to the science of subjectivity, which at the same time elevates psychology to being the only science that focuses on the actual human life. Yet Kierkegaard's most important contribution to psychology is to maintain a radical distinction between subjectivity and objectivity, and in this respect the psychology of today is challenged.

Sustainability. Systems integration for global sustainability.

PubMed

Liu, Jianguo; Mooney, Harold; Hull, Vanessa; Davis, Steven J; Gaskell, Joanne; Hertel, Thomas; Lubchenco, Jane; Seto, Karen C; Gleick, Peter; Kremen, Claire; Li, Shuxin

2015-02-27

Global sustainability challenges, from maintaining biodiversity to providing clean air and water, are closely interconnected yet often separately studied and managed. Systems integration—holistic approaches to integrating various components of coupled human and natural systems—is critical to understand socioeconomic and environmental interconnections and to create sustainability solutions. Recent advances include the development and quantification of integrated frameworks that incorporate ecosystem services, environmental footprints, planetary boundaries, human-nature nexuses, and telecoupling. Although systems integration has led to fundamental discoveries and practical applications, further efforts are needed to incorporate more human and natural components simultaneously, quantify spillover systems and feedbacks, integrate multiple spatial and temporal scales, develop new tools, and translate findings into policy and practice. Such efforts can help address important knowledge gaps, link seemingly unconnected challenges, and inform policy and management decisions. Copyright © 2015, American Association for the Advancement of Science.

Community of Practice and Family Language Policy: Maintaining Heritage Japanese in Sydney--Ten Years Later

ERIC Educational Resources Information Center

Oriyama, Kaya

2016-01-01

Maintaining children's heritage language (HL) is a challenging task for linguistic minorities around the world. While many Japanese heritage children in Sydney attend weekend HL schools, they typically discontinue attendance before, or during, secondary school. To date, no longitudinal study has investigated what happens to their HL maintenance…

Teacher Collaborative Curriculum Design in Technical Vocational Colleges: A Strategy for Maintaining Curriculum Consistency?

ERIC Educational Resources Information Center

Albashiry, Nabeel M.; Voogt, Joke M.; Pieters, Jules M.

2015-01-01

The Technical Vocational Education and Training (TVET) curriculum requires continuous renewal and constant involvement of stakeholders in the redesign process. Due to a lack of curriculum design expertise, TVET institutions in developing contexts encounter challenges maintaining and advancing the quality and relevance of their programmes to the…

Trends in nursery research and production

Treesearch

James P. Barnett

2002-01-01

Forest nursery production is at an all-time high in the southern United States, and to maintain and increase this production capacity we need to integrate research and operational technology. Me must improve the technology to increase production of container southern pine seedlings, especially for longleaf pine. Bareroot nursery managers have challenges to maintain the...

Maintaining Long-Term Therapeutic Programmes: A Qualitative Case Study

ERIC Educational Resources Information Center

Brown, J. F.

2006-01-01

Maintaining therapeutic programmes for people with learning disabilities over long periods of time presents a major challenge to care systems as the limited and slow pace of client behavioural change is often insufficient to sustain staff behaviour. In this study, a 17-year-old young man with profound learning difficulties was successfully…

Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care.

PubMed

Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D

2018-04-01

The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

Identifying Challenges in Supervising School Psychologists

ERIC Educational Resources Information Center

Harvey, Virginia Smith; Pearrow, Melissa

2010-01-01

Previous studies suggest that the majority of school psychologists do not believe they receive sufficient supervision, despite a growing body of research providing empirical support for supervision to maintain and improve skills. This study explores the dynamics underlying the challenges of providing adequate supervision to school psychologists.…

The Supreme Court and Strip Searches

ERIC Educational Resources Information Center

Russo, Charles J.

2009-01-01

Maintaining a safe, orderly learning environment is a significant challenge for education leaders, especially when students insist on bringing alcohol, weapons, and drugs into schools. To compound that challenge, educators who wish to uncover contraband must do so within the confines of the Fourth Amendment's prohibition against unreasonable…

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

Student Motivation in Science Subjects in Tanzania, Including Students' Voices

NASA Astrophysics Data System (ADS)

Mkimbili, Selina Thomas; Ødegaard, Marianne

2017-12-01

Fostering and maintaining students' interest in science is an important aspect of improving science learning. The focus of this paper is to listen to and reflect on students' voices regarding the sources of motivation for science subjects among students in community secondary schools with contextual challenges in Tanzania. We conducted a group-interview study of 46 Form 3 and Form 4 Tanzanian secondary school students. The study findings reveal that the major contextual challenges to student motivation for science in the studied schools are limited resources and students' insufficient competence in the language of instruction. Our results also reveal ways to enhance student motivation for science in schools with contextual challenges; these techniques include the use of questioning techniques and discourse, students' investigations and practical work using locally available materials, study tours, more integration of classroom science into students' daily lives and the use of real-life examples in science teaching. Also we noted that students' contemporary life, culture and familiar language can be utilised as a useful resource in facilitating meaningful learning in science in the school. Students suggested that, to make science interesting to a majority of students in a Tanzanian context, science education needs to be inclusive of students' experiences, culture and contemporary daily lives. Also, science teaching and learning in the classroom need to involve learners' voices.

The challenges of transitioning from linear to high-order overlay control in advanced lithography

NASA Astrophysics Data System (ADS)

Adel, M.; Izikson, P.; Tien, D.; Huang, C. K.; Robinson, J. C.; Eichelberger, B.

2008-03-01

In the lithography section of the ITRS 2006 update, at the top of the list of difficult challenges appears the text "overlay of multiple exposures including mask image placement". This is a reflection of the fact that today overlay is becoming a major yield risk factor in semiconductor manufacturing. Historically, lithographers have achieved sufficient alignment accuracy and hence layer to layer overlay control by relying on models which define overlay as a linear function of the field and wafer coordinates. These linear terms were easily translated to correctibles in the available exposure tool degrees of freedom on the wafer and reticle stages. However, as the 45 nm half pitch node reaches production, exposure tool vendors have begun to make available, and lithographers have begun to utilize so called high order wafer and field control, in which either look up table or high order polynomial models are modified on a product by product basis. In this paper, the major challenges of this transition will be described. It will include characterization of the sources of variation which need to be controlled by these new models and the overlay and alignment sampling optimization problem which needs to be addressed, while maintaining the ever tightening demands on productivity and cost of ownership.

Global nurse leader perspectives on health systems and workforce challenges.

PubMed

Gantz, Nancy Rollins; Sherman, Rose; Jasper, Melanie; Choo, Chua Gek; Herrin-Griffith, Donna; Harris, Kathy

2012-05-01

As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies. © 2012 Blackwell Publishing Ltd.

The "Virtual" Reality of High-Tech Training

ERIC Educational Resources Information Center

Justice, Jamie

2004-01-01

Community and technical colleges are at a crossroads in their history and mission in preparing individuals for the challenges of lifelong learning and the workforce of the future. Many industries are faced with the challenges of replacing an aging and retiring workforce, updating employee skill sets, and maintaining quality and production…

Dancing in the Hall

ERIC Educational Resources Information Center

Schneier, Lisa

2018-01-01

Originally written 30 years ago, this paper is an analysis of the central challenge of schooling--that of engaging fully the powers of students' minds in classroom learning. This challenge maintains its relevance today. The work of engaging what John Dewey referred to as students' "inner attention" becomes the focus of an investigation…

Correspondence between Traditional Models of Functional Analysis and a Functional Analysis of Manding Behavior

ERIC Educational Resources Information Center

LaRue, Robert H.; Sloman, Kimberly N.; Weiss, Mary Jane; Delmolino, Lara; Hansford, Amy; Szalony, Jill; Madigan, Ryan; Lambright, Nathan M.

2011-01-01

Functional analysis procedures have been effectively used to determine the maintaining variables for challenging behavior and subsequently develop effective interventions. However, fear of evoking dangerous topographies of maladaptive behavior and concerns for reinforcing infrequent maladaptive behavior present challenges for people working in…

Psychological Impacts of Challenging Behaviour and Motivational Orientation in Staff Supporting Individuals with Autistic Spectrum Conditions

ERIC Educational Resources Information Center

Merrick, Alistair D.; Grieve, Alan; Cogan, Nicola

2017-01-01

Despite increased risk of experiencing challenging behaviour, psychological impacts on community and residential staff supporting adults with autistic spectrum conditions are under-explored. Studies examining related roles indicate protective psychological factors may help maintain staff well-being. This study investigated relationships between…

On the Viability of Supporting Institutional Sharing of Remote Laboratory Facilities

ERIC Educational Resources Information Center

Lowe, David; Dang, Bridgette; Daniel, Keith; Murray, Stephen; Lindsay, Euan

2015-01-01

Laboratories are generally regarded as critical to engineering education, and yet educational institutions face significant challenges in developing and maintaining high-quality laboratory facilities. Remote laboratories are increasingly being explored as a partial solution to this challenge, with research showing that--for the right learning…

Assessment Challenges for Business Education in Changing Times

ERIC Educational Resources Information Center

Hazari, Sunil; Gaytan, Jorge; North, Alexa

2008-01-01

In addition to the difficult task of identifying teaching methods that ensure student learning, the American educational system is facing significant challenges. Schools are struggling to maintain standards for high-quality teaching while trying to address the learning needs of students with Limited English Proficiency (LEP). The same struggle is…

Seeing the Forest through the Trees: A Challenge Facing Communication across the Curriculum Programs.

ERIC Educational Resources Information Center

Garside, Colleen

2002-01-01

Notes that communication across the curriculum programs (CXCPs) are designed to increase students' communication competence and enhance student learning. Examines the challenge of maintaining the integrity of multiple disciplines when communication gets taken across the curriculum. Concludes with suggestions for future program directions and…

What about School? Educational Challenges for Children and Adolescents with Cancer

ERIC Educational Resources Information Center

Donnan, Barbara M.; Webster, Tracey; Wakefield, Claire E.; Dalla-Pozza, Luciano; Alvaro, Frank; Lavoipierre, Jenny; Marshall, Glenn M.

2015-01-01

Many students treated for cancer experience significant challenges in maintaining their education during and beyond cancer treatment. Late effects of cancer treatment combined with prolonged periods of missed schooling can dramatically impact upon a student's physical, cognitive and social development. This study examined the relationship between…

Maintaining and restoring sustainable ecosystems in southern Nevada [Chapter 7] (Executive Summary)

Treesearch

Jeanne C. Chambers; Burton K. Pendleton; Donald W. Sada; Steven M. Ostoja; Matthew L. Brooks

2013-01-01

Resource managers in southern Nevada are faced with the challenge of determining appropriate goals and objectives and developing viable approaches for maintaining and restoring sustainable ecosystems in the face of rapid socio-ecological and environmental change. Many of southern Nevada’s ecosystems are being subjected to anthropogenic stressors that span global,...

The Promising but Challenging Case of Humility as a Positive Psychology Virtue

ERIC Educational Resources Information Center

Hill, Peter C.; Sandage, Steven J.

2016-01-01

In maintaining that virtue is a legitimate concept worthy of empirical study, a strong situationist approach to the study of behavior is countered. An earlier analysis is then drawn upon to maintain that virtue has the capability of integrating several themes in positive psychology: ethics and health, embodied character, strength and resilience,…

Collaborating with Students to Produce Success in Science

ERIC Educational Resources Information Center

Tobin, Kenneth

2007-01-01

A tenet that appears to be accepted throughout the world is that effective teachers establish and maintain control over their students. This is an assertion that I challenge and deconstruct. In fact, for many teachers their well-intentioned efforts to establish and maintain control over students lead to their demise as teachers and for many more…

Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers.

PubMed

Herstein, Jocelyn J; Biddinger, Paul D; Gibbs, Shawn G; Le, Aurora B; Jelden, Katelyn C; Hewlett, Angela L; Lowe, John J

2017-06-01

To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness.

Maintaining Professional Competence. Approaches to Career Enhancement, Vitality, and Success throughout a Work Life.

ERIC Educational Resources Information Center

Willis, Sherry L., Ed.; Dubin, Samuel S., Ed.

In response to the issues of global competition, the aging workforce, and the rapid rate of technological innovation and how today's professionals must meet these challenges, an examination is made of the key developmental approaches to maintaining and enhancing the knowledge and skills of midcareer and senior-level professionals. Twenty-one…

Workplace safety in Bangladesh ready-made garment sector: 3 years after the Rana Plaza collapse.

PubMed

Barua, Uttama; Ansary, Mehedi Ahmed

2017-12-01

Workplace safety is one of the most important issues in industries worldwide, and is endangered by industrial accidents. Different industrial disasters have resulted in several initiatives worldwide to protect human life and reduce material damage, both nationally and internationally. In Bangladesh, the ready-made garment (RMG) industry is one of the most important export-oriented business sectors, which is facing challenges to ensure workplace safety. The Rana Plaza collapse in Bangladesh is the consequence of such non-compliance. The accident resulted in different local and global initiatives to address the challenges. This article reviews progress and achievement of the initiatives to reduce vulnerability in the Bangladesh RMG industry within 3 years after the deadly accident. In the long run, the challenge is to maintain momentum already created for achieving sustainability in the RMG sector in Bangladesh and maintaining compliance even after the end of support from external partners.

Prospects for stakeholder coordination by protected-area managers in Europe.

PubMed

Mattsson, Brady J; Vacik, Harald

2018-02-01

Growing resource demands by humans, invasive species, natural hazards, and a changing climate have created broad-scale impacts and the need for broader-extent conservation activities that span ownerships and even political borders. Implementing regional-scale conservation brings great challenges, and learning how to overcome these challenges is essential for maintaining biodiversity (i.e., richness and evenness of biological communities) and ecosystem functions and services across scales and borders in the face of system change. We administered an online survey to examine factors potentially driving perspectives of protected-area (PA) managers regarding coordination with neighboring PAs and other stakeholders (i.e., stakeholder coordination) for conserving biodiversity and ecosystem services during the next decade within diverse regions across Europe. Although >70% (n = 58) of responding PA managers indicated that climate change and invasive species are relevant for their PAs, they gave <50% probability that these threats could be mitigated through stakeholder coordination. They thought there was a >60% probability (n = 85) that stakeholder coordination would take place with the aim to improve conservation outcomes. Consistent with the foundation on which many European PAs were established, managers viewed maintaining or enhancing biodiversity as the most important (>70%; n = 61) expected benefit. Other benefits included maintaining or enhancing human resources and environmental education (range of Bayesian credibility intervals [CIs] 57-93%). They thought the main barriers to stakeholder coordination were the lack of human and economic resources (CI 59-67% chance of hindering; n = 64) followed by communication and interstakeholder differences in political structures and laws (CI 51-64% probability of hindering). European policies and strategies that address these hindering factors could be particularly effective means of enabling implementation of green infrastructure networks in which PAs are the nodes. © 2017 Society for Conservation Biology.

Perspective: Randomized Controlled Trials Are Not a Panacea for Diet-Related Research12

PubMed Central

Hébert, James R; Frongillo, Edward A; Adams, Swann A; Turner-McGrievy, Gabrielle M; Hurley, Thomas G; Miller, Donald R; Ockene, Ira S

2016-01-01

Research into the role of diet in health faces a number of methodologic challenges in the choice of study design, measurement methods, and analytic options. Heavier reliance on randomized controlled trial (RCT) designs is suggested as a way to solve these challenges. We present and discuss 7 inherent and practical considerations with special relevance to RCTs designed to study diet: 1) the need for narrow focus; 2) the choice of subjects and exposures; 3) blinding of the intervention; 4) perceived asymmetry of treatment in relation to need; 5) temporal relations between dietary exposures and putative outcomes; 6) strict adherence to the intervention protocol, despite potential clinical counter-indications; and 7) the need to maintain methodologic rigor, including measuring diet carefully and frequently. Alternatives, including observational studies and adaptive intervention designs, are presented and discussed. Given high noise-to-signal ratios interjected by using inaccurate assessment methods in studies with weak or inappropriate study designs (including RCTs), it is conceivable and indeed likely that effects of diet are underestimated. No matter which designs are used, studies will require continued improvement in the assessment of dietary intake. As technology continues to improve, there is potential for enhanced accuracy and reduced user burden of dietary assessments that are applicable to a wide variety of study designs, including RCTs. PMID:27184269

How do Medical Radiation Science educators keep up with the [clinical] Joneses?

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

Giles, Eileen

Medical radiation science (MRS) disciplines include medical imaging, radiation therapy and nuclear medicine. These allied health fields are technology driven and evolving rapidly with regard to imaging and treatment techniques within the clinical environment. This research aims to identify the activities academics are currently participating in to maintain clinical currency and offer strategies to support academics to connect with an ever-changing clinical environment. A cross-sectional designed survey was sampled across the nine Australian universities where MRS programmes are offered. The survey targeted academic teaching staff that were working in MRS programmes at the time of distribution (n ≈ 90). Enablersmore » and barriers to maintaining clinical currency as well as support to participate in continuing professional development were rated by the respondents. Descriptive statistics were used to analyse quantitative data, and free-text comment responses were collated and themed. There were 38 responses to the survey (42%) and all three disciplines were represented. Responses highlighted activities valued by academics as contributing to their knowledge of current practice and as resources to inform their teaching. Positive elements included participating in clinical work and research, attending clinical sites and training days and attending scientific meetings. Common barriers identified by academics in this area were time constraints, workload allocation and employer/financial support. This research has identified that Australian MRS academics participate in a broad range of activities to inform their teaching and maintain knowledge of contemporary clinical practice. A connection with the clinical world is valued highly by academics, however, access and support to maintain that link is often a difficulty and as a result for MRS teaching staff keeping up with the clinical [MRS] Joneses is often a challenge.« less

Exercise-induced menstrual irregularities.

PubMed

Greene, J W

1993-01-01

Exercise of sufficient rigor, particularly when coupled by weight loss and dietary restriction, is capable of producing reversible disturbances of reproductive function in many otherwise healthy women. However, it is clear that there are many health benefits for women who exercise regularly and in moderation. These include improved cardiovascular status, increased bone mineral content, improvement of dysmenorrhea and premenstrual syndrome symptoms, and general stress reduction. In addition, the inclusion of young women in high school and college athletics has provided many new opportunities. With these new opportunities, however, have come new challenges for physicians in assisting these women in maintaining optimal health.

Changes in Space Food over the Last 45 Years

NASA Technical Reports Server (NTRS)

Smith, Scott M.; Lane, Helen W.; Kloeris, Vickie; Perchonok, Michele; Zwart, Sara

2006-01-01

The space food system has improved over the last 45 years. With the advances for a Moon base, there is a potential that foods in space will be more like home cooked foods. However, until that happens, there will continue to be dehydrated and thermostablized foods providing the bulk of the astronauts food. In order for the astronauts to have adequate macronutrients, a food system must be developed including raising plants and food preparation, both a major challenge given the limited water, volume, and power. The lunar kitchens will be very different, but good food is essential to maintain good health.

Dawn Orbit Determination Team: Trajectory Modeling and Reconstruction Processes at Vesta

NASA Technical Reports Server (NTRS)

Abrahamson, Matthew J.; Ardito, Alessandro; Han, Dongsuk; Haw, Robert; Kennedy, Brian; Mastrodemos, Nick; Nandi, Sumita; Park, Ryan; Rush, Brian; Vaughan, Andrew

2013-01-01

The Dawn spacecraft spent over a year in orbit around Vesta from July 2011 through August 2012. In order to maintain the designated science reference orbits and enable the transfers between those orbits, precise and timely orbit determination was required. Challenges included low-thrust ion propulsion modeling, estimation of relatively unknown Vesta gravity and rotation models, track-ing data limitations, incorporation of real-time telemetry into dynamics model updates, and rapid maneuver design cycles during transfers. This paper discusses the dynamics models, filter configuration, and data processing implemented to deliver a rapid orbit determination capability to the Dawn project.

The Kepler End-to-End Model: Creating High-Fidelity Simulations to Test Kepler Ground Processing

NASA Technical Reports Server (NTRS)

Bryson, Stephen T.; Jenkins, Jon M.; Peters, Dan J.; Tenenbaum, Peter P.; Klaus, Todd C.; Gunter, Jay P.; Cote, Miles T.; Caldwell, Douglas A.

2010-01-01

The Kepler mission is designed to detect the transit of Earth-like planets around Sun-like stars by observing 100,000 stellar targets. Developing and testing the Kepler ground-segment processing system, in particular the data analysis pipeline, requires high-fidelity simulated data. This simulated data is provided by the Kepler End-to-End Model (ETEM). ETEM simulates the astrophysics of planetary transits and other phenomena, properties of the Kepler spacecraft and the format of the downlinked data. Major challenges addressed by ETEM include the rapid production of large amounts of simulated data, extensibility and maintainability.

Divorced mothers' coparental boundary maintenance after parents repartner.

PubMed

Ganong, Lawrence; Coleman, Marilyn; Jamison, Tyler; Feistman, Richard

2015-04-01

When divorced parents remarry or cohabit with new partners, it is challenging to maintain functional postdivorce coparenting systems. In this grounded theory study of 19 divorced mothers, we examined the processes by which they maintained boundaries around coparental relationships after 1 or both coparents had repartnered. Mothers saw themselves as captains of the coparenting team, making decisions about who should play what roles in parenting their children. They viewed themselves as having primary responsibility for their children, and they saw their children's fathers as important coparenting partners. Mothers used a variety of strategies to preserve boundaries around the coparental subsystem when either they or their ex-husbands repartnered. Stepparents became more active participants in coparenting when: (a) mothers perceived them to be adequate caregivers, (b) biological parents were able to cooperatively coparent, (c) mothers perceived the fathers as good parents and responsible fathers, and (d) mothers felt secure as the primary parents. When all 4 conditions were present, mothers were likely to expand the coparental subsystem to include new partners. If any of these conditions were not present, mothers resisted including stepparents as part of the child rearing team. The findings from this study highlight how coparental roles in a nonclinical sample of families develop and change; mothers often modify coparenting boundaries over time to include stepparents. (c) 2015 APA, all rights reserved).

Psychosocial issues and mental health treatment recommendations for patients with hepatitis C.

PubMed

Silberbogen, Amy K; Ulloa, Erin W; Janke, E Amy; Mori, DeAnna L

2009-01-01

Mental health needs of patients with HCV are increasingly being addressed in medical contexts. The authors review the psychosocial issues relevant to patients with hepatitis C and provide mental health treatment recommendations. Patients with HCV are faced with a number of challenges, including adjustment to a chronic medical illness, management of symptoms and treatment side effects, and making and maintaining lifestyle changes. Given these issues, mental health clinicians have the opportunity to make a significant contribution to patient care. After reviewing the relevant research on these psychosocial issues, the authors have identified areas in which clinicians can intervene; these include adjustment to having a chronic medical illness, coping with stigma and relationship changes, management of side effects, and implementing healthy lifestyle changes.

Acoustic telemetry observation systems: challenges encountered and overcome in the Laurentian Great Lakes

USGS Publications Warehouse

Krueger, Charles C.; Holbrook, Christopher; Binder, Thomas R.; Vandergoot, Christopher; Hayden, Todd A.; Hondorp, Darryl W.; Nate, Nancy; Paige, Kelli; Riley, Stephen; Fisk, Aaron T.; Cooke, Steven J.

2017-01-01

The Great Lakes Acoustic Telemetry Observation System (GLATOS), organized in 2012, aims to advance and improve conservation and management of Great Lakes fishes by providing information on behavior, habitat use, and population dynamics. GLATOS faced challenges during establishment, including a funding agency-imposed urgency to initiate projects, a lack of telemetry expertise, and managing a flood of data. GLATOS now connects 190+ investigators, provides project consultation, maintains a web-based data portal, contributes data to Ocean Tracking Network’s global database, loans equipment, and promotes science transfer to managers. The GLATOS database currently has 50+ projects, 39 species tagged, 8000+ fish released, and 150+ million tag detections. Lessons learned include (1) seek advice from others experienced in telemetry; (2) organize networks prior to when shared data is urgently needed; (3) establish a data management system so that all receivers can contribute to every project; (4) hold annual meetings to foster relationships; (5) involve fish managers to ensure relevancy; and (6) staff require full-time commitment to lead and coordinate projects and to analyze data and publish results.

Pathfinder radar development at Sandia National Laboratories

NASA Astrophysics Data System (ADS)

Castillo, Steven

2016-05-01

Since the invention of Synthetic Aperture Radar imaging in the 1950's, users or potential users have sought to exploit SAR imagery for a variety of applications including the earth sciences and defense. At Sandia Laboratories, SAR Research and Development and associated defense applications grew out of the nuclear weapons program in the 1980's and over the years has become a highly viable ISR sensor for a variety of tactical applications. Sandia SAR systems excel where real-­-time, high-­-resolution, all-­-weather, day or night surveillance is required for developing situational awareness. This presentation will discuss the various aspects of Sandia's airborne ISR capability with respect to issues related to current operational success as well as the future direction of the capability as Sandia seeks to improve the SAR capability it delivers into multiple mission scenarios. Issues discussed include fundamental radar capabilities, advanced exploitation techniques and human-­-computer interface (HMI) challenges that are part of the advances required to maintain Sandia's ability to continue to support ever changing and demanding mission challenges.

Can Academic Medicine Lead the Way in the Refugee Crisis?

PubMed

Afkhami, Amir A

2016-12-01

The world is currently in the midst of the largest refugee crisis since World War II, with the highest interval of mass displacement in recorded history according to the United Nations. The United States has pledged to maintain its position as one of the world's top resettlement countries in response to this crisis. These new immigrants will arrive with exceptional chronic and acute medical needs, including higher rates of behavioral health disorders. The author describes the health care challenges experienced by refugees seeking asylum in the United States and outlines the ways in which our health care system is currently deficient in helping refugee patients to overcome these challenges. He argues that the academic medical community can change this dynamic by standardizing and expanding instruction in cross-cultural competence and behavioral health screenings throughout the spectrum of medical education. Ensuring the long-term well-being of refugees in the United States, including meeting their mental health needs, will be the best inoculation against the risks of violent extremism which so many fear. With the absence of national leadership on this issue, academic medicine can and should lead the way.

Low power femtosecond tip-based nanofabrication with advanced control

NASA Astrophysics Data System (ADS)

Liu, Jiangbo; Guo, Zhixiong; Zou, Qingze

2018-02-01

In this paper, we propose an approach to enable the use of low power femtosecond laser in tip-based nanofabrication (TBN) without thermal damage. One major challenge in laser-assisted TBN is in maintaining precision control of the tip-surface positioning throughout the fabrication process. An advanced iterative learning control technique is exploited to overcome this challenge in achieving high-quality patterning of arbitrary shape on a metal surface. The experimental results are analyzed to understand the ablation mechanism involved. Specifically, the near-field radiation enhancement is examined via the surface-enhanced Raman scattering effect, and it was revealed the near-field enhanced plasma-mediated ablation. Moreover, silicon nitride tip is utilized to alleviate the adverse thermal damage. Experiment results including line patterns fabricated under different writing speeds and an "R" pattern are presented. The fabrication quality with regard to the line width, depth, and uniformity is characterized to demonstrate the efficacy of the proposed approach.

Developing the Next Generation of International Safeguards and Nonproliferation Experts: Highlights of Select Activities at the National Laboratories

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

Reed, J; Mathews, C; Kirk, B

2010-03-31

With many safeguards experts in the United States at or near retirement age, and with the growing and evolving mission of international safeguards, attracting and educating a new generation of safeguards experts is an important element of maintaining a credible and capable international safeguards system. The United States National Laboratories, with their rich experience in addressing the technical and policy challenges of international safeguards, are an important resource for attracting, educating, and training future safeguards experts. This presentation highlights some of the safeguards education and professional development activities underway at the National Laboratories. These include university outreach, summer courses, internships,more » mid-career transition, knowledge retention, and other projects. The presentation concludes with thoughts on the challenge of interdisciplinary education and the recruitment of individuals with the right balance of skills and backgrounds are recruited to meet tomorrow's needs.« less

Providing care for critically ill surgical patients: challenges and recommendations.

PubMed

Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

2013-07-01

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair.

PubMed Central

Morris-Stiff, G.; Hughes, L. E.

1998-01-01

In an attempt to reduce the high recurrence rate after repair of parastomal hernia, a technique was devised in which non-absorbable mesh was used to provide a permanent closure of the gap between the emerging bowel and abdominal wall. Seven patients were treated during the period 1990-1992. Five-year follow-up has given disappointing results, with recurrent hernia in 29% of cases and serious complications, including obstruction and dense adhesions to the intra-abdominal mesh, in 57% and a mesh-related abscess in 15% of cases. This study highlights a dual problem--failure of a carefully sutured mesh to maintain an occlusive position, and complications of the mesh itself. The poor results obtained with this technique together with the disappointing results with other methods described in the literature confirms that parastomal hernia presents a continuing challenge. Images Figure 1 Figure 2 PMID:9682640

Isolation and Flow Cytometry Analysis of Innate Lymphoid Cells from the Intestinal Lamina Propria.

PubMed

Gronke, Konrad; Kofoed-Nielsen, Michael; Diefenbach, Andreas

2017-01-01

The intestinal mucosa constitutes the biggest surface area of the body. It is constantly challenged by bacteria, commensal and pathogenic, protozoa, and food-derived irritants. In order to maintain homeostasis, a complex network of signaling circuits has evolved that includes contributions of immune cells. In recent years a subset of lymphocytes, which belong to the innate immune system, has caught particular attention. These so-called innate lymphoid cells (ILC) reside within the lamina propria of the small and large intestines and rapidly respond to environmental challenges. They provide immunity to various types of infections but may also contribute to organ homeostasis as they produce factors acting on epithelial cells thereby enhancing barrier integrity. Here, we describe how these cells can be isolated from their environment and provide an in-depth protocol how to visualize the various ILC subsets by flow cytometry.

Exotic encounters with dental implants: managing complications with unidentified systems.

PubMed

Mattheos, N; Janda, M Schittek

2012-06-01

As the application of dental implants increases worldwide, so is the number of technical and biological complications that general dental practitioners will be called to manage, while maintaining implant patients. In addition, the greater patient mobility encountered today combined with a growing trend of 'dental implant tourism' will very often result in situations where the dentist is requested to deal with complications in implants placed elsewhere and which sometimes might be of an 'exotic' system one cannot directly recognize. Such a situation can pose significant challenges to even experienced clinicians. The challenges are not only in the scientific field, but often include professional and ethical implications. This case report will discuss strategies for the management of implant complications in cases of unidentified implant systems. Critical factors in such situations would be the clinician's experience and special training, the correct radiographic technique, as well as access to the appropriate tools and devices. © 2012 Australian Dental Association.

Caring from Afar: Asian H1B Migrant Workers and Aging Parents.

PubMed

Lee, Yeon-Shim; Chaudhuri, Anoshua; Yoo, Grace J

2015-09-01

With the growth in engineering/technology industries, the United States has seen an increase in the arrival of highly skilled temporary migrant workers on H1B visas from various Asian countries. Limited research exists on how these groups maintain family ties from afar including caring for aging parents. This study explores the experiences and challenges that Asian H1B workers face when providing care from a distance. A total of 21 Chinese/Taiwanese, Korean, and Indian H1B workers participated in in-depth qualitative interviews. Key findings indicate that despite distance, caring relationships still continue through regular communications, financial remittances, and return visits, at the same time creating emotional, psychological, and financial challenges for the workers. Findings highlight the need for further research in understanding how the decline of aging parent's health impacts the migrants' adjustment and health in the United States.

Food security and marine capture fisheries: characteristics, trends, drivers and future perspectives

PubMed Central

Garcia, Serge M.; Rosenberg, Andrew A.

2010-01-01

World population is expected to grow from the present 6.8 billion people to about 9 billion by 2050. The growing need for nutritious and healthy food will increase the demand for fisheries products from marine sources, whose productivity is already highly stressed by excessive fishing pressure, growing organic pollution, toxic contamination, coastal degradation and climate change. Looking towards 2050, the question is how fisheries governance, and the national and international policy and legal frameworks within which it is nested, will ensure a sustainable harvest, maintain biodiversity and ecosystem functions, and adapt to climate change. This paper looks at global fisheries production, the state of resources, contribution to food security and governance. It describes the main changes affecting the sector, including geographical expansion, fishing capacity-building, natural variability, environmental degradation and climate change. It identifies drivers and future challenges, while suggesting how new science, policies and interventions could best address those challenges. PMID:20713390

Bridging research and practice: community-researcher partnerships for replicating effective interventions.

PubMed

Rotheram-Borus, M J; Rebchook, G M; Kelly, J A; Adams, J; Neumann, M S

2000-01-01

Long-term collaborations among researchers, staff and volunteers in community-based agencies, staff in institutional settings, and health advocates present challenges. Each group has different missions, procedures, attributes, and rewards. This article reviews areas of potential conflict and suggests strategies for coping with these challenges. During the replication of five effective HIV prevention interventions, strategies for maintaining mutually beneficial collaborations included selecting agencies with infrastructures that could support research-based interventions; obtaining letters of understanding that clarified roles, responsibilities, and time frames; and setting training schedules with opportunities for observing, practicing, becoming invested in, and repeatedly implementing the intervention. The process of implementing interventions highlighted educating funders of research and public health services about (a) the costs of disseminating interventions, (b) the need for innovation to new modalities and theories for delivering effective interventions, and (c) adopting strategies of marketing research and quality engineering when designing interventions.

US military primary care: problems, solutions, and implications for civilian medicine.

PubMed

Mundell, Benjamin F; Friedberg, Mark W; Eibner, Christine; Mundell, William C

2013-11-01

The US Military Health System (MHS), which is responsible for providing care to active and retired members of the military and their dependents, faces challenges in delivering cost-effective, high-quality primary care while maintaining a provider workforce capable of meeting both peacetime and wartime needs. The MHS has implemented workforce management strategies to address these challenges, including "medical home" teams for primary care and other strategies that expand the roles of nonphysician providers such as physician assistants, nurse practitioners, and medical technicians. Because these workforce strategies have been implemented relatively recently, there is limited evidence of their effectiveness. If they prove successful, they could serve as a model for the civilian sector. However, because the MHS model features a broad mix of provider types, changes to civilian scope-of-practice regulations for nonphysician providers would be necessary before the civilian provider mix could replicate that of the MHS.

Developing an interministerial substance use response strategy for Lebanon: process, content and lessons learned.

PubMed

Hajal, Sandra; Kik, Nour; El Chammay, Rabih; Ammar, Walid

2017-05-01

Evidence on substance use in Lebanon shows an increase in usage, limited availability and accessibility to evidence-based services, and high level of stigma and discrimination. In line with the "Mental Health and Substance Use Strategy for Lebanon 2015-2020", the Ministry of Public Health initiated the process of developing a strategy focused on substance use response to address these challenges in collaboration with the Ministries of Education and Higher Education, Interior and Municipalities, Justice and Social Affairs. The result of this process was a strategy launched jointly by the ministries including six domains of action covering the whole spectrum of substance use response with strategic objectives addressing the challenges identified through stakeholders' consultations. The following key principles adopted throughout the process contributed to the successful development of the strategy: building on evidence and international frameworks, maximizing the participation of all stakeholders, prioritising national consensus, maintaining flexibility and maximizing transparency.

Brush Seals for Improved Steam Turbine Performance

NASA Technical Reports Server (NTRS)

Turnquist, Norman; Chupp, Ray; Baily, Fred; Burnett, Mark; Rivas, Flor; Bowsher, Aaron; Crudgington, Peter

2006-01-01

GE Energy has retrofitted brush seals into more than 19 operating steam turbines. Brush seals offer superior leakage control compared to labyrinth seals, owing to their compliant nature and ability to maintain very tight clearances to the rotating shaft. Seal designs have been established for steam turbines ranging in size from 12 MW to over 1200 MW, including fossil, nuclear, combined-cycle and industrial applications. Steam turbines present unique design challenges that must be addressed to ensure that the potential performance benefits of brush seals are realized. Brush seals can have important effects on the overall turbine system that must be taken into account to assure reliable operation. Subscale rig tests are instrumental to understanding seal behavior under simulated steam-turbine operating conditions, prior to installing brush seals in the field. This presentation discusses the technical challenges of designing brush seals for steam turbines; subscale testing; performance benefits of brush seals; overall system effects; and field applications.

Understanding the relationship between stress, distress and healthy lifestyle behaviour: a qualitative study of patients and general practitioners.

PubMed

McKenzie, Suzanne H; Harris, Mark F

2013-11-01

The process of initiating and maintaining healthy lifestyle behaviours is complex, includes a number of distinct phases and is not static. Theoretical models of behaviour change consider psychological constructs such as intention and self efficacy but do not clearly consider the role of stress or psychological distress. General practice based interventions addressing lifestyle behaviours have been demonstrated to be feasible and effective however it is not clear whether general practitioners (GPs) take psychological health into consideration when discussing lifestyle behaviours. This qualitative study explores GPs' and patients' perspectives about the relationship between external stressors, psychological distress and maintaining healthy lifestyle behaviours. Semi-structured telephone interviews were conducted with 16 patients and 5 GPs. Transcripts from the interviews were thematically analysed and a conceptual model developed to explain the relationship between external stressors, psychological distress and healthly lifestyle behaviours. Participants were motivated to maintain a healthy lifestyle however they described a range of external factors that impacted on behaviour in both positive and negative ways, either directly or via their impact on psychological distress. The impact of external factors was moderated by coping strategies, beliefs, habits and social support. In some cases the process of changing or maintaining healthy behaviour also caused distress. The concept of a threshold level of distress was evident in the data with patients and GPs describing a certain level of distress required before it negatively influenced behaviour. Maintaining healthy lifestyle behaviours is complex and constantly under challenge from external stressors. Practitioners can assist patients with maintaining healthy behaviour by providing targeted support to moderate the impact of external stressors.

Attentional Focus Effects as a Function of Task Difficulty

ERIC Educational Resources Information Center

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

2007-01-01

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

Overcoming Personal and Academic Challenges: Perspectives from Latina/o College Students

ERIC Educational Resources Information Center

Cavazos, Javier, Jr.; Johnson, Michael B.; Sparrow, Gregory Scott

2010-01-01

Eleven Latina/o college students were interviewed to provide insight into what kind of coping responses they used to overcome challenges and when such responses were employed. The following responses emerged: positive reframing, acceptance, self-talk, maintaining focus on final goals, using low expectations as motivation, self-reflection, taking…

CHALLENGES IN MAINTAINING DRINKING WATER QUALITY AT THE TAP: CONTAMINATION WITH TOXIC LEAD

EPA Science Inventory

Aging drinking water infrastructure in the US was given a grade of D (poor) by the American Society of Civil Engineers, and was voted as the most urgent of all societal infrastructure challenges. Legacy lead pipe, leaded solder and/or leaded brass are a particularly notorious old...

Precollege Factors and Leading Indicators: Increasing Transfer and Degree Completion in a Community and Technical College System

ERIC Educational Resources Information Center

Davidson, J. Cody

2015-01-01

Today, community colleges are challenged to maintain their historical identity of open access while increasing student success. This challenge is particularly salient in the context of performance-based funding models. These models create student achievements, which determine institutional levels of state funding. Therefore, these new student…

Roman Catholic Schooling in Ontario: Past Struggles, Present Challenges, Future Direction?

ERIC Educational Resources Information Center

Brennan, Terri-Lynn Kay

2011-01-01

Ontario Roman Catholic communities have established and maintained their own schools for over 200 years. Yet, their struggle for survival has not come without many challenges, setbacks, and criticisms. With the achievement of open-access at the secondary level and equal funding across the system, many question the legitimacy and worthiness of…

Functional Communication Training and Chained Schedules of Reinforcement to Treat Challenging Behavior Maintained by Terminations of Activity Interruptions

ERIC Educational Resources Information Center

Falcomata, Terry S.; Roane, Henry S.; Muething, Colin S.; Stephenson, Kasey M.; Ing, Anna D.

2012-01-01

In this article, the authors evaluated functional communication training (FCT) and a chained schedule of reinforcement for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism, respectively. Following a functional analysis with undifferentiated results, the authors demonstrated that…

Maryland Public School Standards for Telecommunications Distribution Systems: Infrastructure Design for Voice, Video, and Data Communications.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore. School Facilities Branch.

Telecommunications infrastructure has the dual challenges of maintaining quality while accommodating change, issues that have long been met through a series of implementation standards. This document is designed to ensure that telecommunications systems within the Maryland public school system are also capable of meeting both challenges and…

Laminar flow: Challenge and potential

NASA Technical Reports Server (NTRS)

Kirchner, Mark E.

1987-01-01

Commercial air transportation has experienced revolutionary technology advances since WWII. These technology advances have resulted in an explosive growth in passenger traffic. Today, however, many technologies have matured, and maintaining a similar growth rate will be a challenge. A brief history of laminar flow technology and its application to subsonic and supersonic air transportation is presented.

The United Nations at 70: The Journey so Far

ERIC Educational Resources Information Center

Muftau, Rufai

2016-01-01

The relevance of the United Nations in maintaining peace and harmonious relationship amongst its members is not in doubt, this being the primary functions as contained in its Charter of 1945. Since that time till date, it has recorded some tremendous achievements in this direction, though not without some challenges. These challenges among others…

Integral Students' Experiences: Measuring Instructional Quality and Instructors' Challenges in Calculus 1 Lessons

ERIC Educational Resources Information Center

Hong, Dae S.; Choi, Kyong Mi; Hwang, Jihyun; Runnalls, Cristina

2017-01-01

In this study, we examined 10 integral lessons to understand students' opportunities to learn cognitively challenging tasks and maintain cognitive demand during integral lessons. Our findings reveal issues with implemented tasks as well as the way these tasks were presented to students. We also examined mathematicians' reasons behind their…

An Initial Evaluation of Direct Care Staff Resilience Workshops in Intellectual Disabilities Services

ERIC Educational Resources Information Center

Ingham, Barry; Riley, Jenny; Nevin, Helen; Evans, Gemma; Gair, Elodie

2013-01-01

The emotional responses to challenging behaviour of direct care staff who support people with intellectual disabilities is thought to be an important mediating factor within the stress experienced by staff and a potential maintaining factor in challenging behaviour. A brief workshop to improve direct care staff resilience was developed and…

Challenges to Popular and Human Rights Education: The Formation of Producer, Citizen, and Person.

ERIC Educational Resources Information Center

Sime, Luis

1994-01-01

Contends that popular, or a form of alternative, education stands in the background of most efforts in human rights education in Latin America. Maintains that education must educate people as producers, citizens, and individuals. Discusses challenges to this task in light of liberation theology and the Peruvian experience. (CFR)

Sources of Support for Women Taking Professional Programs by Distance Education

ERIC Educational Resources Information Center

Cragg, C. E. (Betty); Andrusyszyn, Mary-Anne; Fraser, Joy

2005-01-01

Women with multiple roles face many challenges when taking distance education courses in professional programs to achieve credentials or maintain competence. Among these challenges is finding the supports necessary for success as a distance student. As part of a larger study on advantages and stressors identified by such women in distance…

Abrasive Wear of Four Direct Restorative Materials by Standard and Whitening Dentifrices

DTIC Science & Technology

2013-06-01

after an acidic challenge . Enamel loss was significantly greater when erosive and abrasive effects were combined. They concluded that acid-softened...surrounding soft tissues. Another benefit of restoration is the elimination of a challenging area for the patient and hygienist to clean. These areas...abrasion challenge ; the resin cement with the smallest sized filler particles had the smallest weight loss and maintained the smoothest surface of all the

How do older people with sight loss manage their general health? A qualitative study.

PubMed

Burton, Amy E; Gibson, Jonathan M; Shaw, Rachel L

2016-11-01

Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Preventing and managing challenging behaviour.

PubMed

Hallett, Nutmeg

2018-02-21

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Impacts of international trade, services and investment treaties on alcohol regulation.

PubMed

Grieshaber-Otto, J; Sinclair, S; Schacter, N

2000-12-01

There is an underlying incompatibility between government efforts to minimize the harm associated with alcohol, particularly by regulating its supply, and international commercial treaties that promote the freer flow of goods, services and investment. These treaties have already forced changes to many government measures affecting alcohol availability and control, primarily by constraining the activities of government alcohol monopolies and by altering taxation regimes. The North American Free Trade Agreement and the World Trade Organization agreements open new avenues for challenges against alcohol control measures. Some of these agreements extend beyond trade, border measures and differential taxation and allow challenges that intrude into areas of non-discriminatory domestic regulation affecting market access, intellectual property, investment and services. Effective protection from these agreements for vital public health measures has rarely been obtained, although it is increasingly essential. The WTO "services" agreement, basically unknown to the public, is currently being re-negotiated and poses the gravest new challenge to policies designed to influence patterns of alcohol use and minimize alcohol-related harm. In future, these international agreements will probably affect adversely those alcohol approaches considered to be the most effective or promising. These include: maintaining effective state monopolies, restricting the number and locations of retail outlets, taxing and regulating beverages according to alcohol strength, restricting commercial advertising, and maintaining and enhancing public alcohol education and treatment programs. These effects can, in turn, be expected to increase the availability and access to alcohol, to lower alcohol taxes, and to increase advertising and promotion, resulting in increased alcohol consumption and associated health problems. Until more balanced international rules are developed, the challenge facing alcohol policy researchers is to defend national and local alcohol measures from further erosion. This will require greater coordination with researchers in other affected sectors, intervention with government representatives in health and related areas and the promotion of alternative approaches to current international commercial agreements.

Vaccine trials in the developing world: operational lessons learnt from a phase IV poliomyelitis vaccine trial in South Africa.

PubMed

Geldenhuys, H; Waggie, Z; Jacks, M; Geldenhuys, M; Traut, L; Tameris, M; Hatherill, M; Hanekom, W A; Sutter, R; Hussey, G; Mahomed, H

2012-08-31

Conducting vaccine trials in developing nations is necessary but operationally complex. We describe operational lessons learnt from a phase IV poliomyelitis vaccine trial in a semi-rural region of South Africa. We reviewed operational data collected over the duration of the trial with respect to staff recruitment and training, participant recruitment and retention, and cold chain maintenance. RESULTS-LESSONS LEARNT: The recruitment model we used that relied on the 24h physical presence of a team member in the birthing unit was expensive and challenging to manage. Forecasting of enrolment rates was complicated by incomplete baseline data and by the linear nature of forecasts that do not take into account changing variables. We found that analyzing key operational data to monitor progress of the trial enabled us to identify problem areas timeously, and to facilitate a collegial problem-solving process by the extended trial team. Pro-actively nurturing a working relationship with the public sector health care system and the community was critical to our success. Despite the wide geographical area and lack of fixed addresses, we maintained an excellent retention rate through community assistance and the use of descriptive residential information. Training needs of team members were ongoing and dynamic and we discovered that these needs that were best met by an in-house, targeted and systemized training programme. The use of vaccine refrigerators instead of standard frost-free refrigerators is cost-effective and necessary to maintain the cold-chain. Operational challenges of a vaccine trial in developing world populations include inexperienced staff, the close liaison required between researchers and public health care services, impoverished participants that require complex recruitment and retention strategies, and challenges of distance and access. These challenges can be overcome by innovative strategies that allow for the unique characteristics of the setting, trial population, and trial team. Copyright © 2012 Elsevier Ltd. All rights reserved.

EXTENSION EDUCATION SYMPOSIUM: Getting the most out of your extension appointment and still having a life.

PubMed

Powers, W; Cockett, N; Lardy, G

2017-04-01

Managing the demands of an academic appointment in extension can be a challenging task. Demands from constituent groups, expectations of supervisors, and rigors of promotion and tenure processes can create pressures that young faculty did not expect. Throw in spousal and family duties and you have created a situation that many will find hard to navigate. However, there are ways to cope and, even better news, there are ways to excel in meeting the demands of an academic appointment and enjoying life. Because many new extension faculty members do not have prior experience in extension, best practices in documenting programs and extension scholarship over the pretenure period are provided in this paper. Appointments that include both research and extension are quite common at many land grant universities. The advantages of joint appointments are numerous and include the fact that more and more grant agencies are seeking integrated research, teaching, and/or extension projects. However, the time demands of joint appointments can be challenging. Joint appointments can be designed to help faculty members conduct important translational research and have it be applied in a production setting. By seeking commonalities in research and extension efforts, joint appointments can be very synergistic. Development of highly successful programs requires planning on the front end with an emphasis on an in-depth needs assessment to determine stakeholder needs for both research and extension. Impact assessment should be part of this planning effort. Performing as a successful extension faculty member while maintaining relationships outside of work is challenging and requires deliberate effort on the part of employees and supervisors to realize there is more to life than work. Some authors have referred to this as work-life balance, but it may be more helpful to think of it as work-life effectiveness. To do this, one needs to 1) define what success looks like, 2) set boundaries and maintain control including control of your schedule, and 3) find time to ensure your physical, emotional, and spiritual well-being are nurtured in addition to your professional development. In summary, extension careers can be challenging at times as demands and expectations of stakeholders, supervisors, and rigors of the tenure system create formidable obstacles. However, by keeping a focus on the priorities of the position and looking for synergy in research and extension work, they can actually be quite enjoyable and very rewarding.

Working to make the Clean Air Act and prescribed burning compatible

Treesearch

Trent Procter

1995-01-01

The Federal Clean Air Act of 1963 offers a challenge to the future of prescribed and natural fire programs in the United States. One aspect of maintaining healthy ecosystems for humans and natural resources is clean air. In addition, prescribed and natural fire programs are an important tool in maintaining healthy ecosystems, as well as satisfying the requirements of...

Maintaining and restoring sustainable ecosystems in southern Nevada [Chapter 7

Treesearch

Jeanne C. Chambers; Burton K. Pendleton; Donald W. Sada; Steven M. Ostoja; Matthew L. Brooks

2013-01-01

Managers in southern Nevada are challenged with determining appropriate goals and objectives and developing viable approaches for maintaining and restoring sustainable ecosystems in a time of rapid socio-ecological and environmental change. Sustainable or “healthy” ecosystems supply clean air, water and habitat for a diverse array of plants and animals. As described in...

Engaging offenders on probation in health research: lessons from the field.

PubMed

Sirdifield, Coral; Owen, Sara; Brooker, Charlie

2016-11-18

Background Offenders on probation are considered to be 'hard to reach' by researchers because probation is a 'closed setting' and engaging offenders in research can be problematic due to issues such as return to custody and chaotic lifestyles. Aim To share learning about the challenges encountered when undertaking research with offenders on probation in the UK, strategies for overcoming them and the implications for research design and outcomes. Discussion The authors identify challenges in gaining and maintaining access; recruitment; ethics; data collection and analysis; and dissemination of findings. They also consider the implications of these challenges for research design and outcomes. Conclusion Engaging offenders in research takes time and effort to gain and maintain access. Researchers need to be persistent and flexible. The potential influence of gatekeepers on recruitment and outcomes is critical and constant communication needs to be maintained. When designing and resourcing projects, researchers must consider the transient nature of the population as well as the need to communicate any potential limits of confidentiality. Implications for practice The lessons learned will be helpful for future research in this field, which is needed to provide data for healthcare commissioners to inform the provision of patient-centred care for this vulnerable and hard-to-reach population.

Long-term correction of very long-chain acyl-coA dehydrogenase deficiency in mice using AAV9 gene therapy.

PubMed

Keeler, Allison M; Conlon, Thomas; Walter, Glenn; Zeng, Huadong; Shaffer, Scott A; Dungtao, Fu; Erger, Kirsten; Cossette, Travis; Tang, Qiushi; Mueller, Christian; Flotte, Terence R

2012-06-01

Very long-chain acyl-coA dehydrogenase (VLCAD) is the rate-limiting step in mitochondrial fatty acid oxidation. VLCAD-deficient mice and patients clinical symptoms stem from not only an energy deficiency but also long-chain metabolite accumulations. VLCAD-deficient mice were treated systemically with 1 × 10(12) vector genomes of recombinant adeno-associated virus 9 (rAAV9)-VLCAD. Biochemical correction was observed in vector-treated mice beginning 2 weeks postinjection, as characterized by a significant drop in long-chain fatty acyl accumulates in whole blood after an overnight fast. Changes persisted through the termination point around 20 weeks postinjection. Magnetic resonance spectroscopy (MRS) and tandem mass spectrometry (MS/MS) revealed normalization of intramuscular lipids in treated animals. Correction was not observed in liver tissue extracts, but cardiac muscle extracts showed significant reduction of long-chain metabolites. Disease-specific phenotypes were characterized, including thermoregulation and maintenance of euglycemia after a fasting cold challenge. Internal body temperatures of untreated VLCAD(-/-) mice dropped below 20 °C and the mice became lethargic, requiring euthanasia. In contrast, all rAAV9-treated VLCAD(-/-) mice and the wild-type controls maintained body temperatures. rAAV9-treated VLCAD(-/-) mice maintained euglycemia, whereas untreated VLCAD(-/-) mice suffered hypoglycemia following a fasting cold challenge. These promising results suggest rAAV9 gene therapy as a potential treatment for VLCAD deficiency in humans.

Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior.

PubMed

Czaja, Sara J; Valente, Thomas W; Nair, Sankaran N; Villamar, Juan A; Brown, C Hendricks

2016-05-17

Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

Evaluation of a team-building retreat to promote nursing faculty cohesion and job satisfaction.

PubMed

Birx, Ellen; Lasala, Kathleen B; Wagstaff, Mark

2011-01-01

With the growing global shortage of nursing faculty, there is increased need to develop and evaluate strategies to promote nursing faculty job satisfaction. Using quantitative and qualitative research methods, a team-building faculty retreat including challenge course activities was evaluated to determine its effects on group cohesion and job satisfaction. Mean Job in General scores for the sample (n = 29) at the start of the study were comparable with national norms for employees with graduate degrees. There were statistically significant increases in Job in General scores and group cohesion scores from pretest to posttest on the day of the retreat. However, the positive changes were not maintained at the end of the semester when follow-up data were gathered. Content analysis of the retreat day reflections revealed the following themes: getting to know each other better, seeing commonalities and differences, spending time together, developing trust, and working as a group. Several themes were identified in the end of the semester reflections: getting to know each other, feeling closer as a group, setting a friendlier tone for the semester, and that the retreat was a positive experience. Based on these findings, we recommend the use of a faculty retreat with challenge course activities to promote nursing faculty cohesion and job satisfaction. However, follow-up activities are recommended to maintain positive results over time. 2011 Elsevier Inc. All rights reserved.

The Clinical Relevance of Maintaining the Functional Integrity of the Stratum Corneum in both Healthy and Disease-affected Skin

PubMed Central

Del Rosso, James Q.; Levin, Jacqueline

2011-01-01

It has been recognized for approximately 50 years that the stratum corneum exhibits biological properties that contribute directly to maintaining and sustaining healthy skin. Continued basic science and clinical research coupled with keen clinical observation has led to more recent recognition and general acceptance that the stratum corneum completes many vital “barrier” tasks, including but not limited to regulating epidermal water content and the magnitude of water loss; mitigating exogenous oxidants that can damage components of skin via an innate antioxidant system; preventing or limiting cutaneous infection via multiple antimicrobial peptides; responding via innate immune mechanisms to “cutaneous invaders” of many origins, including microbes, true allergens, and other antigens; and protecting its neighboring cutaneous cells and structures that lie beneath from damaging effects of ultraviolet radiation. Additionally, specific abnormalities of the stratum corneum are associated with the clinical expression of certain disease states. This article provides a thorough “primer” for the clinician, reviewing the multiple normal homeostatic functions of the stratum corneum and the cutaneous challenges that arise when individual functions of this thin yet very active epidermal layer are compromised by exogenous and/or endogenous factors. PMID:21938268

SiglecF+Gr1hi eosinophils are a distinct subpopulation within the lungs of allergen-challenged mice

PubMed Central

Percopo, Caroline M.; Brenner, Todd A.; Ma, Michelle; Kraemer, Laura S.; Hakeem, Reem M. A.; Lee, James J.; Rosenberg, Helene F.

2017-01-01

Although eosinophils as a group are readily identified by their unique morphology and staining properties, flow cytometry provides an important means for identification of subgroups based on differential expression of distinct surface Ags. Here, we characterize an eosinophil subpopulation defined by high levels of expression of the neutrophil Ag Gr1 (CD45+CD11c−SiglecF+Gr1hi). SiglecF+Gr1hi eosinophils, distinct from the canonical SiglecF+Gr1− eosinophil population, were detected in allergen-challenged wild-type and granule protein-deficient (EPX−/− and MBP-1−/−) mice, but not in the eosinophil-deficient ΔdblGATA strain. In contrast to Gr1+ neutrophils, which express both cross-reacting Ags Ly6C and Ly6G, SiglecF+Gr1hi eosinophils from allergen-challenged lung tissue are uniquely Ly6G+. Although indistinguishable from the more-numerous SiglecF+Gr1− eosinophils under light microscopy, FACS-isolated populations revealed prominent differences in cytokine contents. The lymphocyte-targeting cytokines CXCL13 and IL-27 were identified only in the SiglecF+Gr1hi eosinophil population (at 3.9 and 4.8 pg/106 cells, respectively), as was the prominent proinflammatory mediator IL-13 (72 pg/106 cells). Interestingly, bone marrow-derived (SiglecF+), cultured eosinophils include a more substantial Gr1+ subpopulation (∼50%); Gr1+ bmEos includes primarily a single Ly6C+ and a smaller, double-positive (Ly6C+Ly6G+) population. Taken together, our findings characterize a distinct SiglecF+Gr1hi eosinophil subset in lungs of allergen-challenged, wild-type and granule protein-deficient mice. SiglecF+Gr1hi eosinophils from wild-type mice maintain a distinct subset of cytokines, including those active on B and T lymphocytes. These cytokines may facilitate eosinophil-mediated immunomodulatory responses in the allergen-challenged lung as well as in other distinct microenvironments. PMID:27531929

SiglecF+Gr1hi eosinophils are a distinct subpopulation within the lungs of allergen-challenged mice.

PubMed

Percopo, Caroline M; Brenner, Todd A; Ma, Michelle; Kraemer, Laura S; Hakeem, Reem M A; Lee, James J; Rosenberg, Helene F

2017-01-01

Although eosinophils as a group are readily identified by their unique morphology and staining properties, flow cytometry provides an important means for identification of subgroups based on differential expression of distinct surface Ags. Here, we characterize an eosinophil subpopulation defined by high levels of expression of the neutrophil Ag Gr1 (CD45 + CD11c - SiglecF + Gr1 hi ). SiglecF + Gr1 hi eosinophils, distinct from the canonical SiglecF + Gr1 - eosinophil population, were detected in allergen-challenged wild-type and granule protein-deficient (EPX -/- and MBP-1 -/- ) mice, but not in the eosinophil-deficient ΔdblGATA strain. In contrast to Gr1 + neutrophils, which express both cross-reacting Ags Ly6C and Ly6G, SiglecF + Gr1 hi eosinophils from allergen-challenged lung tissue are uniquely Ly6G + Although indistinguishable from the more-numerous SiglecF + Gr1 - eosinophils under light microscopy, FACS-isolated populations revealed prominent differences in cytokine contents. The lymphocyte-targeting cytokines CXCL13 and IL-27 were identified only in the SiglecF + Gr1 hi eosinophil population (at 3.9 and 4.8 pg/10 6 cells, respectively), as was the prominent proinflammatory mediator IL-13 (72 pg/10 6 cells). Interestingly, bone marrow-derived (SiglecF + ), cultured eosinophils include a more substantial Gr1 + subpopulation (∼50%); Gr1 + bmEos includes primarily a single Ly6C + and a smaller, double-positive (Ly6C + Ly6G + ) population. Taken together, our findings characterize a distinct SiglecF + Gr1 hi eosinophil subset in lungs of allergen-challenged, wild-type and granule protein-deficient mice. SiglecF + Gr1 hi eosinophils from wild-type mice maintain a distinct subset of cytokines, including those active on B and T lymphocytes. These cytokines may facilitate eosinophil-mediated immunomodulatory responses in the allergen-challenged lung as well as in other distinct microenvironments. © Society for Leukocyte Biology.

Maintaining Quality and Confidence in Open-Source, Evolving Software: Lessons Learned with PFLOTRAN

NASA Astrophysics Data System (ADS)

Frederick, J. M.; Hammond, G. E.

2017-12-01

Software evolution in an open-source framework poses a major challenge to a geoscientific simulator, but when properly managed, the pay-off can be enormous for both the developers and the community at large. Developers must juggle implementing new scientific process models, adopting increasingly efficient numerical methods and programming paradigms, changing funding sources (or total lack of funding), while also ensuring that legacy code remains functional and reported bugs are fixed in a timely manner. With robust software engineering and a plan for long-term maintenance, a simulator can evolve over time incorporating and leveraging many advances in the computational and domain sciences. In this positive light, what practices in software engineering and code maintenance can be employed within open-source development to maximize the positive aspects of software evolution and community contributions while minimizing its negative side effects? This presentation will discusses steps taken in the development of PFLOTRAN (www.pflotran.org), an open source, massively parallel subsurface simulator for multiphase, multicomponent, and multiscale reactive flow and transport processes in porous media. As PFLOTRAN's user base and development team continues to grow, it has become increasingly important to implement strategies which ensure sustainable software development while maintaining software quality and community confidence. In this presentation, we will share our experiences and "lessons learned" within the context of our open-source development framework and community engagement efforts. Topics discussed will include how we've leveraged both standard software engineering principles, such as coding standards, version control, and automated testing, as well unique advantages of object-oriented design in process model coupling, to ensure software quality and confidence. We will also be prepared to discuss the major challenges faced by most open-source software teams, such as on-boarding new developers or one-time contributions, dealing with competitors or lookie-loos, and other downsides of complete transparency, as well as our approach to community engagement, including a user group email list, hosting short courses and workshops for new users, and maintaining a website. SAND2017-8174A

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters.

PubMed

Katsumi, H K; Kalisvaart, J F; Ronningen, L D; Hovey, R M

2010-04-01

Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI. A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained. In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively. SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.

Integrating high levels of variable renewable energy into electric power systems

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

Kroposki, Benjamin

As more variable renewable energy (VRE) such as wind and solar are integrated into electric power systems, technical challenges arise from the need to maintain the balance between load and generation at all timescales. This paper examines the challenges with integrating ultra-high levels of VRE into electric power system, reviews a range of solutions to these challenges, and provides a description of several examples of ultra-high VRE systems that are in operation today.

Integrating high levels of variable renewable energy into electric power systems

DOE PAGES

Kroposki, Benjamin

2017-11-17

As more variable renewable energy (VRE) such as wind and solar are integrated into electric power systems, technical challenges arise from the need to maintain the balance between load and generation at all timescales. This paper examines the challenges with integrating ultra-high levels of VRE into electric power system, reviews a range of solutions to these challenges, and provides a description of several examples of ultra-high VRE systems that are in operation today.

Challenges and motivators to physical activity faced by retired men when ageing: a qualitative study.

PubMed

Bredland, Ebba Langum; Söderström, Sylvia; Vik, Kjersti

2018-05-15

Active ageing reflects the message from World Health Organisation about addressing the challenge faced by the rapidly ageing population. Knowledge about barriers and facilitators to an active lifestyle must be given more attention. In addition, men seem to participate less in cultural activities and less in fall-prevention groups than women do. When mostly women work with the elderly in primary care, one might question whether the activities offered to older men meet their activity preferences. The aim of this study is to provide new knowledge about challenges and motivators encountered by retired men in maintaining physical activity when ageing. Nine retired men, aged between 66 and 83, wrote a Time Geographic Diary for 7 days each. Two focus group discussions with the men were held. A Systemic Text Condensation was used to analyse the data. The analyses identified three categories to describe challenges in being physical active: differences between men and women; meaningful physical activity; and environmental - especially socio-cultural - constraints. Motivating conditions were seen as: new activities to get younger friends, and more information about how to cope. To achieve the aim of active ageing, service providers as well as local authorities need to have a better understanding of the challenges retired men encounter when ageing. This study highlights vital aspects of the challenges faced by retired men in maintaining their physical activity level.

A mutant of Lithocarpus densiflorus

Treesearch

John M. Tucker; William E. Sundahl; Dale O. Hall

1969-01-01

A peculiar, low, shrubby, oak-like plant was discovered by Dale Hall in January, 1962, on the Challenge Experimental Forest (which is maintained by the Pacific Southwest Forest and Range Experiment Station, Berkeley) approximately one mile north of Challenge, Yuba Co., California. It was quite unlike any species known to the senior author and did not appear to be a...

From Teacher to Manager: Expectations and Challenge in the Further Education Sector. A Relationship Model

ERIC Educational Resources Information Center

Corbett, Stephen

2017-01-01

In a turbulent working environment with varying expectations and challenges is it fair to expect further education teachers and managers to maintain and improve standards? This article highlights that with the incorporation of colleges began a series of initiatives to professionalise the FE sector. This coupled with pressures for those who work…

Accessing Flexible Learning Opportunities: Children's and Young People's Use of Laptops in a Paediatric Hospital

ERIC Educational Resources Information Center

Nisselle, Amy; Hanns, Shaun; Green, Julie; Jones, Tony

2012-01-01

Hospitalised children and young people not only face challenges to their health but also to their continued education and social connections. These challenges can impact on future life trajectories, so it is crucial to maintain learning and socialising. Educational technologies, such as laptops and iPads, are used in the multidisciplinary…

Conformity and Resistance in Self-Management Strategies of "Good Girls"

ERIC Educational Resources Information Center

Sanders, Jackie; Munford, Robyn

2008-01-01

This article examines how girls manage challenging encounters with non-familial adults. Drawing on a subset of qualitative data collected as part of a larger ethnographic study, it examines the ways girls maintain a strong sense of self as a good person in the face of interpersonal challenge from these non-familial adults. The discourse of the…

Challenges in the Use of Social Networking Sites to Trace Potential Research Participants

ERIC Educational Resources Information Center

Marsh, Jackie; Bishop, Julia C.

2014-01-01

This paper reports on a number of challenges faced in tracing contributors to research projects that were originally conducted many decades previously. The need to trace contributors in this way arises in projects which focus on involving research participants in previous studies who have not been maintained on a database, or with whom the…

Weathering the Storms: Acknowledging Challenges to Learning in Times of Stress

ERIC Educational Resources Information Center

Hubschman, Betty; Lutz, Marilyn; King, Christine; Wang, Jia; Kopp, David

2006-01-01

Students and faculty have had numerous disruptions this academic year with Hurricanes Katrina, Rita, and Wilma developing into major stressors. During this innovative session, we will examine some of the challenges and strategies used by faculty to work with students to maintain empathy and academic rigor in times of stress and disruption, and…

Dental Hygiene Entry-Level Program Administrators' Strategies for Overcoming Challenges of Distance Education

ERIC Educational Resources Information Center

Buchanan, Bette A.

2009-01-01

The use of distance education by entry-level dental hygiene programs is increasing. The focus of this study was to determine the number of entry-level dental hygiene program administrators with experience developing and/or maintaining dental hygiene education by distance, the challenges encountered, and the strategies used to overcome the…

'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.

Overcoming a perfect storm: an academic cardiology section's story of survival.

PubMed

Calvin, James E

2007-03-01

Increasingly, academic institutions are grappling with financial pressures that threaten the academic mission. The author presents an actual case history in which a section of cardiology in an academic health center was confronted with huge projected deficits that had to be eliminated within the fiscal year. The section used eight principles to shift from deficit to profitability (i.e., having revenue exceed costs). These principles included confronting the brutal facts, managing costs and revenue cycles, setting expectations for faculty, and quality improvement. The section accomplished deficit reduction through reducing faculty salaries (nearly $2 million) and nonfaculty salaries ($1.3 million) and reducing operational costs while maintaining revenues by increasing individual faculty productivity and reducing accounts receivable. In the face of these reductions, clinical revenues were maintained, but research revenue and productivity fell (but research is being fostered now that clinical services are profitable again). These principles can be used to stabilize the financial position of clinical practices in academic settings that are facing financial challenges.

Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat.

PubMed

Meziane, Mohammed; Elkoundi, Abdelghafour; Ahtil, Redouane; Guazaz, Miloudi; Mustapha, Bensghir; Haimeur, Charki

2017-01-01

The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/rémifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient.

Inflammatory memory sensitizes skin epithelial stem cells to tissue damage.

PubMed

Naik, Shruti; Larsen, Samantha B; Gomez, Nicholas C; Alaverdyan, Kirill; Sendoel, Ataman; Yuan, Shaopeng; Polak, Lisa; Kulukian, Anita; Chai, Sophia; Fuchs, Elaine

2017-10-26

The skin barrier is the body's first line of defence against environmental assaults, and is maintained by epithelial stem cells (EpSCs). Despite the vulnerability of EpSCs to inflammatory pressures, neither the primary response to inflammation nor its enduring consequences are well understood. Here we report a prolonged memory to acute inflammation that enables mouse EpSCs to hasten barrier restoration after subsequent tissue damage. This functional adaptation does not require skin-resident macrophages or T cells. Instead, EpSCs maintain chromosomal accessibility at key stress response genes that are activated by the primary stimulus. Upon a secondary challenge, genes governed by these domains are transcribed rapidly. Fuelling this memory is Aim2, which encodes an activator of the inflammasome. The absence of AIM2 or its downstream effectors, caspase-1 and interleukin-1β, erases the ability of EpSCs to recollect inflammation. Although EpSCs benefit from inflammatory tuning by heightening their responsiveness to subsequent stressors, this enhanced sensitivity probably increases their susceptibility to autoimmune and hyperproliferative disorders, including cancer.

Land use change around protected areas: management to balance human needs and ecological function.

PubMed

DeFries, Ruth; Hansen, Andrew; Turner, B L; Reid, Robin; Liu, Jianguo

2007-06-01

Protected areas throughout the world are key for conserving biodiversity, and land use is key for providing food, fiber, and other ecosystem services essential for human sustenance. As land use change isolates protected areas from their surrounding landscapes, the challenge is to identify management opportunities that maintain ecological function while minimizing restrictions on human land use. Building on the case studies in this Invited Feature and on ecological principles, we identify opportunities for regional land management that maintain both ecological function in protected areas and human land use options, including preserving crucial habitats and migration corridors, and reducing dependence of local human populations on protected area resources. Identification of appropriate and effective management opportunities depends on clear definitions of: (1) the biodiversity attributes of concern; (2) landscape connections to delineate particular locations with strong ecological interactions between the protected area and its surrounding landscape; and (3) socioeconomic dynamics that determine current and future use of land resources in and around the protected area.

Reflective Practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States

ERIC Educational Resources Information Center

Miller Juve, Amy Katrina

2012-01-01

The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge…

Crow Ressurection: The Future of Airborne Electronic Attack

DTIC Science & Technology

2013-06-01

strike assets by attempting to gain and maintain control of the electromagnetic spectrum. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17...receiving his commission through Officer Training School in 2000, Major Howard served as an RC-135V/W RIVET JOINT EWO at Offutt AFB, Nebraska...significant Airborne Electronic Attack challenges in protecting strike assets by attempting to gain and maintain control of the electromagnetic spectrum

Establishing and Maintaining High Expectations for Deaf/Blind Students Using a Team Approach

ERIC Educational Resources Information Center

Mockler, Kimberly

2014-01-01

As a teacher of the deaf as well as the classroom teacher, Kimberly Mockler works very closely with the teacher of the visually impaired. This involves sharing ideas, resources, and lesson plans for the deaf/blind students. Their lessons and goals are very similar and overlap in several areas. A major challenge for both of them is maintaining high…

Opportunities and strategies to further reduce animal use for Leptospira vaccine potency testing.

PubMed

Walker, A; Srinivas, G B

2013-09-01

Hamsters are routinely infected with virulent Leptospira for two purposes in the regulation of biologics: the performance of Codified potency tests and maintenance of challenge culture for the Codified potency tests. Options for reducing animal use in these processes were explored in a plenary lecture at the "International Workshop on Alternative Methods for Leptospira Vaccine Potency Testing: State of the Science and the Way Forward" held at the Center for Veterinary Biologics in September 2012. The use of validated in vitro potency assays such as those developed by the U.S. Department of Agriculture for Leptospira (L.) canicola, Leptospira grippotyphosa, Leptospira pomona, and Leptospira icterohaemorrhagiae rather than the Codified hamster vaccination-challenge assay was encouraged. Alternatives such as reduced animal numbers in the hamster vaccination-challenge testing were considered for problematic situations. Specifically, the merits of sharing challenge controls, reducing group sizes, and eliminating animals for concurrent challenge dose titration were assessed. Options for maintaining virulent, stable cultures without serial passage through hamsters or with decreased hamster use were also discussed. The maintenance of virulent Leptospira without the use of live animals is especially difficult since a reliable means to maintain virulence after multiple in vitro passages has not yet been identified. Published by Elsevier Ltd.

A Quantitative Profiling Method of Phytohormones and Other Metabolites Applied to Barley Roots Subjected to Salinity Stress

PubMed Central

Cao, Da; Lutz, Adrian; Hill, Camilla B.; Callahan, Damien L.; Roessner, Ute

2017-01-01

As integral parts of plant signaling networks, phytohormones are involved in the regulation of plant metabolism and growth under adverse environmental conditions, including salinity. Globally, salinity is one of the most severe abiotic stressors with an estimated 800 million hectares of arable land affected. Roots are the first plant organ to sense salinity in the soil, and are the initial site of sodium (Na+) exposure. However, the quantification of phytohormones in roots is challenging, as they are often present at extremely low levels compared to other plant tissues. To overcome this challenge, we developed a high-throughput LC-MS method to quantify ten endogenous phytohormones and their metabolites of diverse chemical classes in roots of barley. This method was validated in a salinity stress experiment with six barley varieties grown hydroponically with and without salinity. In addition to phytohormones, we quantified 52 polar primary metabolites, including some phytohormone precursors, using established GC-MS and LC-MS methods. Phytohormone and metabolite data were correlated with physiological measurements including biomass, plant size and chlorophyll content. Root and leaf elemental analysis was performed to determine Na+ exclusion and K+ retention ability in the studied barley varieties. We identified distinct phytohormone and metabolite signatures as a response to salinity stress in different barley varieties. Abscisic acid increased in the roots of all varieties under salinity stress, and elevated root salicylic acid levels were associated with an increase in leaf chlorophyll content. Furthermore, the landrace Sahara maintained better growth, had lower Na+ levels and maintained high levels of the salinity stress linked metabolite putrescine as well as the phytohormone metabolite cinnamic acid, which has been shown to increase putrescine concentrations in previous studies. This study highlights the importance of root phytohormones under salinity stress and the multi-variety analysis provides an important update to analytical methodology, and adds to the current knowledge of salinity stress responses in plants at the molecular level. PMID:28119732

Process evaluation of knowledge transfer across industries: Leveraging Coca-Cola's supply chain expertise for medicine availability in Tanzania.

PubMed

Linnander, Erika; Yuan, Christina T; Ahmed, Shirin; Cherlin, Emily; Talbert-Slagle, Kristina; Curry, Leslie A

2017-01-01

Persistent gaps in the availability of essential medicines have slowed the achievement of global health targets. Despite the supply chain knowledge and expertise that ministries of health might glean from other industries, limited empirical research has examined the process of knowledge transfer from other industries into global public health. We examined a partnership designed to improve the availability of medical supplies in Tanzania by transferring knowledge from The Coca-Cola system to Tanzania's Medical Stores Department (MSD). We conducted a process evaluation including in-depth interviews with 70 participants between July 2011 and May 2014, corresponding to each phase of the partnership, with focus on challenges and strategies to address them, as well as benefits perceived by partners. Partners faced challenges in (1) identifying relevant knowledge to transfer, (2) translating operational solutions from Coca-Cola to MSD, and (3) maintaining momentum between project phases. Strategies to respond to these challenges emerged through real-time problem solving and included (1) leveraging the receptivity of MSD leadership, (2) engaging a boundary spanner to identify knowledge to transfer, (3) promoting local recognition of commonalities across industries, (4) engaging external technical experts to manage translation activities, (5) developing tools with visible benefits for MSD, (6) investing in local relationships, and (7) providing time and space for the partnership model to evolve. Benefits of the partnership perceived by MSD staff included enhanced collaboration and communication, more proactive orientations in managing operations, and greater attention to performance management. Benefits perceived by Coca-Cola staff included strengthened knowledge transfer capability and enhanced job satisfaction. Linking theoretical constructs with practical experiences from the field, we highlight the challenges, emergent strategies, and perceived benefits of a partnership across industry boundaries that may be useful to others seeking to promote the transfer of knowledge to improve global health.

Process evaluation of knowledge transfer across industries: Leveraging Coca-Cola’s supply chain expertise for medicine availability in Tanzania

PubMed Central

Yuan, Christina T.; Ahmed, Shirin; Cherlin, Emily; Talbert-Slagle, Kristina; Curry, Leslie A.

2017-01-01

Persistent gaps in the availability of essential medicines have slowed the achievement of global health targets. Despite the supply chain knowledge and expertise that ministries of health might glean from other industries, limited empirical research has examined the process of knowledge transfer from other industries into global public health. We examined a partnership designed to improve the availability of medical supplies in Tanzania by transferring knowledge from The Coca-Cola system to Tanzania’s Medical Stores Department (MSD). We conducted a process evaluation including in-depth interviews with 70 participants between July 2011 and May 2014, corresponding to each phase of the partnership, with focus on challenges and strategies to address them, as well as benefits perceived by partners. Partners faced challenges in (1) identifying relevant knowledge to transfer, (2) translating operational solutions from Coca-Cola to MSD, and (3) maintaining momentum between project phases. Strategies to respond to these challenges emerged through real-time problem solving and included (1) leveraging the receptivity of MSD leadership, (2) engaging a boundary spanner to identify knowledge to transfer, (3) promoting local recognition of commonalities across industries, (4) engaging external technical experts to manage translation activities, (5) developing tools with visible benefits for MSD, (6) investing in local relationships, and (7) providing time and space for the partnership model to evolve. Benefits of the partnership perceived by MSD staff included enhanced collaboration and communication, more proactive orientations in managing operations, and greater attention to performance management. Benefits perceived by Coca-Cola staff included strengthened knowledge transfer capability and enhanced job satisfaction. Linking theoretical constructs with practical experiences from the field, we highlight the challenges, emergent strategies, and perceived benefits of a partnership across industry boundaries that may be useful to others seeking to promote the transfer of knowledge to improve global health. PMID:29121051

REFLECTION IN HOME VISITING: THE WHAT, WHY, AND A BEGINNING STEP TOWARD HOW.

PubMed

Tomlin, Angela M; Hines, Elesia; Sturm, Lynne

2016-11-01

The work of home visitors in early childhood fields may include addressing many challenges to achieving curricular outcomes, including issues such as maintaining boundaries and managing one's own reactions to children, parents, and overall family situations. Increasingly, reflective supervision and consultation are recognized as a way for workers in home-visiting early intervention and early care fields to address these personal and professional challenges and build competence (Watson, Gatti, Cox, Harrison, & Hennes, ). The features of home visiting that make reflective supervision/consultation essential are discussed. Next, results of a pilot project in which a sample of Part C early intervention providers respond to a vignette portraying a challenging parent-child interaction are briefly presented and discussed. Despite often stating the importance of relationships, participants did not identify concrete methods of supporting relationship or demonstrate recognition of parallel process. In addition, providers seldom endorsed the use of reflective skills such as observing, listening, wondering, or reflecting (Weatherston, ), and no providers discussed a need for reflective supervision/consultation. We suggest that these findings illustrate some of the areas in which early intervention home visitors could benefit from participation in reflective supervision/consultation to move from identifying reflective skills as important to actually being able to use such skills in their work with families. © 2016 Michigan Association for Infant Mental Health.

Energy Management Challenges and Opportunities with Increased Intermittent Renewable Generation on the California Electrical Grid

NASA Astrophysics Data System (ADS)

Eichman, Joshua David

Renewable resources including wind, solar, geothermal, biomass, hydroelectric, wave and tidal, represent an opportunity for environmentally preferred generation of electricity that also increases energy security and independence. California is very proactive in encouraging the implementation of renewable energy in part through legislation like Assembly Bill 32 and the development and execution of Renewable Portfolio Standards (RPS); however renewable technologies are not without challenges. All renewable resources have some resource limitations, be that from location, capacity, cost or availability. Technologies like wind and solar are intermittent in nature but represent one of the most abundant resources for generating renewable electricity. If RPS goals are to be achieved high levels of intermittent renewables must be considered. This work explores the effects of high penetration of renewables on a grid system, with respect to resource availability and identifies the key challenges from the perspective of the grid to introducing these resources. The HiGRID tool was developed for this analysis because no other tool could explore grid operation, while maintaining system reliability, with a diverse set of renewable resources and a wide array of complementary technologies including: energy efficiency, demand response, energy storage technologies and electric transportation. This tool resolves the hourly operation of conventional generation resources (nuclear, coal, geothermal, natural gas and hydro). The resulting behavior from introducing additional renewable resources and the lifetime costs for each technology is analyzed.

Crowd Sourcing to Improve Urban Stormwater Management

NASA Astrophysics Data System (ADS)

Minsker, B. S.; Band, L. E.; Heidari Haratmeh, B.; Law, N. L.; Leonard, L. N.; Rai, A.

2017-12-01

Over half of the world's population currently lives in urban areas, a number predicted to grow to 60 percent by 2030. Urban areas face unprecedented and growing challenges that threaten society's long-term wellbeing, including poverty; chronic health problems; widespread pollution and resource degradation; and increased natural disasters. These are "wicked" problems involving "systems of systems" that require unprecedented information sharing and collaboration across disciplines and organizational boundaries. Cities are recognizing that the increasing stream of data and information ("Big Data"), informatics, and modeling can support rapid advances on these challenges. Nonetheless, information technology solutions can only be effective in addressing these challenges through deeply human and systems perspectives. A stakeholder-driven approach ("crowd sourcing") is needed to develop urban systems that address multiple needs, such as parks that capture and treat stormwater while improving human and ecosystem health and wellbeing. We have developed informatics- and Cloud-based collaborative methods that enable crowd sourcing of green stormwater infrastructure (GSI: rain gardens, bioswales, trees, etc.) design and management. The methods use machine learning, social media data, and interactive design tools (called IDEAS-GI) to identify locations and features of GSI that perform best on a suite of objectives, including life cycle cost, stormwater volume reduction, and air pollution reduction. Insights will be presented on GI features that best meet stakeholder needs and are therefore most likely to improve human wellbeing and be well maintained.

Gene correction in patient-specific iPSCs for therapy development and disease modeling

PubMed Central

Jang, Yoon-Young

2018-01-01

The discovery that mature cells can be reprogrammed to become pluripotent and the development of engineered endonucleases for enhancing genome editing are two of the most exciting and impactful technology advances in modern medicine and science. Human pluripotent stem cells have the potential to establish new model systems for studying human developmental biology and disease mechanisms. Gene correction in patient-specific iPSCs can also provide a novel source for autologous cell therapy. Although historically challenging, precise genome editing in human iPSCs is becoming more feasible with the development of new genome-editing tools, including ZFNs, TALENs, and CRISPR. iPSCs derived from patients of a variety of diseases have been edited to correct disease-associated mutations and to generate isogenic cell lines. After directed differentiation, many of the corrected iPSCs showed restored functionality and demonstrated their potential in cell replacement therapy. Genome-wide analyses of gene-corrected iPSCs have collectively demonstrated a high fidelity of the engineered endonucleases. Remaining challenges in clinical translation of these technologies include maintaining genome integrity of the iPSC clones and the differentiated cells. Given the rapid advances in genome-editing technologies, gene correction is no longer the bottleneck in developing iPSC-based gene and cell therapies; generating functional and transplantable cell types from iPSCs remains the biggest challenge needing to be addressed by the research field. PMID:27256364

Surface Characterization of Nanomaterials and Nanoparticles. Important needs and challenging opportunities

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

Baer, Donald R.; Engelhard, Mark H.; Johnson, Grant E.

2013-08-27

This review examines the characterization challenges inherently associated with understanding nanomaterials and how surface characterization methods can help meet those challenges. In parts of the research community, there is growing recognition that many studies and published reports on the properties and behaviors of nanomaterials have involved inadequate characterization. As a consequence, the true value of the data in these reports is, at best, uncertain. As the importance of nanomaterials in fundamental research and technological applications increases, it is necessary for researchers to recognize the challenges associated with reproducible materials synthesis, maintaining desired materials properties during handling and processing, and themore » dynamic nature of nanomaterials, especially nanoparticles. Researchers also need to understand how characterization approaches (surface and otherwise) can be used to minimize synthesis surprises and to determine how (and how quickly) materials and properties change in different environments. The types of information that can be provided by traditional surface sensitive analysis methods (including X-ray photoelectron and Auger electron spectroscopies, scanning probe microscopy and secondary ion mass spectroscopy) and less common or evolving surface sensitive methods (e.g., nuclear magnetic resonance, sum frequency generation, and low and medium energy ion scattering) are discussed and various of their use in nanomaterial research are presented.« less

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

PubMed

Carney, Marie

2010-07-01

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Remote sensing of ecosystem health: opportunities, challenges, and future perspectives.

PubMed

Li, Zhaoqin; Xu, Dandan; Guo, Xulin

2014-11-07

Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges.

Challenges in adopting evidence-based school drug education programmes.

PubMed

Cahill, Helen W

2007-11-01

The paper discusses the school-based challenges that may moderate the implementation of evidence-based drug education in schools. Knowledge about what constitutes an effective evidence-based drug education programme is discussed in relation to the challenge of delivery in the school setting. Research demonstrates that drug education should be engaging, incorporate interactive learning strategies, stimulate higher-order thinking, promote learning and be transferable to real life circumstances. This may difficult to accomplish in practice, as a range of contextual challenges and ideological assumptions may moderate the teacher's capacity to deliver a programme of this nature. Collaborative learning strategies are not the norm in schools and therefore teachers may find interactive drug education programmes difficult to adopt. Conflicting ideological assumptions about effective epistemological approaches to drug education may also direct the way in which teachers modify programmes in the local context. Teachers need professional training and support if they are to adopt successfully evidence-based school drug education programmes. This support may be enhanced if it includes whole school approaches to effective pedagogy and the development of pro-social classroom environments. Drug education research should take account of the complexities of implementation in the school setting and investigate further the professional and organisational support that teachers require in order to maintain high-quality provision in the school context.

Space Shuttle Strategic Planning Status

NASA Technical Reports Server (NTRS)

Henderson, Edward M.; Norbraten, Gordon L.

2006-01-01

The Space Shuttle Program is aggressively planning the Space Shuttle manifest for assembling the International Space Station and servicing the Hubble Space Telescope. Implementing this flight manifest while concurrently transitioning to the Exploration architecture creates formidable challenges; the most notable of which is retaining critical skills within the Shuttle Program workforce. The Program must define a strategy that will allow safe and efficient fly-out of the Shuttle, while smoothly transitioning Shuttle assets (both human and facility) to support early flight demonstrations required in the development of NASA s Crew Exploration Vehicle (CEV) and Crew and Cargo Launch Vehicles (CLV). The Program must accomplish all of this while maintaining the current level of resources. Therefore, it will be necessary to initiate major changes in operations and contracting. Overcoming these challenges will be essential for NASA to fly the Shuttle safely, accomplish the President s "Vision for Space Exploration," and ultimately meet the national goal of maintaining a robust space program. This paper will address the Space Shuttle Program s strategy and its current status in meeting these challenges.

Space Shuttle Strategic Planning Status

NASA Technical Reports Server (NTRS)

Norbraten, Gordon L.; Henderson, Edward M.

2007-01-01

The Space Shuttle Program is aggressively flying the Space Shuttle manifest for assembling the International Space Station and servicing the Hubble Space Telescope. Completing this flight manifest while concurrently transitioning to the Exploration architecture creates formidable challenges; the most notable of which is retaining critical skills within the Shuttle Program workforce. The Program must define a strategy that will allow safe and efficient fly-out of the Shuttle, while smoothly transitioning Shuttle assets (both human and facility) to support early flight demonstrations required in the development of NASA's Crew Exploration Vehicle (Orion) and Crew and Cargo Launch Vehicles (Ares I). The Program must accomplish all of this while maintaining the current level of resources. Therefore, it will be necessary to initiate major changes in operations and contracting. Overcoming these challenges will be essential for NASA to fly the Shuttle safely, accomplish the Vision for Space Exploration, and ultimately meet the national goal of maintaining a robust space program. This paper will address the Space Shuttle Program s strategy and its current status in meeting these challenges.

High Voltage Hybrid Electric Propulsion - Multilayered Functional Insulation System (MFIS) NASA-GRC

NASA Technical Reports Server (NTRS)

Lizcano, M.

2017-01-01

High power transmission cables pose a key challenge in future Hybrid Electric Propulsion Aircraft. The challenge arises in developing safe transmission lines that can withstand the unique environment found in aircraft while providing megawatts of power. High voltage AC, variable frequency cables do not currently exist and present particular electrical insulation challenges since electrical arcing and high heating are more prevalent at higher voltages and frequencies. Identifying and developing materials that maintain their dielectric properties at high voltage and frequencies is crucial.

Different perspectives on the key challenges facing rural health: The challenges of power and knowledge.

PubMed

Malatzky, Christina; Bourke, Lisa

2018-05-25

To examine the effects of dominant knowledge in rural health, including how they shape issues central to rural health. In particular, this article examines the roles of: (i) deficit knowledge of rural health workforce; (ii) dominant portrayals of generalism; and (iii) perceptions of inferiority about rural communities in maintaining health disparities between rural- and metropolitan-based Australians. A Foucauldian framework is applied to literature, evidence, case studies and key messages in rural health. Three scenarios are used to provide practical examples of specific knowledge that is prioritised or marginalised. The analysis of three areas in rural health identifies how deficit knowledge is privileged despite it undermining the purpose of rural health. First, deficit knowledge highlights the workforce shortage rather than the type of work in rural practice or the oversupply of workforce in metropolitan areas. Second, the construction of generalist practice as less skilled and more monotonous undermines other knowledge that it is diverse and challenging. Third, dominant negative stereotypes of rural communities discourage rural careers and highlight undesirable aspects of rural practice. The privileging of deficit knowledge pertaining to rural health workforce, broader dominant discourses of generalism and the nature of rural Australian communities reproduces many of the key challenges in rural health today, including persisting health disparities between rural- and metropolitan-based Australians. To disrupt the operations of power that highlight deficit knowledge and undermine other knowledge, we need to change the way in which rural health is currently constructed and understood. © 2018 National Rural Health Alliance Ltd.

Transitioning from pediatric to adult health care with familial hypercholesterolemia: Listening to young adult and parent voices.

PubMed

Sliwinski, Samantha K; Gooding, Holly; de Ferranti, Sarah; Mackie, Thomas I; Shah, Supriya; Saunders, Tully; Leslie, Laurel K

Young adults with familial hypercholesterolemia (FH) are at a critical period for establishing behaviors to promote future cardiovascular health. To examine challenges transitioning to adult care for young adults with FH and parents of FH-affected young adults in the context of 2 developmental tasks, transitioning from childhood to early adulthood and assuming responsibility for self-management of a chronic disorder. Semistructured, qualitative interviews were conducted with 12 young adults with FH and 12 parents of affected young adults from a pediatric subspecialty preventive cardiology program in a northeastern academic medical center. Analyses were conducted using a modified grounded theory framework. Respondents identified 5 challenges: (1) recognizing oneself as a decision maker, (2) navigating emerging independence, (3) prioritizing treatment for a chronic disorder with limited signs and symptoms, (4) managing social implications of FH, and (5) finding credible resources for guidance. Both young adults and parents proposed similar recommendations for addressing these challenges, including the need for family and peer involvement to establish and maintain diet and exercise routines and to provide medication reminders. Systems-level recommendations included early engagement of adolescents in shared decision-making with health care team; providing credible, educational resources regarding FH; and using blood tests to track treatment efficacy. Young adults with FH transitioning to adult care may benefit from explicit interventions to address challenges to establishing healthy lifestyle behaviors and medication adherence as they move toward being responsible for their medical care. Further research should explore the efficacy of recommended interventions. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Ares I-X Roll Control System Development

NASA Technical Reports Server (NTRS)

Unger, Ronald J.; Massey, Edmund C.

2009-01-01

Project Managers often face challenging technical, schedule and budget issues. This presentation will explore how the Ares I-X Roll Control System Integrated Product Team (IPT) mitigated challenges such as concurrent engineering requirements and environments and evolving program processes, while successfully managing an aggressive project schedule and tight budget. IPT challenges also included communications and negotiations among inter- and intra-government agencies, including the US Air Force, NASA/MSFC Propulsion Engineering, LaRC, GRC, KSC, WSTF, and the Constellation Program. In order to successfully meet these challenges it was essential that the IPT define those items that most affected the schedule critical path, define early mitigation strategies to reduce technical, schedule, and budget risks, and maintain the end-product focus of an "unmanned test flight" context for the flight hardware. The makeup of the IPT and how it would function were also important considerations. The IPT consisted of NASA/MSFC (project management, engineering, and safety/quality) and contractors (Teledyne Brown Engineering and Pratt and Whitney Rocketdyne, who supplied heritage hardware experience). The early decision to have a small focused IPT working "badgelessly" across functional lines to eliminate functional stove-piping allowed for many more tasks to be done by fewer people. It also enhanced a sense of ownership of the products, while still being able to revert back to traditional roles in order to provide the required technical independence in design reviews and verification closures. This presentation will highlight several prominent issues and discuss how they were mitigated and the resulting Lessons Learned that might benefit other projects.

Synopsis of Past Stimulation Methods in Enhanced (Engineered) Geothermal Systems, Boreholes, and Existing Hydrothermal Systems with Success Analysis and Recommendations for Future Projects

NASA Astrophysics Data System (ADS)

Broadhurst, T.; Mattson, E.

2017-12-01

Enhanced geothermal systems (EGS) are gaining in popularity as a technology that can be used to increase areas for geothermal resource procurement. One of the most important factors in the success of an EGS system is the success of the subsurface reservoir that is used for fluid flow and heat mining through advection. There are numerous challenges in stimulating a successful reservoir, including maintaining flow rates, minimizing leak off, preventing short-circuiting, and reducing the risk of microseismicity associated with subsurface activity. Understanding past examples of stimulation can be invaluable in addressing these challenges. This study provides an overview of stimulation methods that have been employed in EGS systems from 1974-2017. We include all geothermal reservoirs and demonstration projects that have experienced hydrofracturing, chemical stimulation, and induced thermal stress for a comprehensive list. We also examine different metrics and measures of success in geothermal reservoir stimulation to draw conclusions and provide recommendations for future projects. Multiple project characteristics are reported including geologic setting, stress conditions, reservoir temperature, injection specifics, resulting microseismicity, and overall project goals. Insight into optimal and unproductive stimulation methods is crucial to conserving mental capital, utilizing project funding, and ensuring EGS technology advances as efficiently as possible.

Nursing's new frontier: reinventing our practice in a restructured health care system.

PubMed

Barter, M; Furmidge, M L

1995-12-01

Nurse managers who are faced with the challenge of maintaining productivity in today's turbulent health care environment need new strategies for managing a redesigned workforce. Registered nurses have assumed leadership responsibilities in work teams that include other nurses, licensed personnel from other disciplines, and unlicensed assistive personnel (UAP). Myths, rumors, and questions deserve thoughtful consideration and response if managers want full cooperation from team leaders. Legal and professional issues relating to assignment, delegation, and supervision of a multidisciplinary team must be understood by everyone. Team leaders must have clearly defined boundaries of authority and an understanding of the competencies of each team member to be effective.

Two Formal Gas Models For Multi-Agent Sweeping and Obstacle Avoidance

NASA Technical Reports Server (NTRS)

Kerr, Wesley; Spears, Diana; Spears, William; Thayer, David

2004-01-01

The task addressed here is a dynamic search through a bounded region, while avoiding multiple large obstacles, such as buildings. In the case of limited sensors and communication, maintaining spatial coverage - especially after passing the obstacles - is a challenging problem. Here, we investigate two physics-based approaches to solving this task with multiple simulated mobile robots, one based on artificial forces and the other based on the kinetic theory of gases. The desired behavior is achieved with both methods, and a comparison is made between them. Because both approaches are physics-based, formal assurances about the multi-robot behavior are straightforward, and are included in the paper.

Piaac: A New Strategy for Assessing Adult Competencies

NASA Astrophysics Data System (ADS)

Schleicher, Andreas

2008-11-01

At a time when governments face the challenges of maintaining competitiveness in a global economy, it is necessary to have high-quality comparative information regarding the fundamental skills of the adult population. Such information can help governments to evaluate policies and design more effective interventions. This article describes a strategy currently being developed by the OECD for assessing the literacy skills of adults, including familiarity with information and communication technologies and the ability to manage information, construct new knowledge and communicate with others. The work will enhance understanding of the effectiveness of education and training systems in developing basic cognitive skills and key generic work skills.

Integrated absence management and the Family and Medical Leave Act.

PubMed

Morris, Judy A

2008-05-01

Intermittent unscheduled absenteeism often challenges employers to meet the needs of their employees, control direct absenteeism costs, and maintain the staff needed to serve customers. Occupational health nurses have opportunities to play an important role in addressing this challenge. Measurable financial impacts have been demonstrated from integrating the management of intermittent FMLA leave with an employer's existing absence management program.

Complex challenges of maintaining whitebark pine in Greater Yellowstone under climate change: A call for innovative research, management, and policy approaches

Treesearch

Andrew Hansen; Kathryn Ireland; Kristin Legg; Robert Keane; Edward Barge; Martha Jenkins; Michiel Pillet

2016-01-01

Climate suitability is projected to decline for many subalpine species, raising questions about managing species under a deteriorating climate. Whitebark pine (WBP) (Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE) crystalizes the challenges that natural resource managers of many high mountain ecosystems will likely face in the coming decades. We...

Threats to cross-border wildlife linkages in the Sky Islands Wildlands Network

Treesearch

Kim Vacariu

2005-01-01

One of the greatest challenges facing conservationists in the Sky Islands region is finding a realistic means to maintain historic travel routes for wide-ranging species crossing the United States-Mexico border. This challenge is made difficult due to the ongoing efforts by the Federal government to install additional security infrastructure to stem the flood of...

The Perceived Benefits and Difficulties in Introducing and Maintaining Supervision Groups in a SEMH Special School

ERIC Educational Resources Information Center

Willis, Jonathan; Baines, Ed

2018-01-01

Supervision groups are often used in professional settings and are introduced to address and provide support in relation to the challenges that arise in everyday practice. Although group supervision is common amongst a range of helping professions, its use in schools is rare. Little research exists as to the merits and challenges of providing…

Can a Catholic College Exist Today?: Challenges to Religious Identity in the Midst of Pluralism

ERIC Educational Resources Information Center

Cesareo, Francesco C.

2007-01-01

One of the most significant and important challenges facing any president of a Catholic college or university is maintaining and enhancing the religious identity and mission of the institution in the midst of the pluralism that exists on every Catholic campus in the United States. Catholic colleges and universities are at an important crossroad, a…

The Effects of a Bibliotherapy Intervention Compared to a Psycho-Educational Intervention to Improve Awareness of Self for Students with Emotional Disturbance in a Special Day School

ERIC Educational Resources Information Center

Kerr, Rhonda Moore

2017-01-01

Students with emotional disturbances often present with internalizing behaviors, such as anxiety, and externalizing behaviors, such as verbally or physically aggressive behaviors, which lead to challenges establishing and maintaining satisfactory relationships with peers and adults. These challenging relationships also present unique disciplinary…

The Perils and Promise of Variable Fees: Institutional and Public Policy Responses in the UK and the US

ERIC Educational Resources Information Center

Ward, David; Douglass, John Aubrey

2005-01-01

On both sides of the Atlantic, public higher education faces similar challenges in how to maintain and expand access to high quality tertiary education at an affordable cost to students and their families. These challenges undermine assumptions about the cost of higher education that were based upon conditions prevalent during the generation…

The journey of islet cell transplantation and future development.

PubMed

Gamble, Anissa; Pepper, Andrew R; Bruni, Antonio; Shapiro, A M James

2018-03-04

Intraportal islet transplantation has proven to be efficacious in preventing severe hypoglycemia and restoring insulin independence in selected patients with type 1 diabetes. Multiple islet infusions are often required to achieve and maintain insulin independence. Many challenges remain in clinical islet transplantation, including substantial islet cell loss early and late after islet infusion. Contributions to graft loss include the instant blood-mediated inflammatory reaction, potent host auto- and alloimmune responses, and beta cell toxicity from immunosuppressive agents. Protective strategies are being tested to circumvent several of these events including exploration of alternative transplantation sites, stem cell-derived insulin producing cell therapies, co-transplantation with mesenchymal stem cells or exploration of novel immune protective agents. Herein, we provide a brief introduction and history of islet cell transplantation, limitations associated with this procedure and methods to alleviate islet cell loss as a means to improve engraftment outcomes.

Fate of free chlorine in drinking water during distribution in premise plumbing.

PubMed

Zheng, Muzi; He, Chunguang; He, Qiang

2015-12-01

Free chlorine is a potent oxidizing agent and has been used extensively as a disinfectant in processes including water treatment. The presence of free chlorine residual is essential for the prevention of microbial regrowth in water distribution systems. However, excessive levels of free chlorine can cause adverse health effects. It is a major challenge to maintain appropriate levels of free chlorine residual in premise plumbing. As the first effort to assessing the fate of chlorine in premise plumbing using actual premise plumbing pipe sections, three piping materials frequently used in premise plumbing, i.e. copper, galvanized iron, and polyvinyl chloride (PVC), were investigated for their performance in maintaining free chlorine residual. Free chlorine decay was shown to follow first-order kinetics for all three pipe materials tested. The most rapid chlorine decay was observed in copper pipes, suggesting the need for higher chlorine dosage to maintain appropriate levels of free chlorine residual if copper piping is used. PVC pipes exhibited the least reactivity with free chlorine, indicative of the advantage of PVC as a premise plumbing material for maintaining free chlorine residual. The reactivity of copper piping with free chlorine was significantly hindered by the accumulation of pipe deposits. In contrast, the impact on chlorine decay by pipe deposits was not significant in galvanized iron and PVC pipes. Findings in this study are of great importance for the development of effective strategies for the control of free chlorine residual and prevention of microbiological contamination in premise plumbing.

Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States.

PubMed

Hammett, Theodore M; Donahue, Sara; LeRoy, Lisa; Montague, Brian T; Rosen, David L; Solomon, Liza; Costa, Michael; Wohl, David; Rich, Josiah D

2015-08-01

One in seven people living with HIV in the USA passes through a prison or jail each year, and almost all will return to the community. Discharge planning and transitional programs are critical but challenging elements in ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission. This paper describes facilitators and challenges of in-prison care, transitional interventions, and access to and continuity of care in the community in Rhode Island and North Carolina based on qualitative data gathered as part of the mixed-methods Link Into Care Study of prisoners and releasees with HIV. We conducted 65 interviews with correctional and community-based providers and administrators and analyzed the transcripts using NVivo 10 to identify major themes. Facilitators of effective transitional systems in both states included the following: health providers affiliated with academic institutions or other entities independent of the corrections department; organizational philosophy emphasizing a patient-centered, personal, and holistic approach; strong leadership with effective "champions"; a team approach with coordination, collaboration and integration throughout the system, mutual respect and learning between corrections and health providers, staff dedicated to transitional services, and effective communication and information sharing among providers; comprehensive transitional activities and services including HIV, mental health and substance use services in prisons, timely and comprehensive discharge planning with specific linkages/appointments, supplies of medications on release, access to benefits and entitlements, case management and proactive follow-up on missed appointments; and releasees' commitment to transitional plans. These elements were generally present in both study states but their absence, which also sometimes occurred, represent ongoing challenges to success. The qualitative findings on the facilitators and challenges of the transitional systems were similar in the two states despite differences in context, demographics of target population, and system organization. Recommendations for improved transitional systems follow from the analysis of the facilitators and challenges.

The journal of undergraduate neuroscience education: history, challenges, and future developments.

PubMed

Dunbar, Gary L; Lom, Barbara; Grisham, William; Ramirez, Julio J

2009-01-01

The 'JUNE and You' sessions presented at the July 2008 Undergraduate Neuroscience Education workshop, sponsored jointly by Faculty for Undergraduate Neuroscience (FUN) and Project Kaleidoscope (PKAL), featured background information about the history and mission of the Journal of Undergraduate Neuroscience Education (JUNE), followed by an informative discussion about the challenges facing JUNE, including new ideas for future developments. This article will highlight some of the information and ideas generated and shared at this conference. Critical discussion points included the need to keep members of FUN actively engaged in submitting and reviewing articles for JUNE. Ways in which authors, reviewers, and interested faculty members could best help in promoting the mission and vision of JUNE were discussed. Concerns about recent hackings into the JUNE website were also raised, and possible solutions and measures that can be taken to minimize this in the future were discussed. In addition, ideas for expanding the role of JUNE to provide a forum to evaluate new and emerging website information that is pertinent to undergraduate neuroscience education was discussed. Ideas for future developments of JUNE included revolving postings of articles as they are accepted, providing links to several related websites, and allowing updates for articles that have been previously published in JUNE. Finally, ideas for maintaining and expanding JUNE's stature as the resource for undergraduate neuroscience education included ensuring that JUNE is listed on important search vehicles, such as PubMed.

Measuring the Complexity of Treatment for Challenging Behavior using the Treatment Intensity Rating Form.

PubMed

Zarcone, Jennifer; Hagopian, Louis; Ninci, Jennifer; McKay, Chloe; Bonner, Andrew; Dillon, Christopher; Hausman, Nicole

2016-01-01

The goal of this study was to develop and evaluate a tool to measure the complexity and intensity of psychotropic medication interventions, behavioral interventions, and issues related to crisis management for challenging behavior using a standardized rating form. The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three categories: pharmacological interventions, behavior supports, and protective equipment. In a retrospective review we examined the final treatment recommendations for 74 individuals with self-injurious behavior (SIB) based on psychiatric and behavioral notes and reports. We also compared whether TIRF scores differed across individuals for whom SIB was maintained by social reinforcement (e.g., to access attention or toys/activities, or escape from tasks) versus those for whom SIB was maintained by automatic reinforcement (e.g., occurs independent of social variables, and is presumed to be maintained by sensory reinforcement). The TIRF was demonstrated to have strong inter-rater reliability (98%) and appears to have good face validity. As hypothesized, individuals with SIB maintained by automatic reinforcement had significantly more medication trials (p=0.0005) and required more protective equipment than individuals with SIB maintained by social reinforcement (p=0.0002). Antidepressant medication was used more often with individuals with automatically reinforced SIB, although antipsychotics and anticonvulsants were also commonly used across both groups. Findings provide initial support for the TIRF's reliability, and face validity as a measure the level of complexity of medical and behavioral treatment plans - although additional research is needed to fully evaluate its psychometric properties.

Timeline-Based Mission Operations Architecture: An Overview

NASA Technical Reports Server (NTRS)

Chung, Seung H.; Bindschadler, Duane L.

2012-01-01

Some of the challenges in developing a mission operations system and operating a mission can be traced back to the challenge of integrating a mission operations system from its many components and to the challenge of maintaining consistent and accountable information throughout the operations processes. An important contributing factor to both of these challenges is the file-centric nature of today's systems. In this paper, we provide an overview of these challenges and argue the need to move toward an information-centric mission operations system. We propose an information representation called Timeline as an approach to enable such a move, and we provide an overview of a Timeline-based Mission Operations System architecture.

Eating For Two: How Metabolism Establishes Interspecies Interactions in the Gut

PubMed Central

Fischbach, Michael A.; Sonnenburg, Justin L.

2011-01-01

In bacterial communities, ‘tight economic times’ are the norm. Of the many challenges bacteria face in making a living, perhaps none are more important than generating energy, maintaining redox balance, and acquiring carbon and nitrogen to synthesize primary metabolites. The ability of bacteria to meet these challenges depends heavily on the rest of their community. Indeed, the most fundamental way in which bacteria communicate is by importing the substrates for metabolism and exporting metabolic end products. As an illustration of this principle, we will travel down a carbohydrate catabolic pathway common to many species of Bacteroides, highlighting the interspecies interactions established (often inevitably) at its key steps. We also discuss the metabolic considerations in maintaining the stability of host-associated microbial communities. PMID:22018234

Temporary wetlands: Challenges and solutions to conserving a ‘disappearing’ ecosystem

USGS Publications Warehouse

Calhoun, Aram J.K.; Mushet, David M.; Bell, Kathleen P.; Boix, Dani; Fitzsimons, James A.; Isselin-Nondedeu, Francis

2017-01-01

Frequent drying of ponded water, and support of unique, highly specialized assemblages of often rare species, characterize temporary wetlands, such as vernal pools, gilgais, and prairie potholes. As small aquatic features embedded in a terrestrial landscape, temporary wetlands enhance biodiversity and provide aesthetic, biogeochemical, and hydrologic functions. Challenges to conserving temporary wetlands include the need to: (1) integrate freshwater and terrestrial biodiversity priorities; (2) conserve entire ‘pondscapes’ defined by connections to other aquatic and terrestrial systems; (3) maintain natural heterogeneity in environmental gradients across and within wetlands, especially gradients in hydroperiod; (4) address economic impact on landowners and developers; (5) act without complete inventories of these wetlands; and (6) work within limited or non-existent regulatory protections. Because temporary wetlands function as integral landscape components, not singly as isolated entities, their cumulative loss is ecologically detrimental yet not currently part of the conservation calculus. We highlight approaches that use strategies for conserving temporary wetlands in increasingly human-dominated landscapes that integrate top-down management and bottom-up collaborative approaches. Diverse conservation activities (including education, inventory, protection, sustainable management, and restoration) that reduce landowner and manager costs while achieving desired ecological objectives will have the greatest probability of success in meeting conservation goals.

Software Engineering Support of the Third Round of Scientific Grand Challenge Investigations: Earth System Modeling Software Framework Survey

NASA Technical Reports Server (NTRS)

Talbot, Bryan; Zhou, Shu-Jia; Higgins, Glenn; Zukor, Dorothy (Technical Monitor)

2002-01-01

One of the most significant challenges in large-scale climate modeling, as well as in high-performance computing in other scientific fields, is that of effectively integrating many software models from multiple contributors. A software framework facilitates the integration task, both in the development and runtime stages of the simulation. Effective software frameworks reduce the programming burden for the investigators, freeing them to focus more on the science and less on the parallel communication implementation. while maintaining high performance across numerous supercomputer and workstation architectures. This document surveys numerous software frameworks for potential use in Earth science modeling. Several frameworks are evaluated in depth, including Parallel Object-Oriented Methods and Applications (POOMA), Cactus (from (he relativistic physics community), Overture, Goddard Earth Modeling System (GEMS), the National Center for Atmospheric Research Flux Coupler, and UCLA/UCB Distributed Data Broker (DDB). Frameworks evaluated in less detail include ROOT, Parallel Application Workspace (PAWS), and Advanced Large-Scale Integrated Computational Environment (ALICE). A host of other frameworks and related tools are referenced in this context. The frameworks are evaluated individually and also compared with each other.

Community-based participatory research in complex settings: clean mind–dirty hands

PubMed Central

Makhoul, Jihad; Nakkash, Rima; Harpham, Trudy; Qutteina, Yara

2014-01-01

Despite the abundance of the literature which discusses factors supporting or inhibiting effective participation of community members in community-based research, there is a paucity of publications analysing challenges to participation in complex settings. This manuscript describes an intervention built on researcher–community partnership amid complex social conditions which challenged participation of community members at different stages of the research process. The research took place in a Palestinian refugee camp in Beirut, Lebanon and 1 of 12 in Lebanon which suffer from deteriorating social, economic and physical conditions perpetuated by state-imposed restrictions. The research team developed a community coalition which was involved in all stages of planning, designing, implementation and dissemination. In all those stages the aim was to maintain rigorous research, to follow a ‘clean mind’ approach to research, but maintain principles of community participation which necessitate ‘a dirty hand’. Despite commitment to the principles of community-based participatory research, participation of community members (including youth, parents and teachers) was affected to a great extent by the social, physical and structural conditions of the community context. Characteristics of the context where research is conducted and how it affects community members should not be overlooked since multiple factors beyond the researchers' control could interfere with the rigour of scientific research. Researchers need to develop a plan for participation with the community from the beginning with an understanding of the community forces that affect meaningful participation and address possible deterrence. PMID:23872385

A Txnrd1-dependent metabolic switch alters hepatic lipogenesis, glycogen storage, and detoxification

PubMed Central

Iverson, Sonya V.; Eriksson, Sofi; Xu, Jianqiang; Prigge, Justin R.; Talago, Emily A.; Meade, Tesia A.; Meade, Erin S.; Capecchi, Mario R.; Arnér, Elias S.J.; Schmidt, Edward E.

2013-01-01

Besides helping to maintain a reducing intracellular environment, the thioredoxin (Trx) system impacts bioenergetics and drug-metabolism. We show that hepatocyte-specific disruption of Txnrd1, encoding Trx reductase-1 (TrxR1), causes a metabolic switch in which lipogenic genes are repressed and periportal hepatocytes become engorged with glycogen. These livers also overexpress machinery for biosynthesis of glutathione and conversion of glycogen into UDP-glucuronate; they stockpile glutathione-S-transferases and UDP-glucuronyl-transferases; and they overexpress xenobiotic exporters. This realigned metabolic profile suggested that the mutant hepatocytes might be preconditioned to more effectively detoxify certain xenobiotic challenges. Hepatocytes convert the pro-toxin acetaminophen (APAP, paracetamol) into cytotoxic N-acetyl-p-benzoquinone imine (NAPQI). APAP defenses include glucuronidation of APAP or glutathionylation of NAPQI, allowing removal by xenobiotic exporters. We found that NAPQI directly inactivates TrxR1, yet Txnrd1-null livers were resistant to APAP-induced hepatotoxicity. Txnrd1-null livers did not have more effective gene expression responses to APAP challenge; however their constitutive metabolic state supported more robust GSH biosynthesis-, glutathionylation-, and glucuronidation-systems. Following APAP challenge, this effectively sustained the GSH system and attenuated damage. PMID:23743293

Towards co-packaging of photonics and microelectronics in existing manufacturing facilities

NASA Astrophysics Data System (ADS)

Janta-Polczynski, Alexander; Cyr, Elaine; Bougie, Jerome; Drouin, Alain; Langlois, Richard; Childers, Darrell; Takenobu, Shotaro; Taira, Yoichi; Lichoulas, Ted W.; Kamlapurkar, Swetha; Engelmann, Sebastian; Fortier, Paul; Boyer, Nicolas; Barwicz, Tymon

2018-02-01

The impact of integrated photonics on optical interconnects is currently muted by challenges in photonic packaging and in the dense integration of photonic modules with microelectronic components on printed circuit boards. Single mode optics requires tight alignment tolerance for optical coupling and maintaining this alignment in a cost-efficient package can be challenging during thermal excursions arising from downstream microelectronic assembly processes. In addition, the form factor of typical fiber connectors is incompatible with the dense module integration expected on printed circuit boards. We have implemented novel approaches to interfacing photonic chips to standard optical fibers. These leverage standard high throughput microelectronic assembly tooling and self-alignment techniques resulting in photonic packaging that is scalable in manufacturing volume and in the number of optical IOs per chip. In addition, using dense optical fiber connectors with space-efficient latching of fiber patch cables results in compact module size and efficient board integration, bringing the optics closer to the logic chip to alleviate bandwidth bottlenecks. This packaging direction is also well suited for embedding optics in multi-chip modules, including both photonic and microelectronic chips. We discuss the challenges and rewards in this type of configuration such as thermal management and signal integrity.

Implementing PAT with Standards

NASA Astrophysics Data System (ADS)

Chandramohan, Laakshmana Sabari; Doolla, Suryanarayana; Khaparde, S. A.

2016-02-01

Perform Achieve Trade (PAT) is a market-based incentive mechanism to promote energy efficiency. The purpose of this work is to address the challenges inherent to inconsistent representation of business processes, and interoperability issues in PAT like cap-and-trade mechanisms especially when scaled. Studies by various agencies have highlighted that as the mechanism evolves including more industrial sectors and industries in its ambit, implementation will become more challenging. This paper analyses the major needs of PAT (namely tracking, monitoring, auditing & verifying energy-saving reports, and providing technical support & guidance to stakeholders); and how the aforesaid reasons affect them. Though current technologies can handle these challenges to an extent, standardization activities for implementation have been scanty for PAT and this work attempts to evolve them. The inconsistent modification of business processes, rules, and procedures across stakeholders, and interoperability among heterogeneous systems are addressed. This paper proposes the adoption of specifically two standards into PAT, namely Business Process Model and Notation for maintaining consistency in business process modelling, and Common Information Model (IEC 61970, 61968, 62325 combined) for information exchange. Detailed architecture and organization of these adoptions are reported. The work can be used by PAT implementing agencies, stakeholders, and standardization bodies.

Measurement of Subsidence Across the Sacramento Delta: Applying InSAR to a Coherence-challenged Area

NASA Astrophysics Data System (ADS)

Jones, C. E.; Sharma, P.

2014-12-01

InSAR-based measurement of ground subsidence rates are notoriously challenging in agricultural areas because of rapid temporal decorrelation introduced by physical disturbance of the ground and water content changes. This can be mitigated by the use of longer wavelength instruments and time series techniques, but measurement remains a challenge particularly in areas where the deformation rates are low. Here we discuss techniques developed to work with low coherence data in a project to measure sub-island scale subsidence rates across the Sacramento-San Joaquin Delta using SBAS processing of L-band UAVSAR data collected between July 2009 and February 2014. Determination of rates in this area is particularly valuable because of the Delta's critical importance as a water resource for the State of California and as an enormously productive estuarine ecosystem. Subsidence across the region has left most of the man-made islands below mean sea level and the levees maintaining their integrity are subject to a wide range of threats, including failure during earthquakes on the nearby Hayward and San Andreas fault. This research was conducted at the Jet Propulsion Laboratory, California Institute of Technology, under contract with the National Aeronautics and Space Administration.

New Capabilities for Hostile Environments on Z Grand Challenge LDRD - Final Status

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

Cuneo, Michael E.; Griffin, P. J.; Balch, D. K.

2016-10-01

The purpose of this project was to develop new physical simulation capabilities in order to support the science-based qualification of nonnuclear weapon components in hostile radiation environments. The project contributes directly to the goals of maintaining a safe, secure, and effective US nuclear stockpile, maintaining strategic deterrence at lower nuclear force levels, extending the life of the nuclear deterrent capability, and to be ready for technological surprise.

CTC Sentinel. Volume 6, Issue 2, February 2013

DTIC Science & Technology

2013-02-01

Use of Militias to Maintain Stability in Abyan Province By Casey L. Coombs 7 Deciphering the Jihadist Presence in Syria: An Analysis of...and impose their authority in their communities . This poses particular challenges for Libya as i t moves through the transit ion process...IssUE 2 5 Yemen’s Use of Militias to Maintain Stability in Abyan Province By Casey L. Coombs in 2011, militants from al-Qa`ida in the Arabian

Social Justice, Competition and Quality: 21st Century Leadership Challenges. The 2012 Yearbook of the National Council of Professors of Educational Administration

ERIC Educational Resources Information Center

Perreault, George, Ed.; Zellner, Luana, Ed.

2012-01-01

This is the 2012 Yearbook of the National Council of Professors of Educational Administration (NCPEA). This Yearbook contains the following papers: (1) Editors' Sidebar (George Perreault and Luana Zellner); (2) The Hour Glass Economy: The Social Justice Challenge for the 21st Century (Fenwick W. English); (3) Maintaining the Human Touch in…

Transforming round pegs to fill square holes:Facing the challenge of forest inventories as tools of environmental policy for the 21st century

Treesearch

Victor A. Rudis

1993-01-01

Todays forest inventory specialist is challenged to combine inventories and analysis of timber with range recreation, soil, water, and wildlife resources, related human uses, and social and economic concerns.Lessons learned in adapting timber-oriented forest inventories toward holistic forest resources assessment are provided.Discussed are ways to maintain dialogue...

Enabled Masses: Challenge and Trust within Modern Social Networks

DTIC Science & Technology

2013-03-01

maintaining the data needed , and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of...mobile technology presents a challenge to future operations in terms of increased scrutiny. Senior military leaders need to understand and appreciate...increased scrutiny. Senior military leaders need to understand and appreciate the human processes underlying social networks as well as why this

Challenges for the aircraft structural integrity program

NASA Technical Reports Server (NTRS)

Lincoln, John W.

1994-01-01

Thirty-six years ago the United States Air Force established the USAF Aircraft Structural Integrity Program (ASIP) because flight safety had been degraded by fatigue failures of operational aircraft. This initial program evolved, but has been stable since the issuance of MIL-STD-1530A in 1975. Today, the program faces new challenges because of a need to maintain aircraft longer in an environment of reduced funding levels. Also, there is increased pressure to reduce cost of the acquisition of new aircraft. It is the purpose of this paper to discuss the challenges for the ASIP and identify the changes in the program that will meet these challenges in the future.

Challenges in the 1990's for astronaut training simulators

NASA Technical Reports Server (NTRS)

Brown, Patrick M.; Hajare, Ankur R.; Stark, George E.

1990-01-01

New challenges for the simulation community at the Johnson Space Center both in near and long terms are considered. In the near term, the challenges of supporting an increasing flight rate, maintaining operations while replacing obsolete subsystems, and incorporating forthcoming changes to the Space Shuttle are discussed, and focus is placed on a change of forward flight-deck instruments from electro-mechanical devices to electronic displays. Training astronauts for complex concurrent missions involving multiple spacecraft and geographically dispersed ground facilities is considered to be foremost of the long-term challenges, in addition to the tasks of improving the simulator reliability and the operational efficiency of the facilities.

Stakeholder Interaction in Participatory Land Restoration in Iceland: Environmental Officers' Challenges and Strategies

NASA Astrophysics Data System (ADS)

Berglund, Brita; Hallgren, Lars; Aradóttir, Ása L.

2015-08-01

Participatory approaches involve stakeholder interaction but environmental agency employees engaged in participatory undertakings often lack training for interaction tasks. This study explored how district officers at the Soil Conservation Service of Iceland (SCSI) experienced and dealt with stakeholder interaction in participatory land restoration. We made semi-structured interviews with all district officers with at least 1-year experience; seven in total. A thematic content analysis revealed five challenges facing the officers in their interaction activities and seven strategies that they used to deal with these challenges. The core challenge was to establish and maintain contacts with farmers and other stakeholders as it enabled the SCSI to support and influence their land restoration practices. Other challenges were to: accomplish SCSI's objectives; represent the SCSI and the government; have adequate skills, knowledge, and background; and deal with one's own emotions. Four of the strategies seemed to promote collaboration: create win-win scenarios; "go local"; direct and positive communication; and motivation and knowledge sharing. The other strategies: supportive district officer team; self-reliance and personal background; and self-control supported the officers in their interaction tasks. Factors undermining their collaboration efforts included insufficient time and other resources, an unsupportive organizational culture and a legal duty to assess the condition of vegetation cover on farmland. Increased resource allocation to the SCSI's local operations, more attention to emotional issues, and efforts to develop a more flexible and learning organizational culture that supports collaboration could counteract these factors.

Stakeholder Interaction in Participatory Land Restoration in Iceland: Environmental Officers' Challenges and Strategies.

PubMed

Berglund, Brita; Hallgren, Lars; Aradóttir, Ása L

2015-08-01

Participatory approaches involve stakeholder interaction but environmental agency employees engaged in participatory undertakings often lack training for interaction tasks. This study explored how district officers at the Soil Conservation Service of Iceland (SCSI) experienced and dealt with stakeholder interaction in participatory land restoration. We made semi-structured interviews with all district officers with at least 1-year experience; seven in total. A thematic content analysis revealed five challenges facing the officers in their interaction activities and seven strategies that they used to deal with these challenges. The core challenge was to establish and maintain contacts with farmers and other stakeholders as it enabled the SCSI to support and influence their land restoration practices. Other challenges were to: accomplish SCSI's objectives; represent the SCSI and the government; have adequate skills, knowledge, and background; and deal with one's own emotions. Four of the strategies seemed to promote collaboration: create win-win scenarios; "go local"; direct and positive communication; and motivation and knowledge sharing. The other strategies: supportive district officer team; self-reliance and personal background; and self-control supported the officers in their interaction tasks. Factors undermining their collaboration efforts included insufficient time and other resources, an unsupportive organizational culture and a legal duty to assess the condition of vegetation cover on farmland. Increased resource allocation to the SCSI's local operations, more attention to emotional issues, and efforts to develop a more flexible and learning organizational culture that supports collaboration could counteract these factors.

‘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

Expert Opinion Editorial Tissue Engineered Blood Vessels as Promising Tools for Testing Drug Toxicity

PubMed Central

Truskey, George A.; Fernandez, Cristina E.

2015-01-01

Drug-induced vascular injury (DIVI) is a serious problem in preclinical studies of vasoactive molecules and for survivors of pediatric cancers. DIVI is often observed in rodents and some larger animals, primarily with drugs affecting vascular tone, but not in humans; however, DIVI observed in animal studies often precludes a drug candidate from continuing along the development pipeline. Thus, there is great interest by the pharmaceutical industry to identify quantifiable human biomarkers of DIVI. Small scale endothelialized tissue-engineered blood vessels using human cells represent a promising approach to screen drug candidates and developed alternatives to cancer therapeutics in vitro. We identify several technical challenges that remain to be addressed, including high throughput systems to screen large numbers of candidates, identification of suitable cell sources, and establishing and maintaining a differentiated state of the vessel wall cells. Adequately addressing these challenges should yield novel platforms to screen drugs and develop new therapeutics to treat cardiovascular disease. PMID:26028128

Path forward: emerging issues and challenges.

PubMed

Gillen, Matt; Gittleman, Janie L

2010-06-01

The NIOSH Construction Program worked with industry stakeholders to develop a National Occupational Safety and Health Construction Agenda to target future research and activities. The Program and its partners are also cognizant that new developments can emerge over time and that research can play an important role in helping to understand and address these emerging issues. Examples of emerging issues relevant to construction safety and health are described. These include: (a) climate change and energy considerations; (b) green construction developments and opportunities; (c) new materials; (d) changes in industry structure and practice; (e) workforce developments and disparities; (f) injury underreporting and cost and risk shifting; and (g) increased interest in addressing root causes. Responding to emerging issues while maintaining a focus on fundamental longstanding issues represents an ongoing challenge for researchers and industry organizations. Additional research to understand the diffusion and adoption of research by the industry is also needed. Research accomplished to date provides a strong foundation for addressing future industry needs and trends. (c) 2010 Elsevier Ltd. All rights reserved.

Overview of Propellant Delivery Systems at the NASA John C. Stennis Space Center

NASA Technical Reports Server (NTRS)

Haselmaier, L. Haynes; Field, Robert E.; Ryan, Harry M.; Dickey, Jonathan C.

2006-01-01

A wide range of rocket propulsion test work occurs at he NASA John C. Stennis Space Center (SSC) including full-scale engine test activities at test facilities A-1, A-2, B-1 and B-2 as well as combustion device research and development activities at the E-Complex (E-1, E-2. E-3 and E-4) test facilities. One of the greatest challenges associated with operating a test facility is maintaining the health of the primary propellant system and test-critical support systems. The challenge emerges due to the fact that the operating conditions of the various system components are extreme (e.g., low temperatures, high pressures) and due to the fact that many of the components and systems are unique. The purpose of this paper is to briefly describe the experience and modeling techniques that are used to operate the unique test facilities at NASA SSC that continue to support successful propulsion testing.

Vocal Fold Surface Hydration: A review

PubMed Central

Leydon, Ciara; Sivasankar, Mahalakshmi; Falciglia, Danielle Lodewyck; Atkins, Christopher; Fisher, Kimberly V.

2009-01-01

Vocal fold surface liquid homeostasis contributes to optimal vocal physiology. In this paper we review emerging evidence that vocal fold surface liquid is maintained in part by salt and water fluxes across the epithelium. Based on recent immunolocalization and electrophysiological findings, we describe a transcellular pathway as one mechanism for regulating superficial vocal fold hydration. We propose that the pathway includes the sodium-potassium pump, sodium-potassium-chloride cotransporter, epithelial sodium channels, cystic fibrosis transmembrane regulator chloride channels, and aquaporin water channels. By integrating knowledge of the regulating mechanisms underlying ion and fluid transport with observations from hydration challenges and treatments using in vitro and in vivo studies, we provide a theoretical basis for understanding how environmental and behavioral challenges and clinical interventions may modify vocal fold surface liquid composition. We present converging evidence that clinical protocols directed at facilitating vocal fold epithelial ion and fluid transport may benefit healthy speakers, those with voice disorders, and those at risk for voice disorders. PMID:19111440

Monetary incentives in support of academic achievement: results of a randomized field trial involving high-achieving, low-resource, ethnically diverse urban adolescents.

PubMed

Spencer, Margaret Beale; Noll, Elizabeth; Cassidy, Elaine

2005-06-01

Significant resources have been directed at understanding and alleviating the achievement gap in education. Most programs focused on this aim rely on a top-down approach, including funding for infrastructure improvement, curriculum development, class size, and teacher salaries. This article presents findings from a randomized field trial that evaluates a bottom-up approach in which high-achieving students of diverse racial and ethnic backgrounds from poor families are given monetary incentives to maintain their academic standing. The evaluation was designed to explore the role of monetary incentives as a mechanism for promoting resiliency in the face of poverty-related challenge. Discussion of what motivates students to learn is framed as a function of normal cognitive and socioemotional development in challenging environments. Evaluation findings indicate that monetary incentives are effective in promoting academic success to different degrees and for different reasons depending on students' perception of the meaning of the incentive in relation to their emergent identity.

Structural and molecular interrogation of intact biological systems

PubMed Central

Chung, Kwanghun; Wallace, Jenelle; Kim, Sung-Yon; Kalyanasundaram, Sandhiya; Andalman, Aaron S.; Davidson, Thomas J.; Mirzabekov, Julie J.; Zalocusky, Kelly A.; Mattis, Joanna; Denisin, Aleksandra K.; Pak, Sally; Bernstein, Hannah; Ramakrishnan, Charu; Grosenick, Logan; Gradinaru, Viviana; Deisseroth, Karl

2014-01-01

Obtaining high-resolution information from a complex system, while maintaining the global perspective needed to understand system function, represents a key challenge in biology. Here we address this challenge with a method (termed CLARITY) for the transformation of intact tissue into a nanoporous hydrogel-hybridized form (crosslinked to a three-dimensional network of hydrophilic polymers) that is fully assembled but optically transparent and macromolecule-permeable. Using mouse brains, we show intact-tissue imaging of long-range projections, local circuit wiring, cellular relationships, subcellular structures, protein complexes, nucleic acids and neurotransmitters. CLARITY also enables intact-tissue in situ hybridization, immunohistochemistry with multiple rounds of staining and de-staining in non-sectioned tissue, and antibody labelling throughout the intact adult mouse brain. Finally, we show that CLARITY enables fine structural analysis of clinical samples, including non-sectioned human tissue from a neuropsychiatric-disease setting, establishing a path for the transmutation of human tissue into a stable, intact and accessible form suitable for probing structural and molecular underpinnings of physiological function and disease. PMID:23575631

How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions

PubMed Central

George, Jim; Long, Susannah; Vincent, Charles

2013-01-01

Maintaining patient safety in acute hospitals is a global health challenge. Traditionally, patient safety measures have been concentrated on critical care and surgical patients. In this review the medical literature was reviewed over the last ten years on aspects of patient safety specifically related to patients with dementia. Patients with dementia do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution. Improving safety and quality of care for patients with dementia in acute hospitals will benefit all patients and is an urgent priority for the NHS. PMID:23759885

Developing and maintaining compassionate care in nursing.

PubMed

Henderson, Amanda; Jones, Jenny

2017-09-20

Compassionate care is a fundamental aspect of nursing, and is an important value that is embedded in nurses' professional standards and codes of practice. However, nurses may experience several challenges in their practice that can impede their ability to provide compassionate care. This article aims to support and guide nurses in developing their capacity to be compassionate. It explores concepts related to compassion, including compassion satisfaction, fatigue, literacy and self-compassion, and outlines strategies that nurses can implement to promote compassionate care. This article encourages nurses to identify their personal and professional values, to understand how these can influence their attitudes and behaviours. By raising awareness of these concepts, as well as the challenges and changing nature of compassion, it is hoped that nurses' capacity to provide compassionate care will be enhanced. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Dialysis in Africa: a personal perspective on a demonstration project in Cameroon.

PubMed

Trebbin, Wayne; Monteleone, Peter

2007-11-01

Despite belief to the contrary, technologically sophisticated medical care can be established in developing countries. The process requires intense effort. Preliminary work must include resolving ethical dilemmas, acquiring adequate funding, establishing supply lines, and cultivating proper political support within the host country. Our organization, WORTH (World Organization of Renal Therapies) has successfully launched and is maintaining a dialysis unit in the sub-Saharan African country of Cameroon. So far our complications rate has been trivial, and our metrics indicate that we are successfully delivering safe, effective treatment that can preserve the lives of people with end-stage renal disease in a part of the world where medical care is laboring under difficult conditions. Work is about to begin in establishing a second dialysis unit in that country. We try here to delineate our experience, and we offer a direct challenge to other nephrologists to be activists in delivering modern, advanced technology medicine to more challenging places than those where it is currently flourishing.

'Lost to follow up': rethinking delayed and interrupted HIV treatment among married Swazi women.

PubMed

Dlamini-Simelane, Thandeka T T; Moyer, Eileen

2017-03-01

Through various campaigns and strategies, more women are being tested for HIV in countries with a high prevalence of the virus. Despite the ready availability of treatment at government clinics in sub-Saharan African countries like Swaziland, women consistently report difficulty in maintaining access to treatment. Drawing on two individual case studies selected from a larger study of the so-called leaky cascade in Swaziland, we illustrate the protracted journeys married women undertake to initiate treatment. We demonstrate how women manoeuvre tactically after diagnosis, highlight factors that influence their decisions related to initiating treatment, and detail the actors involved in the decision-making process. Our research shows the persistence of structural factors that inhibit access, including economic constraints, gender inequality and patriarchal social norms. Patients referred as ‘lost to follow up’ are in many cases actively pursuing treatment within a context that includes the biomedical health system, but also extends well beyond it. We argue that the phrase ‘lost to follow up’ conceals the complex social navigation required by women to initiate and maintain access to treatment. Further, we suggest that many of the logistical challenges of monitoring and tracking people with HIV can be better addressed by taking into account the structural and social aspects of delayed treatment initiative.

Nuclear fuel performance: Trends, remedies and challenges

NASA Astrophysics Data System (ADS)

Rusch, C. A.

2008-12-01

It is unacceptable to have nuclear power plants unavailable or power restricted due to fuel reliability issues. 'Fuel reliability' has a much broader definition than just maintaining mechanical integrity and being leaker free - fuel must fully meet the specifications, impose no adverse impacts on plant operation and safety, and maintain quantifiable margins within design and operational envelopes. The fuel performance trends over the last decade are discussed and the significant contributors to reduced reliability experienced with commercial PWR and BWR designs are identified and discussed including grid-to-rod fretting and debris fretting in PWR designs and accelerated corrosion, debris fretting and pellet-cladding interaction in BWR designs. In many of these cases, the impacts have included not only fuel failures but also plant operating restrictions, forced shutdowns, and/or enhanced licensing authority oversight. Design and operational remedies are noted. The more demanding operating regimes and the constant quest to improve fuel performance require enhancements to current designs and/or new design features. Fuel users must continue to and enhance interaction with fuel suppliers in such areas as oversight of supplier design functions, lead test assembly irradiation programs and quality assurance oversight and surveillance. With the implementation of new designs and/or features, such fuel user initiatives can help to minimize the potential for performance problems.

Personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment in Queensland, Australia.

PubMed

Gladman, Beverley; Waghorn, Geoff

2016-02-15

High non-participation in the labour force and unemployment remain challenging for adults with serious mental illness. This study examined the personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment. The aim was to increase understanding of personal experiences of employment and how these experiences can be used to inform the assistance provided in support of clients' competitive employment goals. Qualitative data from a two-year period were thematically analysed from one participating site in a multi-site trial of employment services integrated with public funded community mental health treatment and care. Both positive and negative themes arose. Positive themes included: Aspirations for a better life, receiving feedback on good job performance, employment displacing preoccupation with illness, and employment improving self-esteem and reducing financial stress. Negative themes included stigma experiences, stress, and health difficulties. Both positive and negative experiences did not depend on type of employment service assistance nor key client characteristics such as age, sex, and diagnostic category. Despite its many benefits, employment can also increase the risk of negative personal experiences. These findings suggest that employment service providers could do more to assist people who commence employment, to reduce the risk of negative personal experiences and to enhance the benefits of competitive employment.

Dental Care in Scleroderma

MedlinePlus

Dental Care in Scleroderma People living with scleroderma face unique challenges while trying to maintain their oral ... They are more likely to be affected by dental conditions such as small mouth, dry mouth, jaw ...

Challenges and Strategies for Research in Prisons

PubMed Central

Apa, Zoltán L.; Bai, Ruo Yu; Mukherejee, Dhritiman V.; Herzig, Carolyn T. A.; Koenigsmann, Carl; Lowy, Franklin D.; Larson, Elaine L.

2013-01-01

In this article, we discuss some of the challenges encountered while conducting research in two maximum security prisons and approaches we found helpful to facilitate the research process through the development of collaborative relationships, the establishment of prison contacts, and the implementation of rigorous research methods. As a result of our experiences, we have been successful at maintaining a high rate of inmate participation (>80%) and a well-functioning multidisciplinary team. The approaches described may be useful to other investigators planning to conduct research in a challenging setting such as prisons. PMID:22924569

Multi-parameter comparison of a standardized mixed meal tolerance test in healthy and type 2 diabetic subjects: the PhenFlex challenge.

PubMed

Wopereis, Suzan; Stroeve, Johanna H M; Stafleu, Annette; Bakker, Gertruud C M; Burggraaf, Jacobus; van Erk, Marjan J; Pellis, Linette; Boessen, Ruud; Kardinaal, Alwine A F; van Ommen, Ben

2017-01-01

A key feature of metabolic health is the ability to adapt upon dietary perturbations. Recently, it was shown that metabolic challenge tests in combination with the new generation biomarkers allow the simultaneous quantification of major metabolic health processes. Currently, applied challenge tests are largely non-standardized. A systematic review defined an optimal nutritional challenge test, the "PhenFlex test" (PFT). This study aimed to prove that PFT modulates all relevant processes governing metabolic health thereby allowing to distinguish subjects with different metabolic health status. Therefore, 20 healthy and 20 type 2 diabetic (T2D) male subjects were challenged both by PFT and oral glucose tolerance test (OGTT). During the 8-h response time course, 132 parameters were quantified that report on 26 metabolic processes distributed over 7 organs (gut, liver, adipose, pancreas, vasculature, muscle, kidney) and systemic stress. In healthy subjects, 110 of the 132 parameters showed a time course response. Patients with T2D showed 18 parameters to be significantly different after overnight fasting compared to healthy subjects, while 58 parameters were different in the post-challenge time course after the PFT. This demonstrates the added value of PFT in distinguishing subjects with different health status. The OGTT and PFT response was highly comparable for glucose metabolism as identical amounts of glucose were present in both challenge tests. Yet the PFT reports on additional processes, including vasculature, systemic stress, and metabolic flexibility. The PFT enables the quantification of all relevant metabolic processes involved in maintaining or regaining homeostasis of metabolic health. Studying both healthy subjects and subjects with impaired metabolic health showed that the PFT revealed new processes laying underneath health. This study provides the first evidence towards adopting the PFT as gold standard in nutrition research.

Plate Boundary Observatory Infrastructure and Data Products in Education and Outreach

NASA Astrophysics Data System (ADS)

Eriksson, S. C.; Barbour, K.; Lee, E.

2005-12-01

As one of three major components of NSF's EarthScope program, the Plate Boundary Observatory (PBO) encourages the integration of research and education. Informing various communities about the current work of PBO and the scientific discoveries related to the use of this instrumentation has contributed to the success of PBO during the first two years of the EarthScope project. UNAVCO(PBO), IRIS (USArray), and the EarthScope project office work together to integrate Education and Outreach (E&O) opportunities into a program that is greater than the sum of its parts and yet maintains the identity of each organization. Building and maintaining the PBO website, documenting and archiving activities of PBO, providing short courses for professional development of scientists using EarthScope data, and developing higher level data products with an appropriate educational framework are a few of the activities that provide both challenges and opportunities. The internet, particularly the World Wide Web, has become the primary tool for disseminating information to various audiences. The primary goals of the PBO website are to provide current information on the progress of GPS and Strainmeter facility construction; to provide access to different levels of data products; and to facilitate networking with and among scientists. Challenges for the PBO website include publishing current stories on installation projects while coordinating with field engineers on a regular basis; providing near to real time updates and maintaining quality assurance processes; and defining personnel requirements for a maintaining a dynamic website. Currently, archived photographs, web diaries, and numerous web highlights document PBO's success and provide a visual record of PBO's accomplishments and behind-the-scene activities over the last two years. The community charged PBO with increasing the number of scientists using its data. UNAVCO does this by providing short courses for professional development of young scientists and more established scientists broadening their research interests. In addition, collecting, manipulating, and aggregating real scientific data for classroom use is a current priority in science education. Educators want their students to use these data to draw conclusions following the logical processes characteristic of the scientific endeavor. Hence, PBO is a natural source of data for use in the classroom. Staff and community members are designing higher level data products for a variety of audiences in formal education (students and instructors in middle/high school, community colleges, undergraduate science majors and students in general science education, graduate students) and in informal education (museums, park information centers, science centers, and media. PBO is working on a chapter for the Earth Exploration Toolbox (http://serc.carleton.edu/eet/) for undergraduate general science education, and the Jules Verne Voyager will include a user-friendly interface and associated educational materials. Evaluation of the effectiveness of this entire program and of individual projects and products is a major undertaking. The multitude of tasks, integration of these tasks into a coherent program, and identification of resources for evaluation are both opportunities and challenges in helping build a program with measurable impact.

A Global Assessment on Climate Research Engaging Indigenous Knowledge Systems and Recommendations for Quality Standards of Research Practice in Indigenous Communities

NASA Astrophysics Data System (ADS)

Davíd-Chavez, D. M.; Gavin, M. C.

2017-12-01

Indigenous communities worldwide have maintained their own knowledge systems for millennia informed through careful observation of dynamics of environmental changes. Withstanding centuries of challenges to their rights to maintain and practice these knowledge systems, Indigenous peoples continually speak to a need for quality standards for research in their communities. Although, international and Indigenous peoples' working groups emphasize Indigenous knowledge systems and the communities who hold them as critical resources for understanding and adapting to climate change, there has yet to be a comprehensive, evidence based analysis into how diverse knowledge systems are integrated in scientific studies. Do current research practices challenge or support Indigenous communities in their efforts to maintain and appropriately apply their knowledge systems? This study addresses this question using a systematic literature review and meta-analysis assessing levels of Indigenous community participation and decision-making in all stages of the research process (initiation, design, implementation, analysis, dissemination). Assessment is based on reported quality indicators such as: outputs that serve the community, ethical guidelines in practice (free, prior, and informed consent and intellectual property rights), and community access to findings. These indicators serve to identify patterns between levels of community participation and quality standards in practice. Meta-analysis indicates most climate studies practice an extractive model in which Indigenous knowledge systems are co-opted with minimal participation or decision-making authority from communities who hold them. Few studies report outputs that directly serve Indigenous communities, ethical guidelines in practice, or community access to findings. Studies reporting the most quality indicators were initiated in mutual agreement between Indigenous communities and outside researchers or by communities themselves. This study also draws from the researcher's experiences as an Indigenous scientist and includes recommendations for quality research practice. This global assessment provides an evidence base to inform our understanding of broader impacts related to research design.

A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes.

PubMed

Bal, M I; Sattoe, J N T; van Schaardenburgh, N R; Floothuis, M C S G; Roebroeck, M E; Miedema, H S

2017-01-01

Finding and maintaining employment is a major challenge for young adults with physical disabilities and their work participation rate is lower than that of healthy peers. This paper is about a program that supports work participation amongst young adults with chronic physical disabilities. The study aims to explore their experienced barriers and facilitators for finding and maintaining employment after starting this program, the participant-perceived beneficial attributes of the program and participants' recommendations for additional intervention components. Semi-structured interviews (n = 19) were held with former intervention participations. Interviews were recorded and transcribed ad verbatim. Themes were derived using the phenomenological approach. Physical functions and capacities, supervisor's attitude, self-esteem and self-efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self-promoting skills and disclosure skills through job interview-training, increased self-esteem or self-efficacy through peer-support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the intervention. Respondents recommended to incorporate assertiveness and openness skills training into future intervention programs. The findings suggest that programs supporting work participation should be designed to provide challenging, real-world experiential opportunities that provide young adults with physical disabilities with new insights, self-efficacy and life skills. Also, such programs should facilitate context centered learning. Former intervention participants, therefore, evaluated job-interview training, sharing learning and social experiences with peers, job placement, arrangement of adjusted work conditions and education as beneficial attributes of the 'At Work' program. In addition, they recommended, to incorporate more training on assertiveness and disclosure. We advise professionals to include these beneficial attributes in similar interventions in other contexts. © 2016 John Wiley & Sons Ltd.

The Evolution of an Imagery Data System

NASA Astrophysics Data System (ADS)

Alarcon, C.; De Cesare, C.; Huang, T.; Roberts, J. T.; Rodriguez, J.; Cechini, M. F.; Boller, R. A.; Baynes, K.

2016-12-01

NASA's Global Imagery Browse Services (GIBS) has provided visualization of NASA's Earth Science data archives since 2011. The scope of GIBS has expanded over time to include community requested features such as granules, vectors, and profile imagery support. Behind the GIBS system lies the data management and automation package, The Imagery Exchange (TIE). As new features are added to GIBS, TIE must keep up with the capabilities that are required to automate the generation of our products while maintaining a robust generation pipeline. This presentation will focus on the challenges and solutions to expanding the TIE subsystem into a more evolved framework that can support the ever- growing needs of GIBS. This includes the efforts into redesigning the workflow to support sub-daily (e.g. granules) imagery while increasing the overall efficiency of the entire generation lifecycle.

Engineering Hydrogel Microenvironments to Recapitulate the Stem Cell Niche.

PubMed

Madl, Christopher M; Heilshorn, Sarah C

2018-06-04

Stem cells are a powerful resource for many applications including regenerative medicine, patient-specific disease modeling, and toxicology screening. However, eliciting the desired behavior from stem cells, such as expansion in a naïve state or differentiation into a particular mature lineage, remains challenging. Drawing inspiration from the native stem cell niche, hydrogel platforms have been developed to regulate stem cell fate by controlling microenvironmental parameters including matrix mechanics, degradability, cell-adhesive ligand presentation, local microstructure, and cell-cell interactions. We survey techniques for modulating hydrogel properties and review the effects of microenvironmental parameters on maintaining stemness and controlling differentiation for a variety of stem cell types. Looking forward, we envision future hydrogel designs spanning a spectrum of complexity, ranging from simple, fully defined materials for industrial expansion of stem cells to complex, biomimetic systems for organotypic cell culture models.

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

PubMed Central

Devlin, Alison M; McGee-Lennon, Marilyn; O’Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O’Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan

2016-01-01

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. PMID:26254480

Drivers, challenges and opportunities of forage technology adoption by smallholder cattle households in Cambodia.

PubMed

Ashley, K; Wilson, S; Young, J R; Chan, H P; Vitou, S; Suon, S; Windsor, P A; Bush, R D

2018-01-01

Forage technology has been successfully introduced into smallholder cattle systems in Cambodia as an alternative feed source to the traditional rice straw and native pastures, improving animal nutrition and reducing labour requirements of feeding cattle. Previous research has highlighted the positive impacts of forage technology including improved growth rates of cattle and household time savings. However, further research is required to understand the drivers, challenges and opportunities of forage technology for smallholder cattle households in Cambodia to facilitate widespread adoption and identify areas for further improvement. A survey of forage-growing households (n = 40) in July-September 2016 examined forage technology adoption experiences, including reasons for forage establishment, use of inputs and labour requirements of forage plot maintenance and use of forages (feeding, fattening, sale of grass or seedlings and silage). Time savings was reported as the main driver of forage adoption with household members spending approximately 1 h per day maintaining forages and feeding it to cattle. Water availability was reported as the main challenge to this activity. A small number of households also reported lack of labour, lack of fencing, competition from natural grasses, cost of irrigation and lack of experience as challenges to forage growing. Cattle fattening and sale of cut forage grass and seedlings was not found to be a widespread activity by interviewed households, with 25 and 10% of households reporting use of forages for these activities, respectively. Currently, opportunities exist for these households to better utilise forages through expansion of forage plots and cattle activities, although assistance is required to support these households in addressing current constraints, particularly availability of water, if the sustainability of this feed technology for smallholder cattle household is to be established in Cambodia.

Surface characterization of nanomaterials and nanoparticles: Important needs and challenging opportunities

PubMed Central

Baer, Donald R.; Engelhard, Mark H.; Johnson, Grant E.; Laskin, Julia; Lai, Jinfeng; Mueller, Karl; Munusamy, Prabhakaran; Thevuthasan, Suntharampillai; Wang, Hongfei; Washton, Nancy; Elder, Alison; Baisch, Brittany L.; Karakoti, Ajay; Kuchibhatla, Satyanarayana V. N. T.; Moon, DaeWon

2013-01-01

This review examines characterization challenges inherently associated with understanding nanomaterials and the roles surface and interface characterization methods can play in meeting some of the challenges. In parts of the research community, there is growing recognition that studies and published reports on the properties and behaviors of nanomaterials often have reported inadequate or incomplete characterization. As a consequence, the true value of the data in these reports is, at best, uncertain. With the increasing importance of nanomaterials in fundamental research and technological applications, it is desirable that researchers from the wide variety of disciplines involved recognize the nature of these often unexpected challenges associated with reproducible synthesis and characterization of nanomaterials, including the difficulties of maintaining desired materials properties during handling and processing due to their dynamic nature. It is equally valuable for researchers to understand how characterization approaches (surface and otherwise) can help to minimize synthesis surprises and to determine how (and how quickly) materials and properties change in different environments. Appropriate application of traditional surface sensitive analysis methods (including x-ray photoelectron and Auger electron spectroscopies, scanning probe microscopy, and secondary ion mass spectroscopy) can provide information that helps address several of the analysis needs. In many circumstances, extensions of traditional data analysis can provide considerably more information than normally obtained from the data collected. Less common or evolving methods with surface selectivity (e.g., some variations of nuclear magnetic resonance, sum frequency generation, and low and medium energy ion scattering) can provide information about surfaces or interfaces in working environments (operando or in situ) or information not provided by more traditional methods. Although these methods may require instrumentation or expertise not generally available, they can be particularly useful in addressing specific questions, and examples of their use in nanomaterial research are presented. PMID:24482557

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.

PubMed

Devlin, Alison M; McGee-Lennon, Marilyn; O'Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O'Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan; Mair, Frances S

2016-01-01

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Surface characterization of nanomaterials and nanoparticles: Important needs and challenging opportunities

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

Baer, Donald R.; Engelhard, Mark H.; Johnson, Grant E.

2013-09-15

This review examines characterization challenges inherently associated with understanding nanomaterials and the roles surface and interface characterization methods can play in meeting some of the challenges. In parts of the research community, there is growing recognition that studies and published reports on the properties and behaviors of nanomaterials often have reported inadequate or incomplete characterization. As a consequence, the true value of the data in these reports is, at best, uncertain. With the increasing importance of nanomaterials in fundamental research and technological applications, it is desirable that researchers from the wide variety of disciplines involved recognize the nature of thesemore » often unexpected challenges associated with reproducible synthesis and characterization of nanomaterials, including the difficulties of maintaining desired materials properties during handling and processing due to their dynamic nature. It is equally valuable for researchers to understand how characterization approaches (surface and otherwise) can help to minimize synthesis surprises and to determine how (and how quickly) materials and properties change in different environments. Appropriate application of traditional surface sensitive analysis methods (including x-ray photoelectron and Auger electron spectroscopies, scanning probe microscopy, and secondary ion mass spectroscopy) can provide information that helps address several of the analysis needs. In many circumstances, extensions of traditional data analysis can provide considerably more information than normally obtained from the data collected. Less common or evolving methods with surface selectivity (e.g., some variations of nuclear magnetic resonance, sum frequency generation, and low and medium energy ion scattering) can provide information about surfaces or interfaces in working environments (operando or in situ) or information not provided by more traditional methods. Although these methods may require instrumentation or expertise not generally available, they can be particularly useful in addressing specific questions, and examples of their use in nanomaterial research are presented.« less

Working with Persistent Pain: An Exploration of Strategies Utilised to Stay Productive at Work.

PubMed

Oakman, Jodi; Kinsman, Natasha; Briggs, Andrew M

2017-03-01

Purpose Maintaining productive employment for people with persistent pain conditions is challenging. This study aims to explore supports-work and non-work- used by employees to assist them in maintaining productive employment. Methods An exploratory, mixed-methods study comprising a questionnaire battery followed by semi-structured interviews to collect in-depth qualitative data was undertaken. The questionnaires measured descriptive variables used to select participants for interviews based on maximum heterogeneity sampling. Thirty-five semi-structured interviews were undertaken (14 males; 21 females). The interview schedule covered: employment situation, workplace challenges, workplace supports, coping strategies, motivations, future employment options and any other resources utilised. Inductive content analysis was undertaken using a grounded theory approach to systematically explore the data. Results Three key themes were identified: barriers to working productively, enablers to working productively, disclosing my condition at work. A key determinant of maintaining productive employment was a supportive employer. In addition, flexibility in the work organisation was also pivotal in maintaining sustainable, productive employment. An important issue emerged with regard to disclosure of one's condition to an employer. For some, this was a significant barrier to employment. Conclusions To ensure sustainable employment is attainable for those with persistent pain conditions, a good match is required between an employee and their work. Workplace accommodations may assist with improving job fit but this requires disclosure of a condition to an employer. Weighing up the risks and benefits of disclosure is difficult, and may be assisted by knowledge of available supports to assist with maintaining ongoing employment.

Measuring the Complexity of Treatment for Challenging Behavior using the Treatment Intensity Rating Form

PubMed Central

Zarcone, Jennifer; Hagopian, Louis; Ninci, Jennifer; McKay, Chloe; Bonner, Andrew; Dillon, Christopher; Hausman, Nicole

2016-01-01

Objectives The goal of this study was to develop and evaluate a tool to measure the complexity and intensity of psychotropic medication interventions, behavioral interventions, and issues related to crisis management for challenging behavior using a standardized rating form. Method The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three categories: pharmacological interventions, behavior supports, and protective equipment. In a retrospective review we examined the final treatment recommendations for 74 individuals with self-injurious behavior (SIB) based on psychiatric and behavioral notes and reports. We also compared whether TIRF scores differed across individuals for whom SIB was maintained by social reinforcement (e.g., to access attention or toys/activities, or escape from tasks) versus those for whom SIB was maintained by automatic reinforcement (e.g., occurs independent of social variables, and is presumed to be maintained by sensory reinforcement). Results The TIRF was demonstrated to have strong inter-rater reliability (98%) and appears to have good face validity. As hypothesized, individuals with SIB maintained by automatic reinforcement had significantly more medication trials (p=0.0005) and required more protective equipment than individuals with SIB maintained by social reinforcement (p=0.0002). Antidepressant medication was used more often with individuals with automatically reinforced SIB, although antipsychotics and anticonvulsants were also commonly used across both groups. Conclusion Findings provide initial support for the TIRF’s reliability, and face validity as a measure the level of complexity of medical and behavioral treatment plans - although additional research is needed to fully evaluate its psychometric properties. PMID:27917287

Bootstrapping disaster: The challenge of growing and maintaining a cross-sector collaborative network.

PubMed

Wachhaus, Aaron

This article examines the interaction of nonprofit and private actors with the traditional bureaucratic structures of government in central Pennsylvania&s recovery from hurricane Irene and tropical storm Lee. That effort relied heavily on private and nonprofit organizations as drivers of the response and recovery. The author maps the organizations involved in the recovery effort and explores the impact of the recovery effort on those organizations. A social network analysis was conducted and complemented with follow-up interviews with key actors. The network analysis reveals weak communication between sectors and a reliance on nonprofits to deliver services; interviews uncover the challenges of intersectoral collaboration. The author addresses the successes and limitations of the means by which a network of nonprofit efforts were coordinated with federal and state relief efforts and draw lessons for improving future practices. The author finds that this case deviates from theory in several ways that complicated community response and recovery. In particular, the challenges of developing and maintaining a recovery network while simultaneously delivering services placed great strain on several organizations, as well as on the fledgling network as a whole.

Remote Sensing of Ecosystem Health: Opportunities, Challenges, and Future Perspectives

PubMed Central

Li, Zhaoqin; Xu, Dandan; Guo, Xulin

2014-01-01

Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges. PMID:25386759

Comparison of Traditional and Innovative Techniques to Solve Technical Challenges

NASA Technical Reports Server (NTRS)

Perchonok, Michele

2010-01-01

Although NASA has an adequate food system for current missions, research is required to accommodate new requirements for future NASA exploration missions. The Inadequate Food System risk reflects the need to develop requirements and technologies that will enable NASA to provide the crew with a safe, nutritious and acceptable food system while effectively balancing appropriate resources such as mass, volume, and crew time in exploratory missions. As we go deeper into space or spend more time on the International Space Station (ISS), there will be requirements for packaged food to be stored for 3 5 years. New food packaging technologies are needed that have adequate oxygen and water barrier properties to maintain the foods' quality over this extended shelf life. NASA has been unsuccessful in identify packaging materials that meet the necessary requirements when using several traditional routes including literature reviews, workshops, and internal shelf life studies on foods packaged in various packaging materials. Small Business Innovative Research grants were used for accelerating food packaging materials research with limited success. In order to accelerate the process, a theoretical challenge was submitted to InnoCentive resulting in a partial award. A similar food packaging challenge was submitted to Yet2.com and several potential commercial packaging material suppliers were identified that, at least partially, met the requirements. Comparisons and results of these challenges will be discussed.

Strategies for online test security.

PubMed

Hart, Leigh; Morgan, Lesley

2009-01-01

As online courses continue to increase, maintaining academic integrity in student evaluation is a challenge. The authors review several strategies, with varying degrees of cost and technology, to improve test security in the online classroom.

Tennessee long-range transportation plan : financial plan

DOT National Transportation Integrated Search

2005-12-01

Meeting Tennessees transportation requirements over the next 25 years is a major challenge. The infrastructure demands associated with building and maintaining the states aviation, bicycle and pedestrian, rail, water, highway, and public transp...

ERC Vision & Research

Science.gov Websites

research. One challenge is to strike the right balance between long-term development, short-term relevance , and application to the present problems. The Center’s research strategy is to maintain this balance

Sedation and Analgesia in Transportation of Acutely and Critically Ill Patients.

PubMed

Johnston, Dawn; Franklin, Kevin; Rigby, Paul; Bergman, Karen; Davidson, Scott B

2016-06-01

Transportation of acutely or critically ill patients is a challenge for health care providers. Among the difficulties that providers face is the balance between adequate sedation and analgesia for the transportation event and maintaining acceptable respiratory and physiologic parameters of the patient. This article describes common challenges in providing sedation and analgesia during various phases of transport. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of high-energy-efficiency powertrain approaches: the 1996 futurecar challenge

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

Sluder, S.; Duoba, M.; Larsen, R.

Twelve colleges and universities were selected to design, build, and develop a mid-size vehicle that could achieve high energy economy while maintaining the performance characteristics of today`s mid-size vehicle. Many of the teams were able to increase the fuel economy of their vehicles, but most of these increases came at the expense of decreased performance or worsened emissions. This paper evaluates and summarizes the high-energy-efficiency powertrain technology approaches that were utilized in the 1996 FutureCar Challenge, which was the first evaluation of these vehicles in a two-year program. Of the 11 vehicles evaluated in the competition, nine utilized hybrid electricmore » vehicle approaches. This paper discusses the design trade- offs made by the teams to achieve high efficiency while trying to maintain stock performance.« less

Immune suppression of human lymphoid tissues and cells in rotating suspension culture and onboard the International Space Station

PubMed Central

Fitzgerald, Wendy; Chen, Silvia; Walz, Carl; Zimmerberg, Joshua; Margolis, Leonid

2013-01-01

The immune responses of human lymphoid tissue explants or cells isolated from this tissue were studied quantitatively under normal gravity and microgravity. Microgravity was either modeled by solid body suspension in a rotating, oxygenated culture vessel or was actually achieved on the International Space Station (ISS). Our experiments demonstrate that tissues or cells challenged by recall antigen or by polyclonal activator in modeled microgravity lose all their ability to produce antibodies and cytokines and to increase their metabolic activity. In contrast, if the cells were challenged before being exposed to modeled microgravity suspension culture, they maintained their responses. Similarly, in microgravity in the ISS, lymphoid cells did not respond to antigenic or polyclonal challenge, whereas cells challenged prior to the space flight maintained their antibody and cytokine responses in space. Thus, immune activation of cells of lymphoid tissue is severely blunted both in modeled and true microgravity. This suggests that suspension culture via solid body rotation is sufficient to induce the changes in cellular physiology seen in true microgravity. This phenomenon may reflect immune dysfunction observed in astronauts during space flights. If so, the ex vivo system described above can be used to understand cellular and molecular mechanisms of this dysfunction. PMID:19609626

Reassessing Escherichia coli as a cell factory for biofuel production.

PubMed

Wang, Chonglong; Pfleger, Brian F; Kim, Seon-Won

2017-06-01

Via metabolic engineering, industrial microorganisms have the potential to convert renewable substrates into a wide range of biofuels that can address energy security and environmental challenges associated with current fossil fuels. The user-friendly bacterium, Escherichia coli, remains one of the most frequently used hosts for demonstrating production of biofuel candidates including alcohol-, fatty acid- and terpenoid-based biofuels. In this review, we summarize the metabolic pathways for synthesis of these biofuels and assess enabling technologies that assist in regulating biofuel synthesis pathways and rapidly assembling novel E. coli strains. These advances maintain E. coli's position as a prominent host for developing cell factories for biofuel production. Copyright © 2017 Elsevier Ltd. All rights reserved.

A case of acute kidney injury caused by granulomatous interstitial nephritis associated with sarcoidosis.

PubMed

Horino, Taro; Matsumoto, Tatsuki; Inoue, Kosuke; Ichii, Osamu; Terada, Yoshio

2018-05-01

Sarcoidosis affects multiple organs including lung, heart and kidney. Sarcoidosis causes hypercalcemia, hypergammaglobulinemia, and rarely, granulomatous interstitial nephritis, resulting in renal stromal damage. Granulomatous interstitial nephritis is characterized as interstitial nephritis with noncaseating epithelioid granulomas. Diagnosing granulomatous interstitial nephritis before patient's death is challenging; hence, only few cases proven by renal biopsy have been reported till date. We present a case of acute kidney injury caused by granulomatous interstitial nephritis as a renal manifestation of sarcoidosis proven by renal biopsy, which can be confirmed by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. Glucocorticoid therapy was helpful for improving and maintaining her renal function over a 6-year period.

The Concept of Ecologically Oriented Progress and Natural Resource Preservation

NASA Astrophysics Data System (ADS)

Gasanov, M. A.; Kolotov, K. A.; Demidenko, K. A.; Podgornaya, E. A.; Kadnikova, O. V.

2017-01-01

The most important issue of scientific and technological progress is considering the environment challenges of industrial development. It means that the progress must be ecologically oriented and environmentally friendly. The most adequate concept for the approach to the issue of “man - society - nature” relations is the ontology of the noosphere - the idea of a common space for human beings and nature. It presents an ideal example of an optimistic attitude towards the coordination between accelerating the scientific and technological development and natural resource saving. However, to maintain the balance between human needs and environmental processes determined by this concept, it is essential to include the lean production training into technological development of society.

Nurse leader resilience: career defining moments.

PubMed

Cline, Susan

2015-01-01

Resilience is an essential component of effective nursing leadership. It is defined as the ability to survive and thrive in the face of adversity. Resilience can be developed and internalized as a measure to improve retention and reduce burnout. Nurse leaders at all levels should develop these competencies to survive and thrive in an increasingly complex health care environment. Building positive relationships, maintaining positivity, developing emotional insight, creating work-life balance, and reflecting on successes and challenges are effective strategies for resilience building. Nurse leaders have a professional obligation to develop resilience in themselves, the teams they supervise, and the organization as a whole. Additional benefits include reduced turnover, reduced cost, and improved quality outcomes through organizational mindfulness.

Traumatic Brain Injury: Unmet Support Needs of Caregivers and Families in Florida

PubMed Central

Dillahunt-Aspillaga, Christina; Jorgensen-Smith, Tammy; Ehlke, Sarah; Sosinski, Melanie; Monroe, Douglas; Thor, Jennifer

2013-01-01

Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented. PMID:24358236

Crystal growth of device quality GaAs in space

NASA Technical Reports Server (NTRS)

Gatos, Harry C.; Lagowski, Jacek

1989-01-01

The program on Crystal Growth of Device Quality GaAs in Space was initiated in 1977. The initial stage covering 1977 to 1984 was devoted strictly to ground-based research. By 1985 the program had evolved into its next logical stage aimed at space growth experiments; however, since the Challenger disaster, the program has been maintained as a ground-based program awaiting activation of experimentation in space. The overall prgram has produced some 80 original scientific publications on GaAs crystal growth, crystal characterization, and new approaches to space processing. Publication completed in the last three years are listed. Their key results are outlined and discussed in the twelve publications included as part of the report.

fMRI for mapping language networks in neurosurgical cases

PubMed Central

Gupta, Santosh S

2014-01-01

Evaluating language has been a long-standing application in functional magnetic resonance imaging (fMRI) studies, both in research and clinical circumstances, and still provides challenges. Localization of eloquent areas is important in neurosurgical cases, so that there is least possible damage to these areas during surgery, maintaining their function postoperatively, therefore providing good quality of life to the patient. Preoperative fMRI study is a non-invasive tool to localize the eloquent areas, including language, with other traditional methods generally used being invasive and at times perilous. In this article, we describe methods and various paradigms to study the language areas, in clinical neurosurgical cases, along with illustrations of cases from our institute. PMID:24851003

Catamaran Nets

NASA Technical Reports Server (NTRS)

1990-01-01

West Coast Netting, Inc.'s net of Hyperester twine, is made of three strands of fiber twisted together by a company-invented sophisticated twisting machine and process that maintain precisely the same tension on each strand. The resulting twine offers higher strength and improved abrasion resistance. The technology that created the Hyperester supertwine has found spinoff applications, first as an extra-efficient seine for tuna fishing, then as a capture net for law enforcement agencies. The newest one is as a deck for racing catamarans. Hyperester twine net has been used on most of the high performance racing catamarans of recent years, including the America's Cup Challenge boats. They are tough and hold up well in the continual exposure to sunlight and saltwater.

Recent Investments by NASA's National Force Measurement Technology Capability

NASA Technical Reports Server (NTRS)

Commo, Sean A.; Ponder, Jonathan D.

2016-01-01

The National Force Measurement Technology Capability (NFMTC) is a nationwide partnership established in 2008 and sponsored by NASA's Aeronautics Evaluation and Test Capabilities (AETC) project to maintain and further develop force measurement capabilities. The NFMTC focuses on force measurement in wind tunnels and provides operational support in addition to conducting balance research. Based on force measurement capability challenges, strategic investments into research tasks are designed to meet the experimental requirements of current and future aerospace research programs and projects. This paper highlights recent and force measurement investments into several areas including recapitalizing the strain-gage balance inventory, developing balance best practices, improving calibration and facility capabilities, and researching potential technologies to advance balance capabilities.

Estimating glucose requirements of an activated immune system in growing pigs.

PubMed

Kvidera, S K; Horst, E A; Mayorga, E J; Sanz-Fernandez, M V; Abuajamieh, M; Baumgard, L H

2017-11-01

Activated immune cells become obligate glucose utilizers, and a large i.v. lipopolysaccharide (LPS) dose causes insulin resistance and severe hypoglycemia. Therefore, study objectives were to quantify the amount of glucose needed to maintain euglycemia following an endotoxin challenge as a proxy of leukocyte glucose requirements. Fifteen fasted crossbred gilts (30.3 ± 1.7 kg) were bilaterally jugular catheterized and assigned 1 of 2 i.v. bolus treatments: control (CON; 10 mL sterile saline; = 7) or LPS challenge + euglycemic clamp (LPS-Eu; 055:B5; 5 μg/kg BW; 50% dextrose infusion to maintain euglycemia; = 8). Following administration, blood glucose was determined every 10 min and dextrose infusion rates were adjusted in LPS-Eu pigs to maintain euglycemia for 8 h. Pigs were fasted for 8 h prior to the bolus and remained fasted throughout the challenge. Rectal temperature was increased in LPS-Eu pigs relative to CON pigs (39.8 vs. 38.8°C; < 0.01). Relative to the baseline, CON pigs had 20% decreased blood glucose from 300 to 480 min postbolus ( = 0.01) whereas circulating glucose content in LPS-Eu pigs did not differ ( = 0.96) from prebolus levels. A total of 116 ± 8 g of infused glucose was required to maintain euglycemia in LPS-Eu pigs. Relative to CON pigs, overall plasma insulin, blood urea nitrogen, β-hydroxybutrate, lactate, and LPS-binding protein were increased in LPS-Eu pigs (295, 108, 29, 133, and 13%, respectively; ≤ 0.04) whereas NEFA was decreased (66%; < 0.01). Neutrophils in LPS-Eu pigs were decreased 84% at 120 min postbolus and returned to CON levels by 480 min ( < 0.01). Overall, lymphocytes, monocytes, eosinophils, and basophils were decreased in LPS-Eu pigs relative to CON pigs (75, 87, 70, and 50%, respectively; ≤ 0.05). These alterations in metabolism and the large amount of glucose needed to maintain euglycemia indicate nutrient repartitioning away from growth toward the immune system. Glucose is an important fuel for the immune system, and data from this study established that the glucose requirements of an intensely and acutely activated immune system in growing pigs are approximately 1.1 g/kg BW/h.

When doctor becomes patient: challenges and strategies in caring for physician-patients.

PubMed

Domeyer-Klenske, Amy; Rosenbaum, Marcy

2012-01-01

The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

The Application of Skin Adhesive to Maintain Seal in Negative Pressure Wound Therapy.

PubMed

Karadsheh, Murad J; Nelson, Josh; Wilcox, Richard

2015-09-01

Optimal wound healing in negative pressure wound therapy (NPWT) depends on a properly sealed vacuum system. Anatomically difficult wounds disrupt the adhesive dressing, resulting in air leaks that impair the integrity of this system. Several techniques have been used in previous reports to prevent air leaks, including the addition of skin adhesives (eg, Skin-Prep [Smith and Nephew, St. Petersburg, FL] or compound tincture of benzoin), hydrocolloid dressings, silicone, and stoma paste. The purpose of this case report is to demonstrate the effectiveness of using a cyanoacrylate tissue adhesive, dermaFLEX (FLEXCon, Spencer, MA), in maintaining an airtight, durable seal in NPWT. The authors present a patient with a difficult to manage anogenital wound where efforts to maintain an airtight seal in NPWT proved difficult. It was decided during the course of treatment to use the cyanoacrylate tissue adhesive to create an airtight, durable seal. The tissue adhesive was applied circumferentially to the skin surrounding the wound edge. After placement of vacuum-assisted closure foam over the wound, the adhesive dressing was applied with its edges overlapping the skin area where the tissue adhesive was applied. The size of the wound was visibly reduced at each dressing change. An airtight seal was consistently maintained for 3 days at a time, surviving the difficult environment of the wound and maximizing the life of each adhesive dressing. For wounds in anatomically challenging locations, the use of the tissue adhesive appears to be a safe and viable option in creating a durable seal in NPWT.

Abide with me: religious group identification among older adults promotes health and well-being by maintaining multiple group memberships.

PubMed

Ysseldyk, Renate; Haslam, S Alexander; Haslam, Catherine

2013-01-01

Aging is associated with deterioration in health and well-being, but previous research suggests that this can be attenuated by maintaining group memberships and the valued social identities associated with them. In this regard, religious identification may be especially beneficial in helping individuals withstand the challenges of aging, partly because religious identity serves as a basis for a wider social network of other group memberships. This paper aims to examine relationships between religion (identification and group membership) and well-being among older adults. The contribution of having and maintaining multiple group memberships in mediating these relationships is assessed, and also compared to patterns associated with other group memberships (social and exercise). Study 1 (N = 42) surveyed older adults living in residential care homes in Canada, who completed measures of religious identity, other group memberships, and depression. Study 2 (N = 7021) longitudinally assessed older adults in the UK on similar measures, but with the addition of perceived physical health. In Study 1, religious identification was associated with fewer depressive symptoms, and membership in multiple groups mediated that relationship. However, no relationships between social or exercise groups and mental health were evident. Study 2 replicated these patterns, but additionally, maintaining multiple group memberships over time partially mediated the relationship between religious group membership and physical health. Together these findings suggest that religious social networks are an especially valuable source of social capital among older adults, supporting well-being directly and by promoting additional group memberships (including those that are non-religious).

Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat

PubMed Central

Meziane, Mohammed; Elkoundi, Abdelghafour; Ahtil, Redouane; Guazaz, Miloudi; Mustapha, Bensghir; Haimeur, Charki

2017-01-01

The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/rémifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient. PMID:28904684

Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program

PubMed Central

King, Laurie A; Horak, Fay B

2009-01-01

This article introduces a new framework for therapists to develop an exercise program to delay mobility disability in people with Parkinson disease (PD). Mobility, or the ability to efficiently navigate and function in a variety of environments, requires balance, agility, and flexibility, all of which are affected by PD. This article summarizes recent research identifying how constraints on mobility specific to PD, such as rigidity, bradykinesia, freezing, poor sensory integration, inflexible program selection, and impaired cognitive processing, limit mobility in people with PD. Based on these constraints, a conceptual framework for exercises to maintain and improve mobility is presented. An example of a constraint-focused agility exercise program, incorporating movement principles from tai chi, kayaking, boxing, lunges, agility training, and Pilates exercises, is presented. This new constraint-focused agility exercise program is based on a strong scientific framework and includes progressive levels of sensorimotor, resistance, and coordination challenges that can be customized for each patient while maintaining fidelity. Principles for improving mobility presented here can be incorporated into an ongoing or long-term exercise program for people with PD. PMID:19228832

Delaying mobility disability in people with Parkinson disease using a sensorimotor agility exercise program.

PubMed

King, Laurie A; Horak, Fay B

2009-04-01

This article introduces a new framework for therapists to develop an exercise program to delay mobility disability in people with Parkinson disease (PD). Mobility, or the ability to efficiently navigate and function in a variety of environments, requires balance, agility, and flexibility, all of which are affected by PD. This article summarizes recent research identifying how constraints on mobility specific to PD, such as rigidity, bradykinesia, freezing, poor sensory integration, inflexible program selection, and impaired cognitive processing, limit mobility in people with PD. Based on these constraints, a conceptual framework for exercises to maintain and improve mobility is presented. An example of a constraint-focused agility exercise program, incorporating movement principles from tai chi, kayaking, boxing, lunges, agility training, and Pilates exercises, is presented. This new constraint-focused agility exercise program is based on a strong scientific framework and includes progressive levels of sensorimotor, resistance, and coordination challenges that can be customized for each patient while maintaining fidelity. Principles for improving mobility presented here can be incorporated into an ongoing or long-term exercise program for people with PD.

Composition and luminescence studies of InGaN epilayers grown at different hydrogen flow rates

NASA Astrophysics Data System (ADS)

Taylor, E.; Fang, F.; Oehler, F.; Edwards, P. R.; Kappers, M. J.; Lorenz, K.; Alves, E.; McAleese, C.; Humphreys, C. J.; Martin, R. W.

2013-06-01

Indium gallium nitride (InxGa1 - xN) is a technologically important material for many optoelectronic devices, including LEDs and solar cells, but it remains a challenge to incorporate high levels of InN into the alloy while maintaining sample quality. A series of InGaN epilayers was grown with different hydrogen flow rates (0-200 sccm) and growth temperatures (680-750 °C) to obtain various InN fractions and bright emission in the range 390-480 nm. These 160-nm thick epilayers were characterized through several compositional techniques (wavelength dispersive x-ray spectroscopy, x-ray diffraction, Rutherford backscattering spectrometry) and cathodoluminescence hyperspectral imaging. The compositional analysis with the different techniques shows good agreement when taking into account compositional gradients evidenced in these layers. The addition of small amounts of hydrogen to the gas flow at lower growth temperatures is shown to maintain a high surface quality and luminescence homogeneity. This allowed InN fractions of up to ˜16% to be incorporated with minimal peak energy variations over a mapped area while keeping a high material quality.

Instrumentation at Paranal Observatory: maintaining the instrument suite of five large telescopes and its interferometer alive

NASA Astrophysics Data System (ADS)

Gillet, Gordon; Alvarez, José Luis; Beltrán, Juan; Bourget, Pierre; Castillo, Roberto; Diaz, Álvaro; Haddad, Nicolás; Leiva, Alfredo; Mardones, Pedro; O'Neal, Jared; Ribes, Mauricio; Riquelme, Miguel; Robert, Pascal; Rojas, Chester; Valenzuela, Javier

2010-07-01

This presentation provides interesting miscellaneous information regarding the instrumentation activities at Paranal Observatory. It introduces the suite of 23 instruments and auxiliary systems that are under the responsibility of the Paranal Instrumentation group, information on the type of instruments, their usage and downtime statistics. The data is based on comprehensive data recorded in the Paranal Night Log System and the Paranal Problem Reporting System whose principles are explained as well. The work organization of the 15 team members around the high number of instruments is laid out, which includes: - Maintaining older instruments with obsolete components - Receiving new instruments and supporting their integration and commissioning - Contributing to future instruments in their developing phase. The assignments of the Instrumentation staff to the actual instruments as well as auxiliary equipment (Laser Guide Star Facility, Mask Manufacturing Unit, Cloud Observation Tool) are explained with respect to responsibility and scheduling issues. The essential activities regarding hardware & software are presented, as well as the technical and organizational developments within the group towards its present and future challenges.

Controlling the Surface Chemistry of Graphite by Engineered Self-Assembled Peptides

PubMed Central

Khatayevich, Dmitriy; So, Christopher R.; Hayamizu, Yuhei; Gresswell, Carolyn; Sarikaya, Mehmet

2012-01-01

The systematic control over surface chemistry is a long-standing challenge in biomedical and nanotechnological applications for graphitic materials. As a novel approach, we utilize graphite-binding dodecapeptides that self-assemble into dense domains to form monolayer thick long-range ordered films on graphite. Specifically, the peptides are rationally designed through their amino acid sequences to predictably display hydrophilic and hydrophobic characteristics while maintaining their self-assembly capabilities on the solid substrate. The peptides are observed to maintain a high tolerance for sequence modification, allowing the control over surface chemistry via their amino acid sequence. Furthermore, through a single step co-assembly of two different designed peptides, we predictably and precisely tune the wettability of the resulting functionalized graphite surfaces from 44 to 83 degrees. The modular molecular structures and predictable behavior of short peptides demonstrated here give rise to a novel platform for functionalizing graphitic materials that offers numerous advantages, including non-invasive modification of the substrate, bio-compatible processing in an aqueous environment, and simple fusion with other functional biological molecules. PMID:22428620

Ethical Considerations in Tissue Engineering Research: Case Studies in Translation

PubMed Central

Baker, Hannah B.; McQuilling, John P.

2016-01-01

Tissue engineering research is a complex process that requires investigators to focus on the relationship between their research and anticipated gains in both knowledge and treatment improvements. The ethical considerations arising from tissue engineering research are similarly complex when addressing the translational progression from bench to bedside, and investigators in the field of tissue engineering act as moral agents at each step of their research along the translational pathway, from early benchwork and preclinical studies to clinical research. This review highlights the ethical considerations and challenges at each stage of research, by comparing issues surrounding two translational tissue engineering technologies: the bioartificial pancreas and a tissue engineered skeletal muscle construct. We present relevant ethical issues and questions to consider at each step along the translational pathway, from the basic science bench to preclinical research to first-in-human clinical trials. Topics at the bench level include maintaining data integrity, appropriate reporting and dissemination of results, and ensuring that studies are designed to yield results suitable for advancing research. Topics in preclinical research include the principle of “modest translational distance” and appropriate animal models. Topics in clinical research include key issues that arise in early-stage clinical trials, including selection of patient-subjects, disclosure of uncertainty, and defining success. The comparison of these two technologies and their ethical issues brings to light many challenges for translational tissue engineering research and provides guidance for investigators engaged in development of any tissue engineering technology. PMID:26282436

Longitudinal Youth-At-Risk Study (LYRIKS): outreach strategies based on a community-engaged framework.

PubMed

Mitter, Natasha; Nah, Guo Quan Ryan; Bong, Yioe Ling; Lee, Jimmy; Chong, Siow-Ann

2014-08-01

Schizophrenia and psychoses are debilitating disorders often leading to serious functional impairments. Early detection efforts have shifted focus to the prodromal phase and the emphasis is now on individuals at risk of developing psychosis. The Longitudinal Youth-At-Risk Study (LYRIKS) seeks to elucidate the biological markers of psychosis. This paper describes the application of a community-engaged framework to the outreach strategies of LYRIKS. It describes the outreach goals, strategies used and their impact, as well as the various challenges faced by the research team and community partners. The target population was defined. Community organizations having close ties with the target population were identified and approached for collaboration. These included educational and healthcare institutions, and government and welfare organizations. Strategies were categorized as active or passive. Active strategies included clinical screening and recruitment, workshops, roadshows and student internships. Passive strategies included utilizing print and social media. Three thousand three hundred twenty-one youth were approached and 401 called the hotline to find out more about the study. Three thousand five hundred one were pre-screened; 864 were further screened using the Comprehensive Assessment of At Risk Mental State. One hundred seventy-eight and 346 were eventually recruited as subjects and controls, respectively. Challenges encountered included differing priorities, maintaining collaborative relationships, stigmatization and inadequate understanding of the profile of at risk youth. Future community-engaged research should be conducted more comprehensively to generate maximum benefits. © 2013 Wiley Publishing Asia Pty Ltd.

Ethical considerations in tissue engineering research: Case studies in translation.

PubMed

Baker, Hannah B; McQuilling, John P; King, Nancy M P

2016-04-15

Tissue engineering research is a complex process that requires investigators to focus on the relationship between their research and anticipated gains in both knowledge and treatment improvements. The ethical considerations arising from tissue engineering research are similarly complex when addressing the translational progression from bench to bedside, and investigators in the field of tissue engineering act as moral agents at each step of their research along the translational pathway, from early benchwork and preclinical studies to clinical research. This review highlights the ethical considerations and challenges at each stage of research, by comparing issues surrounding two translational tissue engineering technologies: the bioartificial pancreas and a tissue engineered skeletal muscle construct. We present relevant ethical issues and questions to consider at each step along the translational pathway, from the basic science bench to preclinical research to first-in-human clinical trials. Topics at the bench level include maintaining data integrity, appropriate reporting and dissemination of results, and ensuring that studies are designed to yield results suitable for advancing research. Topics in preclinical research include the principle of "modest translational distance" and appropriate animal models. Topics in clinical research include key issues that arise in early-stage clinical trials, including selection of patient-subjects, disclosure of uncertainty, and defining success. The comparison of these two technologies and their ethical issues brings to light many challenges for translational tissue engineering research and provides guidance for investigators engaged in development of any tissue engineering technology. Copyright © 2015 Elsevier Inc. All rights reserved.

Community action against asthma: examining the partnership process of a community-based participatory research project.

PubMed

Parker, Edith A; Israel, Barbara A; Williams, Melina; Brakefield-Caldwell, Wilma; Lewis, Toby C; Robins, Thomas; Ramirez, Erminia; Rowe, Zachary; Keeler, Gerald

2003-07-01

Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. To conduct a process evaluation of the CAAA community-academic partnership. In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. Community setting in Detroit, Michigan. Twenty-three members of the CAAA SC. Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.

Evergreening, patent challenges, and effective market life in pharmaceuticals.

PubMed

Hemphill, C Scott; Sampat, Bhaven N

2012-03-01

Observers worry that generic patent challenges are on the rise and reduce the effective market life of drugs. A related concern is that challenges disproportionately target high-sales drugs, reducing market life for these "blockbusters." To study these questions, we examine new data on generic entry over the past decade. We show that challenges are more common for higher sales drugs. We also demonstrate a slight increase in challenges over this period, and a sharper increase for early challenges. Despite this, effective market life is stable across drug sales categories, and has hardly changed over the decade. To better understand these results, we examine which patents are challenged on each drug, and show that lower quality and later expiring patents disproportionately draw challenges. Overall, this evidence suggests that challenges serve to maintain, not reduce, the historical baseline of effective market life, thereby limiting the effectiveness of "evergreening" by branded firms. Copyright © 2012 Elsevier B.V. All rights reserved.

Adapting NDOR's Roadside Seed Mixture for Local Site Conditions

DOT National Transportation Integrated Search

2012-09-06

The Nebraska Department of Roads (NDOR) has considerable challenges with its objectives of rapidly establishing and maintaining a diverse and vigorous vegetation cover on roadsides. Establishing vegetation quickly on NDOR roadsides is important becau...

The Plan to Certify America.

ERIC Educational Resources Information Center

Geber, Beverly

1995-01-01

The national skill standards project may take 10 years to complete and will be expensive to set up and maintain. Getting consensus from industry, unions, and educators and ensuring checks for fairness and nondiscrimination pose challenges. (SK)

Management of hemodialysis access infections.

PubMed

Ryan, Sean V; Calligaro, Keith D; Dougherty, Matthew J

2004-03-01

Management of hemodialysis (HD) access infection is one of the most challenging and most common problems faced by surgeons, interventional radiologists, and nephrologists. The goal to eradicate infection is often at odds with the need to maintain access. Patients on HD are immunocompromised and typically have significant comorbid conditions placing them at high risk for the occurrence of access infection. Infection is most common with central-vein catheter access, followed by prosthetic arteriovenous grafts (AVG) and is rare with autogenous fistulas. The diagnosis is usually evident on physical exam, but it is not uncommon for these patients to present with atypical symptoms and lack of clinical findings. Although Staphylococcal species are the most common organism to cause infection, early empiric antimicrobial therapy should also include coverage for Gram-negative organisms. Management of central-vein catheter infection includes removal and delayed replacement or, in patients with mild clinical symptoms, catheter exchange over a guide wire. Our management of AVG infection includes total graft excision when patients present with sepsis or the entire graft is bathed in pus, subtotal graft excision when all of the graft is removed except a small oversewn cuff of prosthetic material on an underlying patent artery, and partial graft excision when only a limited infected portion of the graft is removed and a new graft is rerouted in adjacent sterile tissue to maintain patency of the original graft. This strategy has proven to be highly successful in the management of these complicated cases.

A synthetic dataset for evaluating soft and hard fusion algorithms

NASA Astrophysics Data System (ADS)

Graham, Jacob L.; Hall, David L.; Rimland, Jeffrey

2011-06-01

There is an emerging demand for the development of data fusion techniques and algorithms that are capable of combining conventional "hard" sensor inputs such as video, radar, and multispectral sensor data with "soft" data including textual situation reports, open-source web information, and "hard/soft" data such as image or video data that includes human-generated annotations. New techniques that assist in sense-making over a wide range of vastly heterogeneous sources are critical to improving tactical situational awareness in counterinsurgency (COIN) and other asymmetric warfare situations. A major challenge in this area is the lack of realistic datasets available for test and evaluation of such algorithms. While "soft" message sets exist, they tend to be of limited use for data fusion applications due to the lack of critical message pedigree and other metadata. They also lack corresponding hard sensor data that presents reasonable "fusion opportunities" to evaluate the ability to make connections and inferences that span the soft and hard data sets. This paper outlines the design methodologies, content, and some potential use cases of a COIN-based synthetic soft and hard dataset created under a United States Multi-disciplinary University Research Initiative (MURI) program funded by the U.S. Army Research Office (ARO). The dataset includes realistic synthetic reports from a variety of sources, corresponding synthetic hard data, and an extensive supporting database that maintains "ground truth" through logical grouping of related data into "vignettes." The supporting database also maintains the pedigree of messages and other critical metadata.

The Big Society in an age of austerity: threats and opportunities for Health Consumer and Patients' Organizations in England.

PubMed

Baggott, Rob; Jones, Kathryn

2015-12-01

Health consumer and patients' organizations (HCPOs) seek to influence policy. But how are they affected by developments in the policy context and political environment? The article draws on original research into HCPOs in the UK by the authors, including a major survey undertaken in 1999 and interviews with HCPOs and policymakers between 2000 and 2003 as well as a further survey in 2010. It also draws on a review of key government policies on health and the voluntary sector since 1997. Developments in the political environment and policy context have created both opportunities and threats for HCPOs as they seek to influence policy. These include policies to promote choice and competition in public services; support for a greater role for the voluntary sector and civil society in health and welfare (including the current government's 'Big Society' idea); NHS reorganization; changes to the system of patient and public involvement; and austerity measures. Devolution of powers within the UK with regard to health policy and the rising profile of the EU in health matters have also had implications for HCPOs. This analysis raises key issues for future research in the UK and elsewhere, such as how will HCPOs be able to maintain independence in an increasingly competitive environment? And how will they fare in an era of retrenchment? There are also challenges for HCPOs in relation to maintaining relationships in a new institutional setting characterized by multilevel governance. © 2014 John Wiley & Sons Ltd.

Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial--design and methods.

PubMed

Wei, John; Nygaard, Ingrid; Richter, Holly; Brown, Morton; Barber, Matthew; Xiao Xu; Kenton, Kimberly; Nager, Charles; Schaffer, Joseph; Visco, Anthony; Weber, Anne

2009-04-01

The primary aims of this trial are to determine whether the use of a concomitant prophylactic anti-incontinence procedure may prevent stress urinary incontinence symptom development in women undergoing vaginal prolapse surgery and to evaluate the cost-effectiveness of this prophylactic approach. To present the rationale and design of a randomized controlled surgical trial (RCT), the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) Trial highlighting the challenges in the design and implementation. The challenges of implementing this surgical trial combined with a cost-effectiveness study and patient preference group are discussed including the study design, ethical issues regarding use of sham incision, maintaining the masking of study staff, and pragmatic difficulties encountered in the collection of cost data. The trial is conducted by the NICHD-funded Pelvic Floor Disorders Network. The ongoing OPUS trial started enrollment in May 2007 with a planned accrual of 350. The use of sham incision was generally well accepted but the collection of cost data using conventional billing forms was found to potentially unmask key study personnel. This necessitated changes in the study forms and planned timing for collection of cost data. To date, the enrollment to the patient preference group has been lower than the limit established by the protocol suggesting a willingness on the part of women to participate in the randomization. Given the invasive nature of surgical intervention trials, potential participants may be reluctant to accept random assignment, potentially impacting generalizability. Findings from the OPUS trial will provide important information that will help surgeons to better counsel women on the benefits and risks of concomitant prophylactic anti-incontinence procedure at the time of vaginal surgery for prolapse. The implementation of the OPUS trial has necessitated that investigators consider ethical issues up front, remain flexible with regards to data collection and be constantly aware of unanticipated opportunities for unmasking. Future surgical trials should be aware of potential challenges in maintaining masking and collection of cost-related information.

More than just a catchy title: The rewards and challenges of geoscience blogging

NASA Astrophysics Data System (ADS)

Ball, J. L.

2011-12-01

Social media have become increasingly important tools for communication, and no less so in the world of the Earth sciences. The "geoblogosphere", a collection of blogs written by geoscientists, began to grow quickly about four years ago and now encompasses more than three hundred blogs in multiple languages. The blog Magma Cum Laude (http://blogs.agu.org/magmacumlaude) was first published in 2007 among some of the earliest geoblogs, and is now part of the AGU Blogosphere, a widely read and lively blogging network. Originally intended as a chronicle of the author's time in graduate school and interest in volcanology, Magma Cum Laude's content has expanded to include science outreach, philanthropic ventures and interdisciplinary communication. In the process, the author has learned a great deal about how to develop and maintain a science blog, and how to integrate blogging with the demands of being a student and geoscientist. Geoblogging can be rewarding and fun, but it should also be approached with concrete goals and a clear understanding of potential drawbacks and difficulties. Geoscientists using social media have created new pathways for collaboration, peer review, science communication, and commentary on current events, making geoblogs a powerful supplement to 'traditional' research processes. In addition, geoblogging breaks down barriers between scientists and the public, demystifying research and giving the scientific community an opportunity to prove why its work is important. Geoblogs also have a lighter side - at any given time, there are a number of lively competitions, memes and conversations going on in the geoblogosphere. But like any social media outlet, blogging can present challenges, such as maintaining a good flow of content, integrating posting into a busy schedule, and dealing with interpersonal, employer and public responses. It is important to understand what these challenges entail, and how to deal with them, in order to utilize geoblogging to its considerable full potential.

The blueprint for stress can be found in invertebrates.

PubMed

Stefano, George B; Cadet, Patrick; Zhu, Wei; Rialas, Christos M; Mantione, Kirk; Benz, Danielle; Fuentes, Rudy; Casares, Federico; Fricchione, Gregory L; Fulop, Zoltan; Slingsby, Brian

2002-04-01

Through an extremely complicated equilibrium called homeostasis, all living organisms maintain their survival in the face of both externally and internally generated "stimuli". This apparent harmony is constantly challenged. Survival through successful adaptation is maintained as close to steady state as possible by adaptive responses, which may also be called perturbation responses since they have a constitutively defined dynamic capacity, i.e., an immediate limit, in a series of balancing and feedback activities reflecting an astounding array of biological, psychological and sociological behaviors. The broad spectrum of stimuli capable of engaging this protective response is remarkable. We define stress as a type of stimulation that is stronger and lasts for a longer duration, upsetting a typical perturbation response given its dynamic parameters. The stress response, which evolves out of the perturbation response, involves inducible signal molecules, i.e., cytokines. We surmise that the ability to exist in an ever-changing environment was a requirement for all life forms, including invertebrates and single celled organisms. It would be expected that these organisms exhibit both perturbation and stress responses. In this regard, we demonstrate that these organisms have mammalian-like signal molecule systems, i.e., opioid, and corresponding behaviors that are similar to those found in mammals with regard to both perturbation and stress responses. Thus, it would appear that these responses evolved first in simpler organisms and were then maintained and enhanced during evolution.

Improving metabolic monitoring in patients maintained on antipsychotics in Penang, Malaysia.

PubMed

Hor, Esther Sl; Subramaniam, Sivasangari; Koay, Jun Min; Bharathy, Arokiamary; Vasudevan, Umadevi; Panickulam, Joseph J; Ng, InnTiong; Arif, Nor Hayati; Russell, Vincent

2016-02-01

To evaluate the monitoring of metabolic parameters among outpatients maintained on antipsychotic medications in a general hospital setting in Malaysia and to assess the impact of a local monitoring protocol. By performing a baseline audit of files from a random sample of 300 patients prescribed antipsychotic medications for at least 1 year; we determined the frequency of metabolic monitoring. The findings informed the design of a new local protocol, on which clinical staff was briefed. We re-evaluated metabolic monitoring immediately after implementation, in a small sample of new referrals and current patients. We explored staff perceptions of the initiative with a follow-up focus group, 6 months post-implementation. The baseline audit revealed a sub-optimal frequency of metabolic parameter recording. Re-audit, following implementation of the new protocol, revealed improved monitoring but persisting deficits. Dialogue with the clinical staff led to further protocol modification, clearer definition of staff roles and use of a standard recording template. Focus group findings revealed positive perceptions of the initiative, but persisting implementation barriers, including cultural issues surrounding waist circumference measurement. Responding to challenges in achieving improved routine metabolic monitoring of patients maintained on antipsychotics required on-going dialogue with the clinical staff, in order to address both service pressures and cultural concerns. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Miniature objective lens with variable focus for confocal endomicroscopy

PubMed Central

Kim, Minkyu; Kang, DongKyun; Wu, Tao; Tabatabaei, Nima; Carruth, Robert W.; Martinez, Ramses V; Whitesides, George M.; Nakajima, Yoshikazu; Tearney, Guillermo J.

2014-01-01

Spectrally encoded confocal microscopy (SECM) is a reflectance confocal microscopy technology that can rapidly image large areas of luminal organs at microscopic resolution. One of the main challenges for large-area SECM imaging in vivo is maintaining the same imaging depth within the tissue when patient motion and tissue surface irregularity are present. In this paper, we report the development of a miniature vari-focal objective lens that can be used in an SECM endoscopic probe to conduct adaptive focusing and to maintain the same imaging depth during in vivo imaging. The vari-focal objective lens is composed of an aspheric singlet with an NA of 0.5, a miniature water chamber, and a thin elastic membrane. The water volume within the chamber was changed to control curvature of the elastic membrane, which subsequently altered the position of the SECM focus. The vari-focal objective lens has a diameter of 5 mm and thickness of 4 mm. A vari-focal range of 240 μm was achieved while maintaining lateral resolution better than 2.6 μm and axial resolution better than 26 μm. Volumetric SECM images of swine esophageal tissues were obtained over the vari-focal range of 260 μm. SECM images clearly visualized cellular features of the swine esophagus at all focal depths, including basal cell nuclei, papillae, and lamina propria. PMID:25574443

Side Channels of the Impounded and Middle Mississippi River: Opportunities and Challenges to Maximize Restoration Potential

DTIC Science & Technology

2016-07-01

considered. That is, it may be necessary to renew side channels according to a schedule to prevent them from filling with sediment and becoming terrestrial...maintain side channels as a restoration feature or to control their succession (i.e., prevent their loss through sedimentation ) have not been developed...features for maximum benefit? • How could advantage be taken of the existing sediment transport regime and flow pattern to maintain side channels or

Improving program documentation quality through the application of continuous improvement processes.

PubMed

Lovlien, Cheryl A; Johansen, Martha; Timm, Sandra; Eversman, Shari; Gusa, Dorothy; Twedell, Diane

2007-01-01

Maintaining the integrity of record keeping and retrievable information related to the provision of continuing education credit creates challenges for a large organization. Accurate educational program documentation is vital to support the knowledge and professional development of nursing staff. Quality review and accurate documentation of programs for nursing staff development occurred at one institution through the use of continuous improvement principles. Integration of the new process into the current system maintains the process of providing quality record keeping.

Current and Future Challenges to Resourcing U.S. Navy Public Shipyards

DTIC Science & Technology

carriers. For this reason, the public shipyards are required to maintain core capabilities that the private sector does not maintain. In addition, they are ...has been on the rise. Direct man-days of work assigned to and executed by the shipyards have increased during that time and are planned to continue to...role in future workforce management as the initiatives are broadened. Planned increases in civilian staffing levels are necessary but not sufficient to mitigate near-term execution risk at the shipyards.

Strategies for improving memory: a randomized trial of memory groups for older people, including those with mild cognitive impairment.

PubMed

Kinsella, Glynda J; Ames, David; Storey, Elsdon; Ong, Ben; Pike, Kerryn E; Saling, Michael M; Clare, Linda; Mullaly, Elizabeth; Rand, Elizabeth

2016-01-01

Governments are promoting the importance of maintaining cognitive health into older age to minimize risk of cognitive decline and dementia. Older people with amnestic mild cognitive impairment (aMCI) are particularly vulnerable to memory challenges in daily activities and are seeking ways to maintain independent living. To evaluate the effectiveness of memory groups for improving memory strategies and memory ability of older people, especially those with aMCI. 113 healthy older adults (HOA) and 106 adults with aMCI were randomized to a six-week memory group or a waitlist control condition. Outcome was evaluated through knowledge and use of memory strategies, memory ability (self-report and neuropsychological tests), and wellbeing. Assessments included a six-month follow-up. Using intention to treat analyses, there were intervention effects for HOA and aMCI groups in strategy knowledge (HOA: η2= 0.20; aMCI: η2= 0.06), strategy use (HOA: η2= 0.18; aMCI: η2= 0.08), and wellbeing (HOA: η2= 0.11; aMCI: η2= 0.05). There were also intervention effects in the HOA group, but not the aMCI group, in self-reported memory ability (η2= 0.06) and prospective memory tests (η2= 0.02). By six-month follow-up, gains were found on most HOA outcomes. In the aMCI group gains were found in strategy use, and by this stage, gains in prospective memory were also found. Memory groups can engage older people in techniques for maintaining cognitive health and improve memory performance, but more modest benefits are seen for older adults with aMCI.

Lack of TRPM5-Expressing Microvillous Cells in Mouse Main Olfactory Epithelium Leads to Impaired Odor-Evoked Responses and Olfactory-Guided Behavior in a Challenging Chemical Environment

PubMed Central

Lemons, Kayla; Aoudé, Imad; Ogura, Tatsuya; Mbonu, Kenechukwu; Matsumoto, Ichiro; Arakawa, Hiroyuki

2017-01-01

The mammalian main olfactory epithelium (MOE) modifies its activities in response to changes in the chemical environment. This process is essential for maintaining the functions of the olfactory system and the upper airway. However, mechanisms involved in this functional maintenance, especially those occurring via paracrine regulatory pathways within the multicellular MOE, are poorly understood. Previously, a population of non-neuronal, transient receptor potential M5-expressing microvillous cells (TRPM5-MCs) was identified in the MOE, and the initial characterization of these cells showed that they are cholinergic and responsive to various xenobiotics including odorants at high concentrations. Here, we investigated the role of TRPM5-MCs in maintaining olfactory function using transcription factor Skn-1a knockout (Skn-1a-/-) mice, which lack TRPM5-MCs in the MOE. Under our standard housing conditions, Skn-1a-/- mice do not differ significantly from control mice in odor-evoked electro-olfactogram (EOG) responses and olfactory-guided behaviors, including finding buried food and preference reactions to socially and sexually relevant odors. However, after a 2-wk exposure to high-concentration odor chemicals and chitin powder, Skn-1a-/- mice exhibited a significant reduction in their odor and pheromone-evoked EOG responses. Consequently, their olfactory-guided behaviors were impaired compared with vehicle-exposed Skn-1a-/- mice. Conversely, the chemical exposure did not induce significant changes in the EOG responses and olfactory behaviors of control mice. Therefore, our physiological and behavioral results indicate that TRPM5-MCs play a protective role in maintaining the olfactory function of the MOE. PMID:28612045

'You started something … then I continued by myself': a qualitative study of physical activity maintenance.

PubMed

Wahlich, Charlotte; Beighton, Carole; Victor, Christina; Normansell, Rebecca; Cook, Derek; Kerry, Sally; Iliffe, Steve; Ussher, Michael; Whincup, Peter; Fox-Rushby, Julia; Limb, Elizabeth; Furness, Cheryl; Harris, Tess

2017-11-01

Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45-75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component. Aim To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial. Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis. Findings Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as 'kick-starting' regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of 'top-up' intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups). A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.

A Concept of Operations for an Integrated Vehicle Health Assurance System

NASA Technical Reports Server (NTRS)

Hunter, Gary W.; Ross, Richard W.; Berger, David E.; Lekki, John D.; Mah, Robert W.; Perey, Danie F.; Schuet, Stefan R.; Simon, Donald L.; Smith, Stephen W.

2013-01-01

This document describes a Concept of Operations (ConOps) for an Integrated Vehicle Health Assurance System (IVHAS). This ConOps is associated with the Maintain Vehicle Safety (MVS) between Major Inspections Technical Challenge in the Vehicle Systems Safety Technologies (VSST) Project within NASA s Aviation Safety Program. In particular, this document seeks to describe an integrated system concept for vehicle health assurance that integrates ground-based inspection and repair information with in-flight measurement data for airframe, propulsion, and avionics subsystems. The MVS Technical Challenge intends to maintain vehicle safety between major inspections by developing and demonstrating new integrated health management and failure prevention technologies to assure the integrity of vehicle systems between major inspection intervals and maintain vehicle state awareness during flight. The approach provided by this ConOps is intended to help optimize technology selection and development, as well as allow the initial integration and demonstration of these subsystem technologies over the 5 year span of the VSST program, and serve as a guideline for developing IVHAS technologies under the Aviation Safety Program within the next 5 to 15 years. A long-term vision of IVHAS is provided to describe a basic roadmap for more intelligent and autonomous vehicle systems.

Reviewing education challenges and solutions for health professionals in community care.

PubMed

Kirk, Mary

2015-10-01

The biggest asset of the NHS is its staff. Health professionals working in the community are faced with a number of challenges to maintain and develop their knowledge and skills in their clinical practice. NHS England's Five Year Forward View describes the need for change, identifying the necessity to reshape care delivery, harnessing technology, and driving down variations in quality and safety of care. This article explores some of the challenges faced by community health-care providers and reviews possible solutions to meet community health-care needs for now as well as the future.

Osmotic Stress Induces Transcriptional Changes in Vasopressin and Vasopressin 1b Receptor Gene Expression

DTIC Science & Technology

2000-08-29

adaptation . Invertebrate organisms as ancient and varied as coelenterates [hydra: (Grimmelikhuijzen et aI., 1982)], gastropods [the land-living mollusks...mammalian salt and water homeostasis. To further define central nervous system adaptation to osmotic challenges, transcription ofAVP and vasopressin Ib...long-term adaptation to an III osmotic challenge. Compared to rats maintained on tap water, salt-drinking rats had increased levels ofAVP and Vt.,R

Stroke Volume During Orthostatic Challenge: Comparison of Two Non-Invasive Methods

DTIC Science & Technology

2005-10-01

transition in posture from supine to HUT, a rapid me- chanical redistribution of blood from the central circu- lation toward the lower extremities...resting 12-lead ECG and clinical orthostatic exam ( supine /seated/ standing consecutive BP mea- surements) were obtained on each of the potential sub...during an orthostatic challenge has been reported elsewhere (4). Subjects maintained a supine posture for 30 min prior to the start of data collection

Challenges in the surgical management of ectopic pregnancy in a low-resource setting: Mpilo Central Hospital, Bulawayo, Zimbabwe.

PubMed

Ngwenya, Solwayo

2017-10-01

Background Ectopic pregnancy contributes to maternal morbidity and mortality, especially in low-resourced countries with limited facilities for early diagnosis and treatment. It is a very challenging condition to diagnose. Patients may collapse and die while undergoing investigation. Aims To assess surgical treatment given to patients presenting at Mpilo Central Hospital, the challenges that are faced and the outcomes; and also to document how women survive this dangerous condition in a setting challenged by low resources. Results All the patients had prompt life-saving surgery within 48 h of admission despite the challenges faced. The survival rate was 100% during the period of the study. Conclusion It is possible to prevent maternal mortality in low-resource countries by maintaining basic clinical and surgical skills.

Leadership and Cultural Challenges in Operating the International Space Station

NASA Technical Reports Server (NTRS)

Clement, J. L.; Ritsher, J. B.; Saylor, S. A.; Kanas, N.

2006-01-01

Operating the International Space Station (ISS) involves an indefinite, continuous series of long-duration international missions, and this requires an unprecedented degree of cooperation across multiple sites, organizations, and nations. ISS flight controllers have had to find ways to maintain effective team performance in this challenging new context. The goal of this study was to systematically identify and evaluate the major leadership and cultural challenges faces by ISS flight controllers, and to highlight the approaches that they have found most effective to surmount these challenges. We conducted a qualitative survey using a semi-structured interview. Subjects included 14 senior NASA flight controllers who were chosen on the basis of having had substantial experience working with international partners. Data were content analyzed using an iterative process with multiple coders and consensus meetings to resolve discrepancies. To further explore the meaning of the interview findings, we also conducted some new analyses of data from a previous questionnaire study of Russian and American ISS mission control personnel. The interview data showed that respondents had substantial consensus on several leadership and cultural challenges and on key strategies for dealing with them, and they offered a wide range of specific tactics for implementing these strategies. Surprisingly few respondents offered strategies for addressing the challenge of working with team members whose native language is not American English. The questionnaire data showed that Americans think it is more important than Russians that mission control personnel speak the same dialect of one shared common language. Although specific to the ISS program, our results are consistent with recent management, cultural, and aerospace research. We aim to use our results to improve training for current and future ISS flight controllers.

A New Look at the Science of Weight Control: How Acceptance and Commitment Strategies Can Address the Challenge of Self-Regulation

PubMed Central

Forman, Evan M.; Butryn, Meghan L.

2014-01-01

Despite decades of work, behavioral interventions for obesity are not yet able to facilitate long-term weight loss maintenance for most participants. The current manuscript proposes an acceptance-based, self-regulation framework for understanding the challenge of maintaining changes in weight-related behavior and describes how this framework can be integrated into the behavioral treatment of obesity. According to this framework, intrinsic drives to consume palatable, high-calorie food interact with a modern environment in which high calorie foods are easily accessible. This combination produces a chronic desire to eat unhealthy foods that exists in opposition to individuals’ weight control goals. Similarly, energy expenditure requirements in the modern environment are limited, and people’s innate preferences to conserve energy typically prevent the concerted effort that would be necessary to engage in lifestyle activity and structured activity. Both external (e.g., sight of food) and internal (e.g., an aversive emotion) cues motivate overeating and sedentary behavior. However, individuals vary in their responsivity to these cues. While standard behavior skills may enable those lower in responsivity to successfully achieve weight control, we suggest that those higher in responsivity need specialized self-regulatory skills to maintain healthy eating and exercise behaviors. These skills include an ability to tolerate uncomfortable internal reactions to triggers and a reduction of pleasure, behavioral commitment to clearly-defined values, and metacognitive awareness of decision-making processes. So-called “acceptance-based” interventions based on these skills have so far proven efficacious for weight control, especially for those who are the most susceptible to eating in response to internal and external cues (as predicted by the model). Despite the current empirical support for the postulated model and for the interventions which stem from it, much remains to be learned including whether acceptance-based interventions will prove efficacious in the longer-term. PMID:25445199

Young children's inclusion decisions in moral and social-conventional group norm contexts.

PubMed

Rizzo, Michael T; Cooley, Shelby; Elenbaas, Laura; Killen, Melanie

2018-01-01

Being a member of a peer group involves making decisions about whom to include in or exclude from the group. Sometimes these decisions are related to whether members of the group support or challenge the norms of the group. To examine how young children weigh concerns for group norms and group membership in both moral and social-conventional norm contexts, children (3- to 6-year-olds; N=73) were asked to decide between including an ingroup member who challenged the group's norm or an outgroup member who supported the norm. Groups held either moral (equal or unequal resource allocation) or social-conventional (traditional or nontraditional) norms. In the moral contexts, children were more likely to include the peer who advocated for the moral concern for equality regardless of the peer's group membership or their group's specific norm. In the social-conventional contexts, however, children were more likely to include the peer who advocated for the conventional concern for maintaining traditions but only at the group-specific level. Furthermore, with age children increasingly based their inclusion decisions on normative concerns, rather than on group membership concerns, and differed in their inclusion decisions for ingroups and outgroups. Finally, children reasoned about their decisions by referencing concerns for fairness, group norms, and group membership, suggesting that preschool children weigh multiple concerns when deciding whom to include in their groups. Overall, the current study revealed differences in how preschool children weigh moral and social-conventional concerns in intergroup contexts. Copyright © 2017 Elsevier Inc. All rights reserved.

Liquid lithium loop system to solve challenging technology issues for fusion power plant

DOE PAGES

Ono, Masayuki; Majeski, Richard P.; Jaworski, Michael A.; ...

2017-07-12

Here, steady-state fusion power plant designs present major divertor technology challenges, including high divertor heat flux both in steady-state and during transients. In addition to these concerns, there are the unresolved technology issues of long term dust accumulation and associated tritium inventory and safety issues. It has been suggested that radiation-based liquid lithium (LL) divertor concepts with a modest lithium-loop could provide a possible solution for these outstanding fusion reactor technology issues, while potentially improving reactor plasma performance. The application of lithium (Li) in NSTX resulted in improved H-mode confinement, H-mode power threshold reduction, and reduction in the divertor peakmore » heat flux while maintaining essentially Li-free core plasma operation even during H-modes. These promising results in NSTX and related modeling calculations motivated the radiative liquid lithium divertor (RLLD) concept and its variant, the active liquid lithium divertor concept (ARLLD), taking advantage of the enhanced or non-coronal Li radiation in relatively poorly confined divertor plasmas. To maintain the LL purity in a 1 GW-electric class fusion power plant, a closed LL loop system with a modest circulating capacity of ~ 1 liter/second (l/sec) is envisioned. We examined two key technology issues: 1) dust or solid particle removal and 2) real time recovery of tritium from LL while keeping the tritium inventory level to an acceptable level. By running the LL-loop continuously, it can carry the dust particles and impurities generated in the vacuum vessel to the outside where the dust / impurities can be removed by relatively simple dust filter, cold trap and/or centrifugal separation systems. With ~ 1 l/sec LL flow, even a small 0.1% dust content by weight (or 0.5 g per sec) suggests that the LL-loop could carry away nearly 16 tons of dust per year. In a 1 GW-electric (or ~ 3 GW fusion power) fusion power plant, about 0.5 g / sec of tritium is needed to maintain the fusion fuel cycle assuming ~ 1 % fusion burn efficiency. It appears feasible to recover tritium (T) in real time from LL while maintaining an acceptable T inventory level. Laboratory tests are being conducted to investigate T recovery feasibility with the surface cold trap (SCT) concept.« less

Liquid lithium loop system to solve challenging technology issues for fusion power plant

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

Ono, Masayuki; Majeski, Richard P.; Jaworski, Michael A.

Here, steady-state fusion power plant designs present major divertor technology challenges, including high divertor heat flux both in steady-state and during transients. In addition to these concerns, there are the unresolved technology issues of long term dust accumulation and associated tritium inventory and safety issues. It has been suggested that radiation-based liquid lithium (LL) divertor concepts with a modest lithium-loop could provide a possible solution for these outstanding fusion reactor technology issues, while potentially improving reactor plasma performance. The application of lithium (Li) in NSTX resulted in improved H-mode confinement, H-mode power threshold reduction, and reduction in the divertor peakmore » heat flux while maintaining essentially Li-free core plasma operation even during H-modes. These promising results in NSTX and related modeling calculations motivated the radiative liquid lithium divertor (RLLD) concept and its variant, the active liquid lithium divertor concept (ARLLD), taking advantage of the enhanced or non-coronal Li radiation in relatively poorly confined divertor plasmas. To maintain the LL purity in a 1 GW-electric class fusion power plant, a closed LL loop system with a modest circulating capacity of ~ 1 liter/second (l/sec) is envisioned. We examined two key technology issues: 1) dust or solid particle removal and 2) real time recovery of tritium from LL while keeping the tritium inventory level to an acceptable level. By running the LL-loop continuously, it can carry the dust particles and impurities generated in the vacuum vessel to the outside where the dust / impurities can be removed by relatively simple dust filter, cold trap and/or centrifugal separation systems. With ~ 1 l/sec LL flow, even a small 0.1% dust content by weight (or 0.5 g per sec) suggests that the LL-loop could carry away nearly 16 tons of dust per year. In a 1 GW-electric (or ~ 3 GW fusion power) fusion power plant, about 0.5 g / sec of tritium is needed to maintain the fusion fuel cycle assuming ~ 1 % fusion burn efficiency. It appears feasible to recover tritium (T) in real time from LL while maintaining an acceptable T inventory level. Laboratory tests are being conducted to investigate T recovery feasibility with the surface cold trap (SCT) concept.« less

Liquid lithium loop system to solve challenging technology issues for fusion power plant

NASA Astrophysics Data System (ADS)

Ono, M.; Majeski, R.; Jaworski, M. A.; Hirooka, Y.; Kaita, R.; Gray, T. K.; Maingi, R.; Skinner, C. H.; Christenson, M.; Ruzic, D. N.

2017-11-01

Steady-state fusion power plant designs present major divertor technology challenges, including high divertor heat flux both in steady-state and during transients. In addition to these concerns, there are the unresolved technology issues of long term dust accumulation and associated tritium inventory and safety issues. It has been suggested that radiation-based liquid lithium (LL) divertor concepts with a modest lithium-loop could provide a possible solution for these outstanding fusion reactor technology issues, while potentially improving reactor plasma performance. The application of lithium (Li) in NSTX resulted in improved H-mode confinement, H-mode power threshold reduction, and reduction in the divertor peak heat flux while maintaining essentially Li-free core plasma operation even during H-modes. These promising results in NSTX and related modeling calculations motivated the radiative liquid lithium divertor concept and its variant, the active liquid lithium divertor concept, taking advantage of the enhanced or non-coronal Li radiation in relatively poorly confined divertor plasmas. To maintain the LL purity in a 1 GW-electric class fusion power plant, a closed LL loop system with a modest circulating capacity of ~1 l s-1 is envisioned. We examined two key technology issues: (1) dust or solid particle removal and (2) real time recovery of tritium from LL while keeping the tritium inventory level to an acceptable level. By running the LL-loop continuously, it can carry the dust particles and impurities generated in the vacuum vessel to the outside where the dust/impurities can be removed by relatively simple dust filter, cold trap and/or centrifugal separation systems. With ~1 l s-1 LL flow, even a small 0.1% dust content by weight (or 0.5 g s-1) suggests that the LL-loop could carry away nearly 16 tons of dust per year. In a 1 GW-electric (or ~3 GW fusion power) fusion power plant, about 0.5 g s-1 of tritium is needed to maintain the fusion fuel cycle assuming ~1% fusion burn efficiency. It appears feasible to recover tritium (T) in real time from LL while maintaining an acceptable T inventory level. Laboratory tests are being conducted to investigate T recovery feasibility with the surface cold trap concept.

Roughing in Human Replumbing of the Water Cycle: Challenges, Opportunities, and Progress in Capturing the Influence of Water Management in Regional Models of Hydrology and Climate

NASA Astrophysics Data System (ADS)

Flores, A. N.; Kaiser, K. E.; Steimke, A.; Leonard, A.; FitzGerald, K.; Benner, S. G.; Vache, K. B.; Hillis, V.; Bolte, J.; Han, B.

2017-12-01

Humans exert tremendous influence on the redistribution of water in space and time. Humans have developed substantial infrastructure to provide water in adequate quantity and quality for production of food and energy, while seeking to maintain landscape processes and properties giving rise to ecosystem services on which humans rely (even when and if they are not well understood). Cyber-physical infrastructure includes dams, distributary canal networks, ditches to manage return flow, and networks of sensors to monitor environmental conditions. Social infrastructure includes legal frameworks for water rights, governance networks, and land management policies aimed at maintaining water quality. Changes in regional climate, land use and its intensity, and land cover in source areas exert pressures on this infrastructure, requiring models to characterize system-wide vulnerability and resilience. Here we present a synthesis of several ongoing and completed studies aimed at advancing our fundamental understanding of and ability to numerically model a system in which biophysical and human components cannot be separated. These studies are set within the Boise and Snake River Basin in the US Pacific Northwest and are organized around the aims of: (1) developing improved understanding and models of the ways that humans interact with each other and with biophysical processes at a range of spatiotemporal scales, and (2) using those models to predict how changes in climate and societal drivers, including in-migration and shifts in agricultural practices, will impact regional hydroclimate and associated ecosystem services. Key findings indicate differential pressures on water availability based on water rights seniority within the Lower Boise River basin under historical conditions, the potential for significantly earlier curtailment of water rights in future decades, and potential changes in agricultural practices in anticipation of future climate changes. This ongoing suite of projects illustrate significant improvements in modeling human modification of the timing and partitioning of hydrologic fluxes. Important challenges and opportunities remain, however, particularly in improving modeling the interactions between and among actors that exert controls on the redistribution of water.

Adapting NDOR's Roadside Seed Mixture for Local Site Conditions : Tables

DOT National Transportation Integrated Search

2012-09-06

The Nebraska Department of Roads (NDOR) has considerable challenges with its objectives of rapidly establishing and maintaining a diverse and vigorous vegetation cover on roadsides. Establishing vegetation quickly on NDOR roadsides is important becau...

Model-Based Systems Engineering Approach to Managing Mass Margin

NASA Technical Reports Server (NTRS)

Chung, Seung H.; Bayer, Todd J.; Cole, Bjorn; Cooke, Brian; Dekens, Frank; Delp, Christopher; Lam, Doris

2012-01-01

When designing a flight system from concept through implementation, one of the fundamental systems engineering tasks ismanaging the mass margin and a mass equipment list (MEL) of the flight system. While generating a MEL and computing a mass margin is conceptually a trivial task, maintaining consistent and correct MELs and mass margins can be challenging due to the current practices of maintaining duplicate information in various forms, such as diagrams and tables, and in various media, such as files and emails. We have overcome this challenge through a model-based systems engineering (MBSE) approach within which we allow only a single-source-of-truth. In this paper we describe the modeling patternsused to capture the single-source-of-truth and the views that have been developed for the Europa Habitability Mission (EHM) project, a mission concept study, at the Jet Propulsion Laboratory (JPL).

Mathematical support for surveying measurements in order to obtain the draft tube three-dimensional model

NASA Astrophysics Data System (ADS)

Gridan, Maria-Roberta; Herban, Sorin; Grecea, Oana

2017-07-01

Nowadays, the engineering companies and contractors are facing challenges never experienced before. They are being charged with - and being held liable for - the health of the structures they create and maintain. To surmount these challenges, engineers need to be able to measure structural movements up to millimetre level accuracy. Accurate and timely information on the status of a structure is highly valuable to engineers. It enables them to compare the real world behaviour of a structure against the design and theoretical models. When empowered by such data, engineers can effectively and cost efficiently measure and maintain the health of vital infrastructure. This paper presents the interpretation of the draft tube topographical measurements in order to obtain its 3D model. Based on the documents made available by the beneficiary and the data obtained in situ, the modernization conclusions were presented.

Promotion of meaningful use of a personal health record in second life.

PubMed

Knapfel, Sarah; Plattner, Broc; Santo, Taylor; Tyndall, Sarah

2014-01-01

Patients today are demanding greater access to and control of their health information. Personal Health Records (PHRs) are paving the way for patients to update, maintain and share their comprehensive medical information. The opportunity to develop and maintain a PHR is equally as important for those individuals in the disabled community who face many unique challenges to access health information. The project, conducted as part of our graduate course, explored the use of Second Life to educate the disabled community on Virtual Ability Island (VAI) about the importance of PHRs. The project examined the tools needed to offer such a presentation for the disabled community and identified legal, ethical, social, or public challenges for PHR use. The project outcomes indicated a desire for knowledge and genuine concerns by the attendees regarding PHRs. The authors note that more research is needed to make this technology available to all.

Resolving Bottlenecks: Converting Three High-Enrollment Nursing Courses to an Online Format.

PubMed

Chen, Ken-Zen; Anderson, Jeff; Hannah, Elizabeth Lyon; Bauer, Christine; Provant-Robishaw, Corinna

2015-07-01

Converting large undergraduate classes from the classroom to online has been an effective way to increase enrollments in high-demand courses in undergraduate education. However, challenges exist to maintaining students' high-quality learning interaction and engagement in large online courses. This article presents a collaborative model between faculty in health sciences and instructional designers to redesign and redevelop three high-enrollment courses to online at Boise State University. Health studies course faculty and eCampus instructional designers conducted this study to reflect the collaborative online course development process at Boise State. The offering of high-enrollment nursing courses met enrollment demand and maintained student retention. Challenges related to instruction were addressed by using a careful course redesign process and continuous improvement. Implications of this educational innovation for health science educators, instructional designers, and lessons learned are provided. Copyright 2015, SLACK Incorporated.

Redesigning a home oxygen assessment and review service.

PubMed

Wrench, Christine; Darwin, Ruth; Lawson, Rod

2015-03-01

The Sheffield home oxygen assessment and review service was developed as a nurse-led, protocol-driven service, offering high standards of care to a limited number of patients. In line with national changes to oxygen provision in 2011, the service team was approached to address inconsistencies and inequalities in the existing care pathway, with a view to becoming a fully commissioned service. This required a complete redesign of the service, using a collaborative approach to include relevant interested parties in planning and decision making. Additional support was gained through participation in the NHS Improvement lung national improvement project. This article outlines the process of service redesign, including some of the major challenges as well as the main learning points. It has led to the provision of an equitable and efficient service for all oxygen patients across the city, offering more community clinics and robust cost controls, while maintaining quality of care.

Systems Modeling for Crew Core Body Temperature Prediction Postlanding

NASA Technical Reports Server (NTRS)

Cross, Cynthia; Ochoa, Dustin

2010-01-01

The Orion Crew Exploration Vehicle, NASA s latest crewed spacecraft project, presents many challenges to its designers including ensuring crew survivability during nominal and off nominal landing conditions. With a nominal water landing planned off the coast of San Clemente, California, off nominal water landings could range from the far North Atlantic Ocean to the middle of the equatorial Pacific Ocean. For all of these conditions, the vehicle must provide sufficient life support resources to ensure that the crew member s core body temperatures are maintained at a safe level prior to crew rescue. This paper will examine the natural environments, environments created inside the cabin and constraints associated with post landing operations that affect the temperature of the crew member. Models of the capsule and the crew members are examined and analysis results are compared to the requirement for safe human exposure. Further, recommendations for updated modeling techniques and operational limits are included.

The upgraded ATLAS and CMS detectors and their physics capabilities.

PubMed

Wells, Pippa S

2015-01-13

The update of the European Strategy for Particle Physics from 2013 states that Europe's top priority should be the exploitation of the full potential of the LHC, including the high-luminosity upgrade of the machine and detectors with a view to collecting 10 times more data than in the initial design. The plans for upgrading the ATLAS and CMS detectors so as to maintain their performance and meet the challenges of increasing luminosity are presented here. A cornerstone of the physics programme is to measure the properties of the 125GeV Higgs boson with the highest possible precision, to test its consistency with the Standard Model. The high-luminosity data will allow precise measurements of the dominant production and decay modes, and offer the possibility of observing rare modes including Higgs boson pair production. Direct and indirect searches for additional Higgs bosons beyond the Standard Model will also continue.

The collaboration imperative.

PubMed

Nidumolu, Ram; Ellison, Jib; Whalen, John; Billman, Erin

2014-04-01

Addressing global sustainability challenges--including climate change, resource depletion, and ecosystem loss--is beyond the individual capabilities of even the largest companies. To tackle these threats, and unleash new value, companies and other stakeholders must collaborate in new ways that treat fragile and complex ecosystems as a whole. In this article, the authors draw on cases including the Latin American Water Funds Partnership, the Sustainable Apparel Coalition (led by Nike, Patagonia, and Walmart), and Action to Accelerate Recycling (a partnership between Alcoa, consumer packaged goods companies, and local governments, among others) to describe four new collaboration models that create shared value and address environmental protection across the value stream. Optimal collaborations focus on improving either business processes or outcomes. They start with a small group of key organizations, bring in project management expertise, link self-interest to shared interest, encourage productive competition, create quick wins, and, above all, build and maintain trust.

Quantum Dot and Polymer Composite Cross-Reactive Array for Chemical Vapor Detection.

PubMed

Bright, Collin J; Nallon, Eric C; Polcha, Michael P; Schnee, Vincent P

2015-12-15

A cross-reactive chemical sensing array was made from CdSe Quantum Dots (QDs) and five different organic polymers by inkjet printing to create segmented fluorescent composite regions on quartz substrates. The sensor array was challenged with exposures from two sets of analytes, including one set of 14 different functionalized benzenes and one set of 14 compounds related to security concerns, including the explosives trinitrotoluene (TNT) and ammonium nitrate. The array was broadly responsive to analytes with different chemical functionalities due to the multiple sensing mechanisms that altered the QDs' fluorescence. The sensor array displayed excellent discrimination between members within both sets. Classification accuracy of more than 93% was achieved, including the complete discrimination of very similar dinitrobenzene isomers and three halogenated, substituted benzene compounds. The simple fabrication, broad responsivity, and high discrimination capacity of this type of cross-reactive array are ideal qualities for the development of sensors with excellent sensitivity to chemical and explosive threats while maintaining low false alarm rates.

Medical Issues for a Human Mission to Mars and Martian Surface Expeditions

NASA Astrophysics Data System (ADS)

Jones, J. A.; Barratt, M.; Effenhauser, R.; Cockell, C. S.; Lee, P.

The medical issues for an exploratory class mission to Mars are myriad and challenging. They include hazards from the space environment, such as space vacuum and radiation; hazards on the planetary surface such as micrometeoroids and Martian dust, and constitutional medical hazards, like appendicitis and tooth abscess. They include hazards in the transit vehicle like foreign bodies and toxic atmospheres, and hazards in the habitat like decompression and combustion events. They also include human physiological adaptation to variable conditions of reduced gravity and prolonged isolation and confinement. The health maintenance program for a Mars mission will employ strategies of disease prevention, early detection, and contingency management, to mitigate the risks of spaceflight and exploration. Countermeasures for altered gravity conditions will allow crewmembers to maintain high levels of performance and nominal physiologic functioning. Despite all of these issues, given sufficient redundancy in on-board life support systems, there are no medical show-stoppers for the first human exploratory class missions.

Challenges and Strategies for Building and Maintaining Effective Preceptor-Preceptee Relationships among Nurses.

PubMed

Matua, Gerald A; Seshan, Vidya; Savithri, Raman; Fronda, Dennis C

2014-11-01

This study aimed to determine the challenges encountered and strategies used by nurse preceptors to build effective professional relationships during the preceptorship of final year nursing students. This study was conducted in November 2012 at the College of Nursing in Sultan Qaboos University, Muscat, Oman. A qualitative research design consisting of focus group discussions was used to investigate the challenges that preceptors encounter and the strategies that they use to build effective relationships with preceptees. A total of 21 preceptors from Sultan Qaboos University Hospital participated in the study as part of a training workshop for nurse preceptors. The interviews were audio recorded, transcribed verbatim and thematically analysed. The main challenges faced by preceptors included discrepancies in applying theory to practice; lack of trust; lack of time, and perceived lack of knowledge. The effective strategies identified by the preceptors to be used in building a healthy preceptor-preceptee relationship were proper orientation; effective communication; preparation for complex situations; appreciation and acknowledgment; positive feedback; assurance of support; spending time together; knowing preceptors personally; giving breaks, and encouraging self-commitment. Preceptors should be encouraged to identify challenges that hinder the building of effective relationships with preceptees early during their preceptorship. The incorporation of appropriate and evidenced-based strategies, such as those identified in this study, can transform the preceptorship experience into one that is fulfilling for both preceptors and preceptees. This may lead to greater job satisfaction, personal and professional growth as well as higher self-esteem levels for preceptors and the realisation of clinical objectives for preceptees.

Challenges and Strategies for Building and Maintaining Effective Preceptor-Preceptee Relationships among Nurses

PubMed Central

Matua, Gerald A.; Seshan, Vidya; Savithri, Raman; Fronda, Dennis C.

2014-01-01

Objectives: This study aimed to determine the challenges encountered and strategies used by nurse preceptors to build effective professional relationships during the preceptorship of final year nursing students. Methods: This study was conducted in November 2012 at the College of Nursing in Sultan Qaboos University, Muscat, Oman. A qualitative research design consisting of focus group discussions was used to investigate the challenges that preceptors encounter and the strategies that they use to build effective relationships with preceptees. A total of 21 preceptors from Sultan Qaboos University Hospital participated in the study as part of a training workshop for nurse preceptors. The interviews were audio recorded, transcribed verbatim and thematically analysed. Results: The main challenges faced by preceptors included discrepancies in applying theory to practice; lack of trust; lack of time, and perceived lack of knowledge. The effective strategies identified by the preceptors to be used in building a healthy preceptor-preceptee relationship were proper orientation; effective communication; preparation for complex situations; appreciation and acknowledgment; positive feedback; assurance of support; spending time together; knowing preceptors personally; giving breaks, and encouraging self-commitment. Conclusion: Preceptors should be encouraged to identify challenges that hinder the building of effective relationships with preceptees early during their preceptorship. The incorporation of appropriate and evidenced-based strategies, such as those identified in this study, can transform the preceptorship experience into one that is fulfilling for both preceptors and preceptees. This may lead to greater job satisfaction, personal and professional growth as well as higher self-esteem levels for preceptors and the realisation of clinical objectives for preceptees. PMID:25364557

Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: a systematic review.

PubMed

Provencher, Véronique; Mortenson, W Ben; Tanguay-Garneau, Laurence; Bélanger, Karine; Dagenais, Marion

2014-01-01

Recruitment and retention of frail elderly in research studies can be difficult. To identify challenges and strategies pertaining to recruitment and retention of frail elderly in research studies. A systematic review was conducted. Four databases (MEDLINE, CINAHL, AgeLine, Embase) were searched from January 1992 to December 2012. Empirical studies were included if they explored barriers to or strategies for recruitment or retention of adults aged 60-plus who were identified as frail, vulnerable or housebound. Two researchers independently determined the eligibility of each abstract reviewed and assessed the level of evidence presented. Data concerning challenges encountered (type and impact) and strategies used (type and impact) were abstracted. Of 916 articles identified in the searches, 15 met the inclusion criteria. The level of evidence of the studies retained varied from poor to good. Lack of perceived benefit, distrust of research staff, poor health and mobility problems were identified as common challenges. The most frequently reported strategies used were to establish a partnership with staff that participants knew and trusted, and be flexible about the time and place of the study. However, few studies performed analyses to compare the impact of specific challenges and strategies on refusal or drop-out rates. This review highlights the need to improve knowledge about the impact of barriers and strategies on recruitment and retention of frail older adults. This knowledge will help to develop innovative and cost-effective ways to increase and maintain participation, which may improve the generalizability of research findings to this population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Non-dairy probiotic beverages: the next step into human health.

PubMed

Gawkowski, D; Chikindas, M L

2013-06-01

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit to the host. The two main genera of microorganisms indicated as sources of probiotic bacteria are Lactobacillus and Bifidobacterium. Historically used to produce fermented dairy products, certain strains of both genera are increasingly utilised to formulate other functional foods. As the consumers' understanding of the role of probiotics in health grows, so does the popularity of food containing them. The result of this phenomenon is an increase in the number of probiotic foods available for public consumption, including a rapidly-emerging variety of probiotic-containing non-dairy beverages, which provide a convenient way to improve and maintain health. However, the composition of non-dairy probiotic beverages can pose specific challenges to the survival of the health conferring microorganisms. To overcome these challenges, strain selection and protection techniques play an integral part in formulating a stable product. This review discusses non-dairy probiotic beverages, characteristics of an optimal beverage, and commonly used probiotic strains, including spore-forming bacteria. It also examines the most recent developments in probiotic encapsulation technology with focus on nano-fibre formation as a means of protecting viable cells. Utilising bacteria's natural armour or creating barrier mechanisms via encapsulation technology will fuel development of stable non-dairy probiotic beverages.

Environmental effects on nutrient and energy metabolism in ruminants.

PubMed

Tamminga, S; Schrama, J W

1998-01-01

Domesticated animals all over the world are subjected to a wide variety of environmental conditions and challenges. Any deviation from "normal" may result in adaptive behavior of which changes in feed intake or feed intake pattern is by far the most important. Adaptive behavior may further include influences on passage rate of feed residues through the digestive tract, resulting in changes in digestibility. Adaptive behavior may also result in changes in heat production, either to maintain body temperature constant, or as a result of an elevated body temperature. Important environmental challenges are infectious diseases. Mild (sub-clinical) infections usually result in reduced performance, without affecting feed intake or digestibility. Severe infections may disrupt the barriers between the internal metabolism and the respiratory and/or digestive tract, resulting in severe losses of energy and protein. This situation is notably apparent in severe infections with parasites of the gastrointestinal tract and may be associated with severe protein losses. Feeding high protein diets may partly alleviate the negative effects. Contamination of air, water and feed may occasionally cause problems in farm animals. Such contamination may include pathogenic microbes, toxic secondary fungal metabolites and heavy metals. Negative effects associated with such contamination often show an impaired reproductive efficiency, but their influence on the utilization of energy and nutrients is not well documented.

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

Intimacy and Sexual Decision Making: Exploring the Perspective of HIV Positive Women Over 50

PubMed Central

Barinas, Jennifer; Robbins, Gregory K.; Bedoya, C. Andres; Safren, Steven A.; Park, Elyse R.

2012-01-01

Abstract Due to advances made in HIV treatment, the population of individuals with HIV over the age of 50 is growing. Aging women face many developmental challenges and some of these challenges, including having or maintaining intimate partner relationships, may be particularly pronounced for aging women living with HIV. However, research exploring the psychosocial needs of aging women with HIV is limited. Thus, the aim of this study was to explore factors that impact intimate partner relationships for older women with HIV. Nineteen women (mean age=56.79, SD=4.63 years) referred from Boston-area community organizations and hospitals completed in-depth individual interviews. Forty-seven percent of participants identified themselves as Black/African American, and 37% as White/Caucasian. Average time since diagnosis was 16.32 years (SD=5.70). Interviews continued until saturation of content was reached. Inclusion criteria included: biologically born female; aged 50 years or older; diagnosis of HIV/AIDS; and English speaking. Qualitative interviews were coded by two raters and content analyses were conducted using NVivo 9 software. The findings are described across the following three main themes: (1) stigma; (2) body image concerns; and (3) the disclosure dilemma. The themes and issues identified by this study may help guide sexual health-related interventions for older HIV-infected women. PMID:23199193

Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50.

PubMed

Psaros, Christina; Barinas, Jennifer; Robbins, Gregory K; Bedoya, C Andres; Safren, Steven A; Park, Elyse R

2012-12-01

Due to advances made in HIV treatment, the population of individuals with HIV over the age of 50 is growing. Aging women face many developmental challenges and some of these challenges, including having or maintaining intimate partner relationships, may be particularly pronounced for aging women living with HIV. However, research exploring the psychosocial needs of aging women with HIV is limited. Thus, the aim of this study was to explore factors that impact intimate partner relationships for older women with HIV. Nineteen women (mean age=56.79, SD=4.63 years) referred from Boston-area community organizations and hospitals completed in-depth individual interviews. Forty-seven percent of participants identified themselves as Black/African American, and 37% as White/Caucasian. Average time since diagnosis was 16.32 years (SD=5.70). Interviews continued until saturation of content was reached. Inclusion criteria included: biologically born female; aged 50 years or older; diagnosis of HIV/AIDS; and English speaking. Qualitative interviews were coded by two raters and content analyses were conducted using NVivo 9 software. The findings are described across the following three main themes: (1) stigma; (2) body image concerns; and (3) the disclosure dilemma. The themes and issues identified by this study may help guide sexual health-related interventions for older HIV-infected women.

Sexual health and relationships after age 60.

PubMed

Minkin, Mary Jane

2016-01-01

A commonly used phrase describing aging is "60 is the new 40". Although in many aspects of life this may be correct, in discussing sexual health, challenges to maintaining excellent sexual health become more common around age 60. Biological aging challenges physical sexual activity and responsiveness. We commence by briefly surveying the extensive coverage of 'normal' physiological aging. We primarily focus on issues that arise in distinct disease and or pathophysiological states, including gynecological and breast cancer, as well as those associated with partners of men who are either prostate cancer survivors or who have taken therapy for erectile dysfunction (ED). Regrettably, there is a very modest literature on sexual health and associated possible interventions in older patients in these cohorts. We discuss a variety of interventions and approaches, including those that we have developed and applied in a clinic at our host university, which have generally produced successful outcomes. The extended focus to sexual relationship dynamics in partners of men with either prostate cancer or ED in particular is virtually unexplored, yet is especially timely given the large numbers of women who encounter this situation. Finally, we briefly discuss cross-cultural distinctions in older couples' expectations, which exhibit remarkable variation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Cargo Commercial Orbital Transportation Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Thacker, Karen; Williams, Dave

2012-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, retired in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

Commercial Orbital Transportation Cargo Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Williams, Dave; Orozco, Nicole; Philistine, Cynthia

2010-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, will retire in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

[Locked volar plating for complex distal radius fractures: maintaining radial length].

PubMed

Jeudy, J; Pernin, J; Cronier, P; Talha, A; Massin, P

2007-09-01

Maintaining radial length, likely to be the main challenge in the treatment of complex distal radius fractures, is necessary for complete grip-strength and pro-supination range recovery. In spite of frequent secondary displacements, bridging external-fixation has remained the reference method, either isolated or in association with additional percutaneous pins or volar plating. Also, there seems to be a relation between algodystrophy and the duration of traction applied on the radio-carpal joint. Fixed-angle volar plating offers the advantage of maintaining the reduction until fracture healing, without bridging the joint. In a prospective study, forty-three consecutive fractures of the distal radius with a positivated ulnar variance were treated with open reduction and fixed-angle volar plating. Results were assessed with special attention to the radial length and angulation obtained and maintained throughout treatment, based on repeated measurements of the ulnar variance and radial angulation in the first six months postoperatively. The correction of the ulnar variance was maintained until complete recovery, independently of initial metaphyseal comminution, and of the amount of radial length gained at reduction. Only 3 patients lost more than 1 mm of radial length after reduction. The posterior tilt of the distal radial epiphysis was incompletely reduced in 13 cases, whereas reduction was partially lost in 6 elderly osteoporotic female patients. There was 8 articular malunions, all of them less than 2 mm. Secondary displacements were found to be related to a deficient locking technique. Eight patients developed an algodystropy. The risk factors for algodystrophy were articular malunion, associated posterior pining, and associated lesions of the ipsilateral upper limb. Provided that the locking technique was correct, this type of fixation appeared efficient in maintaining the radial length in complex fractures of the distal radius. The main challenge remains the reduction of displaced articular fractures. Based on these results, it is not possible to conclude that this method is superior to external fixation.

Cultural Challenges to Engaging Patients in Shared Decision Making

PubMed Central

Hawley, Sarah T.; Morris, Arden M.

2016-01-01

Objective Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making. Discussion The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority. Conclusion While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care. PMID:27461943

Physiological Employment Standards III: physiological challenges and consequences encountered during international military deployments.

PubMed

Nindl, Bradley C; Castellani, John W; Warr, Bradley J; Sharp, Marilyn A; Henning, Paul C; Spiering, Barry A; Scofield, Dennis E

2013-11-01

Modern international military deployments in austere environments (i.e., Iraq and Afghanistan) place considerable physiological demands on soldiers. Significant physiological challenges exist: maintenance of physical fitness and body composition, rigors of external load carriage, environmental extremes (heat, cold, and altitude), medical illnesses, musculoskeletal injuries, traumatic brain injuries, post-traumatic stress disorder, and environmental exposure hazards (i.e., burn pits, vehicle exhaust, etc.). To date there is very little published research and no comprehensive reviews on the physiological effects of deployments. The purpose of this paper is to overview what is currently known from the literature related mainly to current military conflicts with regard to the challenges and consequences from deployments. Summary findings include: (1) aerobic capacity declines while muscle strength, power and muscular endurance appear to be maintained, (2) load carriage continues to tax the physical capacities of the Soldier, (3) musculoskeletal injuries comprise the highest proportion of all injury categories, (4) environmental insults occur from both terrestrial extremes and pollutant exposure, and (5) post-deployment concerns linger for traumatic brain injury and post-traumatic stress disorder. A full understanding of these responses will assist in identifying the most effective risk mitigation strategies to ensure deployment readiness and to assist in establishment of military employment standards.

Nanotechnology in Sustainable Agriculture: Recent Developments, Challenges, and Perspectives

PubMed Central

Prasad, Ram; Bhattacharyya, Atanu; Nguyen, Quang D.

2017-01-01

Nanotechnology monitors a leading agricultural controlling process, especially by its miniature dimension. Additionally, many potential benefits such as enhancement of food quality and safety, reduction of agricultural inputs, enrichment of absorbing nanoscale nutrients from the soil, etc. allow the application of nanotechnology to be resonant encumbrance. Agriculture, food, and natural resources are a part of those challenges like sustainability, susceptibility, human health, and healthy life. The ambition of nanomaterials in agriculture is to reduce the amount of spread chemicals, minimize nutrient losses in fertilization and increased yield through pest and nutrient management. Nanotechnology has the prospective to improve the agriculture and food industry with novel nanotools for the controlling of rapid disease diagnostic, enhancing the capacity of plants to absorb nutrients among others. The significant interests of using nanotechnology in agriculture includes specific applications like nanofertilizers and nanopesticides to trail products and nutrients levels to increase the productivity without decontamination of soils, waters, and protection against several insect pest and microbial diseases. Nanotechnology may act as sensors for monitoring soil quality of agricultural field and thus it maintain the health of agricultural plants. This review covers the current challenges of sustainability, food security and climate change that are exploring by the researchers in the area of nanotechnology in the improvement of agriculture. PMID:28676790

Reduced biological control and enhanced chemical pest management in the evolution of fungus farming in ants

PubMed Central

Fernández-Marín, Hermógenes; Zimmerman, Jess K.; Nash, David R.; Boomsma, Jacobus J.; Wcislo, William T.

2009-01-01

To combat disease, most fungus-growing ants (Attini) use antibiotics from mutualistic bacteria (Pseudonocardia) that are cultured on the ants' exoskeletons and chemical cocktails from exocrine glands, especially the metapleural glands (MG). Previous work has hypothesized that (i) Pseudonocardia antibiotics are narrow-spectrum and control a fungus (Escovopsis) that parasitizes the ants' fungal symbiont, and (ii) MG secretions have broad-spectrum activity and protect ants and brood. We assessed the relative importance of these lines of defence, and their activity spectra, by scoring abundance of visible Pseudonocardia for nine species from five genera and measuring rates of MG grooming after challenging ants with disease agents of differing virulence. Atta and Sericomyrmex have lost or greatly reduced the abundance of visible bacteria. When challenged with diverse disease agents, including Escovopsis, they significantly increased MG grooming rates and expanded the range of targets. By contrast, species of Acromyrmex and Trachymyrmex maintain abundant Pseudonocardia. When challenged, these species had lower MG grooming rates, targeted primarily to brood. More elaborate MG defences and reduced reliance on mutualistic Pseudonocardia are correlated with larger colony size among attine genera, raising questions about the efficacy of managing disease in large societies with chemical cocktails versus bacterial antimicrobial metabolites. PMID:19324734

Nanotechnology in Sustainable Agriculture: Recent Developments, Challenges, and Perspectives.

PubMed

Prasad, Ram; Bhattacharyya, Atanu; Nguyen, Quang D

2017-01-01

Nanotechnology monitors a leading agricultural controlling process, especially by its miniature dimension. Additionally, many potential benefits such as enhancement of food quality and safety, reduction of agricultural inputs, enrichment of absorbing nanoscale nutrients from the soil, etc. allow the application of nanotechnology to be resonant encumbrance. Agriculture, food, and natural resources are a part of those challenges like sustainability, susceptibility, human health, and healthy life. The ambition of nanomaterials in agriculture is to reduce the amount of spread chemicals, minimize nutrient losses in fertilization and increased yield through pest and nutrient management. Nanotechnology has the prospective to improve the agriculture and food industry with novel nanotools for the controlling of rapid disease diagnostic, enhancing the capacity of plants to absorb nutrients among others. The significant interests of using nanotechnology in agriculture includes specific applications like nanofertilizers and nanopesticides to trail products and nutrients levels to increase the productivity without decontamination of soils, waters, and protection against several insect pest and microbial diseases. Nanotechnology may act as sensors for monitoring soil quality of agricultural field and thus it maintain the health of agricultural plants. This review covers the current challenges of sustainability, food security and climate change that are exploring by the researchers in the area of nanotechnology in the improvement of agriculture.

Harnessing Finger Millet to Combat Calcium Deficiency in Humans: Challenges and Prospects.

PubMed

Puranik, Swati; Kam, Jason; Sahu, Pranav P; Yadav, Rama; Srivastava, Rakesh K; Ojulong, Henry; Yadav, Rattan

2017-01-01

Humans require more than 20 mineral elements for healthy body function. Calcium (Ca), one of the essential macromineral, is required in relatively large quantities in the diet for maintaining a sound overall health. Young children, pregnant and nursing women in marginalized and poorest regions of the world, are at highest risk of Ca malnutrition. Elderly population is another group of people most commonly affected by Ca deficiency mainly in the form of osteoporosis and osteopenia. Improved dietary intake of Ca may be the most cost-effective way to meet such deficiencies. Finger millet [ Eleusine coracana (L.) Gaertn.], a crop with inherently higher Ca content in its grain, is an excellent candidate for understanding genetic mechanisms associated with Ca accumulation in grain crops. Such knowledge will also contribute toward increasing Ca contents in other staple crops consumed on daily basis using plant-breeding (also known as biofortification) methods. However, developing Ca-biofortified finger millet to reach nutritional acceptability faces various challenges. These include identifying and translating the high grain Ca content to an adequately bioavailable form so as to have a positive impact on Ca malnutrition. In this review, we assess some recent advancements and challenges for enrichment of its Ca value and present possible inter-disciplinary prospects for advancing the actual impact of Ca-biofortified finger millet.

Harnessing Finger Millet to Combat Calcium Deficiency in Humans: Challenges and Prospects

PubMed Central

Puranik, Swati; Kam, Jason; Sahu, Pranav P.; Yadav, Rama; Srivastava, Rakesh K.; Ojulong, Henry; Yadav, Rattan

2017-01-01

Humans require more than 20 mineral elements for healthy body function. Calcium (Ca), one of the essential macromineral, is required in relatively large quantities in the diet for maintaining a sound overall health. Young children, pregnant and nursing women in marginalized and poorest regions of the world, are at highest risk of Ca malnutrition. Elderly population is another group of people most commonly affected by Ca deficiency mainly in the form of osteoporosis and osteopenia. Improved dietary intake of Ca may be the most cost-effective way to meet such deficiencies. Finger millet [Eleusine coracana (L.) Gaertn.], a crop with inherently higher Ca content in its grain, is an excellent candidate for understanding genetic mechanisms associated with Ca accumulation in grain crops. Such knowledge will also contribute toward increasing Ca contents in other staple crops consumed on daily basis using plant-breeding (also known as biofortification) methods. However, developing Ca-biofortified finger millet to reach nutritional acceptability faces various challenges. These include identifying and translating the high grain Ca content to an adequately bioavailable form so as to have a positive impact on Ca malnutrition. In this review, we assess some recent advancements and challenges for enrichment of its Ca value and present possible inter-disciplinary prospects for advancing the actual impact of Ca-biofortified finger millet. PMID:28798761

Current Status of the Milky Stork Re-introduction Programme in Malaysia and Its Challenges

PubMed Central

Ismail, Ahmad; Rahman, Faid

2016-01-01

This review discussed the current status of the Milky Stork Re-introduction Programme in Malaysia and the challenges it faced. Although it has continued for almost seven years, more challenges appeared as time elapsed mainly due to the arising conflicts between the implementation of conservation policy versus the development projects in Kuala Gula. Hence, the released population is struggling to adapt mainly due to the reduction of suitable habitat for nesting and disturbed foraging areas by the continuous anthropogenic activities. Furthermore, the lack of appropriate training among captive storks prior to being released also slows the adaptation of the birds in their new habitat. The increasing pattern of pollution in the area is also highlighted. Several suggestions were given to help improve the current re-introduction programme. These include improvements to the captive training method, improvement of the existing enclosure’s condition and environment, protection of remaining mangrove forest, creation of a buffer zone to mitigate the increasing pollution level in the area, close monitoring of the released population, and maintaining continuous support and awareness among the public. Considering the ongoing anthropogenic activities that may impair the status of Kuala Gula as an important bird sanctuary, emphasis should be given to achieve sustainable development throughout the area. PMID:27688848

Cultural challenges to engaging patients in shared decision making.

PubMed

Hawley, Sarah T; Morris, Arden M

2017-01-01

Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making. The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority. While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care. Published by Elsevier Ireland Ltd.

Conducting international nursing research: challenges and opportunities.

PubMed

Opollo, Jackline Gloria; Opollo, Diana Alaka; Gray, Jennifer; Spies, Lori

2014-11-01

To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. The researchers conducted three different studies in two developing nations. This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered.

Perampanel and Challenging Behaviour in Intellectual Disability and Epilepsy: A Management Dilemma

PubMed Central

Choudry, Ansar

2014-01-01

We describe a case of a patient with a diagnosis of moderate learning disability with challenging behaviour and treatment refractory epilepsy. Antiepileptics can increase challenging behaviour; however, antipsychotics can provoke seizures. This results in a difficult balance for patient care. Due to worsening seizures, the patient was prescribed perampanel. This increased her aggression and agitation resulting in admission. We trialled four antipsychotic drugs to reduce her challenging behaviour, two of which worsened her seizures. It was necessary to continue antiepileptic medication to maintain adequate seizure control. However, the resulting uncontrolled challenging behaviour persisted, meaning she was unable to return to her family home on discharge. This case emphasises the difficult scenario clinician's encounter when balancing the use of antipsychotics and antiepileptics. The case demonstrates the significant functional loss due to challenging behaviour, balanced against controlling life threatening seizures. PMID:25580340

Toward the second 50 years of Water Resources Research

NASA Astrophysics Data System (ADS)

Rajaram, H.

2014-12-01

Since the first issue in 1965, 49 volumes and 464 issues of Water Resources Research (WRR) have been published, including more than 13,800 contributions that received more than 380,000 citations. WRR has always maintained a forward-looking vision, providing an interdisciplinary platform to nurture the initiation and development of numerous sub-disciplines and research themes in hydrology, water resources, and earth sciences and over the last 50 years. This vision, supported in no small measure by a dedicated community of researchers who submitted their best research to WRR, have helped the journal maintain its international leadership in this field. As we enter the second 50 years of WRR, new trends in scientific publishing, open access publication and web-based discussion forums, pose challenges (and opportunities) for sustaining WRR's leadership role. In this presentation, we will present the vision of the present editorial board for the future of WRR, and discuss several steps we are undertaking to adapt the journal to modern trends in communicating scientific research. This includes the introduction of new article types, such as the forthcoming "Debates on Water Resources", targeted special sections, and efforts to improve the timeliness of the review process. We humbly stand on the shoulders of the thirty-four dedicated previous editors of WRR, and remain open to receiving suggestions from the AGU hydrologic community.

Global faculty development: lessons learned from the Foundation for Advancement of International Medical Education and Research (FAIMER) initiatives.

PubMed

Burdick, William P

2014-08-01

Foundation for Advancement of International Medical Education and Research (FAIMER) faculty development programs have operated since 2001 and are designed to overcome many of the challenges inherent in global health collaborations, including alignment with local needs, avoiding persistent dependency, and development of trust. FAIMER fellowship programs, developed for midcareer faculty members in all health professions from around the world, share goals of strengthening knowledge and skills in education leadership, education methods, and project management and evaluation. Building community is another explicit goal that allows participants to support and learn from each other.The author recommends several practices for successful international collaborations based on 13 years of experience with FAIMER fellowships. These include using authentic education projects to maintain alignment with local needs and apply newly acquired knowledge and skills, teaching leadership across cultures with careful communication and adaptation of concepts to local environments, cultivating a strong field of health professions education to promote diffusion of ideas and advocate for policy change, intentionally promoting field development and leadership to reduce dependency, giving generously of time and resources, learning from others as much as teaching others, and recognizing that effective partnerships revolve around personal relationships to build trust. These strategies have enabled the FAIMER fellowship programs to stay aligned with local needs, reduce dependency, and maintain trust.

More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside.

PubMed

Gisondi, Michael A; Regan, Linda; Branzetti, Jeremy; Hopson, Laura R

2018-05-01

There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

Embedded electronics for a video-rate distributed aperture passive millimeter-wave imager

NASA Astrophysics Data System (ADS)

Curt, Petersen F.; Bonnett, James; Schuetz, Christopher A.; Martin, Richard D.

2013-05-01

Optical upconversion for a distributed aperture millimeter wave imaging system is highly beneficial due to its superior bandwidth and limited susceptibility to EMI. These features mean the same technology can be used to collect information across a wide spectrum, as well as in harsh environments. Some practical uses of this technology include safety of flight in degraded visual environments (DVE), imaging through smoke and fog, and even electronic warfare. Using fiber-optics in the distributed aperture poses a particularly challenging problem with respect to maintaining coherence of the information between channels. In order to capture an image, the antenna aperture must be electronically steered and focused to a particular distance. Further, the state of the phased array must be maintained, even as environmental factors such as vibration, temperature and humidity adversely affect the propagation of the signals through the optical fibers. This phenomenon cannot be avoided or mitigated, but rather must be compensated for using a closed-loop control system. In this paper, we present an implementation of embedded electronics designed specifically for this purpose. This novel architecture is efficiently small, scalable to many simultaneously operating channels and sufficiently robust. We present our results, which include integration into a 220 channel imager and phase stability measurements as the system is stressed according to MIL-STD-810F vibration profiles of an H-53E heavy-lift helicopter.

Synthesis of innovative contracting strategies used for routine and preventive maintenance contracts.

DOT National Transportation Integrated Search

2010-01-01

In 2000, as the United States entered a new millennium, the Federal : Highway Administration (FHWA) challenged state highway agencies : (SHAs) to focus on preserving and maintaining rather than expanding : our existing highway system and to ...

Intelligent rover decision-making in response to exogenous events

NASA Technical Reports Server (NTRS)

Chouinard, C.; Estlin, T.; Gaines, D.; Fisher, F.

2005-01-01

This paper presents an introduction to the CLEAR system which performs rover command generation and re-planning, the challenges faced maintaining domain specific information in an uncertain environment, and the successes demonstrated with several methods of system testing.

Self-regulation of common age-related challenges: benefits for older adults' psychological and physical health.

PubMed

Wrosch, Carsten; Dunne, Erin; Scheier, Michael F; Schulz, Richard

2006-06-01

This article addresses the role played by adaptive self-regulation in protecting older adults' psychological and physical health. A theoretical model is outlined illustrating how common age-related challenges (i.e., physical challenges and life regrets) can influence older adults' health. In addition, the proposed model suggests that older adults can avoid the adverse health effects of encountering these problems if they engage in adaptive self-regulation. Finally, this article reviews recent studies that examined the adaptive value of self-regulation processes for managing physical challenges and life regrets in the elderly. The findings from cross-sectional, longitudinal, and experimental studies document the importance of adaptive self-regulation for maintaining older adults' health.

Effect of Running Speed and Leg Prostheses on Mediolateral Foot Placement and Its Variability

PubMed Central

Arellano, Christopher J.; McDermott, William J.; Kram, Rodger; Grabowski, Alena M.

2015-01-01

This study examined the effects of speed and leg prostheses on mediolateral (ML) foot placement and its variability in sprinters with and without transtibial amputations. We hypothesized that ML foot placement variability would: 1. increase with running speed up to maximum speed and 2. be symmetrical between the legs of non-amputee sprinters but asymmetrically greater for the affected leg of sprinters with a unilateral transtibial amputation. We measured the midline of the body (kinematic data) and center of pressure (kinetic data) in the ML direction while 12 non-amputee sprinters and 7 Paralympic sprinters with transtibial amputations (6 unilateral, 1 bilateral) ran across a range of speeds up to maximum speed on a high-speed force measuring treadmill. We quantified ML foot placement relative to the body’s midline and its variability. We interpret our results with respect to a hypothesized relation between ML foot placement variability and lateral balance. We infer that greater ML foot placement variability indicates greater challenges with maintaining lateral balance. In non-amputee sprinters, ML foot placement variability for each leg increased substantially and symmetrically across speed. In sprinters with a unilateral amputation, ML foot placement variability for the affected and unaffected leg also increased substantially, but was asymmetric across speeds. In general, ML foot placement variability for sprinters with a unilateral amputation was within the range observed in non-amputee sprinters. For the sprinter with bilateral amputations, both affected legs exhibited the greatest increase in ML foot placement variability with speed. Overall, we find that maintaining lateral balance becomes increasingly challenging at faster speeds up to maximum speed but was equally challenging for sprinters with and without a unilateral transtibial amputation. Finally, when compared to all other sprinters in our subject pool, maintaining lateral balance appears to be the most challenging for the Paralympic sprinter with bilateral transtibial amputations. PMID:25590634

Does gender impact on female doctors'experiences in the training and practice of surgery? A single centre study.

PubMed

Umoetok, F; Van Wyk, J M; Madiba, T E

2017-09-01

Surgery has been identified as a male-dominated specialty in South Africa and abroad. This study explored how female registrars perceived the impact of gender on their training and practice of surgery. A self-administered questionnaire was used to explore whether females perceived any benefits to training in a male-dominated specialty, their choice of mentors and the challenges that they encountered during surgical training. Thirty-two female registrars participated in the study. The respondents were mainly South African (91%) and enrolled in seven surgical specialties. Twenty-seven (84%) respondents were satisfied with their training and skills development. Twenty-four (75%) respondents had a mentor from the department. Seventeen (53%) respondents perceived having received differential treatment due to their gender and 25 (78.2%) thought that the gender of their mentor did not impact on the quality of the guidance received in surgery. Challenges included physical threats to female respondents from patients and disrespect, emotional threats and defaming statements from male registrars. Additional challenges included time-constraints for family and academic work, poor work-life balance and being treated differently due to their gender. Seventeen (53%) respondents would consider teaching in the Department of Surgery. Generally, females had positive perceptions of their training in Surgery. They expressed concern about finding and maintaining a work-life balance. The gender of their mentor did not impact on the quality of the training but 'bullying' from male peers and selected supervisors occurred. Respondents will continue to recommend the specialty as a satisfying career to young female students.

How I treat CLL patients with ibrutinib.

PubMed

Brown, Jennifer R

2018-01-25

Ibrutinib is a transformative therapy for high-risk and relapsed refractory chronic lymphocytic leukemia (CLL) patients. In clinical trials in relatively healthy younger patients, ibrutinib has been well tolerated. As its use has become more widespread in the community, however, its full adverse event profile has emerged and proven more challenging than was initially anticipated. Reports of community-based use have estimated discontinuation rates as high as 40% in the first year of therapy. This article therefore reviews my approach to the evaluation and management of a CLL patient starting on ibrutinib, with the goal of minimizing and managing toxicity to maintain patients on ibrutinib. Key topics discussed include bleeding risk; cardiac complications, particularly atrial fibrillation; drug interactions; and infections. © 2018 by The American Society of Hematology.

The ‘mystery’ of opioid-induced diarrhea

PubMed Central

Bril, Silviu; Shoham, Yoav; Marcus, Jeremy

2011-01-01

Bowel dysfunction, mainly constipation, is a well-known and anticipated side effect of opioids. The physician prescribing an opioid frequently confronts the challenge of preventing and treating bowel dysfunction. Different strategies have emerged for managing opioid-induced constipation. These strategies include physical activity, maintaining adequate fluid intake, adhering to regular daily bowel habits, using laxatives and other anticonstipation medications and, recently, using a peripheral opioid antagonist, either as a separate drug or in the form of an opioid agonist-antagonist combination pill. What options exist for the physician when a patient receiving opioids complains of diarrhea, cramps and bloating, rather than the expected constipation? The present article describes a possible cause of opioid-induced diarrhea and strategies for management. PMID:21766071

U.S. Spacesuit Legacy: Maintaining it for the Future

NASA Technical Reports Server (NTRS)

Chullen, Cinda; McMann, Joe; Thomas, Ken; Kosmo, Joe; Lewis, Cathleen; Wright, Rebecca; Bitterly, Rose; Olivia, Vladenka Rose

2013-01-01

The history of U.S. spacesuit development and its use are rich with information on lessons learned, and constitutes a valuable legacy to those designing spacesuits for the future, as well as to educators, students, and the general public. The genesis of lessons learned is best understood by studying the evolution of past spacesuit programs - how the challenges and pressures of the times influenced the direction of the various spacesuit programs. This paper shows how the legacy of various spacesuit-related programs evolved in response to these forces. Important aspects of how this U.S. spacesuit legacy is being preserved today is described, including the archiving of spacesuit hardware, important documents, videos, oral history, and the rapidly expanding U.S. Spacesuit Knowledge Capture program.

USGS microbiome research

USGS Publications Warehouse

Kellogg, Christina A.; Hopkins, M. Camille

2017-09-26

Microbiomes are the communities of microorganisms (for example, bacteria, viruses, and fungi) that live on, in, and around people, plants, animals, soil, water, and the atmosphere. Microbiomes are active in the functioning of diverse ecosystems, for instance, by influencing water quality, nutrient acquisition 
and stress tolerance in plants, and stability of soil and aquatic environments. Microbiome research conducted by the U.S. Geological Survey spans many of our mission areas. Key research areas include water quality, understanding climate effects on soil and permafrost, ecosystem and wildlife health, invasive species, contaminated environments to improve bioremediation, and enhancing energy production. Microbiome research will fundamentally strengthen the ability to address the global challenges of maintaining clean water, ensuring adequate food supply, meeting energy needs, and preserving human and ecosystem health.

Glucose Biosensors: An Overview of Use in Clinical Practice

PubMed Central

Yoo, Eun-Hyung; Lee, Soo-Youn

2010-01-01

Blood glucose monitoring has been established as a valuable tool in the management of diabetes. Since maintaining normal blood glucose levels is recommended, a series of suitable glucose biosensors have been developed. During the last 50 years, glucose biosensor technology including point-of-care devices, continuous glucose monitoring systems and noninvasive glucose monitoring systems has been significantly improved. However, there continues to be several challenges related to the achievement of accurate and reliable glucose monitoring. Further technical improvements in glucose biosensors, standardization of the analytical goals for their performance, and continuously assessing and training lay users are required. This article reviews the brief history, basic principles, analytical performance, and the present status of glucose biosensors in the clinical practice. PMID:22399892

Considerations and benefits of implementing an online database tool for business continuity.

PubMed

Mackinnon, Susanne; Pinette, Jennifer

2016-01-01

In today's challenging climate of ongoing fiscal restraints, limited resources and complex organisational structures there is an acute need to investigate opportunities to facilitate enhanced delivery of business continuity programmes while maintaining or increasing acceptable levels of service delivery. In 2013, Health Emergency Management British Columbia (HEMBC), responsible for emergency management and business continuity activities across British Columbia's health sector, transitioned its business continuity programme from a manual to automated process with the development of a customised online database, known as the Health Emergency Management Assessment Tool (HEMAT). Key benefits to date include a more efficient business continuity input process, immediate situational awareness for use in emergency response and/or advanced planning and streamlined analyses for generation of reports.

Addressing demoralization in clinical staff: a true test of leadership.

PubMed

Gabel, Stewart

2011-11-01

Demoralization is a state that occurs when an individual's personal or professional goals, principles, or values are threatened. Psychiatrists working in mental healthcare organizations may experience demoralization for numerous reasons, including diminished funding for valued programs, personnel reductions, and administrative burdens hindering patient care. Demoralization places psychiatrists and other mental health professionals at increased risk for burnout, and its associated problems related to physical and mental difficulties, poor patient care, and staff losses and turnover. Demoralization, therefore, presents an important challenge to medical and clinical leaders who must address this issue to maintain the organizational commitment to optimal patient-centered care. This can be done using sound and accepted leadership principles coupled with a values orientation. The paper provides an illustration.

Focal therapy as primary treatment for localized prostate cancer: definition, needs and future.

PubMed

Ouzzane, Adil; Betrouni, Nacim; Valerio, Massimo; Rastinehad, Ardeshir; Colin, Pierre; Ploussard, Guillaume

2017-04-01

Focal therapy (FT) may offer a promising treatment option in the field of low to intermediate risk localized prostate cancer. The aim of this concept is to combine minimal morbidity with cancer control as well as maintain the possibility of retreatment. Recent advances in MRI and targeted biopsy has improved the diagnostic pathway of prostate cancer and increased the interest in FT. However, before implementation of FT in routine clinical practice, several challenges are still to overcome including patient selection, treatment planning, post-therapy monitoring and definition of oncologic outcome surrogates. In this article, relevant questions regarding the key steps of FT are critically discussed and the main available energy modalities are analyzed taking into account their advantages and unmet needs.

U.S. Spacesuit Legacy: Maintaining it for the Future

NASA Technical Reports Server (NTRS)

Chullen, Cinda; McMann, Joe; Thomas, Ken; Kosmo, Joe; Lewis, Cathleen; Wright, Rebecca; Bitterly, Rose; Oliva, Vladenka

2012-01-01

The history of US Spacesuit development and use is rich with information on lessons learned, and constitutes a valuable legacy to those designing spacesuits for the future, as well as educators, students and the general public. The genesis of lessons learned is best understood by studying the evolution of past spacesuit programs how the challenges and pressures of the times influenced the direction of the various spacesuit programs. This paper will show how the legacy of various programs evolved in response to these forces. Important aspects of how this rich U.S. spacesuit legacy is being preserved today will be described, including the archiving of spacesuit hardware, important documents, videos, oral history, and the rapidly expanding US Spacesuit Knowledge Capture program.

Bisphosphonate Treatment for Children With Disabling Conditions

PubMed Central

Boyce, Alison M.; Tosi, Laura L.; Paul, Scott M.

2014-01-01

Fractures are a frequent source of morbidity in children with disabling conditions. The assessment of bone density in this population is challenging, because densitometry is influenced by dynamic forces affecting the growing skeleton and may be further confounded by positioning difficulties and surgical hardware. First-line treatment for pediatric osteoporosis involves conservative measures, including optimizing the management of underlying conditions, maintaining appropriate calcium and vitamin D intake, encouraging weight-bearing physical activity, and monitoring measurements of bone mineral density. Bisphosphonates are a class of medications that increase bone mineral density by inhibiting bone resorption. Although bisphosphonates are commonly prescribed for treatment of adult osteoporosis, their use in pediatric patients is controversial because of the lack of long-term safety and efficacy data. PMID:24368091

Advances in native high-performance liquid chromatography and intact mass spectrometry for the characterization of biopharmaceutical products.

PubMed

Tassi, Marco; De Vos, Jelle; Chatterjee, Sneha; Sobott, Frank; Bones, Jonathan; Eeltink, Sebastiaan

2018-01-01

The characterization of biotherapeutics represents a major analytical challenge. This review discusses the current state-of-the-art in analytical technologies to profile biopharma products under native conditions, i.e., the protein three dimensional conformation is maintained during liquid chromatographic analysis. Native liquid-chromatographic modes that are discussed include aqueous size-exclusion chromatography, hydrophobic interaction chromatography, and ion-exchange chromatography. Infusion conditions and the possibilities and limitations to hyphenate native liquid chromatography to mass spectrometry are discussed. Furthermore, the applicability of native liquid-chromatography methods and intact mass spectrometry analysis for the characterization of monoclonal antibodies and antibody-drug conjugates is discussed. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.